Search

Background Acute appendicitis is a common surgical emergency, and accurate imaging is crucial for diagnosis. This study aims to compare the diagnostic accuracy of ultrasound (US) and computed tomography (CT) imaging in adult patients presenting with symptoms suggestive of acute appendicitis. Methods A prospective study was conducted on 100 adult patients (50 males and 50 females) with a mean age of 35 years (range: 18-60 years). Each patient underwent both US and CT imaging. The diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of both imaging modalities were calculated and compared. Results Ultrasound imaging demonstrated a sensitivity of 75% (95% CI: 64%-84%), specificity of 85% (95% CI: 75%-92%), PPV of 81% (95% CI: 70%-89%), and NPV of 80% (95% CI: 70%-88%). CT imaging showed a sensitivity of 94% (95% CI: 86%-98%), specificity of 90% (95% CI: 81%-96%), PPV of 92% (95% CI: 84%-97%), and NPV of 93% (95% CI: 85%-98%). The accuracy of US was 79%, while CT achieved 92%. Comparative analysis revealed that CT imaging had significantly higher sensitivity (p<0.05) than ultrasound, with no significant difference in specificity (p>0.05). Conclusion CT imaging demonstrates superior diagnostic accuracy and sensitivity compared to ultrasound in diagnosing acute appendicitis in adults, though both modalities have comparable specificity. CT should be preferred for its higher diagnostic confidence, especially in equivocal cases. [ABSTRACT FROM AUTHOR]

Abstract Objective This study evaluates the efficacy of Acu‐URO17, a highly sensitive and specific immunocytochemistry (ICC) test targeting Keratin 17, in comparison to urine cytology and UroVysion™ fluorescence in situ hybridization (FISH) for detecting bladder cancer cells in voided urine specimens. Methods Acupath conducted a large‐scale comparison study using 2378 voided urine specimens. Acu‐URO17, urine cytology and UroVysion™ FISH were performed on these specimens according to standardized protocols. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for Acu‐URO17 in comparison to urine cytology and UroVysion™ FISH. Results In cases diagnosed with high‐grade urothelial cancer via urine cytology, Acu‐URO17 demonstrated a sensitivity of 96% and a specificity of 82%. When compared to UroVysion™ FISH results, Acu‐URO17 exhibited a sensitivity of 97.1% and a specificity of 77.8%, surpassing the sensitivity of UroVysion™ FISH (57.1%). Notably, Acu‐URO17 showed a high NPV of 99.9%, indicating its reliability in confirming negative urine cytology results and risk‐stratifying atypical and suspicious cytology results. Conclusion The results of this large‐scale prospective study support Acu‐URO17 as a clinically relevant, non‐invasive and cost‐effective tool for detecting bladder cancer cells in voided urine specimens. Its high sensitivity, specificity and NPV make it a valuable adjunct to urine cytology and UroVysion™ FISH in the diagnosis and management of urothelial carcinoma (UC).

Simple Summary: This study explores an innovative approach to cervical cancer screening by employing a 7-type HPV mRNA E6/E7 test on self-collected samples from women in Mexico. It investigates whether this method can enhance the accuracy of diagnostics and increase acceptance among participants referred for colposcopy and biopsy due to abnormal cytology results (ASC-US+). The potential benefits include reducing the rate of cervical cancer and the need for unnecessary medical procedures, making screening more accessible and acceptable, especially in underserved areas. The findings could significantly influence the future practices of cervical cancer screening. Cervical cancer remains a significant public health issue, particularly in regions with low screening uptake. This study evaluates the effectiveness of self-sampling and the 7-type HPV mRNA E6/E7 test in improving cervical cancer screening outcomes among a referral population in Mexico. A cohort of 418 Mexican women aged 25 to 65, referred for colposcopy and biopsy due to abnormal cytology results (ASC-US+), participated in this study. Self-samples were analyzed using both the 14-type HPV DNA test and the 7-type HPV mRNA E6/E7 test. The study assessed the sensitivity, specificity, positive predictive value (PPV), and the necessity of colposcopies to detect CIN3+ lesions. Participant acceptability of self-sampling was also evaluated through a questionnaire. The 7-type HPV mRNA E6/E7 test demonstrated equivalent sensitivity but significantly higher specificity (77.0%) and PPV for CIN3+ detection compared to the 14-type HPV DNA test (specificity: 45.8%, p < 0.001). The use of the HPV mRNA test as a triage tool reduced the number of colposcopies needed per CIN3+ case detected from 16.6 to 7.6 (p < 0.001). Self-sampling was highly accepted among participants, with the majority reporting confidence in performing the procedure, minimal discomfort, and willingness to undertake self-sampling at home. Self-sampling combined with the 7-type HPV mRNA E6/E7 testing offers a promising strategy to enhance cervical cancer screening by improving accessibility and ensuring precise diagnostics. Implementing these app roaches could lead to a significant reduction in cervical cancer morbidity and mortality, especially in underserved populations. Future research should focus on the long-term impact of integrating these methods into national screening programs and explore the cost-effectiveness of widespread implementation. [ABSTRACT FROM AUTHOR]

Introduction: In case of pneumonia, some biological findings are suggestive for Legionnaire's disease (LD) including C-reactive protein (CRP). A low level of CRP is predictive for negative Legionella Urinary-Antigen-Test (L-UAT). Method: Observational retrospective study in Nord-Franche‐Comté Hospital with external validation in Besançon University Hospital, France which included all adults with L-UAT performed during January 2018 to December 2022. The objective was to determine CRP optimal threshold to predict a L-UAT negative result. Results: URINELLA included 5051 patients (83 with positive L-UAT). CRP optimal threshold was 131.9 mg/L, with a negative predictive value (NPV) at 100%, sensitivity at 100% and specificity at 58.0%. The AUC of the ROC-Curve was at 88.7% (95% CI, 86.3–91.1). External validation in Besançon Hospital patients showed an AUC at 89.8% (95% CI, 85.5–94.1) and NPV, sensitivity and specificity was respectively 99.9%, 97.6% and 59.1% for a CRP threshold at 131.9 mg/L; after exclusion of immunosuppressed patients, index sensitivity and NPV reached also 100%. Conclusion: In case of pneumonia suspicion with a CRP level under 130 mg/L (independently of the severity) L-UAT is useless in immunocompetent patients with a NPV at 100%. We must remain cautious in patients with symptoms onset less than 48 h before CRP dosage. [ABSTRACT FROM AUTHOR]

Barsha Suwal,1 Deepak Khadka,1 Arjun Shrestha,1 Rinkal Suwal,2 Bijay Khatri3 1Department of Ophthalmology, BP Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services, Bhaktapur, Nepal; 2Department of Optometry, BP Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services, Bhaktapur, Nepal; 3Academic and Research Department, BP Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services, Bhaktapur, NepalCorrespondence: Barsha Suwal, Department of Ophthalmology, BP Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services, Bhaktapur, Nepal, Tel +977-9803056313, Email suwal.barsha@gmail.comPurpose: To quantify metamorphopsia in patients with resolved idiopathic Central Serous Chorioretinopathy (CSCR) using M-CHARTS and compare the results with the traditional Amsler grid and optical coherence tomography (OCT).Patients and Methods: For the purpose of this study, all consecutive cases of patients with resolved CSCR were evaluated for metamorphopsia (using the standard Amsler grid and M-CHARTS) and spectral domain OCT. The OCT images were analyzed for the following five parameters: central macular thickness, pigment epithelial detachment, retinal pigment epithelial bumps, discontinuation in the inner segment/outer segment junction or the external limiting membrane, fibrinous exudates in the subretinal space, and hyperreflective dots in the intraretinal and/or subretinal layer. Binary logistic regression was used to find the association between metamorphopsia and foveal morphology. Cohen’s Kappa was used to determine the agreement between the M-CHARTS and Amsler grid for diagnosing metamorphopsia. The sensitivity, specificity, and accuracy in the diagnosis of metamorphopsia were calculated against the Amsler grid.Results: Of 41 eyes, Amsler Grid detected metamorphopsia in 39.02%, and M-CHARTS detected metamorphopsia in 53.66%. The agreement rate of detection between the two tests was moderate (Kappa=0.52). M-CHARTS had a sensitivity of 87.50%, a specificity of 68.00%, a positive predictive value of 63.64%; and a negative predictive value of 89.47% for the diagnosis of metamorphopsia compared to the Amsler grid. The presence of PED in OCT was significantly associated with metamorphopsia.Conclusion: M-CHARTS can be a useful ancillary test to detect and quantify metamorphopsia even after fluid resolution in CSCR. Structural changes in macular morphology as observed with OCT can predict the likelihood of metamorphopsia.Keywords: agreement, negative predictive value, positive predictive value, sensitivity, specificity

