Sensitivity Of Clinical Diagnosis Research Articles

Comprehensive diagnostic testing identifies diverse aetiologies of acute febrile illness among hospitalised children and adults in Sri Lanka: a prospective cohort study

IntroductionAcute febrile illness (AFI) is a common cause of hospital admissions in tropical settings. Identifying AFI aetiology is essential for guiding clinicians’ diagnoses and developing diagnostic and management guidelines. We...

Salivary Gland Lesions: A Clinico-Pathological Correlation.

To study the usefulness of clinical features, histopathological and radiological features in diagnosis and management of salivary gland lesions. Prospective study conducted at the department of ENT of a tertiary care centre in central India. A total of 162 patients who were treated over a period of 2 years for salivary gland lesions were studied with regards to correlation between clinical diagnosis, cytological examination and radiological features with histopathological diagnosis. Mean age group was 23.94 (± 15.43) years. There was slight male preponderance. Commonest presenting complaint was swelling. The most common gland involved was minor salivary glands followed by parotid gland. Sensitivity of clinical diagnosis, USG and FNAC for neoplastic lesions was found to be 80%, 95.65% and 79.61% respectively. Specificity of clinical diagnosis, USG and FNAC for neoplastic lesions was found to be 100%, 100% and 97.23% respectively. At the end of the study we concluded that combination of thorough clinical examination, radiological and cytological examination help in proper diagnosis, but it should always be confirmed on histopathology because some surprises are expected with regards to the nature of salivary gland lesions.

Exploring High-Throughput Immunoassays for Biomarker Validation in Rheumatic Diseases in the Context of the Human Proteome Project.

Rheumatic diseases are high prevalence pathologies with different etiology and evolution and low sensitivity in clinical diagnosis. Therefore, it is necessary to develop an early diagnosis method which allows personalized treatment, depending on the specific pathology. The biology/disease initiative, at Human Proteome Project, is an integrative approach to identify relevant proteins in the human proteome associated with pathologies. A previously reported literature data mining analysis, which identified proteins related to osteoarthritis (OA), rheumatoid arthritis (RA), and psoriatic arthritis (PSA) was used to establish a systematic prioritization of potential biomarkers candidates for further evaluation by functional proteomics studies. The aim was to study the protein profile of serum samples from patients with rheumatic diseases such as OA, RA, and PSA. To achieve this goal, customized antibody microarrays (containing 151 antibodies targeting 121 specific proteins) were used to identify biomarkers related to early and specific diagnosis in a screening of 960 serum samples (nondepleted) (OA, n = 480; RA, n = 192; PSA, n = 288). This functional proteomics screening has allowed the determination of a panel (30 serum proteins) as potential biomarkers for these rheumatic diseases, displaying receiver operating characteristics curves with area under the curve values of 80-90%.

35336 Do dermatologists realize a reliable clinical diagnosis of melanocytic nevi?

Background: The presence of melanocytic nevi (MN) is due to the accumulation of melanocytes in the epidermis, dermis or both. A clinical-histopathologic concordance was sought in a previous study, where MN and other dermatoses were included, finding a global concordance of 64%. There is no previous literature of clinical-histopathologic concordance of MN in our population. Objective: To determine clinical-histopathologic concordance of MN, and to evaluate sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of clinical diagnosis of MN. Cross-sectional, observational and retrospective study from a registry of patients who requested medical care in an outpatient dermatology clinic. Patients who underwent biopsy during a 2-year period were included. We determined frequency and percentages of histopathologic findings from patients with a clinical diagnosis (by dermatologists) of MN. Sensitivity, specificity, PPV and NPV of clinical diagnosis was evaluated. Data were analyzed using the IBM SPSS Statistics program. From 102 biopsies, 41 were included; 68.3% of patients were women, mean age was 40.37 years, the most frequent topography was the head (82.9%). Diagnosis of MN was confirmed in 73.2% of biopsies. Lesions clinically confused with MN were mainly seborrheic keratoses (14.6%) and basal cell carcinomas (4.9%). Sensitivity of clinical diagnosis was 83.3%, specificity 83.3%, PPV 73% and NPV 90%. Conclusion: diagnosis of MN was confirmed by histopathology in 73.2%, a higher percentage when compared with previous literature. The diagnosis most frequently confused with MN was seborrheic keratosis. Our findings highlight the importance of the clinical diagnosis made by the dermatologist, which reached a sensitivity and specificity of 83.3% in this study.

