Screening Test For Disease Research Articles

Assessment of M-mode index of obstruction in patients with chronic obstructive pulmonary disease

Background Diaphragm motion during forced expiration can be analyzed using M-mode ultrasound in an anterior subcostal approach. Maximal expiratory diaphragmatic excursion and forced expiratory diaphragmatic excursion in the first second physiologically mimic forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1), respectively, and may be used as a marker of obstruction. Aim The aim of the work was to assess the role of the M-mode index of obstruction (MIO) as a screening test (tool) for chronic obstructive pulmonary disease (COPD). Patients and methods This case–control study involved 200 participants (100 patients with COPD and 100 age-matched and sex-matched healthy controls). The authors performed spirometry and the diaphragm ultrasonography, during forced expiration. MIO was calculated as the slope of diaphragmatic excursion in first second/slope of diaphragmatic excursion at end of expiration. Results Diaphragmatic excursion was significantly lower in COPD group than control group (4.27±1.49 vs 5.36±1.67 for slope in the first second of expiration, 4.82±1.55 vs 5.72±1.57 for maximum slope at the end of expiration, 4.42±1.53 vs 5.44±1.69 for velocity of diaphragm contraction in first second, and 2.40±1.04 vs 3.52±1.26 for velocity of diaphragm contraction at the end of expiration; P= Conclusion Diaphragmatic excursion during forced expiration is significantly decreased in COPD in comparison with the control group. MIO is significantly lower in COPD in comparison with control and significantly correlated with FEV1/FVC.

Clinical Results of Various Treatments for Retinal Capillary Hemangioma.

PurposeWe report the clinical outcomes of retinal capillary hemangioma (RCH) after the application of various treatments.MethodsWe performed a retrospective chart analysis of eight eyes treated for RCH between August 2009 and January 2018. During the follow-up period, the status and progression of the RCHs were checked by fundus photography, fluorescein angiography, and optical coherence tomography, and additional treatments were applied when necessary.ResultsThree of the five patients had bilateral RCH, and two had unilateral RCH. Six eyes received laser photocoagulation; two eyes received cryotherapy, and one eye received intravitreal Avastin injection. Three eyes each had intravitreal triamcinolone injection, subtenon triamcinolone injection, and intravitreal dexamethasone injection to control inflammation. Also, two patients took oral prednisolone, and one patient used prednisolone eye drops to control inflammation. Two eyes underwent vitrectomy and scleral buckling due to deterioration of the epiretinal membrane and vitreal traction, respectively. As a result of those treatments, the tumors were stable in five of the eight eyes. However, one eye is now in a pre-phthisis state, and one patient who refused treatment showed progression of the tumor, epiretinal membrane, and traction.ConclusionsBecause RCHs vary in size, the degree of inflammation, and symptoms, this disorder should be actively treated on a case-by-case basis. Fluorescein angiography should be used periodically to determine recurrence of the tumor or inflammation, and the appropriate treatment should be repeated as necessary. Moreover, regular systemic screening tests for von Hippel-Lindau disease should be performed in RCH patients to ensure that they have no abnormalities other than in the eye.

Is HOMA-IR a potential screening test for non-alcoholic fatty liver disease in adults with type 2 diabetes?

Is HOMA-IR a potential screening test for non-alcoholic fatty liver disease in adults with type 2 diabetes?

Misuse of serological screening tests for celiac disease in children: A prospective study in Italy

BackgroundDespite a well-established diagnostic algorithm for celiac disease, it remains unclear whether prescriptions for celiac serological tests comply with the current pediatric guidelines. AimTo analyze the appropriateness of test prescription in children investigated for celiac disease in Italy, compared to the current European pediatric guidelines. MethodsAll children who had performed a first evaluation for celiac disease were prospectively enrolled. Prescribed tests and related indications for testing were recorded, and compared to the European pediatric guidelines. ResultsOverall, 202 children were enrolled (females 59%, mean age 7.1 years ±4.1) in two centers. The reasons for celiac disease testing were typical, atypical symptoms or celiac disease-associated conditions in 46.5%, 49%, and 4.5% of cases, respectively. First-line tests were IgA and IgG anti-transglutaminase antibodies in 88.1% and 29.7% of children, IgA and IgG anti-deamidated gliadin peptide antibodies in 43% and 47%, IgA and IgG anti native gliadin in 15.8%, IgA anti-endomysium antibodies in 44.5%, HLA predisposing genes in 10% of patients. Test redundancy was very common, and the current diagnostic guidelines were correctly followed only in 23/202 patients (11.4%). ConclusionsDiagnostic European guidelines for celiac disease screening are often disregarded in Italy. Intervention to implement adherence to these guidelines is needed, with the aim of improving resource utilization, and quality of patient care.

