Predictive Value Of Test Research Articles

(170) ASSESSMENT OF C-REACTIVE PROTEIN AND PROCALCITONIN VALUES MAY AVOID EXPLANT IN EQUIVOCAL FINDINGS FOR IPP INFECTION

Abstract Introduction Inflatable penile prosthesis (IPP) is the gold standard surgical treatment for erectile dysfunction. IPP infections require device removal and may lead to permanent erectile dysfunction and penile size loss. Infection is a clinical diagnosis made based on the presence of pain, fevers, chills, swelling, redness, tethering and fluctuance or purulence. However, postoperative exam findings may be equivocal, and hematologic testing could help support the need for explanation vs observation in borderline cases. C-reactive protein (CRP), a marker of inflammation, and procalcitonin, a marker of infection, may help to differentiate infection from inflammation. Objective To evaluate whether CRP and procalcitonin can be utilized to avoid explant in the setting of equivocal exam findings in suspected penile prosthesis infection. Methods We retrospectively reviewed records from a single surgeon at a tertiary care center from 2020-2023. Patient were identified if they had exam findings or clinical history concerning for possible IPP infection. Records were then further queried to determine if explant occurred or if the patient was successfully managed nonoperatively. CRP and/or procalcitonin lab values around the time of presentation were obtained and trended, where applicable. CRP and procalcitonin categorical ranges (eg, normal, mild, moderate, marked, or severe elevation), as defined by clinical standards, were compared between groups. Age, Charlson Comorbidity Index (CCI), and IV antibiotic choice at initial surgery were also compared. Fisher’s exact test was utilized to compare categorical outcomes, while independent t-test or Wilcoxon rank sum test were used to compare continuous variables. Results A total of 209 patients (n = 202 virgin cases, 96.7%) received IPP implant during the study period. Of these, 21 (10%) presented with concern for IPP infection with only 5 patients (2.4%) ultimately requiring explanation. When compared to the explanted cohort, patients who were successfully managed nonoperatively had significantly higher frequency of initial normal CRP/procalcitonin, or experienced down trending values (93.75% vs 40%, p = 0.03, Table 1). Negative predictive value of these tests was 71.4%. Age, CCI, and intravenous (IV) antibiotic choice did not differ between groups (Table 1). Conclusions In patients presenting with concern for IPP infection, obtaining and trending procalcitonin and CRP lab values, in concordance with other standard infectious labs such as a complete blood count, may help a urologist determine if a patient truly requires explant. This may be especially true in cases of suspected IPP infection when postoperative signs and symptoms are equivocal. Future, prospective studies are required to determine the predictive value of these laboratory tests in a larger, more diverse population. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast Corporation; Boston Scientific.

Rapid point-of-care test for diagnosis of peritonitis in peritoneal dialysis patients.

Periplex® is a rapid point-of-care test based on the detection of interleukin-6 (IL-6) or matrix metalloproteinase-8 (MMP-8) to diagnose peritonitis in peritoneal dialysis (PD) patients. This single-centre study was conducted in Singapore General Hospital from 2019 to 2022. The study recruited PD patients suspected of having peritonitis. Periplex was performed at the presentation and recovery of peritonitis. Primary outcomes were sensitivity and specificity of Periplex at presentation. The positive and negative predictive values of tests were also performed. A total of 120 patients were included in the study. The mean age was 60.9 ± 14.9 years, 53% were male, 79% were Chinese and 47.5% had diabetes mellitus. Periplex was positive in all patients with peritonitis (n = 114); sensitivity of 100%; 95% confidence interval (CI): 100-100%. Periplex was falsely positive in three patients with non-infective eosinophilic peritonitis, resulting in a low specificity of 50%; 95% CI: 41.1-59.0%. Periplex had a positive predictive value of 97.4% and a negative predictive value of 100%. During recovery from peritonitis, Periplex had high specificity (93.6%) and negative predictive value (98.7%) to indicate the resolution of infection. MMP-8 was more sensitive than IL-6 in detecting peritonitis. Periplex was positive in all patients with peritonitis regardless of the types of PD solutions used. Periplex had high sensitivity, and positive and negative predictive values in the diagnosis of peritonitis can be considered as a screening tool for peritonitis. Given its high specificity and negative predictive value, it may also be used to document the resolution of peritonitis.

