Kappa Statistical Test Research Articles

Development of an Instrument for the Online Evaluation of Orthodontic-Treated Cases: A Pilot Study

Background: It is necessary to create a sound method for the optimal evaluation of treated cases of orthodontic board exam candidates. This cross-sectional study aimed to design and validate a new method for the national orthodontic board exam using a web-based program. Methods: Complete documents of 10 patients randomly selected from a pool of the previously presented cases at the national board examination were entered into a web-based program called "the Orthoboard". The documents were arranged according to the European Board of Orthodontist Standards, and 15 related questions were asked based on the index of complexity, outcome, and need index and the American Board of Orthodontics evaluation standards. A customized grading system was used for the finalized questionnaire. They were asked to be evaluated by 10 orthodontists (5 with less and 5 with more than 10 years of experience). The content validity of the questionnaire was analyzed by the content validity index and content validity ratio. The reliability of this questionnaire was measured using the Kappa statistical test. Results: Most evaluators do not consider it necessary to ask questions about the diagnostic resume, problem list, treatment plan, and treatment resume. Crowding after treatment and cross-biting before and after treatment had the best interexaminer reliability. The least agreement among examiners was between the pre-treatment aesthetic index and the pre-treatment buccal segment relationship. Conclusion: Inter-examiner reliability was lower than expected, indicating that the orthodontic board test scoring is too subjective. The addition of a 3-dimensional cast is recommended for better objective evaluation.

Agreement Between Two Cephalometric Analyses of Facial Growth Direction and Biotype

Cephalometry is a morphological and descriptive diagnostic method that provides relevant data on skeletal and dentoalveolar malocclusions of patients seeking orthodontics treatment. Several authors have proposed different cephalometric measurements to determine facial growth direction and facial biotype, the results of these different measurements from the same patient do not always agree on the diagnosis. The aim of this study was to determine the level of agreement between Ricketts and Björk-Jarabak cephalometric analyses for the determination of facial growth direction and facial biotype in patients from a population of Yucatan, Mexico. A total of 260 lateral cephalograms of patients between 18 and 59 years of age were digitally traced using the Ricketts and Björk-Jarabak cephalometric analyses to determine the direction of facial growth and facial biotype using Dolphin Imagine software. Cohen's kappa statistical test was performed to establish the strength of agreement between the diagnostic results obtained by the cephalometric analyses. A poor diagnostic concordance strength was found for growth direction (K=0.105), and acceptable for facial biotype (K=0.362). The concordance strengths for each diagnostic possibility (level) ranged from slight to acceptable, except for the brachyfacial and dolichofacial biotypes, with a moderate strength of agreement. In conclusion, the Ricketts and Björk-Jarabak cephalometric measurements used for the determination of facial biotype and facial growth direction could suggest non-concordant diagnostic assessments in some individuals.

How do babies roll? Identifying the coordinated movements of infant rolling through video compared to laboratory techniques.

Rolling is an important developmental milestone for infants where identifying the coordinated movement patterns could facilitate the early identification of motor development delays. Current methods for identifying coordinated movements of rolling are limited to a laboratory setting and not feasible for clinicians. To develop video-based methods in which six coordinated movements, previously defined through motion capture, can be identified through video alone. Forty-five videos of sixteen healthy infants achieving a roll were used to develop the video-based methodology and twenty-four videos had corresponding motion capture data used for validation. Four raters comprised of researchers and a clinician identified rolling coordination using the new video-based methods. A Fleiss' Kappa statistical test determined the inter- and intra-rater reliability of agreement for the new methodology and compared it to motion capture. The comparison of the motion capture and video-based methods resulted in substantial agreement. The video-based methods inter- and intra-rater reliability were substantial and almost perfect, respectively. We developed reliable methodology to accurately identify the coordinated movements of infant rolling using only 2D video. This methodology will allow researchers to reliably define coordinated movements of infants through video alone and may assist clinicians in identifying possible motor development delays and disorders.

