Diagnostic Value Of Clinical Signs Research Articles

Risk factors and predictors of angiostrongylosis in naturally infected dogs in the southeast of England

Canine pulmonary angiostrongylosis is a snail-borne parasitic infection caused by the nematode Angiostrongylus vasorum. The spread of A. vasorum across the UK in recent years, alongside the launch of new pharmaceutical products licenced for its treatment and prevention, has led to raised awareness of this parasite among veterinarians and the public alike. This raised profile has been beneficial in reducing canine morbidity and mortality associated with infection, especially in parts of the country where it had not previously been routinely diagnosed. It is vital, therefore, given raised public awareness and geographical spread of the parasite, that the veterinary professionals have demographic data to help give accurate risk-based advice. This study retrospectively evaluated demographic factors (age, gender and breed) and clinical presentation of 100 dogs with natural A. vasorum infection by reviewing the clinical record database at private practices, spanning the period from 2003 to 2009, alongside 100 dogs presenting for other reasons as a control sample. A significant relationship was detected between young age and A. vasorum infection (P<0.001), with dogs less than 1 year of age 4.2 times more likely to fall into the infected group. Gender was not identified as a significant risk factor for A. vasorum infection in dogs. Breed was a significant risk factor, with Cocker Spaniels over-represented in the infected group, and Staffordshire Bull Terriers and cross-breeds under-represented. The strongest contrast was between cross-bred and pure-bred dogs as a whole, with the latter 23 times more likely to present with angiostrongylosis. Significant associations were found between A. vasorum infection and dogs presenting with cough, coagulopathy, vomiting/diarrhoea and/or lethargy (P<0.05). The diagnostic value of clinical signs for the presence of disease, expressed by area under the receiver operating characteristic curve, was >0.7, indicating that correct diagnosis (discrimination between dogs with or without the disease) can be achieved in 70% of the clinical cases by accurate history taking. These findings provide important clues regarding the risk of infection to an individual dog, and thus may facilitate improved recognition of infection based on clinical presentation, and implementation of preventative strategies to combat A. vasorum infection.

The Evolving Clinical Presentation of Acute Rejection in Facial Transplantation.

Acute rejection is one of the most frequent complications in facial transplantation, with potentially severe consequences for the recipient if overlooked. Clinical signs, such as erythema or edema, are helpful to diagnose acute rejection in the early follow-up stage; however, it is not well known whether these clinical signs remain reliable markers of acute rejection beyond the second posttransplant year. To determine the diagnostic value of clinical signs of acute rejection after facial transplantation over time. A retrospective, single-center cohort study was conducted of patients who underwent facial transplantation at Brigham and Women's Hospital between April 2009 and October 2014, with up to an 8-year follow-up. Medical records were reviewed until September 30, 2017. The medical records from 104 encounters with 7 patients who underwent partial or full facial transplantation were analyzed for symptoms of rejection, immunosuppressive therapy, and histopathologic findings. The occurrence of 5 clinical signs of acute rejection were evaluated: erythema, edema, exanthema, suture line erythema, and mucosal lesions. Odds ratios (ORs) were calculated to determine the statistically significant association of these signs with the histopathologic diagnosis of rejection. In addition, tacrolimus blood levels, as a surrogate marker of immunosuppressive therapy, were evaluated. Of the 7 patients included in the study, 5 were men. The mean follow-up was 66 months (range, 35-101). Of 104 clinical encounters, 46 encounters (44.2%) represented rejection episodes and 58 encounters (55.8%) represented no-rejection episodes. Beyond 2 years posttransplantation, only erythema (OR, 6.53; 95% CI, 1.84-20.11; P = .004) and exanthema (OR, ∞; 95% CI, 2.2-∞; P = .004) were demonstrated to be reliable clinical signs of acute rejection in facial transplantation. There was also a statistically significant association of subtherapeutic tacrolimus levels with late rejection episodes (OR, 3.79; 95% CI, 1.25-12.88; P = .03). In addition, the occurrence of subclinical rejection was more frequent during later follow-up times (7 [24.1%] late rejections vs 1 [5.9%] early rejection). Five of 8 subclinical rejections (62.5%) were associated with subtherapeutic tacrolimus levels. Clinical signs of acute rejection in facial transplantation appear to be of limited diagnostic value, particularly after the second postoperative year. Until alternative biomarkers for rejection are identified, protocol skin biopsies will remain necessary for guiding assessments of allograft rejection. 3.

Accuracy of Neck stiffness, Kernig, Brudzinski, and Jolt Accentuation of Headache Signs in Early Detection of Meningitis.

