Low Positive Predictive Value Research Articles

Glutamate dehydrogenase combined with ferrochelatase as a biomarker of liver injury induced by antituberculosis drugs.

To explore the potential value of serum glutamate dehydrogenase (GLDH), ferrochelatase (FECH), heme oxygenase-1 (HO-1) and glutathione-S-transferase-α (GST-α) as diagnostic biomarkers for liver injury caused by antituberculosis drugs. We established a rat model of isoniazide-induced liver injury and recruited 122 hospitalized tuberculosis patients taking antituberculosis drugs. We detected the concentration of GLDH, FECH, HO-1 and GST-α by enzyme-linked immunosorbent assay. GraphPad Prism8 and SPSS 26.0 were used for statistical analysis. In the rat model, serum GLDH concentration gradually increased during isoniazid (INH) administration, while serum FECH, HO-1 and GST-α concentrations significantly increased after INH administration was stopped. The receiver operating characteristic curve showed that the areas under the curve (AUCs) of serum GLDH and FECH for the diagnosis of anti-tuberculosis (TB) drug-induced liver injury (anti-TB-DILI) were 0.7692 (95% confidence interval [CI] 0.5442-0.9943) and 0.7284 (95% CI 0.4863-0.9705) and the diagnostic accuracies were 81.25% and 78.79%, respectively. In clinical research, the AUCs of GLDH and FECH were 0.9124 (95% CI 0.8380-0.9867) and 0.6634 (95% CI 0.5391-0.7877), and the optimal thresholds were 10.40 mIU/mL and 1.304 ng/mL, respectively. The diagnostic accuracy, specificity and positive predictive value (PPV) of GLDH were 82.61%, 79.38% and 47.22%. We performed a joint diagnostic test for GLDH and FECH. The diagnostic accuracy (90.43%), specificity (91.75%) and PPV (65.21%) of serial tests were better than for GLDH and FECH alone. GLDH in the diagnosis of liver injury induced by anti-TB drugs has high sensitivity, but low specificity and low PPV. The combination of GLDH and FECH could significantly improve the specificity, PPV and diagnostic accuracy, and reduce the false-positive rate of anti-TB-DILI.

Genetic susceptibility to drug-induced liver injury

Drug-induced liver injury (DILI) risk prediction, diagnosis establishment, clinical management, and all other aspects are facing great challenges. Although the current understanding of its pathogenesis is still incomplete, research over the past 20 years has shown that genetic susceptibility may play an important role in the occurrence and development of DILI. In recent years, pharmacogenomics studies have further revealed the association between human leukocyte antigen (HLA) genes, some non-HLA genes, and hepatotoxicity from certain drugs. However, due to the lack of well-designed, prospective, large-sample cohort validation and low positive predictive values, there may still be some way to go before the current results can be truly translated into clinical practice for precise prediction and prevention of DILI risk.

Post-treatment 18F-fludeoxyglocuse-positron emission tomography in human papillomavirus-associated oropharyngeal cancer.

Human papillomavirus association has changed the landscape of treatment for oropharyngeal squamous cell carcinoma; it remains to be seen whether current post-treatment surveillance schedules are effective. Evaluate whether post-treatment surveillance of oropharyngeal cancer through FDG-PET imaging is modified by human papillomavirus association. A prospective cohort analysis of retrospective data was conducted for patients undergoing treatment of oropharyngeal cancer between 2016 and 2018. This study was conducted at a single large tertiary referral center in Brisbane, Australia. Two-hundred and twenty-four patients were recruited for the purposes of the study, 193 (86%) with HPV-associated disease. In this cohort FDG-PET had a sensitivity of 48.3%, specificity of 72.6%, positive predictive value of 23.7%, and negative predictive value of 88.8% in detecting disease recurrence. FDG-PET in HPV-associated oropharyngeal cancer has significantly lower positive predictive value when compared to non-HPV-associated oropharyngeal cancer. Caution should be used when interpreting positive post-treatment FDG-PET.

