Higher Rate Of Positive Results Research Articles

Comparing planned versus ad hoc coronary microvascular assessment: Early findings from the Coronary Microvascular Disease Registry

BackgroundCoronary microvascular dysfunction (CMD) is an etiology for angina with non-obstructive coronary disease. However, the initial adoption of CMD assessment, whether planned or conducted ad hoc, is limited. We characterize planned and ad hoc CMD assessments and highlight evolving trends of a CMD referral center. MethodsWe analyzed outpatient data from the Coronary Microvascular Disease Registry from 2021 to 2023. Patients were categorized into planned or ad hoc CMD assessment groups, and baseline characteristics, hospital stay, medications, and physiological measurements were compared. Secondary analysis evaluated a CMD referral center's evolution. ResultsOf 101 included outpatients, 67.3 % underwent ad hoc procedures and 32.7 % planned procedures. Average age was 63.1 ± 10.1 years. The planned procedure group was 87.9 % female, and the ad hoc procedure group was 51.5 % female. There were no significant differences in index of microvascular resistance or coronary flow reserve between groups. Hospital stay duration was <1 day for both groups, and neither reported complications. Ad hoc patients were more frequently prescribed aspirin before (64.7 % vs. 36.4 %, p = 0.007) and after the procedure (66.2 % vs. 39.4 %, p = 0.01). CMD rates were higher for planned procedures (30.3 % vs. 10.3 %, p = 0.01). We observed that CMD referral centers have more planned procedures and a higher rate of positive results over time. ConclusionCMD referral centers' planned procedures, and subsequent positive cases, increased over time. This emphasizes the importance of planned procedures, appropriate patient selection, and increased awareness of CMD among healthcare providers. Clinical trial registrationCoronary Microvascular Disease (CMD) Registry, NCT05960474, https://clinicaltrials.gov/study/NCT05960474

Устранение краевого заворота век методом поперечной тарзотомии с ротацией хряща

Aim. Estimation of clinic and results of surgical treatment of patients with marginal eyelids inversion. Methods. The study included 9 patients (10 eyes) with marginal inversion of the lower eyelid. Mean age of the patients was 64 years; there were 3 males and 6 females. All the patients had disturbance of normal square shape of eyelid margin and a slight inversion of the lower eyelid towards the ocular surface. To correct the eyelid malposition in all the patients transversal tarsotomy with marginal tarsus rotation was performed. Results. Complete correction of the marginal inversion was achieved in 9 of 10 cases (90 %). One patient had a slight overcorrection and local deformation of eyelid margin. Wedge resection allowed to eliminate the defect. Within a follow-up with mean terms of 6.2 months no recurrencies were observed. Conclusion. The suggested method of marginal eyelid inversion surgery provides a high rate of positive results, allows to avoid unforeseen complications and to achieve quick cosmetic rehabilitation. Key words: entropion; trichiasis; eyelids surgery.

Reliability of the galactomannan enzyme-linked immunoassay in healthy preterm infants: A prospective cohort study.

In healthy preterm infants, the galactomannan enzyme-linked immunoassay shows a high rate of positive results and should not be used for the early diagnosis of invasive aspergillosis, particularly in the very preterm age group.

Principles and techniques of migraine surgery.

The idea to treat migraine patients with a surgical procedure is relatively recent. The aim of this paper was to describe the surgical techniques and our 11-year experience in migraine surgery. From June 2011 till December 2021, we have performed MH decompression surgery over 527 patients with either frontal (90 pts), occipital (232 pts) or temporal (205 pts) migraine trigger sites. The surgical procedure elicited a positive response in: (a) occipital trigger site, 95% of patients (86% complete recovery); (b) frontal trigger site, 87% of patients (32% complete recovery); (c) temporal trigger site, 88% of patients (50% complete recovery). The described techniques allowed us to obtain a high rate of positive results with a low percentage of minor complications.

Surgical therapy of occipital (Arnold) neuralgia: A case series

ObjectiveThe idea to treat occipital neuralgia patients with a surgical procedure is relatively recent. The aim of this paper was to describe the surgical techniques and our 12-year experience in this field. Materials and methodsFrom June 2011 till February 2022 we have performed surgery over 232 patients with occipital neuralgia. ResultsThe surgical procedure elicited a positive response in 86% of the patients. ConclusionsThe described techniques allowed to obtain an high rate of positive results with a minimum percentage of complications.

