Positive Likelihood Ratio Research Articles

Predictive Modeling of Acute Respiratory Distress Syndrome Using Machine Learning: Systematic Review and Meta-Analysis.

Acute respiratory distress syndrome (ARDS) is a critical condition commonly encountered in the intensive care unit (ICU), characterized by a high incidence and substantial mortality rate. Early detection and accurate prediction of ARDS can significantly improve patient outcomes. While machine learning (ML) models are increasingly being used for ARDS prediction, there is a lack of consensus on the most effective model or methodology. This study is the first to systematically evaluate the performance of ARDS prediction models based on multiple quantitative data sources. We compare the effectiveness of ML models via a meta-analysis, revealing factors affecting performance and suggesting strategies to enhance generalization and prediction accuracy. This study aims to evaluate the performance of existing ARDS prediction models through a systematic review and meta-analysis, using metrics such as area under the receiver operating characteristic curve, sensitivity, specificity, and other relevant indicators. The findings will provide evidence-based insights to support the development of more accurate and effective ARDS prediction tools. We performed a search across 6 electronic databases for studies developing ML predictive models for ARDS, with a cutoff date of December 29, 2024. The risk of bias in these models was evaluated using the Prediction model Risk of Bias Assessment Tool. Meta-analyses and investigations into heterogeneity were carried out using Meta-DiSc software (version 1.4), developed by the Ramón y Cajal Hospital's Clinical Biostatistics team in Madrid, Spain. Furthermore, sensitivity, subgroup, and meta-regression analyses were used to explore the sources of heterogeneity more comprehensively. ML models achieved a pooled area under the receiver operating characteristic curve of 0.7407 for ARDS. The additional metrics were as follows: sensitivity was 0.67 (95% CI 0.66-0.67; P<.001; I²=97.1%), specificity was 0.68 (95% CI 0.67-0.68; P<.001; I²=98.5%), the diagnostic odds ratio was 6.26 (95% CI 4.93-7.94; P<.001; I²=95.3%), the positive likelihood ratio was 2.80 (95% CI 2.46-3.19; P<.001; I²=97.3%), and the negative likelihood ratio was 0.51 (95% CI 0.46-0.57; P<.001; I²=93.6%). This study evaluates prediction models constructed using various ML algorithms, with results showing that ML demonstrates high performance in ARDS prediction. However, many of the existing models still have limitations. During model development, it is essential to focus on model quality, including reducing bias risk, designing appropriate sample sizes, conducting external validation, and ensuring model interpretability. Additionally, challenges such as physician trust and the need for prospective validation must also be addressed. Future research should standardize model development, optimize model performance, and explore how to better integrate predictive models into clinical practice to improve ARDS diagnosis and risk stratification. PROSPERO CRD42024529403; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024529403.

Cutoff Points for Commonly Used Instruments to Assess Mental Health Problems Among Adults With Tourette's Syndrome.

Attention-deficit hyperactivity disorder, obsessive-compulsive disorder, depression, and anxiety are highly comorbid in Tourette's syndrome. Cutoff points of screening instruments for these conditions have been validated in the general population. The authors assessed whether established cutoff points on the General Anxiety Disorder-7 (GAD-7) scale; Patient Health Questionnaire-9 (PHQ-9); PHQ-2; Adult ADHD Self-Report Scale, version 1.1 (ASRS v1.1); and Obsessive-Compulsive Inventory (OCI) need to be adjusted for adults with Tourette's syndrome. Thirty-six adults with Tourette's syndrome completed these instruments and a diagnostic psychiatric interview. Measures of diagnostic accuracy were calculated (area under the receiver operating characteristic curve [AUC], sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio) for each instrument at various cutoffs. Cutoffs for the sample of adults with Tourette's syndrome were suggested by the lowest value derived from a Euclidean distance method. In this sample of adults with Tourette's syndrome, the optimal cutoff points were a GAD-7 score ≥13 (sensitivity, 67%; specificity, 91%; and AUC, 79%), a PHQ-9 score ≥15 (sensitivity, 67%; specificity, 73%; and AUC, 70%), a PHQ-2 score ≥3 (sensitivity, 67%; specificity, 67%; and AUC, 67%), an ASRS v1.1 score ≥14 (sensitivity, 83%; specificity, 77%; and AUC, 80%), and an OCI score ≥63 (sensitivity, 70%; specificity, 89%; and AUC, 79%). The best-performing instrument was the ASRS v1.1, followed by the GAD-7 and OCI; the PHQ-9 and PHQ-2 performed least well in this population. Further research is needed to adapt screening instruments for the assessment of comorbid conditions among patients with Tourette's syndrome.

