Cohen's Kappa Test Research Articles

ChatGPT and oral cancer: a study on informational reliability

BackgroundArtificial intelligence (AI) and large language models (LLMs) like ChatGPT have transformed information retrieval, including in healthcare. ChatGPT, trained on diverse datasets, can provide medical advice but faces ethical and accuracy concerns. This study evaluates the accuracy of ChatGPT-3.5's answers to frequently asked questions about oral cancer, a condition where early diagnosis is crucial for improving patient outcomes.MethodsA total of 20 questions were asked to ChatGPT-3.5, selected from Google Trends and questions asked by patients in the clinic. The responses provided by ChatGPT were evaluated for accuracy by medical oncologists and oral and maxillofacial radiologists. Inter-rater agreement was assessed using Fleiss’s and Cohen kappa tests. The scores given by the specialties were compared with the Mann-Whitney U test. The references provided by ChatGPT-3.5 were evaluated for authenticity.ResultsOf the 80 responses from 20 questions, 41 (51.25%) were rated as very good, 37 (46.25%) as good, 2 (2.50%) as acceptable. There was no significant difference between oral and maxillofacial radiologists and medical oncologists in all 20 questions. Of the 81 references to ChatGPT-3.5 answers, only 13 were scientific articles, 10 were fake, and the remaining references were data from websites.ConclusionChatGPT provided reliable information about oral cancer and did not provide incorrect information and suggestions. However, all information provided by ChatGPT is not based on real references.

Molecular Profiles of Sensitization to Non-Specific Lipid Transfer Proteins in Lithuania: Single Center Experience.

Non-specific Lipid Transfer proteins (nsLTPs) are relevant allergens of several pollens and plant foods. Sensitization to nsLTPs is not typical in our region. Still, it has become an increasingly common cause of IgE-mediated food allergies and food-induced anaphylaxis in Northern Europe in recent decades. No in-depth studies describe the prevalence of sensitization of molecular components to nsLTPs in Lithuania. This study aimed to determine the sensitization profile of atopic patients at the Immunology and Allergy Department of Kauno Klinikos to the components of nsLTPs, using molecular allergen component analysis. Sixty Lithuanian adults with symptoms of allergic rhinitis and/or allergic asthma and/or food allergies were included into the study. Specific immunoglobulin E (IgE) levels were measured using two in vitro techniques: allergen extract and molecular component analysis. Results showed that 25% of subjects were sensitized to nsLTP-containing allergen sources, mostly to Zea m 14, Mal d 3, Vit v 1, and Art v 3. The median amount of total IgE was higher in nsLTP-sensitized patients than in nsLTP-nonsensitized patients. Based on Cohen's Kappa and McNemar tests, the results of allergen extract and component analysis tests do not always agree, especially when we determine the sensitization to allergen sources containing nsLTPs. Molecular allergen component analysis could be the first choice in determining detailed sensitization to nsLTPs in patients who experienced anaphylaxis of unknown origin.

Translation, cross-cultural adaptation and validation of the General Movement checklist.

The Prechtl's General Movement Assessment (GMA) is a widely accepted tool for predicting neurodevelopmental outcomes in infants. However, access to formal training in GMA is limited in low- and middle-income countries, such as Mexico. This study aimed to validate the Spanish version of the General Movement checklist (GMC), a tool designed to facilitate the evaluation of general movements, particularly for clinicians with limited experience. An observational, cross-sectional study was conducted on infants with high neurological risk. The inter- and intra-observer reliability of GMC in its original version was analyzed using Cohen's kappa test. The checklist was translated and cross-cultural adapted to Spanish following international guidelines. Its internal consistency was assessed using Cronbach's alpha test. Content validity was determined by a panel of experts (the content validity index (CVI)), criterion and predictive validity were determined using the General Movement Optimality Score-Revised (GMOS-R) and the clinical diagnosis at 2 years corrected age. Receiver Operating Characteristic (ROC) curves were generated to identify the cut-off points on the GMC. Intra-observer reliability (Kappa = 0.91) and inter-observer reliability (Kappa = 0.75-1.0) demonstrated excellent agreement. Cronbach's alpha was 0.8579. Content validity was strong, with all items achieving a CVI > 0.7. Predictive validity showed high sensitivity (90%) and specificity (92%) when comparing checklist results with the clinical diagnosis. The Spanish version of the GMC was validated as a reliable and valid tool to guide the early assessment of neurodevelopmental disorders in Mexican infants. Further studies are recommended to confirm these findings.

Assessment of diagnostic accuracy and inter-pathologist agreement in telecytology performed for canine round cell tumours using images captured by a smartphone camera.

