Proportion Of Positive Findings Research Articles

Immune response in new coronavirus infection COVID-19 in children and adults

Introduction. It is known that COVID-19 occurs more often in adult patients, especially if they have concomitant somatic diseases, children are at less risk of developing it. The aim of this work is to evaluate and compare immune response parameters in new coronavirus infection COVID-19 in children and adults. Materials and methods. The results of the examination of 56 adults 19-55 years old and 57 children 14-18 years old were included in the work. The examination results of COVID-19 patients were compared with similar data in practically healthy individuals of the corresponding age groups. All patients underwent laboratory tests to determine the following parameters: presence of SARS-CoV-2 RNA, general blood test parameters, major lymphocyte subpopulations, level of total immunoglobulins (IgM, IgG, IgA), number of CIC, absorbance and bactericidal activity of leukocytes.Results. The proportion of positive findings for SARS-CoV-2 RNA in different age groups ranged from 13.6% to 25.8%. General and specific patterns of immune response in patients of different age groups were established. Common features were an increase in the number of circulating immune complexes and activated T-lymphocytes. Differences were noted in the level of serum immunoglobulins IgM and IgG, neutrophil uptake activity, the number of monocytes, as well as in the level of different subpopulations of lymphocytes. Discussion. In adults, changes in the adaptive immune response, including the cellular level, are predominantly expressed. In children, there are signs of inefficiency of innate mechanisms of immune responses. Conclusion. The dynamics of the number of examined and positive findings correlate with similar figures in Russia and have a two-wave pattern. Increased number of circulating immune complexes and activated T-lymphocytes is typical for all patients with new coronavirus infection COVID-19 regardless of age, which is a sign of acute infection-inflammatory process development and insufficiently effective elimination of antigen (pathogen).

Indications and diagnostic yield of small-bowel capsule endoscopy in a real-world setting

BackgroundIndications and diagnostic yield of small-bowel video capsule endoscopy (SB-VCE) are communicated in recent clinical academic guidelines. However, guidelines are based mainly on relatively few, small, selection-biased studies at experienced centers, and thus we lack information on indications and diagnostic yield of SB-VCE in the real-world community setting. The aim of the study was to evaluate indications and diagnostic yield of SB-VCE in the real-world community setting.MethodsOur local VCE clinical database was used to identify patients undergoing SB-VCE procedures over a 7-year period (2011–2018). Patients were broadly referred and underwent SB-VCE using PillCam™ SB 2 and SB 3 capsule systems. Procedures were reviewed by local endoscopists, who had undergone similar formal SB-VCE review training. Medical reports of the procedures were composed as such. We retrospectively reviewed all reports and gathered data regarding indications and findings. Diagnostic yield was considered positive if SB-VCE visualized any type of clinically significant pathological finding.Results536 SB-VCE procedures in 516 patients were included in final assessment. Patient mean (± SD) age was 50 ± 20 years with approximately even female/male ratio (275:241). The overall proportion of positive findings was 42% (225/536). The two main indications were obscure gastrointestinal bleeding (occult/anemia or overt/active, OGIB) of 46% (246/536) and definite/suspected Crohn’s disease (CD) of 39% (210/536). Positive SB-VCE findings were obtained in 44% (108/246) of procedures with indication of OGIB and in 50% (104/210) of procedures with indication of CD.ConclusionsThe indications for SB-VCE are largely consistent with guidelines but with an apparently relatively low diagnostic yield in our real-world community setting.

HSR19-104: Patterns of Providers’ Mammogram Referrals for Asymptomatic Breast Cancer Survivors