Positive and negative estimates are commonly used by clinicians to evaluate the likelihood of a disease stage being present based on test results. The predicted values are dependent on the prevalence of the underlying illness. However, for certain diseases or clinical conditions, the prevalence is unknown or different from one region to another or from one population to another, leading to an erroneous diagnosis. This article introduces innovative post-test diagnostic precision measures for continuous tests or biomarkers based on the combined areas under the predictive value curves for all possible prevalence values. The proposed measures do not vary as a function of the prevalence of the disease. They can be used to compare different diagnostic tests and/or biomarkers’ abilities for rule-in, rule-out, and overall accuracy based on the combined areas under the predictive value curves. The relationship of the proposed measures to other diagnostic accuracy measures is discussed. We illustrate the proposed measures numerically and use a real data example on breast cancer. [ABSTRACT FROM AUTHOR]

This prospective study aimed to assess the accuracy of electrocardiography (ECG) and 2D echocardiography (2D-ECHO) in identifying the infarct vessel in acute myocardial infarction (AMI), correlating findings with coronary angiography (CAG). Seventy-five AMI cases were included, diagnosed by ECG and cardiac enzymes, and underwent 2D-ECHO and CAG. Statistical analysis was conducted using SPSS and R environment. Results showed significant correlations between ECG, 2D-ECHO, and CAG findings, aiding in accurate identification of infarct vessels. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ECG and 2D-ECHO in identifying coronary artery involvement were evaluated. Findings suggest ECG and 2D-ECHO as valuable tools in AMI diagnosis, with implications for patient management. [ABSTRACT FROM AUTHOR]

Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Histopathological analysis of tissue sections continues to be the preferred and definitive diagnostic method. However, frozen sections serve a purpose in rapid intraoperative diagnosis and guides patient management during surgery. Aim: The objective of the research is to study a range of lesions by frozen section at different anatomical locations and determination of efficacy of frozen section in terms of accuracy, sensitivity, and specificity. Method: This is a retrospective study conducted at the Department of Pathology, SIMS, RC, Bangalore from November 2021 to November 2023. The analysis of frozen section was done followed by its comparision with subsequent histopathology reports. The overall Accuracy, Sensitivity and Specificity were calculated along with Positive predictive value and Negative predictive values. Results: The study involved 100 cases with 91 female and 9 male patients, aged between 17 and 80. Among the cases, 58 were gynecological, 7 were related to breast, 6 involved oral cavity margins, and 5 focused on sentinel lymph nodes. The overall accuracy of the study was 98.8%, with sensitivity and specificity rate at 98.8% and 92.8%, respectively. Additionally, the positive predictive value was determined as 98.8%, while the negative predictive value stood at 92.8%. Conclusion: Validity of frozen section analysis is confirmed by the study's results on specificity, sensitivity, and accuracy, which closely align with those of prior research. However continual refinement and larger prospective studies are required to enhance diagnostic accuracy and reliability across diverse pathological process. [ABSTRACT FROM AUTHOR]

Abstract Background Globally, urinary tract infections (UTIs) are the leading cause of hospital visits, especially among women. In many developing countries, especially in lower health facilities, the dipstick urinalysis is the most commonly requested test, as urine culture is not routinely performed. The dipstick test can potentially reduce the number of patients who could be treated with empirical antibiotics and reduce the burden of antibiotic resistance. The current study determined the utility of dipstick urinalysis in diagnosing UTIs using urine culture as a gold standard method. Methods A cross-sectional study was conducted between July and November 2021. The study involved 1327 outpatients attending lower health centres in Mwanza (n = 678) and Dar es Salaam (n = 649) regions. The samples were subjected to dipstick urinalysis (nitrite and leucocytes) and quantitative bacterial culture. Results Of all 1326 patient samples, 808(60.9%) and 48(3.6%) were positive for urinary leucocyte and nitrite, respectively, while significant urine culture was found in 364(27.4%). leucocyte test correctly diagnosed UTI in 283 (77.75%) and nitrite test in 36 (9.89%). The leucocytes and nitrites, in combination, exhibited a sensitivity of 79.40% and NPV of 85.24% but a lower specificity of 44.96% and a lower PPV of 35.29%. Urinary leucocyte test had a higher discrimination ability to detect urinary tract infection than urinary nitrite test (AUC = 0.073, 95% CI 0.043–0.103, p

Background: Globally, urinary tract infections (UTIs) are the leading cause of hospital visits, especially among women. In many developing countries, especially in lower health facilities, the dipstick urinalysis is the most commonly requested test, as urine culture is not routinely performed. The dipstick test can potentially reduce the number of patients who could be treated with empirical antibiotics and reduce the burden of antibiotic resistance. The current study determined the utility of dipstick urinalysis in diagnosing UTIs using urine culture as a gold standard method. Methods: A cross-sectional study was conducted between July and November 2021. The study involved 1327 outpatients attending lower health centres in Mwanza (n = 678) and Dar es Salaam (n = 649) regions. The samples were subjected to dipstick urinalysis (nitrite and leucocytes) and quantitative bacterial culture. Results: Of all 1326 patient samples, 808(60.9%) and 48(3.6%) were positive for urinary leucocyte and nitrite, respectively, while significant urine culture was found in 364(27.4%). leucocyte test correctly diagnosed UTI in 283 (77.75%) and nitrite test in 36 (9.89%). The leucocytes and nitrites, in combination, exhibited a sensitivity of 79.40% and NPV of 85.24% but a lower specificity of 44.96% and a lower PPV of 35.29%. Urinary leucocyte test had a higher discrimination ability to detect urinary tract infection than urinary nitrite test (AUC = 0.073, 95% CI 0.043–0.103, p < 0.001); likewise, combined results of urinary nitrite and leucocytes tests had higher discrimination ability to detect UTI than nitrite only (AUC = − 0.079, 95% CI − 0.107–0.050, p < 0.001). Conclusions: In settings where culture is available, dipstick urinalysis can be a helpful screening method for reducing unnecessary urine cultures and related expenses because of its higher negative predictive value. In most low-resource settings where patients' diagnosis solely depends on clinical diagnosis and culture is not easily available, urine dipstick can decrease the risk of overuse of antibiotics. However, the combined (leucocytes and nitrites) dipstick urinalysis has a rather low positive predictive value, with approximately one-third of cases giving positive test results being truly UTI, subjecting over 65% of cases to unnecessary antibiotic treatment. [ABSTRACT FROM AUTHOR]

Background: Fine-Needle Aspiration Cytology (FNAC) is a valuable, minimally invasive diagnostic tool for discerning benign and malignant thyroid lesions. In the realm of thyroid cytopathology, both the traditional approach and the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) are widely utilized for diagnosing and categorizing these lesions. Aims and Objectives: This study aims to classify thyroid cytology smears using both the conventional method and the Bethesda system and to compare their findings with histopathological diagnoses. Method and Materials: A hospital-based cross-sectional study was conducted over one year, spanning from February 1, 2022, to January 31, 2023. We included 191 cases of FNAC thyroid lesions and categorized them following the guidelines of both the conventional system and the Bethesda system for reporting thyroid cytopathology. Sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy for both systems were calculated, with histopathology serving as the gold standard for comparison. Furthermore, we calculated the Risk of Malignancy (ROM) for each category within the Bethesda system. Results: The Bethesda system exhibited a notably high sensitivity of 83.33%, surpassing the conventional method's sensitivity of 50%, while both systems shared the same specificity of 90%. The diagnostic accuracy of the Bethesda system, at 89.13%, outperformed that of the conventional method, which stood at 84.78%. Conclusion: This study demonstrates a strong positive correlation with histopathology, indicating high sensitivity, specificity, and accuracy when employing TBSRTC, in contrast to the conventional method. [ABSTRACT FROM AUTHOR]