Neoplasia is a common disease in companion animals. Rapid and accurate diagnosis of neoplasia often leads to a better disease outcome. Cytology is an inexpensive and minimally invasive method frequently used to diagnose neoplasia. However, the physical distance between veterinary practices and pathologists often impedes rapid diagnosis. Telecytology facilitates rapid interpretation of cytology results leading to prompt diagnosis. Smartphone cameras have been suggested as an alternative to image-capturing devices used in conventional telecytology. This project was designed to evaluate whether telecytology with smartphone cameras can be effectively used to diagnose canine round cell neoplasms. For this purpose, five round cell tumours [lymphoma, mast cell tumour (MCT), transmissible venereal tumour (TVT), plasmacytoma and histiocytoma] were imaged using a smartphone camera and the images were sent to two pathologists at distant locations via emails. For each tumour type, the cytopathological diagnosis from the two pathologists was compared with the histopathological diagnosis of the same tumour and the agreement was determined by Cohen's kappa test. Inter-pathologist variability was also determined using the same test. The diagnostic agreement between histopathology and cytopathology was excellent (κ = 1.0) for lymphoma and MCT when x10 objective images were used. Variable agreements were reported for TVT, plasmacytoma and histiocytoma. When both 10x and 40x objective images were used, diagnostic agreement between histopathology and cytopathology was excellent for all tumours except histiocytoma. The inter-pathologist agreement was excellent for lymphoma, MCT and TVT using the 10x objective, while with the 40x objective it was excellent for all tumours except histiocytoma. The diagnostic accuracy was greater when both 10x and 40x objective images were used for diagnosis than when only 10x objective images were used (χ2 = 40.0, p = < 0.001). The use of images obtained using 10x and 40x objectives increased the diagnostic accuracy compared to the use of only 10x objective. These findings suggest that telecytology performed with smartphone cameras is a promising method to rapidly diagnose canine round cell tumours. Future studies with larger number of samples and samples with atypical presentations of round cell neoplasms will be helpful to further elaborate the present findings.

Assessment of Reproducibility and Agreement of the IDEAL Classification for Distal Radius Fractures.

Objective To analyze the reproducibility and intra- and interobserver agreement of the IDEAL classification for distal radius fractures. Methods This qualitative, analytical study evaluated 50 pairs of radiographs in two views of patients with distal radius fractures. There were ten observers with different levels of orthopedic training who assessed the radiographs in three different evaluations. The results underwent the Cohen and Fleiss Kappa tests to determine intra- and interobserver agreement levels. Statistical calculations used Excel and SPSS, version 26.0. Results The Cohen Kappa index values for intraobserver evaluation indicated poor to little agreement (-0.177-0.259), with statistical significance in only one instance. The Fleiss Kappa index values revealed little agreement among the resident group (0.277-0.383) with statistical significance, poor to little agreement among the general orthopedists (0.114-0.225) with statistical significance in most instances, and moderate agreement among hand surgeons (0.449-0.533) with statistical significance. Conclusion The IDEAL classification had interobserver agreement levels ranging from poor to moderate, influenced by the physicians' training level. Other intraobserver agreement levels ranged from poor to little agreement but without statistical significance.

MFFE CT-like MRI Sequences for the Assessment of Vertebral Fractures.

The aim of this study was to evaluate the diagnostic performance, image quality, and inter- and intra-observer agreement of the 3D T1 multi-echo fast field echo (mFFE) sequence in cervico-thoraco-lumbar vertebral fractures compared with conventional computed tomography (CT) as the gold standard. We conducted a prospective single-centre study including 29 patients who underwent spinal magnetic resonance imaging (MRI) at the surgeon's request, in addition to CT for vertebral fracture assessment and classification. A 3D T1 mFFE sequence was added to the standard MRI protocol. Consecutively, two readers analyzed the 3D mFFE sequence alone, the 3D mFFE sequence with the entire MRI protocol, including the STIR and T1 sequences, and, finally, the CT images in random order and 1 month apart. A standardized assessment was performed to determine the presence or absence of a fracture, its location, its classification according to the Genant and AO classifications for traumatic and osteoporotic fractures, respectively, the loss of height of the anterior and posterior walls of the vertebral body, and the presence of concomitant disco-ligamentous lesions. Contingency tables, intraclass correlation coefficients, and Cohen's kappa tests were used for statistical analysis. A total of 25 fractures were recorded (48% cervical, 20% thoracic, and 32% lumbar), of which 52% were classified A, according to the AO classification system. The quality of the 3D mFFE image was good or excellent in 72% of cases. Inter-observer agreement was near perfect (0.81-1) for vertebral body height and for AO and Genant classifications for all modalities. Intra-observer agreement was strong-to-near perfect between CT and the 3D mFFE sequence. Regarding the diagnostic performance of the 3D mFFE sequence, the sensitivity was 0.9200 and 0.9600, the specificity was 0.9843 and 0.9895, and the accuracy was 0.9861 and 0.9769 for Readers 1 and 2, respectively. In addition, up to 40% of intervertebral disc lesions and 33% of ligamentous lesions were detected by the 3D mFFE sequence compared to CT, allowing four AO type A fractures to be reclassified as type B. The 3D mFFE sequence allows accurate diagnosis of vertebral fractures, with superiority over CT in detecting disco-ligamentous lesions and a more precise classification of fractures, which can prompt clinicians to adapt their management despite an image quality that still requires improvement in some cases. Vertebral fractures and disco-ligamentous lesions can be assessed using CT-like MRI sequences, with 3D T1 mFFE being superior to CT for the detection of disco-ligamentous lesions. CT-like images using the 3D T1 mFFE sequence improve the diagnostic accuracy of bone structures in MRI.

