Predictive Value Of Positive Test Research Articles

Prevalence threshold and positive predictive value of noninvasive prenatal testing.

Noninvasive prenatal testing (NIPT) has increased the number of conditions that can be screened. However, the prevalence of conditions assessed by NIPT has remained stable. The "prevalence threshold," a novel epidemiological concept, uses a test's sensitivity and specificity to determine the prevalence below which a test's positive predictive value declines most sharply relative to disease prevalence. In this article, we calculated the prevalence threshold for common conditions assessed through NIPT and compared the value with the actual prevalence of each condition to best ascertain the reliability of NIPT results. Six databases and PubMed were searched from January 2010 to March 2023 for sensitivity and specificity parameters of common conditions tested through NIPT. Using an equation previously derived by the authors of the current paper, the prevalence threshold for each condition was calculated. The theoretical number of test iterations required to reach the prevalence threshold was also reported. None of the conditions tested through the NIPT had a prevalence rate that met or exceeded the calculated prevalence threshold. Trisomy 21 had the greatest concordance between the prevalence rate and the prevalence threshold. In contrast, Angelman, Cri-du-chat, and Prader-Willi syndromes had the most significant discordance. Apart from trisomy 21 and XXY, all remaining conditions required more than one test iteration to reach their respective prevalence threshold. We conclude that at the current prevalence levels, the positive predictive value of NIPT remains low, with the prevalence of disease levels significantly lower than the prevalence threshold for each condition tested.

Predicting implantation by using dual AI system incorporating three-dimensional blastocyst image and conventional embryo evaluation parameters-A pilot study.

To investigate the usefulness of an original dual artificial intelligence (AI) system, in which the first AI system eliminates the background of sliced tomographic blastocyst images, then the second AI system predicts implantation success using three-dimensional (3D) reconstructed images of the sequential images and conventional embryo evaluation parameters (CEE) such as maternal age. Patients (from June 2022 to July 2023) could opt out and there was additional information on the Web site of the clinic. Implantation and non-implantation cases numbered 458 and 519, respectively. A total of 10 747 tomographic images of the blastocyst in a time-lapse incubator system with the CEE were obtained. The statistic values by the dual AI system were 0.774 ± 0.033 (mean ± standard error) for area under the characteristic curve, 0.727 for sensitivity, 0.719 for specificity, 0.727 for predictive value of positive test, 0.719 predictive value of negative test, and 0.723 for accuracy, respectively. The usefulness of the dual AI system in predicting implantation of blastocyst in handling 3D data with conventional embryo evaluation information was demonstrated. This system may be a feasible option in clinical practice.

Molecular triaging options for women testing HPV positive with self-collected samples.

We review developments in molecular triaging options for women who test positive for high-risk human papillomavirus (hrHPV) on self-collected samples in the context of cervical cancer elimination. The World Health Organization (WHO) recommends hrHPV screening as the primary test for cervical screening due to its high sensitivity compared to other screening tests. However, when hrHPV testing is used alone for treatment decisions, a proportion of women of childbearing age receive unnecessary treatments. This provides the incentive to optimize screening regimes to minimize the risk of overtreatment in women of reproductive age. Molecular biomarkers can potentially enhance the accuracy and efficiency of screening and triage. HrHPV testing is currently the only screening test that allows triage with molecular methods using the same sample. Additionally, offering self-collected hrHPV tests to women has been reported to increase screening coverage. This creates an opportunity to focus health resources on linking screen-positive women to diagnosis and treatment. Adding an additional test to the screening algorithm (a triage test) may improve the test's positive predictive value (PPV) and offer a better balance of benefits and risks for women. Conventional triage methods like cytology and visual inspection with acetic acid (VIA) cannot be performed on self-collected samples and require additional clinic visits and subjective interpretations. Molecular triaging using methods like partial and extended genotyping, methylation tests, detection of E6/E7 proteins, and hrHPV viral load in the same sample as the hrHPV test may improve the prediction of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and invasive cancer, offering more precise, efficient, and cost-effective screening regimes. More research is needed to determine if self-collected samples are effective and cost-efficient for diverse populations and in comparison to other triage methods. The implementation of molecular triaging could improve screening accuracy and reduce the need for multiple clinical visits. These important factors play a crucial role in achieving the global goal of eliminating cervical cancer as a public health problem.

