Positive And Negative Predictive Values Research Articles

Comparative laboratory diagnosis of malaria: Microscopy versus rapid diagnostic test kits in a tertiary institution of North-Central Nigeria

Laboratory diagnosis of malaria is a vital key for its effective management. Diagnosis of malaria includes rapid, sensitive, and specific test methods. This study was aimed to assess the diagnostic performance of PfHRP2 rapid malaria test with reference to light microscopy for the diagnosis of malaria at the Bingham University Teaching Hospital (BhUTH) Jos –Plateau State, Nigeria. A total of 150 febrile patients attending BHUTH who were sent to the Hospital Laboratory from the General out patients Department (GOPD) for malaria parasite test (MPT)request had their blood sample collected and tested for malaria parasites (MP) using Field Stain A and B stain microscopy and PfHRP2 rapid malaria test between September and November 2021.Results shows that the sensitivity and specificity of PfHRP2 rapid malaria were 9.23% and 90.0% respectively, with corresponding positive and negative predictive values (PPV) as 90.0%and (NPV) as13. 2%. PfHRP2 rapid malaria test showed good sensitivity and specificity that is in agreement with that of the reference light microscopy. The rapid diagnostic test (RDT) results compared well with the light microscopy (Gold standard) for Laboratory diagnosis for malaria. Sustained use of RDT as an alternative to light microscopy is recommended especially in malaria endemic areas and the rural communities where electricity is out of reach.

Evaluation of Srivastava index to distinguishing Beta-Thalassemia Trait from Iron Deficiency

Objective: To assist in the differential diagnosis of beta thalassemia trait and iron deficiency anaemia, many alternative red blood cell index-based formulae were examined. Methods: The Rawalpindi PEMH performed this study from June 2021 to March 2022. For individuals with beta- thalassemia trait and iron deficient anaemia, age and gender were not considered. More than five millilitres of blood were drawn from each patient in order to determine the haemoglobin content, the number of red blood cells, how they were distributed, and the average cell volume. Five alternative formulas may be used to differentiate these two circumstances. Shine and Lal index, Mentzer index, Srivastava index and Green & King index are among the most well- known ones. Youden's index was included in the calculation of sensitivity, specificity, and positive and negative predictive values (PPVs). Results: The iron deficiency anaemia rate was 70%, and the beta thalassemia phenotype was 30% among the 1500 participants. This indicator has a sensitivity of 100% and specificity of 93.3% when it comes to discriminating between beta-thalassemia trait and iron deficiency anaemia. Conclusion: The red cell distribution width index may be used to differentiate between beta thalassemia trait and iron deficiency anaemia. If a haemoglobin electrophoresis is not available, a diagnosis of beta thalassemia may still be made. Keywords: Srivastava index, beta-thalassemia, Anemia, Cell redness, Hb electrophoresis

Risk Factors for Clinical Seizures in Neonates with Hypoxic-ischemic Encephalopathy Treated with Therapeutic Hypothermia.

This study aimed to assess the risk factors for clinical seizures in newborns treated with whole body cooling (WBC) for hypoxic ischemic encephalopathy (HIE). Infants with gestational age≥36 weeks and birth weight≥2.000 g who were treated with WBC due to HIE were retrospectively enrolled in this study. Patients were assigned to two groups: infants without clinical seizures (Group 1) and infants with clinical seizures (Group 2). The two groups were compared to determine the risk factors for the occurrence of clinical seizures. A total of 25 patients (Group 1=10 and Group 2=15) were included in the study. Prothrombin time (PT) was determined as independent risk factor for clinical seizures (p=0.046) and the odds ratio for the effect of PT was found as 1.475 (%95 CI:1.006-2.299). PT (area under the curve [AUC]=0.764; p=0.041), and increased cardiac troponin-I (cTnI) (AUC=0.935; p=0.002) were found to be significant risk factors for predicting the occurrence of clinical seizures. The optimal PT cut-off value was 22.7 sec, with a sensitivity and specificity of 45.4% and 90%, respectively; as well as positive and negative predictive value of 83.3% and 60.0%, respectively. The chest compression in the delivery room, severely abnormal amplitude integrated electroencephalography and high encephalopathy score were also found risk factors for occurrence of clinical seizures. Chest compression in the delivery room, high encephalopathy score, prolonged PT, and increased cTnI are significant factors for clinical seizures in newborns treated with WBC for HIE.