Revolutionizing cancer diagnosis and dose biodistribution: a meta-analysis of [68ga] FAPI- 46 vs. [18f] FDG imaging

BackgroundAdvancements in novel peptides significantly affect cancer diagnosis by targeting cancer-specific markers, thereby improving imaging modalities, such as positron emission tomography combined with computed tomography (PET/CT) for more accurate tumor detection. This systematic review and meta-analysis aimed to assess the diagnostic accuracy of [18F] Fluorodeoxyglucose (FDG) and 68Ga-fibroblast activation protein inhibitor (FAPI- 46) PET/CT for early cancer detection.MethodsA comprehensive search was conducted in Scopus, MEDLINE, Web of Science, and Embase databases up to March 28, 2024, using MeSH keywords. Titles and abstracts were screened to identify studies on hybrid [68Ga] FAPI- 46 and [18F] FDG, followed by a detailed full-text evaluation. Only cohort or cross-sectional studies published in English, focusing on the clinical diagnosis of cancer patients, were included, while reviews, case reports, conference proceedings, and abstracts were excluded. Random-effects meta-analysis was used for the estimation of pooled specificity and sensitivity with 95% confidence intervals (CIs). In addition, the heterogeneity was assessed across studies and subgroup meta-analyses for the detection rate via Stata.ResultsAmong the 615 retrieved studies, nine articles were incorporated in the present systematic review, with five (n = 144 patients) eligible for meta-analysis. For [68Ga] FAPI- 46, the pooled sensitivity and specificity compared with immunohistopathology were 0.96 (95% CI 0.84, 0.99) and 0.92 (95% CI 0.53, 0.99), respectively, with a positive likelihood ratio (LR +) of 4.41 (95% CI 1.64, 11.79) and a negative likelihood ratio (LR −) of 3.07 (95% CI 1.01, 9.37). For [18F] FDG, pooled sensitivity and specificity compared with immunohistopathology were 0.73 (95% CI 0.34, 0.93) and 0.83 (95% CI 0.57, 0.95), with an LR + of 12.73 (95% CI 1.43, 113.45) and an LR − of 0.32 (95% CI 0.11, 0.17). The pooled odds ratio for the detection rate on a per-lesion basis was 1.73 (95% CI 0.99, 3.02) for [68Ga] FAPI- 46 compared with [18F] FDG. The pooled weighted mean differences in the standardized uptake value (SUVmax) for primary tumor uptake and the tumor-to-background ratio (TBR) in [68Ga] FAPI- 46 vs. 18F-FDG were 4.40 (95% CI − 0.7, 9.5) and 6.18 (95% CI 1.74, 10.61), respectively. Moderate to high heterogeneity was noted because of the variations in patient selection, interpretation criteria, and scanning procedures.ConclusionsThis study revealed that [68Ga] FAPI- 46 outperforms [18F] FDG in cancer diagnosis, with higher sensitivity (0.96 vs. 0.73) and specificity (0.92 vs. 0.83). [Ga] FAPI- 46 improved tumor detection with higher SUVmax and TBR. While FDG had a higher LR +, its lower LR − highlighted more false negatives. Accordingly, [68Ga] FAPI- 46 exhibited superior accuracy and reliability than FDG in cancer diagnosis.Systematic review registrationPROSPERO CRD 42023472270.Graphical

Confirmatory Testing for Primary Aldosteronism : A Study of Diagnostic Test Accuracy.

