Positive Test Results Research Articles

Deciphering Positive Cytomegalovirus IgM Test Results in Immunocompetent Adults Hospitalized with Illness Suspicious for Acute Cytomegalovirus Infection: A Multihospital Study

Abstract Background Previously healthy adults hospitalized with an acute undifferentiated illness who test positive for cytomegalovirus (CMV) immunoglobulin M (IgM) in their serum may have a primary CMV infection, CMV reactivation/reinfection, or a false-positive result. We aimed to understand how clinicians interpret and incorporate positive CMV IgM test results into their diagnostic and management decisions. Methods A retrospective case series study of 13 previously healthy, immunocompetent adults hospitalized with an acute illness in a 12-hospital system from January 1, 2017, to January 1, 2020, who tested positive for CMV IgM within 3 days of hospitalization. Twelve of 13 had CMV IgG. Results Among these 13 adults (median age, 36), elevated liver enzymes (100%), fever (85%), hepatosplenomegaly (54%), and headache (38%) were common. Lymphocytosis was observed in five patients, reactive lymphocytes in three, and one patient died from hemophagocytic lymphohistocytosis. Dual positivity for CMV and EBV IgM was frequent, yet only one patient was tested for both CMV and EBV DNA in blood or for CMV IgG avidity index, which indicated a primary CMV infection. Of the six patients with CMV DNA in blood, four received anti-CMV treatment. Uncertainty regarding CMV’s role in the illness was common, and final assessments varying even among cases with similar clinical presentations and serologic patterns. Conclusions Interpreting positive CMV IgM results in immunocompetent adults hospitalized with acute illness is challenging and ambiguous due to test limitations and confounders. Supplemental CMV IgG avidity testing can help determine whether primary CMV infection caused the illness, thereby refining the diagnosis and potentially influencing clinical decision-making.

Development of Visual Loop-Mediated Isothermal Amplification Assays for Foodborne Hepatitis A Virus

(1) Background: There are many cases of human disease caused by the hepatitis A virus contamination of aquatic products, so the development of the rapid detection of hepatitis A virus in aquatic products is crucial. (2) Methods: In this study, we developed three visual loop-mediated isothermal amplification methods for the rapid and intuitive detection of hepatitis A virus in aquatic products. New specific LAMP primers were designed for the HAV-specific VP1 protein shell. (1) HNB dye was added to the LAMP reaction system. After the reaction, the color of the reaction mixture changed from violet to sky blue, showing a positive result. (2) Cresol red dye was added to the LAMP reaction system, and a positive result was indicated by orange, while a negative result was indicated by purple. (3) By labeling FIP with biotin and LF with 6-FAM, the amplified product simultaneously contained biotin and 6-FAM, which bound to the anti-biotin antibody on the gold nanoparticles on the lateral flow dipstick (LFD). Subsequently, biotin was further combined with the anti-fam antibody on the T-line of the test strip to form a positive test result. (3) Results: The three visual LAMP methods were highly specific for HAV. The sensitivity of the visual assay was 2.59 × 100 copies/μL. The positive detection ratio for 155 bivalve shellfish samples was 8.39%, which was the same as that for RT-qPCR. The three visual LAMP methods established in our work have better sensitivity than the international gold standard, and their operation is simple and requires less time. (4) Conclusions: The results can be obtained by eye color comparison and lateral flow dipsticks. Without the use of large-scale instrumentation, the sensitivity is the same as that of RT-qPCR. The test strips are lightweight, small in size, and easy to carry; they are suitable for emergency detection, on-site monitoring, field sampling, or remote farms and other non-laboratory environments for rapid identification.

Diagnostic Value of Liquid-Based Cervical Cytology Test in Endometrial Carcinoma.