Comparative study of pulse oximetry and ankle-brachial index as a screening test for asymptomatic peripheral vascular disease in type 2 diabetes mellitus against color doppler ultrasonography as reference standard

Background: Currently about 35 million Indians are reported to suffer from diabetes mellitus, a significant proportion of whom are either undiagnosed or diagnosed but undertreated leading to poor glycemic control. This leads to accelerated development of macrovascular complications like Peripheral Vascular Disease (PVD). As most of the patients are asymptomatic, hence, early detection and treatment of PVD in patients with diabetes mellitus carries utmost importance.Methods: The present study was undertaken in SGRDIMSAR, Amritsar on 100 patients of type 2 Diabetes Mellitus with asymptomatic PVD. The diagnostic accuracy of Ankle-Brachial Index (ABI) and pulse oximetry as a screening tool was compared against Color Doppler ultrasonography as the reference standard.Results: The sensitivity, specificity, positive predictive value and negative predicted value of pulse oximetry to diagnose asymptomatic PVD in diabetics was found to be 98.31% (95% CI: 90.91-99.96), 41.46% (95% CI: 26.32- 57.89), 70.73% (95% CI: 65.08-75.81) and 94.44% (95%CI: 70.19-99.19) respectively. The sensitivity, specificity, positive predictive value and negative predicted value of ABI to diagnose asymptomatic PVD in diabetics was found to be 77.97% (95% CI: 65.27-87.71), 97.56% (95% CI: 87.14-99.94), 97.87% (95% CI: 86.85-99.69) and 75.47% (95% CI: 65.51-83.29) respectively.Conclusions: Pulse oximetry is better than ABI for the screening for asymptomatic PVD among diabetics. However, ABI is more accurate as compared to pulse oximetry in diagnosing asymptomatic PVD in diabetics.

Evaluation of Risk of Zoonotic Pathogen Transmission in a University-Based Animal Assisted Intervention (AAI) Program.

Introduction: Previous studies have shown that apparently healthy animals participating in Animal-Assisted Interventions (AAI) have the potential to asymptomatically carry and even transmit zoonotic pathogens to people, which is of particular concern for therapy animal teams visiting healthcare settings. This two-part study was designed to investigate the risk of zoonotic pathogen transmission within a university-based AAI program as a combination of the prevalence of these pathogens in the animal population as well as the handlers' understanding of the risks of zoonoses in AAI and their adherence to infection control practices.Methods: In part one of the study, AAI program records were retrospectively reviewed and infectious disease screening test results were compiled from 22 dogs and 2 cats. Screening tests for dogs and cats included a zinc sulfate fecal float, fecal culture, and nasal and perianal skin swabs for methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant Staphylococcus pseudointermedius (MRSP). Additional tests for cats were blood cultures for Bartonella henselae and Toxoplasmosis IgG and IgM antibody titers. In part two, a survey was conducted of 40 registered therapy animal handlers to assess knowledge, attitudes, and perceptions regarding risk of infectious disease transmission in AAI settings, including risk to the animal, the handler, and those being visited.Results: In part one, there were 17 total positive results of the 118 infectious disease screenings performed, 14 of which were potentially zoonotic organisms. In part two of the study, a majority (70%) of respondents expressed they had no concerns regarding infectious disease transmission in AAI settings. Despite handler education and guidelines, adherence to infection control practices was lacking.Discussion: The results of this study support prior findings that animals participating in AAI can be asymptomatic carriers of zoonotic organisms. Compliance with infection control practices and hand hygiene are paramount to mitigate risk of zoonotic disease transmission, but was inconsistent among this group of handlers. Given the popularity of AAI programs in the U.S., similar studies should be performed on a larger scale to determine the level of adherence to currently recommended practices and potential need for improvement in infectious disease control education and/or policies.

Development of a miniaturized protein microarray as a new serological IgG screening test for zoonotic agents and production diseases in pigs.