Confirmatory testing to verify the diagnosis of primary aldosteronism (PA) in patients who have an abnormal screening result is of uncertain benefit. To perform a blinded assessment of the seated saline suppression test (SSST). Diagnostic test accuracy study. (ClinicalTrials.gov: NCT04422756). The regional Endocrine Hypertension Clinic in Calgary, Alberta, Canada. 156 adults with a positive screening result for PA. The SSST was done by administering 2 L of 0.9% sodium chloride intravenously over 4 hours with the patient seated. Treatment response was considered the reference standard for determining disease status and was based on blood pressure lowering, reduction of antihypertensive drug dose, and normalization of biochemistry. Measures of diagnostic test accuracy, including sensitivity, specificity, positive predictive value, and negative predictive value, were estimated. Post-SSST aldosterone concentrations measured using immunoassay overlapped between treatment responders (median, 329 pmol/L [IQR, 227 to 525 pmol/L]) and nonresponders (median, 255 pmol/L [IQR, 162 to 346 pmol/L]). The SSST could not discriminate between response statuses (area under the curve, 62.1% [95% CI, 45.1% to 79.1%]). The positive and negative likelihood ratios were equivocal for aldosterone cutoffs ranging from 140 to 300 pmol/L. These findings remained consistent after differences in treatment, occurrence of hypokalemia, and laboratory assay used were accounted for. The study population had many patients with high-risk features of PA and few nonresponders. The SSST is associated with a high false-negative rate, and reliance on it may lead to missed opportunities for intervention. The Canadian Institutes of Health Research, Hypertension Canada, and the Heart and Stroke Foundation of Canada.

Machine Learning Predictive Models for Survival in Patients with Brain Stroke

Background: This study aims to harness the predictive power of machine learning (ML) algorithms for accurately predicting mortality and survival outcomes in brain stroke (BS) patients. Methods: A total of 332 patients diagnosed with BS were enrolled in the study between April 21, 2006, and December 22, 2007, and then followed for 15 years (until 2023). Mortality outcomes were modeled using various statistical techniques, including the Cox model, decision trees, random survival forests (RSF), support vector machines (SVM), gradient boosting, and mboost. The best-performing model was selected based on diagnostic performance metrics: specificity, sensitivity, precision, accuracy, area under the receiver operating characteristic curve (AUC), positive likelihood ratio, negative likelihood ratio, and negative predictive value. Results: The results indicate that ML models in small sample sizes, particularly the SVM, outperformed the Cox model in predicting mortality and survival over 15 years, achieving an accuracy of 85% and an AUC of 0.765 (95% CI 0.637-0.83). Furthermore, the study identified important variables, including blood pressure history, waterpipe smoking, lack of physical activity, type of cerebrovascular accident, current smoking status, sex, and age, which provide valuable insights for clinicians in risk assessment. Conclusion: Our study showed that the SVM model outperforms the Cox model in predicting 15-year mortality and survival, particularly in small sample sizes. Moreover, the identification of key risk factors such as blood pressure history, waterpipe smoking, lack of physical activity, type of cerebrovascular accident, current smoking status, sex, and age highlights the need for their consideration in clinical assessments to enhance patient care.

Self-reported HIV viral load is reliable and not affected by adverse lived experiences of women living with HIV in British Columbia.

HIV viral load (VL) is a key predictor of long-term health for women living with HIV. Here, we investigate how HIV VL self-reported by women living with HIV enrolled in the British Columbia CARMA-CHIWOS Collaboration Study relates to clinically measured HIV VL. Three HIV-related stigma scales and associations with selected socio-demographic characteristics, such as lifetime history of homelessness, history of substance use, ethnicity, and knowledge about 'Undetectable = Untransmittable', were also examined. For 219 women enrolled between December 2020 and August 2023, self-reported HIV VL status (classified as undetectable ≤40 copies/mL or detectable >40 copies/mL) was compared with HIV VL obtained from chart review closest to, but before the date of self-report (SR). Sensitivity, specificity, predictive values, and likelihood ratios were calculated for the study sample overall and for socio-demographically defined subgroups. Concordance between self-reported HIV VL and (CC) clinical chart-derived values was examined by Cohen's kappa. Three HIV-related stigma scores were compared between women stratified by the concordance of their self-reported and chart review-based HIV VL. Ninety-five percent (208/219) of women were able to estimate their most recent HIV VL via self-report, and among them, 96% (200/208) were on antiretroviral therapy, 50% reported a history of homelessness, and 30% reported current substance use. Overall, the self-reported HIV VL was correctly estimated by 189 out of 219, and showed high overall concordance (86%) and moderate agreement (Cohen's kappa = 0.55) with HIV VL values derived from CCs. Correctly self-reported undetectable HIV VL showed high sensitivity (97.2%) and positive likelihood ratio (1.92), low negative likelihood ratio (0.06), moderate specificity (50%), and performed similarly across socio-demographic subgroups. HIV stigma scores did not differ between women who estimated their HIV VL correctly versus incorrectly. Of note, knowledge about 'Undetectable = Untransmittable' was lower (40%) among women who were not able to estimate their most recent VL than among those who did (74%). Our findings confirm previous reports of high awareness of HIV VL by women in British Columbia, Canada, despite a high prevalence of adverse socio-demographic experiences in this cohort. Our data further suggest that despite highly stigmatized life experiences, women living with HIV in British Columbia have a strong awareness of their VL status.