Abstract 769: Evaluating the diagnostic burden of tumor localization strategies for multi-cancer early detection tests

Abstract Introduction: Blood-based multi-cancer early detection (MCED) tests in development may substantially expand the number of “screenable” cancers. Defining an optimal approach for tissue of origin (TOO) localization in individuals with cancer-suspected MCED results is critical. Two recent prospective trials employed differing and distinct approaches for conducting TOO evaluation. The PATHFINDER study conducted molecular TOO testing for localization and DETECT-A used upfront neck-to-thigh imaging-first to rule-in or rule-out and then to localize the cancer. Using mathematical modeling, we examined the diagnostic burden of each approach. Methods: Building upon a published quantitative framework, a mathematical expression for diagnostic burden was derived as a function of positive predictive value (PPV) of the detection module, TOO accuracy of the localization module, and number of procedures associated with each diagnostic outcome; the latter were estimated from established clinical guidelines with diagnostic procedures narrowly selected for molecular TOO calls. We then explored the relationship between PPV, TOO accuracy, and diagnostic burden. Imaging and molecular TOO strategies were compared by estimating absolute difference in diagnostic burden across a range of performance levels. Results: With a molecular TOO strategy we estimate 2.1 procedures to reach diagnostic resolution for correctly-localized true positives, 4.4 for incorrectly-localized true positives, and 4 for false positives; with imaging TOO, 2.75 procedures for true positives and 2.4 for false positives. Across the entire spectrum of performance for both detection and localization, a strategy with molecular TOO resulted in a mean diagnostic burden of 3.6 (Var 0.198); with imaging TOO, 2.6 (Var 0.010). The breakeven curve defined by zero absolute difference between strategies shows that molecular TOO has lower burden for only 4.5% of all possible PPV and TOO accuracy combinations and that 79% PPV is required for a 90% accurate molecular TOO strategy to be less burdensome than imaging TOO. Conclusions: This analysis demonstrates that imaging TOO is more efficient than molecular TOO across 95.5% of all possible PPV and TOO accuracy combinations. Molecular TOO can reduce diagnostic burden when localization accuracy is very high or overall test PPV is very high. This analysis highlights the need for ongoing innovation in cancer detection and cancer localization as separable parts of the MCED test. In summary, the use of advanced imaging first to determine TOO as part of an MCED screening approach is likely less burdensome than a broad molecular TOO approach, although a nuanced approach to molecular TOO based on probability and type of cancer may contribute to diagnostic efficiency. Citation Format: Christopher Tyson, Elizabeth K. O'Donnell, Elliot Fishman, Vijay Parthasarathy, Tomasz M. Beer. Evaluating the diagnostic burden of tumor localization strategies for multi-cancer early detection tests [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 769.

Validation of screening tool for diagnosis of childhood asthma by exclusion method

Introduction: In the 21st century, with growing concerns over over-diagnosis of asthma in children; the diagnosis of asthma is left as diagnosis by exclusion. On the same lines, an attempt had been made to device a criteria to exclude diagnosis of asthma. The criteria are labeled as other than asthma (OTA) criteria. It is assumed that if a case does not satisfy OTA tool, then it is likely to be asthma. This study had objectives of validation of screening tool by expert and validation of OTA tool by direct application on patients. Materials and Methods: This was an observational and prospective study only. Total 120 cases were enrolled. Questionnaire applied on all cases and all of the 120 cases were followed up on day 30 with clinical diagnosis and were included in results estimation. Results: According to the screening tool, out of 120 cases, 83 cases (69.2%) were found to have OTA while 37 cases (30.8%) werefound to have non-OTA. However, among this study population, 94 cases (78.3%) had non-asthma and 26 cases (21.7%) had clinical diagnosis of asthma taken as gold standard. The association between clinical diagnosis and total score based diagnosis was found to bestatistically significant (p=1.96E-07). Sensitivity was 91.57% and specificity was 51.35% which helps detect OTA cases effectively. Predictive value of positive test is 80.85% and predictive value of negative test was 73.08%. OTA category has relative risk of 3.003 for diagnosis of non-asthma as compared to 0.262 for non-OTA category being almost 3 times in comparison to non-OTA category. Thus, OTA was consistent with non-asthma diagnosis. Conclusion: On direct application of patients in prospective study, this tool has proven its value as an effective screening tool. This was the first such study to diagnose asthma by exclusion, devising a criterion for other than asthma conditions.