Inter-Reader Agreement for Contrast-Enhanced Ultrasound Liver Imaging Reporting and Data System Major Features and Final Categorization: A Subanalysis From a Prospective Multicenter Study.

Contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) is used to definitively diagnose hepatocellular carcinoma (HCC) in patients at risk. However, the user variability associated with CEUS LI-RADS has not been validated in North American and European patients. This study aims to evaluate the inter-reader agreements of CEUS LI-RADS features for, and final categorization of, HCC in patients at risk. This retrospective multicenter clinical study used the database of a previous prospective multinational study, evaluating the accuracy of CEUS LI-RADS for HCC diagnosis in patients at risk. All cases were first evaluated by a site physician performing/supervising the CEUS examination. Randomly selected cases were re-evaluated by a blinded central reader. Final diagnosis was confirmed with the reference standard, which was a composite of imaging tests and histology. Cohen's kappa test was used to evaluate inter-reader agreement. This study included 150 liver nodules and 58.0% (87/150) were confirmed as HCC, 4.7% (7/150) non-HCC malignancies, 22.7% (34/150) had no confirmed final diagnosis, and 14.7% (22/150) were nonmalignant. Inter-reader agreements were substantial for CEUS LI-RADS categorization (κ = 0.61; 95% confidence interval [CI]: 0.51-0.71) and major features assessment (ranged κ = 0.64-0.78), LR-5 (κ = 0.65; 95% CI: 0.52-0.77), and LR-M (κ = 0.67; 95% CI: 0.44-0.90), while for LR-1 and LR-2 categorization was almost perfect (κ = 0.85; 95% CI: 0.65-1.00). Our study reported a substantial inter-reader agreement for overall CEUS LI-RADS categorization, especially for LR-5 and LR-M, and major imaging features of HCC, further confirming CEUS LI-RADS as a valuable and reliable tool for diagnosis of HCC.

The Concordance between GeneXpert MTB/RIF and Isothermal Amplification Assay for Detecting Mycobacterium tuberculosis

Tuberculosis (TB) is an infectious disease and one of the biggest causes of death worldwide. The main problem today is the lack of accurate and rapid tests to detect Mycobacterium tuberculosis (MTB). Several molecular methods have been developed to detect MTB. GeneXpert MTB/RIF® can detect MTB and rifampicin resistance simultaneously in &lt;2 hours. Cross Priming Amplification (CPA) is one of the isothermal amplification assay methods that can detect MTB. Both of these methods are molecular rapid tests so they can detect MTB faster. This study aims to evaluate the concordance of GeneXpert MTB/RIF® results with CPA to detect MTB at Hasan Sadikin General Hospital, Bandung. This is an observational cross-sectional study. The subjects were patients with suspected pulmonary TB and examined with GeneXpert MTB/RIF® then CPA (Ustar EasyNAT MTC™) was also examined. This study used total sampling with 50 subjects and analyzed with Cohen's Kappa test. The results of GeneXpert MTB/RIF® and Ustar EasyNAT MTC™ in detecting MTB obtained Kappa of 0.662 (good agreement) with p-value &lt;0.001. Of the 11 low positive samples on GeneXpert MTB/RIF® as many as 6 subjects (54.55%) had positive results, and 5 subjects (45.45%) had negative results on UStar EasyNAT MTC™. Meanwhile, of the 4 very low positive samples, there was only 1 sample with positive results on UStar EasyNAT MTC™. There is a match results between high and medium positive GeneXpert MTB/RIF® and UStar EasyNAT MTC™. However, there is a difference between low and very low positive results on GeneXpert MTB/RIF® and UStar EasyNAT MTC™.