Development, Implementation, and Evaluation of an Early Sepsis Screening Tool at Triage in a Pediatric Emergency Department in Latin America.

Sepsis screening tools in Pediatric Emergency Departments (PEDs) enable timely alerts and treatment. This study aimed to develop, implement, and evaluate a sepsis screening tool applied during triage in patients with fever or hypothermia in a PED. The study was conducted in 3 phases (design, implementation, and evaluation) from July 1, 2023, to July 31, 2024. The screening tool included the Pediatric Assessment Triangle (PAT), parental concern, critical appearance, vital signs, mental status, skin condition, capillary refill, and risk factors, with results classified as positive or negative. Evaluation followed an observational, prospective diagnostic test design using 3 reference standards: intention-to-treat standard, Phoenix criteria, and final diagnosis at case closure. Patients aged >28 days to <18 years with fever or hypothermia were included. Results were analyzed for diagnostic accuracy (sensitivity, specificity, predictive values, and likelihood ratios). Additional analyses were performed to examine the triggers of positive alerts and causes of missed alerts. During the evaluation period, 16,771 of 40,005 PED patients had fever or hypothermia. The tool was positive in 1.4% (240/16,672). These patients had significantly more triage levels I and II (99.6% vs. 4.8%), higher hospitalization rates (66% vs. 5%), pediatric intensive care unit admissions (11% vs. 0.03%), and mortality (3.8% vs. 0.01%). For sepsis at case closure, the tool showed sensitivity of 0.80, specificity of 0.99, positive predictive value of 0.33, negative predictive value of 1, positive likelihood ratio of 84, and negative likelihood ratio of 0.20. Circulatory alteration in the PAT [odds ratio (OR): 2.8], abnormal capillary refill (OR: 1.9), and critical risk factors (OR: 2.1) independently increased the risk of sepsis. The sepsis screening tool evaluated demonstrated good performance in detecting sepsis in the PED. Circulatory alteration in the PAT, abnormal capillary refill, and presence of a critical risk factor were key sepsis predictors.

IOTA Three-Step Strategy for Classifying Adnexal Masses: A Systematic Review and Meta-Analysis

Background: Our goal was to assess the diagnostic performance of the IOTA 3-step strategy for discriminating benign from malignant adnexal masses. Methods: Systematic review and meta-analysis design. A systematic search across three databases (Medline [PubMed], SCOPUS, and Web of Science) was conducted to identify primary studies reporting on the use of the IOTA three-step strategy from January 2012 to July 2024. Prospective cohort studies utilizing the three-step strategy, with histologic diagnosis or conservative management confirming spontaneous resolution or persistence in cases of benign-appearing masses for at least one year of follow-up, were used as the reference standard. Studies unrelated to the topic, those not addressing the IOTA three-step strategy, studies focusing on other prediction models, letters to the editor, commentaries, narrative reviews, consensus documents, and studies lacking data for constructing a 2 × 2 table were excluded. Quantitative synthesis was done, calculating the pooled sensitivity, specificity, and positive and negative likelihood ratios. Qualitative synthesis was done using QUADAS-2. Results: A total of 448 citations were initially identified, with 7 studies meeting inclusion criteria, comprising 5722 patients. The mean prevalence of ovarian malignancy was 28%. The quality of the studies was considered good. IOTA 3-step strategy showed a pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of the three-step strategy for adnexal mass classification were 94% (95% CI = 91–95%), 94% (95% CI = 91–97%), 17.0 (95% CI = 10–28.8), and 0.07 (95% CI = 0.05–0.1), respectively. Heterogeneity for sensitivity was moderate, and for specificity it was high. Conclusions: We conclude that the three-step strategy has good diagnostic performance, reducing the need for expert examiner evaluation.

