Good Screening Tool Research Articles

Associations of the pre-pregnancy weight status with anaemia and the erythropoiesis-related micronutrient status.

The coexistence of underweight (UW) and overweight (OW)/obese (OB) at the population level is known to affect iron deficiency (ID) anaemia (IDA), but how the weight status affects erythropoiesis during pregnancy is less clear at a population scale. This study investigated associations between the pre-pregnancy BMI (pBMI) and erythropoiesis-related nutritional deficiencies. Anthropometry, blood biochemistry and 24-h dietary recall data were collected during prenatal care visits. The weight status was defined based on the pBMI. Mild nutrition deficiency-related erythropoiesis was defined if individuals had an ID, folate depletion or a vitamin B12 deficiency. The Nationwide Nutrition and Health Survey in Taiwan (Pregnant NAHSIT 2017-2019). We included 1456 women aged 20 to 45 years with singleton pregnancies. Among these pregnant women, 9·6 % were UW, and 29·2 % were either OW (15·8 %) or OB (13·4 %). A U-shaped association between the pBMI and IDA was observed, with decreased odds (OR; 95 % CI) for OW subjects (0·6; 95 % CI (0·4, 0·9)) but increased odds for UW (1·2; 95 % CI (0·8, 2·0)) and OB subjects (1·2; 95 % CI (0·8, 1·8)). The pBMI was positively correlated with the prevalence of a mild nutritional deficiency. Compared to normal weight, OB pregnant women had 3·4-fold (3·4; 95 % CI (1·4, 8·1)) higher odds for multiple mild nutritional deficiencies, while UW individuals had lowest odds (0·3; 95 % CI (0·1, 1·2)). A dietary analysis showed negative relationships of pBMI with energy, carbohydrates, protein, Fe and folate intakes, but positive relationship with fat intakes. The pre-pregnancy weight status can possibly serve as a good nutritional screening tool for preventing IDA during pregnancy.

Role of C-reactive protein and gastric aspirate polymorphs in early onset neonatal sepsis

Background: Neonatal septicemia is a major cause of morbidity and mortality in the neonates. It presented a diagnostic challenge in the resource poor setting of most of the developing countries of world.Methods: This prospective observational study included all term and preterm babies inborn and outborn referred cases. We included neonates less than 7 days of age with clinical suspicion of sepsis. Significant values for screening tests were taken as total leucocyte count (TLC) of >25,000/<5000, C-reactive protein>0.6 mg/dl and gastric aspirate polymorphs>5 per HPF. Sepsis screen was considered positive for two or more positive tests. Blood culture was used as the gold standard. The statistical analysis was done using SPSS 22.0 version.Results: A total number of 60 subjects were included in the study with 45 (75%) as outborn neonates. Most of them presented with tachypnea followed by difficulty in feeding and lethargy. Significant p values were observed using CRP and gastric aspirate polymorphs as independent sepsis screening markers and when combined together (p<0.001).Conclusions: Sepsis screen in neonates is required for detection of infection as blood culture may be negative and even positive result takes time. CRP showed high sensitivity. Gastric aspirate cytology with its relatively high specificity and negative predictive values serves as a good screening tool to rule out neonates unaffected by sepsis. When all the three parameters were combined together, sensitivity and specificity increased to 100% and 91.67% respectively with p values of 0.001.