The Role of LVOT-VTI Measurement in the Evaluation of Systolic Heart Function in Pulmonary ICU Patients

Introduction: The detection of cardiac systolic dysfunction is very important for well management of pulmonary critical care patients (PCCPs). However, there is a poor correlation between echocardiographic cardiac systolic function (CSF) parameters and it is not easy to obtain these parameters in PCCPs. Therefore, this cross-sectional observational study was planned for the detection of a more easily obtainable echocardiographic CSF parameter that is well correlated with other CSF parameters in PCCPs. Materials and Methods: Total 88 PCCPs were included. Demographic and clinical information and laboratory tests of all patients were recorded. The CSF parameters of the heart were obtained by transthoracic echocardiography with appropriate technique. LVOT-VTI (Left ventricular outflow tract velocity time integral), CO (cardiac output), EPSS (e point septal separation), Left ventricular EF (ejection fraction) and TAPSE (Tricuspid Annular Plane Systolic Excursion) as an indicator of CSF were tried to obtain from all patients. We also calculated sensitivity, specificity, positive and negative predictive values of LVOT-VTI<20 parameters to diagnose heart failure. Results: The mean age of the patients was 73±12, 40% were female, 38% were intubated and 52% had COPD. LVOT-VTI, EF, CO, EPSS parameters were obtained in 54(61%), 24(27%), 48(54%), 48(54%) patients, respectively. Decreased LVOT-VTI (<20 cm) was well correlated with decreased EF (<45%) (p=0.001, r=0.77), decreased CO (<5 L/dk) (p=0.03, r=0.64) and decreased TAPSE (<17 mm) (p=0.001, r=0.71). Also, there was good agreement between the EF and LVOTVTI measurements (Kappa:0.78, p:0.001). Sensitivity, specificity, positive and negative predictive values of LVOT-VTI<20 for heart failure were 58, 78, 84, 49, repectively. Conclusion: LVOT-VTI is a more easily obtainable and well correlated parameter, which can be used as an indicator of CSF in PCCPs. Clinical Significances: The authors believe that LVOT-VTI measurement has good correlation with other echocardiographic systolic function parameters, and its easy measurement in intensive care patients makes it a very useful test for cardiac systolic function evaluation.

Evaluation of the Role of Toluidine Blue Paint as an Adjunctive Method to Biopsy in Suspicious Oral Lesion: A Hospital Based Study.

Early detectionisamajorstep in thesuccessof cancer therapy.Histopathology report is considered as the gold standard in theformulationof management protocol of anymalignancyworldwide. Butunfortunately, there is adelayin thedetectionof oral cancer very often due to inconclusive histopathology reports.Themainreason behind it isobtaininga biopsy specimen from the non-representativearea of thelesion.A hospital-basedevaluationof theroleofToluidine Blue dye, used as an adjunctive methodprior tobiopsywasconductedin a tertiary carehospitalon 200patientspresentingwith oral lesions persistent for more than 3weeks. Theparticipantsweredividedinto two equal groups by alternate sampling.In onegroupbiopsywastakenby clinical judgment and inothers,Toluidine Bluewas usedprior toobtainingabiopsytodecidetheareato bebiopsied.Datawascollectedusinga predesigned proforma and wasanalyzedwith thehelpofSPSSversion 20.Resultsin twogroupswerecomparedwithrespecttosensitivity,specificity,positiveandnegative predictive values,falsepositiveandfalsenegativepercentages. The Sensitivity, Specificity, PositivePredictiveValueand NegativePredictiveValueof wedge biopsy without staining were 73.68, 58.14, 70.00, and 62.50% respectively.Thesevalueswere 95.08, 82.05, 89.23, and 91.43% respectively when Toluidine Blue staining wasdoneas an adjunctive before thebiopsyprocedure.Theseresultsindicatethe promising role of Toluidine blue staining before thebiopsytodiagnoseoralmalignancymore efficiently than obtainingbiopsyspecimens on clinical assessment only and inavoidingthedelayininitiatingthetreatmentincaseoforalmalignant lesions.