Interpreting Blood Culture Results as Early Guidance for Infective Endocarditis

Few bedside tools with defined accuracy have been described that are useful to alter bayesian prior probability for infective endocarditis (IE) in patients with bacteremia. To evaluate the accuracy of simple blood culture parameters to guide pretest probability of IE. This multicenter, retrospective case-control study of blood culture data in adults with IE vs without IE was conducted at 3 acute care public hospitals in the Los Angeles County Department of Health Services between December 2018 and August 2022. Patients were individuals aged 18 years or older who had positive blood cultures and met the inclusion criteria, including cases who met the Duke criteria for definite or possible IE, and control cases who did not have concern for endocarditis. Positive blood cultures for methicillin-susceptible Staphylococcus aureus, methicillin-resistant S aureus, Enterococcus faecalis, low-risk Streptococcus species, or high-risk Streptococcus species. The primary outcome was the negative likelihood ratio (LR) of having endocarditis based on the number of positive blood cultures on admission. Positive LRs, evaluation of 2 or more of 4 bottles positive on admission, bacteremia lasting for at least 2 days, and combination groups were secondary outcomes. A total of 252 eligible patients with IE (182 male [72%]; median [IQR] age, 54 [38-65] years), including 164 definite and 88 possible IE cases, and 455 controls (321 male [71%]; median [IQR] age, 53 [41-63] years) were identified. The negative LR point estimates for having IE with only 1 of 4 positive blood culture bottles on admission ranged from 0.05 (95% CI, 0.01-0.37) for E faecalis to 0.12 (95% CI, 0.03-0.49) for methicillin-susceptible S aureus. Sensitivity analysis of cases restricted to definite IE found similar results. Blood culture clearance by day 2 also had modestly helpful negative LRs for methicillin-resistant S aureus (0.24; 95% CI, 0.13-0.42) and Enterococcus species (0.34; 95% CI, 0.21-0.56). If patients had 4 of 4 bottles positive on admission, positive LRs were helpful for Enterococcus species (LR, 4.21; 95% CI, 2.53-7.02) and high-risk streptococci (LR, 5.35; 95% CI, 3.39-8.42) and for all organisms with persistent bacteremia (with LRs ranging from 1.78 [95% CI, 1.36-2.34] to 9.60 [95% CI, 3.43-44.60]). If both were true, the positive LRs ranged from 1.63 (95% CI, 1.17-2.28) to 8.59 (95% CI, 3.43-21.55) for all organisms. In this case-control study of patients with and without IE, the number of initial positive blood culture bottles and days to culture clearance were helpful to adjust pretest probability of IE. These findings may help guide diagnostic and therapeutic decisions around bacteremia early during hospitalization.

Diagnostic value of contrast-enhanced ultrasound in ovarian cancer: a meta-analysis.