Performance of a prehospital HEART score in patients with possible myocardial infarction: a prospective evaluation

IntroductionThe History, Electrocardiogram (ECG), Age, Risk Factors and Troponin (HEART) score is commonly used to risk stratify patients with possible myocardial infarction as low risk or high risk in the...

Electronic phenotyping of community-acquired pneumonia: A tool for inpatient syndrome-specific antimicrobial stewardship

Background: Using patient data from the electronic health record (EHR) and computer logic, an “electronic phenotype” can be created to identify patients with community-acquired pneumonia (CAP) in real time to assist with syndrome-specific antimicrobial stewardship efforts.1 We adapted and validated the performance of an inpatient CAP electronic phenotype for antimicrobial stewardship interventions. Methods: An automated scoring system was created within the EHR (Epic Systems) to identify hospitalized patients with CAP based on the variables and logic listed in Fig. 1B. We adapted a score used by the Michigan Hospital Medicine Safety Consortium (HMS) to identify patients with CAP, with additions made to improve sensitivity (Fig. 1).1 The score can be displayed in a column within the EHR patient list (Fig. 2). We validated the electronic phenotype via chart review of all hospitalized patients on systemic antimicrobials admitted to a medicine team consecutively between November 8 and 18, 2021. Patients who were readmitted within the validation time frame were excluded. We assessed the performance of the electronic phenotype by comparing the score to manual chart review, where “CAP diagnosis” was defined as (1) mention of “pneumonia” or “CAP” as part of the differential diagnosis in the admission documentation, (2) antimicrobials were started within 48 hours of admission, and (3) radiographic findings were suggestive of pneumonia. After initial evaluation, the scoring system was adjusted, and performance was re-evaluated during prospective audit and feedback performed on EHR CAP–positive patients over 13 days between July 2022 and December 2022. Results: We included 191 patients in our initial validation cohort. The CAP score had high sensitivity (95.83%), specificity (92.2%), and negative predictive value (99.35%), though lower positive predictive value (63.89%) was noted (Table 2). The rules were further refined to include bloodstream infection only with Haemophilus influenza or Streptococcus pneumoniae in rule 2B, and azithromycin was removed from “CAP antibiotics.” After these changes, repeated evaluation of 88 patients with positive CAP EHR score was performed, and only 20 (23%) were considered false-positive results. Conclusions: Electronic phenotypes can be used to create automated tools to identify patients with CAP with reasonable performance. Data from this tool can be used to guide more focused antimicrobial stewardship interventions and clinical decision support in the future. Reference: Vaughn VM, et al. A statewide collaborative quality initiative to improve antibiotic duration and outcomes in patients hospitalized with uncomplicated community-acquired pneumonia. Clin Infect Dis 2022;75:460–467.Disclosures: None

Pathologic concordance rate and outcomes by histologic subtype in advanced papillary renal cell (pRCC) carcinoma: An analysis from the SWOG S1500 (PAPMET) trial.