QuantiFERON-CMV and monitor predict cytomegalovirus, mortality, and graft-versus-host disease in transplant recipients.

Cytomegalovirus (CMV) is the most prevalent infection in recipients of hematopoietic stem cell transplant (HSCT). QuantiFERON-CMV (QF-CMV) and QuantiFERON-Monitor (QFM) assays were used to test whether immune-competent adult allogeneic HSCT recipients with CMV-specific T cells can control CMV infection or reactivation. Our data demonstrated a significant correlation between CMV infection measured by CMV-antigenemia test and QF-CMV results, graft versus host disease (GvHD), and mortality rates. The QF-CMV test revealed that CMV-specific T cells with higher interferon-γ (IFN-γ) release were correlated with lower CMV infection rates. There was a significant negative association between QF-CMV results, GvHD, and mortality rates. Data showed that a one-unit rise in IFN-γ was linked with a 12.7% reduction in GvHD and a 20.7% reduction in the mortality odds ratio. In addition, a negative correlation was found between QF-M results and CMV infection, with the QFM test predicting protection against CMV infection by 1.9%. This is one of the few studies establishing the QF-CMV test's predictive value for GvHD and mortality, its use to monitor HSCT patients for pre-emptive therapy, and the use of the QFM test to predict CMV infection and mortality in HSCT patients. Thus, these assays could be utilized to optimize preventive and pre-emptive therapy procedures to reduce transplant recipient adverse effects and posttransplant therapy costs.

Increasing the reliability and availability of the electric motor using combined static and dynamic diagnostics

The aim of this paper is to point out the importance of early diagnostics and assessment of the condition of the electric motor in increasing the reliability and availability of the plant. Electric motors are unavoidable elements in every production process. As the complexity of the process increases, the number of electric motors involved in it increases. By increasing the number of electric motors, the possibility of cancelling and interrupting production increases. It is therefore very important to monitor the situation and detect defects at an early stage so that timely repair or replacement can be planned, without affecting the production process. Modern diagnostic methods that can be used both during the operation of the electric motor, and with the dismounted and dismantled electric motor are presented in the paper. With good organization and testing schedule and a combination of static and dynamic diagnostic methods, the reliability and availability of the plant can be significantly increased. With increased reliability and availability, a reduction in maintenance costs is achieved. In this article, some examples from the author's practice are given, when serious engine defects were discovered. These cases confirm the value of predictive testing to increase reliability of electric motor.

Reliability of Extensor Pollicis Brevis (EPB) Entrapment Test in Identifying a Separate Compartment for EPB in Patients with de Quervain Disease.

Background: The presence of a separate compartment for the extensor pollicis brevis tendon (EPB) has an implication in the treatment outcome for de Quervain disease. The EPB entrapment test, proposed by Alexander and colleagues, claims to correlate with the presence of a separate compartment for EPB. The purpose of our study is to evaluate the reliability of the EPB entrapment test in predicting a separate compartment for EPB in patients with de Quervain disease. Methods: This was a prospective observational study involving 50 consecutive patients who underwent de Quervain release by a single surgeon. Preoperatively, EPB entrapment test was performed by the operating surgeon. The outcome of the test was recorded and the presence of a separate compartment for the EPB was determined during surgery. Sensitivity, specificity, positive predictive value and negative predictive value of the EPB entrapment test was determined. Results: EPB entrapment test was positive in 28 of 50 patients. In 21 of them, a separate compartment for the EPB was noted. The positive predictive value of the test was found to be 75.8%. The test had a false positive rate of 26.9%, a false negative rate of 12.5%, sensitivity of 87.5% and specificity of 73%. There is a significant association between a positive EPB entrapment test and the presence of a separate compartment for the EPB (p value <0.001). The sensitivity of the test increases to 95.8% if pain on both extension and abduction of the thumb is considered a positive response. Conclusions: The EPB entrapment test is a reliable clinical test to look for the presence of a separate compartment for EPB. Considering the response of pain on both extension and abduction of the thumb further improves the sensitivity of the test. Hence, we suggest including this response also as a positive test. Level of Evidence: Level II (Diagnostic).