Comparison of the clinical significance of serum HE4, CA125 and ROMA in the differential diagnosis of ovarian tumor

Objective To compare the clinical significance of human epididymis protein 4(HE4), CA125, ROMA in the differential diagnosis of ovarian cancer. Methods From May 2016 to October 2017, 240 patients with ovarian tumor in Xuzhou Cancer Hospital were selected.According to the result of postoperative pathology, the patients were divided into benign ovarian disease group(n=120) and ovarian cancer group(n=120). And 100 healthy women from medical examination center were selected as control group.The electrochemiluminescence (ECLIA) technique was used to assess the serum levels of CA125, HE4, and ROMA was calculated.The clinical significance of HE4, CA125, ROMA in the differential diagnosis of ovarian cancer was analyzed by statistic methods. Results The CA125, HE4 concentrations and ROMA in the ovarian cancer group[(370.9±213.2)U/mL, (364.4±227.0)pmpl/L, (80.2±26.1)%]were higher than those in the benign ovarian disease group and the health control group(all P<0.01), there were no statistically significant differences between the benign ovarian disease group and the healthy control group(P=0.356, P=0.321, P=0.292). The sensitivity, specificity, positive and negative predictive values, accuracy of ROMA were higher than those of HE4 and CA125.By using the ROC analysis, the AUC for CA125, HE4, ROMA were 0.832, 0.888, 0.960, respectively, AUC(CA125)<AUC(HE4)<AUC(ROMA). Conclusion CA125 and HE4 have important value in the diagnosis of ovarian cancer, but the ROMA shows the best diagnostic performance and actual value. Key words: Ovarian neoplasms; CA-125 antigen; Human epididymis protein 4; ROC curve; Diagnosis, differential; ROMA

Diagnostic value of combined serum CA19-9 with CT scanning in patients with pancreatic cancer

Objective To evaluate the diagnostic value of combined serum tumor marker CA19-9 with CT scanning in the patients with pancreatic cancer. Methods A total of 89 patients with suspected pancreatic cancer diagnosed by CT scanning were selected at our hospital from May 2012 to December 2016.The detected results of serum CA19-9 were recorded, and the specificity, sensitivity, positive and negative predictive value of serum CA19-9 in the diagnosis of pancreatic cancer were statistically calculated and analyzed.The correlations between the pre- and post-operative serum levels of CA19-9 and the survival time in pancreatic cancer patients undergoing operation were analyzed. Results The specificity, sensitivity, positive predictive value and negative predictive value of serum CA19-9 combined with CT scanning in the diagnosis of pancreatic cancer were 97.2%, 86.4%, 100.0%, 94.0% respectively.With the increase of preoperative serum levels of CA19-9, the resection rate and median postoperative survival time gradually decreased.Patients with normal serum levels of CA19-9 after operation had longer postoperative survival time than patients with high postoperative serum levels of CA19-9. Conclusions As one of the tumor markers of pancreatic cancer, serum CA19-9 detection has a high diagnostic sensitivity.Combined with CT scanning, serum CA19-9 detection can significantly improve the diagnostic accuracy of pancreatic cancer.Serum CA19-9 can also be used as a mean of efficacy evaluation after radical resection of pancreatic cancer. Key words: Pancreatic neoplasms; Antigens, neoplasm

Comparison of predictive power of Padua Scale and Wells Scale on stroke complicated with deep venous thrombosis

Objective To compare the predictive power of Padua Scale and Wells Scale on stroke complicated with deep venous thrombosis (DVT) . Methods Totally 300 patients with stroke admitted in the Department of Neurology, Peking University Third Hospital from November 2016 to November 2017 were selected by convenient sampling and investigated with Padua Scale and Wells Scale. The incidence of DVT was determined according to color Doppler ultrasonography for deep veins. The predictive power of the two scales on stroke complicated with DVT was evaluated; and the Receiver Operating Characteristic (ROC) model was established to compare the sensitivity, specificity and area under the ROC (AUC) . The positive and negative predictive values of the two scales were calculated. Results Both scales could predict the risks of stroke complicated with DVT (P<0.01) . The AUC of Padua Scale and Wells Scale was 0.802 (95%CI=0.704-0.900) and 0.746 (95%CI=0.642-0.851) . The sensitivity of Padua Scale and Wells Scale at the best cutoff value was 80.00% and 64.00%, and their specificity was 58.18% and 77.82%. Their positive predictive values were 14.81% and 20.78%, and their negative predictive values were 96.96% and 95.96%. Conclusions Padua Scale is more suitable for predicting the risk of DVT in lower extremities of patients with stroke. Key words: Stroke; Deep venous thrombosis; Padua Scale; Wells Scale; Risk prediction