First Molecular Confirmation of Treponema spp. in Lesions Consistent with Digital Dermatitis in Chilean Dairy Cattle.

Digital dermatitis (DD) is a highly contagious and infectious disease in cattle which has a considerable negative economic impact worldwide, and adversely affects animal welfare. Members of the genus Treponema are the only bacterial agents for which there is consistent evidence of participation in DD lesions. In Chile, DD has been described since the 1990s, but only under a clinical approach. To date, the presence of the pathogenic agent has not been confirmed in Chile by any type of confirmatory microbiological diagnosis. The aim of the present study was to detect the presence of Treponema spp. DNA in lesions consistent with DD, in Chilean dairy cattle for the first time. We provide PCR confirmation of Treponema spp. in Chilean dairy cattle affected by DD. The high rate of positive results, as well as the proportion of the main Treponema species involved, is in line with what have been described in published studies elsewhere. Future herd control plans should benefit from the molecular detection of these pathogenic bacteria associated with DD.

Early detection and persistent positivity of anti-Leishmania antibodies using a recombinant protein-based ELISA in naturally infected dogs in Brazil

BackgroundVisceral leishmaniasis (VL) is a zoonotic disease caused by Leishmania infantum, for which dogs constitute the main urban parasite reservoir. Control measures and the treatment of canine visceral leishmaniasis (CVL) are essential to reduce VL cases. Early and accurate detection of L. infantum-infected dogs is crucial to the success of VL control. To improve the serological detection of L. infantum-exposed dogs, we evaluated the early diagnosis capacity of a recombinant protein (rLci5) in an immunosorbent assay (ELISA) to detect naturally infected dogs. Additionally, we evaluated the persistence of the positive results obtained by rLci5 ELISA in comparison to other conventional diagnostic test methods.MethodsSerum samples obtained from 48 L. infantum-infected dogs involved in a cohort study were evaluated using different diagnostic methods (qPCR, EIE-LVC, DPP-LVC and splenic culture). The results were compared to rLci5 ELISA to determine its capacity to diagnose L. infantum infection at earlier infection time points. The persistence of positive diagnostic test results was also compared for each dog evaluated.ResultsrLci5 ELISA presented higher rates of positive results at early time points compared to the other diagnostic tests employed in the cohort study, as early as 24 months prior to detection by other tests. rLci5 ELISA positivity was 52.1% (25/48) at baseline, while qPCR was 35.4% (17/48), DPP-LVC 27.1% (13/48), EIE-LVC 22.9% (11/48) and culture only 4.2% (2/48). In at least one of the time points of the 24-month cohort study, rLci5 ELISA was positive in 100% (48/48) of the dogs, versus 83% (40/48) for qPCR, 75% (36/48) for DPP-LVC, 65% (31/48) for EIE-LVC and 31% (15/48) for culture. Investigating clinical signs in association with diagnostic test positivity, rLci5 ELISA successfully detected CVL in 62.9% (95/151) of the clinical evaluations with a score of 0–3, 64.3% (45/70) with scores between 4 and 7, and 73.7% (14/19) with scores > 7, providing higher rates of positivity than all other methods evaluated. Moreover, rLci5 ELISA presented the greatest persistence with respect to test positivity: 45.8% of the dogs evaluated.ConclusionFour diagnostic tests were compared to rLci5 ELISA, which presented earlier infection diagnosis and a greater persistence of positive test results. Accordingly, the use of the rLci5 ELISA can improve CVL diagnostic performance by detecting infected dogs sooner than other testing methods, with enhanced persistence of positive results over the course of the infection.Graphic abstract

Prevalence of positive toxicology analysis from the French national registry for sudden unexpected infant death (Tox-MIN)

Background Sudden unexpected infant death (SUID) remains the leading cause of postnatal mortality in many countries. French and international guidelines recommend a thorough examination with toxicology studies. Objectives The main objective was to determine the prevalence of toxic detection and positive analyses. The secondary objectives were to describe the different toxics and compare children with positive (Tox+) and negative results (Tox-) with other SUID risk factors. Design and methods We used the data registered from May 2015 to December 2018 by the French national SUID registry (OMIN). It collects data for all SUID cases admitted to any of the 35 participating French SUID referral centers. Results Of the 624 SUID cases registered in the OMIN, a post-mortem toxicological analysis was performed in 398 infants. Thirty-six patients (9%) were positives for expected (Etox+ (n = 19 [53%], e.g., resuscitation drugs, regular treatments) and unexpected (UTox+) (n = 17 [47%]) toxics. The unexpected toxics were opioids (n = 8), cannabis (n = 4), cocaine (n = 3), cotinine (n = 2), carbon monoxide (n = 2), caffeine (n = 2), alcohol (n = 1) and GHB (n = 1). UTox + infants had a different seasonal distribution (p = .03), a higher incidence of inappropriate sleeping position and bedding at the time of death (respectively OR 3.8, p = .037 – OR 5.4, p = .026); inadequate body hygiene (OR 10.6, p = .0005), a younger maternal age (p = .045) and a higher rate of maternal drug abuse (OR 21.9, p = .0008). Conclusion The high rate of positive results warrants routine toxicology testing. The imputability of identified molecules is complicated by the presence of other known risk factors for SUID.