Background: NCCN Guidelines recommend annual mammography for surveillance in asymptomatic women diagnosed with breast cancer. There is limited evidence to support which type of mammogram—screening or diagnostic—should be ordered for asymptomatic breast cancer survivors. Our objective was to assess the referral patterns for mammograms in 2 breast clinics: survivorship (SC) and oncology (OC). Methods: A retrospective analysis of institutional databases was conducted to identify a convenience sample of women with limited invasive breast cancer who were (1) alive 5 years post-treatment and (2) seen at a SC or OC visit scheduled from January 1 to December 31, 2015. The primary outcome was women who received a diagnostic or screening mammogram during the 2015 calendar year. Demographic, clinical, and mammogram characteristics were also analyzed. Simple descriptive statistics were used to aggregate and compare data. Chi-square analysis tested for statistical significance. Results: A convenience sample of 354 cases was identified. Of those, 247 met the eligibility criteria for this analysis, SC=147 and OC=100. In this cohort, the mean age of diagnosis was 50.42 (±11.12), the majority were white (74.1%), and most received a diagnostic mammogram (64.4%). A greater proportion of diagnostic mammograms were ordered for women seen in OC (40.1%) vs SC (24. 3%). This finding was statistically significant (P=.00). Overall, 91.9 % of the mammogram results were negative and with a low proportion of “positive” (2.0%) or “need for additional imaging testing” (6.1%) reported. Recurrence rates in this cohort were also found to be low (1.6%). Conclusions: In this cohort, we found a difference in the type of mammogram ordered by providers in dedicated survivorship or medical oncology clinics. Our findings suggest that despite the greater use of diagnostic mammograms among this cohort of long-term breast cancer survivors, the overall proportion of positive findings, further imaging tests, or recurrence rates was low. It is concerning that many asymptomatic breast cancer survivors continue to receive a diagnostic mammogram as part of their surveillance visit. Further studies are needed to identify the emotional, financial, and physical toxicities associated with diagnostic mammograms.

Routine chest radiographs in the surgical intensive care unit: Can we change clinical habits with no proven benefit?

Daily routine chest radiographs (CR) are commonly performed in surgical ICU. Unnecessary CR increase costs and expose the staff and the patients to radiation risk. The goal of our study was to estimate the value of daily routine CR in the ICU and to determine the correlation between CR and physical findings in surgical ICU patients. Prospective observational study was conducted during period of two months at the ICU department at the Clinic for Digestive Surgery, Clinical Center of Serbia, Belgrade. It included 97 consecutive patients who underwent digestive surgery and stayed at the ICU for at least two days. During their ICU stay, CRs were obtained as a clinical routine or to monitor lung pathology. Patients were followed daily, and CRs (as the proportion of positive findings) were compared with physical examination and clinical presentation. A total of 717 CRs were obtained, median number per patient was 4.0 (2.0-7.0). Proportion of positive findings was significantly higher comparing to auscultation until the sixth day of ICU stay. There was no difference in CR findings from day to day after the sixth day. Therapeutic efficacy of CRs was low as only 56 (7.8%) resulted in a change of patient management. We conclude that daily routine CRs are justified in the first six days of ICU stay, and after that time they show no advantages over clinical examination.

Examination of Acid-Fast Bacilli in Sputum Using Modified Light Microscope with Homemade Light Emitting Diode Additional Attachment

Typical clinical symptoms and chest X-ray is a marker of Tuberculosis (TB) sufferers. However, the diagnosis of TB in adults should be supported by microscopic examination. Currently, Bacilli microscopic examination of acid-fast bacilli (AFB) in sputum by Ziehl-Neelsen (ZN) coloring is the most widely used. However, for reasons of convenience, especially for laboratories with a considerable amount of smear samples, and due to higher sensitivity compared with ZN staining, the World Health Organization (WHO) has recommended the use of auramine-O-staining (fluorochrome staining), which is visualized by light emitting diode (LED) fluorescence microscopy. The aim of this study was to evaluate the performance of modified light microscope with homemade LED additional attachment for examination of AFB in sputum using auramine-O-staining method. We compared the sensitivity and specificity of 2 kinds of AFB in sputum methods: ZN and fluorochrome, using culture on Lowenstein-Jensen media as the gold standard. The results showed auramine-O-staining gives more proportion of positive findings (81%) compared to the ZN method (70%). These results demonstrated that the sensitivity of auramine-O-staining was higher than ZN, however it gives more potential false positive results than ZN. The sensitivity of auramine-O-staining in detecting AFB in sputum was 100% while the specificity was 88%.