English

BACKGROUND Patients with diabetic peripheral neuropathy (DPN) suffer from numbness, burning feet, lightning pain, and pins-and-needles sensations. Recently, High resolution ultrasonography is commonly used for evaluation of peripheral nerve diseases because of its easy availability, time saving and non-invasiveness of the procedure. This study intended to compare the cross sectional area (CSA) of posterior tibial nerve (PTN) in type 2 diabetic patients with peripheral neuropathy with that of non-diabetic healthy adults using high resolution ultrasonography (HRU) and study the role of increase in HbA1c level and severity of DPN comparing with CSA of PTN. METHODS A cross sectional comparative descriptive study was conducted from November 2018 to May 2020 with 50 type 2 diabetic patients and 50 healthy adults. 50 type 2 diabetic patients, clinically diagnosed with DPN were analysed and using the Toronto Clinical Neuropathy Score (TCNS) System, the severity of neuropathy was determined. HbA1c level and other demographic data were collected. 50 healthy adults were taken as controls. The CSA of posterior tibial nerve was measured 3 cm proximal to the medial malleolus in both lower limbs using HRU. RESULTS The mean CSA of posterior tibial nerve in healthy subjects was 6.0 + / - 0.142 mm2 , and in diabetic patients with peripheral neuropathy was 11.77 + / - 0.291 mm2 . Upon comparing the mean CSA of posterior tibial nerve of diabetic subjects with peripheral neuropathy and control subjects were statistically significant (P < 0.001) in unpaired ‘t’ test. In our study, CSA of the posterior tibial nerve correlated significantly with TCNS and HbA1c levels, at P < 0.001. CONCLUSIONS This study showed that there is a significant difference between the cross sectional areas of posterior tibial nerve in diabetic subjects with peripheral neuropathy and healthy adult subjects. HRU can detect cross sectional area changes in the posterior tibial nerve early. Thus, ultrasonography can be used as a good screening tool in these patients. KEYWORDS Diabetic Peripheral Neuropathy, Posterior Tibial Nerve, High Resolution Ultrasonography

The Sungai Buloh experience: A retrospective study in olfactory and gustatory disturbance in COVID-19

Introduction: Olfactory and gustatory disturbance has been recognized as one of the COVID-19 symptoms. The prevalence of the symptoms may vary between region globally and multiple factors may have contributed to the development of the symptoms. Objective: To identify the prevalence of olfactory and gustatory disturbance in patients with COVID-19 in Sungai Buloh centres. Methods: This retrospective study, conducted for a month – April/May 2020, recruited 201 COVID-19 patients from Hospital Sungai Buloh (HSB), National Leprosy Control Centre (NLCC), and Institut Latihan Kejururawatan Kebangsaan Malaysia (ILKKM) who met the inclusion criteria. Socio-clinical data were collected from ‘ehis’ electronic system database and anosmia clerking sheet, designed for the study. Statistical analyses were performed using IBM-SPSS statistical software version 26. Results: This study reported 14.9% of patients diagnosed with COVID-19 experienced olfactory and/or gustatory disturbances, where the mean age is 33 years, and patients predominantly male (70%) and asymptomatic of COVID-19 symptoms (70%). Some patients (4.5%) had olfactory and/or gustatory disturbance in the absence of other symptoms, and 10.4% reported olfactory and/or gustatory disturbances with other COVID-19 symptoms. Logistic regression showed an association between developments of olfactory and/or gustatory disturbances with symptomatic of COVID-19 symptoms, smoking status, and nationality. Conclusion: New onset of olfactory and/or gustatory disturbances during the COVID-19 pandemic is a good screening tool for early detection of COVID-19 in the absence of other symptoms. Patients who are symptomatic of COVID-19 symptoms, smoker and Malaysian may have a higher risk of developing olfactory and/or gustatory disturbances in COVID-19.

Can a Questionnaire Be Useful for Assessing Reading Skills in Adults? Experiences with the Adult Reading Questionnaire among Incarcerated and Young Adults in Norway

Background: Good screening tools can be of immense value in educational counselling for adults. We report two studies where we explored the factor structure and discriminative power of the Adult Reading Questionnaire (ARQ) in different samples of young adults at risk for reading impairments. Method: The ARQ was designed to screen for literacy skills with low resource requirement. The instrument includes 11 questions regarding reading and writing skills and 6 questions regarding attention deficits and hyperactivity. The first study included of 246 undergraduate students. One-third of the sample were under assessment of specific learning impairments/dyslexia. The second study included 1475 incarcerated adults, where 1 in 4 reported specific reading impairments. Results: Principal Component Analyses (PCA) with varimax rotation returned four components for the participants in Study 1: Reading skills, Reading habits, Attention, and Hyperactivity. For the incarcerated sample in Study 2, the analysis returned three components, as the Attention and Hyperactivity items were combined. Conclusion: The ARQ is useful for identifying individuals at risk for dyslexia with acceptable measures of sensitivity and specificity, as well as for identifying those who report difficulties with reading and writing but have not been assessed for their difficulties earlier. The increased prevalence of attention-deficit/hyperactivity disorder (ADHD) seen among incarcerated adults must be considered when screening for reading problems as it may confound the scores on reading questionnaires.