Background: The process of describing the location, size, and character of uterine fibroids, commonly referred to as 'fibroid mapping'. Mapping techniques helps surgeons plan efficient resection of the fibroid to optimize surgical outcomes. Hence this study was done to correlate and estimate the diagnostic accuracy of 3D ultrasound in fibroid mapping compared with intraoperative findings. Methodology: A longitudinal study was done in a tertiary care hospital during March 2022 to September 2023 in all 50 patients posted for elective surgery. Complete 3D ultrasound assessment (both transabdominal and transvaginal) and mapping was performed by same radiologist for number of fibroids, size, location, type and FIGO class. Intraoperative findings were documented immediately after surgery. Spearman's Correlation and diagnostic accuracy was estimated with P<0.05 considered as significant. Results: The mean age and range of patients in this study includes 39±9.5 years and 15-48 years. Of 50 patients studied, the number of fibroids predicted by ultrasound matched with intraoperative findings in 42 patients which was 105 out of 117 (89.7%) fibroids. Strong positive correlation was seen with fibroid mapping with Spearman rho value of 0.89, 0.94 and 0.97 in subserosal, intramural and submucosal respectively. Diagnostic accuracy of subserosal, Intramural, Submucosal fibroids was 70.6%, 73.6% and 90.6% respectively. Conclusion: Strong positive correlation was seen with fibroid mapping, done on ultrasound compared to intraoperative findings in 42 patients (84%) which was significant statistically. Also diagnostic accuracy of Subserosal, Intramural, Submucosal was 70.6%, 73.6% and 90.6% respectively. [ABSTRACT FROM AUTHOR]

The utility and sensitivity of quantitative D-Dimer assay to rule out the diagnosis of deep vein thrombosis is well established. We extrapolated this principle to evaluate the utility of D-Dimer assay in exclusion of cerebral venous sinus thrombosis (CVST). As advanced imaging modalities required for the diagnosis of CVST might not be available everywhere, it is important to have a sensitive biomarker and a clinical decision rule which can assist in the diagnosis. Patients undergoing CT/MR Venography of the brain with the suspicion of CVST were enrolled. Quantitative D-Dimer assay was performed in those who had CVST on CT/MR Venography and was compared with those who did not. A Clinical decision rule for the diagnosis of CVST was formulated using logistic regression analysis. Receiver operating characteristic analysis evaluating the diagnostic accuracy of D Dimer for patients with CVST as compared to those who did not revealed an AUROC of 0.694. D-Dimer levels of < 300 ng/mL had a sensitivity of 90% for the exclusion of CVST. After logistic regression analysis, a clinical decision rule with a total score of 16 and individual components of Female gender (2 points), Headache (7 points), D-Dimer levels of ≥ 792 ng/mL (7 points) was proposed. D-Dimer had a poor diagnostic accuracy for differentiation of patients who had CVST from those who did not, however, had a high sensitivity at values < 300 ng/mL. The proposed clinical decision rule with a score of ≥ 9 had a good diagnostic accuracy in prediction of CVST (AUROC = 0.809). [ABSTRACT FROM AUTHOR]

The medical field commonly employs post‐test measures such as predictive values and likelihood ratios to assess diagnostic accuracy. Predictive values, including positive and negative values (PPV and NPV), indicate the probability that individuals have a target health condition based on test results. On the other hand, likelihood ratios, including positive and negative ratios (LR+ and LR− respectively), compare the probability of a particular test result between the diseased and non‐diseased groups. While predictive values are useful in evaluating diagnostic test accuracy in populations with varying disease prevalence, likelihood ratios provide a direct link between pre‐test and post‐test probabilities in specific patients. In this study, we introduce and analyze a new approach called generalized predictive values and likelihood ratios, using a tree ordering of disease classes. We evaluate the effectiveness of these methods through simulation studies and illustrate their use with real data on lung cancer. [ABSTRACT FROM AUTHOR]

Background: The utility of head computed tomography (CT) in predicting elevated intracranial pressure (ICP) is known to be limited in traumatic brain injury; however, few data exist in patients with spontaneous intracranial hemorrhage. Methods: We conducted a retrospective review of prospectively collected data in patients with nontraumatic intracranial hemorrhage (subarachnoid hemorrhage [SAH] or intraparenchymal hemorrhage [IPH]) who underwent external ventricular drain (EVD) placement. Head CT scans performed immediately prior to EVD placement were quantitatively reviewed for features suggestive of elevated ICP, including temporal horn diameter, bicaudate index, basal cistern effacement, midline shift, and global cerebral edema. The modified Fisher score (mFS), intraventricular hemorrhage score, and IPH volume were also measured, as applicable. We calculated the accuracy, positive predictive value (PPV), and negative predictive value (NPV) of these radiographic features for the coprimary outcomes of elevated ICP (> 20 mm Hg) at the time of EVD placement and at any time during the hospital stay. Multivariable backward stepwise logistic regression analysis was performed to identify significant radiographic factors associated with elevated ICP. Results: Of 608 patients with intracranial hemorrhages enrolled during the study time frame, 243 (40%) received an EVD and 165 (n = 107 SAH, n = 58 IPH) had a preplacement head CT scan available for rating. Elevated opening pressure and elevated ICP during hospitalization were recorded in 48 of 152 (29%) and 103 of 165 (62%), respectively. The presence of ≥ 1 radiographic feature had only 32% accuracy for identifying elevated opening pressure (PPV 30%, NPV 58%, area under the curve [AUC] 0.537, 95% asymptotic confidence interval [CI] 0.436–0.637, P = 0.466) and 59% accuracy for predicting elevated ICP during hospitalization (PPV 63%, NPV 40%, AUC 0.514, 95% asymptotic CI 0.391–0.638, P = 0.820). There was no significant association between the number of radiographic features and ICP elevation. Head CT scans without any features suggestive of elevated ICP occurred in 25 of 165 (15%) patients. However, 10 of 25 (40%) of these patients had elevated opening pressure, and 15 of 25 (60%) had elevated ICP during their hospital stay. In multivariable models, mFS (adjusted odds ratio [aOR] 1.36, 95% CI 1.10–1.68) and global cerebral edema (aOR 2.93, 95% CI 1.27–6.75) were significantly associated with elevated ICP; however, their accuracies were only 69% and 60%, respectively. All other individual radiographic features had accuracies between 38 and 58% for identifying intracranial hypertension. Conclusions: More than 50% of patients with spontaneous intracranial hemorrhage without radiographic features suggestive of elevated ICP actually had ICP > 20 mm Hg during EVD placement or their hospital stay. Morphological head CT findings were only 32% and 59% accurate in identifying elevated opening pressure and ICP elevation during hospitalization, respectively. [ABSTRACT FROM AUTHOR]

The high negative predictive value of post-chemoradiation (CRT) positron emission tomography-computed tomography (PET-CT) is well established in head and neck squamous cell cancers (HNSCC). The positive predictive value (PPV) remains under scrutiny, with increasing evidence that it is affected by several factors. The aim of this study was to assess the PPV of post-treatment PET-CT for residual nodal disease when stratified by treatment modality and tumour human papillomavirus (HPV) status. This was a retrospective cohort study in a tertiary oncology centre carried out between January 2013 and December 2019. Patients were radically treated with radiotherapy only/CRT for node-positive HNSCC. PET-CT nodal responses were categorised as complete, equivocal (EQR) or incomplete (ICR), and outcomes extracted from electronic records. In total, 480 patients were evaluated, all had a minimum potential follow-up of 2 years, with a median of 39.2 months. The PPV of 12-week PET-CT was significantly different between HPV-positive (22.5%) and HPV-unrelated (52.7%) disease, P < 0.001. It was also significantly different between the CRT (24.8%) and radiotherapy-only (51.1%) groups, P = 0.001. The PPV of an EQR was significantly less than an ICR, irrespective of HPV status and primary treatment modality. In HPV-positive disease, the PPV of an EQR was 9.0% for the CRT group compared with 21.4% for radiotherapy only, P = 0.278. The PPV in those who achieved an ICR was 34.2% in the CRT group, significantly lower than 70.0% in the radiotherapy-only group, P = 0.03. The PPV of 12-week PET-CT is significantly lower for HPV-positive compared with HPV-unrelated HNSCC. It is poorer in patients with HPV-positive disease treated with CRT compared with radiotherapy alone. • NPV of 12-week PET-CT is high irrespective of treatment and HPV status. • PPV is affected by HPV status and treatment modality (CRT versus radiotherapy alone). • PPV is significantly poorer in HPV-positive compared with HPV-unrelated HNSCC. • PPV of PET-CT is poorer in HPV-positive patients treated with CRT compared with radiotherapy. [ABSTRACT FROM AUTHOR]