4562 Background: The PAPMET trial demonstrated significantly improved progression-free survival (PFS) with cabozantinib vs. sunitinib in advanced pRCC (median: 9.0 vs. 5.6 mos; hazard ratio (HR): 0.60; 95% CI 0.37–0.97). Until recently, pRCC was subclassified as type 1 vs. 2 based on histologic features. During conception of the PAPMET study, we hypothesized that patients with type 1 pRCC will derive more benefit from cabozantinib compared to those with type 2 disease, given enrichment of MET alterations in the former. In this secondary analysis, we report the outcomes stratified by histologic subtype per central review. Methods: Patients with advanced pRCC who had received up to 1 line of therapy were randomized to receive either sunitinib, or cabozantinib, crizotinib or savolitinib stratified by pRCC subtype (type 1, type 2 or not otherwise specified [NOS]). Pathologic data from local pathology review was catalogued. Central pathology review was conducted by 3 expert genitourinary pathologists who independently reviewed tumor specimens. Discordant opinions among these pathologists were individually arbitrated and a unified diagnosis was assigned. Central pathology review results were considered the true positive and the sensitivity, and the positive predictive value (PPV) of local review was estimated for histologic subtypes. Clinical outcomes (objective response rate (ORR) and PFS) were compared between histologic subtypes (by central review) in the cabozantinib and sunitinib arms. Results: Amongst the 147 patients with available local and central pathology review, 17.7% (n=26), 53% (n=78) and 29.3% (n=43) were characterized as having type 1, 2 or NOS/mixed pRCC by local review compared to 29.3% (n=43), 45.6% (n=67) and 25.2% (n=37) respectively by central review. Individual cases were frequently reclassified and local pathology review demonstrated low sensitivity (type 1: 49%, type 2: 67% and NOS: 43%) and PPV (type 1: 80%, type 2: 57% and NOS/mixed: 37%) across subtypes. During central review, complete agreement amongst the 3 pathologists was seen in only 33.3% (n=49) of cases and was highest in type 2 tumors (40%; n=27). Compared to sunitinib, cabozantinib demonstrated numerically higher ORR and PFS in both type 1 and type 2 pRCC subgroups. Conclusions: Designation of pRCC subtype by central review did not identify a subset of patients with greater clinical benefit from cabozantinib. Further, classification of subtype was challenged by discordance in both local and central review. Supporting the removal of type 1 and 2 designations from the 2022 WHO guidelines, these findings highlight the limited clinical value and significant challenges associated with subtyping of pRCC. Clinical trial information: NCT02761057 . [Table: see text]

The dilemma of recalling well-circumscribed masses in a screening population: A narrative literature review and exploration of Dutch screening practice.

In Dutch breast cancer screening, solitary, new or growing well-circumscribed masses should be recalled for further assessment. This results in cancers detected but also in false positive recalls, especially at initial screening. The aim of this study was to determine characteristics of well-circumscribed masses at mammography and identify potential methods to improve the recall strategy. A systematic literature search was performed using PubMed. In addition, follow-up data were retrieved on all 8860 recalled women in a Dutch screening region from 2014 to 2019. Based on 15 articles identified in the literature search, we found that probably benign well-circumscribed masses that were kept under surveillance had a positive predictive value (PPV) of 0-2%. New or enlarging solitary well-circumscribed masses had a PPV of 10-12%. In general the detected carcinomas had a favorable prognosis. In our exploration of screening practice, 25% of recalls (2133/8860) were triggered by a well-circumscribed mass. Those recalls had a PPV of 2.0% for initial and 10.6% for subsequent screening. Most detected carcinomas had a favorable prognosis as well. To recognize malignancies presenting as well-circumscribed masses, identifying solitary, new or growing lesions is key. This information is missing at initial screening since prior examinations are not available, leading to a low PPV. Access to prior clinical examinations may therefore improve this PPV. In addition, given the generally favorable prognosis of screen-detected malignant well-circumscribed masses, one may opt to recall these lesions at subsequent screening, if grown, rather than at initial screening.

0476 Peripheral Arterial Tonometry-Based Home Sleep Apnea Test vs. Polysomnography in Detection of Central Disordered Breathing Events

Abstract Introduction In-laboratory polysomnography (PSG) is the gold standard diagnostic test for sleep-disordered breathing (SDB). WatchPAT® is a type of home sleep apnea testing (HSAT) that utilizes peripheral arterial tone (PAT) signals and other sensors to evaluate for SDB. There is an abundance of data to support the use of a PAT-based HSAT for obstructive sleep apnea (OSA), though data to support its use in central sleep apnea (CSA) in the general population undergoing PSG is lacking. We therefore aimed to compare the agreement of a PAT-based HSAT and PSG in detecting central disordered breathing events in the general population undergoing PSG. Methods A prospective cross-sectional study was conducted in eligible adult participants with suspected sleep apnea who were scheduled to undergo diagnostic or split-night PSG at the Center for Sleep Medicine at Mayo Clinic in Rochester, MN, between May 2021 and October 2022. The PAT-based HSAT was applied during the night of PSG to obtain simultaneous recording. Subjects were excluded if they had chronic atrial fibrillation, permanent pacemaker, or finger deformity precluding finger probe use or if they were on alpha- antagonists or short-acting nitrates. The PAT-based HSAT data were automatically scored with the use of proprietary software, and the PSG data were manually scored by registered polysomnography technologists. All studies were reviewed by board-certified sleep medicine providers. Results A total of 147 subjects (53% female) were included in the final analysis after excluding 18 subjects due to malfunction of the PAT-based HSAT. The subjects had a mean age of 58±15 yrs and BMI of 34±9 kg/m². 95 (65%) subjects underwent split-night studies. OSA was diagnosed in 81% with a mean PSG AHI of 28±27 events per hour. CSA was diagnosed in 3% of subjects with a mean PSG AHI of 33±27 events per hour. Of the total 2120 central disordered breathing events reported by the PAT-based HSAT (mean pAHIc 3±5 events per hour), 365 (17%) correlated with central apneas and 78 (3.7%) correlated with central hypopneas found on PSG. Conclusion In our prospective study, the PAT-based HSAT demonstrated low positive predictive value in detecting central disordered breathing events when compared to PSG. Support (if any)