Patterns of Pulpal Mineralization in Mandibular Anteriors: A Micro-computed Tomography Analysis

IntroductionCurrent understanding of the morphology of pulpal mineralizations is limited. Understanding the specific location and type of such mineralizations will aid clinicians in diagnosis, case complexity assessment, and treatment planning. Therefore, this study correlated the appearance of a reduced canal volume (CV) in conventional radiographs with the presence of pulp mineralizations (PMs) utilizing micro-computed tomography (CT) analysis. The morphology of PMs utilizing micro-CT technology was also analyzed. MethodsOne hundred and twenty-one extracted permanent mandibular incisors were collected. Periapical radiographs were taken of the teeth to determine if a reduced canal space was present, in which case the sample was included for micro-CT assessment. Various descriptors for PM were then determined and these labels were then applied to the entire sample to demonstrate PM. Numerical analysis was undertaken for all teeth scanned; the following data was extracted: the presence or absence of PMs, types of PM, and their morphological structures; CVs were determined. Cohen's kappa test was used to assess intraexaminer agreement. ResultsBased on radiographic appearance, forty-two teeth were included for micro-CT analysis. PMs were demonstrable in 57% and absent 43% of teeth. When PMs were absent, the CV was significantly smaller compared to when they were present (P < .05). Discrete mineralizations were more frequently located in the coronal and middle thirds compared to diffuse mineralization (P < .01). No differences in the prevalence of the individual features of discrete or diffuse mineralizations were detected (P > .05). ConclusionsTwo detectable forms of PMs were found in micro-CT analysis at all levels of the canal: discrete and diffuse mineralizations. A reduced CV on a PA was reflective of mineralized changes within the pulp but the type of PM could not be determined. PMs occurred at any level of the root canal; clinicians need to be aware of this when performing root canal treatment.

Evaluation of the sedative properties of oral trazodone, gabapentin or their combination in healthy cats.

Sedation before veterinary visits is advocated to help reduce fear and anxiety in cats and facilitate safe handling. The aim of this study was to evaluate the effectiveness of trazodone, gabapentin and a trazodone/gabapentin combination for oral sedation in healthy feline patients before blood donation. A total of 21 cats were included in the study. Baseline sedation scores were obtained, and cats were randomly assigned to receive oral trazodone at 5 mg/kg (T), oral gabapentin at 10 mg/kg (G), their combination (TG) or placebo (control group). A sedation score was obtained 1 h after drug administration. A blood sample was obtained at the time of blood collection for quantification of drug plasma concentrations. Agreement between observers was tested with a Cohen's Kappa test. Sign tests to compare change within treatment and a Skilling-Mack rank ANOVA to test for differences between groups were performed to compare pre- and post-sedation scores as well as a magnitude of differences over time between the groups. A Spearman's rank correlation coefficient test was used to correlate sedation scores with drug plasma concentrations. Post-sedation final scores were significantly higher only in the T (P = 0.022) and TG groups (P <0.001). The magnitude of change between pre- and post-sedation scores was larger in the TG (P <0.0032) and T groups (P <0.038) compared with the control group. There were no other significant differences between the groups. There was no correlation between drug plasma concentrations and sedation scores in any of the groups. Administration of oral trazodone alone at 5 mg/kg or in combination with gabapentin at 10 mg/kg resulted in significant sedation in healthy cats with no evident side effects. The degree of sedation was more profound when both drugs were combined, but a gabapentin dose of 10 mg/kg alone failed to provide significant sedation in this population.

Psoriatic Arthritis Acceptable Symptoms State: Does Sex Make a Difference?