Pelvic floor muscle dysfunctions in women with deep infiltrative endometriosis: An underestimated association.

Deep infiltrative endometriosis (DIE) may cause pelvic pain and thus negatively affect the function of different structures. We hypothesised that women with DIE may have dysfunctions of the pelvic floor muscles (PFMs) and lower limb muscles (LLMs). This cross-sectional study included 160 women (80 with DIE under hormonal treatment and 80 women without DIE), who were assessed to determine the presence of pelvic symptoms (dysmenorrhea, chronic pelvic pain [CPP], deep/penetration dyspareunia, dysuria, dyschezia and vulvodynia), PFM function (PERFECT scheme, presence of hypertonia and trigger points, and muscle contraction and relaxation), abdominal muscle pain (Carnett's test) and muscle shortening in LLM (Thomas, Pace and Ober tests). Women with DIE presented more CPP (30% vs 5%; P<.001), dysuria (12.5% vs 3.75%; P=.043) and dyschezia (47.5% vs 2.5%; P<.001) than the control group. Moreover, they had higher PFM hypertonia (28.75% vs 13.75%; P=.02), weaker PFM contraction (36.35% vs 2.5%; P<.001), and incomplete PFM relaxation (45% vs 13.75%; P<.001). Women with DIE had a higher rate of positive results in the Carnett's test (21.25% vs 2.5%; P<.001) than the control group. Moreover, they had a higher frequency of shortening of the anterior thigh (30% vs 10% in both LLM; P<.001), piriformis (16.25% vs 6.25%; P<.001) and iliotibial band muscles (bilateral; P<.001). Multivariate analysis revealed that the presence of pain increased the risk of PFM hypertonia (OR=3.73 [1.26-11.07]; P=.018) and caused difficulty in PFM relaxation (OR=2.98 [1.01-9.37]; P=.049). Women with DIE exhibited a greater number of pelvic symptoms and greater PFM/LLM dysfunction than those in the control group. Pain was associated with PFM hypertonia and difficulty in PFM relaxation.

Analysis of mutagenic components of oxidative hair dyes with the Ames test

Oxidative hair dyes consist of two components (I and II) that are mixed before use. Aromatic amines in component I and their reaction with hydrogen peroxide after mixing them with component II have been of primary concern. In addition, two in vitro genotoxicity assays are still required for the approval of the final products of oxidative hair dyes in China, and the substance in the oxidative hair dye that causes the high rate of positive results in genotoxicity tests, especially the Ames test, has not been fully elucidated. In this study, we analyzed the formulation of 55 different oxidative hair dyes from 7 color series and performed Ames tests in the strain TA98 with the S9 mix (oxidative hair dyes No. 1-30) and in strain TA97a without the S9 mix (oxidative hair dyes No. 31-55). We found that toluene-2,5-diamine sulfate (2,5-diaminotoluene sulfate, DATS) in component I may be the cause of mutagenicity in TA98, and hydrogen peroxide in component II may be the cause of mutagenicity in TA97a, and their positive concentrations were consistent with those that we calculated from Ames tests. The results suggest that the positive results for the oxidative hair dye in the Ames test were inevitable because of the existence of DATS in component I and of hydrogen peroxide in component II. Therefore, we should carry out safety assessments on each raw material and carry out risk assessments on the final products of oxidative hair dyes instead of genotoxicity tests in China.