Application of thermal texture maps in cerebral insufficiency

Objective To compare and analyze the risk factors of cerebral insufficiency, and to explore the application of thermal texture maps (TTM) in the diagnosis and screening of cerebral insufficiency. Methods 8 787 healthy subjects were selected as the research object, and theit clinical data were collected, including blood pressure, blood lipid, X-ray of cervical vertebra, Doppler ultrasound of the stiff artery, cranial magnetic resonance imaging (MRI) and TTM examination. Subjects were grouped according to the results of TTM examination of cerebral insufficiency, and high risk factors for cerebral insufficiency were comparatively analyzed. The results of TTM and MRI in diagnosis of cerebral ischemia were comparative analysis. Results Among the 8 787 subjects, 3 734 subjects (42.49%) had cerebral insufficiency (TTM positive group), and 5 053 (57.51%) had no significant abnormalities (TTM negative group). The differences between the two groups in high risk factors were statistically significant, including obesity, abnormal low density lipoprotein cholesterol, smoking, alcoholism, hypertension, multiple cerebral ischemia and carotid atherosclerosis (all P<0.01). By taking the MRI as the gold standard, the sensitivity, specificity, positive and negative predictive value of brain blood supply TTM for diagnosing focal cerebral ischemia was 84.63%, 65.17%, 30.66% and 95.88%, respectively. Conclusions TTM can be an important early warning index of cerebral insufficiency in disease despreventive and intervention. Key words: Thermal texture maps; Cerebral ischemia; Diagnosis; Risk factors

Evaluating the expression of caveolin-1 immunohistochemistry in differentiating malignant pleural epithelioid mesothelioma from lung adenocarcinoma

Background To evaluate the efficacy of new marker caveolin-1 (Cav-1) in differentiating between malignant pleural mesothelioma (MPM) and lung adenocarcinoma (LAC) and to compare its results with other well-known markers used to differentiate MPM from LAC. Patients and methods This study is a retrospective one conducted on 150 cases presented with pleural and/or pulmonary lesion and diagnosed by pleural segmental resection or biopsy at Pathology Department, National Cancer Institute, Cairo University, during the period from January 2016 to December 2017. Paraffin blocks were immunostained by Cav-1 using Dakoautostainer. Sensitivity, specificity, positive and negative predictive values, and total accuracy of the marker were calculated. Results Cav-1 achieved a sensitivity of 97.1%, a specificity of 93.75%, a positive predictive value of 93.1%, and a negative predictive value of 97.4%, and total accuracy of 95.3% in the cases diagnosed as MPM. Overall, 45 (66.2%) cases showed cytoplasmic expression in more than 50% (3+) of tumor cells, 20 (29.4%) cases in 5–50% (2+), and only three (4.4%) cases in less than 5% of tumor cells (1+). No significant difference was detected in the Cav-1 expression between well-differentiated and poorly-differentiated cases of malignant mesothelioma (MM) regarding score 3+ immunostaining. Conclusion Cav-1 is an immunohistochemical marker that can be used to differentiate MPM from LAC and can be added to the panel of markers used for such purpose.

Diagnostic value of intraductal ultrasonography and brush cytology on differentiating malignant and benign biliary stricture