Role of usg in Ectopics: Recent Update

This study is undertaken to emphasize the role of ultrasonography in the diagnosis of ectopic pregnancy and clinicalanalysis of the same in a tertiary care referral hospital.MethodologyOne hundred patients with provisional diagnosis of ectopic pregnancy were studied. Physical examination, urinepregnancy test, transabdominal scan using 5 MHz transducer or transvaginal ultrasonography of 7 MHz was done. Thediagnosis of ectopic pregnancy was confirmed by direct observation by laparotomy or laparoscopy (which was taken asgold standard).ResultsThe study showed ectopic pregnancy was most common in gravida 2 and in age group 26–30 years with most of themhaving married life <10 years. One or more risk factors were found in 66 % of cases. 54 % of cases presented with acutesymptoms, 14 % of cases in shock. Among clinical presentation pain abdomen, history of amenorrhea, bleeding pervaginum, abdominal tenderness, and cervical motion tenderness was most common. In ultrasonography, complex massin adnexa was present in 60 % of cases and hemoperitoneum in 50 %. 96 % of cases were tubal pregnancy with most ofthem tubal rupture. In 98 % of cases, radical surgery was done. Salpingectomy was the most common surgery done (90%). There was no negative laparotomy in this study. There was no maternal mortality in this series.ConclusionsIn all the 100 cases of ectopic pregnancy studied, the ultrasonography provided definitive diagnosis resulting in 100 %sensitivity and 100 % specificity, predictive value of positive test being 100 %. Ultrasonography done in earlier weeks ofgestation had sensitivity of 96 % and false negative 4 %

NESTROFT AS SCREENING TEST FOR BETA THALASSEMIA TRAIT

Objective: To evaluate the utility of NESTROFT as a screening test for Beta Thalassemia Trait. Material and Methods: A Prospective study of total 137 clinically normal siblings of thalassemia major patients registered at thalassemia clinic in department of pediatrics, Govt. medical college, Kota were selected randomly for the study. All cases were investigated for CBC, Mentzer’s index, NESTROFT and HbA2 estimation by HPLC method. Result: Total 137 cases were screened for thalassemia carrier by HbA2 estimation using HPLC technique. Total 67 (48.90%) cases having HbA2 level ≥3.5 % considered as carrier whereas rest 70 (51.10%) cases were normal. In this study 95 cases showed MCV<80. Out of them 59 cases were carrier and 36 cases were normal. The Sensitivity, specificity, positive predictive value and negative predictive value of MCV<80 are 90.12%, 49.71%, 63.78% and 84.68% respectively. The Sensitivity, specificity, positive predictive value and negative predictive value of Mentzer index are 85.25%, 97.16%, 96.45% and 89.19 % respectively. In present study, NESTROFT were done in all cases, the sensitivity of NESTROF test is 94.21%, specificity is 89.72%, Predictive value of positive test is 89.17% and Predictive value of negative test is 93.75%. So NESTROFT is better test for screening for Beta Thalassemia trait. Conclusion: NESTROF test is reliable, cost effective and better screening test for Thalassemia carrier detection. Positive cases can be confirmed by HPLC. NESTROFT can be used as mass screening programme for hemoglobinopathies.

Changing epidemiology of COVID-19.

Background: We analyzed the epidemiology of COVID-19 in Regensburg after the first wave ended in June 2020 and compared it with patients’ characteristics and symptoms in late summer/early autumn 2020.Methods: Retrospective analysis of epidemiological data from Regensburg (city/county) on age and initial symptoms as reported during case investigation for containment. Observed periods: March 7, 2020 to June 6, 2020 and August 12, 2020 to October 9, 2020.Results: The proportion of asymptomatic persons who tested positive for SARS-COV-2 in the second period was 55% (286 of 520 cases), whereas during the first wave from March to June 2020 this percentage was 14.4% (169 of 1,170 cases). A comparison of typical symptoms shows that the most common symptoms of COVID-19 in the first wave (cough, fever and generally feeling ill) were less often reported in the second period: cough 14% vs. 42%, fever 17% vs. 38%, general signs of illness 14% vs. 22% in the second vs. first period, respectively overall cases were younger in the second period, the median age of asymptomatic cases was comparable in both periods. The case fatality rate for the first period was 2.1%, in the second it was 0.2%. Discussion: The epidemiological situation in the second period is different from that during the first wave. We observed a considerable proportion of questionable cases in August/September 2020 (asymptomatic cases, high ct values, often only detection of one gene). False positive cases/non-contagious cases have to be taken into account for this period. On-demand or free-of-charge testing for asymptomatic persons will lower the positive predictive value of tests and place a high burden on finite capacities.