Estimation of the Prevalence of Latent Abnormalities in the Lung and the Accuracy of Indirect Chest X-ray Examination among Japanese Workers of Different Age Groups

It is considered that annual chest x-ray (CXR) examination can be restricted to workers by age; however, adequate epidemiological evidence is needed regarding the difference in the effectiveness of CXR examination between younger and older age groups. This study attempted to estimate the prevalence of latent abnormalities (P) in the lung and the false negative rate (F) and false positive rate (G) of examinations among workers of different age groups. 112,482 subjects who were screened for three consecutive years with no findings at the first screening, were selected. The proportion of positive findings at the second screening and the proportion of negative findings at the third screening were incorporated into a stochastic model, and 5-yr-age-specific P, F, and G were estimated. P tended to increase with increasing age. F was 40-45% in <45-yr-old subjects and was only 10% in the older age groups. G showed a steady increase with increasing age. This study indicates that the nature of findings differs between younger and older age groups, and this difference affects the accuracy of examination. In Japan, the age of workers should be considered when a CXR examination is performed.

Anterior dynamic ultrasound of the infant hip: evaluation of investigator dependence

Anterior dynamic ultrasound of the infant hip has been shown to be a valuable tool for detection of developmental dysplasia of the infant hip, but to what extent the results from this method depends on the investigator is unknown. To study to what extent the proportion of positive findings at anterior dynamic ultrasound investigation of infant hips varies with the observer. Information on all ultrasound investigations of infant hips at a county hospital between January 2004 and August 2007 was evaluated. Proportion of findings for different investigators were calculated and in a multivariable logistic regression analysis, risk of treatment by investigating orthopedic surgeon and radiologist were adjusted for each other as well as for calendar period and infant sex. There was a striking variation in proportion of positive findings depending on the investigator. The proportion of infants treated varied with orthopedic surgeon from 4.2 to 53.9% (95% CI: 2.27 to 7.13 and 43.0 to 64.6, respectively) and the corresponding variation for radiologists ranged from 7.4 (95% CI: 4.29 to 11.8) to 23.9% (95% CI: 17.2 to 31.8). In the adjusted analysis, variation between different investigators remained essentially unaltered. Although the true proportions of positive findings in our study are unknown, our findings are unlikely to be explained by selection bias or chance. Thus, our study suggests that anterior dynamic ultrasound of the infant hip is highly dependent on the investigator and further studies of the implications of our results are warranted.

The Value of Interhospital Transfer and Emergency MRI for Suspected Cauda Equina Syndrome: A 2-Year Retrospective Study

The timing of surgery in cauda equina syndrome due to prolapsed intervertebral disc remains controversial. Assessment of these patients requires magnetic resonance imaging (MRI), which is of limited availability outside normal working hours in the UK. We reviewed radiological results in all patients undergoing emergency MRI within our unit for suspected cauda equina syndrome over a 2-year period, and all subjects undergoing emergency lumbar discectomy for cauda equina syndrome within the same period. Outcome measures were: proportion of positive findings in symptomatic patients and proportion of patients referred with diagnostic MRI scans undergoing emergency surgery. We also assessed outcomes of patients having surgery for cauda equina syndrome in terms of improvement of pain, sensory and sphincter disturbance. A total of 76 patients were transferred for assessment and 'on-call' MRI; 27 were subsequently operated upon. Only 5 proceeded to emergency discectomy that night (prior to next scheduled list). This may be due to delays in timing--from referral to acceptance, to arrival in the department, to diagnostic scan and to theatre. With the second group of patients, 43 had emergency discectomy for cauda equina syndrome during the study period. Of these, 6 patients had an out-of-hours MRI at our hospital for assessment (one patient living locally). Most surgically treated patients experienced improvement in their pain syndrome, with approximately two-thirds experiencing improvement in sensory and sphincter disturbance. These data support a policy of advising MRI scan for cauda equina syndrome at the earliest opportunity within the next 24 h in the referring hospital, rather than emergency transfer for diagnostic imaging which has a relatively low yield in terms of patients operated on as an emergency.