Validation of a primary care electronic medical records case definition for eczema: retrospective cross-sectional study

BackgroundTo validate case definitions for eczema using primary care Electronic Medical Record (EMR) data from the Canadian Primary Care Sentential Surveillance Network (CPCSSN).MethodsThis study used EMR data from 1,574 primary care providers in seven Canadian provinces, representing 689,301 patients. Using a subset of patient records seven medical students or family medicine residents created a reference set of 1,772 patients. A total of 23 clinician-informed case definitions were validated against the reference. We assessed agreement using sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV) and overall accuracy. The case definitions with the best agreement statistics were deployed to estimate the prevalence of eczema in the CPCSSN.ResultsCase definition 1 had the highest SE (92.1%,85.0-96.5) but a lower SP (88.5%,86.7–90.1) and PPV (36.6%,33.1–40.3). Case definition 7 was the most specific case definition with a SP (99.8%, 99.4–100) and PPV (84.2%,61.2–94.7) but low SE (15.8%,9.3–24.5). Case definition 17 had a SE (75.3%, 65.7–83.3), SP (93.8%, 91.5–94.3) and PPV 43.7% (38.3–49.2). When we applied the most specific and most sensitive case definitions, we estimate the prevalence of eczema to be between 0.8 and 15.1%. Case definition 17 suggests an eczema prevalence estimate of 8.2% (8.08–8.21%).ConclusionsWe validated EMR-based eczema case definitions to estimate the prevalence of clinician-documented eczema. Future studies may choose to apply one or more of these definitions’ dependent on their studies objectives to inform disease surveillance as well as explore burden of illness or interventions related to eczema care in Canada.

A comparative analysis of APGAR score and the gold standard in the diagnosis of birth asphyxia at a tertiary health facility in Kenya.

Birth asphyxia is a consistent key contributor to neonatal morbidity and mortality, notably in sub-Saharan Africa. The APGAR score, though a globally used diagnostic tool for birth asphyxia, remains largely understudied especially in resource-poor settings. This study determined how effectively the APGAR score is used to diagnose birth asphyxia in comparison to the gold standard (umbilical cord blood pH <7 with neurologic involvement) at Moi Teaching and Referral Hospital (MTRH), and identified healthcare provider factors that affect ineffective use of the score. Using a quantitative cross-sectional hospital-based design, term babies born in MTRH who weighed ≥2500g were randomly and systematically sampled; and healthcare providers who assign APGAR scores were enrolled via a census. Umbilical cord blood was drawn at birth and at 5minutes for pH analysis. APGAR scores assigned by healthcare providers were recorded. Effective use of the APGAR score was determined by sensitivity, specificity, positive and negative predictive values. At a significance level of 0.05, multiple logistic regression analysis identified the independent provider-associated factors affecting ineffective use of the APGAR score. We enrolled 102 babies, and 50 (49%) were females. Among the 64 healthcare providers recruited, 40 (63%) were female and the median age was 34.5years [IQR: 31.0, 37.0]. Assigned APGAR scores had a sensitivity of 71% and specificity of 89%, with positive and negative predictive values of 62% and 92% respectively. Healthcare provider factors associated with ineffective APGAR score use included: instrumental delivery (OR: 8.83 [95% CI: 0.79, 199]), lack of access to APGAR scoring charts (OR: 56.0 [95% CI: 12.9, 322.3]), and neonatal resuscitation (OR: 23.83 [95% CI: 6.72, 101.99]). Assigned APGAR scores had low sensitivity and positive predictive values. Healthcare provider factors independently associated with ineffective APGAR scoring include; instrumental delivery, lack of access to APGAR scoring charts, and neonatal resuscitation.