A Relook into Visceral Slide Test as a Preoperative Screening Modality to Detect Abdominal Wall Adhesions: A Prospective Observational Cohort Study

Background: Ultrasound has become an invaluable tool in our daily practice. Its role in screening for adhesions has been tested since the 1990s. Objective: This study aims to determine the role of the visceral slide test as a screening method to predict abdominal wall adhesions in women undergoing gynecological surgery. Methods: We conducted a prospective observational cohort study from August 2017 to July 2019 in women undergoing elective abdominopelvic surgery for a gynecological indication. Preoperatively, a visceral slide test was performed in 5 specified zones on the abdomen and the test results were clinically correlated with the presence, severity, and extent of adhesions intra-operatively. Results: Results were reported as mean, standard deviation, range of values or number and percent. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy (including 95% confidence interval for all) of visceral slide test were calculated to determine intra- abdominal adhesions . We also found a correlation between the number of negative slide tests and PAI scores using Spearman’s correlation test. Of the 339 women who completed the study, 41.2% had a previous history of abdominopelvic surgery. In this study, the visceral slide test was found to have a sensitivity of 70.87% (95%CI 62.15-78.59), specificity of 86.32% (95% CI 80.95-90.64), Positive Predictive Value (PPV) of 75.63% (95% CI 68.49-81.59), negative predictive value (NPV) of 83.18%(95% CI 78.95-86.70) and diagnostic accuracy of 80.53%(95% CI 75.91-84.61)with p-value less than 0.001. The number of negative slide tests positively correlated with the Peritoneal Adhesion Index score (r = 0.662, p &lt; 0.001) and also with increasing operative time and intraoperative blood loss. Accuracy and positive predictive value of the test were significantly higher in patients with a history of abdominal surgeries, endometriosis and PID. Conclusion: Visceral slide test is an easy, rapid, non-invasive and reliable screening test to predict abdominal adhesions in women undergoing gynecological surgery. The presence of risk factors for adhesions increases the accuracy of the test.

The Accuracy of Provocative Tests on Diabetic Patients with Suspected Carpal Tunnel Syndome and Comparison with Nondiabetics

Objective: Carpal tunnel syndrome in diabetic patients differ in some aspects from those in the nondiabetic population. The study was designed to evaluate the diagnostic accuracy of widely used provocative tests in the diabetic population in comparison to nondiabetic population. Materials and Methods: 87 nondiabetic and 25 diabetic hands suspicious of carpal tunnel syndrome were included in this retrospective study. The presence of carpal tunnel syndrome is confirmed by nerve conduction studies. The hands were divided into DM- and DM+ groups based on patients’ diabetes mellitus history. From patient records, results of Tinel’s, Phalen’s, Durkan’s, median nerve compression, and scratch collapse tests were obtained. Sensitivity, specificity, positive predictive value, and negative predictive values of tests are calculated for each population and then compared with each other. Results: Tinel’s test had a higher sensitivity in the diabetic population. Accuracies of Phalen’s, Durkan’s, median nerve compression, and scratch collapse tests in diabetic patients were similar to those in diabetic patients. None of the tests had a high enough sensitivity to be used alone in either group. Scratch collapse test had very high specificity in both groups but very low sensitivity. Conclusion: The studied provocative tests have comparable accuracy for carpal tunnel syndrome in diabetic patients to those in nondiabetic patients, with Tinel even having higher sensitivity. But excluding scratch collapse test, none of the tests is strong enough to achieve a diagnosis and none is sensitive enough to rule out a disease.

PSA density is complementary to prostate MP-MRI PI-RADS scoring system for risk stratification of clinically significant prostate cancer.