A new method for fully automated detection of algae blooms in Antarctica using Sentinel-2 satellite images

The melting of Antarctic glaciers has become a significant issue as a result of global climate change. Algae on the Antarctic ice/snow is an important part of terrestrial photosynthetic organisms. Monitoring and tracking these algal blooms is crucial for understanding the melting of glaciers in the region. Due to the climatic and natural conditions of the region, traveling to and arranging logistics for monitoring and observing snow algae in the Antarctic continent becomes extremely challenging. To overcome these challenges, a novel algorithm has been developed and designed to automatically detect and analyze green algae (Chlorella sp.) from satellite images. Leveraging the vast and free available data from the Sentinel-2 satellite, the algorithm utilizes its high spectral resolution capabilities, capturing invaluable information from various spectral bands. The algorithm was formulated based on the image obtained on February 28, 2017, where green algae formations were intensively seen in the Ryder Bay. The algorithm was developed based on rule-based detection of algae, with the usage of reflection values from the areas where ground truth was established on this date. The developed algorithm was coded and tested using Python version 3.9. The accuracy analysis of the algorithm was conducted using overall accuracy (OA), F1 score, and Kappa statistical test. As a result of the analysis, the OA, F1 score, and Kappa statistic values were calculated as %91, %88.82-%95.27, and 0.901, respectively.

Inter-observer variability in library plan selection on iterative CBCT and synthetic CT images of cervical cancer patients.

In the Library-of-Plans (LoP) approach, correct plan selection is essential for delivering radiotherapy treatment accurately. However, poor image quality of the cone-beam computed tomography (CBCT) may introduce inter-observer variability and thereby hamper accurate plan selection. In this study, we investigated whether new techniques to improve the CBCT image quality and improve consistency in plan selection, affects the accuracy of LoP selection in cervical cancer patients. CBCT images of 12 patients were used to investigate the inter-observer variability of plan selection based on different CBCT image types. Six observers were asked to individually select a plan based on clinical X-ray Volumetric Imaging (XVI) CBCT, iterative reconstructed CBCT (iCBCT) and synthetic CTs (sCT). Selections were performed before and after a consensus meeting with the entire group, in which guidelines were created. A scoring by all observers on the image quality and plan selection procedure was also included. For plan selection, Fleiss' kappa (κ) statistical test was used to determine the inter-observer variability within one image type. The agreement between observers was significantly higher on sCT compared to CBCT. The consensus meeting improved the duration and inter-observer variability. In this manuscript, the guidelines attributed the overall results in the plan selection. Before the meeting, the gold standard was selected in 76% of the cases on XVI CBCT, 74% on iCBCT, and 76% on sCT. After the meeting, the gold standard was selected in 83% of the cases on XVI CBCT, 81% on iCBCT, and 90% on sCT. The use of sCTs can increase the agreement of plan selection among observers and the gold standard was indicated to be selected more often. It is important that clear guidelines for plan selection are implemented in order to benefit from the increased image quality, accurate selection, and decrease inter-observer variability.

Accuracy and Reliability of Smartphone Virtual Shade-Matching Technique: An In Vitro Study.

To determine and compare the accuracy and reliability of shade matching using the conventional and smartphone virtual methods. A phantom head with both maxillary central incisors removed was set up. A central incisor of various standard shades was inserted into the phantom head. Five undergraduate and five postgraduate students were asked to select the closest shade to match the central incisor using the Vita Classic shade guide. The procedure was then repeated using images taken by a smartphone. Each technique was repeated three times. Differences in accuracy of shade matching between the two techniques for every shade tab and between undergraduate and postgraduate dental students were compared using chi-square statistical analysis. The P value was set at .001. Differences in intra-rater and inter-rater reliability between the two techniques and among the three sessions were compared using paired t test and analysis of variance (ANOVA), respectively, with a P value of .05. The reliability of both techniques was further measured using Cohen kappa statistical test. The smartphone virtual shade-matching technique showed significantly higher accuracy in shade matching with most of the tested shade tabs than the conventional method (P < .001), irrespective of observers' clinical experience. Higher repeatability was found in the virtual technique than the conventional technique, with higher intra-rater and inter-rater reliability observed. Smartphone virtual shade matching showed better accuracy and reliability than the conventional method and could be used as an alternative shade-matching method.