In order to monitor the occurrence of zoonotic agents in pig herds as well as to improve herd health management, the development of new cost-effective diagnostic methods for pigs is necessary. In this study, a protein microarray-based assay for the simultaneous detection of immunoglobulin G (IgG) antibodies against different zoonotic agents and pathogens causing production diseases in pigs was developed. Therefore, antigens of ten different important swine pathogens (Toxoplasma gondii, Yersinia enterocolitica, Salmonella spp., Trichinella spp., Mycobacterium avium, Hepatitis E virus, Mycoplasma hyopneumoniae, Actinobacillus pleuropneumoniae, the porcine reproductive and respiratory syndrome virus, Influenza A virus) were spotted and covalently immobilized as ‘antigen-spots’ on microarray chips in order to test pig serum for the occurrence of antibodies. Pig serum was sampled at three German abattoirs and ELISA tests for the different pathogens were conducted with the purpose of creating a panel of reference samples for microarray analysis. To evaluate the accuracy of the antigens on the microarray, receiver operating characteristic (ROC) curve analysis using the ELISA test results as reference was performed for the different antigens. High area under curve values were achieved for the antigens of two zoonotic agents: Toxoplasma gondii (0.91), Yersinia enterocolitica (0.97) and for three production diseases: Actinobacillus pleuropneumoniae (0.77), Mycoplasma hyopneumoniae (0.94) and the porcine reproductive and respiratory syndrome virus (0.87). With the help of the newly developed microarray assay, collecting data on the occurrence of antibodies against zoonotic agents and production diseases in pig herds could be minimized to one measurement, resulting in an efficient screening test.

Role of HLA-DQ typing and anti-tissue transglutaminase antibody titers in diagnosing celiac disease without duodenal biopsy in type 1 diabetes: A study of the population-based pediatric type 1 diabetes cohort of Western Australia.

The primary aim of the present study was to determine if it is cost effective to use human leukocyte antigen (HLA) typing as a first-line screening test for celiac disease (CD) in children with type 1 diabetes (T1D), as recommended by the European Society of Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN). The second aim was to investigate whether anti-tissue transglutaminase IgA (anti-tTGA) antibodies can be used to diagnose CD without the need for a confirmatory duodenal biopsy in T1D. Data for all T1D patients aged <18 years, who attended the diabetes clinics in Western Australia up to June 2017, were extracted from the Western Australian Children's Diabetes Database (WACDD) and analyzed for their demographic data and CD permissive HLA alleles (DQ2, DQ8, and DQ7). For T1D patients already diagnosed with CD, the mode of diagnosis of CD, anti-tTGA titers, and CD permissive HLA alleles were analyzed. Of the 936 eligible T1D patients identified, HLA-DQ typing was available for 551 (59%). Of these 551 patients, 504 (91.2%) were positive for celiac permissive HLA alleles. Eight percent (n = 75) of the T1D patients had a co-diagnosis of CD. High anti-tTGA titers were observed in those who were diagnosed with a positive duodenal biopsy. HLA-DQ typing is not cost effective as a first-line screening test for CD in T1D patients because of over-representation of CD permissive HLA alleles in this group. Anti-tTGA titers may be useful in diagnosing CD in T1D without duodenal biopsy, as high levels were found to be strongly predictive of CD.

Noninvasive Diagnosis of Irritable Bowel Syndrome via Bowel Sound Features: Proof of Concept.

INTRODUCTION:Irritable bowel syndrome (IBS) is a common and debilitating disorder estimated to affect approximately 11% of the world's population. Typically, IBS is a diagnosis of exclusion after patients undergo a costly and invasive colonoscopy to exclude organic disease. Clinician's and researchers have identified a need for a new cost-effective, accurate, and noninvasive diagnostic test for IBS.METHODS:Using a diagnostic case-control study, we explored the use of bowel sounds to characterize IBS with a view to diagnostic use. We recruited participants with an existing clinical diagnosis of IBS or healthy (asymptomatic) digestive systems. We recorded bowel sounds for 2 hours after fasting and then for 40 minutes after a standard meal.RESULTS:We here report our results including our accuracy in characterizing IBS-related bowel sounds and differentiation between participants with IBS and healthy participants. Leave-one-out cross-validation of our model developed using the first 31 IBS and 37 healthy participants gave 90% sensitivity and 92% specificity for IBS diagnosis. Independent testing using the next 15 IBS and 15 healthy participants demonstrated 87% sensitivity and 87% specificity for IBS diagnosis.CONCLUSIONS:These preliminary results provide proof of concept for the use of bowel sound analysis to identify IBS. A prospective study is needed to confirm these findings.TRANSLATIONAL IMPACT:Our belt and model offer hope of a new approach for IBS diagnosis in primary practice. Combined with screening tests for organic disease, it would offer greater confidence to patients and could reduce the burden of unnecessary colonoscopies for health care systems and patients.