While prostate multiparametric-magnetic resonance imaging (MP-MRI) has improved the diagnosis of clinically significant prostate cancer (CSPC), the complementary use of prostate-specific antigen (PSA) levels to risk-stratify for CSPC requires further study. The objective of this project was to determine if prostate MP-MRI and PSA can provide complementary insights into CSPC risk stratification. In an IRB-approved study, pathologic outcomes from patients who underwent MR/US fusion-targeted prostate biopsy were stratified by various parameters including PSA, PSA density (PSAD), age, race, and PI-RADS v2 score. CSPC was defined as a Gleason score ≥7. Logistic regression was used to determine odds ratios (OR) with 95% confidence intervals (CI). P values were reported as two-sided with p < 0.05 considered statistically significant. ROC curves were generated for assessing the predictive value of tests and sensitivity + specificity optimization was performed to determine optimal testing cutoffs. A total of 327 patients with 709 lesions total were analyzed. PSAD and PI-RADS scores provided complementary predictive value for diagnosis of CSPC (AUC PSAD: 0.67, PI-RADS: 0.72, combined: 0.78, p < 0.001). When controlling for PI-RADS score, age, and race, multivariate analysis showed that PSAD was independently associated with CSPC (OR 1.03 per 0.01 PSAD increase, 95% CI 1.02-105, p < 0.001). The optimal cutoff of PSAD ≥ 0.1 ng/ml/cc shows that a high versus low PSAD was roughly equivalent to an increase in 1 in PI-RADS score for the presence of CSPC (4% of PI-RADS ≤3 PSAD low, 6% of PI-RADS 3 PSAD high vs. 5% of PI-RADS 4 PSAD low, 22% of PI-RADS 4 PSAD high vs. 29% of PI-RADS 5 PSAD low, 46% of PI-RADS 5 PSAD high were found to have CSPC). PSAD with a cutoff of 0.1 ng/ml/cc appears to be a useful marker that can stratify the risk of CSPC in a complementary manner to prostate MP-MRI.

Suspected Dementia in Young Adults: Cognitive Screening Tools for Use in Primary Care.

Memory complaints are frequent among young adults presenting in general practice. Many of them will have reversable, functional cognitive impairment that can easily be mistaken for dementia. Its accurate and timely identification is warranted to prevent further escalation to overt dementia syndrome. To evaluate the recommended primary care screening cognitive tools for dementia for use in younger people. 2.5 years clinical data were collected during the course of ongoing patient care for all assessed face-to-face patients in a secondary care memory service for younger adults. Cognitive screening and assessment tests used in primary [General Practice Assessment of Cognition (GPCOG)] and secondary [Addenbrooke's Cognitive Examination-III (ACE-III), Rowland Universal Dementia Assessment Scale (RUDAS), Salzburg Dementia Test Prediction (SDTP)] care were analyzed for their accuracy to identify dementia and memory complaints. Area under the curve in receiver operating characteristic curves was used to measure predictive value of tests for a clinical diagnosis of dementia. 348 young adults were assessed for cognitive impairment. Following comprehensive Memory Clinic assessments, 241 (69.25%) were diagnosed with memory complaints in the absence of relevant neuropathology and 107 with dementia. GPCOG, especially the informant part, and RUDAS had low accuracy to identify dementia (AUC = 0.465 and AUC = 0.698, respectively). In contrast, ACE-III and SDTP demonstrated the highest accuracy (AUC = 0.799 and AUC = 0.809/0.817, respectively). Dementia screening in younger people will benefit from SDTP incorporated as part of the screening cognitive toolset. The national guidance on dementia screening tools, diagnostic pathways, and management should also refer to younger adults.

Sustainable Math Education of Female Students during a Pandemic: Online versus Face-to-Face Instruction

The present study was driven by the assumption that a key feature of sustainable education is its ability to preserve standards of quality even amid unforeseen, potentially disruptive events. It asked whether students’ academic success in math general education courses differed between synchronous online (during the COVID-19 pandemic) and face-to-face (before the pandemic), under the ancillary assumption that computational competency, a pillar of sustainable education, shapes enduring success in a variety of professional fields. As the early identification of at-risk students and ensuing remedial interventions can bring about academic success, the study also investigated the predictive validity of students’ initial performance in online and face-to-face math courses. Two general education courses (introductory calculus and statistics), taught by the same instructor, were selected. Class grades did not differ between instructional modes, thereby providing no evidence for the widespread concern that the switch to the online mode had damaged learning. Yet, during the semester, test and homework performance were differentially sensitive to modes of instruction. Furthermore, both test and homework performance during the first half of the semester predicted class grades in online courses, whereas only test performance predicted class grades in face-to-face courses. These results suggest that sustainable math education in times of crisis is feasible and that educators’ consideration of the differential predictive value of test and homework performance may aid its attainment.