Serological and Molecular Detection of Hepatitis B virus among patients referred to Kurdistan Center for Hepatology and Gastroenterology in Sulaimani City/Kurdistan Region of Iraq

Hepatitis B virus infection is caused by the hepatitis B virus, a major global health problem. This infection can lead to chronic conditions, followed by cirrhosis and hepatocellular carcinoma (HCC). The current study was aimed to detect HBV using serological and molecular techniques. During 2019, 300 blood samples were collected from Kurdistan Center for Hepatology and Gastroenterology in Sulaimani city. Enzyme-linked immunosorbent assay (ELISA) and real-time polymerase chain reaction (RT-PCR) techniques were used for the detection of HBsAg and HBV DNA, respectively. Obtained results were revealed that 92 out of 300 tested patients (30.66%) seropositive for HBsAg. Among 92 seropositive patients, 53 were shown positive results for HBV DNA by RT-PCR. Dental clinic visiting and dialysis were among the important risk factors for HBV transmission. The vast majority of positive results were among males. Smokers showed relatively high rates of positive results. One-third of the referred patients who had liver complaints were positive for HBsAg. More than half of the seropositive patients showed RT-PCR positive results. It was concluded that the molecular method (RT-PCR) is more sensitive and gives a more accurate result than serology (ELISA). Therefore, it can be used as a diagnostic tool for HBV detection.

Usability aspects of medication-related decision support systems in the outpatient setting: A systematic literature review

In this study, we evaluated the usability aspects of medication-related clinical decision support systems in the outpatient setting. Articles published between 2000 and 2016 in Scopus, PubMed and EMBASE were searched and classified into three usability aspects: Effectiveness, Efficiency and Satisfaction. Using Van Welie et al.'s usability model, we categorized usability aspects in terms of usage indicators and means. Out of the 1999 articles, 24 articles met the selection criteria of which the main focus was on reducing inappropriate medication, prescription rate and prescription errors. Evidence could mainly be found for Effectiveness and showed high rates of positive results in reducing medication errors. To date, the effects of Efficiency and Satisfaction of clinical decision support systems regarding medication prescription remain understudied. Usability aspects such as memorability, learnability, adaptability, shortcuts and consistency require more attention. Studies are needed for better insight into the user model and to design a knowledge/task model for clinical decision support systems regarding medication prescription.

Examining reproducibility in psychology: A hybrid method for combining a statistically significant original study and a replication

The unrealistically high rate of positive results within psychology has increased the attention to replication research. However, researchers who conduct a replication and want to statistically combine the results of their replication with a statistically significant original study encounter problems when using traditional meta-analysis techniques. The original study’s effect size is most probably overestimated because it is statistically significant, and this bias is not taken into consideration in traditional meta-analysis. We have developed a hybrid method that does take the statistical significance of an original study into account and enables (a) accurate effect size estimation, (b) estimation of a confidence interval, and (c) testing of the null hypothesis of no effect. We analytically approximate the performance of the hybrid method and describe its statistical properties. By applying the hybrid method to data from the Reproducibility Project: Psychology (Open Science Collaboration, 2015), we demonstrate that the conclusions based on the hybrid method are often in line with those of the replication, suggesting that many published psychological studies have smaller effect sizes than those reported in the original study, and that some effects may even be absent. We offer hands-on guidelines for how to statistically combine an original study and replication, and have developed a Web-based application (https://rvanaert.shinyapps.io/hybrid) for applying the hybrid method.

ИНФОРМАТИВНОСТЬ ПРОБЫ С ДИАСКИНТЕСТОМ В СКРИНИНГЕ МОЧЕПОЛОВОГО ТУБЕРКУЛЕЗА

Goal of the study : to define the informativeness of diaskintest as a screening method in urogenital tuberculosis patients. Materials and methods . A simple, open cohort study was conducted enrolling 130 patients: Group 1 included active cases of urogenital tuberculosis – 58 persons; Group 2 included those suffering from chronic urogenital disorders confirmed to have no urogenital tuberculosis – 72 persons. Results . 63.8% of patients from Group 1 had a positive result of diaskintest, as well as 62.5% of patients from Group 2. Sensitivity to diaskintest in adult cases of active urogenital tuberculosis made 63.8%. The high rate of positive results of diaskintest in those suffering from chronic urogenital disorders proved the low specificity of the test – 37.5%.