Tomosynthesis-Detected Architectural Distortions: Correlations between Imaging Characteristics and Histopathologic Outcomes.

to determine the positive predictive value (PPV) of tomosynthesis (DBT)-detected architectural distortions (ADs) and evaluate correlations between AD's imaging characteristics and histopathologic outcomes. biopsies performed between 2019 and 2021 on ADs were included. Images were interpreted by dedicated breast imaging radiologists. Pathologic results after DBT-vacuum assisted biopsy (DBT-VAB) and core needle biopsy were compared with AD detected by DBT, synthetic2D (synt2D) and ultrasound (US). US was performed to assess a correlation for ADs in all 123 cases and a US correlation was identified in 12/123 (9.7%) cases, which underwent US-guided core needle biopsy (CNB). The remaining 111/123 (90.2%) ADs were biopsied under DBT guidance. Among the 123 ADs included, 33/123 (26.8%) yielded malignant results. The overall PPV for malignancy was 30.1% (37/123). The imaging-specific PPV for malignancy was 19.2% (5/26) for DBT-only ADs, 28.2% (24/85) for ADs visible on DBT and synth2D mammography and 66.7% (8/12) for ADs with a US correlation with a statistically significant difference among the three groups (p = 0.01). DBT-only ADs demonstrated a lower PPV of malignancy when compared with syntD mammography, and DBT detected ADs but not low enough to avoid biopsy. As the presence of a US correlate was found to be related with malignancy, it should increase the radiologist's level of suspicion, even when CNB returned a B3 result.

Genetic examination of the Mood Disorder Questionnaire and its relationship with bipolar disorder.

The Mood Disorder Questionnaire (MDQ) is a common screening tool for bipolar disorder that assesses manic symptoms. Its utility for genetic studies of mania or bipolar traits has not been fully examined. We psychometrically compared the MDQ to self-reported bipolar disorder in participants from the United Kingdom National Institute of Health and Care Research Mental Health BioResource. We conducted genome-wide association studies of manic symptom quantitative traits and symptom subgroups, derived from the MDQ items (N = 11,568-19,859). We calculated genetic correlations with bipolar disorder and other psychiatric and behavioral traits. The MDQ screener showed low positive predictive value (0.29) for self-reported bipolar disorder. Neither concurrent nor lifetime manic symptoms were genetically correlated with bipolar disorder. Lifetime manic symptoms had a highest genetic correlation (rg = 1.0) with posttraumatic stress disorder although this was not confirmed by within-cohort phenotypic correlations (rp = 0.41). Other significant genetic correlations included attention deficit hyperactivity disorder (rg = 0.69), insomnia (rg = 0.55), and major depressive disorder (rg = 0.42). Our study adds to existing literature questioning the MDQ's validity and suggests it may capture symptoms of general distress or psychopathology, rather than hypomania/mania specifically, in at-risk populations.

Systemic Inflammatory Molecules Are Associated with Advanced Fibrosis in Patients from Brazil Infected with Hepatitis Delta Virus Genotype 3 (HDV-3).

