Medical Diagnostic Tests Research Articles

Surgical Management of Crohn’s Disease: An Overview

Crohn's Disease (CD) is a chronic inflammatory condition of the digestive tract resulting in symptoms such as abdominal pain, weight loss, and fatigue, requiring a multifaceted approach to management. While not curative, the surgical management of CD forms a vital part of the therapeutic strategy for complications. This article overviews various surgical methods for treating CD, their indications, and potential complications. CD predominantly emerges in developed countries, with known risk factors including genetic predisposition, environmental triggers, and diet. The clinical presentation involves varied symptoms based on the inflammation's location within the gastrointestinal tract. Diagnosis necessitates a comprehensive approach, including medical history, physical examination, and diagnostic tests. Surgical intervention may be necessary due to severe complications like intestinal obstruction, abscesses, strictures, fistulas, and perforation. Common reasons for surgery include medically resistant disease and malignancy. However, postoperative recurrence is frequent, necessitating repeated surgery in 26% of cases. This narrative review paper examines three major surgical interventions in detail. Fistulotomy, primarily used for simple fistulas, can offer symptomatic relief in well-selected CD cases but may risk complications and high recurrence rates. Stricturoplasty, useful for widening narrow bowels, preserves intestinal length and function and can serve as an effective alternative to resection. Lastly, the intestinal resection and colectomy procedures are explored, focusing on their indications and complications. Future research should focus on optimizing surgical approaches to reduce recurrence rates and improve patient outcomes.

Into the unknown: The end of the coronavirus disease 2019 public health emergency in the United States and potential impacts on organ transplant recipients

The public health emergency for coronavirus disease 2019 ended on April 11, 2023, 1 month earlier than its planned termination. The hasty cessation of emergency measures may negatively impact the care of solid organ transplant recipients and other immunosuppressed hosts. Accelerated pathways for drug and vaccine approvals, research funding, and insurance coverage for medical therapies and diagnostic testing are likely to be affected. Health care disparities that characterized the early pandemic may again be intensified. It is imperative that the transplant community promptly anticipate the impact of these changes and prepare accordingly to avoid disruptions in care for the most vulnerable patients.

Role of viral pathogen(s) detection in hospital-based management of 29-90-day-old infants with unexplained fever.

The risk for invasive bacterial infection (IBI) in young infants with fever increases the use of invasive and therapeutic interventions, such as lumbar puncture (LP) and antimicrobials which may be unnecessary. In the present study, we analyzed whether viral pathogen(s) detection using a respiratory pathogen panel (RPP) alters the use of LP and antibiotics in 29-90-day-old infants presenting with fever to a regional pediatric hospital. We collected medical history, clinical presentation, diagnostic tests and results, treatment, disposition, and length of stay (LOS) for selected patients. Data were compared between RPP positive (+) and RPP negative (-) infants. Use of LP and antibiotics were controlled for using regression analysis. P values <0.05 were considered significant. Among 172 RPP-tested infants, 45.4% had a virus(es). LP and antibiotics were used in 14.2% and 19.5% of infants in RPP(+) and in 17.0% and 28.7% in RPP(-) groups (P=0.60, 0.16), respectively. Nearly half of the infants in both groups were admitted and had comparable LOS. Hospitalization and at least one abnormal laboratory result were associated with a 2-3 times higher chance of LP and antibiotic utilization, irrespective to age and temperature level. No studied infant had been diagnosed with IBI, and 14.5% of infants in the RPP(-) group had bacteriuria. Detection of viral pathogen(s) did not significantly reduce the use of LP or antimicrobials in young infants with unexplained fever.

Geometry-Gradient Magnetocontrollable Lubricant-Infused Microwall Array for Passive/Active Hybrid Bidirectional Droplet Transport.