Exploratory study on classification of diabetes mellitus through a combined Random Forest Classifier

BackgroundDiabetes Mellitus (DM) has become the third chronic non-communicable disease that hits patients after tumors, cardiovascular and cerebrovascular diseases, and has become one of the major public health problems in the world. Therefore, it is of great importance to identify individuals at high risk for DM in order to establish prevention strategies for DM.MethodsAiming at the problem of high-dimensional feature space and high feature redundancy of medical data, as well as the problem of data imbalance often faced. This study explored different supervised classifiers, combined with SVM-SMOTE and two feature dimensionality reduction methods (Logistic stepwise regression and LAASO) to classify the diabetes survey sample data with unbalanced categories and complex related factors. Analysis and discussion of the classification results of 4 supervised classifiers based on 4 data processing methods. Five indicators including Accuracy, Precision, Recall, F1-Score and AUC are selected as the key indicators to evaluate the performance of the classification model.ResultsAccording to the result, Random Forest Classifier combining SVM-SMOTE resampling technology and LASSO feature screening method (Accuracy = 0.890, Precision = 0.869, Recall = 0.919, F1-Score = 0.893, AUC = 0.948) proved the best way to tell those at high risk of DM. Besides, the combined algorithm helps enhance the classification performance for prediction of high-risk people of DM. Also, age, region, heart rate, hypertension, hyperlipidemia and BMI are the top six most critical characteristic variables affecting diabetes.ConclusionsThe Random Forest Classifier combining with SVM-SMOTE and LASSO feature reduction method perform best in identifying high-risk people of DM from individuals. And the combined method proposed in the study would be a good tool for early screening of DM.

Accuracy and Incremental Yield of the Chest X-Ray in Screening for Tuberculosis in Uganda: A Cross-Sectional Study.

The WHO END TB strategy requires ≥90% case detection to combat tuberculosis (TB). Increased TB case detection requires a more sensitive and specific screening tool. Currently, the symptoms recommended for screening TB have been found to be suboptimal since up to 44% of individuals with TB are asymptomatic. The chest X-ray (CXR) as a screening tool for pulmonary TB was evaluated in this study, as well as its incremental yield in TB diagnosis using a cross-sectional study involving secondary analysis of data of 4512 consented/assented participants ≥15 years who participated in the Uganda National TB prevalence survey between 2014 and 2015. Participants with a cough ≥2 weeks, fever, weight loss, and night sweats screened positive for TB using the symptoms screening method, while participants with a TB defining abnormality on CXR screened positive for TB by the CXR screening method. The Löwenstein-Jensen (LJ) culture was used as a gold standard for TB diagnosis. The CXR had 93% sensitivity and 65% specificity compared to LJ culture results, while symptoms had 76% sensitivity and 31% specificity. The screening algorithm involving the CXR in addition to symptoms led to a 38% increment in the yield of diagnosed tuberculosis. The number needed to screen using the CXR and symptoms screening algorithm was 32 compared to 45 when the symptoms are used alone. Therefore, the CXR in combination with symptoms is a good TB screening tool and increases the yield of diagnosed TB.

Comparing the diagnostic value of Echocardiography In Stroke (CEIS) \u2013 results of a prospective observatory cohort study

BackgroundEchocardiography is one of the main diagnostic tools for the diagnostic workup of stroke and is already well integrated into the clinical workup. However, the value of transthoracic vs. transesophageal echocardiography (TTE/TEE) in stroke patients is still a matter of debate. Aim of this study was to characterize relevant findings of TTE and TEE in the management of stroke patients and to correlate them with subsequent clinical decisions and therapies.MethodsWe evaluated n = 107 patients admitted with an ischemic stroke or transient ischemic attack to our stroke unit of our university medical center. They underwent TTE and TEE examination by different blinded investigators.ResultsMajor cardiac risk factors were found in 8 of 98 (8.2%) patients and minor cardiac risk factors for stroke were found in 108 cases. We found a change in therapeutic regime after TTE or TEE in 22 (22.5%) cases, in 5 (5%) cases TEE leads to the change of therapeutic regime, in 4 (4%) TTE and in 13 cases (13.3%) TTE and TEE lead to the same change in therapeutic regime. The major therapy change was the indication to close a patent foramen ovale (PFO) in 9 (9.2%) patients with TTE and in 10 (10.2%) patients with TEE (p = 1.000).ConclusionMajor finding with clinical impact on therapy change is the detection of PFO. But for the detection of PFO, TTE is non inferior to TEE, implicating that TTE serves as a good screening tool for detection of PFO, especially in young age patients.Trial registrationThe trial was registered and approved prior to inclusion by our local ethics committee (1/3/17).