Skin tests in the diagnosis of food allergy

Skin tests are an important step in diagnosing food allergy. Several types of skin tests are used: prick test, intradermal, patch tests, as well as a special version of skin tests - these are tests with native (fresh allergens) – prick-prick tests. We review sensitivity, specificity, the possibility of false positive and false negative results when using natural products in testing. The safety of skin tests and certain contraindications for their use have to be considered. The advantages of using fresh products specimens for skin tests, their high sensitivity and negative predictive value of tests are described. This allows to reduce the likelihood of missing true positives:: the real patients with risk of a severe systemic reaction.

Clinical, radiological, and laboratory predictors of a positive urine lipoarabinomannan test in sputum-scarce and sputum-negative patients with HIV-associated tuberculosis in two Johannesburg hospitals.

BackgroundTuberculosis (TB) is a major cause of mortality in persons living with HIV (PLWH). Sputum-based diagnosis of TB in patients with low CD4 counts is hampered by paucibacillary disease and consequent sputum scarcity or negative sputum results. Urine lipoarabinomannan (LAM) has shown promise in the point-of-care detection of TB in this patient subset but lacks sensitivity, and its exact role in a diagnostic algorithm for TB in South Africa remains to be clarified.ObjectivesThe objective of this study was to better define the patient profile and the TB characteristics associated with a positive urine LAM (LAM+ve) test.MethodThis multicentre retrospective record review examined the clinical, radiological, and laboratory characteristics of hospitalised PLWH receiving urine LAM testing with sputum-scarce and/or negative sputum GeneXpert ® (mycobacterium tuberculosis/resistance to rifampicin [MTB/RIF]) results.ResultsMore than a third of patients, 121/342 (35%), were LAM+ve. The positive yield was greater in the sputum-scarce than the sputum-negative group, 66/156 (42%) versus 55/186 (30%), P = 0.0141, respectively. Patients who were LAM+ve were more likely to be confused (odds ratio [OR] = 2.2, 95% confidence interval [CI] = 1.2–3.7, P = 0.0045), have a higher median heart rate (P = 0.0135) and an elevated quick sepsis-related organ failure assessment score (≥ 2), OR = 3.5, 95% CI = 1.6–7.6, P = 0.0014. A LAM+ve test was significantly associated with disseminated TB (dTB), P < 0.0001, TB-related immune reconstitution inflammatory syndrome (IRIS), P = 0.0035, and abdominal TB, P < 0.0001. Laboratory predictors of a LAM+ve status included renal dysfunction, P = 0.044, severe anaemia, P = 0.0116, and an elevated C-reactive protein, P = 0.0131. Of the 12 PLWH with disseminated non-TB mycobacteria cultured from the blood and/or bone marrow, n = 9 (75%) had a LAM+ve result (OR = 5.8, 95% CI = 1.6–20.8, P = 0.0053).ConclusionUrine LAM testing of hospitalised PLWH with suspected active TB had significant diagnostic utility in those that were sputum-scarce or sputum-negative. A LAM+ve result was associated with dTB, clinical and laboratory markers of severe illness, and TB-IRIS. Disseminated non-tuberculous mycobacterial infection of hospitalised PLWH may also yield urine LAM+ve results, and mycobacterial cultures must be checked in those non-responsive to conventional TB treatment. Selective use of the LAM test in the critically ill is likely to maximise the diagnostic yield, improve the test’s predictive value, and reduce the time to TB diagnosis and initiation of treatment.

Relations among sensitivity, specificity and predictive values of medical tests based on biomarkers

Diagnostic tests are usually based on some quantitative biomarkers. Two key parameters used to characterise the quality of a test are test sensitivity and specificity. Predictive values of the disease...