Manipulation of droplets has increasingly garnered global attention, owing to its multifarious potential applications, including microfluidics and medical diagnostic tests. To control the droplet motion, geometry-gradient-based passive transport has emerged as a well-established strategy, which induces a Laplace pressure difference based on the droplet radius differences in confined state and transport droplets with no consumption of external energy, whereas this transportation method has inevitably shown some critical limitations: unidirectionality, uncontrollability, short moving distance, and low velocity. Herein, a magnetocontrollable lubricant-infused microwall array (MLIMA) is designed as a key solution to this issue. In the absence of a magnetic field, droplets can spontaneously travel from the tip toward the root of the structure as a result of the geometry-gradient-induced Laplace pressure difference. When the subject of an external magnetic field, the microwalls bend and overlap sequentially, ultimately resulting in the formation of a continuous slippery meniscus surface. The formed meniscus surface can exert sufficient propulsive force to surmount the Laplace pressure difference of the droplet, thereby effectuating active transport. Through the continuous movement of the microwalls, droplets can be actively transported against the Laplace pressure difference from the root to the tip side of the MLIMA or continue to actively move to the root after finishing the passive self-transport. This work demonstrates passive/active hybrid bidirectional droplet transport capabilities, validates its feasibility in the accurate control of droplet manipulation, and exhibits great potential in chemical microreactions, bioassays, and the medical field.

Kidney Segmentations Using CNN models

For medical diagnostic tests, kidney segmentation from high-volume imagery is an important major. Since 3D medical images need a lot of GPU memory, slices and patches are used for training and inference in traditional neural network variant architectures, which necessarily slows down contextual learning. In this research, Mobile Net and Efficient Net CNN models were trained for segmenting human kidney images generated from The Human Biomolecular Atlas Program (HuBMAP). The purpose of this work is to evaluate the effectiveness of different strategies for Glomeruli identification in order to solve the issue. The high size images were decoded to be fitted and trained in the models first, then the CNN models were trained. The CNN models result show that the Efficient Net has the highest accuracy rate with 99.49 %, and Mobile Net with 99.33 %.

Global Barriers to the Diagnosis of Multiple Sclerosis: Data From the Multiple Sclerosis International Federation Atlas of MS, Third Edition.

Recent data suggest increasing global prevalence of multiple sclerosis (MS). Early diagnosis of MS reduces the burden of disability-adjusted life years and associated health care costs. Yet diagnostic delays persist in MS care and even within national health care systems with robust resources, comprehensive registries, and MS subspecialist referral networks. The global prevalence and characteristics of barriers to expedited MS diagnosis, particularly in resource-restricted regions, have not been extensively studied. Recent revisions to MS diagnostic criteria demonstrate potential to facilitate earlier diagnosis, but global implementation remains largely unknown. The Multiple Sclerosis International Federation third edition of the Atlas of MS was a survey that assessed the current global state of diagnosis including adoption of MS diagnostic criteria; barriers to diagnosis with respect to the patient, health care provider, and health system; and existence of national guidelines or national standards for speed of MS diagnosis. Coordinators from 107 countries (representing approximately 82% of the world population), participated. Eighty-three percent reported at least 1 "major barrier" to early MS diagnosis. The most frequently reported barriers included the following: "lack of awareness of MS symptoms among general public" (68%), "lack of awareness of MS symptoms among health care professionals" (59%), and "lack of availability of health care professionals with knowledge to diagnose MS" (44%). One-third reported lack of "specialist medical equipment or diagnostic tests." Thirty-four percent reported the use of only 2017 McDonald criteria (McD-C) for diagnosis, and 79% reported 2017 McD-C as the "most commonly used criteria." Sixty-six percent reported at least 1 barrier to the adoption of 2017 McD-C, including "neurologists lack awareness or training" by 45%. There was no significant association between national guidelines pertaining to MS diagnosis or practice standards addressing the speed of diagnosis and presence of barriers to early MS diagnosis and implementation of 2017 McD-C. This study finds pervasive consistent global barriers to early diagnosis of MS. While these barriers reflected a lack of resources in many countries, data also suggest that interventions designed to develop and implement accessible education and training can provide cost-effective opportunities to improve access to early MS diagnosis.

Estimating transformations for evaluating diagnostic tests with covariate adjustment.

Receiver operating characteristic analysis is one of the most popular approaches for evaluating and comparing the accuracy of medical diagnostic tests. Although various methodologies have been developed for estimating receiver operating characteristic curves and their associated summary indices, there is no consensus on a single framework that can provide consistent statistical inference while handling the complexities associated with medical data. Such complexities might include non-normal data, covariates that influence the diagnostic potential of a test, ordinal biomarkers or censored data due to instrument detection limits. We propose a regression model for the transformed test results which exploits the invariance of receiver operating characteristic curves to monotonic transformations and accommodates these features. Simulation studies show that the estimates based on transformation models are unbiased and yield coverage at nominal levels. The methodology is applied to a cross-sectional study of metabolic syndrome where we investigate the covariate-specific performance of weight-to-height ratio as a non-invasive diagnostic test. Software implementations for all the methods described in the article are provided in the tram add-on package to the R system for statistical computing and graphics.