Introgression and monitoring of wild Helianthus praecox alien segments associated with Sclerotinia basal stalk rot resistance in sunflower using genotyping-by-sequencing.

Sclerotinia basal stalk rot (BSR) and downy mildew are major diseases of sunflowers worldwide. Breeding for BSR resistance traditionally relies upon cultivated sunflower germplasm that has only partial resistance thus lacking an effective resistance against the pathogen. In this study, we report the transfer of BSR resistance from sunflower wild species, Helianthus praecox, into cultivated sunflower and molecular assessment of the introgressed segments potentially associated with BSR resistance using the genotyping-by-sequencing (GBS) approach. Eight highly BSR-resistant H. praecox introgression lines (ILs), H.pra 1 to H.pra 8, were developed. The mean BSR disease incidence (DI) for H.pra 1 to H.pra 8 across environments for four years ranged from 1.2 to 11.1%, while DI of Cargill 270 (susceptible check), HA 89 (recurrent parent), HA 441 and Croplan 305 (resistant checks) was 36.1, 31.0, 19.5, and 11.6%, respectively. Molecular assessment using GBS detected the presence of H. praecox chromosome segments in chromosomes 1, 8, 10, 11, and 14 of the ILs. Both shared and unique polymorphic SNP loci were detected throughout the entire genomes of the ILs, suggesting the successful transfer of common and novel introgression regions that are potentially associated with BSR resistance. Downy mildew (DM) disease screening and molecular tests revealed that a DM resistance gene, Pl17, derived from one of the inbred parent HA 458 was present in four ILs. Introgression germplasms possessing resistance to both Sclerotinia BSR and DM will extend the useful diversity of the primary gene pool in the fight against two destructive sunflower diseases.

Predictive Accuracy of Dobutamine Stress Echocardiography in Detection of Presence and Extent of Coronary Artery Disease

Introduction: Exercise tolerance test (ETT) is an established screening test for coronary artery disease (CAD), but not feasible in 30−40% of patients. Dobutamine stress echocardiography (DSE) is an excellent alternative. Traditionally, inducible worsening of wall motion by 1 grade from baseline provides an index of CAD; worsening by 2 grade or more theoretically represents a more severe perfusion abnormality. The present study represents the inaugural experience of DSE at the National Institute of Cardiovascular Disease, Dhaka.&#x0D; Objective: To assess the predictive accuracy of DSE results with the presence and extent of CAD in subjects with suspected stable angina pectoris.&#x0D; Materials and Methods: In this prospective observational study, 35 subjects with intermediate to high probability of CAD were subjected to DSE followed by coronary angiography (CAG) within one month. Comparison of DSE results and predicted coronary artery involvement with angiographic findings were done. Overall sensitivity, specificity, accuracy as well as accuracy by arterial territory involvement were calculated.&#x0D; Results: DSE identified 82 abnormal segments, 66 with 1 grade change in 23 subjects (Group A) and 16 with 2 grade change in 8 subjects (Group B). CAG detected 54 significant lesions, 23 (42.59%) in left circumflex (LCX), 18 (33.33%) in left anterior descending (LAD), 11 (20.37%) in right coronary (RCA) and 2 (3.7%) in left coronary (LCA) artery. DSE had a sensitivity of 93.1% and a specificity of 66.7%. The accuracy was 88.57% overall, 94.29% for LAD and 91.43% for both LCX and RCA territories. Group B subjects had significantly higher number of coronary stenosis per patient (2.63 versus 1.38, p&lt;0.001), triple vessel (62.5% versus 8.6%, p=0.003) and lower single vessel CAD (0% versus 47.8%, p=0.005).&#x0D; Conclusion: This study shows that DSE is a reliable test for prediction of the presence and extent of CAD.&#x0D; J Enam Med Col 2019; 9(1): 16-24

Performance of the Four-Plex Tandem Mass Spectrometry Lysosomal Storage Disease Newborn Screening Test: The Necessity of Adding a 2nd Tier Test for Pompe Disease.

Early diagnosis of lysosomal storage diseases (LSDs) through newborn screening (NBS) has been adapted widely. The National Taiwan University Hospital Newborn Screening Center launched the four-plex tandem mass spectrometry LSD newborn screening test in 2015. The test determined activities of acid α-glucosidase (GAA; Pompe), acid α-galactosidase (GLA; Fabry), acid β-glucocerebrosidase (ABG; Gaucher), and acid α-l-iduronidase (IDUA; MPS-I) in dried blood spots (DBS). Through 2017, 64,148 newborns were screened for these four LSDs. The screening algorithm includes enzyme activity/ratio as the cutoffs for the first screening test and a second-tier test for Pompe disease screening. The second-tier Pompe disease screening test measured activity inhibition by acarbose. Twenty-nine newborns required a confirmatory test; six were confirmed to have Pompe disease, and nine were confirmed to have Fabry disease. The screen-positive rate for Pompe disease was 0.031%. Therefore, in Pompe disease newborn screening, a validated 2nd tier test is necessary to decrease false positives.