Brief Screening for Four Mental Illnesses of the Elderly in Community Mental Health Services: the BS4MI-Elderly.

ObjectiveEarly detection and proper management of mental illness can help to prevent severe deterioration. However, with limited financial and human resources of community mental health services, it is not practical to carry out all conventional screening tools simultaneously. In this study, we aimed to develop and validate a brief but comprehensive screening questionnaire for four common mental illnesses of the elderly. MethodsThe brief screening for four mental illnesses of elderly (BS4MI-elderly) is a 14-item binary response questionnaire that covers dementia, depressive disorder, sleep disorder, and hwa-byung. To test validity, we compared conventional scale scores for three groups of participants classified using the BS4MI-elderly. The sensitivity, specificity, predictive value of positive test, likelihood ratio of positive test and internal consistency of the BS4MI-elderly were assessed. Finally, a correlation analysis between the BS4MI-elderly and general mental health scales was conducted. ResultsA total of 254 participants aged over 65 years were recruited. The BS4MI-elderly showed moderate to high sensitivity for the test that distinguishes the normal group from the risk and disorder groups (dementia: 0.61, depressive disorder: 0.88, sleep disorder: 0.85, hwa-byung: 0.94) and high specificity for the test that distinguishes the disorder group from the normal and risk groups (dementia: 0.91, depressive disorder: 0.93, hwa-byung: 0.84, sleep disorder: 0.84). The BS4MI-elderly also exhibited good internal consistency and significant correlations with general mental health scales. ConclusionThe BS4MI-elderly, a brief but comprehensive screening tool, could be a useful instrument for screening the elderly in community mental health services.

The efficacy and reliability of Solubility test followed by High-Performance Liquid Chromatography (HPLC) for sickle cell disorders in Gujarat- An original research article

Introduction: Sickle cell anemia (SCA) is a genetic disorder characterized by severe hemolytic anemia. Diagnosis is an important aspect of the management of the disease. In the present study, the efficacy of the solubility test was assessed and High-performance liquid chromatography (HPLC) in the diagnosis of Sickle cell disorders. Material and Methods: A total of 1890 patients were screened. Among them, 1022 samples were tested positive for Sickle cell disorders. All the samples were observed for peripheral smear, subjected to solubility test and were further analyzed on HPLC ‘BIO-RAD’ analyzer for the confirmation along with the distinction of Sickle cell trait (SCT), sickle cell disease (homozygous) and Heterozygous sickle cell and beta-thalassemia. Results: Out of all 1890 patients screened, 1022 samples were found to be positive with the solubility test. A total of 686 samples were diagnosed as Sickle cell Trait, 247 for sickle cell disease (homozygous) and 89 samples were diagnosed as Sickle cell beta-thalassemia (heterozygous) with HPLC. Conclusion: Solubility test is very effective with 96.8% sensitivity. Specificity calibrated was on average 29.6%, with the predictive value of positive test 87.9% and a predictive value of negative test 64.0%. The most commonly used method now in Gujarat is HPLC although the solubility test is also sensitive and cheap.

Loop-Mediated Isothermal Amplification Assay for Rapid and Reliable Detection of Mycobacterium tuberculosis in Sputum Samples