Simple Summary: Despite being preventable, cervical cancer remains a lead killer among women in low–middle income countries. The reasons are clear. Global inequity is reflected in limited health resources, such as limited access to HPV-vaccination, screening, and treatment, which are the key pillars for the elimination of cervical cancer. The high burden of HPV-coinfections in women living with HIV/AIDS challenges the use of sensitive HPV-testing, leading to massive over-treatment. As advised by the WHO, a "test-and-treat" strategy could be optimal. In this study, 710 under-screened South African women, about half of them living with HIV, were tested for mRNA expression restricted to the predominant HPV types of cervical cancer. The effectiveness of a test-and-treat strategy to detect and manage severe cervical abnormalities (CIN3+) by increasing the number of HPV types included in the test was modeled. A combination of 6 types (16, 18, 31, 33, 35, 45) resulted in 25% positive tests requiring treatment, with the potential to prevent up to 85% of all cervical cancers. Background: Cervical cancer prevention in regions with limited access to screening and HPV vaccination necessitates innovative approaches. This study explored the potential of a test-and-treat strategy using mRNA HPV tests to impact cervical cancer prevention in a high-prevalence HIV population. Methods: A cervical screening study was conducted at three South African hospitals involving 710 under-screened, non-pregnant women (25 to 65 years) without known cervical diseases. Cytology, HPV testing, colposcopy, and biopsies were performed concurrently. Histopathologists determined final histological diagnoses based on biopsy and LLETZ histology. mRNA-HPV-genotyping for 3 (16, 18, 45) to 8 (16, 18, 31, 33, 35, 45, 52, 58) high-risk types was performed on leftover liquid-based cytology material. The preventive potential of the test-and-treat approach was estimated based on published data, reporting the causative HPV types in cervical cancer tissue from South African women. Treatment was provided as needed. Results: The HPV positivity rate more than doubled from 3-type (15.2%; 95% CI: 12.6–17.8) to 8-type mRNA (31.5%; 95% CI: 28.8–34.9) combinations, significantly higher among HIV-positive women. CIN3+ prevalence among HIV-positive women (26.4%) was double that of HIV-negative women (12.9%) (p < 0.01). The 6-type combination showed the best balance of sensitivity, specificity and treatment group size, and effectiveness to prevent cervical cancer. A 4-type combination (16, 18, 35, 45) could potentially prevent 77.6% (95% CI: 71.2–84.0) of cervical cancer burden by treating 20% and detecting 41.1% of CIN3 cases in the study group. Similarly, a 6-type combination (16, 18, 31, 33, 35, 45), treating 25% and including 62% of CIN3 cases, might prevent 85% of cervical cancer cases (95% CI: 79.6–90.6) among HIV-positive and negative women. Conclusion: Employing mRNA HPV tests within a test-and-treat approach holds huge promise for targeted cervical cancer prevention in under-screened populations. Testing for mRNA of the 6 highest-risk HPV types in this population and treating them all is projected to effectively prevent progression from CIN3 to invasive cervical cancer while reducing overtreatment in resource-constrained settings. [ABSTRACT FROM AUTHOR]

Abdulrhman Alghamdi,1,2 Abdullah Alshibani,1,2 Meshary Binhotan,1,2 Mohmad Alsabani,2,3 Tareq Alotaibi,2,4 Rayan Alharbi,5 Abdullah Alabdali1,2 1Emergency Medical Services Department, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 2King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; 3Anesthesia Technology Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 4Respiratory Therapy Department, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 5Department of Emergency Medical Service, College of Applied Medical Sciences, Jazan University, Jazan, Saudi ArabiaCorrespondence: Abdulrhman Alghamdi, Emergency Medical Services Department, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, P.O. Box.3660, Riyadh, 11481, Saudi Arabia, ; +96611 429 51986, Email Ghamdia@ksau-hs.edu.saPurpose: Paramedics’ decision to notify receiving hospitals and transport patients to an appropriate healthcare facility is based on the Prediction of Intensive Care Unit (ICU) and Hospital Admissions guide. This study aimed to assess the paramedics’ gestalt on both ward and ICU admission.Patients and Methods: A prospective study was conducted at King Abdulaziz Medical City between September 2021 and March 2022. Paramedics were asked several questions related to the prediction of the patient’s hospital outcome, including emergency department (ED) discharge or hospital admission (ICU or ward). Additional data, such as the time of the ambulance’s arrival and the staff years of experience, were collected. The categorical characteristics are presented by frequency and percentage for each category.Results: This study included 251 paramedics and 251 patients. The average age of the patients was 62 years. Of the patients, 32 (12.7%) were trauma, and 219 (87.3%) were non-trauma patients. Two-thirds of the patients (n=171, 68.1%) were predicted to be admitted to the hospital, and 80 (31.8%) of the EMS staff indicated that the patient do not need a hospital or an ambulance. The sensitivity, specificity, PPV, and NPV of the emergency medical service (EMS) staffs’ gestalt for patient admission to the hospital were, respectively (77%), (33%), (16%), and (90%). Further analysis was reported to defend the EMS staffs’ gestalt based on the level of EMS staff and the nature of the emergency (medical vs trauma), are reported.Conclusion: Our study reports a low level of accurately predicting patient admission to the hospital, including the ICU. The results of this study have important implications for enhancing the accuracy of EMS staff predictive ability and ensuring that patients receive appropriate care promptly.Keywords: emergency medical service, predictably, hospital admission, ambulance, patient discharge, sensitivity, specificity, positive predictive value, negative predictive value

Wireless capsule endoscopy (WCE) has emerged as a valuable non-invasive technique for visualizing the entire gastrointestinal (GI) tract. However, manual evaluation of WCE videos is a time-consuming and costly process. In this study, we present a novel diagnostic assistant system that employs deep convolutional neural networks (DCNNs) to accelerate the evaluation process. Our primary objective is to achieve a high negative predictive value (NPV), which is essential for the efficient identification of normal frames. Six distinct DCNN models were developed and implemented with this objective in mind. The models were trained on a limited dataset encompassing common GI pathologies that reflect real clinical scenarios. Each DCNN architecture comprises a convolutional part derived from renowned pre-trained networks and a custom-designed classifier block optimized for high NPV and classification accuracy. Following a comprehensive assessment utilizing the 5-fold cross-validation approach, the VG_BFCG model was identified as the most effective, exhibiting an average test accuracy of 0.946 and an NPV of 0.983. Moreover, in the event of encountering novel pathologies not present in the training data, our models exhibited robustness in NPV, which is of great importance for practical applications. For example, the DN_BFCG model demonstrated consistent performance, with an NPV exceeding 0.99 across a range of new pathologies. This validates the reliability of our models in clinical settings. Our findings suggest that our developed DCNN architectures have the potential to enhance the efficiency and accuracy of WCE video analysis, which could transform the landscape of gastroenterological diagnostics.

Background: Postpartum haemorrhage is the leading cause of maternal mortality globally and in sub-Saharan Africa. The shock index( ratio of the pulse to systolic pressure) is a quicker and more objective assessment tool for assessing the risk of deterioration as may occur in PPH, before apparent clinical deterioration. The diagnostic accuracy of the shock index in a Ugandan setting is not known. The objective of the study was to determine the sensitivity and specificity, positive and negative predictive values of shock index in the diagnosis of primary postpartum haemorrhage after caesarean section among women delivering at Kawempe National Referral Hospital. Methods: A cross-sectional study design was used. The study was conducted in Kawempe National Referral Hospital among women who were delivered by a caesarean section between 1st January and 31st May 2021. A sample size of 594 was determined using formulae by Buderer. A consecutive sampling technique was used. The research assistants approached 650 participants; while 591 participants were fit for analysis. All participants were subjected to the determination of shock index at different intervals and the change in haematocrit as the gold standard for post-partum haemorrhage. Results: The sensitivity and specificity of the shock index at 2 hours were 40.0 and 82.8 percent respectively at a threshold of 0.8. The sensitivity and specificity were 70.0 and 54.6 percent after 24 hours when the shock index threshold of 0.7 was used. The PPV and NPV were 3.8 and 98.3 percent at 2 hours respectively while 2.6 and 99.1 percent at 24 hours. Conclusion: The shock index is a poor screening tool for diagnosing primary postpartum haemorrhage after caesarean section. Recommendations : Shock index may not be included in routine care of post-operative mothers for early recognition of those at risk of primary postpartum haemorrhage.