Validation and Feasibility of a Point of Care Screening Test for Sickle Cell Disease in a Resource Constrained Setting — a New Frontier

Introduction and ObjectivesSickle cell disease (SCD) is a neglected tropical disease disproportionally affecting malaria endemic regions of sub-Saharan Africa. Estimated to affect up to 3% of the population in some areas, 50-90% of children affected with SCD die before age five due to lack of diagnosis and preventative care. Early screening and intervention improves survival, but is not the standard of care throughout much of the continent. Kenya, like several other sub-Saharan African countries, has piloted newborn screening (NBS) for SCD, but NBS programs based on the infrastructure and approaches in Western countries have proved challenging to replicate in resource constrained environments (RCEs). As many as 50% of patients who have screened positive for SCD in programs throughout Africa are lost to follow-up.The recent development of affordable, point of care (POC) screening tests have provided an alternative approach to testing for SCD in RCEs. This study aimed to determine the validity and feasibility of utilizing a POC SCD screening test, HemoTypeSC™ (HTSC) in a RCE, to determine the prevalence of SCD in western Kenya, and to determine the rate of attendance at follow-up clinic after a positive POC screening test for SCD.MethodologyAsymptomatic patients from birth through five years of age were approached for study enrollment in the pediatric vaccine clinic of Homabay County Referral Hospital (HCRH). 700 study participants were screened at HCRH over a 6 month period using HTSC. Isoelectric focusing (IEF) was run on a sample collected contemporaneously with the sample collected for testing with HTSC . At least one parent of each study participant was consented and counselled regarding SCD. Participants with a positive screen for either SCD or Sickle Cell Trait (SCT) were asked to return for confirmatory testing with Hb Electrophoresis (HBE). The HTSC screening results were compared to IEF and HBE results to determine the specificity and sensitivity, respectively. Samples yielding discordant results between HTSC or IEF and HBE were referred for molecular genotyping. Study participants with confirmed SCD were scheduled to attend a follow-up clinic. Participants unreachable by phone after at least ten attempts were declared lost to follow up.ResultsThe median age of participants was 14 months (IQR: 5,30), 387(55.3%) were male. 18 patients had discordant results between screening tests and HBE and are pending molecular testing. 214 (30.6%) subjects screened positive for SCT or SCD on HTSC . 155 of these patients returned for HBE testing. The sensitivity of HTSC from the 155 receiving HBE testing was 92.1% for SCD and 95.0% for SCT. By comparison, the sensitivity of the concurrent IEF testing was 90.2% for SCD and 90.0% for SCT. The specificity of HTSC was 95.0% for SCD and 89.1% for SCT (as compared to IEF specificity of 92.0% and 89.1% for SCD and SCT, respectively). 9.6% of the subjects were found to have SCD, 20% had SCT. Of those with a positive screen for SCT or SCD, 191 (88%) were successfully contacted. 40 (78.4%) of those subjects confirmed to have SCD attended a follow-up clinical appointment. These data are summarized in Table 1. The majority of participants contacted who did not present for HBE testing or attend follow-up clinic cited socioeconomic factors as the main impediment.Discussion and ConclusionsHTSC was found to be a feasible, valid POC screening test for SCD. The test was easy to perform and interpret, and facilitated prompt delivery of results. Education and counseling about SCD at the time of a positive screen led to a high rate of attendance at follow-up clinic. Further investigation is required to determine the long-term effect of POC testing on survival and quality of life outcomes. The prevalence of SCD in this cohort was among the highest rates reported in the literature. Though consanguinity was not documented as part of this study, it likely contributed to the high Hb SS frequency. These results support the notion that there is substantial regional variability in the frequency of Hb SS compared to national estimates extrapolated from Hb S frequency and highlight the criticality of more systematic, broad-based screening and treatment programs in targeted sub-Saharan African locations. [Display omitted] DisclosuresWanjiku:Silverlake Research Cooperation: Research Funding.