Ability of SARC-F to Find Probable Sarcopenia Cases in Older Adults.

In 2018 EWGSOP2 has suggested low muscle strength as the primary parameter of sarcopenia. The consensus has recommended SARC-F questionnaire as a screening test to find cases with low muscle strength which has been designated as probable sarcopenia. We aimed to study the ability of SARC-F to find probable sarcopenia cases in older patients. Retrospective, cross-sectional. Istanbul University Istanbul Faculty of Medicine. A total of 456 older adults (71.1% female, mean age: 74.6±6.6 years). We diagnosed probable sarcopenia by EWGSOP 2 criteria, i.e., presence of low handgrip strength (HGS). SARC-F questionnaire was performed by all participants. We used a receiver operating characteristics curve to obtain SARC-F cut-off values to detect probable sarcopenia and calculated the area under the curve and 95% confidence interval (CI). We included 456 participants (71.1% female; mean age: 74.6 ± 6.6 years). Probable sarcopenia was present in 58 (12.7%). SARC-F cut-off ≥ 2 presented the best balance between sensitivity and specificity (sensitivity: 64.9% vs specificity: 67.9%) to detect probable sarcopenia [the area under the receiver operating characteristics curve (AUC) = 0.710; 95% Cl: 0.660-0.752, p< 0.001]. SARC-F with a cut-off point ≥ 1 had sensitivity 84.2% and specificity 40.5% and SARC-F ≥ 4 had high specificity 88.2% with 40.3% sensitivity. SARC-F is a good screening tool for sarcopenia in practice. Our findings suggest SARC-F ≥ 1 cut-off point to be used as the probable sarcopenia screening tool regarding its high sensitivity. Consequently, SARC-F ≥ 4 cut-off is better to be used if one prefers to exclude probable sarcopenia.

Brief international cognitive assessment for multiple sclerosis (BICAMS) cut-off scores for detecting cognitive impairment in multiple sclerosis

Background: Cognitive impairment (CI) affects 35–65% of multiple sclerosis (MS) patients. The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) has been proposed as a highly feasible and cost-effective tool for cognitive impairment (CI) screening in MS. The tool yields scores that should, ideally, readily convey patients’ cognitive status to the clinicians. Methods: To this aim, this study sought for cut-off scores of the three BICAMS test in a sample of 960 MS patients. We used three definitions for CI: 1.5, 1,65 and 2 standard deviations below the mean. Receiver operating characteristic (ROC) statistics helped us determine the capacity of BICAMS to diagnose CI. Optimal cut-offs were determined by the delta distance. Positive and negative predictive values, along with overall accuracy were also calculated. Results: Symbol Digit Modalities Test (SDMT) and California Verbal Learning Test-II (CVLT-II) showed a diagnostic accuracy ranging from 74.6 to 77.4%, across the three CI definitions. The accuracy of Brief Visuospatial Memory Test-Revised (BVMT-R) was over 88%. SDMT had a balanced sensitivity, while CVLT-II and BVMT-R had higher specificities than sensitivities at detecting CI. More specifically, BVMT-R showed 100% specificity for all CI definitions. Raw cut-off scores for BICAMS tests are also provided within the manuscript, along with the diagnostic calculations. Conclusions: In this study, we confirmed that BICAMS is a good screening tool for CI and that simple cut-offs can be used in the everyday neurological practice.

Clinical use of STOP-BANG and ESS questionnaires in the evaluation of obstructive sleep apnoea-related risk factors for motor vehicle accidents among public transport drivers in Delhi, India.