Objective To investigate the diagnostic value of intraductal ultrasonography (IDUS) with or without brush cytology on distinguishing malignant from benign biliary stricture. Methods The data of patients with biliary stricture, who underwent endoscopic retrograde cholangiography(ERC) and IDUS in Drum Tower Hospital from September 2007 to October 2015 were retrospectively analyzed. Features of IDUS images and results of brush cytology were compared with postoperative histological results to evaluate the diagnostic yield of IDUS and brush cytology on differential diagnosis of malignant biliary stricture. Results A total of 230 patients with biliary stricture underwent ERC and IDUS, and 206 patients meanwhile received brush cytology, including 84 cases of malignant biliary stricture. Of the 230 patients, 87 cases underwent surgery, and 75 revealed malignant results, including 65 cases of cholangiocarcinoma, 8 cases of pancreatic adenocarcinoma, and 2 cases of periampullary adenocarcinoma. Using postoperative pathologic results as the gold standard, 72 malignant and 9 benign biliary strictures were correctly diagnosed by IDUS. The sensitivity, specificity, positive predictive value, and negative predictive value of IDUS for diagnosis of malignant biliary stricture was 96.0%, 75.0%, 96.0%, and 75.0%, respectively. Sixty-five patients underwent IDUS with brush cytology during ERC before surgery, and 56 out of 65 showed malignant results. Thirty-one malignant and 9 benign biliary stricture were correctly diagnosed by brush cytology. The sensitivity, specificity, positive predict value, and negative predict value of brush cytology for diagnosis of malignant biliary stricture was 55.4%, 100%, 100%, and 26.5%, respectively. If brush cytology combined with IDUS to diagnose malignant biliary stricture, the sensitivity rose up to 94.6%, while the specificity went down to 77.8%, and the positive and negative predictive value was 96.4% and 70.0%, respectively. Conclusion IDUS exhibited excellent sensitivity and specificity, while brush cytology revealed perfect specificity and positive predictive value on diagnosis of malignant biliary stricture. If IDUS combined with brush cytology, the sensitivity and negative predictive value could rise significantly, while the specificity and positive predictive value mildly went down, which suggested that IDUS remained a certain degree of over judgment and false positive rate. Key words: Endosonography; Cholangiopancreatography, endoscopic retrograde; Biliary stricture; Brush cytology

The Role of Serological Testing and HLA Genotyping in the Diagnosis of Celiac Disease in Slovak Cohort. Can Duodenal Biopsies be Omitted

Presented analysis focuses on usefulness of consecutive celiac disease antibodies testing anti-TG2 and EMA, and HLA-DQ2/DQ8 genotyping in symptomatic children and adolescents with suspected celiac disease refered to the latest ESPGHAN guidelines (2012), that permit confirmation of celiac disease without previous duodenal biopsy. A total of 258 children and adolescents (86 male and 172 girls), aged 2 to 18 years, were retrospectively examined performance of celiac disease testing according national guidelines from 2009 included duodenal sampling and the ESPGHAN nonbiopsy criteria in a pediatric population. In applying nonbiopsy criteria to our cohort, 33,3 % (86) of symptomatic children and adolescents with such high anti-TG2 titers and positive EMA could have been initially diagnosed without an intestinal biopsy. All of them presented with advanced intestinal atrophy Marsh 2-3. Part of the rational of the study was to determine sensitivity and specificity, positive and negative predictive values of the final laboratory tests and diagnostic accuracy of the combined tests for antibodies.

Role of contrast-enhanced digital mammography in evaluation of breast lesions

Objective The purpose of this study was to assess the role of dual-energy contrast mammography (MX) in evaluating breast lesions. Background Contrast-enhanced digital mammography (CEDM) can significantly improve diagnostic quality such as clarification of mammographic and sonographic equivocal lesions, detection of occult lesions on MX, determination of the extent of disease, and assessment of recurrent disease. Patients and methods A total of 50 female patients were enrolled into the present study, with their ages ranging from 22 to 77 years (mean age of about 49.5), during the period between 2012 and 2014. All of them presented with benign or malignant breast lesions detected by sonomammography, categorized as Breast Imaging Reporting and Data System from 2 to 5. All were subjected to CEDM, and the images were obtained by a modified full-field digital MX system. The nonionic iodinated contrast agent was administered into the contralateral antecubital vein manually. The results were compared with the sonomammography results, and cases were histopathologically proven. Results In our study, 37/50 cases were histopathologically proven as malignant and 16/50 were benign, whereas three patients had double pathology. Different patterns of enhancement were depicted on contrast-enhanced digital mammography (CEDM) in all histologically proven breast carcinomas. Our results show that sensitivity was higher for MX + CEDM (83.3%) compared with pathology and Breast Imaging Reporting and Data System analysis, respectively, with no loss in specificity. Compared with MX associated with breast ultrasound, CEDM had a better diagnostic accuracy mainly because of improved specificity and better positive and negative predictive values (positive predictive value and negative predictive value were 86 and 64.7%, respectively). Conclusion The addition of dual energy contrast-enhanced MX technique to conventional sonomammography can significantly improve diagnostic quality and cancer detection rate.

[Consistency analysis between preoperative CT enterography and intraoperative findings in patients undergoing surgery for Crohn's disease].