The prediction of dangerous and/or violent behavior is particularly important to the conduct of the U.S. criminal justice system when it makes decisions about restrictions of personal freedom, such as preventive detention, forensic commitment, parole, and in some states such as Texas, when to permit an execution to proceed of an individual found guilty of a capital crime. This article discusses the prediction of dangerous behavior both through clinical judgment and actuarial assessment. The general conclusion drawn is that for both clinical and actuarial prediction of dangerous behavior, we are far from a level of accuracy that could justify routine use. To support this later negative assessment, two topic areas are emphasized: (1) the MacArthur Study of Mental Disorder and Violence, including the actuarial instrument developed as part of this project (the Classification of Violence Risk), along with all the data collected that helped develop the instrument; and (2) the U.S. Supreme Court case of Barefoot v. Estelle (1983) and the American Psychiatric Association "friend of the court" brief on the (in)accuracy of clinical prediction for the commission of future violence. Although now three decades old, Barefoot v. Estelle is still the controlling Supreme Court opinion regarding the prediction of future dangerous behavior and the imposition of the death penalty in states, such as Texas; for example, see Coble v. Texas (2011) and the Supreme Court denial of certiorari in that case. [ABSTRACT FROM AUTHOR]

Pulmonary tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis (MTB). Whole-genome sequencing (WGS) holds great promise as an advanced technology for accurately predicting anti-TB drug resistance. The development of a reliable method for detecting drug resistance is crucial in order to standardize anti-TB treatments, enhance patient prognosis, and effectively reduce the risk of transmission. In this study, our primary objective was to explore and determine the potential of WGS for assessing drug resistance based on genetic variants recommended by the World Health Organization (WHO). A total of 1105 MTB strains were selected from samples collected from 2014–2018 in Zhejiang Province, China. Phenotypic drug sensitivity tests (DST) of the anti-TB drugs were conducted for isoniazid (INH), rifampicin (RFP), streptomycin, ethambutol, fluoroquinolones (levofloxacin and moxifloxacin), amikacin, kanamycin, and capreomycin, and the drug-resistance rates were calculated. The clean WGS data of the 1105 strains were acquired and analyzed. The predictive performance of WGS was evaluated by the comparison between genotypic and phenotypic DST results. For all anti-TB drugs, WGS achieved good specificity values (>90%). The sensitivity values for INH and RFP were 91.78% and 82.26%, respectively; however, they were ≤60% for other drugs. The positive predictive values for anti-TB drugs were >80%, except for ethambutol and moxifloxacin, and the negative predictive values were >90% for all drugs. In light of the findings from our study, we draw the conclusion that WGS is a valuable tool for identifying genome-wide variants. Leveraging the genetic variants recommended by the WHO, WGS proves to be effective in detecting resistance to RFP and INH, enabling the identification of multi-drug resistant TB patients. However, it is evident that the genetic variants recommended for predicting resistance to other anti-TB drugs require further optimization and improvement. [ABSTRACT FROM AUTHOR]

Palliative care has several tools and questionnaires which are commonly used for patient-related outcomes and prognosis. As an example, the Surprise Question (I would or would not be surprised that this person would have died in a year) has been used as a screen for palliative care referral but also used as a prognostic tool. Diagnostic tests, prognostic tools, and tools for gauging outcomes have certain sensitivity and specificity in predicting a diagnosis or outcome. Clinicians often use positive and negative predictive values in judging the merits of a diagnostic tool or questionnaire. However positive and negative predictive values are highly dependent on the prevalence of disease or outcome in a population and thus are not portable across studies. Likelihood ratios are both portable across populations but also provide the strength of the diagnostic or predictive measure of a test or questionnaire. In this article, we review the value and limitations of likelihood ratios and illustrate the value of using likelihood ratios using 3 studies centered on the Surprise Question published in 2022. [ABSTRACT FROM AUTHOR]

In the area of diagnostics, it is common practice to leverage external data to augment a traditional study of diagnostic accuracy consisting of prospectively enrolled subjects to potentially reduce the time and/or cost needed for the performance evaluation of an investigational diagnostic device. However, the statistical methods currently being used for such leveraging may not clearly separate study design and outcome data analysis, and they may not adequately address possible bias due to differences in clinically relevant characteristics between the subjects constituting the traditional study and those constituting the external data. This paper is intended to draw attention in the field of diagnostics to the recently developed propensity score‐integrated composite likelihood approach, which originally focused on therapeutic medical products. This approach applies the outcome‐free principle to separate study design and outcome data analysis and can mitigate bias due to imbalance in covariates, thereby increasing the interpretability of study results. While this approach was conceived as a statistical tool for the design and analysis of clinical studies for therapeutic medical products, here, we will show how it can also be applied to the evaluation of sensitivity and specificity of an investigational diagnostic device leveraging external data. We consider two common scenarios for the design of a traditional diagnostic device study consisting of prospectively enrolled subjects, which is to be augmented by external data. The reader will be taken through the process of implementing this approach step‐by‐step following the outcome‐free principle that preserves study integrity. [ABSTRACT FROM AUTHOR]

The predictive receiver operating characteristic (PROC) curve differs from the more well-known receiver operating characteristic (ROC) curve in that it provides a basis for the evaluation of binary diagnostic tests using metrics defined conditionally on the outcome of the test rather than metrics defined conditionally on the actual disease status. Application of PROC curve analysis may be hindered by the complex graphical patterns that are sometimes generated. Here we present an information theoretic analysis that allows concurrent evaluation of PROC curves and ROC curves together in a simple graphical format. The analysis is based on the observation that mutual information may be viewed both as a function of ROC curve summary statistics (sensitivity and specificity) and prevalence, and as a function of predictive values and prevalence. Mutual information calculated from a 2 × 2 prediction-realization table for a specified risk score threshold on an ROC curve is the same as the mutual information calculated at the same risk score threshold on a corresponding PROC curve. Thus, for a given value of prevalence, the risk score threshold that maximizes mutual information is the same on both the ROC curve and the corresponding PROC curve. Phytopathologists and clinicians who have previously relied solely on ROC curve summary statistics when formulating risk thresholds for application in practical agricultural or clinical decision-making contexts are thus presented with a methodology that brings predictive values within the scope of that formulation.

Diagrammatic formats are useful for summarizing the processes of evaluation and comparison of forecasts in plant pathology and other disciplines where decisions about interventions for the purpose of disease management are often based on a proxy risk variable. We describe a new diagrammatic format for disease forecasts with two categories of actual status and two categories of forecast. The format displays relative entropies, functions of the predictive values that characterize expected information provided by disease forecasts. The new format arises from a consideration of earlier formats with underlying information properties that were previously unexploited. The new diagrammatic format requires no additional data for calculation beyond those used for the calculation of a receiver operating characteristic (ROC) curve. While an ROC curve characterizes a forecast in terms of sensitivity and specificity, the new format described here characterizes a forecast in terms of relative entropies based on predictive values. Thus it is complementary to ROC methodology in its application to the evaluation and comparison of forecasts.