SMOKING CESSATION COUNSELLING

Tobacco use is the leading preventable cause of premature morbidity and death in the world and it is responsible for approximately 15 years of healthy life lost. The world average smoking prevalence is 21% (35% for men and 6% for women), with the worst situation in low- and middle-income countries. In the Russian Federation, 31% of adults smoke (51% of men and 14% of women); meanwhile in the last decade the prevalence of smoking declines by about 1% per year. From a clinical standpoint, smoking is a behavioral disorder caused by psychophysical dependence from nicotine. Tobacco dependence is associated with the characteristic smoking habits and withdrawal symptoms that prevent successful cessation. The role of physician is to identify smokers on a regular basis, increase their readiness to quit, and support them during a quit attempt. Smoking status should be assessed in any patient who seeks medical care. All tobacco users should be encouraged to quit in a clear and personalized manner. The further content of medical care is determined by the patient’s willingness to make a quit attempt. For those who are not ready to discuss smoking cessation, physician should express readiness to help in a quit attempt at any time. For the patients who are not ready to quit at this time, physician should initiate brief motivational intervention and discuss possible benefits of smoking cessation and obstacles to successful quitting. For those who are ready to quit, physician provides behavioral counselling and prescribes medications (nicotine replacement therapy or nicotinic receptor partial agonists). At the follow-up visits in a week and a month after the quit date, physician should discuss treatment effectiveness and problems with smoking habits. For continued smokers physician should reassess their readiness to quit at the following visits and repeat motivational interviewing. Screening tests for smoking-related diseases should be recommended when necessary.

Maximum blink interval is associated with tear film breakup time: A new simple, screening test for dry eye disease

The prevalence of dry eye disease (DED) is increasing worldwide, and its diagnosis often needs dedicated reagents and machines. We investigated the usefulness of maximum blink interval (MBI) (the length of time that participants could keep their eyes open) in screening for DED. This cross-sectional study included 292 patients (194 with DED and 98 without DED) recruited between September 2016 and September 2017. We compared the MBI between patients with and without DED; examined correlations between MBI and other clinical features of DED, including subjective symptoms (Dry Eye-Related Quality-of-Life Score), tear film breakup time (TFBUT), cornea fluorescence score (CFS), and Schirmer test I value; and determined the optimal cutoff value of MBI to suspect DED using a receiver operating characteristic (ROC) analysis. The MBI was significantly shortened in DED group compared to the non-DED group (10.0 ± 9.1 vs. 24.3 ± 38.2 seconds, p < 0.001). TFBUT was strongly positively correlated with MBI (r = 0.464), whereas CFS was negatively correlated with MBI (r = −0.273). The area under the ROC curve was 0.677, and the optimal MBI cutoff value was 12.4 seconds, providing a sensitivity of 82.5% and specificity of 51.0% to suspect DED. In conclusion, MBI may be a simple, useful test for screening DED.

Agreement of clinical tests for the diagnosis of peripheral arterial disease

AimThe aim of this study was to compare different screening modalities in the detection of PAD in a primary care setting. MethodsFifty participants living with Type 2 diabetes were recruited. Pulse palpation, waveform analysis, ankle brachial pressure index, absolute toe pressure, toe brachial pressure index and transcutaneous oxygen pressure were compared in the detection of peripheral arterial disease. One hundred limbs were included for analysis. ResultsThis study showed different results in peripheral arterial disease screening tests in the same group of participants. The highest percentage of participants who had PAD was for the Doppler Waveform (93.0%). This was followed by TBPI (72.0%), ABPI (57.0%), ATP (35.0%), TCPO (30.0%) and pulse palpation (23.0%). The difference between these percentages is significant (p<0.0005). The magnitude of the effect size is medium/moderate (Cramer’s V=0.498). ConclusionThis study demonstrates that inconsistencies exist between the agreement of the 6 different modalities used to detect PAD. These findings should create an awareness amongst clinicians when interpreting results of these tests. The authors advocate for urgent, more robust studies utilizing a gold standard modality for the diagnosis of PAD in order to provide evidence regarding which screening modalities would yield the most valid results.

Adenosine deaminase activity in type 2 diabetes mellitus: does it have any role?

