scholarly journals P.055 A clinical pathway of combined EEG monitoring in high-risk critically ill neonates

2019 ◽  
Vol 46 (s1) ◽  
pp. S28-S29
Author(s):  
R Mendelsohn ◽  
D Pohl ◽  
K Mabilangan ◽  
B Lemyre
Keyword(s):  
Predictive Value ◽  
Limited Resource ◽  
Small Sample ◽  
List Type ◽  
Eeg Monitoring ◽  
Neonatal Seizures ◽  
Neurological Morbidity ◽  
Bedside Clinician ◽  
Critically Ill Neonates ◽  
Low Sensitivity

Background: overtreatment of neonatal seizures may result in neurological morbidity. aEEG, despite low sensitivity, is widely used, for ease of bedside interpretation. vEEG, is a limited resource needing expert interpretation. We hypothesize that using aEEG combined with vEEG will increase the sensitivity and specificity of seizure detection and reduce anti-convulsants use compared to aEEG alone. Methods: Prospective cohort of neonates admitted to CHEO NICU with suspected seizures between April 1st 2018 to present. Seizures (clinical/aEEG) were documented by bedside clinicians and compared to the vEEG. Bedside clinicians could call a neurologist for remote review of the vEEG. Outcomes include concordance of aEEG and vEEG events and number of episodes where management was changed based on both readings Results: 27 patients had both modalities recording simultaneously. No seizure was identified by either modality in 23 recordings. Seizures were identified in 4 vEEG recordings; the aEEG partially identified these seizures.aEEG specificity of 0.87, negative predictive value 0.8, sensitivity 0.44 and positive predictive value 0.57Bedside clinician contacted a neurologist 9 times; in 2 cases, this prevented unnecessary treatment.Conclusions: In this small sample, aEEG had good specificity for ruling out seizures, but low sensitivity for detecting them. The new combined pathway may prevent unnecessary treatment.

scholarly journals Whole-exome sequencing with targeted analysis and epilepsy after acute symptomatic neonatal seizures

2021 ◽  
Author(s):  
Adam L. Numis ◽  
Gilberto da Gente ◽  
Elliott H. Sherr ◽  
Hannah C. Glass
Keyword(s):  
Exome Sequencing ◽  
Whole Exome Sequencing ◽  
De Novo ◽  
List Type ◽  
Sequencing Analysis ◽  
Neonatal Seizures ◽  
Pathogenic Variants ◽  
Targeted Analysis ◽  
Whole Exome ◽  
Epilepsy Gene

Abstract Background The contribution of pathogenic gene variants with development of epilepsy after acute symptomatic neonatal seizures is not known. Methods Case–control study of 20 trios in children with a history of acute symptomatic neonatal seizures: 10 with and 10 without post-neonatal epilepsy. We performed whole-exome sequencing (WES) and identified pathogenic de novo, transmitted, and non-transmitted variants from established and candidate epilepsy association genes and correlated prevalence of these variants with epilepsy outcomes. We performed a sensitivity analysis with genes associated with coronary artery disease (CAD). We analyzed variants throughout the exome to evaluate for differential enrichment of functional properties using exploratory KEGG searches. Results Querying 200 established and candidate epilepsy genes, pathogenic variants were identified in 5 children with post-neonatal epilepsy yet in only 1 child without subsequent epilepsy. There was no difference in the number of trios with non-transmitted pathogenic variants in epilepsy or CAD genes. An exploratory KEGG analysis demonstrated a relative enrichment in cell death pathways in children without subsequent epilepsy. Conclusions In this pilot study, children with epilepsy after acute symptomatic neonatal seizures had a higher prevalence of coding variants with a targeted epilepsy gene sequencing analysis compared to those patients without subsequent epilepsy. Impact We performed whole-exome sequencing (WES) in 20 trios, including 10 children with epilepsy and 10 without epilepsy, both after acute symptomatic neonatal seizures. Children with post-neonatal epilepsy had a higher burden of pathogenic variants in epilepsy-associated genes compared to those without post-neonatal epilepsy. Future studies evaluating this association may lead to a better understanding of the risk of epilepsy after acute symptomatic neonatal seizures and elucidate molecular pathways that are dysregulated after brain injury and implicated in epileptogenesis.