One-year follow-up of microscopical and clinical behavior of bioactive self-etching resin sealant.

The development of early carious lesions can be prevented with the use of sealants. This study aimed to evaluate the retention and sealant quality of conventional and bioactive self-etching sealants by direct (clinical) and indirect (microscopical) assessment. Sixty newly erupted mandibular second molars (International Caries Detection and Assessment System ≤2) from adolescents were selected for the split-mouth trial study. The tooth was randomized and treated with conventional Fluoroshield (FS) and BeautiSealant (BS) bioactive self-etching sealants. Molds were taken and cast with epoxy resin after treatment. Indirect and direct assessments of retention degree and sealant remnant quality were performed after baseline, 1 month, and 1 year. The Chi-square test, ordinal regression, reasons of chance, and Fleiss' kappa statistical test were employed. After 1 month, greater total retention was observed for FS, but 1-year follow-up demonstrated no retention difference for FS and BS. The odds ratios showed an 86% greater chance of FS showing better marginal adaptation, after 1 month. At 1 year, the clinical assessment showed better anatomical shape and marginal adaptation scores for FS, but no microscopical difference was observed. A pour agreement between clinical and microscopical data was observed. The 1-year follow-up showed no significant difference in the degree of retention, and in the microscopic evaluation of the conventional sealant (FS) and the bioactive self-etching sealant (BS), but in the clinical evaluation, better marginal and anatomical adaptation scores for FS were observed.

Assessing the role of sow parity on PRRSv detection by RT-qPCR through weekly processing fluids monitoring in breeding herds

The use of processing fluids to monitor the breeding herd’s porcine reproductive and respiratory syndrome (PRRS) status has gained industry acceptance. However, little is known about PRRS virus RT-qPCR detection dynamics in processing fluids and factors that may contribute to maintain PRRS virus in the herd after an outbreak. This study aimed to describe weekly RT-qPCR processing fluid results in breeding herds after an outbreak and to evaluate the proportion of RT-qPCR positive results among parity groups. Processing tissues of 15 first parity (P1), 15 second parity (P2), and 15 third parity or higher (P3+) litters (parity groups) were collected weekly for between 19 and 46 weeks in nine breeding herds. Processing fluids were aggregated, and RT-qPCR tested by parity group weekly. Additionally, a subset of 743 processing fluid samples of litters that formed 50 parity groups, as previously described, were RT-qPCR tested individually at the litter level. The agreement between RT-qPCR results of processing fluid samples of parity groups (15 litters) and results based on individual litter testing was assessed using overall percent of agreement, Kappa statistic, and McNemar test. The association between RT-qPCR results and the parity group was evaluated using a generalized estimating equations model, after accounting for the effects of sampling week, breeding herd PRRS control strategy (i.e., open to replacements v/s closed) and herd. An autoregressive correlation structure was used to account for the repeated samplings within a herd in time. The overall agreement was 98 %, and Kappa statistic 0.955 (McNemar p = 1.0). Sensitivity of parity group processing fluid samples was estimated at 100 % (95 % CI 89–100 %), while specificity was estimated at 94 % (95 % CI 71–100 %). Although P1 aggregated litters had on average a higher proportion of RT-qPCR positive results from outbreak week 25 onwards, the proportion was not significantly different to the one observed for P2 and P3+ aggregated litters (p > 0.13). Additionally, herds that interrupted gilt entry had lower odds of PRRS RT-qPCR positivity than herds that continued entering gilts (OR = 0.35, 95 % CI 0.16–0.78). PRRS virus persistence in processing fluids was not affected by the sow parity effect in most of the breeding herds studied. No evidence of disagreement between RT-qPCR results of an aggregated sample of 15 litters and those of individual litters was observed. This level of litter aggregation testing strategy may be of particular use at the last stages of an elimination program under low PRRS virus prevalence.