To evaluate the diagnostic value of preoperative CT enterography (CTE) on obstruction, fistula and abscess formation compared to intraoperative findings in patients undergoing surgery for Crohn's disease(CD), aiming to provide reference to clinical practice. Preoperative CTE data of 176 CD patients confirmed by clinic, endoscopy, imaging, operation and pathology at the Department of General Surgery in Nanjing Jinling Hospital from January 2013 to December 2015 were enrolled in retrospective cohort study. All the patients underwent enhanced full abdominal CT scan using SIMENS SOMATOM Definition Flash 64 row dual-source CT machine. CTE scans were performed from the dome of diaphragm to the symphysis pubis. The CT images in arterial and venous phase were reconstructed with 1.0 mm thin layer, and then processed in MMWP 4.0 workstation including multi-planar recombination, surface recombination and maximum density projection. The sensitivity, specificity, positive and negative predictive value, false negative rate and accuracy of preoperative CTE on obstruction, fistula and abscess were compared with intraoperative findings. Among 176 patients, 122 were males and 54 were females with median age of 29 (18 to 65) years, median disease duration of 48 (1 to 240) months, median time interval from CT scan to operation of 16(1 to 30) days, and median body mass index of 17.8 (10.8 to 34.7) kg/m2. Twenty-six cases (14.8%) had nutritional risk (NRS2002≥3); 23 cases (13.1%) had lesions limited to ileum; 19 cases (10.8%) had lesions limited to colon; 126 cases (71.6%) had simultaneous lesions of ileum and colon, and 8 cases (4.5%) had lesion in upper gastrointestinal tract. A total of 199 lesions of small intestine were identified by preoperative CTE, including 131 of obstruction (65.8%), 42 of fistula (21.1%), and 26 of abscess (13.1%), while 235 lesions were confirmed by operation, including 133 of obstruction (56.6%), 74 of fistula (31.5%), 28 of abscess (11.9%). The modification of planned surgical procedure due to unexpected intraoperative findings were found in 29(16.5%) patients. The sensitivity, specificity, positive predictive value and negative predictive value of preoperative CTE were 86.4%, 78.8%, 86.9% and 76.0% for obstruction; 83.8%, 79.1%, 67.5% and 90.4% for fistula; and 96.2%, 98.0%, 90.1% and 99.3 for abscess, respectively. Preoperative CTE can effectively evaluate the lesions of intestinal obstruction, fistula and abscess in CD patients, with the highest accuracy of abscess, and has quite good consistency with intraoperative findings, which may be used as the first choice of imaging diagnosis of CD.

Application of flow cytometry combined with immunohistochemistry in lymphoma diagnosis by lymph node core needle biopsy

Objective To investigate the application value of flow cytometry(FC) combined with immunohistochemistry(IHC) in the diagnosis of lymphoma by lymph node core needle biopsy(CNB). Methods 212 CNB cases suspected of lymphoma in Beaumont Hospital of America from Jan.2000 to Dec.2007, and 340 lymphoma cases with combined application of FC and IHC from Jan.2008 to June.2015 were retrospectively analyzed. Diagnostic rate and complete diagnostic rate between IHC and IHC combined with FC were compared. Some cases who underwent lymph node excision were collected; besides, the sensitivity, specificity, positive and negative predictive values of the diagnosis by CNB were analyzed respectively. Disease types and sampling sites in patients with complete diagnosis were also investigated. Results Diagnostic and complete diagnostic rate of 212 CNB cases only by IHC were 82 % (174/212) and 76 % (161/212). Diagnostic and complete diagnostic rate of 340 CNB cases by IHC and FC were 94 % (320/340) and 89 % (303/340). The sensitivity and specificity of CNB were 97 % (40/41) and 100 % (40/40), the positive and negative predictive values were 100 % (30/30) and 91 % (10/11). As for sampling sites of 552 CNB cases, 35 % (193 cases) were deep and 65 % (359 cases) were superficial. Conclusions Combination IHC with FC can improve the diagnostic rate and complete diagnostic rate of CNB significantly. Furthermore, CNB has a good application value in the diagnosis of lymphoma. Key words: Core needle biopsy; Flow cytometry; Immunohistochemistry; Diagnostic rate; Sensitivity; Specificity

Evaluation of Tracheobronchial Lesions with Virtual Bronchoscopy; Correlation with Fiber Optic Bronchoscopy