BackgroundOvarian cancer has been reported to be the eighth most common cancer among women worldwide.PurposeTo assess the diagnostic efficacy of contrast-enhanced ultrasound (CEUS) in distinguishing between benign and malignant ovarian tumors.Material and MethodsA comprehensive search of scientific literature databases, including PubMed, Cochrane Library, Web of Science, Wanfang, and CNKI, was conducted from their inception to November 2019 to identify relevant studies on the use of CEUS in the differential diagnosis of benign and malignant ovarian tumors. Sensitivity (SEN), specificity (SPE), positive and negative likelihood ratios (LR+/LR-), diagnostic odds ratios (DORs), and their corresponding 95% confidence intervals (CIs) were retrieved and analyzed using Stata 15.0.ResultsAfter rigorous screening, a total of 15 high-quality clinical studies encompassing 934 patients with ovarian cancer, comprising 969 ovarian tumors (403 malignant tumors and 566 benign tumors), were included in the analysis. Data analysis revealed significant correlations between CEUS and various diagnostic indices for ovarian tumors: the combined SEN and SPE were 0.93 (95% CI = 0.88-0.96) and 0.93 (95% CI = 0.90-0.96), respectively, and the combined LR+ and LR- were 14.07 (95% CI = 9.46-20.92) and 0.08 (95% CI = 0.05-0.13), respectively, with a combined DOR of 185.15 (95% CI = 93.31-367.41). The area under the summary receiver operating characteristic curve (AUC) was 0.98 (95% CI = 0.96-0.99). No publication bias was detected in the meta-analysis (P = 0.62).ConclusionCEUS demonstrates significant value in the diagnosis and differential diagnosis of benign and malignant ovarian tumors.

Application of metagenomic next-generation sequencing in pathogen detection of lung infections

BackgroundMetagenomic next-generation sequencing (mNGS) has been widely reported to provide crucial information for the diagnosis and treatment of infectious diseases. In this study, we aimed to evaluate mNGS in pathogens diagnosis of lung infections.MethodsA total of 188 patients who were suspected of pulmonary infection and received medical treatment at the Second Affiliated Hospital of Nanchang University from August 2022 to December 2023 were enrolled in this study. Conventional microbiological tests (CMTs) and mNGS were employed for pathogens diagnosis.ResultsStatistical results indicated that mNGS were significantly better than CMTs in sensitivity, negative predictive value, and negative likelihood ratio. Remarkably, the positive detection rate of mNGS was significantly higher than that of CMTs (86.17% vs 67.55%, P &amp;lt; 0.01). Through mNGS, we identified 96 pathogens, comprising 59 bacteria, 18 fungi, 15 viruses, and 4 special pathogens. In contrast, CMTs detected 28 species, including 25 bacteria and 3 fungi. The effectiveness rate of antibiotic treatment decisions based on mNGS results was 40.60%. Out of 54 cases with positive treatment impacts, mNGS results contributed to the treatment and improved prognosis of 16 infections caused by atypical pathogens.ConclusionOur results proved the essential role of mNGS in lung infection diagnosis, enabling early detection and the prompt development of targeted anti-infection therapies. We recommended that the clinical application of mNGS can enhance treatment effectiveness and improve patient prognosis.

Incidental Mucinous Neoplasms of the Pancreas: Performance of the AGA, European, and IAP Guidelines in Advising Further Management After Endoscopic Ultrasound-guided Fine Needle Aspiration.

We compared the performance of AGA-2015, ESG-2018, and IAP-2024 guidelines in referring patients for surgery versus surveillance when applied to incidental after diagnosis by EUS-FNA. This is a single-center, retrospective study with prospective data collection. PLs identified incidentally on CT or MRI/MRCP performed for other diseases with inconclusive imaging results were eligible for analysis. After EUS-FNA and microhistologic diagnosis, each of the guidelines was applied; sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were compared. One hundred and forty asymptomatic patients (mean age 64.7y, 61% females) had a confirmed diagnosis of MN. Of these, 42 (30%) had "high-risk stigmata," and 16 (11.4%) were malignant. AGA-2015, ESG-2018, and IAP-2024 criteria would have advised surgery unnecessarily in 66%, 15%, and 46%, respectively ( P <0.001). AGA-2015, ESG-2018, and IAP-2024 criteria failed to identify 59%, 46.1%, and 33.3% of HGD/IC, respectively ( P =1.00). The AGA-2015 criteria were highly specific, while IAP-2024 had superior sensitivity. All had moderate sensitivity to indicate surgery, and all missed similar numbers of malignant lesions. Performing EUS-FNA before the application of guidelines seems appropriate to guide further management of asymptomatic PLs, preventing unnecessary surgery and referring patients appropriately for surveillance. The ESG-2018 guideline proved the most accurate for this purpose.