Malaria control and its elimination heavenly depend on successful and reliable diagnosis using recommended diagnostic techniques. These available techniques often have certain peculiarities and mode applications, thus making them have different levels of performance and accuracy. Therefore the aim of this study was to evaluate the performance of PCR in relation to Rapid Diagnostic Test Kit (SD Bio line Malaria Ag P.f (05fk50)) in malaria diagnosis. A total of 200 blood samples were collected from the consented study subjects using the vein puncture technique and analysed using PCR and RDTs. Plasmodium falcifarum’s DNA was extracted using Quick-DNA™ Miniprep Plus Kit with catalog number D4069. 18SrRNA gene of Plasmodium falciparum from chromosome 13 was amplified using the two primers. For the RDTs technique, the SD Bio line Malaria Ag P.f (05fk50) test kit was used. Malaria prevalence of 106(53.0%) and 132(66.0%) were recorded using PCR and RDTs respectively. The PCR demonstrates an overall accuracy of 0.53 with sensitivity and specificity values of 56.06 and 52.94% respectively. The negative and positive predictive values were 69.81 and 38.30% respectively. PCR demonstrated a good level of performance and is therefore recommended as an effective diagnostic tool for malaria, especially in patients where the parasite density/parasitaemia level is very low.

Abstract Aims To examine the effectiveness of D‐dimer values to be used as an independent diagnostic marker for excluding peripherally inserted central catheter‐associated upper extremity deep vein thrombosis and superficial vein thrombosis. Design This was a retrospective case–cohort study. Methods Records were reviewed for 281 patients who underwent peripherally inserted central catheter insertion between 1 October 2017 and 1 October 2019. According to the modified Wells score after peripherally inserted central catheter insertion, the patients who had low vein thrombosis risk underwent a D‐dimer test and colour Doppler ultrasound. Results Among 281 patients, 180 patients (64%, 95% CI: 58.2%–69.4%) had negative D‐dimer results and 39 of 180 patients had vein thrombosis despite having a negative D‐dimer result, resulting in a failure rate of 21.7% (95% CI: 16.3%–28.3%). The negative predictive value of peripherally inserted central catheter‐associated vein thrombosis in the cancer group (80.0%, 95% CI: 73.2%–85.4%) was higher than that of the non‐cancer group (60.0%, 95% CI: 35.7%–80.2%). The negative predictive value of peripherally inserted central catheter‐associated deep venous thrombosis (84.9%, 95% CI: 78.7%–89.6%) was lower than that of the PICC‐associated superficial venous thrombosis (91.0%, 95% CI: 85.4%–94.6%). Conclusion The D‐dimer levels maybe should not be used as a diagnostic index to rule out peripherally inserted central catheter‐associated upper extremity vein thrombosis.

Abstract Background By identifying individuals at high risk for non-alcoholic fatty liver disease (NAFLD), interventional programs could be targeted more effectively. Some studies have demonstrated that triglyceride glucose-body mass index (TyG-BMI) showed an independent positive association with NAFLD. However, research on its diagnostic value in patients with suspected NAFLD is limited. In this study, we aimed to evaluate whether TyG-BMI was accurate in detecting NAFLD in the general Japanese population. Methods A cross-sectional study of 14,280 individuals who underwent a comprehensive health examination was conducted. Standard protocols were followed to collect anthropometric measurements, lab data, and ultrasonography features. All participants were randomly stratified into the development group (n = 7118) and validation group (n = 7162). The TyG-BMI was calculated. Following this, the diagnostic value of the TyG-BMI was evaluated based on the area under the receiver-operating characteristic curve (AUROC). Two cutoff points were selected and used to rule out or rule in the NALFD, and the specificity, sensitivity, negative predictive value, and positive predictive value were explored, respectively. In order to verify the stability of the results, external verification was performed. Results There were 1272 and 1243 NAFLD participants in the development and validation groups, respectively. The area under the ROC curve (AUC) of TyG-BMI was 0.888 (95% CI 0.876–0.896) and 0.884 (95% CI 0.875–0.894) for the training and validation group, respectively. Using the low TyG-BMI (182.2) cutoff, NAFLD could be excluded with high accuracy (negative predictive value: 96.9% in estimation and 96.9% in validation). The presence of NAFLD could effectively be determined by applying the high cutoff of TyG-BMI (224.0), as the positive predictive value of the estimation and validation groups is 70.7% and 70.1%, respectively. As a result of applying this model, 9996 (70%) of the 14,280 participants would not have undergone ultrasonography, with an accurate prediction of 9308 (93.1%). AUC was 0.874 for external validation using 183,730 Chinese non-obese participants. TyG-BMI was demonstrated to be an excellent diagnostic tool by both internal and external validation. Conclusions In conclusion, the present study developed and validated a simple, non-invasive, and cost-effective tool to accurately separate participants with and without NAFLD in the Japanese population, rendering ultrasonography for identifying NAFLD unnecessary in a substantial proportion of people.

Local anesthetics (LA) are commonly used in procedures and in topical agents for pain management. With the increasing use of LA drugs, the management of LA reactions is more frequently encountered in the office and in operating rooms. True allergic reactions involving IgE-mediated reactions and anaphylaxis are rare; they have only been identified in case reports and account for less than 1% of adverse LA reactions. Most reactions are non-allergic or are a result of hypersensitivity to other culprits such as preservatives, excipients, or other exposures. LA reactions that are misclassified as true allergies can lead to unnecessary avoidance of LA drugs or delays in surgical procedures that require their use. A detailed history of prior LA reactions is the first and most crucial step for understanding the nature of the reaction. Reactions that are suspicious for an immediate hypersensitivity reaction can be evaluated with skin prick and intradermal testing with subsequent graded challenge. Reactions that are suspicious for a delayed hypersensitivity reaction can be evaluated with patch testing. [ABSTRACT FROM AUTHOR]

Aims: Surveillance for hepatocellular carcinoma (HCC) is recommended for patients with cirrhosis. Multiple risk scores aim to stratify HCC risk, potentially allowing individualized surveillance strategies. We sought to validate four risk scores and quantify the consequences of surveillance via the calculation of numbers needed to benefit (NNB) and harm (NNH) according to classification by risk score strata.Methods: Data were collected on 482 patients with cirrhosis during 2013-2014, with follow-up until 31/12/2019. Risk scores (aMAP, Toronto risk index, ADRESS HCC, HCC risk score) were derived from index clinic results. The area under the receiving operating characteristic curve (AUC) was calculated for each. Additionally, per-risk strata, NNB was calculated as total surveillance ultrasounds per surveillance diagnosed early HCC (stage 0/A) and NNH as total ultrasounds performed per false positive (abnormal surveillance with normal follow-up imaging).Results: 22 (4.6%) patients developed HCC. 77% (17/22) were diagnosed through surveillance, of which 13/17 (76%) were early stage. There were 88 false positives and no false negatives (normal surveillance result however subsequent HCC detection). Overall NNB and NNH were 241 and 36, respectively. No score was significantly superior using AUC. Patients classified as low risk demonstrated no surveillance benefit (AMAP, THRI) or had a high NNB of > 300/900 (ADRESS HCC, HCC risk score), with low NNH (24-38).Conclusion: Given the lack of benefit and increased harm through false positives in low-risk groups, a risk-based surveillance strategy may have the potential to reduce patient harm and increase benefit from HCC surveillance.Clinical Trials Registration: This was not a clinical trial and the study was not pre-registered. [ABSTRACT FROM AUTHOR]

Most children with fever without source (FWS) require diagnostic laboratory tests to exclude a serious bacterial infection (SBI), often followed by admission and empirical antibiotics. As febrile children with a viral infection are less likely to have a SBI, identifying patients with systemic viral infection could contribute to exclude SBI. We evaluated whether the presence of virus in the blood could be used as a biomarker to rule out SBI. Children < 3 years old with FWS were prospectively enrolled and had real-time (reverse-transcription) PCR performed on the blood for adenovirus, enterovirus, parechovirus, and HHV6. 20/135 patients had SBI, and in 47/135, at least one virus was detected in the blood. Viremia had a higher sensitivity and negative predictive value (90% and 96%) to rule out SBI compared to CRP (65% and 93%) and PCT (55% and 90%). The odds ratio (OR) for the presence of SBI among non-viremic patients was 5.8 (p = 0.0225), compared to 5.5 for CRP ≥ 40 mg/l (p = 0.0009) and 3.7 for PCT ≥ 0.5 ng/mL (0.0093). This remained significant after adjusting for CRP and PCT (OR 5.6 and 5.9, respectively; p = 0.03 for both). Area under the ROC curve for CRP and PCT were 0.754 and 0.779, respectively, but increased to 0.803 and 0.832, respectively, when combined with viremia. Conclusion: The presence of viremia had a better performance than commonly used biomarkers to rule-out SBI and could potentially be used in conjunction with CRP and/or PCT in the evaluation of children with FWS. Larger studies should evaluate the role of point-of-care testing of viruses by (revere-transcription) PCR in the plasma in management algorithms of children with FWS. What is Known: • Most children with FWS have a viral infection, but up to 15% have a SBI; most require laboratory tests, and many admission and empirical antibiotics. • Children with a viral infection are less likely to have a SBI. What is New: • Children with a systemic viral infection are less likely to have an SBI. • Viremia is a better predictor of absence of SBI than commonly used biomarkers and could potentially be used in conjunction with CRP and/or PCT in the evaluation of children with FWS. [ABSTRACT FROM AUTHOR]

