scholarly journals P.056 Combined conventional and amplitude-integrated EEG monitoring in neonates: a prospective study

2019 ◽  
Vol 46 (s1) ◽  
pp. S29
Author(s):  
SG Buttle ◽  
B Lemyre ◽  
E Sell ◽  
S Redpath ◽  
S Bulusu ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Clinical Observation ◽  
Average Duration ◽  
Diagnostic Yield ◽  
Standard Of Care ◽  
Seizure Detection ◽  
Clinical Events ◽  
A Prospective Study ◽  
Post Hoc ◽  
Limited Sensitivity

Background: Seizure monitoring via amplitude-integrated EEG (aEEG) is standard of care in many NICUs; however, conventional EEG (cEEG) is the gold standard for seizure detection. We compared the diagnostic yield of aEEG interpreted at the bedside, aEEG interpreted by an expert, and cEEG. Methods: Neonates received aEEG and cEEG in parallel. Clinical events and aEEG were interpreted at bedside and subsequently independently analyzed by experienced neonatology and neurology readers. Sensitivity and specificity of bedside aEEG as compared to expert aEEG interpretation and cEEG were evaluated. Results: Thirteen neonates were monitored for an average duration of 33 hours (range 15-94). Fourteen seizure-like events were detected by clinical observation, and 12 others by bedside aEEG analysis. None of the bedside aEEG events were confirmed as seizures on cEEG. Expert aEEG interpretation had a sensitivity of 13% with 46% specificity for individual seizure detection (not adjusting for patient differences), and a sensitivity of 50% with 46% specificity for detecting patients with seizures. Conclusions: Real-world bedside aEEG monitoring failed to detect seizures evidenced via cEEG, while misclassifying other events as seizures. Even post-hoc expert aEEG interpretation provided limited sensitivity and specificity. Considering the poor sensitivity and specificity of bedside aEEG interpretation, combined monitoring may provide limited clinical benefit.

Combined Conventional and Amplitude-Integrated EEG Monitoring in Neonates: A Prospective Study

2019 ◽  
Vol 34 (6) ◽  
pp. 313-320 ◽  
Author(s):  
Sarah Grace Buttle ◽  
Brigitte Lemyre ◽  
Erick Sell ◽  
Stephanie Redpath ◽  
Srinivas Bulusu ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Neonatal Intensive Care ◽  
Diagnostic Yield ◽  
Standard Of Care ◽  
Seizure Detection ◽  
Neonatal Intensive Care Units ◽  
Eeg Monitoring ◽  
Clinical Events ◽  
A Prospective Study ◽  
Post Hoc

Background/Objective: Seizure monitoring via amplitude-integrated EEG is standard of care in many neonatal intensive care units; however, conventional EEG is the gold standard for seizure detection. We compared the diagnostic yield of amplitude-integrated EEG interpreted at the bedside, amplitude-integrated EEG interpreted by an expert, and conventional EEG. Methods: Neonates requiring seizure monitoring received amplitude-integrated EEG and conventional EEG in parallel. Clinical events and amplitude-integrated EEG were interpreted at bedside. Subsequently, amplitude-integrated EEG and conventional EEG were independently analyzed by experienced neonatology and neurology readers. Sensitivity and specificity of bedside amplitude-integrated EEG as compared to expert amplitude-integrated EEG interpretation and conventional EEG were evaluated. Results: Thirteen neonates were monitored for an average duration of 33 hours (range 15-94, SD 25). Fourteen seizure-like events were detected by clinical observation, and 12 others by bedside amplitude-integrated EEG analysis. One of the clinical, and none of the bedside amplitude-integrated EEG events were confirmed as seizures on conventional EEG. Post hoc expert amplitude-integrated EEG interpretation revealed eight suspected seizures, all different from the ones detected by the bedside amplitude-integrated EEG team, of which one was confirmed via conventional EEG. Eight seizures were recorded on conventional EEG. Expert amplitude-integrated EEG interpretation had a sensitivity of 13% with 46% specificity for individual seizure detection, and a sensitivity of 50% with 46% specificity for detecting patients with seizures. Conclusion: Real-world bedside amplitude-integrated EEG monitoring failed to detect all seizures evidenced via conventional EEG, while misclassifying other events as seizures. Even post hoc expert amplitude-integrated EEG interpretation provided limited sensitivity and specificity. Considering the poor sensitivity and specificity of bedside amplitude-integrated EEG interpretation, combined monitoring may provide limited clinical benefit.