Two Distinct Nutritional Assessment Tools Have Dissimilar Outcomes in a Sample of Older Adult Patients With Cancer

Abstract Introduction Malnutrition is strongly associated with negative outcomes in aged populations with cancer. Several studies have compared the outcomes of nutritional-screening tools, but knowledge specifically covering older adult patients with cancer remains limited. The aim of this study was to compare the outcomes of two tools, the Patient-Generated Subjective Global Assessment (PG-SGA) versus the Mini Nutritional Assessment (MNA) for this population. Method Cross-sectional study with 432 participants who consented to participate and were enrolled at admission to medical and surgical wards of a tertiary referral hospital. The participants’ nutritional statuses were simultaneously assessed using the PG-SGA and the MNA, and the outcomes compared using the kappa statistical test. The Receiver Operating Characteristic Curve (ROC) was employed to calculate the MNA sensitivity, specificity, positive and negative predictive values, and was compared with PG-SGA. Results Prevalence of good nourishment was observed in 62.5% and 61.1% of the participants, as detected by PG-SGA and MNA, respectively. Both tools concurred moderately (kappa = 0.453). Importantly, there were significant differences in the diagnosis of malnutrition (7.6% vs. 4.6%, p = 0.000). The MNA showed sensitivity of 72.2% and specificity of 75.9% in detecting good nourishment for the population investigated. Conclusion The MNA may not present greater sensitivity, possibly due to a lack of coverage of gastrointestinal symptoms. It is a quick and efficient tool for nutritional assessment of older adult patients with cancer, but as it is more specific than sensitive, caution is recommended when identifying borderline or early malnourished individuals of this population.

Application of a semi-automated dicentric scoring system in triage and monitoring occupational radiation exposure.

The dicentric chromosome assay (DCA) is considered the gold standard for radiation biodosimetry, but it is limited by its long dicentric scoring time and need for skilled scorers. The automation of scoring dicentrics has been considered a strategy to overcome the constraints of DCA. However, the studies on automated scoring methods are limited compared to those on conventional manual DCA. Our study aims to assess the performance of a semi-automated scoring method for DCA using ex vivo and in vivo irradiated samples. Dose estimations of 39 blind samples irradiated ex vivo and 35 industrial radiographers occupationally exposed in vivo were estimated using the manual and semi-automated scoring methods and subsequently compared. The semi-automated scoring method, which removed the false positives of automated scoring using the dicentric chromosome (DC) scoring algorithm, had an accuracy of 94.9% in the ex vivo irradiated samples. It also had more than 90% accuracy, sensitivity, and specificity to distinguish binary dose categories reflecting clinical, diagnostic, and epidemiological significance. These data were comparable to those of manual DCA. Moreover, Cohen's kappa statistic and McNemar's test showed a substantial agreement between the two methods for categorizing in vivo samples into never and ever radiation exposure. There was also a significant correlation between the two methods. Despite of comparable results with two methods, lower sensitivity of semi-automated scoring method could be limited to assess various radiation exposures. Taken together, our findings show the semi-automated scoring method can provide accurate dose estimation rapidly, and can be useful as an alternative to manual DCA for biodosimetry in large-scale accidents or cases to monitor radiation exposure of radiation workers.

Content and Usability Validation of an Intelligent Virtual Conversation Assistant Used for Virtual Triage During the COVID-19 Pandemic in Brazil.

This study aimed to describe the development process, content validation, and usability of a COVID-19 screening system incorporated into a chatbot-type intelligent virtual assistant (CoronaBot). This is a methodological research carried out in three phases. The first corresponded to the development of the flowchart and content of the virtual assistant, the second phase consisted of the implementation of the content in chatbot, and the third phase consisted of content validation. Data analysis was performed by agreement rate, content validity index, and kappa statistical test. Finally, in the third phase, the chatbot's usability was analyzed using the System Usability Scale, by 10 users. The CoronaBot content presented domains with agreement rate above 87.5%, and its items referring to symptomatological scores and interface screens had values of content validity index with a mean of 0.96, kappa test with values from 0.70 to 0.76, and interspecialist agreement of 1.00, demonstrating excellence of prototype content. The global usability score was 80.1. The script developed and incorporated into the chatbot prototype achieved a satisfactory level of content validity. The usability of the chatbot was considered good, adding to the credibility of the device.