ObjectiveIn this secondary analysis of data from the Veterans Affairs Augmentation and Switching Treatments for Improving Depression Outcomes (VAST-D) study, the authors sought to determine the effectiveness of early improvement (or lack thereof) for predicting remission from depression with antidepressant therapy.MethodsThis study used data from the VAST-D study, a multisite, randomized, single-blind trial with parallel assignment to one of three medication interventions for 1,522 veterans whose major depressive disorder was unresponsive to at least one course of antidepressant treatment meeting minimal standards for dosage and duration. The authors calculated the positive predictive value (PPV) and negative predictive value (NPV) of early improvement on remission, response, or greater than minimal improvement from depression for various degrees of improvement (10%-50%) on the Quick Inventory of Depressive Symptomatology-Clinician Rated (QIDS-C) at 1, 2, 4, and 6 weeks.ResultsThe end of week 2 of treatment was identified as the best time to evaluate early improvement. The presence of a ≥20% drop from the baseline QIDS-C score by the end of week 2 resulted in a PPV for remission of 38% and an NPV of 93% by week 12. Extending the observational window to week 6 minimally improved NPV (97%). This association did not differ across treatment groups.ConclusionsA lack of early improvement at the end of week 2 of antidepressant therapy can be used to inform clinical decisions on the likelihood of nonremission of depression during the subsequent 10 weeks, even when dosage optimization is incomplete.

BackgroundEarly screening is crucial for early autism spectrum disorders (ASD) diagnosis and intervention. ASD screening tools have mostly been constructed based on the Western cultural context. We hypothesized that their use in Mali may require a prior validation.ObjectiveTo validate the modified checklist for autism in toddlers-Revised (M-CHAT-R) and the social communication questionnaire (SCQ) in the Malian sociocultural context for ASD screening.Study designWe administered M-CHAT-R and SCQ in 947 toddlers aged 16-30 months old at the district and community health centers in Bamako and 120 patients (60 autistic and 60 age and sex matched controls) aged ≥4 years old at the psychiatry department in Bamako. Toddlers at moderate to high risk of ASD underwent M-CHAT-R/F and clinical evaluation by an ASD multidisciplinary team. M-CHAT-R and SCQ were evaluated for cultural appropriateness by Malian anthropologists. The sensitivity, specificity, PPV, NPV were determined for both M-CHAT-R and SCQ. Health professionals have been trained during ASD seminary on how to use M-CHAT-R and SCQ for ASD screening in Bamako.ResultsWe found for the M-CHAT-R a sensitivity of 50%, a specificity of 100%, a PPV of 100% and a NPV of 87%. The SCQ had a sensitivity of 71%, a specificity of 72%, a PPV of 73% and a NPV of 70%. We have found four out of 20 items on the M-CHAT-R that were culturally inappropriate in the Malian context.DiscussionM-CHAT-R and SCQ can be used for early autism screening in Mali. In the future, we plan to train a descent number of Malian physicians in chief and pediatricians at the district hospitals across the country to integrate the early ASD screening into the national health system.ConclusionM-CHAT-R has a perfect specificity and SCQ a fair diagnostic accuracy for ASD in Mali.

Objective: Sentinel lymph node biopsy (SLNB) is currently the standard of care in clinically node negative (cN0) breast cancer. The present study aimed to evaluate the negative predictive value (NPV) of 18F-FDG dedicated lymph node positron emission tomography (LymphPET) in cN0 patients. Methods: This was a prospective phase II trial divided into 2 stages (NCT04072653). In the first stage, cN0 patients underwent axillary LymphPET followed by SLNB. In the second stage, SLNB was omitted in patients with a negative preoperative axillary assessment after integration of LymphPET. Here, we report the results of the first stage. The primary outcome was the NPV of LymphPET to detect macrometastasis of lymph nodes (LN-macro). Results: A total of 189 patients with invasive breast cancer underwent LymphPET followed by surgery with definitive pathological reports. Forty patients had LN-macro, and 16 patients had only lymph node micrometastasis. Of the 131 patients with a negative LymphPET result, 16 patients had LN-macro, and the NPV was 87.8%. After combined axillary imaging evaluation with ultrasound and LymphPET, 100 patients were found to be both LymphPET and ultrasound negative, 9 patients had LN-macro, and the NPV was 91%. Conclusions: LymphPET can be used to screen patients to potentially avoid SLNB, with an NPV > 90%. The second stage of the SOAPET trial is ongoing to confirm the safety of omission of SLNB according to preoperational axillary evaluation integrating LymphPET.

Coeliac disease (CD) is frequently underdiagnosed with a consequent heavy burden in terms of morbidity and health care costs. Diagnosis of CD is based on the evaluation of symptoms and anti-transglutaminase antibodies IgA (TGA-IgA) levels, with values above a tenfold increase being the basis of the biopsy-free diagnostic approach suggested by present guidelines. This study showcased the largest screening project for CD carried out to date in school children (n=20,000) aimed at assessing the diagnostic accuracy of minimally invasive finger prick point-of-care tests (POCT) which, combined with conventional celiac serology and the aid of an artificial intelligence-based system, may eliminate the need for intestinal biopsy. Moreover, this study delves deeper into the “coeliac iceberg” in an attempt to identify people with disorders who may benefit from a gluten-free diet, even in the absence of gastrointestinal symptoms, abnormal serology and histology. This was achieved by looking for TGA-IgA mucosal deposits in duodenal biopsy. This large European multidisciplinary health project paves the way to an improved quality of life for patients by reducing the costs for diagnosis due to delayed findings of CD and to offer business opportunities in terms of diagnostic tools and support.

ObjectiveTo explore the changing trend of negative predictive value and number of false negatives in screening tests under the condition of low infection rate of infectious diseases.MethodsAssuming that the population is 20 million， to calculate the negative predictive value， numbers of true negatives and false negatives of the combination of different sensitivity （75.0%， 80.0%， 85.0%， 90.0%， 95.0%， 99.0%） and specificity （90.0%， 95.0%， 99.0%， 99.9%） when the disease infection rate of the population is 0.10%， 1.0% and 5.0% respectively.ResultsWhen the population infection rate is 0.1%， with the screening test sensitivity ≥75.0% and specificity ≥90.0%， the number of true negatives in 20 million people is about 17.98‒19.96 million. When the sensitivity is 75.0%， the negative predictive value is 99.972%‒99.975%， and the number of false negatives is 5 000； When the sensitivity increases to 99.0%， the negative predictive value is 99.999%， and the number of false negatives decreases to 200. When the population infection rate is 1.0%， a screening test with sensitivity ≥75.0% and specificity ≥90.0% can detect about 17.82‒19.78 million true negatives in 20 million population. When the sensitivity is 75.0%， the negative predictive value is 99.720%‒99.748%， and the number of false negatives is 50 000； When the sensitivity increases to 99.0%， the negative predictive value increases to 99.990%， and the number of false negatives decreases to 2 000. When the population infection rate is 5.0%， with sensitivity ≥75.0% and specificity ≥90.0%， the number of true negatives in 20 million people is about 17.10‒18.98 million； when the sensitivity is 75.0%， the negative predictive value is 98.559%‒98.700%， and the number of false negatives can reach 250 000； When the sensitivity is 99.0%， the negative predictive value increases to 99.942%‒99.947%， and the number of false negatives decreases to 10 000. The lower the infection rate of the population， the fewer false negatives will appear in the screening.ConclusionThe number of false negatives in large-scale screenings increases exponentially with the increase of infection rate. Screenings should be carried out as early as possible in a pandemic of infectious diseases， so as to control the spread of the pandemic as soon as possible.