Abnormal endometrial cells could be detected by liquid-based cervical cytology test due to the anatomical continuity of the uterine cavity with the cervix. Our aim was to evaluate the diagnostic value of Papanicolaou (Pap) test in endometrial cancer (ECa). ECa cases with liquid-based Pap smears within 6 months before the histological diagnosis were retrospectively searched from an academic women's and children's hospital pathology archive. Corresponding smears were reviewed, and clinicopathological parameters and Pap test results were recorded. A total of 171 cases were identified. Among these patients, 43 (25.1%) cases were interpreted as abnormal, 32 (74.4%) of which suggested glandular abnormality in the routine screening (initial Pap smear reports). After re-examining all slides, 123 (72.5%) cases showed the presence of endometrial abnormality. Among these, 87 cases (70.7%) were diagnosed as atypical endometrial cells (AEC), 33 cases (26.8%) as adenocarcinoma (ADC), and 3 cases (2.4%) as benign endometrial cells. The cases with non-endometrioid histology were more likely to be interpreted cytologically as ADC, while endometrioid subtypes were often diagnosed as AEC (p < 0.05). Except for the tumour type (p < 0.05), the other clinicopathological factors were not significantly related to a higher percentage of positive Pap test results, including age, histological grade, myometrial invasion, cervical involvement, lymphovascular invasion, and FIGO stage(p > 0.05). Pap test plays a role in the detection of ECa. Detection could be improved in routine screening by paying more attention to endometrial lesions in high-risk populations.

Interpreting clinical outcomes using different strut thickness in coronary artery disease: insights from vascular imaging analysis

BackgroundCoronary artery disease is a global health concern that necessitates treatments, such as percutaneous coronary intervention (PCI) with drug-eluting stents (DES). Recent advancements in biodegradable polymer-coated DES have improved long-term outcomes by reducing neointimal hyperplasia. Superior long-term outcomes in patients with ultrathin-strut sirolimus-eluting Orsiro stent (BP-SES) compared with those with thick-strut biolimus-eluting BioMatrix stent (BP-BES) have been shown. This study aimed to explore the mechanisms underlying these differences by using quantitative coronary angiography (QCA) and optical coherence tomography (OCT).MethodsThis sub-analysis of the BIODEGRADE trial, a prospective, randomized, multi-center study, compared BP-SES and BP-BES in patients who underwent PCI between July 2014 and September 2017. Patients with positive stress test results, ischemic symptoms, or those who consented to routine follow-up angiography were included. QCA and OCT were used to evaluate the lumen diameter, cross-sectional areas and stent apposition or coverage. OCT images were analyzed at 1 mm intervals within 5 mm proximal and distal to the stented segment.ResultsOf the 2,341 patients, 689 underwent follow-up angiography between 18- and 36-months post-PCI, and 929 stents were analyzed via QCA. OCT images of 61 participants were available. The BP-SES group exhibited a significantly larger minimal lumen diameter and reduced late lumen loss compared to the BP-BES group (0.34 ± 0.45 mm vs. 0.42 ± 0.44 mm, P = 0.005). OCT analysis showed significantly less neointimal hyperplasia in the BP-SES group (0.04 ± 0.4 mm2 vs. 0.64 ± 0.54 mm2, P &amp;lt; 0.001), with no significant differences in stent strut coverage or inflammation markers, than in the BP-BES group.ConclusionsQCA and OCT analyses revealed less neointimal growth with BP-SES than with BP-BES, without delayed healing or increased inflammation. These findings underscore the importance of stent design characteristics and suggest that thinner struts may enhance clinical success by reducing restenosis and improving long-term vessel patency.Clinical Trial Registrationhttps://clinicaltrials.gov/study/NCT02299011 (NCT02299011).

The role of general practitioners in the follow-up of positive results from the Australian National Bowel Cancer Screening Program - a scoping review.