Calculated globulin as a screening tool for hypogammaglobulinaemia or paraproteins in hospitalized patients

2021 ◽  
pp. 000456322198973
Author(s):  
Teng Hoo ◽  
Ee Mun Lim ◽  
Mina John ◽  
Lloyd D’Orsogna ◽  
Andrew McLean-Tooke
Keyword(s):  
Positive Predictive Value ◽  
Predictive Value ◽  
Screening Tool ◽  
Haematological Malignancy ◽  
Laboratory Data ◽  
Liver Function Tests ◽  
Serum Globulin ◽  
Tertiary Hospitals ◽  
Low Sensitivity ◽  
Diagnostic Delays

Background Calculated globulin fraction is derived from the liver function tests by subtracting albumin from the total protein. Since immunoglobulins comprise the largest component of the serum globulin concentration, increased or decreased calculated globulins and may identify patients with hypogammaglobulinaemia or hypergammaglobulinaemia, respectively. Methods A retrospective study of laboratory data over 2.5 years from inpatients at three tertiary hospitals was performed. Patients with paired calculated globulins and immunoglobulin results were identified and clinical details reviewed. The results of serum electrophoresis testing were also assessed where available. Results A total of 4035 patients had paired laboratory data available. A calculated globulin ≤20 g/L (<2nd percentile) had a low sensitivity (5.8%) but good positive predictive value (82.5%) for hypogammaglobulinaemia (IgG ≤5.7 g/L), with a positive predictive value of 37.5% for severe hypogammaglobulinaemia (IgG ≤3 g/L). Paraproteins were identified in 123/291 (42.3%) of patients with increased calculated globulins (≥42 g/L) who also had a serum electrophoresis performed. Significantly elevated calculated globulin ≥50 g/L (>4th percentile) were seen in patients with either liver disease (37%), haematological malignancy (36%), autoimmune disease (13%) or infections (9%). Conclusions Calculated globulin is an inexpensive and easily available test that assists in the identification of hypogammaglobulinaemia or hypergammaglobulinaemia which may prompt further investigation and reduce diagnostic delays.

381 Role of CT scans of abdomen and pelvis in management of patients with immunotherapy-induced colitis

2020 ◽  
Vol 8 (Suppl 3) ◽  
pp. A406-A406
Author(s):  
Juan Ibarra Rovira ◽  
Raghunandan Vikram ◽  
Selvi Thirumurthi ◽  
Bulent Yilmaz ◽  
Heather Lin ◽  
...  
Keyword(s):  
Negative Predictive Value ◽  
Clinical Diagnosis ◽  
Predictive Value ◽  
Clinical Symptoms ◽  
Cytotoxic T Lymphocyte ◽  
Checkpoint Inhibitors ◽  
Ct Scans ◽  
Wall Thickening ◽  
Low Sensitivity ◽  
Sensitivity Specificity

BackgroundColitis is one of the most common immune-related adverse event in patients who receive immune checkpoint inhibitors targeting cytotoxic T-lymphocyte antigen 4 (CTLA-4) and programmed cell death-1 (PD-1). Although radiographic changes are reported on computed tomography such as mild diffuse bowel thickening or segmental colitis, the utility of CT in diagnosis of patients with suspected immune-related colitis is not well studied.MethodsCT scans of the abdomen and pelvis of 34 patients on immunotherapy with a clinical diagnosis of immunotherapy induced colitis and 19 patients receiving immunotherapy without clinical symptoms of colitis (control) were enrolled in this retrospective study. Segments of the colon (rectum, sigmoid, descending, transverse, ascending and cecum) were assessed independently by two fellowship trained abdominal imaging specialists with 7 and 13 years‘ experience who were blinded to the clinical diagnosis. Each segment was assessed for mucosal enhancement, wall thickening, distension, peri-serosal fat stranding. Any disagreements were resolved in consensus. The degree of distension and the spurious assignment of wall thickening were the most common causes for disagreement. The presence of any of the signs was considered as radiographic evidence of colitis.ResultsCT evidence of colitis was seen in 16 of 34 patients with symptoms of colitis. 7 of 19 patients who did not have symptoms of colitis showed signs of colitis on CT. The sensitivity, specificity, Positive Predictive Value and Negative Predictive Value for colitis on CT is 47%, 63.2%, 69.5% and 40%, respectively.ConclusionsCT has a low sensitivity, specificity and negative predictive value for the diagnosis of immunotherapy-induced colitis. CT has no role in the diagnosis of patients suspected of having uncomplicated immune-related colitis and should not be used routinely for management.Trial RegistrationThis protocol is not registered on clinicaltrials.gov.Ethics ApprovalThis protocol was IRB approved on: 11/16/2015 - IRB 4 Chair Designee FWA #: 00000363 OHRP IRB Registration Number: IRB 4 IRB00005015ConsentThis protocol utilizes an IRB approved waiver of consent.