To assess the clinical use of Epworth Sleepiness Score (ESS) and STOP-BANG questionnaires in the evaluation of sleep apnoea-related risk factors for motor vehicle accident (MVA) among public transport drivers in Delhi, India. The present cross-sectional study is based on data collected between April 2018 and March 2019 from public transport drivers in Delhi. All drivers coming for gas filling to 43 compressed natural gas (CNG) stations in Delhi were included in the study. The evaluation of sleep apnoea-related risk factors for motor vehicle accident was done using ESS and STOP-BANG Score. A total of 4094 drivers participated in this study, and 299 drivers (7%) gave ahistory of motor vehicle accidents during the preceding 3 years. Drivers with STOP-BANG score ≥ 3 had a higher risk for MVA (OR 1.59; 95% CI 1.26-2.02; p value < 0.0001). Score of ESS ≥ 10 carried a very high risk for MVA (OR 26.95; 95% CI 16.18-44.87; p value < 0.0001). The other risk factor of significance was alcoholism (OR 1.37; 95% CI 1.04-1.80; p value < 0.0248). Among public transport drivers in Delhi, daytime sleepiness is the major contributing factor to motor vehicle accidents. ESS and STOP-BANG questionnaires may be good screening tools for the clinical evaluation of OSA. Community-based screening of OSA is required for identification of public transport drivers at high risk of MVA.

OBESITY AND SEVERE STEATOSIS: THE IMPORTANCE OF BIOCHEMICAL EXAMS AND SCORES.

ABSTRACT - INTRODUCTION:Nonalcoholic fatty liver disease (NAFLD) is considered a public health problem, mainly in severely obese patients.OBJECTIVE: The aim of the present study was to investigate different biochemical-based scores available and determine which one could best serve as an NAFLD predicting tool in a severely obese population.METHODS: This was a cross-sectional study involving severely obese patients. All patients were evaluated with serum laboratory parameters for 1 week before biopsy, and all patients were treated with intraoperative liver biopsy, during bariatric surgery.RESULTS: A total of 143 severely obese patients were included. The median body mass index (BMI) was 48 kg/m2 (35-65). Diabetes mellitus was present in 36%, and steatosis was present in 93% (severe steatosis in 20%). Only aspartate transaminase (AST) to platelet ratio index (APRI=0.65 (95% CI: 0.55-0.8) and homeostatic model assessment for insulin resistance (HOMA-IR=0.7 (95% CI: 0.58-0.82) showed significant capacity for the prediction of severe steatosis. Hepatic steatosis index (HSI), NAFLD fibrosis score (NAFLDS), alanine aminotransferase (ALT)/AST, and fibrosis-4 (FIB-4) were not able to correctly predict severe steatosis on liver biopsy. APRI showed high specificity of 82% and low sensitivity of 54%. In contrast, HOMA-IR showed high sensitivity of 84% and low specificity of 48%.CONCLUSIONS: NAFLDS, FIB-4, AST/ALT, and HSI have no utility for the evaluation of severe steatosis in severely obese patients. Diabetes and insulin-resistance-related biochemical assessments, such as HOMA-IR, can be used as good screening tools for severe steatosis in these patients. APRI score is the most specific biochemical diagnostic tool for steatosis in severely obese patients and can help clinicians to decide the need for bariatric or metabolic surgery.

The role of fluoroscopically detected coronary calcium in predicting the presence of significant coronary lesions

Context: Coronary artery disease (CAD) accounts for over 16' of deaths worldwide.[1] As part of its diagnosis and stratification of severity in a patient, a noninvasive modality would certainly be useful to triage CAD. Aims: To assess the diagnostic accuracy of fluoroscopically detected coronary artery calcification (CAC) as a tool to grade coronary stenosis. Settings and Design: Comparing severity of fluoroscopic CAC with a severity of CAD by coronary angiograms (CAGs) in a high-volume center. Subjects and Methods: Fluoroscopic presence of CAC was graded using the Yamanaka method and correlated with CAGs in 200 patients. Statistical Analysis Used: Sensitivity, specificity, predictive values, accuracy, Chi-squared tests for significance. Results: The overall prevalence of CAC was 43' varying with age, sex, and CAD severity. The most common location of CAC was the left anterior descending artery followed by right coronary artery. Fluoroscopic CAC had 94' specificity and 96.5' positive predictive value for significant stenosis, albeit lower sensitivity of 55.3'. While 63' of those patients with single-vessel CAC had multivessel CAD, 91' of those with multivessel CAC had multivessel CAD. CAC was detected as follows: 6' in minor CAD, 40' in single-vessel disease (VD), 64' in two- or three-VD, and 100' in those with four-VD (P = 0.001). CAC was seen in 69.6' of patients having chronic total occlusions (CTOs) while in only 32.6' without CTOs (P = 0.001). Conclusions: A strong relation is present between CAC and severity of CAD. CAC is not a good screening tool for CAD due to low sensitivity. Notably, multivessel CAC strongly predicts multivessel CAD.