Background There are several studies investigating the effectiveness and participation rates of the Australian National Bowel Cancer Screening Program (NBCSP), but there is limited literature pertaining to the role and processes that general practitioners (GPs) follow after a positive immunochemical faecal occult blood test (iFOBT) result. The aim of this paper is to review evidence examining GP involvement in the follow-up of positive iFOBT results from the NBCSP and identify knowledge gaps. Methods A scoping review was undertaken involving the search of the Cochrane Library, Informit, PubMed and Scopus electronic databases. Inclusion criteria were the follow-up processes and practices by GPs subsequent to notification of a positive iFOBT from this program. Searches were limited to English and publication was from January 2006 to January 2024. A combination of keywords was used and adapted to each search engines' requirements: general practitioner AND bowel cancer AND screening AND Australia. Results Relevant sources of evidence were reviewed, and 24 records met inclusion criteria. Results are represented across three themes: (i) screening process and GP follow-up; (ii) follow-up rates and facilitation; and (iii) recommendations for improved follow-up. Conclusion This scoping review provides insight into the central role GPs play in the implementation of the NBCSP and highlights the lack of information regarding steps taken and systems employed in general practice to manage positive iFOBTs.

Utility of CINtec PLUS in Identification of High-Grade Lesions on Short-Term Follow-Up in Patients With Negative Cytologic Interpretation.

Screening for cervical cancer may include cervical cytology and/or high-risk human papillomavirus testing (HPV). The FDA (Food and Drug Administration)-approved CINtec PLUS dual stain (DS) for p16 and Ki-67 can provide helpful information for challenging follow-up care. We retrospectively analyzed 272 cases with negative intraepithelial malignancy (NILM) Papanicolaou (Pap) tests and positive HPV test results. All 272 women had colposcopy-directed biopsies or endocervical curettage (ECC) (histopathology) within a year. We compared DS test results with corresponding ECC/colposcopy specimens. Two subgroup analyses were conducted to examine the correlation of DS results with a prior history of abnormal Pap/colposcopy and to compare DS results with regard to HPV genotype. For analysis purposes, only high-grade lesions were considered positive, while low-grade lesions were grouped with negative results. Of 272 cases, 113 tested positive for DS, while 159 were negative. On follow-up histopathology within a year, three of the 113 positive cases (2.6%) showed high-grade lesions. In comparison, none of the 159 negative cases showed any high-grade lesions (95% confidence interval [CI]: -0.3% to 5.4% [p = 0.14]). Further analysis by HPV status showed that DS helped in risk discrimination in both subcategories (HPV16/18 and other 12 high-risk HPV), although it was not statistically significant (p = 0.99). Subgroup analysis based on the history of high-grade lesions demonstrated that in cases with no previous history, the risk difference was 2.8% between DS positive and negative results (95% CI -0.3% to 6%, p = 0.134). All three high-grade lesions were in the DS positive category, suggesting DS may help in the risk stratification for HPV-positive NILM women (either HPV16/18 or other). Furthermore, DS may help with risk stratification, specifically in patients with no prior high-grade lesions.

Prevalence of BCG scar among vaccinated children and its correlation with Mantoux skin test at Omdawanban area, Sudan.

Prevalence of BCG scar among vaccinated children and its correlation with Mantoux skin test at Omdawanban area, Sudan.

Interstitial lung disease, antineutrophil cystoplasmic antibodies and microscopic polyangiitis.

This mini review explores the association of interstitial lung disease (ILD) with antineutrophil cystoplasmic antibodies (ANCA) and the clinical syndrome of microscopic polyangiitis (MPA). Reports on radiographic and histopathologic findings as well as genetic predispositions are reviewed. Based on this evidence a concept for the pathogenesis of the relationship of ILD, MPO-ANCA and MPA is proposed. Finally, a practical clinical management approach to patients presenting either with ILD and a positive ANCA test result, or to patients with MPA found to have pulmonary abnormalities qualifying as an ILD, is derived from the currently available literature. Treatment of these patients is based on up-to-date guidelines for the management of ILD as well as ANCA-associated vasculitis.

Evaluation of first-trimester ultrasound screening strategy for fetal congenital heart disease.