Electrocardiographic abnormalities in chagasic patients compared to the general population: A systematic review with updated meta-analysis.

Electrocardiographic abnormalities in chagasic patients compared to the general population: A systematic review with updated meta-analysis.

Diagnostic performance of the Enferplex bovine tuberculosis antibody test using bulk tank milk samples from dairy cattle.

Bovine tuberculosis, caused mainly by Mycobacterium bovis, is a major disease of cattle worldwide associated with significant economic losses and is usually diagnosed using periodic tuberculin skin tests, IFNγ release assay, or at postmortem. Recently, we developed a multiplex test for detecting antibodies to Mycobacterium bovis in cattle that has high sensitivity and specificity using serum or individual milk samples. Here, we assessed the performance of the test using bulk tank milk samples from skin test-positive and bovine tuberculosis-free cattle herds. In nonanamnestic bulk tank milk samples, the sensitivity relative to the comparative cervical skin test was 77.2% and the specificity was 99.8% using the high sensitivity setting of the antibody test. A kappa value of 0.85 was found, indicating almost perfect agreement between the test results and comparative cervical skin test status of the herds. Likelihood ratio analysis gave a positive likelihood ratio of 53.1 and a negative likelihood ratio of 0.030, indicating that the test provides good diagnostic evidence of the infection being either present or absent, respectively. Bulk tank milk samples from herds with inconclusive reactors to the comparative cervical skin test but had no reactors gave a test positivity of 73.7%, indicating that antibody-positive animals were present in the herd after removal of the reactors. Variances in herd prevalence did not result in statistically significant differences in test positivity, and the test was able to detect a herd prevalence of 0.1% of comparative cervical skin test reactors in 80% of low prevalence herds. The test showed good repeatability and reproducibility, giving complete concordance in results from 3 independent laboratories. The results show that the bulk milk antibody test could be used as a nonanamnestic surveillance tool for detecting and monitoring bovine tuberculosis in dairy cattle herds.

Ultrasonographic assessment of the uterocervical angle in the second trimester of pregnancy as a predictor of spontaneous preterm birth.

Ultrasonographic assessment of the uterocervical angle in the second trimester of pregnancy as a predictor of spontaneous preterm birth.

Artificial intelligence for osteoporosis detection on panoramic radiography: A systematic review and meta analysis.

Artificial intelligence for osteoporosis detection on panoramic radiography: A systematic review and meta analysis.

The role of the HINTS exam, TriAGe+ score, and ABCD2 score in predicting stroke in acute vertigo patients in the ED.

The role of the HINTS exam, TriAGe+ score, and ABCD2 score in predicting stroke in acute vertigo patients in the ED.

Comparative Analysis of Smear Testing, In-house PCR and Commercial Real-time PCR for Genital Chlamydia Detection

Introduction: Genital infection caused by Chlamydia trachomatis serovars D-K is the commonest bacterial sexually transmitted disease (STD) with the highest prevalence seen among youth. The objectives of the study were to determine the effectiveness of smear testing in diagnosing chlamydia infection, provide an alternative diagnostic test (in-house conventional polymerase chain reaction) for the detection of chlamydia, and compare it with a commercial rt-PCR as the reference test.Methods: The study was a cross-sectional, descriptive study enrolling 216 female and 252 male consecutive adult attendees of the Central STD Clinic, Colombo. Gram stain of cervical smear, urethral smear, and urine was carried out and compared with the reference standard of COBAS® TaqMan® CT v2.0 rt-PCR on endocervical swabs from females and urine from males. In addition, a comparative study was conducted on 50 endocervical swabs to compare the commercial real-time (rt)PCR with the conventional in-house PCR.Results: Cervical smears , urethral smears in females and males, and urine deposits in males had sensitivity of 10-50% and specificity of 0-99.4% compared to the reference test. The in-house PCR had sensitivity, specificity, positive and negative predictive values, diagnostic accuracy, positive likelihood ratio, and negative likelihood ratio of 91.3%, 96.3%, 95.4%, 92.8%, 94%, 24.6 and 0.09, respectively, when compared to the reference test.Conclusion: This study concluded that smear tests are not effective in diagnosing genital chlamydia infection. The PCR assay evaluated in this study can significantly improve the sensitivity and specificity of diagnosing genital chlamydia infection in the local setting.