In situ repair of partial articular surface lesions of the supraspinatus tendon

ObjectiveTo demonstrate the in situ repair technique of high-degree partial-thickness articular surface lesions of the supraspinatus tendon (SS). The procedure consists of the arthroscopic surgical repair of these lesions, without the need to complete the lesion, as occurs in traditional classical technique. A small incision is made in the longitudinal direction of the intact bursal fibers and where bone fixation anchors are introduced, which makes the procedure easier. These anchors are transferred to the tendon and thus enable the repair of the lesion. Methods48 shoulders were operated in the period 2010–2015. The minimum follow-up was 12 months and maximum 60 months. Ages ranged from 38 years to 75 years (mean 54 years). They were indicated for the repair of high-degree symptomatic lesions and at least 30% intact superior bursal fibers of good quality. ResultsPatients were evaluated according to the UCLA criteria, the results were: 69% excellent, 17% good, 7% fair, and 7% poor. Fair results occurred in three patients with associated symptoms of polyarthralgia who remained with residual pain. Three patients developed postoperative joint stiffness (7%). ConclusionThe procedure under study is safe and easy to reproduce. It shows high rates of positive results (86%). The opening made in the bursal side of the SS tendon allowed the arthroscope to remain in the subacromial space, making it easier to perform surgery.

Técnica de reparo in situ das lesões parciais da superfície articular do tendão do supraespinal

ObjectiveTo demonstrate the in situ repair technique of high‐degree partial‐thickness articular surface lesions of the supraspinatus tendon (SS). The procedure consists of the arthroscopic surgical repair of these lesions, without the need to complete the lesion, as occurs in traditional classical technique. A small incision is made in the longitudinal direction of the intact bursal fibers and where bone fixation anchors are introduced, which makes the procedure easier. These anchors are transferred to the tendon and thus enable the repair of the lesion. Methods48 shoulders were operated in the period 2010 to 2015. The minimum follow‐up was 12 months and maximum 60 months. Ages ranged from 38 years to 75 years (mean 54 years). They were indicated for the repair of high‐degree symptomatic lesions and at least 30% intact superior bursal fibers of good quality. ResultsPatients were evaluated according to the UCLA criteria, the results were: 69% excellent, 17% good, 7% fair, and 7% poor. Fair results occurred in three patients with associated symptoms of polyarthralgia who remained with residual pain. Three patients developed postoperative joint stiffness (7%). ConclusionThe procedure under study is safe and easy to reproduce. It shows high rates of positive results (86%). The opening made in the bursal side of the SS tendon allowed the arthroscope to remain in the subacromial space, making it easier to perform surgery.

Abstract 12225: Effects of Obesity on Noninvasive Testing and Angiography Results in Patients With Suspected Cardiac Ischemia: Insights From the PROMISE Trial

Background: Evaluation of obese patients with suspected CAD is challenging because obesity is a CV risk factor, but adiposity itself may mimic symptoms of CAD and reduce the accuracy of diagnostic testing. Optimal testing strategies in obese patients are not known. Methods: Patients with stable symptoms suggestive of cardiac ischemia from the PROMISE trial (n=9230) were classified according to BMI. Providers specified a functional test modality prior to stratified randomization to functional (stress testing) or anatomical (CTA) testing. We assessed relationships between BMI, physician’s preference of functional test, test positivity and results of catheter angiography (cath) using logistic regression. Results: Providers were more likely to choose SPECT over other functional tests as BMI increased (OR 1.04 per unit increase in BMI above 27, p&lt;0.001). In patients with BMI ≥ 35 vs. &lt; 35, the rate of positivity with CTA was similar (10% vs. 12%; see Table). The same was true for stress echo and stress ECG (positivity 8-13%, p&gt;0.8 for both). In contrast, SPECT was significantly more likely to be positive in those with BMI ≥ 35 vs. &lt;35 (18% vs. 13%; p=0.001). The likelihood of finding obstructive CAD at cath did not differ with BMI ≥ 35 vs. &lt;35 in patients having CTA (59% vs. 52%, p=0.22), but among SPECT patients, positivity was only 29% with BMI ≥ 35 compared to 52% with BMI &lt; 35 (p=0.005; Table). Conclusions: Increasing levels of obesity were associated with stronger physician preference for SPECT over other noninvasive tests. In patients receiving SPECT, higher levels of obesity were associated with a higher rate of positive results, but a lower cath yield for obstructive CAD. In contrast, in patients receiving CTA, positivity rates and cath yield did not vary by BMI. Obesity appears to significantly influence provider decision-making with regard to noninvasive test choice, probability of abnormal test results and probability of finding obstructive disease at cath.