Hepatitis Delta virus (HDV) genotype 3 is responsible for outbreaks of fulminant hepatitis in Northeastern South America. This study investigates if systemic inflammatory molecules are differentially expressed in patients with advanced fibrosis chronically infected with Hepatitis Delta virusgenotype 3(HDV-3). Sixty-one patients from the north of Brazil coinfected with hepatitis B virus (HBV)/HDV-3 were analyzed. HDV quantification and genotyping were performed by semi-nested real-time polymerase chain reaction (RT-PCR) and restriction fragment length polymorphism (RFLP) methodologies. Ninety-two systemic inflammatory molecules (SIMs) were measured by Proximity Extension Assay (PEA) technology. The Shapiro-Wilk, Student's t-test, Mann-Whitney tests, and logistic regression analysis were used when appropriate. The median age was 41 years, and all patients were HBeAg negative. Advanced fibrosis or cirrhosis was diagnosed by histological staging in 17 patients, while 44 presented with minimal or no fibrosis. Advanced necroinflammatory activity correlated positively with serum levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Established non-invasive fibrosis scores (APRI, FIB-4, and AST/ALT ratio) revealed low sensitivities and positive predictive values (PPVs) with an AUROC maximum of 0.586. Among the 92 SIMs analyzed, MCP.4, CCL19, EN.RAGE, SCF, and IL18 showed a positive correlation with fibrosis stage. A combined score including CCL19 and MCP.4 revealed a sensitivity of 81% and an odds ratio of 2.202 for advanced fibrosis. Standard non-invasive fibrosis scores showed poor performance in HDV-3 infection. We here suggest that the determination of CCL19 and MCP.4 may be used to identify patients with advanced fibrosis. Moreover, this study gives novel insights into the immunopathogenesis of HDV-3 infection.

Predictors of the need for re-evacuation of newborns from secondary level hospitals

BACKGROUND: The medical evacuation of premature newborns to institutions providing a higher level of medical care results in the reduction of death risk. The use of pediatric intensive care units in level 2 organizations for the hospitalization of newborns can be a potential solution to the lack of neonatal beds in level 3 institutions.&#x0D; AIM: This study aimed to determine the predictors of the re-evacuation of newborns from level 2 medical organizations to level 3 institutions.&#x0D; MATERIALS AND METHODS: This observational, cohort, retrospective study included data of 284 cases of the evacuation of newborns from level 1 and 2 medical organizations without a pediatric intensive care unit to level 2 medical organizations with a pediatric intensive care unit. The sample was divided into two groups: the first group included patients who received the necessary therapy in level 2 medical organizations and did not require further evacuation to level 3 (n = 261), and the second group included patients who required further transfer to level 3 (n = 23). Anamnesis data, nosological structure, respiratory support parameters, intensive therapy, and volume of pretransoport activities in the groups were analyzed. Methods of statistical analysis included median, interquartile range, proportion and its 95% CI, Fisher exact test, MannWhitney test, receiver operating characteristic analysis, and odds ratio.&#x0D; RESULTS: The predictor of the requirement for re-evacuation was birthweight (area under the curve [AUC] 0.658 [0.5220.795]). When only patients on a ventilator were included in the analysis, the saturation oxygenation index (AUC 0.730 [0.5790.863]) and the SpO2/FiO2 ratio (AUC 0.720 [0.5710.869]) have the maximum predictive value.&#x0D; CONCLUSIONS: Birthweight of 1390 g (AUC 0.658 [0.5220.795], sensitivity 0.348 [0.1530.542], and specificity 0.950 [0.9240.977]) is a predictor of the requirement for further evacuation of newborns from level 2 pediatric and neonatal intensive care units to a level 3 organization. For patients on a ventilator, such predictors included saturation oxygenation index 4.25 (AUC 0.730 [0.5790.863], sensitivity 0.471 [0.2330.708] and specificity 0.928 [0.8880.967]) and SpO2/FiO2 ratio 265.71 (AUC 0.720 [0.5710.869], sensitivity 0.588 [0.3540.822], and specificity 0.837 [0.7810.893]). However, the high negative and low positive predictive values for these parameters do not allow their solitary use when deciding about routing a newborn.

Low Specificity of Rapid Eye Movement Sleep Behavior Disorder Questionnaires: Need for Better Screening Methods.