High-sensitivity strain sensor with micron-scale imitation dumbbell structure based on differential temperature self-compensation

A micron-sized dumbbell-like -MZI structure has been developed using hydroxide flame melt taper and arc fusion discharge, with the dumbbell rod region prepared by melt taper drawing and the dumbbell sheet region prepared by arc fusion discharge. This structure has a sensitive light intensity response in the sensing field due to a double-order mode-field coupled excitation region. The geometrical parameters of the dumbbell-like system are optimized theoretically, and the feasibility of the microstructure to achieve high strain sensing sensitivity is analyzed. Experimental results show that the microstructure has a high strain sensing sensitivity of ∼ 0.074 dB/µε and a consistent temperature sensing sensitivity over the entire monitoring wavelength range. Therefore, a light intensity-dependent temperature self-compensation calculation is proposed to achieve a uniform light intensity-strain response for each characteristic peak in the monitored wavelength domain. Since the device has a significant advantage in light intensity modulation and is not affected by polarization light perturbations, it can be used as an alternative light intensity modulation device in optical communication networks and laser research. It can also be used as a probe for medical diagnostic testing based on its enhanced evanescent field properties.

Machine Learning in Cardiology: a Survey of Early Detection Models for Heart Diseases

Heart disease detection and early prediction is one of the most difficult tasks in the medical field. Almost two people die every minute due to cardio vesicular diseases. According to World Health Organization (WHO), 17.9 million people depart their life every year out of which 4.77 million people are from India alone. About 13% of the world's total population is involved in cardiac disease. Early detection of the disease is crucial for effective treatment that can save millions of lives in the world. Traditional methods of heart disease detection typically involve a combination of medical history, physical examination, and diagnostic tests which are less accurate. With the advancements in machine learning and deep learning techniques, the development of accurate prediction models for heart disease has become possible. Nowadays a large volume of data is being generated in the healthcare sector, which can be leveraged to empower the development of accurate prediction models for heart diseases. Various techniques such as logistic regression, decision trees, random forest, support vector machine, artificial neural networks, and convolutional neural networks have been applied to predict heart diseases. Over the years, advancements in medical technology have led to the development of new diagnostic tools and techniques for detecting heart disease. In this study, a comparative analysis of these techniques is carried out to understand the architectures, parametric characteristics, and datasets involved in heart disease prediction. Our analysis indicates that most heart disease prediction system that have been designed using deep learning algorithms show promising performance.

Acute central corneal haze and thinning with atypical keratitis presentation

A 24-year-old woman presented with a 7-day history of blurry vision, redness, and extreme pain in her right eye. She had no pertinent medical or ocular history and did not use spectacles or contacts. Uncorrected distance visual acuity (UDVA) was 20/40 in the right eye and could not be improved with refraction. Slitlamp examination revealed a 1.5 × 1.5 mm central epithelial defect with surrounding white blood cell recruitment. Confocal microscopy (Figure 1JOURNAL/jcrs/04.03/02158034-202304000-00020/figure1/v/2023-03-24T200747Z/r/image-tiff) was performed, and she was treated with chlorhexidine 0.02% drops every hour in the right eye. 2 weeks later, the cornea had completely re-epithelialized; however, persistent corneal haze, decreased visual acuity, and corneal thinning and flattening was noted. Pachymetry was 484 µm in the right eye and UDVA was 20/40 (Supplemental Figure 1, available at http://links.lww.com/JRS/A836). In the following 2 weeks, UDVA improved to 20/25. 6 months after the initial presentation, UDVA was unchanged and faint central corneal haze was noted on examination (Figure 2JOURNAL/jcrs/04.03/02158034-202304000-00020/figure2/v/2023-03-24T200747Z/r/image-tiff). Of interest, her family history is significant for her younger 16-year-old brother with 3 prior episodes of a similar type of keratitis/keratopathy over the course of 2 years in both eyes with similar central paracentral corneal haze, thinning, and flattening and similar confocal findings (Figure 3JOURNAL/jcrs/04.03/02158034-202304000-00020/figure3/v/2023-03-24T200747Z/r/image-tiff). He also was unresponsive to topical antibiotics and antivirals except topical chlorhexidine. Her brother has been our patient for the last several years prior to her first visit to our clinic. What is your diagnosis? What medical diagnostic tests, if any, would you recommend? Is this an infectious or simply an inflammatory response? Is there any genetic or familial predisposition?