Evaluation of a sensitive blood test for the detection of colorectal advanced adenomas in a prospective cohort using a multiomics approach.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 43-43
Author(s):  
Jimmy Lin ◽  
Eric Ariazi ◽  
Michael Dzamba ◽  
Teng-Kuei Hsu ◽  
Steven Kothen-Hill ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Blood Test ◽  
High Sensitivity ◽  
Test Methods ◽  
Screening Tests ◽  
Advanced Adenomas ◽  
A Prospective Study ◽  
Negative Controls ◽  
Generation Sequencing ◽  
Limited Sensitivity

43 Background: Blood-based screening tests for colorectal cancer (CRC) with high sensitivity and specificity are needed to improve adherence, facilitate early detection, and ultimately reduce mortality from CRC. Current stool-based tests have a sensitivity of 24-42% for colorectal advanced adenomas (AAs), while blood tests that rely on tumor-derived cell-free DNA (cfDNA) methylation signatures have shown limited sensitivity for AAs. Here we demonstrate the ability to detect AAs from blood using a multiomics test that incorporates both tumor- and immune-derived signatures, and compare it to the performance of a cfDNA methylation-only test. Methods: Participants enrolled in a prospective study (NCT03688906) were included in this analysis. The multiomics test includes signatures for cell-free nucleic acids based on next-generation sequencing, and for plasma proteins based on high-throughput multiplexed assays. Signatures are integrated computationally with a combination of convolutional neural networks and regularized logistic regression. We compared the multiomics test with one based on cfDNA methylation only. Results: This sub-study included 542 participants (AA: n = 122; colonoscopy-confirmed negative controls: n = 420). Participants with AA were 56% male with a mean age of 63 years, and colonoscopy-confirmed negative controls were 54% male with a mean age of 61 years. The multiomics test achieved a sensitivity of 41% (n = 50/122, 95% CI 34-48%) at 90% specificity (377/420). By contrast, the cfDNA methylation-only test achieved a sensitivity of 20% (24/122, 95% CI 15-25%) at 91% specificity (383/420). Performance was also analyzed by histological subtype and location, and superiority of the multiomics test to the cfDNA-methylation-only test was consistently observed. Conclusions: A novel multiomics blood test can detect colorectal AAs at a sensitivity and specificity comparable to existing stool-based tests. Combining signatures from both tumor- and immune-derived sources resulted in AA sensitivity greater than that of cfDNA-methylation alone.

Longitudinal Study of Adverse Reactions Following Diphtheria-Tetanus-Pertussis Vaccine in Infancy

PEDIATRICS ◽  
1990 ◽  
Vol 85 (3) ◽  
pp. 294-302 ◽  
Author(s):  
Sarah S. Long ◽  
Adamadia Deforest ◽  
David Gary Smith ◽  
Carlos Lazaro ◽  
Steven G. F. Wassilak ◽  
...  
Keyword(s):  
Pertussis Vaccine ◽  
Adverse Reactions ◽  
Clinical Observation ◽  
Local Reaction ◽  
Vaccine Dose ◽  
Dose Schedule ◽  
Clinical Events ◽  
Dose Number ◽  
A Prospective Study ◽  
Antibody Levels

A prospective study of immunogenicity and adverse effects of 1553 doses of diphtheria and tetanus toxoids and whole cell pertussis vaccine (DTP) was performed in 538 children observed longitudinally from 2 months to 20 months of age. Subjects were randomized to the standard four-dose immunization schedule or to a three-dose schedule (with a saline injection substituted for DTP at 6 months of age). The three-dose schedule could not be recommended on the basis of serologic data. Compliance for completing a clinical observation form in the 48 hours following injections was >99%. Fever, local reactions, or adverse behavioral effects were described in association with 96% of DTP doses and 36% of placebo injections. Contraindications to DTP immunization developed in 3% of study children. No convulsion, hypotonic hyporesponsive episode, encephalopathy, or temperature >40.5°C occurred. Behavioral and local imflammatory effects occurred maximally in the first 6 hours following vaccine but fever peaked later. There was no interrelationship between occurrence of local reaction and fever. Data suggest that age has more effect on the type and rate of adverse clinical events than does vaccine dose number. Existing antibody levels to vaccine components, lot of vaccine, breast-feeding, or gestational age did not affect rate or type of clinical reactions. Neither occurrence of reactions nor the use of acetaminophen affected antibody response to vaccine.