Investigating Fire Protection Condition in the Units of Imam Khomeini Hospital Tehran, Iran

Background: Various studies indicate that in many cases, fire has broken out in hospitals. Objectives: This study aims to assess fire protection in the selected units of Imam Khomeini hospital located in Tehran, Iran in 2020. Methods: In this descriptive-analytic study, first, a researcher-made checklist was developed for the data collection by valid scientific resources (CVI=0.90 and CVR&gt;0.62). After revising and the final confirmation of reliability, the checklist was separately completed by two members of the risk management committee in 22 units of Imam Khomeini hospital, Tehran, Iran. Cronbach’s weighted Kappa statistical test was calculated. Results: The domain of Ability and Capability of Fire Prevention was 66.1%; the domain of Responsiveness was 65.1%, and the domain of Urgent Evacuation Ability was 27.3%. In the domain of Responsiveness, the highest scores were relevant to accessing fire extinguishers cylinder in the units (95.5%) and holding fire extinguishing practice courses, and doing seasonal practices with that region’s fire station (90.9% for both). The highest scores in the domain of Urgent Evacuation Ability were assigned to accessing adequate ambulances to evacuate patients (90.9%) and mapping the units as well as determining patient evacuation routes when a fire breaks out (72.7%). Conclusion: The essential protection measures should be taken in order to improve the hospitals’ fire protection by better access to the exits, increasing the number of the exits and standardizing the emergency exits, enhancing the due fire extinguishing practices and hospital evacuation as well as training the staff.

A novel symplectic relevance matrix machine method for intelligent fault diagnosis of roller bearing

In the fault classification of roller bearing, it is often encountered that the input sample is composed of feature matrix with rich structural information. As a new classifier, support matrix machine (SMM) makes full use of the structural information of input samples to establish prediction model. However, SMM lacks necessary probability information, and its sparsity and robustness are not clear. To resolve the above issues, a new matrix classifier - symplectic relevance matrix machine (SRMM) is proposed based on the probability framework and symplectic geometry theory. In SRMM, the model takes the original signal matrix as the input, and constructs the model elements with rich structural information. Then, symplectic geometry matrix is obtained by symplectic geometry similarity transformation, which makes SRMM robust. Meanwhile, the model elements are constructed by symplectic geometry, which can solve the difficulty of constructing recursive kernel function, reduce the complexity of the model, avoid the time consumption in the process of model parameter optimization. The experimental results of three roller bearing datasets show that SRMM has good classification performance in roller bearing fault diagnosis by comparing recognition rate, time, kappa, accuracy, recall rate and F1 and statistical test.

Double Layer Lateral Crural Perichondrial Flap for Coverage and Stabilization of Tip Graft.

Tip plasty is the most important step of rhinoplasty. To achieve symmetrical cartilages with ideal tip rotation, projection and supratip break many techniques were defined. Besides suture techniques, tip grafts still maintain their importance and widely used among surgeons. However, graft visibility and distortion are the main drawbacks of this technique. In this study double-layered lateral crural perichondrial flap technique was introduced to prevent graft visibility and distortion as a novel technique. A total of 16 patients who underwent rhinoplasty with this novel technique were enrolled in this retrospective study. Patient satisfaction was assessed with Rhinoplasty Outcome Evaluation Questionnaire (ROE-Q). Graft visibility and asymmetry of tip defining point as an indicator of graft distortion were evaluated by two independent Plastic, Reconstructive and Aesthetic surgeons. Pre and postoperative photographs were taken and used for evaluation. A three-point Likert scale was used for assessment. Cohen's Kappa statistic and percent agreement test were usedtotest inter-rater reliability RESULTS: The mean follow-up time was 15 months (ranging between 12 and 19 months). According to the ROE-Q score, the mean total preoperative score was 6,25 and the mean total postoperative score was 18,06 (p<0,05). No or minimal evident graft visibility and asymmetry of tip defining point was observed in 12 patients and 10 patients, respectively. Mild evident graft visibility was observed in only 1 patient with thin skin. Severe evident graft visibility or asymmetry of tip defining point was not observed in none of the patients. The double-layer crural perichondrial flap was an effective and sufficient method for preventing graft visibility and graft distortion. Features like easy and fast flap elevation, no additional comorbidity, being autologous tissue and sufficient flap length and thickness make this technique valuable and useful. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Reliability of Class II Bulk-fill Composite Restorations With and Without Veneering: A Two-year Randomized Clinical Control Study.