The aim of this study was to compare the diagnostic accuracy of 3-D virtual bronchoscopy (VB) with that of Fiber-optic (FB) bronchoscopy in patients who had symptoms of respiratory disorders. Thirty patients underwent VB examination. Thin section helical computerized tomography (CT) image were obtained. The volumetric data was downloaded to a workstation equipped with software for surface shaded rendering technique to achieve interactive 3-D virtual “fly-through” examinations of the tracheobronchial tree. Comparison was made between the results of 3-D virtual bronchoscopy, along with multiplanar reconstruction examination with the findings of conventional FB. This information was correlated with the surgical and pathological outcome wherever possible. Virtual bronchoscopy was true positive in twenty-four lesions. Further analysis revealed six cases were with strictures due to tracheobronchial tuberculosis or infection, eight were strictures due to carcinoma, five were endoluminal growths or polyps, three cases had nodes compressing the bronchi, one case had carcinoma of esophagus with tracheal extension and one had a congenital stricture. Virtual bronchoscopy was found false positive in one case, in which a polyp was misdiagnosed. Two endoluminal growths/ polyps were not appreciated on virtual bronchoscopy due to their small size and mild mucosal irregularity. Sensitivity, specificity, positive and negative predictive values were 96%, 50%, 92% and 66% respectively. To conclude VB represents a noninvasive method for evaluating helical CT findings. Further trials with larger sample size are needed on patient populations with any respiratory tract pathology, who do not have any gross findings on conventional examinations and are thus indicated for conventional bronchoscopy.

[Onodera prognostic nutrition index predicts nutrition risk in gastrointestinal elective operation patients].

To evaluate the clinical effectiveness of Onodera prognostic nutrition index (OPNI) in the predictive value of nutrition risk. In a prospective cohort study from July 2014 to June 2015 in the Department of General Surgery of the Ninth People's Hospital of Chongqing, NRS2002 and OPNI were conducted in 200 patients undergoing gastrointestinal elective operation. OPNI was calculated with serum albumin (Alb) and peripheral lymphocyte (TLC) [OPNI=Alb(10(9)/L)+5×TLC(10(9)/L)]. By using the results of NRS2002 as the golden standard for diagnosis of nutrition risk (A NRS2002 score≥3 was deemed as nutritional risk and a nutritional care plan should be initiated. A NRS2002 score <3 was deemed as no nutritional risk), the effectiveness of OPNI was evaluated by the receiver operator characteristic(ROC) curve. The sensitivity, specificity, positive and negative predictive values, Youden indexes and area under ROC curve(AUC) of different diagnostic cut-off points of OPNI were analyzed to determine the optimal operating point (OOP). Kappa test was used to estimate the consistency of different cut-off points for OPNI with NRS2002 in defining nutrition risk. A total of 103 patients were of NRS2002 ≥3 group, and 97 of NRS2002 <3 group. The overall OPNI was 45.4±7.4. When OOP was 45.8, the AUC of OPNI was 0.914 (95% CI: 0.873 to 0.954); the sensitivity, specificity, Youden indexes were 85.4%, 85.6%, 0.711; the positive predictive value and negative predictive value were 85.3% and 83.7%, respectively. According to this OOP, the subjects were divided into the OPNI ≥45.8 group(n=102) and OPNI <45.8 group (n=98). Compared with OPNI ≥45.8 group, OPNI <45.8 group were older [(66.5±12.1)years vs. (57.0±15.3) years, t=-4.905, P=0.000], and had lower BMI[(20.4±3.0) kg/m(2) vs. (21.7±3.0) kg/m(2), t=3.069, P=0.002], lower albumin[(34.7±4.7)10(9)/L vs.(43.6±3.4)10(9)/L, t=15.542, P=0.000] and lower TLC[(1.0±0.5)10(9)/L vs.(1.6±0.7)10(9)/L, t=7.254, P=0.000], respectively. Kappa test indicated that when using OPNI=45.8, the diagnostic value of OPNI on nutrition risk was consistence with NRS2002(Kappa=0.691, P=0.000). OPNI can be used as a relatively simple and reliable method for clinical screening and assessment of nutrition risk.