Lateral flow-device aspergillus routine -testing for invasive pulmonary aspergillosis in critically ill patients – A multicenter ICU cohort study

Abstract Background The incidence of invasive pulmonary aspergillosis (IPA) is rising among ICU patients with early diagnosis and treatment being critical for survival. Recently, lateral flow assays for Aspergillus antigen detection have been introduced, enabling rapid results within an hour and potentially supporting earlier clinical decision-making and timely antifungal therapy. Methods This retrospective multicenter study included 180 ICU patients,48 with IPA and 132 controls, across nine treatment centers. Fungal infections were classified according to the FUNDICU criteria (Invasive Fungal Infections in Adult Patients in Intensive Care Units). Results Among the 180 patients, 48 were classified as having probable IPA, while 132 exhibited host factors and radiologic findings consistent with IPA but did not meet the FUNDICU criteria. In this cohort, the sensitivity and specificity of the BAL LFD test for diagnosing probable IPA (vs. no IPA) were 71% [95% CI: 56–83] and 98% [94–100], respectively. The area under the receiver operating characteristic (ROC) curve was 0.84, indicating good diagnostic performance. The positive and negative likelihood ratios were 31.17 [10.03–96.80] and 0.30 [0.19–0.46], respectively, yielding a diagnostic odds ratio of 104 [30–360]. The positive and negative predictive values were 92% [78–98] and 90% [84–95], respectively. Conclusions LFD testing may serve as a valuable tool for the rapid diagnosis of IPA in time-critical ICU settings. However, it is not sufficient to definitively rule out the disease, and a comprehensive diagnostic approach remains essential.

Vital Sign and Biochemical Data Collection Using Non-contact Photoplethysmography and the Comestai Mobile Health App: Protocol for an Observational Study.

Early detection of vital sign changes is key to recognizing patient deterioration promptly, enabling timely interventions and potentially preventing adverse outcomes. In this study, vital parameters (heart rate, respiratory rate, oxygen saturation, and blood pressure) will be measured using the Comestai app to confirm the accuracy of photoplethysmography methods compared to standard clinical practice devices, analyzing a large and diverse population. In addition, the app will facilitate big data collection to enhance the algorithm's performance in measuring hemoglobin, glycated hemoglobin, and total cholesterol. A total of 3000 participants will be consecutively enrolled to achieve the objectives of this study. In all patients, personal data, medical condition, and treatment overview will be recorded. The "by face" method for remote photoplethysmography vital sign data collection involves recording participants' faces using the front camera of a mobile device (iOS or Android) for approximately 1.5 minutes. Simultaneously, vital signs will be continuously collected for about 1.5 minutes using the reference devices alongside data collected via the Comestai app; biochemical results will also be recorded. The accuracy of the app measurements compared to the reference devices and standard tests will be assessed for all parameters. CIs will be calculated using the bootstrap method. The proposed approach's effectiveness will be evaluated using various quality criteria, including the mean error, SD, mean absolute error, root mean square error, and mean absolute percentage error. The correlation between measurements obtained using the app and reference devices and standard tests will be evaluated using the Pearson correlation coefficient. Agreement between pairs of measurements (app vs reference devices and standard tests) will be represented using Bland-Altman plots. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and likelihood ratios will be calculated to determine the ability of the new app to accurately measure vital signs. Data collection began in June 2024. As of March 25, 2025, we have recruited 1200 participants. The outcomes of the study are expected at the end of 2025. The analysis plan involves verifying and validating the parameters collected from mobile devices via the app, reference devices, and prescheduled blood tests, along with patient demographic data. Our study will enhance and support the accuracy of data on vital sign detection through PPG, also introducing measurements of biochemical risk indicators. The evaluation of a large population will allow for continuous improvement in the performance and accuracy of artificial intelligence algorithms, reducing errors. Expanding research on mobile health solutions like Comestai can support preventive care by validating their effectiveness as screening tools and guiding future health care technology developments. ClinicalTrials.gov NCT06427564; https://clinicaltrials.gov/study/NCT06427564.