BackgroundDiabetes mellitus is a group of metabolic disorders of carbohydrate metabolism in which glucose is underused, producing hyperglycemia. Diabetic patients are prone to opportunistic infection, thus serum ADA levels in these patients is very important as a screening test for Tuberculosis and autoimmune diseases. Thus, the present study was conducted to estimate the Serum ADA activity, glycated Haemoglobin (HbA1c), fasting and postprandial glucose level in patients with T2DM and to correlate the serum level of ADA with glycated Hemoglobin (HbA1c), fasting and postprandial glucose level in T2DM.MethodsThis is a Hospital based cross-sectional study done in BPKIHs, Dharan, Nepal. 204 diagnosed patients (102 males and 102 females) with T2DM and 102 healthy controls were enrolled in the study. Diabetic patients were categorized into Uncontrolled and Controlled Diabetes on the basis of HbA1C; HbA1c > 7% = Uncontrolled Diabetes, HbA1c < 7% = Controlled Diabetes.ResultsSerum ADA levels (U/L) was significantly raised in Uncontrolled Diabetic patients (49.24 ± 16.89) compared to controlled population (35.74 ± 16.78) and healthy controls (10.55 ± 2.20),p value < 0.001. A significant positive correlation was obtained between Serum ADA and HbA1c, Fasting Plasma Glucose and Post-prandial Glucose respectively.ConclusionThere is a significant increase in Serum ADA activity in DM with increase in HbA1c levels which may play an important role in predicting the glycemic and immunological status in these patients.

Second-trimester maternal serum screening for fetal Down syndrome: As a screening test for hemoglobin Bart's disease: A prospective population-based study.

The purpose of this study is to determine the effectiveness of second-trimester maternal serum screening for Down syndrome as a screening test for fetal hemoglobin (Hb) Bart's disease among an unselected population. A secondary analysis of a large prospective database (20254 pregnancies) was conducted to compare the levels of maternal serum screening, alpha-fetoprotein (AFP), free beta-human chorionic gonadotropin, and unconjugated estriol between pregnancies with Hb Bart's disease and unaffected pregnancies. The median AFP levels were much higher among affected fetuses (1.96 vs 1.12 multiple of the median; P<.001), yielding a sensitivity of 81.6% and specificity of 86.4%. Thus, AFP measurement is effective in predicting fetal Hb Bart's disease among an unselected population when using a cutoff value of 1.5 multiple of the median. The serum free beta-human chorionic gonadotropin levels were slightly, but significantly, higher in the affected pregnancies, while the serum unconjugated estriol levels were minimally, but significantly, lower among the affected pregnancies. Second-trimester maternal serum AFP levels were significantly elevated in cases of fetal Hb Bart's disease. Pregnancies with unexplained elevated serum AFP levels in areas of high prevalence of Hb Bart's disease should always undergo a detailed ultrasound examination to detect any early signs of fetal anemia before development of hydrops fetalis.

Diagnostic Accuracy of Serologic Screening Tests for Celiac Disease in Asymptomatic Adults and Children with Type 1 Diabetes