The diagnostic value of clinical signs in early diagnosis of meningitis has been evaluated but the existing results are contradicting. The present study aimed to evaluate the accuracy of Kernig, Brudzinski, neck stiffness, and Jolt Accentuation of Headache (JAH) signs in this regard. In this diagnostic accuracy study, patients with suspected meningitis who were referred to the emergency department were examined regarding presence or absence of the mentioned clinical signs and screening performance characteristics of the signs were calculated. Cerebrospinal fluid analysis was used as the reference test. 120 cases with mean age of 48.79 ± 21.68 years (18 - 93) were studied (63.3% male). Diagnosis of meningitis was confirmed for 45 (37.5%) cases. Neck stiffness (p < 0.001), Kernig (p < 0.001), Brudzinski (p < 0.001), and JAH (p < 0.001) had significantly higher frequency among patients with meningitis. The accuracy of neck stiffness, Kernig, Brudzinski, and JAH signs in early detection of meningitis were 0.676 (95% CI: 0.575-0.776), 0.667 (95% CI: 0.552-0.782), 0.720 (95% CI: 0.619-0.821), 0.749 (95% CI: 0.659-839), respectively. It seems that diagnostic value of JAH is higher than other clinical signs but the accuracy of all signs is in poor to fair range. JAH had the highest sensitivity and Kernig and Brudzinski had the highest specificity.

Gynura segetum-related hepatic sinusoidal obstruction syndrome: a national multicenter clinical study

Objective To investigate the clinical features, diagnosis and treatment of Gynura segetum-related hepatic sinusoidal obstruction syndrome (HSOS). Methods From January 2010 to May 2017, 458 hospitalized patients with HSOS from 29 hospitals were enrolled, and among them 239 cases were Gynura segetum-related HSOS. The diagnostic value of clinical signs in Gynura segetum-related HSOS were evaluated by Seattle criteria which used in HSOS caused by hemopoietic stem cells transplantation. The pathological diagnosis of liver biopsy was taken as gold standard. The diagnostic value of computed tomography (CT)/magnetic resonance imaging (MRI) in Gynura segetum-related HSOS was also investigated. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy and Kappa value were used for the assessment of diagnostic value. Cox regression analysis was performed for prognosis analysis. Results Among 362 patients with drugs-related HSOS, 239 cases (66.02%) was Gynura segetum-related HSOS and 232(97.07%) of the 239 patients with Gynura segetum-related HSOS presented with ascites. The diagnostic sensitivity and specificity of ascites in HSOS were 97.07% and 75.86%, respectively, and the Kappa value was 0.751. The diagnostic sensitivities of patchy map-like enhancement and (or) heterogeneous hypoattenuation of CT or inhomogeneous signal of MRI were 100.0% and 97.4%, respectively; and the specificities were 88.9% and 100.0%, respectively, and both of the Kappa value were more than 0.75, with excellent consistency. The accuracies of patchy enhancement, heterogeneous hypoattenuation of CT or inhomogeneous signal of MRI and ascites were all over 90%. Among 239 patients with Gynura segetum-related HSOS, 229 (95.82%) patients were treated with hepatoprotectants and diuretics, and 105 (43.93%) patients received anticoagulant drugs. The mortality rate was 8.37% (20/239). The percentage of patients with no improvement or deterioration was 17.57% (42/239). Increased total bilirubin and lactic dehydrogenase levels were related with poor prognosis (the relative risk was 1.012 and 1.009, respectively; both P<0.05). Conclusions Gynura segetum is a major cause of hospitalized patients with HSOS in China. Ascites is the major clinical manifestation. The patchy enhancement, heterogeneous hypoattenuation of CT or inhomogeneous signal of MRI are the main CT/MRI signs of HSOS. There are no reliable and effective treatments for Gynura segetum-related HSOS and the mortality is relatively low. Key words: Hepatic sinusoidal obstruction syndrome; Pyrrolizidine alkaloids; Multicenter study; Retrospective studies

Clinical features for diagnosis of pneumonia in children younger than 5 years: a systematic review and meta-analysis

Pneumonia is the biggest cause of deaths in young children in developing countries, but early diagnosis and intervention can effectively reduce mortality. We aimed to assess the diagnostic value of clinical signs and symptoms to identify radiological pneumonia in children younger than 5 years and to review the accuracy of WHO criteria for diagnosis of clinical pneumonia. We searched Medline (PubMed), Embase (Ovid), the Cochrane Database of Systematic Reviews, and reference lists of relevant studies, without date restrictions, to identify articles assessing clinical predictors of radiological pneumonia in children. Selection was based on: design (diagnostic accuracy studies), target disease (pneumonia), participants (children aged <5 years), setting (ambulatory or hospital care), index test (clinical features), and reference standard (chest radiography). Quality assessment was based on the 2011 Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) criteria. For each index test, we calculated sensitivity and specificity and, when the tests were assessed in four or more studies, calculated pooled estimates with use of bivariate model and hierarchical summary receiver operation characteristics plots for meta-analysis. We included 18 articles in our analysis. WHO-approved signs age-related fast breathing (six studies; pooled sensitivity 0·62, 95% CI 0·26-0·89; specificity 0·59, 0·29-0·84) and lower chest wall indrawing (four studies; 0·48, 0·16-0·82; 0·72, 0·47-0·89) showed poor diagnostic performance in the meta-analysis. Features with the highest pooled positive likelihood ratios were respiratory rate higher than 50 breaths per min (1·90, 1·45-2·48), grunting (1·78, 1·10-2·88), chest indrawing (1·76, 0·86-3·58), and nasal flaring (1·75, 1·20-2·56). Features with the lowest pooled negative likelihood ratio were cough (0·30, 0·09-0·96), history of fever (0·53, 0·41-0·69), and respiratory rate higher than 40 breaths per min (0·43, 0·23-0·83). Not one clinical feature was sufficient to diagnose pneumonia definitively. Combination of clinical features in a decision tree might improve diagnostic performance, but the addition of new point-of-care tests for diagnosis of bacterial pneumonia would help to attain an acceptable level of accuracy. Swiss National Science Foundation.