The role of metal patch testing in evaluating patients for metallic prosthetic joint failure

BackgroundMetal allergy may be an uncommon cause of prosthetic joint failure. There exist little data on patch testing to metals in this context and its impact on outcomes of joint revision in these patients. ObjectiveTo explore the use and indications for metal patch testing in the evaluation of patients suspected of having metal allergy as a cause of failed joint replacements and to clarify the outcomes of patients revised with alternative metallic joints because of positive patch testing result. MethodsA retrospective analysis from January 2016 to April 2020 was completed on a patient cohort referred for evaluation of metal hypersensitivity. Charts were reviewed for age, biological sex, referring specialty, patch testing results, joint, revision status, and outcome measures. Biostatistical analysis and descriptive statistics were performed to determine patch testing performance and functional outcome trends among this patient cohort. ResultsThe sensitivity and specificity of patch testing, in general, are limited when evaluating patients with metallic joint replacements. However, the predictive value of testing seemed to improve with strongly positive patch testing results. Functional outcomes in patients when positive results were used to guide revision prosthesis revealed clinical improvement. ConclusionThe attribution of metal allergy or hypersensitivity as a cause of failure in metal prosthetic joint replacement remains unproven. Some patients with positive histories and patch testing results that were used to modify the implanted prosthesis had improved functional outcomes. These results suggest that patch testing may be useful in patients with history of metal sensitivity and prosthetic failure.

Updated reference values in pelvic ultrasonography for a Spanish population of healthy girls between 6 and 12 years old.

BackgroundPelvic ultrasonography (PUS) of the uterus and ovaries allows the diagnosis of changes in sexual development. However, the reference values used in Spain originate from old studies conducted in other countries.ObjectiveTo determine reference uterine and ovarian measurements by PUS and according to pubertal status and bone age in a Spanish population of healthy girls aged between 6 and 12 years.Materials and methodsDescriptive cross‐sectional study performed on 221 healthy girls from 2017 to 2019. Ovarian and uterine measurements were described and associated with chronological age, bone age, and Tanner stage. ROC curves were used to assess the predictive value of tests for Tanner stage II.ResultsWe described reference values for all PUS uterine and ovarian measurements assessed. Subjects in Tanner II (thelarche) had a mean age of 9.7 years (SD = 1.1) and mean BMI of 19.2 kg/m2. Fundal–cervical ratio changed from 1:1 to 2:1 at 12 years of chronological age (62.5% with 1:1 ratio; p < 0.0001) and 13 years of bone age (2:1 in 85.71%, p < 0.0001). Mean uterine length for Tanner II was 4.065 cm (SD = 0.736); mean ovarian volume was 2.466 cm3 (SD = 1.719). Bone age, ovarian volume, and uterine length were good predictors of Tanner stage II.ConclusionThis is the first study providing reference uterine and ovarian PUS values in a Spanish population of healthy girls aged 6 to 12 years. Use of updated data characteristic of a specific population increases the diagnostic accuracy.

Clinical examination of partial ruptures of the anterior cruciate ligament: A retrospective case–control study

BackgroundAnterior drawer test, Lachman test including evaluation of the endpoint, and pivot shift test have been commonly applied clinically in diagnosing anterior cruciate ligament (ACL) injury but how they function in the appraisal of partial ACL tears is less known. The aims of this study were to examine the diagnostic values of the commonly used knee function tests on patients in detecting ACL injury including partial injury patterns, to assess each of the test's predictive values on the specific ACL injury pattern, and to assess if using multiple tests collectively for the diagnosis of the injury could improve diagnostic accuracy. MethodsWe evaluated 36 consecutive patients who underwent ACL single bundle augmentation surgery. Those patients were matched by gender and age to 36 patients with a complete rupture of the ACL. Data was obtained from the patients' records. The rupture pattern was confirmed by arthroscopy. An examination under anesthesia was routinely performed by two surgeons who were blinded to the rupture pattern prior to surgery. ResultsCollectively using both Lachman test and pivot shift test increases ability to distinguish between partial tears and complete ruptures. When comparing partial PL tears and complete ruptures the pivot shift test is more important than the Lachman test. In diagnosing a complete rupture, the evaluation of the endpoint during the Lachman test is more sensitive than the evaluation of the anterior tibial translation during the Lachman test. ConclusionBased on the findings of this study, a diagnostic algorithm has been implemented and is presented in this manuscript.

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.

Clinical Implication of Immunohaematological Tests in ABO haemolytic disease of newborn: Revisiting an old disease.