The PatientAcceptable Symptoms State (PASS) is a validated instrument that is used to assess whether a patient withpsoriatic arthritis (PsA) accepts her/his disease status by asking them a simple question: "Think about all the ways your PsA has affected you during the last 48h. If you were to remain in the next few months as you were during the last 48h, would this be acceptable to you?" The aim of the present study was to explore any PASS differences in patients with PsA based on sex by looking at the corresponding thresholds of Disease Activity for Psoriatic Arthritis (DAPSA), Psoriatic Arthritis Impact of the Disease-12 (PsAID-12) and the Health Assessment Questionnaire-Disability Index (HAQ-DI) in female and male patients. This was a cross-sectional study that included two PsA cohorts. To identify the DAPSA, PsAID and HAQ-DI thresholds that differentiated patients who reported "yes" in response to the PASS question from those who reported "no," we used the receiver operating characteristic curves both for the female and male sexes. Moreover, Cohen's kappa test was used to determine the agreement of a PASS "yes" with DAPSA≤14, PsAID≤4 and HAQ-DI≤0.5. Three-hundred ten patients were considered for the study. The DAPSA, PsAID-12 and HAQ-DI thresholds that differentiated PASS "yes" patients from PASS "no" patients were 11.7, 1.85 and 0.625 in male patients and 13.3, 3.85 and 0.750 in female patients, respectively. A PASS "yes" and DAPSA≤14 showed moderate agreement in males (kappa = 0.56) and good agreement in females (kappa = 0.80); the agreement between a PASS "yes" and PsAID≤4 and between a PASS "yes" and HAQ-DI≤0.5 was higher in female patients (moderate). Female patients accept their disease at higher DAPSA, PsAID and HAQ-DI values than male patients do. The clinical meaning of this could be that a female patient generally has a greater global disease acceptance inclination. Therefore, this study further supports the concept that sex differences are present in patients with PsA.

Inter- and Intra-observer Reproducibility of Thyroid Fine Needle Aspiration Cytology: An investigation of Bethesda 2023 Using Immunohistochemical BRAFV600E Antibody.

The Bethesda System for Reporting Thyroid Cytology (TBSRTC) recommended for the interpretation of needle aspiration cytology of the thyroid, is the most widely used worldwide. Studies have shown that the disagreement between observers, especially in the Bethesda III and IV diagnostic categories, is not insignificant at 10%-40%. In the TBSRTC 2023 version, some definitions were removed and simplified, and molecular pathology was proposed as a complement to cytopathology. The current availability of molecular tests is limited because they can be performed in a few centers and are expensive. Therefore, our study investigated intra- and inter-observer agreement according to TBSRTC 2023 using only immunohistochemically BRAFV600E antibodies. The study included 173 cases with aspiration cytology evaluated between 2019 and 2022. The immunohistochemical procedure applied BRAFV600E (RM8) monoclonal antibody to cell block sections. All slides were assessed and categorized by three different observers. Data were interpreted using Cohen's kappa and Fleiss's kappa test in the Statistical Package for Social Sciences Windows 2021 program. For the applied RM8 antibody, sensitivity was 64.71% and specificity was 87.27%. In terms of diagnostic categories, inter-observer agreement was good for Bethesda II (K = 0.606) and moderate for Bethesda III (K = 0.429), Bethesda IV (K = 0.523), Bethesda V (K = 0,464), and Bethesda VI (K = 0.544), respectively. In conclusion, the study reveals that the 2023 version of TBSRTC provides improvement, especially in the categories of uncertain diagnosis, but is still insufficient to improve cytological diagnostic accuracy, at which point molecular analyses become even more important.

Comparison of Blood-Gas Hemoglobin and Electrolyte Measurements and Automated Laboratory Values in Pediatric Kidney Transplant Patients.

The reliability of blood-gas measurements compared with automated laboratory tests in providing rapid results for pediatric patients is currently under investigation. The compatibility between fast-response blood-gas tests and standard automatic laboratory tests remains a subject of debate. In this retrospective single-center study, our objective was to compare the measurements of hemoglobin and electrolytes obtained through blood-gas analysis with the corresponding values obtained from standard laboratory tests in pediatric renal transplantation, specifically focusing on the immediate pretransplant period. We retrospectively investigated 26 pediatric kidney transplant patients in the pretransplant period. We reviewed their medical records and compared and simultaneous measurements of hemoglobin, sodium, and potassium from a blood-gas analyzer versus a laboratory automatic analyzer. We assessed the agreement between the 2 analyses with BlandAltman analysis and Cohen kappa statistic. Among the 26 pediatric kidney transplant recipients, mean age was 10.1 ± 4.9 years and 60.0% were male patients. The mean differences between blood-gas and the venous laboratory analyzer (95% CI) were as follows: 0.11 g/dL for hemoglobin (-0.27 to 0.05 g/dL; P > .05), 0.39 mEq/L for sodium (-0.58 to 1.35 mEq/L; P > .05), and 0.00 mEq/L for potassium (-0.25 to 0.25 mEq/L; P > .05). Cohen kappa test showed the highest agreement for sodium, with no significant difference in mean values. Our study demonstrated strong agreement between hemoglobin, sodium, and potassium values obtained through blood-gas measurements and venous blood samples in pediatric kidney transplant recipients. Demonstrating the concordance between rapid blood-gas analysis and automated laboratory tests can offer valuable guidance to clinicians.