End‐tidal CO2 and transcutaneous CO2: Are we ready to replace arterial CO2 in awake children?

AbstractIntroductionArterial blood gas analysis (ABG) is the gold standard test for carbon dioxide measurement. End‐tidal PCO2 (PetCO2) and transcutaneous PCO2 (PtcCO2) are noninvasive alternative methods.ObjectiveTo examine the use of PetCO2 and PtcCO2 as PaCO2 surrogates in awake children.MethodsA prospective observational study. Consecutive awake children in a stable condition referred to the Sleep Unit of Hospital de Pediatría Dr. J. P. Garrahan with suspected or confirmed sleep‐related respiratory disorders requiring ABG were included. PetCO2 and PtcCO2 were recorded simultaneously during arterial puncture. PetCO2 and PtCO2 values were compared with PaCO2. Correlation coefficient and Bland–Altman analysis were applied. The sample size was calculated considering a mean difference ≤3 mmHg as clinically acceptable.ResultsSixty‐eight sample sets were obtained from 67 patients. The median age was 9.11 years (0.23–18.76). During 94.1% of the procedures patients breathed spontaneously, 30% needed multiple punctures and 92% resulted in pain. Median (IQR) PaCO2 (mmHg) was 36.3 (31.45; 40.90), PetCO2 33.0 (29; 39) and PtcCO2 38.8 (32.95; 43.32). Correlation and agreement for PaCO2/PetCO2 and PaCO2/PtcCO2 was r = .6 and .9, and media of bias = 2.83 (−9.97; 15.64) and −1.88 (−9.01; 5.24), respectively. Hypercapnia (PaCO2 &gt; 45.0 mmHg) was present in 8/68 (11.8%) samples. Sensitivity, specificity, positive predictive value and negative predictive value to detect hypercapnia with PetCO2 was 38%, 98%, 75%, and 92%, respectively, and with PtcCO2, 100%, 90%, 57%, and 100%, respectively.ConclusionPtcCO2 showed better agreement with PaCO2 than PetCO2 but because of the wide dispersion of values, neither method can replace the gold standard. Transcutaneous CO2 might be a good screening tool to detect hypercapnia in awake children.

Role of uterine artery Doppler in early prediction of pre-eclampsia and intrauterine growth restriction at 16-24 weeks of gestation

Introduction: Pre-eclampsia and intrauterine growth restriction are important causes of maternal and perinatal morbidity and mortality. Gestational age at the onset of pre-eclampsia will determine the degree of fetal compromise. Hence, early detection of preeclampsia is important to improve maternal and perinatal outcome. Utero placental circulation can be non-invasively assessed by Doppler analysis of uterine arteries. Aims and Objectives: The aim of our study is early prediction of pre-eclampsia and Intra uterine growth restriction by Doppler assessment of uterine artery. Materials and Methods: 100 antenatal women of singleton pregnancy at 16-24 weeks of gestation were selected for study in the department of Obstetrics and Gynecology at MNR Medical College, Sangareddy from May 2015 to April 2016. Doppler evaluation of uterine artery along with routine biometry was done. Results: Out of 100 cases studied, 19 patients showed abnormal uterine artery Doppler results and among these 16(84.2%) developed preeclampsia, 8(42%) had intrauterine growth restriction, 6(31.5%) babies required NICU admission and 2(10.5%) intrauterine fetal deaths were noted. Sensitivity and specificity to detect pre-eclampsia was 84.2% and 83% respectively and that of intrauterine growth restriction was 42% and 96% respectively. Conclusion: Uterine artery notching, high PI, RI in uterine artery Doppler analysis can be a good screening tool for early prediction of pre-eclampsia and intrauterine growth restriction. Keywords: Pre-eclampsia, Intrauterine growth restriction, Uterine artery Doppler.