Electrographic Seizure Detection by Neuro ICU Nurses via Bedside Real-Time Quantitative EEG

2021 ◽  
pp. 10.1212/CPJ.0000000000001107
Author(s):  
Safa Kaleem ◽  
Jennifer H. Kang ◽  
Alok Sahgal ◽  
Christian E. Hernandez ◽  
Saurabh R. Sinha ◽  
...  
Keyword(s):  
Real Time ◽  
Sensitivity And Specificity ◽  
Standard Of Care ◽  
Seizure Detection ◽  
Quantitative Eeg ◽  
Primary Objective ◽  
Clinical Trial Registration ◽  
Icu Patients ◽  
Registration Number ◽  
Nurse Time

ABSTRACTObjective:Our primary objective was to determine the performance of real-time Neuroscience ICU (Neuro ICU) nurse interpretation of quantitative EEG (qEEG) at the bedside for seizure detection. Secondary objectives included determining nurse time to seizure detection and assessing factors that influenced nurse accuracy.Methods:Nurses caring for Neuro ICU patients undergoing cEEG were trained using a 1-hour qEEG panel (rhythmicity spectrogram and amplitude-integrated EEG) bedside display. Nurses’ hourly interpretations were compared to post-hoc cEEG review by two neurophysiologists as the gold standard. Diagnostic performance, time to seizure detection as compared to standard of care (SOC), and effects of other factors on nurse accuracy were calculated.Results:109 patients and 65 nurses were studied. Eight patients had seizures during the study period (7%). Nurse sensitivity and specificity for the detection of seizures were 74% and 92%, respectively. Mean nurse time to seizure detection was significantly shorter than SOC by 132 minutes (Cox proportional hazard ratio 6.96). Inaccurate nurse interpretation was associated with increased hours monitored and presence of brief rhythmic discharges.Conclusions:This prospective study of real-time nurse interpretation of qEEG for seizure detection in Neuro ICU patients showed clinically adequate sensitivity and specificity. Time to seizure detection was less than that of SOC.Classification of Evidence:This study provides Class I evidence that Neuro ICU nurse interpretation of qEEG detects seizures in adults with a sensitivity of 74% and specificity of 92% as compared to traditional cEEG review.Clinical Trial Registration Number: NCT02082873

scholarly journals Diagnostic Yield of Electroanatomic Voltage Mapping in Guiding Endomyocardial Biopsies

Circulation ◽  
2020 ◽  
Vol 142 (13) ◽  
pp. 1249-1260 ◽  
Author(s):  
Michela Casella ◽  
Antonio Dello Russo ◽  
Marco Bergonti ◽  
Valentina Catto ◽  
Edoardo Conte ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Sensitivity And Specificity ◽  
Low Voltage ◽  
Diagnostic Yield ◽  
Gadolinium Enhancement ◽  
Promising Tool ◽  
Voltage Mapping ◽  
Few Data ◽  
New Diagnosis ◽  
Complications Rate

Background: Electroanatomic voltage mapping (EVM) is a promising modality for guiding endomyocardial biopsies (EMBs). However, few data support its feasibility and safety. We now report the largest cohort of patients undergoing EVM-guided EMBs to show its diagnostic yield and to compare it with a cardiac magnetic resonance (CMR)–guided approach. Methods: We included 162 consecutive patients undergoing EMB at our institution from 2010 to 2019. EMB was performed in pathological areas identified at EVM and CMR. CMR and EVM sensitivity and specificity regarding the identification of pathological substrates of myocardium were evaluated according to EMB results. Results: Preoperative CMR showed late gadolinium enhancement in 70% of the patients, whereas EVM identified areas of low voltage in 61%. Right (73%), left (19%), or both ventricles (8%) underwent sampling. EVM proved to have sensitivity similar to CMR (74% versus 77%), with specificity being 70% and 47%, respectively. In 12 patients with EMB-proven cardiomyopathy, EVM identified pathological areas that had been undetected at CMR evaluation. Sensitivity of pooled EVM and CMR was as high as 95%. EMB analysis allowed us to reach a new diagnosis, different from the suspected clinical diagnosis, in 39% of patients. The complications rate was low, mostly related to vascular access, with no patients requiring urgent management. Conclusions: EVM proved to be a promising tool for targeted EMB because of its sensitivity and specificity for identification of myocardial pathological substrates. EVM was demonstrated to have accuracy similar to CMR. EVM and CMR together conferred a positive predictive value of 89% on EMB.