Simultaneous quantification of 17-hydroxyprogesterone, androstenedione, testosterone and cortisol in human serum by LC-MS/MS using TurboFlow online sample extraction

BackgroundThe simultaneous quantification of a steroid hormones panel provides more clinical information than a single steroid assay. Traditionally, steroids have been quantified with immunoassays which are characterized by high rate of positive results. Aim of this work, was to develop a TurboFlow-LC-MS/MS method for the simultaneous quantification of 17-hydroxyprogesterone, androstenedione, cortisol and testosterone in serum. MethodsTo 100μL of serum, 100μL of internal standard solution in methanol were added; after centrifugation the supernatant was injected in the TurboFlow for further purification. Steroids were determined using a TSQ Vantage operating with an atmospheric pressure chemical ionization source. Method was fully validated and results compared with immunoassay methods. ResultsLimit of quantification ranged from 0.02ng/mL to 1ng/mL. The precision was lower than 11% and accuracy ranged from 93.5 to 121.6%. The correlation was acceptable for all analytes except for low levels of testosterone. However, the Bland-Altman plots display a positive bias for androstenedione and 17-hydroxyprogesterone, and a negative bias for cortisol and testosterone. ConclusionsTurboFlow analysis provides a simple and effective clean-up procedure minimizing the interference of the matrix. The presented method is selective, precise, and sensitive being suitable in a clinical laboratory.

Characteristics of NIH- and industry-sponsored head and neck cancer clinical trials.

Compare U.S. clinical trials sponsored by the National Institutes of Health (NIH) and industry, especially with regard to trial design, interventions studied, and results reporting rates. U.S. head and neck cancer clinical trials. We used information from ClinicalTrials.gov to compare NIH- and industry-sponsored head and neck cancer clinical trials, specifically analyzing differences in trial design and interventions studied. We examined publication rates and positive results rates using PubMed.gov. About 50% of NIH- and industry-sponsored clinical trials have their results reported in peer-reviewed literature. Industry-sponsored trials had higher rates of positive results than NIH-sponsored trials. NIH- and industry-sponsored clinical trials had similar trial designs, although industry-sponsored trials had significantly lower rates of randomization. Industry trials utilized radiation in 19% of trials and surgery in 2% of trials. NIH trials also had low utilization of both radiation and surgery (27% and 12% of trials, respectively). NIH- and industry-sponsored trials published their results in journals with comparable impact factors. There is significant underreporting of results in U.S. head and neck cancer clinical trials, whether sponsored by NIH or industry. Industry trials have significantly higher rates of positive results, although it is unclear what contributes to this. Both NIH- and industry-sponsored trials underutilize surgery and radiation as treatment modalities, despite the fact that these are standard-of-care therapies for head and neck cancer. We recommend that the NIH and industry report all results from clinical trials and use surgery and radiation as treatment arms in order to arrive at more balanced therapeutic recommendations. N/A. Laryngoscope, 126:E300-E303, 2016.

Cytotoxic‑based assays in delayed drug hypersensitivity reactions induced by antiepileptic drugs.

INTRODUCTION Cytotoxic mechanisms are present in the majority of delayed drug hypersensitivity reactions, but are not used as a diagnostic tool. OBJECTIVES The aim of the study was to compare cytotoxic‑based assays with a proliferation assay and drug patch tests in patients with maculopapular eruptions induced by antiepileptic drugs. Peripheral blood mononuclear cells of 23 patients and 24 controls exposed to the drugs were cultured under defined conditions. A drug‑specific response was assessed by measuring granzyme B (GrB) release with an enzyme‑linked immunospot assay, intracellular expression of granulysin (Grl) in CD3-NKp46+ cells with flow cytometry, perforin concentrations in cell culture supernatants with an enzyme‑linked immunosorbent assay, and using the lymphocyte proliferation test. Patch tests with culprit drugs were done in all patients. Lymphocyte proliferation, GrB release, and Grl expression were significantly higher in patients than in controls, while perforin concentrations were not elevated. The sensitivities were 30.4%, 55%, 39.1%, and 17.4% for proliferation, GrB, Grl, and perforin‑based assays, respectively. A significantly higher rate of positive results was observed when assays were done within 2 years after a drug‑induced reaction. The specificities of all assays remained in the range of 95.8% to 100%. The results of patch tests were positive only in 3 patients (sensitivity, 14.3%) and negative in all controls. In vitro assays based on the detection of Grl, and in particular of GrB, are superior to routine diagnostic tests in patients with hypersensitivity to antiepileptic drugs. They can detect a low‑level response that might be overlooked by standard techniques. In the remission phase, drug‑specific cells are more easily detectable directly in the circulation than in the skin.