A novel binary luminophore based high-efficient electrochemiluminescence biosensor for ultrasensitive detection of human epidermal growth factor receptor-2

For the first time, a high-efficient and low-cost electrochemiluminescence (ECL) biosensor was constructed for ultrasensitive detection of breast cancer related human epidermal growth factor receptor-2 (HER-2) using a novel binary luminophore and low concentration of coreactant. Firstly, Au nanoparticles decorated graphite-like carbon nitride (g-C3N4@Au) was designed as sensing platform, which can generate ECL signal in the potential range from −1.2 V to 0 V when peroxydisulfate (S2O82−) was used as the coreactant. Secondly, amino-modified capture probes (CP) were immobilized on the surface of g-C3N4@Au via Au-N bonds. In addition, Zr-based metal organic framework (Zr-MOF) modified bulk boron carbon oxynitride (BCNO), named ZMB, exhibited remarkable ECL intensity at the potential window of −2.0 V to 0 V with 0.8 mM S2O82−. ZMB possessed a large specific surface area and abundant amino groups to anchor Au@Pt nanoparticles (Au@PtNPs). Therefore, HER-2 binding aptamers (HBA) could be anchored on Au@PtNPs to form the tracer label. Under optimal conditions, the proposed ECL biosensor displayed a wide linear range from 10 fg mL−1 to 100 ng mL−1 with a limit of detection (LOD) as low as 0.2 fg mL−1. Importantly, this work utilized ZMB/S2O82− as new ECL system with satisfactory detection performances, which provided a potential approach to improve the sensitivity in clinical diagnosis.

Clinical diagnosis of cholecystitis in emergency department patients with cholelithiasis is indication for urgent cholecystectomy: A comparison of clinical, ultrasound, and pathologic diagnosis

BackgroundBiliary pathology is a common reason for emergency department visits with discharge and outpatient follow up if sonographic evaluation does not reveal evidence of cholecystitis. This retrospective review was conducted to assess the sensitivity of clinical versus sonographic evaluation for indication of urgent cholecystectomy. MethodsRetrospective chart review of 308 patients who presented to the emergency department (ED) with right upper quadrant (RUQ) pain and cholelithiasis whom underwent cholecystectomy. The history and physical exam, laboratory values, ultrasound (US), and final surgical pathology were compared for accuracy of clinical to pathologic diagnosis. Results95.5% of our patients that presented to the ED secondary to RUQ pain with cholelithiasis had pathologic cholecystitis. Sensitivity of clinical diagnosis was superior to US findings as compared to pathologic diagnosis of cholecystitis at 96% vs 44% and 87% vs 18% for acute (AC) and chronic cholecystitis (CC) respectively. ConclusionRUQ pain with known cholelithiasis lasting longer than 4 hours is sensitive for pathologic cholecystitis. This finding, even with the absence of sonographic evidence of cholecystitis, is indication for index encounter urgent cholecystectomy.

A bio-adhesive ion-conducting organohydrogel as a high-performance non-invasive interface for bioelectronics

Bioelectrical signal is the basis of the rapidly growing field of physiological activity research, clinical diagnosis, therapeutic applications and neural science. However, current bioelectrical signal monitor methods face challenges such as skin mismatch, impedance defect, insufficient cycle performance, tissue damage, and scar/biofilm interface formation. Here, we report a sterilizable bio-adhesive interface based on ion-conducting organohydrogel with skin-compliance for precise and motion-robust epidermal bioelectrical signals monitoring. The interface material is based on silk fibroin-reinforced organohydrogel, which is formed by UV curing. The interface material represents energy storage efficiency up to 97%, extremely low impedance (less than40 Ω) at physiologically relevant frequencies and the electrocardiogram (ECG) signals measurement maintains accurate even after multiple disinfections (100 times) by 75% ethanol. Hence, this interface material can be used for multiple times in long-term bioelectrical signals monitoring during daily life. We further investigated the capabilities of the interface in an auditory brainstem response test and realized its ability to achieve competitive monitoring sensitivity in clinical diagnosis as non-invasive electrodes.