To assess the performance of a standardized first-trimester ultrasound screening strategy for fetal congenital heart disease (CHD). This was a large retrospective study involving 74 839 consecutive mixed-risk pregnancies (77 396 fetuses). Routine ultrasound scans at 11 + 0 to 13 + 6 weeks' gestation were performed in a single center from January 2015 to June 2023. All fetuses were examined using a predefined standardized ultrasound scanning strategy with adjustment of imaging parameters, which included assessment of the fetal heart. The ultrasound results (e.g. extracardiac congenital malformations), ultrasound markers (e.g. nuchal translucency thickening, reversed a-wave in the ductus venosus and tricuspid regurgitation), follow-up, genetic tests and diagnostic results were recorded and analyzed. In total, there were 831 cases of CHD, with an incidence of 1.07% (831/77 396). In the first-trimester scan, 590 fetuses were diagnosed with CHD, but four were confirmed as normal in later examinations. In addition, 245 cases were missed. The detection rate was 70.52%, with a sensitivity, specificity, false-positive rate and false-negative rate of 70.52%, 99.99%, 0.01% and 29.48%, respectively. In fetuses with negative ultrasound markers and no extracardiac malformations, the detection rate of CHD was 45.79% (185/404). There were 281 cases that underwent karyotyping and chromosomal microarray (245 fetuses) or whole-exome sequencing (36 fetuses). In total, 38.79% (109/281) had a positive genetic test result. There were 273/831 CHD cases associated with extracardiac malformations. The abnormal image patterns and abnormal features of each view in the scanning strategy were summarized. Ultrasound screening for fetal CHD in the first trimester of pregnancy enables earlier prenatal diagnosis and consultation. The standardized ultrasound screening strategy used in this study had a high detection rate for fetal CHD in the first trimester. Our proposed fetal heart screening strategy shows promising effectiveness for early diagnosis of CHD and we recommend its use. It is important to note, however, that first-trimester ultrasound screening for fetal CHD should not replace fetal echocardiography in the second trimester. © 2025 International Society of Ultrasound in Obstetrics and Gynecology.

Utility of preoperative syphilis screening on the detection of syphilis at a tertiary care center: a retrospective cohort study.

The incidence of syphilis has been rising globally but effective screening strategies are lacking. Preoperative syphilis screening is commonly performed at Japanese hospitals for infection prevention purposes. However, its effectiveness in improving subsequent management is unclear. A retrospective cohort study was conducted to assess the effectiveness of universal preoperative syphilis screening testing implemented at a Japanese tertiary care hospital from April 2017 to March 2023. The annual prevalence of positive preoperative treponemal tests was tracked, and subsequent clinical management for patients with a positive test result was investigated. Attributes of patients with a positive result who were more likely to receive further evaluation were also elucidated. In total, 82,439 patients underwent surgery during the study period. Preoperative treponemal testing was performed in 94.8% (78,170/82,439) of the patients. A positive test result was recorded in 544 (0.70%) with an annual positivity rate ranging from 0.61 to 0.83%, whereas the proportion of presumed active syphilis ranged from 0.02 to 0.08%. A total of 85 patients with a positive syphilis screening test, a nontreponemal test with a positive titer, and without history of syphilis were identified. Of those, only 45 patients (52.9%) received further evaluation. The positivity of preoperative treponemal testing was low despite the rising incidence of syphilis in Japan, and the prevalence of presumed active syphilis identified during the preoperative period was even smaller. Routine treponemal testing in the preoperative setting had limited utility in effectively identifying patients with active syphilis.

The role of genetics in the prognosis of acute myocarditis: a systematic review and meta-analysis.