Lin et al. Respond to “Assessment of Respiratory Symptoms after September 11”

We appreciate the observations made by Drs. Vlahov and Galea in their invited commentary (1) on our paper (2). Given that the World Trade Center (WTC) disaster was an unprecedented event, this was not a traditional epidemiologic study but rather a community health investigation designed to respond to the public’s concerns, as well as the first step in examining the potential health effects on local residents. Many constraints made this study difficult to design, including a lack of baseline prevalence and exposure data and unknown mobility patterns. As we explain below, most of the problems discussed by Vlahov and Galea were considered in our article and addressed to the extent possible. Selection bias is one of their main concerns. Since a significant number of residents moved out of the affected area after September 11, the actual response rate might have been higher than estimated. In addition, the response rates were similar in the affected and control areas, and the demographic distribution of the participants was similar to that of the underlying population. To estimate selection bias, we targeted a subset of buildings in the affected and control areas for increased recruitment efforts and achieved higher response rates in both areas. The risk estimates from the targeted buildings, in which the samples are assumed to be more representative, were not only consistent with but also higher than those in the nontargeted buildings. Another potential problem is information bias. We reported that ‘‘we emphasized the importance of participation for people with and without breathing problems’’ and that we used ‘‘general terms such as ‘breathing or lung problems’ rather than specific terms like ‘asthma’ ’’ (2, p. 505). We also stated that ‘‘we asked symptom questions not only qualitatively but also quantitatively, by including questions on specific time frames, severity, and frequency, which are less prone to recall bias’’ (2, p. 505). In addition, the symptom questions that we chose for the questionnaire have been validated in many epidemiologic studies. To reduce reporting bias, we asked participants about prescription medications and listed the names of the medications. We also used more objective measures by asking participants about new diagnoses by a physician, unplanned medical visits, and hospitalizations (including the dates and reasons for hospitalization). We checked the differences between the two areas for WTC-unrelated variables (e.g., physical disabilities) and excluded participants who responded affirmatively to every question. To estimate reporting bias, we compared the proportions of unplanned medical visits among participants with specific respiratory symptoms and found them be similar in the affected and control areas for most symptoms. Finally, as we described in another article (3), screening spirometry was conducted in some participants to validate self-reported symptoms. Although there were no significant differences between the affectedarea residents and the control-area residents (screening spirometry might not be sensitive for this exposure), the results of a pilot methacholine challenge test showed a higher proportion of positive findings in the participants with persistent new-onset symptoms than in asymptomatic participants. We are conducting additional studies to address some of these concerns. A follow-up study will use nitric oxide in exhaled breath (eNO) as an objective measure of airway inflammation. Self-reported symptoms will be correlated with eNO measurements and validated. Another study will estimate changes in hospitalizations (an objective indicator of outcome) for respiratory and cardiovascular diseases before and after September 11, 2001, and compare the rates in both areas. The WTC Health Registry, which has recruited a larger cohort, also plans to follow this population. The ambient air monitoring site located at the WTC was destroyed in the collapse, so ambient pollution levels immediately after September 11 were not available for exposure assessment. For this reason, we did not attribute our findings

Helminthic infestations in the Tyrol, Austria

At the federal public health laboratory, Innsbruck, 142 426 samples were examined for intestinal helminthosis from 1990 until 2000. Enterobius vermicularis accounted for half (49.7%) of the cases diagnosed, followed by Taenia saginata (28.3%), Ascaris lumbricoides (12.8%), and Trichuris trichiura (3.9%). Of all specimens tested for helminths, 26% had been positive in 1945, and 0.98% in 1985. The proportion of positive findings with respect to the total number of specimens tested was 0.24% in the time span 1990-2000. It appears to us that these numbers fairly reflect the real prevalence of helminthosis in Austria.

An Audit of Positive Findings in Flexible and Rigid Check Cystoscopy

Both flexible and rigid cysto-urethroscopy are routinely used in the surveillance of transitional cell bladder tumours. This study addressed the issue of patient selection for either rigid or flexible cystoscopy....

A RELIABLE METHOD OF STAINING SPIROCHAETA PALLIDA IN SMEARS

For the identification of Spirochaeta pallida in serous exudates from a suspected superficial lesion the methods available include immediate examination of the material by dark field procedure, the application of various stains to the smear and the india ink method. A staining method is here described which gives more dependable results than other methods, such as Giemsa's, Fontana's, Ghoregeb's, Gelarie's and others with which I am acquainted. Experience shows that except in the hands of well trained examiners dark field examinations are not dependable and the proportion of positive findings is much below that actually possible. The biopsy method for demonstrating spirochetes is most satisfactory but entails a certain amount of inconvenience and added cost, which prevents the physician from performing the test on doubtful lesions of skin and mucous membrane. More frequent testing and the consequent finding of syphilis in a higher proportion of cases should result from the