Bulk-fill composites are increasingly used in stress-bearing areas in posterior teeth, with a diversity of reports concerning their effectiveness and clinical reliability. The objective of this randomized clinical control study was to investigate the effectiveness of bulk-fill versus veneered bulk-fill Class II composite restorations. A double-blind split-mouth technique was employed in 80 subjects recruited for restoring Class II caries in one molar bilaterally in the same arch following respective inclusion and exclusion criteria and after obtaining written consent. While one molar was randomly restored with bulk-fill composite using the sealed-envelope technique, Tetric N-Ceram Bulk Fill (TBF), the contralateral was restored with a bulk-fill composite veneered with an increment of a heavy-body microhybrid composite-Tetric-Ceram HB (TBF/V). Box-only cavities were prepared and received etch-and-rinse adhesive bonding and Tetric N-Bond treatment before composite insertion. Restorations were assessed at 24 hours, 2 weeks, 6 months, 12 months, and 24 months for esthetic, functional, and biological quality employing the FDI ranking criteria. Friedman repeated-measures analysis of variance, the McNemar test, and the Cohen's kappa statistical test were used for statistical analysis. Over a 24-month interval, none of the test restorations were ranked as clinically unsatisfactory. In terms of functional criteria, clinically excellent restorations were significantly more prevalent in TBF/V than in TBF (p<0.05). For long-term satisfactory performance of Class II bulk-fill composites, an occlusal veneering increment of conventional heavy body microhybrid composite appears to be favorable.

Informasi Citra Anatomi pada Penggunaan Variasi Increment Pemeriksaan MSCT Abdomen Irisan Axial Kasus Nodul Hepar

Background : Liver nodules are tumors that are less than 2 cm in size and are single or multiple. In making a diagnosis of liver nodules can be done by examination of abdominal MSCT. According to Seeram (2009), using 50% overlapping there was an increase in nodule detection by 10% compared to incremental increments. The purpose of the study was to determine differences in information on anatomical images on the use of increment variations in abdominal MSCT examination and to find the appropriate increment values to produce optimal anatomical image information.Methods : This type of research is quantitative with an experimental approach. The study was conducted at the RSUD. Tugurejo Semarang, the image was taken from abdominal MSCT examination in 5 patients with a variation of increments of 100% (8 mm), 50% (4 mm), 30% (2, 4 mm). The results of the study were assessed by 3 respondents. Data analysis used the kappa statistical test, crosstabulation, and friedman.Results : From the statistical test, the results of the 2.4 mm increment value show clear anatomical criteria and can detect small nodules. Supported by using friedman statistical test p-value = 0.000 which means that p-value 0.05 thus Ha is accepted so that there are differences in anatomical image information.Conclusion : The most optimal increment value is 30% (2.4 mm) because it has the highest mean rank value of 2.37.