We aimed to assess the frequency distribution of of ABO haemolytic disease of newborn (ABO-HDN) and to know the predictive value of immunohaematological tests in identifying at risk neonates. ABO incompatibility, although a common cause of haemolytic disease of newborn, has several unaddressed issues related to it. A prospective study over 20 months was carried out in a tertiary care centre in South India. Blood grouping, Direct Antiglobulin test (DAT) and elution studies were performed on neonatal samples, whereas blood grouping, antibody screening and antibody titration were performed on maternal samples. In suspected cases, ABO-HDN was diagnosed after excluding other possible causes for haemolysis. The laboratory results were correlated with the clinical details to assess the predictive value of the tests. Of the total 2856 pregnancies, 34% had ABO incompatibility. On testing with columnagglutination test (CAT), the overall DAT positivity and that among ABO-incompatible cases were 3.8% and 11.2%, respectively,) whereas by conventinal tube technique (CTT) it was 0.6% and 2.4% respectively. CAT was found to have higher sensitivity, and the predictive value was higher for CTT. Maternal IgG titre showed a positive linear relationship with the DAT strength and the rise in indirect bilirubin levels. The positive predictive value of combination of tests such as DAT, elution and titation was 94.12%, which was much higher than that of the individual tests. DAT positivity is a predictor of early rise in serum bilirubin level, and a combination of tests has a better predictive value than individual tests towards development of clinically significant hyperbilirubinemia in ABO-HDN.

Assessment of transvaginal ultrasound measurement of cervical length for prediction of spontaneous onset of labor at term

The objective of this study was to measure the cervical length by transvaginal sonography at term to predict onset and course of spontaneous labor. One hundred and nighty nine pregnant women between 37 to 40 weeks of gestation who fulfilled the inclusion criteria were enrolled in this prospective observational study conducted in department of obstetrics and gynecology of IGGMC, NAGPUR. Out of 199 pregnant women, 154 women had full term vaginal delivery and 45 women underwent emergency cesarean section. The mean cervical length was 2.58cm in women who had vaginal birth and was 3.45cm in women who underwent emergency cesarean section. The best cutoff of transvaginal cervical length was 2.7cm for predicting the spontaneous onset of labor within 7 days, having sensitivity of 90.91% and specificity of 84%.The positive predictive value was 84.9% and negative predictive value of test 90.3%, with diagnostic accuracy of 87.4%. When cervical length is less, then chances of vaginal delivery are significantly higher. Transvaginal cervical length measurement between 37 to 40 weeks is useful test for predicting spontaneous onset of labor within 7 days. It helps women and healthcare providers to plan vaginal birth and also timely decision of referral of those cases requiring immediate care to higher centres for better maternal and foetal outcome.

Analysis of preoperative circulating tumor cells for recurrence in patients with hepatocellular carcinoma after liver transplantation.

BackgroundLiver transplantation (LT) is an effective option for hepatocellular carcinoma (HCC) and end-stage liver cirrhosis. However, organ shortage and tumor recurrence are the main obstacles limiting its popularization and application in HCC patients. Testing for circulating tumor cells (CTCs) would be a valuable strategy to predict the recurrence and metastasis of HCC after LT. Various CTCs detection methods have different advantages and disadvantages. This study aims to investigate the predictive value of testing for CTCs based on immunofluorescence in situ hybridization of peripheral blood cells in patients with HCC after LT.MethodsA total of 50 patients who received testing for CTCs and then underwent LT were enrolled in this study. Negative enrichment and immunofluorescence in situ hybridization (imFISH) methods were introduced to detect CTCs.ResultsTwenty-six (52%) patients were CTC-positive, and 24 (48%) patients were CTC-negative. The results showed that CTCs result was correlated with tumor size (ꭓ2=5.773, P=0.016), AFP level (ꭓ2=5.454, P=0.020), tumor grade (ꭓ2=6.478, P=0.039) and Recurrence(ꭓ2=6.211, P=0.013).Twelve patients had recurrence after LT within one year. The results showed that the CTCs result (P=0.034) was the only independent factor impacting long-term survival. The 1-year disease-free survival rates of CTC-negative and CTC-positive patients were 91.6% and 61.5%, respectively (P=0.020). The 1-year overall survival of CTC-positive patients and CTC-negative was 88.5% and 91.7%, respectively (P=0.751).ConclusionsCTCs result was closely related to the early recurrence of patients with HCC after LT. CTC-positive patients had a worse prognosis after LT than the CTC-negative group.