Is SDF better than the SMART (silver modified atraumatic restorative technique) in the management of molar incisor hypomineralisation molars with initial caries?

A prospective, randomized, split-mouth clinical study by thetwo previously trained and calibrated pediatric dentists without blinding operators and patients due to different protocols in both treatment groups. An SDF + potassium iodide (KI) and SDF + KI + glass ionmer cement(GIC) on International Caries Detection and Assessment System (ICDAS) 1/2 molar was received by each patient on either sideof mouth. The local Ethics Committee approved this study. Sample size calculation was not performed due to the lack of published studies on the longevity of SMART sealant on MIH-affected molarsand the absence of research on the apparent difference between the effectiveness of SMART and SDF treatments in preventing further caries and sensitivity. These were children between the ages of 6 years to 13 years, who visited the Pediatric Dentistry Clinic at XX University School of Dentistry for routine exams and treatment between July 2019 to May 2020. They were in good health and had at least two fully erupted permanent first molars with MIH as per the European Academy of Pediatric Dentistry, ICDAS code 1/2. This study recorded 12 months of treatment outcomes on hypomineralised molars of 48 children with a follow-up of three years. Children were excluded with specific syndromes associated with enamel malformation, lack of cooperation, ongoing orthodontic treatment, and teeth with ICDAS 3/4/5/6 lesions, existing restorations, fluorosis, or pulpal symptoms. Mann-Whitney U Test was used to assess differences between independent groups (SDF and SMART) and the Friedman Test between dependent groups at different time points. Kaplan-Meier analysis to evaluate the cumulative survival of SMART sealants and survival of caries-free hypomineralised molars in both groups. Chi-Square test was used to compare the success percentages of the SDF and SMART groups. To assess the changes in success percentages at three different time intervals for the caries preventive effect of SDF and SMART, and to evaluate the retention percentages for the SMART group. McNemar's test with a Bonferroni correction was used for significant differences. Cohen's kappa test indicated that the inter-examiner reliability determining the presence of MIH was 0.87. The intra-examiner reliability for US Public Health Service (USPHS)-Modified criteria was 0.90. The statistical significance level was set at p < 0.05 for all statistical analyses. At 12, 24 and 36 months the caries preventive effect was 100%, 67.9%, and 65.4% for SDF + KI-treated teeth; and 100%, 97.6%, and 94.7% for SMART (SDF + KI + GIC) respectively. During the recall period, there was no substantial difference in hypersensitivity scores between the groups. There was no hypersensitivity in teeth at 18 months and beyond. Compared to the baseline Schiff Cold Air Sensitivity Scale (SCASS) score 26 molar with initial hypersensitivity to hypomineralisation had a massive reduction at evaluation periods. The mean survival probabilities for the caries-preventive effect were considerably lower in SDF + KI-treated teeth (31.01 months) than in SMART-treated teeth (35.61 months) (p < 0.001). Considering the limitation of the study, both SMART (SDF + KI + GIC) sealants and 6-monthly application of SDF + KI, provided similar and substantial levels of desensitisation on the permanent MIHmolars. When used as a sealing material on non-cavitated permanent MIHmolars, the clinical retention rate for SMART was 88.7%, 73.1%, and 66.6% at 1, 2, and 3 years respectively. The caries preventive effect of SMART (SDF + KI + GIC) sealants was superior to SDF + KI application in hypomineralised teeth, however, a long-term monitoring and review is essential due to the gradual decrease in retention of SMART sealants.

Validity test of the Global Leadership Initiative on Malnutrition (GLIM) diagnostic criteria compared with the American Society for Parenteral and Enteral Nutrition (ASPEN) criteria in inpatients at Dr. Cipto Mangunkusumo hospital

Background: Malnutrition experienced by numerous inpatients is linked to various complications. The Global Leadership Initiative on Malnutrition (GLIM), which established the latest malnutrition criteria, recommends a two-step methodology for diagnosing malnutrition in adult inpatients. This study aims to evaluate the validity of the GLIM criteria for the diagnosis of malnutrition in hospitalized patients at Cipto Mangunkusomo Hospital Jakarta by comparing them with the ASPEN criteria. Methods: This cross-sectional study was conducted at Cipto Mangunkusomo Hospital, Jakarta. Secondary data was taken from 100 inpatients from October 2021 to February 2022 selected by consecutive sampling technique. The diagnosis of malnutrition in the patients applied the ASPEN and GLIM criteria. Furthermore, data were analyzed using Cohen's Kappa and chi-square tests. Results: Of 100 inpatients, 63% were diagnosed with malnutrition according to the GLIM diagnostic criteria. Meanwhile, 48% of them were found to be malnourished according to the ASPEN criteria. The GLIM criteria have a specificity of 69.2%, a sensitivity of 97.9%, a PPV of 74.6%, and an NPV of 97.3%. Conclusion: The GLIM diagnostic criteria are valid as an instrument for diagnosing malnutrition but require further research to assess the severity of malnutrition.