Background: As related autoimmune conditions, celiac disease (CD) is more common in individuals with type 1 diabetes (T1D) and is frequently asymptomatic. Despite this association, evidence as to the diagnostic accuracy of screening as well as the potential benefits or harms of screening for CD is limited in asymptomatic patients with T1D. Methods: T1D patients, aged 8-45 years, were serologically screened for CD at multiple centers across Ontario, Canada as part of the Celiac Disease and Diabetes Dietary Intervention and Evaluation Trial (CD-DIET). Patients were deemed asymptomatic on the basis of the absence of GI symptoms, weight changes, anemia and other CD-related clinical features. Screening was conducted in 2,386 patients using chemiluminescent (CL, BioFlash™) and/or ELISA (Celikey™) tissue transglutaminase (TTG) IgA assays, yielding 140 positives. Of these, 104 patients had a duodenal biopsy with CD confirmation (Marsh ≥2). Receiver operating characteristic (ROC) curve analysis was conducted and positive predictive values (PPV) of available screening tests for CD were evaluated. Results: CL and ELISA data were available for 100/104 and 36/104 patients, respectively. The area under the curve of the ROC for CL TTG was 0.918, while the PPV using the manufacturer referenced upper limit (RUL) of 30 CU was 85.9% (95% CI: 82.3-90.8%). According to our data, an optimal cut-off of 156.5 CU, or 5.2 times the RUL, showed an improved PPV of 95.8% (95% CI: 92.4-100.0%). With respect to ELISA TTG, the PPV was 94.4% at the RUL of 8 U/ml and reached to 100% at the optimal cut-off determined by our analysis of 58.7 U/ml, which translates to 7.3 times the RUL. Conclusion: Results from serologic CL and ELISA TTG assays that were greater than 5 times the reported upper limit showed a high PPV for biopsy-confirmed CD in asymptomatic adult and pediatric T1D patients, which may help guide diagnostic evaluation in this population. Disclosure M. Gould: None. F.H. Mahmud: None. A.B. Clarke: None. E. Assor: None. A. Parikh: None. A. Advani: Research Support; Self; AstraZeneca, Boehringer Ingelheim GmbH. Other Relationship; Self; Boehringer Ingelheim GmbH. B.A. Perkins: Advisory Panel; Self; Boehringer Ingelheim GmbH. Research Support; Self; Boehringer Ingelheim GmbH, Novo Nordisk Inc.. Advisory Panel; Self; Novo Nordisk Inc., Abbott. Speaker's Bureau; Self; Abbott, Janssen Pharmaceuticals, Inc.. Advisory Panel; Self; Insulet Corporation. Speaker's Bureau; Self; Insulet Corporation, Dexcom, Inc.. B.R. Shah: None. C.S. Zuijdwijk: None. C. McDonald: None. D. Mack: None. D. Koltin: None. E. Hsieh: None. E.M. Szentgyorgyi: None. F. Saibil: None. G. Mukerji: None. H.A. Lochnan: Research Support; Self; Amylin Pharmaceuticals, Boston Therapeutics, Inc., Sanofi. J. Gilbert: Other Relationship; Self; AstraZeneca, Boehringer Ingelheim GmbH, Eli Lilly and Company, Merck &amp; Co., Inc., Novo Nordisk Inc., Janssen Pharmaceuticals, Inc., Sanofi. K. Bax: None. M.L. Lawson: None. M.D. Beaton: Advisory Panel; Self; Takeda Canada Inc., Janssen Pharmaceuticals, Inc., AbbVie Inc.. N.A. Saloojee: None. O. Lou: None. P.H. Gallego: None. R.L. Houlden: Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk Inc., AstraZeneca, Eli Lilly and Company. R. Aronson: Other Relationship; Self; Novo Nordisk Inc., Janssen Pharmaceuticals, Inc., Sanofi, AstraZeneca. Research Support; Self; Eli Lilly and Company, Becton, Dickinson and Company, Merck &amp; Co., Inc., Senseonics, Boehringer Ingelheim Pharmaceuticals, Inc.. S.E. Kirsch: None. W.G. Paterson: None. Z. Punthakee: Research Support; Self; Amgen, Astra Zeneca/Bristol Myers Squibb, Lexicon, Merck, NovoNordisk, Sanofi. Speaker's Bureau; Self; Abbott, Astra Zeneca/Bristol Myers Squibb, Boehringer Ingelheim/Eli Lilly, Janssen, Merck, NovoNordisk, Pfizer, Sanofi. Advisory Panel; Self; Astra Zeneca/Bristol Myers Squibb, Boehringer Ingelheim/Eli Lilly, Dexcom, Janssen, Medtronic, NovoNordisk, Pfizer, Sanofi. M.A. Marcon: None.

Costs of Chagas' disease screening test in blood donors in two Colombian blood banks, 2015

Transfusion is a mechanism of transmission of Chagas' disease. There are no studies on the costs of the screening test in Colombian blood banks. To estimate the costs of the screening test for Chagas' disease among blood donors in two Colombian blood banks, 2015. We conducted a micro-costing study from the perspective of the health care provider to estimate the cost of Chagas' disease testing in two blood banks, Banco de Sangre de la Cruz Roja, Seccional Bolívar, and Banco de Sangre del Hospital de Yopal, Casanare, taking into account four cost categories: 1) Administrative costs: public services and insurance costs were calculated based on the blood bank area in square meters; 2) capital costs: building and equipment costs that were annualized using a 3% discount rate and a lifespan of 20 years for building and five for equipment; 3) costs of Chagas' disease test materials and reagents adjusted by blood bank production level, and 4) costs of staff in charge of Chagas' disease test processing. The costs of transfusion bagsand immunohematology tests are also reported. The cost of Chagas' disease test in the blood bank of Seccional Bolívar was COP$ 37,804 (USD$ 12), and the blood bag and immunohematology test costs were COP$ 25,941 (USD$ 8.2) and COP$ 6,800 (USD$ 2.2), respectively. In the blood bank of Yopal, Casanare, the costs were COP$ 77,384 (USD$ 24.6), COP$ 30,141 (USD$ 9.6) and COP$ 12,627 (USD$ 4), respectively. Personnel cost accounted for the highest percentage of the total cost for both blood banks (47.5% in Seccional Bolívar, and 55.7% in Yopal, Casanare). Our results are an important input for the planning of services and cost-effectiveness studies for screening tests for Chagas' disease in Colombian blood banks.