scholarly journals Practicability and Diagnostic Yield of One-Stop Stroke CT with Delayed-Phase Cardiac CT in Detecting Major Cardioembolic Sources of Acute Ischemic Stroke

2021 ◽  
Author(s):  
Friederike Austein ◽  
Matthias Eden ◽  
Jakob Engel ◽  
Annett Lebenatus ◽  
Naomi Larsen ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Early Stage ◽  
Recurrent Stroke ◽  
Cardiac Computed Tomography ◽  
Standard Of Care ◽  
Routine Work ◽  
One Stop ◽  
Work Up ◽  
Delayed Phase ◽  
Multimodal Ct

Abstract Purpose Recurrent stroke is considered to increase the incidence of severe disability and death. For correct risk assessment and patient management it is essential to identify the origin of stroke at an early stage. Transthoracic echocardiography (TTE) is the initial standard of care for evaluating patients in whom a cardioembolic source of stroke (CES) is suspected but its diagnostic capability is limited. Transesophageal echocardiography (TEE) is considered as gold standard; however, this approach is time consuming, semi-invasive and not always feasible. We hypothesized that adding a delayed-phase cardiac computed tomography (cCT) to initial multimodal CT might represent a valid alternative to routine clinical echocardiographic work-up. Material and Methods Patients with suspected acute cardioembolic stroke verified by initial multimodal CT and subsequently examined with cCT were included. The cCT was evaluated for presence of major CES and compared to routine clinical echocardiographic work-up. Results In all, 102 patients with suspected acute CES underwent cCT. Among them 60 patients underwent routine work-up with echocardiography (50 TTE and only 10 TEE). By cCT 10/60 (16.7%) major CES were detected but only 4 (6.7%) were identified by echocardiography. All CES observed by echocardiography were also detected by cCT. In 8 of 36 patients in whom echocardiography was not performed cCT also revealed a major CES. Conclusion These preliminary results show the potential diagnostic yield of delayed-phase cCT to detect major CES and therefore could accelerate decision-making to prevent recurrence stroke. To confirm these results larger studies with TEE as the reference standard and also compared to TTE would be necessary.

scholarly journals Evaluation of malignant effusions using MR-based T1 mapping

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
D. Kuetting ◽  
J. Luetkens ◽  
A. Faron ◽  
A. Isaak ◽  
U. Attenberger ◽  
...  
Keyword(s):  
T1 Mapping ◽  
Ex Vivo ◽  
Diagnostic Yield ◽  
Spin Echo ◽  
Relaxation Times ◽  
Inversion Recovery ◽  
Malignant Effusions ◽  
Mapping Techniques ◽  
Set Up ◽  
Post Hoc

AbstractOur aim was to investigate the diagnostic yield of rapid T1-mapping for the differentiation of malignant and non-malignant effusions in an ex-vivo set up. T1-mapping was performed with a fast modified Look-Locker inversion-recovery (MOLLI) acquisition and a combined turbo spin-echo and inversion-recovery sequence (TMIX) as reference. A total of 13 titrated albumin-solutions as well as 48 samples (29 ascites/pleural effusions from patients with malignancy; 19 from patients without malignancy) were examined. Samples were classified as malignant-positive histology, malignant-negative histology and non-malignant negative histology. In phantom analysis both mapping techniques correlated with albumin-content (MOLLI: r = − 0.97, TMIX: r = − 0.98). MOLLI T1 relaxation times were shorter in malignancy-positive histology fluids (2237 ± 137 ms) than in malignancy-negative histology fluids (2423 ± 357 ms) as well as than in non-malignant-negative histology fluids (2651 ± 139 ms); post hoc test for all intergroup comparisons: < 0.05. ROC analysis for differentiation between malignant and non-malignant effusions (malignant positive histology vs. all other) showed an (AUC) of 0.89 (95% CI 0.77–0.96). T1 mapping allows for non-invasive differentiation of malignant and non-malignant effusions in an ex-vivo set up.

scholarly journals A prospective study antenatally detected hydronephrosis and their postnatal evaluation and management

2020 ◽  
Vol 7 (3) ◽  
pp. 660
Author(s):  
Karpaga Vinayagam ◽  
C. Saravanan
Keyword(s):  
Prospective Study ◽  
Vesicoureteric Reflux ◽  
Outlet Obstruction ◽  
Standard Of Care ◽  
Voiding Cystourethrogram ◽  
Distal Ureter ◽  
Antenatal Hydronephrosis ◽  
Upj Obstruction ◽  
A Prospective Study ◽  
Near Future