Access to diabetes diagnosis in Brazil based on recent testing and consultation: The Brazilian national health survey, 2013 and 2019.

Screening for undiagnosed diabetes using glucose testing is recommended globally to allow preventive action among those detected. Our aim was to evaluate the access to glucose testing to screen for diabetes in Brazil using self-reported information on recent testing and medical consultation from national surveys of Brazilian adults. The Pesquisa Nacional de Saúde (PNS) was conducted in 2013 and 2019 drawing probabilistic samples of Brazilians aged 18 years and above. To evaluate glucose testing among those undiagnosed, we excluded those self-reporting a previous diagnosis of diabetes. We then defined recent access to diabetes diagnosis by considering the previous two years and choosing the last blood glucose test and the proximal medical consultation reported. We used Poisson regression with robust variance to assess correlates of access, expressing them with adjusted prevalence ratios (PR) and their 95% confidence intervals. Access to recent glucose testing documented that over 70% reported a recent glycemic test, 71% in 2013, and 77% in 2019. These findings are consistent with a wide recent access to medical consultation, 86% and 89% in 2013 and 2019, respectively. Reporting recent glucose testing and medical consultation may better reflect the actual access to medical diagnostic testing. When analyzing this joint outcome, diagnostic access was still wide, 67% and 74%, respectively. Greater access (p< 0.001) was seen for women (PR=1.16; 1.15-1.17), older individuals (PR=1.25; 1.22-1.28), and those with higher education (PR=1.17; 1.15-1.18), obesity (PR=1.06; 1.05-1.08), and hypertension (PR=1.12; 1.11-1.13). In contrast, lower access (p<0.001) was seen for those declaring being Black (PR=0.97; 0.95-0.99) or of mixed-race (PR=0.97; 0.96-0.98), those residing in rural areas (PR=0.89; 0.87-0.90), and not having a private health insurance plan (PR=0.85; 0.84-0.86). Although access to diagnostic testing for diabetes is high in Brazil, partly due to its universal health system, social inequities are still present, demanding specific actions, particularly in rural areas and among those self-declaring as being Black or mixed-race.

Machine learning enables precise holographic characterization of colloidal materials in real time.

Holographic particle characterization uses in-line holographic video microscopy to track and characterize individual colloidal particles dispersed in their native fluid media. Applications range from fundamental research in statistical physics to product development in biopharmaceuticals and medical diagnostic testing. The information encoded in a hologram can be extracted by fitting to a generative model based on the Lorenz-Mie theory of light scattering. Treating hologram analysis as a high-dimensional inverse problem has been exceptionally successful, with conventional optimization algorithms yielding nanometer precision for a typical particle's position and part-per-thousand precision for its size and index of refraction. Machine learning previously has been used to automate holographic particle characterization by detecting features of interest in multi-particle holograms and estimating the particles' positions and properties for subsequent refinement. This study presents an updated end-to-end neural-network solution called CATCH (Characterizing and Tracking Colloids Holographically) whose predictions are fast, precise, and accurate enough for many real-world high-throughput applications and can reliably bootstrap conventional optimization algorithms for the most demanding applications. The ability of CATCH to learn a representation of Lorenz-Mie theory that fits within a diminutive 200 kB hints at the possibility of developing a greatly simplified formulation of light scattering by small objects.

Deep eutectic solvent-driven self-assembly of metal mercaptide complexes with enzyme-mimicking activities for detection of uric acid through one-step cascade catalytic reaction

This work presents a generic strategy to create a series of metal mercaptides complexes via coordination self-assembly between transition metals (Mn, Cu, Co, Fe, and Ni) and cysteine (Cys) by forming the sulfur-metal bridges. This strategy involves dissolving metal chlorides and Cys into deep eutectic solvents (DES), followed by the precipitation of metal mercaptides complexes (such as Cys-Mn) by adding water as an antisolvent, where DES serves as the solvent, shape directing, and capping agent, thereby preventing the formation of other metal impurities. Interestingly, the prepared complexes possess both laccase and peroxidase-like properties, allowing the design of a technique for the detection of L-3,4-dihydroxyphenylalanine (l-DOPA) and uric acid, respectively. The prepared Cys-Mn can linearly oxidize l-DOPA with its concentrations from 0.1 to 130 μM and the detection limit was calculated to be 75.5 nM. Additionally, the Cys-Mn can mimic the activity of peroxidase towards oxidization of o-phenylenediamine at neutral pH, allowing single-step and one-pot cascade reactions for visual and fluorometric measurements of uric acid (UA) that could work in the range of 0.2–500 μM UA with a detection limit of 0.06 μM and 0.054 μΜ, respectively. The assay was successful in detecting UA in serum and urine samples with relative standard deviation (RSD) ranging from 7.3% to 10.2% and 3.0%–8.5% respectively, suggesting that it may prove useful in medical diagnostic testing.