Drawing the line in the Edinburgh Postnatal Depression Scale (EPDS): a vital decision

2011 ◽  
Vol 23 (1) ◽  
Author(s):  
Dagmar Lagerberg ◽  
Margaretha Magnusson ◽  
Claes Sundelin
Keyword(s):  
Positive Predictive Value ◽  
Predictive Value ◽  
Postnatal Depression ◽  
Edinburgh Postnatal Depression Scale ◽  
Depression Scale ◽  
Child Interaction ◽  
Mother Child Interaction ◽  
Problem Behaviours ◽  
Low Sensitivity ◽  
Sensitivity Specificity

Abstract Background: The Edinburgh Postnatal Depression Scale (EPDS) is widely used in early child health care. This study examined the appropriateness of the recommended EPDS cut-off score 11/12. Methods: Two main analyses were performed: 1. Associations between EPDS scores and maternal health behaviour, stress, life events, perceived mother-child interaction quality and child behaviour. 2. Screening parameters of the EPDS, i.e., sensitivity, specificity and positive predictive value. EPDS scores were available for 438 mothers and maternal questionnaires for 361 mothers. Results: Already in the EPDS score intervals 6–8 and 9–11, there were notable adversities, according to maternal questionnaires, in stress, perceived quality of mother-child interaction, perceived child difficultness and child problem behaviours. Using maternal questionnaire reports about sadness/distress postpartum as standard, the recommended EPDS cut-off score 11/12 resulted in a very low sensitivity (24%). The cut-off score 6/7 yielded a sensitivity of 61%, a specificity of 82% and a positive predictive value of 61%. Conclusions: In terms of both clinical relevance and screening qualities, an EPDS cut-off score lower than 11/12 seems recommendable.

scholarly journals A study to assess the role of raised total leucocyte count in diagnosis of acute appendicitis

2020 ◽  
Vol 7 (10) ◽  
pp. 1541
Author(s):  
Rajesh Kumar ◽  
Renu Chauhan
Keyword(s):  
Acute Appendicitis ◽  
Predictive Value ◽  
Leucocyte Count ◽  
Histopathological Examination ◽  
Perforated Appendicitis ◽  
Cross Sectional Study ◽  
Total Leucocyte Count ◽  
Cross Sectional ◽  
Gandhi Medical College ◽  
Low Sensitivity

Introduction: Total Leucocyte Count (TLC) is an easily available and commonly performed investigation and studies have reported various degrees of leucocytosis in patients with acute appendicitis. This study was performed with the aim to assess the diagnostic validity of raised TLC count in acute appendicitis.Methods: This was a cross sectional study conducted from 2013 to 2015, in the Department of General Surgery, Indira Gandhi Medical College, Shimla. A clinical diagnosis of acute appendicitis was made based on detailed history taking, clinical examination, and laboratory investigations including TLC count. 50 patients with acute appendicitis were enrolled in the study by convenience sampling, after taking a written, informed consent. Appendicectomy specimen were sent for histopathological examination (HPE).Results: The mean age of the patients was 26.48 ± 12.28 years. 29 (58%) patients were male, and 21 (42%) were female. The negative appendicectomy rate in the present study was 14%. 7 (14%) were normal appendices, 31 (62%) inflamed appendices, 4 (8%) perforated appendices, and 8 (16%) gangrenous appendices as per HPE report. In our study, there were 12 (24%) cases of complicated appendicitis i.e., 8 (16%) cases of gangrenous appendicitis and 4 (8%) cases of perforated appendicitis). TLC had a sensitivity 76.74%, specificity 51.14%, positive predictive value 91.66%, and negative predictive value 28.57%.Conclusion: In our study, TLC was found to have low sensitivity and specificity for acute appendicitis. Hence, used alone, TLC may not be diagnostic of acute appendicitis. However, used in conjunction with other laboratory parameters, it will lead to improvement of diagnostic accuracy.