Mental health disparities in people living with human immunodeficiency virus: A cross-sectional study on physician-patient concordance and treatment regimens.

Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) can profoundly affect the mental health of the people living with HIV (PLWH), with higher rates of anxiety, depression, and sleep disturbances. The disparities in neuropsychological problems evaluated by physicians and self-assessed by patients are still unknown. A total of 5000 PLWH and 500 physicians from 167 hospitals were enrolled in this cross-sectional study from September 2022 to February 2023. 4-Item Patient Health Questionnaire (PHQ-4) was used for the evaluation of depressive issues and anxiety issues by PLWH. Each physician assessed 10 PLWH under their care for the presence of depressive or anxiety issues. The primary outcomes of this study are the concordance rates on the depressive issues and anxiety issues evaluation between physicians and PLWH. The Cohen's kappa test was used to assess the agreement between physicians and PLWH. The concordance rate for the evaluation of depressive issues is 73.84% (95% confidence interval [CI]: 72.60-75.04%), and it is significantly different from the expected rate of 80% (P<0.001). Similarly, the concordance rate for the evaluation of anxiety issues is 71.74% (95% CI: 70.47-72.97%), which is significantly different from the expected rate of 80% as per the null hypothesis (P<0.001). The overestimation rate by physicians on depressive issues is 12.20% (95% CI: 11.32-13.14%), and for anxiety issues is 12.76% (95% CI: 11.86-13.71%). The mismatch rate for depressive issues is 26.16% (95% CI: 24.96-27.40%), and for anxiety issues is 28.26% (95% CI: 27.02-29.53%). The underestimation rate by physicians on depressive issues is 13.96% (95% CI: 13.03-14.95%), and for anxiety issues is 15.50% (95% CI: 14.52-16.53%). For the treatment regiments, PLWH sustained on innovative treatment regimen (IR) related to a lower prevalence of depressive issues (odds ratio [OR]=0.71, 95% CI: 0.59-0.87, P=0.003) and a lower prevalence of anxiety issues (OR=0.63, 95% CI: 0.52-0.76, P<0.001). PLWH switch from conventional treatment regimen (CR) to IR also related to a lower prevalence of depressive issues (OR=0.79, 95% CI: 0.64-0.98) and a lower prevalence of anxiety issues (OR=0.81, 95% CI: 0.67-0.99). Nearly one in three PLWH had their condition misjudged by their physicians. The findings underscore the need for improved communication and standardized assessment protocols in the care of PLWH, especially during the acute phase of HIV infection.

Prevalence of alveolar bone crest resorption patterns at the age of 12-30 years from panoramic radiographs at RSGMP Universitas Trisakti

Objectives: The aim of this study is determine the prevalence of alveolar bone crest resorption patterns at the age of 12-30 years from panoramic radiographs. Materials and Methods: This study used consecutive sampling method based on secondary data from panoramic radiographs at the age 12-30 years, who had resorption on central insisivus and first molars at maxilla and mandibula. The samples used in this study were teeth 11, 21, 31, 41, 16, 26, 36 and 46 with using digital measurements from the CEJ to the top of the alveolar bone. Data is presented in tabular form with simple statistical calculations using SPSS and MS. Excel, and intraobserver reliability test. After the measurements were taken, intraobserver reliability was tested using the Cohen's Kappa test. Data processing was carried out using SPSS and Microsoft Excel. Results: The results of this study showed that the prevalence of patients diagnosed with periodontitis was 6.19% with Horizontal bone resorption 4,26% and vertical 1.93%. Conclusion: The prevalence of patients diagnosed with periodontitis in 2022 was 6.19% with horizontal bone destruction patterns of 4.26% and vertical 1.93%.

LI-RADS v2018 category and imaging features: inter-modality agreement between contrast-enhanced CT, gadoxetate disodium-enhanced MRI, and extracellular contrast-enhanced MRI.