CURRENT APPROACH ON CUTANEOUS MELANOMA DIAGNOSTICS

Melanoma is on the first place in mortality among all skin tumors. Over the past 50 years, there has been a steady increase in the incidence of cutaneous melanoma compared to other types of tumors. Rates of 5-year survival are fairly high, if melanoma is diagnosed in the early stages, which requires adequate diagnostics and treatment. Melanoma diagnostic, especially in the early stages, can be problematic even for an experienced dermatologist. However, primary contact doctor can be any specialty. Melanoma and other skin tumors can be detected by physical examination during treatment for another disease. Phenotypic risks factors, anamnestic data, and physical examination data are important in cutaneous melanoma diagnostics. The sensitivity of clinical diagnosis during a visual examination by an experienced dermatologist is approximately 70 percent. However, dermascopy can significantly increase the accuracy of a clinical diagnostics. In recent years there has been an active research for new non-invasive methods and algorithms for cutaneous melanoma diagnostics. The main goal of non-invasive diagnostics is to determine need for biopsy. This decision should be based on a combination of clinical and dermascopic examinations and other information, including growth dynamics, symptoms and medical history. Thus, an adequate diagnostic of cutaneous melanoma, including non-invasive and invasive methods, is a simple and economically viable way to early detection of cutaneous melanoma and to reduce mortality from this aggressive disease.

Accuracy of clinical diagnosis, mammography and ultrasonography in preoperative assessment of breast cancer.

Cancer of the breast is the most common malignancy affecting women in many parts of the world. Its early detection has, therefore, become necessary to reduce morbidity and mortality from the disease. In sub-Saharan Africa, radiological imaging, histology and management programs are associated with challenges. This study seeks to assess the validity of clinical diagnosis, mammography and breast ultrasonography in the preoperative assessment of suspected breast cancer patients for accurate detection of the disease to enable appropriate management. A prospective cross-sectional study was carried out in the Radiology Department of Komfo Anokye Teaching Hospital, Kumasi, Ghana, between November 2007 and July 2008 with a sample size of 103. All patients with a clinical suspicion of breast cancer who gave informed consent were recruited, underwent bilateral mammography and whole breast ultrasonography and then biopsy for all BIRADS categories 4 or 5 lesions. The histopathology results were retrieved to complete the study. In this study the definition of malignancy was made using histology as the gold standard. A total of 103 patients were recruited for this study with mean age of 55(±15) years, out of which 52 (50.5%) had malignant lesions. The overall sensitivity of clinical diagnosis was 50.5%. While the overall sensitivity and specificity for mammogram and ultrasound were 73.0%, 80.0% and 100%, 80.4% respectively. In conclusion, this study has demonstrated that clinical diagnosis, ultrasound and mammography can potentially predict breast cancer disease with considerable sensitivity and specificity. Not declared.

Single Molecule Upconversion-Linked Immunosorbent Assay with Extended Dynamic Range for the Sensitive Detection of Diagnostic Biomarkers.

The ability to detect disease markers at the single molecule level promises the ultimate sensitivity in clinical diagnosis. Fluorescence-based single-molecule analysis, however, is limited by matrix interference and can only probe a very small detection volume, which is typically not suitable for real world analytical applications. We have developed a microtiter plate immunoassay for counting single molecules of the cancer marker prostate specific antigen (PSA) using photon-upconversion nanoparticles (UCNPs) as labels that can be detected without background fluorescence. Individual sandwich immunocomplexes consisting of (1) an anti-PSA antibody immobilized to the surface of a microtiter well, (2) PSA, and (3) an anti-PSA antibody-UCNP conjugate were counted under a wide-field epifluorescence microscope equipped with a 980 nm laser excitation source. The single-molecule (digital) upconversion-linked immunosorbent assay (ULISA) reaches a limit of detection of 1.2 pg mL-1 (42 fM) PSA in 25% blood serum, which is about ten times more sensitive than commercial ELISAs, and covers a dynamic range of three orders of magnitude. This upconversion detection mode has the potential to pave the way for a new generation of digital immunoassays.