Application of amplitude-integrated electroencephalography in term neonates with brain injury

Objective To explore the value of amplitude-integrated electroencephalography(aEEG) in diagnosis and prognosis in term newborns with brain injury. Methods One hundred and thirty consecutive patients with brain injury admitted in NICU were prospectively enrolled in the study from Nov 2013 to Apr 2015.The monitoring of aEEG was done at 1d, 4d, 7d, respectively.Clinical data were collected and compared with the result of aEEG. Results All the cases of newborns with abnormal aEEG background: discontinuous voltage(109 cases), continuous low voltage(12 cases), flat(4 cases). The epileptic activity were recorded in 33 cases, and 15 cases showed burst-suppression; sleep wake cycle: mature(32 cases), immature(54 cases), no sleep wake cycle(39 cases). The judgment of abnormal level: 70 cases had mildly abnormal aEEG, severe abnormalities 60 cases, and no significant difference in different types of diseases(χ2=6.176, P=0.19). Recent prognosis: the death of mild and severe abnormalities were 1 case, 12 cases, respectively, there were significant differences(χ2=12.76, P<0.001). Developmental quotient(DQ) of these newborns were followed up for more than 6 months, and there were significant differences in mild, severe abnormal aEEG in them with DQ≥85 and DQ<85(χ2=33.195, P<0.001). The sensitivity of aEEG in severe abnormal aEEG was 68.75%, the specificity was 78.68%, and the positive and negative predictive values of aEEG were 77.19% and 70.58%, respectively.The results of aEEG classification and sleep wake cycle were correlated with the prognosis of the patients(r=0.505, 0.507, respectively, P<0.001). Conclusion aEEG can be used to monitor brain function, and it is helpful to evaluation of early diagnosis and prognosis. Key words: Electroencephalography; Amplitude-integrated electroencephalography; Brain injury; Infant, newborn; Prognosis

Screening for Streptococcus agalactiae in pregnancy – do we need to take a step forward?

Abstract Background: Streptococcus agalactiae is the leading infectious cause of morbidity among neonates. Majority of early onset neonatal infections can be prevented using antimicrobial prophylaxis during labour. Different diagnostic procedures can be employed to detect maternal colonization during pregnancy and labour. In the present study we analysed diagnostic characteristics of two common methods for detection of S. agalactiae. Methods: One hundred and one consecutive vaginal or combined vaginal-rectal swabs were included in this prospective study. All samples were tested with enrichment culture and molecular illumigene GBS assay. Results of repeatedly disconcordant samples were retested and confirmed with a different molecular assay. Sensitivity, specificity, positive and negative predicted values were determined for both assays. Results: Mean age of women was 33 years. Prevalence of colonisation in the sample was 23,8 %. Positivity rates using enrichment culture only, illumigene GBS assay only and combination of both assays were 19,8 %, 22,7 % and 23,8 %, respectively. Sensitivity, specificity, positive and negative predictive values were 83,3 %, 100 %, 100 % in 95,1 % for enrichment culture and 95,8 %, 100 %, 100 % in 98,7 % for illumigene GBS assay, respectively. Combining both methods 20 % more colonized women were detected compared to enrichment culture alone. Conclusions: With a combination of enrichment culture and illumigene GBS assay we can detect substantially more colonized women compared to currently most frequently used method of enrichment culture. Comprehensive evaluation of current strategies for prevention of S. agalactiae early neonatal infection is warranted in Slovenia.

Diagnostic performance of serum bone turnover marker lysylpyridinoline in diabetic foot osteomyelitis: a preliminary study

Objectives: The aim of the study was to determine whether serum levels of lysylpyridinoline (LP) differ between diabetic foot osteomyelitis (DFO) and diabetic foot ulcers without osteomyelitis (cellulitis). Methods: A case controlled study was designed comparing the aforementioned groups. Subjects were classified as osteomyelitis and controls based on the International Working Group diagnostic criteria. Serum LP samples were analysed using enzyme linked immunosorbent assay. Results: The serum LP levels were significantly higher in the DFO group (n: 16) than the control group (n: 11): LP median ± SD of 9.3 ± 3.5 nmol/l, interquartile range (IQR) 6.8-11.2 in DFO compared to 2.1 nmol/l 3.5, IQR 0.7-4.2 in the controls, p=0.001. The receiver operator characteristic curve in the DFO was 0.9. The diagnostic sensitivity, specificity, positive and negative predictive values were 100%, 77.8%, 89.0% and 100% respectively. Conclusions: This appears to be the first evidence of serum LP elevation in diabetic foot osteomyelitis with potential diagnostic value in clinical setting.