Correct diagnosis of rapid eye movement sleep behavior disorder (RBD) is critical due to its link to α-synucleinopathies and risk of injuries and requires video-polysomnography (V-PSG). Usefulness of screening questionnaires outside the context of validation studies is limited. The aim was to assess the performance of three validated RBD screening questionnaires compared with gold-standard V-PSG. In this bicentric prospective study, 400 consecutive subjects referred to a sleep center for the first time filled three RBD questionnaires (RBD Screening Questionnaire, RBD Single Question, and Innsbruck RBD Inventory) in random order before sleep experts' interview. Subjects positive for at least one questionnaire were invited to undergo V-PSG. Data from patients negative for all questionnaires undergoing V-PSG for other reasons were also evaluated. Questionnaire performances were compared to gold-standard V-PSG RBD diagnosis. Three hundred ninety-nine patients (median age: 51 [interquartile range: 37-64] years, 54.9% men) participated. Two hundred thirty-eight (59.6%) were positive for at least one questionnaire, and RBD was diagnosed using V-PSG in 30 patients (7.5%). Questionnaire specificity was 48.1% to 67.4%, sensitivity 80% to 92%, accuracy 51% to 68.3%, negative predictive value 94.2% to 98%, and positive predictive value 14.1% to 20.7%, with no relevant differences in performances among the evaluated questionnaires. RBD questionnaires have low specificity and low positive predictive value and should not be used as a standalone tool for the diagnosis of RBD. Further development of RBD screening methods is needed, particularly for upcoming neuroprotective trials. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Calibrating the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) for detecting alcohol-related problems among Canadian, UK and US soldiers: cross-sectional pre-deployment and post-deployment survey results

ObjectivesExcessive alcohol use can bring about adverse health and work-related consequences in civilian and military populations. Screening for excessive drinking can help identify individuals at risk for alcohol-related problems who...

Impact of prostate imaging quality (PI-QUAL) score on the detection of clinically significant prostate cancer at biopsy

PurposeTo investigate the impact of Prostate Imaging Quality (PI-QUAL) scores on the diagnostic performance of multiparametric MRI (mpMRI) in a targeted biopsy cohort. Patients and methods300 patients who underwent both mpMRI and biopsy were included. PI-QUAL scores were retrospectively assigned by two radiologists in consensus and were correlated to pre-biopsy PI-RADS scores and biopsy outcomes. Clinically significant prostate cancer (csPCa) was defined as ISUP grade ≥ 2. ResultsImage quality was optimal (PI-QUAL ≥ 4) in 249/300 (83%) and suboptimal (PI-QUAL < 4) in 51/300 (17%). The proportion of PI-RADS 3 scores referred for biopsy was higher in scans of suboptimal vs optimal quality (51% vs 33%). For PI-QUAL < 4 scans, the positive predictive value (PPV) was lower compared to PI-QUAL ≥ 4 (35% [95%CI: 22, 48] vs 48% [95%CI: 41, 55]; difference −13% [95%CI: −27, 2]; p 0.090), as was the detection rate of csPCa in both PI-RADS 3 and PI-RADS 4–5 (15% vs 23% and 56 vs 63%, respectively). The overall MRI quality increased over time. ConclusionsScan quality may affect the diagnostic performance of prostate mpMRI in patients undergoing MRI-guided biopsy. Scans of suboptimal quality (PI-QUAL < 4) were associated with lower PPV for csPCa.

Patient Factors in the Dose Selection of Oral Sumatriptan for Acute Migraine: A Post Hoc Analysis of Two Randomized Controlled Studies.