Background: Detection of urologic anomalies prenatally permits fetal interventions that avoid complications in rare cases of bladder outlet obstruction with oligohydramnios even though their final benefits still remain controversial. To analyse the incidence of ureteropelvic junction (UPJ) obstruction in antenatally detected hydronephrosis cases.Methods: This prospective study was conducted February 2019 to August 2019 at the Institute of Child Health and Hospital for Children Egmore, Chennai. All the cases of hydronephrosis which were detected antenatally and those children presented with hydronephrosis in the neonatal period were taken for this study. Totally 58 cases were analyzed in the study, among that 32 cases detected antenatally with UPJ obstruction. Their epidemiology and their immediate postnatal findings (USG abdomen by 3-7 days, IVP and DTPA by 4-6 weeks) were recorded and the percentage of cases in which pelvic-ureteric junction obstruction was significant.Results: Among the cases that were diagnosed to have hydronephrosis antenatally (46), 69% (32/46) had UPJ obstruction, 21% (10/46) had bilateral hydronephrosis, 6.5% (3/46) had vesicoureteric reflux and rest had other anomalies (1/46).Conclusions: Antenatal hydronephrosis (ANH), one of the most common abnormal findings on the antenatal ultrasound (US), continues to increase as the standard of care includes the 2nd trimester US. US is the mainstay of the postnatal evaluation and voiding cystourethrogram may be safely reserved for high-grade ANH or dilated distal ureter. New urinary biomarkers may offer promising potential for more accurate risk stratification in the near future.

Abstract 204: Transcranial Doppler Versus Transthoracic Echocardiography for the Detection of Patent Foramen Ovale in Patients With Cryptogenic Cerebral Ischemia: A Systematic Review and Diagnostic Test Accuracy Meta-analysis

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Georgios Tsivgoulis ◽  
Aristeidis H Katsanos ◽  
Theodora Psaltopoulou ◽  
Theodoros Sergentanis ◽  
Alexandra Frogoudaki ◽  
...  
Keyword(s):  
Cerebral Ischemia ◽  
Sensitivity And Specificity ◽  
Transcranial Doppler ◽  
Transthoracic Echocardiography ◽  
Patent Foramen Ovale ◽  
Diagnostic Yield ◽  
Positive Likelihood Ratio ◽  
Receiver Operating Curve ◽  
Test Accuracy ◽  
Foramen Ovale

Background & Purpose: Patent foramen ovale (PFO) can be detected in up to 43% of patients with cryptogenic cerebral ischemia undergoing investigation with transesophageal echocardiography (TEE). The diagnostic value of transthoracic echocardiography (TTE) in the detection of PFO in patients with cryptogenic cerebral ischemia has not been compared with that of transcranial Doppler (TCD) using a comprehensive meta-analytical approach. Methods: We performed a systematic literature review according to PRISMA guidelines to identify all prospective observational studies of patients with cryptogenic cerebral ischemia that provided both sensitivity and specificity measures of TTE, TCD or both compared to the gold standard of TEE. Results: Our literature search identified 35 eligible studies including 3067 patients. The summary sensitivity and specificity for TCD was 96.1% (95% confidence interval: 93.0%-97.8%) and 92.4% (95%CI: 85.5%-96.1%), whereas the respective measures for TTE were 45.1% (95%CI: 30.8-60.3%) and 99.6% (95%CI: 96.5-99.9%). The summary diagnostic odds ratio (DOR) for TCD (DOR=297.97, 95%CI: 131.18-676.83) and TTE (DOR=193.44, 95%CI: 30.38-1231.67) did not significantly differ (z-value=0.418, p=0.676). TTE was superior in terms of higher positive likelihood ratio values (LR+= 106.61, 95%CI: 15.09-753.30 for TTE vs. LR+=12.62, 95%CI: 6.52-24.43 for TCD; p=0.043), while TCD yielded lower negative positive likelihood values (LR- = 0.04, 95%CI: 0.02-0.08) compared to TTE (LR- =0.55, 95%CI: 0.42-0.72; p<0.001). Finally, the area under the summary receiver operating curve was significantly greater (p<0.001) in TCD (AUC=0.98, 95%CI: 0.97-0.99; Figure A) compared to TTE studies (AUC=0.86, 95%CI: 0.82-0.89; Figure B). Conclusions: TCD is more sensitive but less specific compared to TTE for the detection of PFO in patients with cryptogenic cerebral ischemia. The overall diagnostic yield of TCD appears to outweigh that of TTE.

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