Laboratory tests

Background The lack of awareness of COVID-19 severity in the early stages of the disease has led to a dramatic increase in the number of patients worldwide. A cost-effective, easily acquired biomarker is needed to classify disease severity at early stages. Objective The objective of this paper is to explore the role of basic laboratory tests in the classification of COVID-19 patients into different severity groups. Methods Socio-demographic data, including age and gender together with laboratory investigations, including complete blood count, CRP, serum D-dimer, ferritin, LDH, and liver function tests were collected during the period from November 2020 to January 2021 from the medical records of 100 adult COVID-19 patients admitted at the Quarantine Hospitals of Ain-Shams University. Results The present study included 100 COVID-19 patients (51 females and 49 males) with a mean age of 57±15.74 years. They were 27 mild, 40 moderate, and 33 severe. The disease severity could not be linked to a specific gender; however, the severity increased with advanced age. CBC results showed no significant differences in total leucocytic counts, hemoglobin levels, or platelet counts; however, the absolute lymphocyte counts decreased significantly as the disease worsened. Also, in more severe disease, there was a highly significant increase in ferritin, D-dimer, LDH, and CRP levels with no significant differences in ferritin and LDH levels between moderate and severe groups. On the other hand, AST and ALT levels showed no significant differences between the three groups. Significant negative correlations were found between absolute lymphocyte count and ferritin, D-dimer, and CRP levels. By ROC curve, a cut-off point for absolute lymphocyte count of less than or equal to 1.5×103/cmm, D-dimer of greater than 0.78 mg/l, and CRP of greater than 56 mg/l were used to differentiate mild and moderate cases, and a cut-off point for absolute lymphocyte count of less than or equal to 1.06×03/cmm, D-dimer of greater than 1.58 mg/l, and CRP of greater than 78 mg/l were used to differentiate moderate and severe cases. Furthermore, the kappa statistic test found a moderate degree of agreement between the existing guideline for disease typing, and absolute lymphocyte count, D-dimer, and CRP levels. Conclusion This study suggested that incorporation of laboratory variables including absolute lymphocyte count, D-dimer, and CRP into the existing guideline for disease typing, may be of value for quick cost-effective identification of potentially critically ill patients at an early stage of the disease.

Evaluation of semi-quantitative compared to quantitative cultures of tracheal aspirates for the yield of culturable respiratory pathogens \u2013 a cross-sectional study

BackgroundDiagnosis of lower respiratory tract infections (LRTI) depends on the presence of clinical, radiological and microbiological findings. Endotracheal suction aspirate (ETSA) is the commonest respiratory sample sent for culture from intubated patients. Very few studies have compared quantitative and semi-quantitative processing of ETSA cultures for LRTI diagnosis. We determined the diagnostic accuracy of quantitative and semi-quantitative ETSA culture for LRTI diagnosis, agreement between the quantitative and semi quantitative culture techniques and the yield of respiratory pathogens with both methods.MethodsThis was a cross-sectional study conducted at the Aga Khan University clinical laboratory, Karachi, Pakistan. One hundred and seventy-eight ETSA samples sent for routine bacteriological cultures were processed quantitatively as part of regular specimen processing method and semi-quantitatively. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy was calculated for both methods using clinical diagnosis of pneumonia as reference standard. Agreement between the quantitative and semi quantitative methods was assessed via the kappa statistic test. Pathogen yield between the two methods was compared using Pearson’s chi-square test.ResultsThe quantitative and semi-quantitative methods yielded pathogens in 81 (45.5%) and 85 (47.8%) cases respectively. There was complete concordance of both techniques in 155 (87.1%) ETSA samples. No growth was observed in 45 (25.3%) ETSA specimens with quantitative culture and 37 (20.8%) cases by semi-quantitative culture. The diagnostic accuracy of both techniques were comparable; 64.6% for quantitative and 64.0% for semi-quantitative culture. The kappa agreement was found to be 0.84 (95% CI, 0.77–0.91) representing almost perfect agreement between the two methods. Although semi-quantitative cultures yielded more pathogens (47.8%) as compared to quantitative ETSA cultures (45.5%), the difference was only 2.3%. However, this difference achieved statistical (chi-square p-value < 0.001) favoring semi-quantitative culture methods over quantitative culture techniques for processing ETSA.ConclusionIn conclusion, there is a strong agreement between the performances of both methods of processing ETSA cultures in terms of accuracy of LRTI diagnosis. Semi-quantitative cultures of ETSA yielded more pathogens as compared to quantitative cultures. Although both techniques were comparable, we recommend processing of ETSA using semi-quantitative technique due to its ease and reduced processing time.