Introduction: Tuberculosis (TB) remains a major global health problem. The most common method for diagnosing TB in developing countries is sputum smear microscopy; however, the sensitivity of this test is relatively lower. Detection of Mycobacterium tuberculosis using conventional culture and biochemical-based assays is time-consuming and laborious. Polymerase Chain Reaction (PCR) is also available for diagnosis of Mycobacterium tuberculosis. However, the PCR assay requires an expensive thermal cycler to amplify the DNA fragment in multiple temperature-dependent steps. Therefore, a simple and sensitive method for rapid detection has been anxiously awaited. The loop-mediated isothermal amplification (LAMP) assay is a diagnostic technique which can aid in the fight against TB in resource-poor countries. The LAMP assay can amplify a targeted sequence at a constant temperature. Therefore, a large and costly thermal cycler is not necessary for a LAMP assay.Objectives: The objective of this study was to identify Mycobacterium tuberculosis directly from sputum by LAMP and to compare its efficacy over routinely used methods.Methods: A total of 106 (53 fluorochrome staining positive and 53 fluorochrome staining negative) sputum samples were collected in this study. Mycobacterial DNA was extracted from concentrated sputum samples by freezing and boiling method. LAMP assay using a set of six specific primers targeting the M. tuberculosis 16S rRNA gene with high sensitivity was used to analyze sputum samples. The results were then compared with that of the culture method, which was considered as the gold standard method.Results: Among total of 106 samples studied by microscopy and culture, 53 were positive by both, whole four were positive by culture but negative by microscopy. With reference to culture, the microscopy had sensitivity 92.98%, specificity 100%, and predictive value of positive test 100%, predictive value of negative test 92.5%. Out of 106 samples subjected to culture and LAMP for the diagnosis of TB, 55 samples were positive by both tests and two were positive only in culture, while 48 were negative in both tests and one was negative only in culture. While comparing the LAMP with culture as a gold standard, the sensitivity of LAMP was 96.49%, specificity was 97.95%, predictive value of positive test was 98.21%, predictive value of negative test was 96%.Conclusions: Comparative experiments showed that the LAMP assay is a rapid, sensitive, and specific method to detect M. tuberculosis infection. Indeed, an inexpensive LAMP assay would be potential as a diagnostic test for tuberculosis, especially in resource-limited settings. J-GMC-N | Volume 11 | Issue 01 | January-June 2018, Page: 27-34

Improved perfusion pattern score association with type 2 diabetes severity using machine learning pipeline: Pilot study.

Type 2 diabetes mellitus (T2DM) is associated with alterations in the blood-brain barrier, neuronal damage, and arterial stiffness, thus affecting cerebral metabolism and perfusion. There is a need to implement machine-learning methodologies to identify a T2DM-related perfusion pattern and possible relationship between the pattern and cognitive performance/disease severity. To develop a machine-learning pipeline to investigate the method's discriminative value between T2DM patients and normal controls, the T2DM-related network pattern, and association of the pattern with cognitive performance/disease severity. A cross-sectional study and prospective longitudinal study with a 2-year time interval. Seventy-three subjects (41 T2DM patients and 32 controls) aged 50-85 years old at baseline, and 42 subjects (19 T2DM and 23 controls) aged 53-88 years old at 2-year follow-up. 3T pseudocontinuous arterial spin-labeling MRI. Machine-learning-based pipeline (principal component analysis, feature selection, and logistic regression classifier) to generate the T2DM-related network pattern and the individual scores associated with the pattern. Linear regression analysis with gray matter volume and education years as covariates. The machine-learning-based method is superior to the widely used univariate group comparison method with increased test accuracy, test area under the curve, test positive predictive value, adjusted McFadden's R square of 4%, 12%, 7%, and 24%, respectively. The pattern-related individual scores are associated with diabetes severity variables, mobility, and cognitive performance at baseline (P < 0.05, |r| > 0.3). More important, the longitudinal change of individual pattern scores is associated with the longitudinal change of HbA1c (P = 0.0053, r = 0.64), and baseline cholesterol (P = 0.037, r = 0.51). The individual perfusion diabetes pattern score is a highly promising perfusion imaging biomarker for tracing the disease progression of individual T2DM patients. Further validation is needed from a larger study. 1 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;49:834-844.

UJI KESAHIHAN (VALIDITAS) PEMERIKSAAN D-DIMER CARA MENYARING KEKEBALAN (METODE IMUNOFILTRASI) DAN CARA MENGUKUR IMUNOTURBIDIMETRI