Myocarditis is a heterogeneous disease with varying clinical presentations, etiologies, and courses. Apart from environmental factors, genetic factors may also play a role in its pathophysiology. Through a systematic review and meta-analysis, we aimed to characterize the relationship between acute myocarditis (AM), underlying genetic background, and prognosis. We searched on MEDLINE/PubMed and Web of Science for studies reporting clinical outcomes of patients presenting with AM and undergoing genetic testing. The prevalence of a positive genetic test result was 27.3%, with a higher proportion of males (61.3%). Patients with a positive genetic test often had a family history of cardiovascular events (53.3%) and late gadolinium enhancement on cardiac magnetic resonance (81.2%), suggesting that these clinical features may represent a population with a higher burden of genetic background and risk for worse outcomes. The risk of recurrence of AM among patients with a positive genetic test was four times greater than among non-carriers (RR=4.02, p<0.001), and the most frequently observed variants among AM carriers were in the TTN, DSP, PKP2, MYH7, BAG3, RMB20, DSG2, TNNT2, and SCN5A genes. Overall, these findings underscore the need to improve the criteria used for genetic testing in the setting of AM episodes and to identify affected individuals who may benefit from increased surveillance and genetic testing.

Genetic counseling referral rates and genetic testing outcomes in women with young breast cancer: a 20-year Canadian review.

Despite guidelines recommending genetic testing for all cases of very young breast cancer (VYBC), poor uptake has been reported. This study aimed to examine genetic testing referral rates and outcomes over a 20-year period within the Canadian context. A retrospective chart review of all incident VYBC cases (at or below 35 years of age) between January 1, 2000 and December 31, 2019 was conducted. Descriptive statistics were used to summarize demographic factors and logistic regression analyses were performed to identify the predictors associated with referral for genetic counseling and positive genetic test results. 628 women were identified with VYBC. Most women presented with stage 2 (42%), hormone receptor-positive (HR +) and HER2-negative (54%) invasive ductal carcinoma (94%). Over the study period, referral rates increased from 44 to 84%. Of women initially tested for BRCA1/BRCA2, only 21% were referred for updated panel testing. Among those tested, 19% had a pathogenic variant, 21% of whom reported no family history of cancer. Predictors of referral included stage 0-2 disease while predictors of positive test results included a second breast cancer diagnosis and positive family history. Despite guidelines based on age alone, barriers to referral persist. Results of this study suggest the need for new models of care that ensure equitable access to genetic testing for all women diagnosed with VYBC regardless of family history, ethnicity, or disease stage. As genetic testing criteria evolve, protocols must address these barriers to prevent missed opportunities for testing.

Identifying Cellular Immunodeficiency Through a Persistent Herpetic Whitlow

ABSTRACTCutaneous infections caused by HSV are common, with the oral and genital mucosa being most frequently affected (1, 2). In individuals with immunodeficiency, HSV‐2 caused skin lesions may appear severe and unusual, or occur simultaneously with other skin diseases (3). We report on a patient who presented with painful peri‐ and subungual hypergranulation of digitus III, accompanied by ulceration, honey‐coloured crusts and seropurulent exudate. Immunohistochemistry and PCR confirmed HSV‐2 caused chronic herpetic whitlow. Simultaneously, Herpes zoster and seborrhoeic dermatitis were diagnosed, leading to a thorough evaluation for underlying immunosuppressive conditions. While belonging to the MSM (Men who have sex with men) community, the patient declined HIV‐testing. Fluorescence‐activated cell sorting (FACS) analysis revealed a substantial reduction in CD4+ T‐cells, indicating severe cellular immunodeficiency. Following in‐depth conversations, the patient revealed that he had not undergone HIV testing due to anxiety of a positive test result and the potential associated social stigma. After underlining the significance of HIV testing for his own health, the risk of transmitting a potential infection to others, and informing about modern antiretroviral treatment, the patient ultimately decided to undergo testing, leading to HIV diagnosis. Antiretroviral medication was initiated, resulting in a reduction of HIV viral load and an improvement in cellular immunity. This case report demonstrates the enduring HIV stigma, which can lead to fear‐driven avoidance in HIV testing. Healthcare professionals should approach patients' fears with empathy, while also underscoring the importance of disclosing one's HIV status to others.

Workplace Drug Testing-Prevalence of Positive Test Results, Most Common Substances, and Importance of Medical Review.