Fine needle aspiration cytology diagnostic accuracy corelation to histopathology of head and neck swelling in Manipal teaching hospital

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Palpable neck swelling is a common clinical manifestation in otolaryngology. Rapid, inexpensive and simple method of examination for the diagnosis of such superficial masses is fine needle aspiration cytology (FNAC). Objectives were to evaluate the usage of fine needle aspiration cytology as a first-line tool for diagnosis, accuracy compared with histopathology.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method&lt;/strong&gt;: A hospital based prospective cross sectional was conducted by taking 65 patients with neck swelling presentation thyroid swelling were highest in number followed by lymph node and salivary, in which female were 43 (66.15%) and male were 22 (33.85%), the age group ranged from 6 to 75 years in ear, nose, throat (ENT) OPD of Manipal teaching hospital between 15&lt;sup&gt;th &lt;/sup&gt;November 2015 to 15&lt;sup&gt;th&lt;/sup&gt; May 2017. FNAC along with histopathological examination (HPE) were done and compared. For data analysis SPSS 20 version was used. The sensitivity, specificity and accuracy rates were calculated. The Cohen’s Kappa statistical test was employed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results&lt;/strong&gt;&lt;strong&gt;: &lt;/strong&gt;The overall sensitivity and specificity of FNAC was 90.76% and 98.075% respectively in determining the various pathologies. The diagnostic accuracy of FNAC in comparison to histopathology was 92.25%. This study showed almost perfect correlation (measure of agreement) between FNAC and final histopathology diagnosis of neck swellings from Cohen’s Kappa test.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;FNAC is a safe, simple and rapid method with a high sensitivity and specificity that can be done in diagnosing wide range of neck swellings.&lt;/p&gt;

Characteristics of the Filtering Bleb and the Agreement between Glaucoma Specialist and Anterior Segment-Optical Coherence Tomography Assessment

Introduction: This study aimed to evaluate the characteristics of the filtering bleb in failed late trabeculectomy and the agreement between glaucoma specialist assessment and anterior segment-optical coherence tomography (AS-OCT) system assessment in terms of the presence of subconjunctival fluid in the filtering bleb. Methods: Patients with a diagnosis of glaucoma who were scheduled to undergo trabeculectomy in at least one eye and with uncontrolled intraocular pressure (IOP) were enrolled. All participants underwent a complete ophthalmological examination. The presence of fluid under the filtering bleb was first evaluated by a glaucoma specialist using biomicroscopy evaluation and then using the OCT 1000 AS-OCT Version 3.0.1.8 (Carl Zeiss Meditec, Dublin, CA, USA) system. A Kappa statistical test was used to evaluate the agreement between AS-OCT and the examiner. The correlation between conjunctiva and tenon thickness and clinical parameters was also assessed. Results: Forty eyes of 40 patients were evaluated in this study. The ages ranged from 21 to 86 years, with a mean of 66.55 ± 12.33. The average IOP was 21.20 ± 4.44 mm Hg (range 14–38 mm Hg) in the entire group. The mean thickness of the conjunctiva and tenon was 302.03 ± 406.76 µm (range 251–1,616 µm). There was a significant negative correlation between the mean thickness of the conjunctiva and tenon and IOP (p = 0.045; confidence interval = −0.558, 0.024). Additionally, there was a significant negative correlation between the mean thickness of the conjunctiva and tenon, and the number of medications used at baseline (p = 0.043; confidence interval = −0.538, 0.051). There was significant negative correlation between the horizontal measurement of the bleb and the use of glaucoma medications (p = 0.017; confidence interval = −0.560, 0.004). A total of 26 patients were determined to have fluid by the examiner (glaucoma expert), and the presence of fluid in AS was confirmed in 19 patients by AS-OCT. Of the 14 patients who were determined to have an absence of fluid, this was confirmed by AS-OCT in 7 patients (Kappa = 0.231; agreement of 65.00%). Conclusion: There is fair agreement between glaucoma specialist assessment and AS-OCT assessment in terms of the presence of fluid in trabeculectomy. Our findings highlight the importance of AS-OCT in some patients before deciding upon a new intervention.