D-Dimer parameter is the most usefull laboratory assay to detect the present of activated coagulation. The D-Dimer fragment directlyindicate the fibrinolitic proccess whereas the increasing mark of D-Dimer is the most hemostatic parameter that was used to detectthe early stage of Disseminated Intravascular Coagulation (DIC) and has a correlation with the patient prognosis. D-Dimer assay byimmunoturbidimetric method was used to detect antigen-antibody reaction automatically and it can detect D-Dimer concentration lessthan 0.5 μg/mL. The immunoturbidimetric method has a good correlation with the ELISA method, but the proccess is complicated, ishigh costed, and need the competence of practical human resource. D-Dimer assay with immunofiltration method has the same principleas immunoturbidimetric method, but it's work more simpler, low cost and does not need the competence of practical human resource.The aim of this study is to compare the D-Dimer assay concentration between immunofltration and immunoturbidimetric method. Therewere 30 plasma samples assayed with these two methods (immunoturbidimetric and immunofiltration), and then compared betweenthem. The samples were collected between November until December 2008 at Rumah Sakit dr. Hasan Sadikin Bandung. The validity ofD-Dimer using immunofiltration method showed sensitivity 74%, specificity 95%, predictive value of negative test (PV-) 22%, predictivevalue of positive test (PV+) 95% with likelihood ratio 5.2. The conclusion of this study so far that the immunofiltration method has agood validity for diagnosing. D-Dimer work rapidly with low cost laboratory assay than the immunoturbidimetric method.

Study on early warning threshold values for 7 common communicable diseases in Gansu province, 2016

Objective: To optimize the warning threshold values of common communicable diseases in Gansu province, and improve the early warning effect. Method: An early warning model was set up for influenza, scarlet fever, other infectious diarrheal diseases, dysentery, typhoid and paratyphoid, viral hepatitis type E and hand foot and mouth disease (HFMD) respectively in Gansu by using the moving percentile method and cumulative sum method. By calculating the sensitivity, specificity, predictive value of positive test, predictive value of negative test, Youden' index and receiver-operating characteristic curve, the optimum early warning threshold values for communicable diseases in Gansu were selected. Results: The optimum early warning boundary values of influenza, scarlet fever, other infectious diarrheal diseases, dysentery, typhoid and paratyphoid, and viral hepatitis type E were P(90), P(80), P(95), P(90), P(80) and P(90) respectively. The optimum early warning parameters of HFMD were k=1.2, H=5σ. Under the optimum early warning boundary values/parameters, the early warning sensitivities of influenza, scarlet fever, other infectious diarrheal diseases, dysentery, typhoid and paratyphoid, viral hepatitis type E and HFMD were 86.67%, 100.00%, 91.67%, 100.00%, 100.00%, 100.00% and 100.00%, the specificities were 86.49%, 62.22%, 75.00%, 100.00%, 97.92%, 89.13% and 74.47%. The predictive values of positive test were 72.22%, 29.17%, 52.38%, 100.00%, 80.00%, 54.55% and 29.41%, and the predictive values of negative test were 94.12%, 100.00%, 96.77%, 100.00%, 100.00%, 100.00% and 100.00%, and the Youden' indexes were 0.73, 0.62, 0.67, 1.00, 0.98,0.89 and 0.74. Receiver-operating characteristic curve showed that the values/parameters of this warning boundary were the points closest to the upper left of the coordinate diagram. Conclusion: The early warning thresholds of influenza, other infectious diarrheal diseases, dysentery and hepatitis E in Gansu may be raised appropriately and the early warning parameters of HFMD need to be adjusted to improve the effectiveness of early warning.

Is Dementia Screening of Apparently Healthy Individuals Justified?

Despite efforts to raise awareness and develop guidelines for care of individuals with dementia, reports of poor detection and inadequate management persist. This has led to a call for more identification of people with dementia, that is, screening individuals who may or may not complain of symptoms of dementia in both acute settings and primary care. The following should be considered before recommending screening for dementia among individuals in the general population. Dementia Tests. Low prevalence reduces positive predictive value of tests and screening tests will miss people who have dementia and identify people who do not have dementia in substantial numbers. Clinical Issues. The clinical course of dementia has not yet been shown to be amenable to intervention. Misdiagnosis and overdiagnosis can have significant long-term effects including stigmatization, loss of employment, and autonomy. Economic Issues. Health systems do not have the capacity to respond to increased demand resulting from screening. In conclusion, at present attention to life-course risk reduction and support in the community for frail and cognitively impaired older adults is a better use of limited healthcare resources than introduction of unevaluated dementia screening programs.