Autism spectrum disorders: a meta-analysis of executive function

Evidence of executive dysfunction in autism spectrum disorders (ASD) across development remains mixed and establishing its role is critical for guiding diagnosis and intervention. The primary objectives of this meta-analysis is to analyse executive function (EF) performance in ASD, the fractionation across EF subdomains, the clinical utility of EF measures and the influence of multiple moderators (for example, age, gender, diagnosis, measure characteristics). The Embase, Medline and PsychINFO databases were searched to identify peer-reviewed studies published since the inclusion of Autism in DSM-III (1980) up to end of June 2016 that compared EF in ASD with neurotypical controls. A random-effects model was used and moderators were tested using subgroup analysis. The primary outcome measure was Hedges’ g effect size for EF and moderator factors. Clinical sensitivity was determined by the overlap percentage statistic (OL%). Results were reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 235 studies comprising 14 081 participants were included (N, ASD=6816, Control=7265). A moderate overall effect size for reduced EF (Hedges’ g=0.48, 95% confidence interval (CI) 0.43–0.53) was found with similar effect sizes across each domain. The majority of moderator comparisons were not significant although the overall effect of executive dysfunction has gradually reduced since the introduction of ASD. Only a small number of EF measures achieved clinical sensitivity. This study confirms a broad executive dysfunction in ASD that is relatively stable across development. The fractionation of executive dysfunction into individual subdomains was not supported, nor was diagnostic sensitivity. Development of feasible EF measures focussing on clinical sensitivity for diagnosis and treatment studies should be a priority.

Pertussis in infants: an underestimated disease.

BackgroundThe clinical diagnosis of pertussis is not easy in early infancy since clinical manifestations can overlap with several different diseases. Many cases are often misclassified and underdiagnosed. We conducted a retrospective study on infants to assess how often physicians suspected pertussis and the actual frequency of Bordetella pertussis infections.MethodsWe analyzed all infants with age ≤90 days hospitalized from March 2011 until September 2013 for acute respiratory symptoms tested with a Real Time Polymerase Chain Reaction able to detect Bordetella pertussis and with a Real Time Polymerase Chain Reaction for a multipanel respiratory virus. Therefore, we compared patients with pertussis positive aspirate, patients with respiratory virus positive aspirate and patients with negative aspirate to identify symptoms or clinical findings predictive of pertussis.ResultsOut of 215 patients analyzed, 53 were positive for pertussis (24.7 %), 119 were positive for respiratory virus (55.3 %) and 43 had a negative aspirate (20 %). Pertussis was suspected in 22 patients at admission and 16 of them were confirmed by laboratory tests, while 37 infants with different admission diagnosis resulted positive for pertussis. The sensitivity of clinical diagnosis was 30.2 % and the specificity 96.3 %. Infants with pertussis had more often paroxysmal cough, absence of fever and a higher absolute lymphocyte count than infants without pertussis.ConclusionsPertussis is a serious disease in infants and it is often unrecognized; some features should help pediatricians to suspect pertussis, but clinical suspicion has a low sensitivity. We suggest a systematic use of Real Time Polymerase Chain Reaction to support the clinical suspicion of pertussis in patients with less than 3 months of age hospitalized with acute respiratory symptoms.

Accuracy of clinical diagnosis and malaria rapid diagnostic test and its influence on the management of children with fever under reduced malaria burden in Misungwi district, Mwanza Tanzania.