Breast tumor parameter estimation and interactive 3D thermal tomography using discrete thermal sensor data

This work uses a simple low-cost wearable device embedded with discrete thermal sensors to map the breast skin surface temperature. A methodology has been developed to estimate diameter, blood perfusion, metabolic heat generation and location in X, Y, Z coordinate of tumor from this discrete set of data. An interactive 3D thermal tomography was developed which provides a detailed 3D thermal view of the breast anatomy. Using this system, the user can interactively rotate and slice the 3D thermal image of the breast for a detailed study of the tumor. Finite element method (FEM) and an evolution-based inverse method were used for the parameter estimation. The method was first validated using phantom experiments and the results obtained were within an error of 10% (0.005 W cm−3) for heat generation and 15% (0.3 cm) for heater location. Further validation was carried out through clinical trials on 60 human subjects. Estimated blood perfusion rate and metabolic heat generation rate exhibit distinguishable difference between cancerous and non-cancerous breast. Estimated diameter and location of tumor in cancerous breast shows good agreement with the actual clinical reports. We have obtained a sensitivity of 82.78% and specificity of 87.09%. Proposed breast tumor parameter estimation methodology with interactive 3D thermal tomography is a good screening tool for breast cancer detection and also useful for clinicians to find out location including depth.

A-qCPR risk score screening model for predicting 1-year mortality associated with hospice and palliative care in the emergency department

Background: Evaluating the need for palliative care and predicting its mortality play important roles in the emergency department. Aim: We developed a screening model for predicting 1-year mortality. Design: A retrospective cohort study was conducted to identify risk factors associated with 1-year mortality. Our risk scores based on these significant risk factors were then developed. Its predictive validity performance was evaluated using area under receiving operating characteristic analysis and leave-one-out cross-validation. Setting and participants: Patients aged 15 years or older were enrolled from June 2015 to May 2016 in the emergency department. Results: We identified five independent risk factors, each of which was assigned a number of points proportional to its estimated regression coefficient: age (0.05 points per year), qSOFA ⩾ 2 (1), Cancer (4), Eastern Cooperative Oncology Group Performance Status score ⩾ 2 (2), and Do-Not-Resuscitate status (3). The sensitivity, specificity, positive predictive value, and negative predictive value of our screening tool given the cutoff larger than 3 points were 0.99 (0.98–0.99), 0.31 (0.29–0.32), 0.26 (0.24–0.27), and 0.99 (0.98–1.00), respectively. Those with screening scores larger than 9 points corresponding to 64.0% (60.0–67.9%) of 1-year mortality were prioritized for consultation and communication. The area under the receiving operating characteristic curves for the point system was 0.84 (0.83–0.85) for the cross-validation model. Conclusions: A-qCPR risk scores provide a good screening tool for assessing patient prognosis. Routine screening for end-of-life using this tool plays an important role in early and efficient physician-patient communications regarding hospice and palliative needs in the emergency department.

Application of tele-podiatry in diabetic foot management: A series of illustrative cases

Background and aimsTelemedicine had been proposed as a tool to manage diabetes, but its role in management of diabetic foot ulcer is still evolving. The COVID-19 pandemic and related social restrictions have necessitated the use of telemedicine in the management of diabetic foot disease (tele-podiatry), particularly of patients classified as low-risk. Materials and methodsWe present a report of three cases of varied diabetic foot problems assessed during the present pandemic using different forms of telemedicine for triaging, management of low-risk cases and for follow-up. ResultsTele-podiatry was effective in the management of low-risk subjects with diabetic foot ulcer, and also useful in referral of high-risk subjects for hospital/clinic visit, facilitating proper management. It also helped in the follow-up of the cases. ConclusionTelemedicine is a good screening tool for diagnosing and managing low-risk subjects with diabetic foot problems, and also enables a triaging system for deciding on hospital visits and hospitalization. Telemedicine offers several benefits in the management of diabetic foot disease, although it also has some limitations. Based on our experience during the pandemic, we recommend its judicious use in the triaging of patients of diabetic foot disease and management of low-risk cases. Future innovation in technology and artificial intelligence may help in better tele-podiatry care in the time to come.