Background: The Status Epilepticus Severity Score (STESS) has become frequently utilized in recent years to predict the prognosis of SE patients (status epilepticus). Objective: The study’s purpose was to find determinants of SE severity and short-term outcomes in SE patients admitted to the hospitals of Al-Azhar University. Patients and methods: At the hospitals of Al-Azhar University in Cairo, Egypt, A prospective observational study of 43 consecutive SE patients admitted and treated over six months was done. Demographics and clinical data from established SE patients were gathered, and their association to SE duration and short-term outcomes was examined.Results: The STESS findings demonstrated a statistically significant connection between the failure to respond to therapy after one hour (P-value = 0.0001). There was a tendency (P-value = 0.7508) toward greater fatality, the necessity for coma induction (P-value = 0.1799), and a bad outcome (P-value = 0.0636), with a higher STESS score. A STESS score of < 3 has NPV of 96.67 % for fatality, 76.67 % for the necessity for coma induction, and 53.85 % for bad outcomes.Conclusion: The outcome of status epilepticus can be consistently predicted using STESS. Additional research on STESS-based treatment techniques could aid in the development of more effective SE treatment regimens.

Background: Due to the high transmissibility of SARS-CoV-2, accurate diagnosis is essential for effective infection control, but the gold standard, real-time reverse transcriptase-polymerase chain reaction (RT-PCR), is costly, slow, and test capacity has at times been insufficient. We compared the accuracy of clinician diagnosis of COVID-19 against RT-PCR in a general adult population. Methods: COVID-19 diagnosis data by 30th September 2021 for participants in an ongoing population-based cohort study of adults in Western Sweden were retrieved from registers, based on positive RT-PCR and clinician diagnosis using recommended ICD-10 codes. We calculated accuracy measures of clinician diagnosis using RT-PCR as reference for all subjects and stratified by age, gender, BMI, and comorbidity collected pre-COVID-19. Results: Of 42,621 subjects, 3,936 (9.2%) and 5705 (13.4%) had had COVID-19 identified by RT-PCR and clinician diagnosis, respectively. Sensitivity and specificity of clinician diagnosis against RT-PCR were 78% (95%CI 77–80%) and 93% (95%CI 93–93%), respectively. Positive predictive value (PPV) was 54% (95%CI 53–55%), while negative predictive value (NPV) was 98% (95%CI 98–98%) and Youden's index 71% (95%CI 70–72%). These estimates were similar between men and women, across age groups, BMI categories, and between patients with and without asthma. However, while specificity, NPV, and Youden's index were similar between patients with and without chronic obstructive pulmonary disease (COPD), sensitivity was slightly higher in patients with (84% [95%CI 74–90%]) than those without (78% [95%CI 77–79%]) COPD. Conclusions: The accuracy of clinician diagnosis for COVID-19 is adequate, regardless of gender, age, BMI, and asthma, and thus can be used for screening purposes to supplement RT-PCR. [ABSTRACT FROM AUTHOR]

• NSCLCs that are assumed to be pN0 may in fact be understaged due to sampling error. • Confidence in a pN0 diagnosis depends on the number of lymph nodes (LNs) examined. • The proposed tool quantifies the risk of occult nodal disease for each T-stage. • These risk probabilities are calculated corresponding to the number of LNs examined. • This tool can help guide decision-making regarding treatments after lung resections. Accurate lymph node (LN) staging is crucial for prognostication in NSCLC. Diagnosis of pN0 disease is based on the absence of positive LNs, irrespective of the number of LNs excised, and is thus susceptible to sampling error. Tumors that are assumed to be pN0 may in fact be understaged. We developed a tool to quantify the risk of occult nodal disease (OND) among patients with pN0 NSCLC in terms of the number of LNs examined. Patients treated surgically for stage I-III primary NSCLC between 2004 and 2014 (n = 49,356) were extracted from the Surveillance, Epidemiology, and End Results database. The probability of missing a positive node in terms of the number of LNs examined was modeled using a beta-binomial model. A mathematical tool was then used to calculate the negative predictive value (NPV) corresponding to the number of LNs examined. Ranging from 0 to 100%, higher NPV reflects greater confidence in the pN0 diagnosis and a lower probability of OND. The median number of LNs examined was 7 for N0, 10 for N1/N2, and 8 for N3 disease. The probability of missing a positive node decreased as LNs examined increased. Additionally, higher T stage required more LNs to confirm an N0 diagnosis. After accounting for false-negative diagnoses, the prevalence of node-positive disease was readjusted from 16% to 22% among patients with T1 disease. According to our tool, with 10 LNs examined, the NPV was 85% (15% probability of OND) for a patient with T3 disease, compared with 95% (5% probability of OND) for a patient with T1 disease. Accurate pN0 diagnosis depends on the number of LNs examined. The proposed tool offers the ability to quantify, in a patient-specific manner, the confidence in a diagnosis of node-negative disease on the basis of the number of LNs examined. [ABSTRACT FROM AUTHOR]

Oral drug provocation tests (DPT) are the basic diagnostic tool for the detection of hypersensitivity to non-opioid analgesics and for selecting a safe alternative for a patient. They are of great practical importance due to their common use, but the data on the follow-up of patients after negative DPT are still very scarce. We examined the further fate of 164 such adult patients after negative NSAID or paracetamol tests and analyzed which excipients in the studied drugs they could be exposed to after the diagnostic workup. A structured medical interview was performed 32.9 months (mean) after the provocation tests. Of the 164 patients, 131 (79.9%) retook the tested drug and 12 developed another hypersensitivity reaction, giving the estimated negative predictive value of 90.8%. These reactions were induced by acetylsalicylic acid, paracetamol, meloxicam, and diclofenac, and were clinically similar to the initial ones (most commonly urticaria and angioedema). There are 93 generics of these drugs on the local market, containing a total of 33 excipients for which hypersensitivity reactions have been reported. All available generics contain such excipients. Thirty-one patients (20.1%) did not take the previously tested drug again, most often because it was not needed or because they were afraid of another reaction. DPT with analgesics has a high diagnostic performance. A minority of patients had relapsed after reexposure. One of the underestimated reasons for this may be drug excipients provoking a reaction, so it is advisable to use exactly the same medical product that has been negatively tested. Many patients avoid reexposure to a given drug, despite negative tests, therefore very reliable patient education in connection with DPT is highly needed. [ABSTRACT FROM AUTHOR]

To determine the predictive value of International Classification of Diseases, 9th Revision (ICD-9) codes for identifying infantile eye diagnoses. Population-based retrospective cohort study of all residents of Olmsted County, Minnesota diagnosed at ≤1 year of age with an ocular disorder. The medical records of all infants diagnosed with any ocular disorder from January 1, 2005, through December 31, 2014, were identified. To assess ICD-9 code accuracy, the medical records of all diagnoses with ≥20 cases were individually reviewed and compared to their corresponding ICD-9 codes. Main outcome measures included positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity of ICD-9 codes. In a cohort of 5,109 infants with ≥1 eye-related ICD-9 code, 10 ocular diagnoses met study criteria. The most frequent diagnoses were conjunctivitis (N = 1,695) and congenital nasolacrimal duct obstruction (N = 1,250), while the least common was physiologic anisocoria (N = 23). The PPVs ranged from 8.3% to 88.0%, NPVs from 96.3% to 100%, sensitivity from 3.0% to 98.7%, and specificity from 72.6% to 99.9%. ICD-9 codes were most accurate at identifying physiologic anisocoria (PPV: 88.0%) and least accurate at identifying preseptal cellulitis (PPV: 8.3%). In eye specialists versus non-eye specialists, there was a significant difference in PPV of ICD-9 codes for conjunctivitis (26.8% vs. 63.9%, p <.001), pseudostrabismus (85.9% vs. 25.0%, p <.001), and physiologic anisocoria (95.5% vs. 33.3%, p =.002). The predictive value of ICD-9 codes for capturing infantile ocular diagnoses varied widely in this cohort. These findings emphasize the limitations of database research methodologies that solely utilize claims data to identify pediatric eye diseases.Abbreviations/Acronyms PPV: positive predictive value; NPV: negative predictive value; CNLDO: congenital nasolacrimal duct obstruction [ABSTRACT FROM AUTHOR]