scholarly journals P.130 Canadian physician attitudes towards long term EEG monitoring in the neonatal intensive care unit

2018 ◽  
Vol 45 (s2) ◽  
pp. S50-S50
Author(s):  
SG Buttle ◽  
E Sell ◽  
B Lemyre ◽  
D Pohl
Keyword(s):  
Neonatal Intensive Care ◽  
Physician Attitudes ◽  
Eeg Monitoring ◽  
Educational Materials ◽  
Education Session ◽  
Provider Attitudes ◽  
Canadian Physician ◽  
Critically Ill Neonates ◽  
Current Monitoring

Background: Long-term EEG monitoring (LTEM), including amplitude-integrated (aEEG) or conventional EEG (cEEG), is increasingly being used in critically ill neonates. Despite an abundance of studies regarding the clinical utility of LTEM, much is unknown regarding provider attitudes toward this tool. We aimed to evaluate neurologist and neonatologist opinions regarding LTEM in the NICU and describe current Canadian practices. Methods: A 15-item questionnaire was developed with input from neonatologists and pediatric neurologists at two Canadian centres. The questionnaire was piloted at our hospital and subsequently distributed to Canadian neonatologists and pediatric neurologists. Results: All 16 local respondents use LTEM in the NICU. Neonatologists were more likely to combine aEEG and cEEG, and monitor for longer durations than pediatric neurologists. However, most pediatric neurologists would like to monitor more (71%), compared to neonatologists who were more likely to say that current monitoring practices are sufficient. High rates of neonatologists (88%) and neurologists (85%) are interested in attending an education session on LTEM. Conclusions: Preliminary data suggests neonatologists and pediatric neurologists differ in their approach to LTEM. Results from our national questionnaire will be analyzed shortly, and may inform the development of educational materials as well as future studies that involve multi-centre efforts.

scholarly journals Characterisation of neonatal seizures and their treatment using continuous EEG monitoring: a multicentre experience

2018 ◽  
Vol 104 (5) ◽  
pp. F493-F501 ◽  
Author(s):  
Janet M Rennie ◽  
Linda S de Vries ◽  
Mats Blennow ◽  
Adrienne Foran ◽  
Divyen K Shah ◽  
...  
Keyword(s):  
Genetic Disorders ◽  
Genetic Disorder ◽  
Median Number ◽  
Eeg Monitoring ◽  
Neonatal Seizures ◽  
Continuous Electroencephalography ◽  
Continuous Eeg ◽  
Continuous Eeg Monitoring ◽  
Electrographic Seizures ◽  
Median Maximum

ObjectiveThe aim of this multicentre study was to describe detailed characteristics of electrographic seizures in a cohort of neonates monitored with multichannel continuous electroencephalography (cEEG) in 6 European centres.MethodsNeonates of at least 36 weeks of gestation who required cEEG monitoring for clinical concerns were eligible, and were enrolled prospectively over 2 years from June 2013. Additional retrospective data were available from two centres for January 2011 to February 2014. Clinical data and EEGs were reviewed by expert neurophysiologists through a central server.ResultsOf 214 neonates who had recordings suitable for analysis, EEG seizures were confirmed in 75 (35%). The most common cause was hypoxic-ischaemic encephalopathy (44/75, 59%), followed by metabolic/genetic disorders (16/75, 21%) and stroke (10/75, 13%). The median number of seizures was 24 (IQR 9–51), and the median maximum hourly seizure burden in minutes per hour (MSB) was 21 min (IQR 11–32), with 21 (28%) having status epilepticus defined as MSB>30 min/hour. MSB developed later in neonates with a metabolic/genetic disorder. Over half (112/214, 52%) of the neonates were given at least one antiepileptic drug (AED) and both overtreatment and undertreatment was evident. When EEG monitoring was ongoing, 27 neonates (19%) with no electrographic seizures received AEDs. Fourteen neonates (19%) who did have electrographic seizures during cEEG monitoring did not receive an AED.ConclusionsOur results show that even with access to cEEG monitoring, neonatal seizures are frequent, difficult to recognise and difficult to treat.Oberservation study numberNCT02160171

scholarly journals Evaluation of the anterior cervical angle of the uterus to predict spontaneous preterm birth