DIFFERENTIAL DIAGNOSIS OF ORGANIC AND FUNCTIONAL PATHOLOGY BOWELS ON THE BASIS OF FECAL LACTOFERRIN AND IMMUNOCHEMICAL HEMOCCULT TEST

The aim of the study was to assess the possibility of differential diagnosis of organic and functional bowels pathology in the comprehensive comparative analysis of the diagnostic value of clinical signs before the symptoms of anxiety, ESR, and immunochemical tests for fecal occult blood and fecal lactoferrin. 90 patients with organic pathology of intestines (42 patients with active ulcerative colitis and 48 patients with colorectal cancer) and 46 patients with irritable bowel syndrome have been examined. Lactoferrin was detected in stool samples taken from one defecation act, enzyme immunoassay (ELISA) using kits ELISA TEST KIT Hycult Biotechnology (Netherlands). The concentration of the marker at the level of 15,25 mg/g was defined with point of separation. The presence of hemoglobin in the feces was determined using immunochemical test for occult blood in the stool sets firm «Biotech Atlantic, Inc.» (U.S.). Fecal lactoferrin (0,931 ± 0,021) and immunochemical tests for fecal occult blood (0,922 ± 0,0224) showed the highest diagnostic utility in the differential diagnosis of organic and functional pathology of the intestines. They are ahead of the symptoms of anxiety (p = 0,002 and p = 0,005 respectively) and erythrocyte sedimentation rate (p < 0,001 and p = 0,001 respectively). The sensitivity of fecal lactoferrin was 85.56 % (95 % CI: 70,80-87,30), specificity - 84,78 % (95 % CI: 71,10-93,60), immunochemical test for occult blood in feces - 84,44 % (95 % CI: 75,30-91,20) and 100,00 % (95 % CI: 92,20-100,00), respectively. Consequently, fecal lactoferrin and immunochemical hemoccult test were sensitive and specific markers in the differential diagnosis of organic and functional pathology of the intestines.

DIFFERENTIAL DIAGNOSIS OF SPINAL CORD CONCUSSION AND CONTUSION WITHOUT MRI CHANGES IN CHILDREN

Objective. To prove a significance of a diagnostic table for effective diagnosis and evaluation of spinal cord injury in children. Material and Methods. Retrospective analysis of 191 case records of children with spinal cord injury without the evidence of hemorrhage or compression was performed. Specific clinical manifestations were analyzed using Wald’s statistical sequential analysis with calculation of diagnostic factor informative value in accordance with A. Kulback. Results. Diagnostic value of clinical signs was calculated on the basis of statistically analyzed data of initial examination. The analyzed incidence of clinical signs became the ground for diagnostic table used for differential diagnosis of spinal cord injury in children. Conclusion. Functional outcome of the spinal cord contusion in children can be good; and application of the suggested diagnostic table improves the quality of spinal cord injury diagnosis.

Clinical Signs of Brain Injury in Infants

The predictive and diagnostic value of clinical signs of intracranial injury (ICI) in head-injured infants was studied at Children’s Hospital, Harvard Medical School, Boston, MA.

Eight years' experience with foreign-body aspiration in children: What is really important for a timely diagnosis?

Background/Purpose : Aspiration of foreign bodies remains a major cause of morbidity and mortality in childhood. The aim of this study was to evaluate the predictive diagnostic value of clinical signs and symptoms, the history, and the radiology to perform early diagnosis and therapy. Methods : From January 1990 to March 1998, 87 children were admitted to the Pediatric Surgery Department of Universita di Padova because of suspected foreign body aspiration. Sensitivity and specificity of the considered diagnostic tools were evaluated. Results : Neither clinical signs and symptoms nor radiology have sufficient diagnostic sensitivity, and especially specificity, on which to rely for the diagnosis. Only the choking crisis, when present in the history, has good sensitivity and specificity (respectively, 96% and 76% in this series). Conclusions : A choking crisis in the child's history should alert physicians to the possibility of a foreign body aspiration. In the present series, complications always were related to the diagnostic delay.