A beginner’s guide to peripheral nerve ultrasound

Ultrasonography is currently being developed as a tool for evaluating peripheral neuropathy. It is one of the painless and least-invasive methods of medical diagnostic testing that yields anatomic views of the nerves and their surrounding structures. Here I first describe the equipment settings and technique for nerve ultrasound along with typical sonographic findings for normal nerves. I then address frequently used parameters for nerve measurements that facilitate diagnoses of focal and generalized neuropathies.

305 Managing Low and Intermediate Risk Transient Ischemic Attacks in the Time of a Pandemic

Transient Ischemic Attacks (TIA) are both a harbinger of acute ischemic stroke and warrant urgent evaluation and management to reduce stroke risk. Recently, there has been increasing acceptance to evaluate low-risk (ABCD2 score 0-3) patients in an outpatient setting, but there is limited data on management of intermediate (ABCD2 score 4-5) risk patients. We hypothesized that intermediate risk TIA patients being treated according to protocolized medical management and diagnostic testing would have similar clinic follow-up and re- admission rates to low-risk patients.

Ensemble multimodal deep learning for early diagnosis and accurate classification of COVID-19

Over the past few years, the awful COVID-19 pandemic effect has become a lethal sickness. The processing of the gathered samples requires extra time due to the use of medical diagnostic equipment, methodologies, and clinical testing procedures for the early diagnosis of infected individuals. An innovative multimodal paradigm for the early diagnosis and precise categorization of COVID-19 is put up as a solution to this issue. To extract distinguishing features from the prepared chest X-ray picture and cough (audio) database, chest X-ray-based and cough-based model are used here. Other public chest X-ray image datasets, and the Coswara cough (audio) dataset containing 92 COVID-19 positive, and 1079 healthy subjects (people) using the deep Uniform-Net, and Convolutional Neural Network (CNN). The weighted sum-rule fusion method and ensemble deep learning algorithms are utilized to further combine the extracted features. For the early diagnosis of patients, the framework offers an accuracy of 98.67%.

Two Cases of Adult Inclusion Conjunctivitis Masquerading as Chronic Conjunctivitis

Purpose: To report two cases of adult inclusion conjunctivitis masquerading as chronic conjunctivitis.Case summary: (Case 1) A 34-year-old man presented with a foreign body sensation in his right eye for 2 months. At the first visit, slit lamp examination showed follicles on the inferior palpebral conjunctiva. Chlamydia trachomatis immunoglobulin M (IgM) antibody and polymerase chain reaction (PCR) tests were positive. The patient was prescribed doxycycline for 1 week, which improved the symptoms, followed by gentamicin and levofloxacin for an additional 5 days, which further improved the clinical symptoms and conjunctivitis. (Case 2) A 39-year-old man presented with right eye pain and redness for 5 months. At the first visit, slit lamp examination showed follicles on the inferior palpebral conjunctiva. Chlamydia trachomatis IgM antibody and PCR tests were positive. After 1 week of doxycycline treatment, the clinical symptoms and conjunctivitis improved.Conclusions: Because adult inclusion conjunctivitis caused by chlamydial infection has non-specific symptoms, it can be misdiagnosed as chronic conjunctivitis. A detailed medical history and appropriate diagnostic tests are necessary to make this diagnosis.