To perform an intra-individual comparison of LI-RADS category and imaging features in patients at high risk of hepatocellular carcinoma (HCC) on contrast-enhanced CT, gadoxetate disodium-enhanced MRI (EOB-MRI), and extracellular agent-enhanced MRI (ECA-MRI) and to analyze the diagnostic performance of each imaging modality. This retrospective study included cirrhotic patients with at least one LR-3, LR-4, LR-5, LR-M or LR-TIV observation imaged with at least two imaging modalities among CT, EOB-MRI, or ECA-MRI. Two radiologists evaluated the observations using the LI-RADS v2018 diagnostic algorithm. Reference standard included pathologic confirmation and imaging criteria according to LI-RADS v2018. Imaging features were compared between different exams using the McNemar test. Inter-modality agreement was calculated by using the weighted Cohen's kappa (k) test. A total of 144 observations (mean size 34.0 ± 32.4mm) in 96 patients were included. There were no significant differences in the detection of major and ancillary imaging features between the three imaging modalities. When considering all the observations, inter-modality agreement for category assignment was substantial between CT and EOB-MRI (k 0.60; 95%CI 0.44, 0.75), moderate between CT and ECA-MRI (k 0.46; 95%CI 0.22, 0.69) and substantial between EOB-MRI and ECA-MRI (k 0.72; 95%CI 0.59, 0.85). In observations smaller than 20mm, inter-modality agreement was fair between CT and EOB-MRI (k 0.26; 95%CI 0.05, 0.47), moderate between CT and ECA-MRI (k 0.42; 95%CI -0.02, 0.88), and substantial between EOB-MRI and ECA-MRI (k 0.65; 95%CI 0.47, 0.82). ECA-MRI demonstrated the highest sensitivity (70%) and specificity (100%) when considering LR-5 as predictor of HCC. Inter-modality agreement between CT, ECA-MRI, and EOB-MRI decreases in observations smaller than 20 mm. ECA-MRI has the provided higher sensitivity for the diagnosis of HCC.

Applicability of ChOLE staging to preoperative HRCT temporal bone in chronic otitis media with cholesteatoma.

Chronic otitis media with cholesteatoma is a frequent disease entity in otology, requiring surgery in overwhelming majority of cases. Despite the huge burden there is no established grading system available to assess the severity and extent of disease preoperatively until date. Aim of our study is to assess the applicability of ChOLE staging to preoperative HRCT temporal bone in Chronic otitis media with cholesteatoma. Patients clinically diagnosed as COM with cholesteatoma, who underwent preoperative HRCT temporal bone imaging and mastoid exploration at our tertiary care centre were included. Preoperative radiology was assessed and a radiological ChOLE (r-ChOLE) was given by radiologist. This was then compared with the postop ChOLE. 21 patients were included in the study. Data was linear and normally distributed (Shapiro wilk test). Pearson's product-moment correlation used to see relationship between radiological and postop Total score showed strong statistically significant positive correlation with correlation coefficient (r) of 0.977. Paired t test showed p value was 0.329(p > 0.05) suggesting no significant difference between radiological and postop Total scores. Cohen kappa test of agreement was applied. It revealed an overall strong agreement (p < 0.001). ChOLE staging may be extended to preoperative HRCT of temporal bone in COM with cholesteatoma (rCHOLE). A preoperative radiological staging will help in better prioritizing, planning and execution of tympanomastoid surgeries.

Non-invasive Assessment and Management of Folliculitis Decalvans by Trichoscopy and Reflectance Confocal Microscopy.

Folliculitis decalvans (FD) is a rare scarring alopecia mainly affecting middle-aged men, characterized by recurring episodes of follicular pustules, crusts, erythema, tufted hairs, and scars. This study investigates the effectiveness of reflectance confocal microscopy (RCM) compared to trichoscopy for diagnosing and monitoring FD. The study involved 24 Caucasian patients diagnosed with FD. Patients were examined using trichoscopy and RCM, with a focus on specific features like erythema and inflammatory cell distribution. A subgroup of 16 patients was followed up after 3 months of therapy. The reproducibility of RCM and trichoscopy was assessed using Cohen Kappa Test. RCM and trichoscopy consistently detected features such as tufted hairs, pustules, and perifollicular fibrosis. However, RCM provided more detailed insights into inflammatory activity and types of fibrosis, often overlooked by trichoscopy. It showed a reduction in vessels and inflammatory cells, which trichoscopy failed to detect. The concordance between RCM evaluations was excellent, indicating high reproducibility. RCM is effective in diagnosing and monitoring FD, offering detailed insights into inflammation and fibrosis. It complements trichoscopy, especially in aspects where trichoscopy is limited, such as precise measurement of inflammation. The study suggests that combining RCM with trichoscopy could enhance the accuracy of diagnosis and monitoring of FD, leading to tailored therapeutic approaches. Further studies with larger sample sizes and longitudinal designs are recommended to confirm these findings.