Recent data indicate that the use of controlled substances is increasing in working life, which can negatively affect work environment, performance, and safety. Many employers have an alcohol and drug policy that describes routines for preventive measures and early detection of illicit drug use. This often includes drug tests that provide objective information about recent use, and can be done routinely, randomly, and on suspicion. For some substances, however, a positive drug test may also result from prescription as medicine. Controlled substances that are abused and prescribed include amphetamines (ADHD medication), benzodiazepines and opiates. In a 2023 study of 23,900 urine and oral fluid drug test results from Swedish workplaces, 4.6% tested positive for one or more controlled substances. Most samples were collected in connection with random testing (40%) and new employment (36%), whereas the highest proportions of drug-positive samples were observed in cases related to accidents or incidents, or on suspicion of drug use. The highest percentage of positive random drug tests was recorded in the construction sector. The most common substances were cannabis (> 40% of cases), amphetamine (> 20%), and cocaine and benzodiazepines (> 10% each). However, many samples containing opiates (71% of cases), amphetamine (63%) and benzodiazepines (44%) were verified by a specialist trained Medical Review Officer (MRO) to be due to medical prescription, while those containing cannabis or cocaine were almost entirely due to illicit drug use. Considering the potentially negative consequences of a positive drug test in working life, an MRO should verify the results before they become final.

Cervical cancer screening: comparative study of human papillomavirus detection between cervical cytology and urine samples

ObjectiveTo evaluate the efficacy of urine-based human papillomavirus detection in detecting high-grade cervical lesions (CIN2+) compared to cervical cytology examination.MethodThe data of 458 patients with cytological abnormalities and/or positive human papillomavirus test results were retrospectively selected from December 1, 2017, to March 31, 2022, at the Beijing Obstetrics and Gynecology Hospital affiliated with Capital Medical University. Cervical cytology and urine samples were used to detect human papillomavirus status and analyze the correlation between the results and cervical biopsy results.ResultsAmong the selected 458 samples, 386 were positive for human papillomavirus through cervical cytology examination, with a detection rate of 84.3%. Out of 458 urine samples, 362 were positive, with a detection rate of 79.0%. The data shows a high consistency between cervical cytology and urine sample testing, with a kappa value of 0.637 (P < 0.01). The most prevalent subtypes in cervical samples included HPV16, HPV58, and HPV52, while the detection rates of HPV16 and HPV58 subtypes were relatively high in urine samples. The comparison of subtype distribution between cervical and urine samples showed that the positivity rate of HPV44 subtype was consistent, both at 3.9%. Among the five HPV subtypes corresponding to the HPV nine-valent vaccine, the kappa value of HPV16 in cervical and urine samples was 0.791 (P < 0.05), the kappa value of HPV52 was 0.766 (P < 0.05), HPV18 was 0.762 (P < 0.05), HPV33 was 0.539 (P < 0.01), and HPV31 was 0.458 (P < 0.05). Among 458 specimens, the sensitivity of human papillomavirus detection in cervical cytology was 96.7%, with a specificity of 20.2% (P < 0.01). The sensitivity of human papillomavirus detection in urine samples was 85.2%, with a specificity of 23.2% (P < 0.01).ConclusionUrine human papillomavirus testing, as a non-invasive screening method, has significant application effects. The screening results are highly consistent with cervical cytology screening and may improve the compliance of women who do not want to undergo invasive gynecological examinations. This screening method simplifies the screening process and has great potential in screening cancer lesions and preventing cervical cancer.