Characterization of Fluid Flow Through Porous Media

Microfluidic paper-based analytical devices (μPADs) are highly in demand because of their important usage in the field of medical diagnostic, biology and environmental testing. Porous media has been used as a μPADs with the benefits of cost-effective, excellent performance and ease of usage. Recently, porous media from paper-based filter paper has also been used as the main component for a self-powered imbibing micropump actuation. In this study, characterization of porous media from different specifications of Whatman ashless grade W40, W41 and W42 filter papers has been studied. In addition, the wicking or capillary flow capability of the porous media under an open and confined environment was also analyzed. Scanning Electron Microscope (SEM) and ImageJ image processing have been used as the method to determine the filter paper characteristics. Whatman filter paper grade W41 has the highest percentage of porosity which is 70.82 %. The porosity of filter paper grade W40 and W42 are 70.24 % and 61.8 % respectively. Meanwhile, experiments were conducted to understand the water wicking process for Whatman filter paper for different paper shapes and environments. Diamond-shaped filter paper resulted in faster wicking in the free environment compared with the constraint environment. The percentage difference of the wicking under these environments is 61.56 % and 141.09 % for W40 and W41 filter paper respectively. The experiment conducted also confirmed that the wicking behavior of the capillary height of the liquid in filter paper is proportional to the square root of the time. This result agreed well with the Lucas-Washburn equation. In conclusion, the characteristics of the liquid flow in porous media are closely related to its specification as provided by the manufacturer. Furthermore, the decrease of liquid wicking in a confined environment is the result of the high resistance of a liquid to flow with decreased filter paper porosity, permeability and thickness. This study provides important findings that will help in the optimization and best design of self-powered imbibing micropump for microfluidic device development.

Can Infant Dyschezia Be a Suspect of Rectosigmoid Redundancy?

Infant dyschezia is a functional gastrointestinal disorder that occurs in children less than nine months of age. This disorder causes much anxiety among parents who consult different physicians when suspecting major intestinal problems. The aim of this study is to verify whether infant dyschezia involves an anatomic abnormality (redundancy) of the colon. In this retrospective study (48 months) we analyzed all the children younger than 9 months who came to our attention through the suspicion of gastrointestinal abnormality (Hirschsprung’s disease, anorectal malformations, colonic disorders or constipation). They all had a complete medical history, clinical examination and diagnostic tests, such as blood samples, suction rectal biopsy, a study of stool characteristics and, finally, a contrast enema. In cases with infant dyschezia, different colonic sizes and rectosigmoid length were measured, which created a ratio with the diameter of the second lumbar vertebra. These values were compared with those reported in the literature as normal for the age of one year. Of the 24 patients evaluated (mean age 4 months), 9 were excluded for different diagnoses (aganglionic megacolon, hypothyroidism, constipation). The comparison of the ratios obtained in the remaining 15 cases showed a significantly higher rectosigmoid length (redundancy) in children with dyschezia, 18.47 vs. 9.75 (p < 0.001). The rectosigmoid redundancy, a congenital anomaly already reported as a cause of refractory constipation, may be present in children with infant dyschezia.

Evaluation of Pivot Shift under Anesthesia in Anterior Cruciate Ligament (ACL) Deficient knees

Background: Knee injuries are common injuries sustained in sports or accidents (domestic, road traffic, etc.).These injuries affect the different structures of the knees, affecting the skin, muscles, bone, ligaments, tendons, etc. Some of the structures are extra-articular and others are intra-articular. There are a lot of different ways that the anterior cruciate ligament (ACL) can be torn. The most common are low-speed, non-contact, deceleration, and contact injuries with a rotational component. Contact sports can also cause twisting, valgus stress, or hyperextension from direct contact or collision-related ACL secondary injuries. The pivot is one of these injuries. The shift test for anterolateral stability of the knee It is a painful test, so most of the patients will not cooperate if not under anesthesia. Objective: This study evaluates the angle of displacement of the tibia in relation to the femur at 30-degree knee flexion, knee extension, and the difference between knee flexion and knee extension. It also determined the angular estimation as outlined above after reconstruction. To compare the angular displacement in the pivot shift before and after reconstruction in an ACL-deficient knee. Methods: This study was conducted in the department of orthopedics, arthroscopy, and sports medicine at Aware Global Hospital, Hyderabad, India. The study was initiated from January 2015 to March 2015. Through inclusion criteria, 15 patients with knee instability were included in the study. Results: After completing the pivot shift test using spinal anesthesia, the knee was flexed to 30 degrees. Three K-wires are placed in three key locations. Compared to the affected knee, the angular displacement in flexed and extended knees is a more reliable and sensitive method for screening anterior instability of the knee due to ACL tear. It is also a low-cost method when specialized medical diagnostic tests are not available. Compared to MRI, it is a dynamic modality and has proven to be just as reliable in diagnosing ACL injuries.