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Threshold BMI to predict Non-Insulin-resistance in PCOS

Objectives: To suggest a threshold BMI at which IR becomes significant. Methods: This is a cross sectional study conducted at Gandhi Hospital, a tertiary care centre, teaching hospital at Hyderabad, India. The study includes 167patients diagnosed as PCOS by revised Rotterdam criteria in the age-group of 18-30 years attending the gynaecology O.P between January 2013 to August2013. All were subjected to a uniform questionnaire, medical examination, investigations, inclusion and exclusion criteria. Results: 40% of 167 PCOS patients studied had IR. 87.88% of 66 IR PCOS patients had a BMI >25 kg/m² (Sensitivity- 87.88%). 60.39% of 101 non-IR PCOS patients had BMI 25 kg/m²,58 (59.18%) had IR. Hence the predictive value of positive test is 59.18%. Among 69 PCOS patients with BMI

Endometriosis as a risk factor for ovarian or endometrial cancer - results of a hospital-based case-control study.

BackgroundNo screening programs are available for ovarian or endometrial cancer. One reason for this is the low incidence of the conditions, resulting in low positive predictive values for tests, which are not very specific. One way of addressing this problem might be to use risk factors to define subpopulations with a higher incidence. The aim of this study was to investigate the extent to which a medical history of endometriosis can serve as a risk factor for ovarian or endometrial cancer.MethodsIn a hospital-based case–control analysis, the cases represented patients with endometrial or ovarian cancer who were participating in studies aimed at assessing the risk for these diseases. The controls were women between the age of 40 and 85 who were invited to take part via a newspaper advertisement. A total of 289 cases and 1016 controls were included. Using logistic regression models, it was tested whether self-reported endometriosis is a predictor of case–control status in addition to age, body mass index (BMI), number of pregnancies and previous oral contraceptive (OC) use.ResultsEndometriosis was reported in 2.1 % of the controls (n = 21) and 4.8 % of the cases (n = 14). Endometriosis was a relevant predictor for case–control status in addition to other predictive factors (OR 2.63; 95 % CI, 1.28 to 5.41).ConclusionThis case–control study found that self-reported endometriosis may be a risk factor for endometrial or ovarian cancer in women between 40 and 85 years. There have been very few studies addressing this issue, and incorporating it into a clinical prediction model would require a more precise characterization of the risk factor of endometriosis.

Endometriosis as a risk factor for Ovarian or Endometrial Cancer – Results of a hospital based case control study

There is no screening program for ovarian or endometrial cancer. One reason for that could be the relatively low incidence with subsequently low positive predictive values for tests with low specifity. One way to address the problem could be the utilization of risk factors to define sub-populations with a higher incidence. Recently, there were hints that endometriosis could be a risk factor for ovarian cancer.

Whole-Body Plethysmography in Suspected Asthma: A Prospective Study of Its Added Diagnostic Value in 302 Patients.

Whole-body plethysmography (WBP) with bronchial challenge testing to measure the (specific) airway resistance, (s)R(AW), is considered to be a more sensitive diagnostic procedure than spirometry, which can only measure the forced expiratory volume in one second (FEV1). The evidence for the added diagnostic value of WBP is not yet conclusive. In a prospective diagnostic study, we carried out WBP with bronchial challenge testing as well as a bronchodilation test in 400 patients with suspected asthma from June 2010 to October 2011. The bronchial provocation test was considered positive if the FEV1 fell by at least 20% and/or the airway resistance doubled, with an increase of the sR(AW) to at least 2.0 kPA × s and/or of the R(AW) to 0.5 kPA × s/L. Follow-up evaluation was performed one year later. The prevalence of asthma in the 302 patients who completed follow-up was 27.5%. The sensitivity of WBP with sR(AW) measurement for asthma was 95.2% (95% confidence interval [CI] 88.3%-98.1%), and its specificity was 81.7% (95% CI 76.1%-86.3%). The sensitivity of FEV1 was 44.6% (95% CI 34.4%-55.3%), and its specificity was 91.3% (95% CI 86.6%-94.4%). The negative predictive value (NPV) of WBP with sR(AW) measurement was 97.8% (95% CI 94.5%-99.1%), while that of FEV1 was 81.3% (95% CI 76.0%-85.7%). The positive predictive value (PPV) of WBP with sR(AW) measurement was 66.4% (95% CI 57.5%-74.2%), while that of FEV1 was 66.1% (95% CI 53.0%-77.1%). With sR(AW) measurement, asthma can be ruled out with high certainty. Improving the positive predictive value of testing for asthma remains a challenge, however, as sR(AW) measurement does not yield any increase in specificity.