Estimation of Trypanosoma cruzi infection in the main vector Triatoma infestans: accounting for imperfect detection using site-occupancy models

BackgroundVector infection prevalence is a key component of vectorial capacity and transmission risk. Optical microscopy observation (OM) of fecal drops has been the classic method for detecting Trypanosoma cruzi infection in triatomine bugs until the advent of polymerase chain reaction (PCR)-based techniques. However, agreement among OM- and PCR-based techniques has been highly heterogeneous.MethodsWe used hierarchical site-occupancy models accounting for imperfect detection to estimate method-specific detection probabilities of T. cruzi infection in field-collected Triatoma infestans and to assess whether T. cruzi infection varied with triatomine developmental stage and collection ecotope. We also performed a scoping review of the literature on comparisons between OM and PCR for T. cruzi infection diagnosis in triatomines. Triatomines were collected before vector control interventions in Pampa del Indio houses (Argentine Chaco) and examined by OM. We amplified the variable regions of the kinetoplastid minicircle genome (vkDNA-PCR) in DNA extracted from the rectal ampoules of 64 OM-positive and 65 OM-negative T. infestans.ResultsvkDNA-PCR detected T. cruzi infection in 59 (92.2%) OM-positive bugs and in 19 (29.2%) OM-negative triatomines in blind tests. The overall prevalence of infection, as determined by a positive test result by either vkDNA-PCR or OM, was 64.3% [95% confidence interval (95% CI) 55.8–72.1%]. Detection probability of T. cruzi infection by vkDNA-PCR (92%, 95% CI 83–97%) was substantially higher than for OM (76%, 95% CI 65–84%). Infection was minimal (26.2%) in peridomestic nymphs and maximal in domestic adult triatomines (81.7%). In the literature review encompassing 26 triatomine species from 11 countries, inter-method agreement ranged from 28.6% to 100%. The lowest agreement was observed in Rhodnius sp. and Panstrongylus lutzi and the highest among Triatoma sp., with wide variability in the protocols and outcomes of molecular diagnosis in comparison with OM.ConclusionsOur study provides a synthesis on the different sources (both biological and technical) of variation of the outcomes of OM- and PCR-based diagnosis of T. cruzi infection in triatomines and identifies new research needs for diagnostic improvement.Graphical

Relation of Perivascular Adipose Tissues on Computed Tomography to Coronary Vasospasm.

Coronary computed tomography angiography (CTA) can be used to quantitatively and qualitatively evaluate the characteristics of perivascular adipose tissue (PVAT), including PVAT volume and perivascular fat attenuation index (FAI). Moreover, PVAT volume and perivascular FAI on CTA are reportedly high in patients with vasospastic angina (VSA); however, previous investigations have focused on the patient rather than vessel-level analyses. Therefore, this study aimed to assess the relationship between coronary vasospasm and PVAT or FAI by using coronary CTA at the vessel level. This retrospective study included 51 patients who underwent intracoronary acetylcholine (ACh) provocation testing for the VSA diagnosis and coronary CTA within a 6-month interval. A total of 125 coronary vessels were evaluated. PVAT and FAI on CTA were quantitatively evaluated. The primary interest of the present study was to determine the relationship between PVAT volume and FAI- and ACh-induced coronary vasospasms at the vessel level. Of the 51 patients, 24 (47.1%) had a positive ACh provocation test (VSA), with 40 of 125 (32.0%) vessels having ACh-induced vasospasm. Obstructive epicardial coronary artery disease was observed in 12 vessels (9.6%). No significant differences in PVAT volume or FAI were identified between vessels with and without ACh-induced vasospasms. Similarly, PVAT volume and FAI did not differ significantly in the individual major coronary arteries between patients with and without positive ACh provocation test results. In contrast, FAI was significantly higher in vessels with obstructive coronary artery disease than in those without. In patients undergoing intracoronary ACh provocation tests and coronary CTA, no significant association was observed between ACh-induced coronary vasospasm and PVAT volume or FAI at the vessel level. However, FAI significantly increased in vessels with epicardial coronary disease.