2017 ◽  
Vol 6 (6) ◽  
pp. 2323 ◽  
Author(s):  
Bijay Sur ◽  
Sujata Misra ◽  
Sanghamitra Dash
Keyword(s):  
Preterm Birth ◽  
Predictive Value ◽  
False Negative ◽  
False Negative Rate ◽  
Cervical Length ◽  
Small Sample ◽  
Transvaginal Sonography ◽  
P Value ◽  
Spontaneous Preterm Birth ◽  
Preterm Group

Background: This prospective observational study was conducted to evaluate the anterior cervical angle (ACA) of the uterus by transvaginal sonography (TVS) and to determine the feasibility to predict spontaneous preterm birth (PTB). The duration of the study was from December 2014-December 2016.The participants included 100 pregnant women with singleton pregnancy who were asymptomatic. They were enrolled after excluding all known risk factors of preterm birth.Methods: The ACA and cervical length were measured in all cases by transvaginal sonography either in the 1st trimester or 2nd trimester. All cases were followed and well documented with respect to the gestational age at delivery.Results: There was a significant risk of preterm labour in women with cervical length <2.5cm in the 2nd trimester with Odds Ratio 3.625, P value=0.001, sensitivity 75% and specificity 79.31%. The positive predictive value was 33.33% and negative predictive value 95.83%. The false positive rate was 20.65% and false negative rate 25%. The difference of mean cervical angle in women who delivered preterm and that of those who delivered at term, in the 1st    trimester (preterm group 114.2°Vs term group 93.0°, P<0.001) and in the 2nd trimester (preterm group 127.66° Vs term group 103.65°, P <0.001) was significant. An ACA of 114.2° in the 1st trimester was associated with a risk of spontaneous preterm birth (P value 0.0065, sensitivity 90% and specificity 80%). An ACA of 127.66° in 2nd trimester was associated with a risk of spontaneous preterm birth (P value 0.0004, sensitivity 80%and specificity 88.23%).Conclusions: Despite the limitations of a small sample size, the results suggest that the anterior cervical angle has potential as a new predictor of spontaneous preterm birth especially when measured in the 1st trimester.

scholarly journals Evaluation of broad-range 16S rRNA PCR for the diagnosis of bloodstream infections: two years of experience

2014 ◽  
Vol 8 (10) ◽  
pp. 1252-1258 ◽  
Author(s):  
Reem Mostafa Hassan ◽  
Mervat G El Enany ◽  
Hussien H Rizk
Keyword(s):  
Blood Culture ◽  
16S Rrna ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Bloodstream Infections ◽  
Molecular Techniques ◽  
Molecular Technique ◽  
High Negative Predictive Value ◽  
Patient Groups ◽  
Low Sensitivity

Introduction: Diagnosis of bloodstream infections using bacteriological cultures suffers from low sensitivity and reporting delay. Advanced molecular techniques introduced in many laboratories provide rapid results and may show improvements in patient outcomes. This study aimed to evaluate the usefulness of a molecular technique, broad-range 16S rRNA PCR followed by sequencing for the diagnosis of bloodstream infections, compared to blood culture in different patient groups. Methodology: Conventional PCR was performed, using broad-range 16S rRNA primers, on blood cultures collected from different patients with suspected bloodstream infections; results were compared with those of blood culture. Results: Though blood culture is regarded as the gold standard, PCR evaluation showed sensitivity of 86.25%, specificity of 91.25%, positive predictive value of 76.67%, negative predictive value of 95.22%, and accuracy of 88.8%. Conclusions: Molecular assays seem not to be sufficient to replace microbial cultures in the diagnosis of bloodstream infections, but they can offer a rapid, good negative test to rule out infection due to their high negative predictive value.

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