Patients are seeking greater involvement in their healthcare. It therefore may be beneficial to provide guidance on initial oral sumatriptan dose selection for the treatment of acute migraine in nontraditional settings, such as telehealth and other remote forms of medical care. We sought to determine whether clinical or demographic factors are predictive of oral sumatriptan dose preference. This was a post hoc analysis of two clinical studies designed to determine preference for 25, 50, or 100mg oral sumatriptan. Patients were aged 18-65years with at least a 1year history of migraine and experienced, on average, between one and six severe or moderately severe migraine attacks per month, with or without aura. Predictive factors were demographic measures, medical history, and migraine characteristics. Possibly predictive factors were identified using three analyses: classification and regression tree analysis, marginal significance (P < 0.1) within a full-model logistic regression, and/or selection within a forward-selection procedure in a logistic regression. A reduced model containing the variables identified in the preliminary analyses was developed. Due to differences in study design, data were not combined. A dose preference was expressed by 167 patients in Study 1 and 222 patients in Study 2. Gender and medical history of urologic and/or psychological conditions in Study 1 and duration of migraine history, height, and medical history of endocrine or neurologic disease and headache severity in Study 2 were identified as possibly predictive. The predictive model showed low positive predictive value (PPV; 23.8%) and low sensitivity (21.7%) for Study 1. For Study 2, the model showed moderate PPV (60.0%) but low sensitivity (10.9%). No clinical or demographic characteristics alone or in combination were consistently or strongly associated with preference for oral sumatriptan dose level. The studies on which this paper is based were conducted before trial registration indexes were introduced.

Antinükleer Antikor Pozitif Hastalarda Test İsteme Nedenleri ve Hastaların Nihai Tanıları

Background: The aim of this study was to determine the reasons for the request for antinuclear antibody (ANA) in ANA-positive patients and to determine the final diagnosis of these patients and whether they developed a rheumatologic disease. Method: In this retrospective study, the files of 559 patients with positive ANA were reviewed. Demographic, laboratory and clinical characteristics of the patients were noted. At the end of follow-up, the final diagnosis was recorded. Results: The study included 346 patients. 233 of the patients were female, and 113 were male. The mean age at the time of ANA positivity was 9.4  4.7 years, and the mean follow-up period was 19  5.7 months. The most common symptom was myalgia/arthralgia (21.7%). Other common reasons were urticaria, abdominal pain, thrombocytopenia, and proteinuria. Extractable nuclear antigens (ENA) panel results were negative in 170 patients (49.1%). In the ENA panel, dense fine speckled antigen 70 antibodies were most frequently positive in 135 patients (39.2%). At the end of follow-up, 234 patients had no disease. One hundred and one patients were diagnosed with non-rheumatologic diseases, and 11 patients were diagnosed with rheumatologic diseases. Eleven patients with rheumatologic diseases were girls. Rash was the most common symptom in patients with rheumatologic diseases. The positive predictive value of ANA positivity for rheumatologic disease was 3.2% and 1.7% for systemic lupus erythematosus. Conclusions: Due to the low positive predictive value of ANA testing, patients at risk for autoimmune diseases should be identified and carefully evaluated before ANA is requested.

Prediction Models for Intravenous Immunoglobulin Resistance in Kawasaki Disease: A Meta-analysis.

Approximately 10% to 20% of patients with Kawasaki disease (KD) are refractory to initial intravenous immunoglobulin (IVIG) therapy. KD is mainly associated with coronary artery abnormalities. To identify and evaluate all developed prediction models for IVIG resistance in patients with KD and synthesize evidence from external validation studies that evaluated their predictive performances. PubMed Medline, Dialog Embase, the Cochrane Central Register of Controlled Trials, the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov were searched from inception until October 5, 2021. All cohort studies that reported patients diagnosed with KD who underwent an initial IVIG of 2 g/kg were selected. Study and patient characteristics and model performance measures. Two authors independently extracted data from the studies. The Kobayashi, Egami, Sano, Formosa, and Harada scores were the only prediction models with 3 or more external validation of the161 model analyses in 48 studies. The summary C-statistics were 0.65 (95% confidence interval [CI]: 0.57-0.73), 0.63 (95% CI: 0.55-0.71), 0.58 (95% CI: 0.55-0.60), 0.50 (95% CI: 0.36-0.63), and 0.63 (95% CI: 0.44-0.78) for the Kobayashi, Egami, Sano, Formosa, and Harada models, respectively. All 5 models showed low positive predictive values (0.14-0.39) and high negative predictive values (0.85-0.92). Potential differences in the characteristics of the target population among studies and lack of assessment of calibrations. None of the 5 prediction models with external validation accurately distinguished between patients with and without IVIG resistance.