IntroductionMalaria diagnosis is known to be non-specific because of the overlap of symptoms of malaria with other infectious diseases that is made worse with declining malaria burden. Though the use of malaria rapid diagnostic test (mRDT) for malaria confirmation has universally been adopted, malaria decline may alter performance of mRDT. This study examined accuracy of clinical diagnosis and mRDT and its influence on prescription for febrile underfives.MethodsA cross-sectional study of 600 underfives was carried out in 6 randomly selected health facilities in Misungwi district, Mwanza; from November - December 2014. Consecutive underfives with a fever consultation were recruited: for each fever and the clinical diagnosis entertained were recorded. Parasitological confirmation of malaria was done by mRDT and microscopic examination of finger prick blood samples. Treatment was based on mRDT results, drugs prescribed recorded. Accuracy of clinical diagnosis and mRDT in predicting malaria was assessed by performance indices against microscopy. Antimalarial and antibiotics prescriptions were assessed against parasitological findings.ResultsClinically, 37.2% had malaria; 32.8% were mRDTpositive and 17.0% microscopically positive. Sensitivity of clinical diagnosis was very high (97.0% [95%CI: 91.0-99.2]); specificity 66.7% [95%CI: 62.3-70.8], and positive predictive value 37.4% (95%CI: 31.6-43.5). Sensitivity of mRDTwas very high (99.0% [95%CI: 93.9-99.9]), specificity (80.7% [95%CI: 76.9-84.0]), positive predictive value 51.3% [95% CI: 44.1-58.4]) and negative predictive 99.75% [95%CI: 99.4-100.0]. Those receiving antimalarial prescription, 75.0% were mRDT positive; 39.4% microscopically positive. Those receiving antibiotic, 78.8% were mRDT negative; 90.1% microscopically negative.ConclusionDecline in malaria lowered specificity of mRDT to < 95% against WHO recommendation. Though adherence to mRDT results was high, there was over prescription of antibiotics.

Sensitivity of the three-step test in diagnosis of superior oblique palsy

Although the Parks-Bielschowsky three-step test is the cornerstone of cyclovertical strabismus diagnosis, it has not been validated against an external benchmark. We evaluated the test's sensitivity in clinical diagnosis of superior oblique palsy in patients with unequivocal magnetic resonance imaging (MRI) evidence of superior oblique atrophy. A total of 73 strabismic patients were selected from a prospective MRI study because they exhibited superior oblique atrophy indicative of superior oblique denervation and thus confirmatory of superior oblique palsy. Of these, 50 patients who had no confounding factors were included for detailed study. Ocular motility data were evaluated to determine sensitivity of single and combined clinical findings in diagnosis of superior oblique palsy. Maximum mean ipsilesional superior oblique cross section was reduced to 9.6 ± 0.6 mm(2) (mean ± standard error) in superior oblique palsy, representing 52% of the 18.5 ± 0.6 mm(2) contralesional superior oblique maximum cross section and 52% of the 18.4 ± 0.4 mm(2) control maximum superior oblique cross section (P < 0.001). Of the 50 patients, 35 (70%) with superior oblique atrophy fulfilled the entire three-step test. In 14 (28%) patients two steps were fulfilled; in 1 patient (2%), only one step. Affected superior oblique cross section was similar in orbits that fulfilled the three-step test (9.8 ± 0.9 mm(2)) and those that did not (9.1 ± 0.7 mm(2); P = 0.58). The complete three-step test fails to detect 30% of cases of superior oblique atrophy. Often only two of three steps are positive in superior oblique palsy.

Clinical versus histological diagnosis of diabetic nephropathy--is renal biopsy required in type 2 diabetic patients with renal disease?

The clinical and histological diagnosis (gold standard) of diabetic nephropathy (dNP) and vascular nephropathy (vNP) were compared in type 2 diabetic patients with end-stage renal disease (ESRD). The aim of the study was to investigate indication for renal biopsy in type 2 diabetic patients with renal disease. Retrospective study in diabetic patients with clinical and histological diagnosis of renal disease. Eighty-four patients with type 2 diabetes and ESRD were investigated. Histological findings of the kidneys were available in all patients, 14 had undergone a renal biopsy before their first dialysis while a post-mortem kidney investigation was performed in 70 subjects. According to the histological findings, 66 patients had dNP and 18 subjects had vNP. The histological diagnosis was compared with the clinical diagnosis, and the sensitivity as well as the specificity of the clinical diagnosis of dNP and vNP were calculated. The clinical diagnosis was not identical with the histological diagnosis in 10 cases. In the dNP group the diagnosis was 4 false positive and 3 false negative as in the vNP group 1 false positive and 2 false negative. The sensitivity of clinical diagnosis was 95% for dNP and 89% for vNP. Specificity was 78% for dNP and 97% for vNP. The sensitivity of the clinical diagnosis is very high for dNP as well as vNP. A renal biopsy is not required in the majority of type 2 diabetic patients with ESRD, especially in patients who exhibit all criteria for clinical diagnosis.