S1641 Utility of Colon Capsule Endoscopy in Diagnosis of Colorectal Cancer

INTRODUCTION: Colonoscopy is the gold standard for diagnosis of colorectal cancers. Recent advances in endoscopic technologies has introduced Video capsule endoscopy, which has become widely used to evaluate small bowel and large mucosa for obscure bleeding and even mass lesions. This has led to colon capsule endoscopy (CCE). CCE was introduced in late 2000s and has gained popularity due to non-invasive, and efficacious method in diagnosis of colon lesions. CASE DESCRIPTION/METHODS: We present a case of a 68 yo man with hematochezia for three months. His PMHx includes A fib (takes coumadin). He had intermittent bleeding with bowel moments where he noticed fresh bleed in toilet bowel. He denied any abdominal pain, constipation, diarrhea, or weight loss. His physical exam was benign. His hemoglobin was 14.5 g/dl. No prior endoscopic procedures. He was offered colonoscopy however patient was not amenable to the procedure. Therefore, we offered colon capsule endoscopy (CCE). The CCE was of good quality. Colon was well visualized and showed an ulcerated lesion in the distal rectosigmoid area, occupying more than 70% of the lumen, measuring at least 5 cm in diameter that was concerning for cancer. With this finding, patient was agreeable to proceeded with colonoscopy. Colonoscopy to the ileum (BBPS 3,3,3) showed a rectosigmoid mass seen on capsule colonoscopy at 16 cm from the anal verge. Lesion was non obstructing and occupied 70% of the luminal circumference. Multiple biopsies were taken. Biopsies were consistent with moderately differentiated adenocarcinoma. He was referred to general surgery and oncology. He underwent Lower Anterior Resection. Path showed locally advanced rectal cancer. DISCUSSION: With this case, we intent to highlight the utility of CCE as a screening and diagnostic tool for Colorectal cancer. CCE has emerged as a promising new modality for colonic evaluation. As this procedure is non-invasive, and painless, there is no need for sedation. The patient’s do not need to be off of anticoagulation and take significant time of for colonoscopy that usually requires one to two days of leave. Hence, it a good diagnostic and screening tool for appropriate candidates who do not wish to undergo routine colonoscopy. The limitations include unable to do biopsies, polypectomies and provide therapeutic options for patients with mass lesions, polyps or bleeding. Therefore, CCE can be utilized to decide if colonoscopy is warranted in individuals based on CCE findings.Figure 1.: Colon Capsule Endoscopy imaging of rectosigmoid tumor.Figure 2.: Colon Capsule Endoscopy imaging of rectosigmoid tumor.Figure 3.: Colonoscopy image of circumferential mass lesion in rectosigmoid identified on colon capsule endoscopy.

Transcranial Doppler as a Screening Tool for High-Risk Patent Foramen Ovale in Cryptogenic Stroke.

The identification of high-risk patent foramen ovale (PFO) is important for selecting suitable patients for PFO closure to prevent recurrent stroke in those with cryptogenic stroke. We aimed to evaluate the predictability of transcranial Doppler (TCD) in diagnosing high-risk PFO compared with that of transesophageal echocardiography (TEE), which is not feasible for some stroke patients. We retrospectively reviewed the data of 461 cryptogenic stroke patients who underwent TEE and TCD for PFO evaluation. High-risk PFO on TEE was defined as PFO with atrial septal aneurysm (phasic septal excursion ≥10 mm) or large PFO (≥2 mm). Spencer grading of right-to-left shunt was used to classify the amount of shunt on TCD. PFO on TEE was observed for 242 (52.5%) patients, and high-risk PFO was detected for 123 (26.7%) patients. However, PFO on TCD was observed for 336 (72.9%) patients. Among patients with significant shunt (Spencer grade III or higher) who underwent TCD after Valsalva maneuver (VM), 60.0% of patients had high-risk PFO. However, only 5.3% of patients had high-risk PFO among those without significant shunt. Receiver operating characteristic curves showed that significant shunt after VM had higher predictability (AUC = .876, 95% CI: .843-.905) for detecting the high-risk PFO compared with the predictability based on significant shunt at rest (AUC = .718, 95% CI: .674-.759). (P<.0001 for the differences between two AUCs). TCD is a good screening tool for evaluating high-risk PFO. VM is important for the evaluation of PFO. Patients with minimal or no shunt on TCD after VM are unlikely to have high-risk PFO.