PREVALENCE OF LATERAL EPICONDYLITIS AMONG RESIDENTIAL PAINTERS IN PESHAWAR

Background: Lateral epicondylitis (LE), commonly known as tennis elbow, is an overuse injury caused by eccentric overload of the common extensor tendon, particularly at the origin of the extensor carpi radialis brevis (ECRB). It frequently affects individuals engaged in repetitive manual labor and is prevalent among both males and females, typically involving the dominant arm. Despite extensive research across various professions, little is known about its prevalence among residential painters, a group prone to repetitive upper limb movements. This study aims to determine the prevalence of lateral epicondylitis in residential painters in Peshawar. Objective: To determine the prevalence of lateral epicondylitis among residential painters and assess its impact on daily activities using clinical and functional assessments. Methods: A cross-sectional study was conducted in Peshawar, including 184 male residential painters aged 21–45 years. Participants were selected through non-probability convenient sampling, with a confidence interval of 95% and a margin of error of 5%, calculated using Raosoft software. Data collection involved a customized questionnaire capturing demographic and occupational information, the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire for pain and disability assessment, and the Cozen test for clinical diagnosis. Informed consent was obtained from all participants, and ethical approval was granted by the relevant institutional review board. Results: The mean age of participants was 32.9 years (SD = 8.5), with the largest age groups being 21–25 (29.9%) and 41–45 (33.2%). A positive Cozen test result was observed in 54.3% of participants, indicating a high prevalence of lateral epicondylitis. PRTEE scores revealed that 38.1% experienced moderate pain, 34.2% severe pain, and 27.7% mild pain, with a mean score of 54.41. A significant positive correlation (r = 0.672, p &lt; 0.001) was found between Cozen test results and PRTEE scores, confirming the consistency between clinical diagnosis and self-reported disability. Conclusion: The findings reveal a high prevalence of lateral epicondylitis among residential painters, with both younger and older age groups affected. The strong correlation between Cozen test results and PRTEE scores highlights the condition’s impact on daily activities and occupational performance. These results emphasize the need for preventive strategies, including ergonomic interventions and awareness programs.

Diagnostic tests performance indices: an overview.

Diagnostic tests are important means in clinical practice. To assess the performance of a diagnostic test, we commonly need to compare its results to those obtained from a gold standard test. The test sensitivity is the probability of having a positive test in a diseased-patient; the specificity, a negative test result in a disease-free person. However, none of these indices are useful for clinicians who are looking for the inverse probabilities, i.e., the probabilities of the presence and absence of the disease in a person with a positive and negative test result, respectively, the so-called positive and negative predictive values. Likelihood ratios are other performance indices, which are not readily comprehensible to clinicians. There is another index proposed that looks more comprehensible to practicing physicians - the number needed to misdiagnose. It is the number of people who need to be tested in order to find one misdiagnosed (a false positive or a false negative result). For tests with continuous results, it is necessary to set a cut-off point, the choice of which affects the test performance. To arrive at a correct estimation of test performance indices, it is important to use a properly designed study and to consider various aspects that could potentially compromise the validity of the study, including the choice of the gold standard and the population study, among other things. Finally, it may be possible to derive the performance indices of a test solely based on the shape of the distribution of its results in a given group of people.

The usefulness of the forced oscillation technique in the diagnosis of bronchial asthma in seniors

ABSTRACT Background Obstructive pulmonary diseases are common in the elderly but often remain underdiagnosed due to limited spirometry availability or challenges with patient cooperation during testing. This study evaluated the potential of the forced oscillation technique (FOT) as a diagnostic tool for bronchial asthma in individuals over 60 years old. Research design and methods A total of 189 patients diagnosed with asthma after age 60 and a control group of nonasthmatic seniors were included. Participants underwent spirometry, FOT, and bronchial reversibility testing using both methods. The primary outcomes were correlations between positive results from resting spirometry and FOT in asthmatics and the agreement between reversibility test results across the two methods. Results FOT parameters (FEV1, V5, R5) effectively distinguished asthmatics from nonasthmatics. Positive reversibility test results were observed in 71 (73.2%) patients using FOT and 68 (70.1%) using spirometry, with both methods aligning in 64 (66%) cases. Conclusion These results highlight the value of FOT, particularly for bronchial reversibility testing, in improving asthma diagnosis in seniors. FOT offers a practical alternative for patients who face difficulties performing spirometry, addressing a critical need in this population.