Low sensitivity in clinical diagnoses of dementia with Lewy bodies

The success of future neurodegenerative disease (ND) therapies depends partly on accurate antemortem diagnoses. Relatively few prior studies have been performed on large, multicenter-derived datasets to test the accuracy of final clinical ND diagnoses in relation to definitive neuropathological findings. Data were analyzed from the University of Kentucky Alzheimer's Disease Center autopsy series and from the National Alzheimer's Coordinating Center (NACC) registry. NACC data are derived from 31 different academic medical centers, each with strong clinical expertise and infrastructure pertaining to NDs. The final clinical diagnoses were compared systematically with subsequent neuropathology diagnoses. Among subjects meeting final inclusion criteria (N = 2,861 for NACC Registry data), the strength of the associations between clinical diagnoses and subsequent ND diagnoses was only moderate. This was particularly true in the case of dementia with Lewy bodies (DLB): the sensitivity of clinical diagnoses was quite low (32.1% for pure DLB and 12.1% for Alzheimer's disease (AD + DLB) although specificity was over 95%. AD clinical diagnoses were more accurate (85.0% sensitivity and 51.1% specificity). The accuracy of clinical DLB diagnoses became somewhat lower over the past decade, due apparently to increased "over-calling" the diagnosis in patients with severe cognitive impairment. Furthermore, using visual hallucinations, extrapyramidal signs, and/or fluctuating cognition as part of the clinical criteria for DLB diagnosis was of minimal utility in a group (N = 237) with high prevalence of severe dementia. Our data suggest that further work is needed to refine our ability to identify specific aging-related brain disease mechanisms, especially in DLB.

Quality of the Clinical Diagnosis of Endometriosis

Background Endometriosis is a benign but chronic disease, often associated with chronic pelvic pain and sterility in reproductive age women. Definite diagnosis of endometriosis requires surgical intervention. In our study we determined the sensitivity and specificity of the routine non-invasive diagnosis of endometriosis. Methods 543 women underwent laparoscopy or laparotomy for benign gynecological reasons; of these, 156 women presented with endometriosis and 387 women presented without endometriosis. Charts were examined for preoperative prediction and diagnosis of endometriosis by gynecologists in private practice and by clinicians. Charts were also examined for the diagnosis after surgical and histological confirmation. Results Out of 101 cases, where first time endometriosis was diagnosed, in 43 patients (42.6%) the diagnosis of endometriosis was accurately predicted preoperatively by clinicians. Gynecologists in private practice suspected endometriosis in 29.7% of the cases. In the group of at least one recurrence of endometriosis (n=55), 89.1% clinic and 74.5% private practice suspected the correct diagnosis before surgery. The sensitivity for clinical diagnosis of endometriosis was calculated to be 59.0% in the clinic and 54.5% in private practice. The specificity was calculated to be 95.6% in the clinic and 96.9% in private practice. Conclusions According to the results of this study, the sensitivity of the clinical diagnosis for patients with newly detected endometriosis is very low, whereas it increases significantly for patients with recurrent disease. We recommend more investigations using non-invasive diagnostic tools. It should thereupon be possible to detect endometriosis earlier than the current delay of around nine years between the onset of symptoms and the final diagnosis.

Streptococcus A in paediatric accident and emergency: are rapid streptococcal tests and clinical examination of any help?

Background: Rapid streptococcal tests (RSTs) for streptococcal pharyngitis have made diagnosis at once simpler and more complicated. The American Academy of Pediatrics recommends that all RSTs be confirmed by a...

Venous thrombosis and anticoagulant therapy.

Venous thrombosis and anticoagulant therapy.

Computed Tomography in Diagnosing Suspected Appendicitis

Computed Tomography in Diagnosing Suspected Appendicitis