scholarly journals Utility of routine oral contrast study for detecting postesophagectomy anastomotic leak – a systematic review and meta-analysis

2019 ◽  
Vol 32 (7) ◽  
Author(s):  
G Yonis ◽  
C S Cabalag ◽  
E Link ◽  
C P Duong
Keyword(s):  
Anastomotic Leak ◽  
Meta Analysis ◽  
Contrast Study ◽  
Oral Contrast ◽  
Predictive Values ◽  
Low Sensitivity ◽  
Esophagectomy For Cancer ◽  
Sensitivity Specificity ◽  
Prolonged Hospital ◽  
Contrast Studies

SUMMARY Oral contrast studies are used to detect anastomotic leak (AL) postesophagectomy. However, recent evidence suggests oral contrast studies have low sensitivity in detecting ALs, and their false positive results can lead to unnecessary prolonged hospital stay. The objective of this study was to determine if oral contrast studies should be used routinely post-esophagectomy for cancer. A systematic literature search was conducted for studies published between January 1990 and June 2018. Data extracted for analyses included type of esophagectomy, operative morbidity (such as AL and pneumonia), mortality rates, timing of contrast study, and type of oral contrast used. The sensitivity, specificity, and positive and negative predictive values of routine oral contrast studies to detect AL were calculated using the aforementioned variables. Two hundred and forty-seven studies were reviewed with 16 studies included in the meta-analysis. Postoperative oral contrast study was performed in 94.0% of cases between day 5 and 7. The rates of early and delayed leaks were 2.4% (1.8%–3.3%) and 2.8% (1.8%–4.4%), respectively. Routine contrast studies have a sensitivity and specificity of 0.44 (0.32–0.57) and 0.98 (0.95–0.99), respectively. Analysis of covariates revealed that sensitivity is reduced in centers with a higher volume of cases (greater than 15 per year: 0.50 [0.34–0.75; p = 0.0008]) and specificity was higher in centers with a lower leak rate. Given its poor sensitivity and inability to detect early/delayed AL, oral contrast study should be used selectively with endoscopy and/or computerized tomography scan to assess surgical anastomoses following esophagectomy.

Validity of hearTest Smartphone-Based Audiometry for Hearing Screening in Workers Exposed to Noise

2020 ◽  
Author(s):  
Luma Cordeiro Rodrigues ◽  
Silvia Ferrite ◽  
Ana Paula Corona
Keyword(s):  
Hearing Loss ◽  
High Specificity ◽  
Hearing Screening ◽  
Youden Index ◽  
Hearing Level ◽  
Predictive Values ◽  
Auditory Thresholds ◽  
The Mean ◽  
Low Sensitivity ◽  
Sensitivity Specificity

Abstract Purpose This article investigates the validity of a smartphone-based audiometry for hearing screening to identify hearing loss in workers exposed to noise. Research Design This is a validation study comparing hearing screening with the hearTest to conventional audiometry. The study population included all workers who attended the Brazilian Social Service of Industry to undergo periodic examinations. Sensitivity, specificity, the Youden index, and positive (PPV) and negative predictive values (NPV) for hearing screening obtained by the hearTest were estimated according to three definitions of hearing loss: any threshold greater than 25 dB hearing level (HL), the mean auditory thresholds for 0.5, 1, 2, and 4 kHz greater than 25 dB HL, and the mean thresholds for 3, 4, and 6 kHz greater than 25 dB HL. Note that 95% confidence intervals were calculated for all measurements. Results A total of 232 workers participated in the study. Hearing screening with the hearTest presented good sensitivity (93.8%), specificity (83.9%), and Youden index (77.7%) values, a NPV (97.2%), and a low PPV (69.0%) for the identification of hearing loss defined as any auditory threshold greater than 25 dB HL. For the other definitions of hearing loss, we observed high specificity, PPV and NPV, as well as low sensitivity and Youden index. Conclusion The hearTest is an accurate hearing screening tool to identify hearing loss in workers exposed to noise, including those with noise-induced hearing loss, although it does not replace conventional audiometry.

scholarly journals Diagnosing anastomotic leak post-esophagectomy: a systematic review

2020 ◽  
Author(s):  
Antonio Barbaro ◽  
Thomas A Eldredge ◽  
Jonathan Shenfine
Keyword(s):  
Systematic Review ◽  
Anastomotic Leak ◽  
Predictive Value ◽  
Diagnostic Algorithm ◽  
Primary Concern ◽  
Oral Contrast ◽  
Contrast Imaging ◽  
Asymptomatic Patients ◽  
Sensitivity Specificity ◽  
Drain Amylase

SUMMARY Esophagectomy is the gold-standard treatment for esophageal cancer; however, postoperative anastomotic leakage remains the primary concern for surgeons. No consensus exists on the optimal investigations to predict an anastomotic leak. This systematic review aims to identify a single test or combination of tests with acceptable sensitivity and specificity to identify anastomotic leak after esophagectomy and to formulate a diagnostic algorithm to facilitate surgical decision-making. A systematic review of PubMed and EMBASE databases was undertaken to evaluate diagnostic investigations for anastomotic leak post-esophagectomy. Each study was reviewed and where possible, the sensitivity, specificity, positive predictive value, and negative predictive value were extracted. The review identified 3,204 articles, of which 49 met the inclusion criteria. Investigations most commonly used for diagnosis of anastomotic leak were: C-reactive protein (CRP), oral contrast imaging, computed tomography (CT), pleural drain amylase concentration, and the ‘NUn score’. The sensitivity of CRP for detecting anastomotic leak varied from 69.2% to 100%. Oral contrast studies sensitivities varied between 16% and 87.5% and specificity varied from 20% to 100%. Pleural drain amylase sensitivities ranged between 75% and 100% and specificity ranged from 52% to 95.5%. The NUn score sensitivities ranged from 0% to 95% and specificity from 49% to 94.4%. No single investigation was identified to rule out anastomotic leak in asymptomatic patients. However, the authors propose a diagnostic algorithm incorporating CRP, pleural drain amylase concentration, and CT with oral contrast to aid clinicians in predicting anastomotic leak to facilitate safe, timely discharge post-esophagectomy.

scholarly journals Diagnostic accuracy of MRA and MRI for the bursal-sided partial-thickness rotator cuff tears: a meta-analysis

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Tao Huang ◽  
Jian Liu ◽  
Yupeng Ma ◽  
Dongsheng Zhou ◽  
Liang Chen ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
Mr Arthrography ◽  
Diagnostic Value ◽  
Rotator Cuff Tears ◽  
Cochrane Library ◽  
Predictive Values ◽  
Partial Thickness ◽  
Sensitivity Specificity

Abstract Background Numerous quantitatively studies have focused on the diagnosis of bursal-sided partial-thickness rotator cuff tears (RCTs); however, the accuracy of magnetic resonance imaging (MRI) and MR arthrography (MRA) remains inconclusive. This study was performed systematically to compare the diagnostic value of MRA and MRI for the bursal-sided partial-thickness RCTs. Methods Three electronic databases, PubMed, Embase, and Cochrane Library, were utilized to retrieve articles comparing the diagnostic value of MRA and MRI for detecting bursal-sided partial-thickness RCTs. After screening and diluting out the articles that met the inclusion criteria to be used for statistical analysis, the pooled evaluation indexes include sensitivity, specificity, positive and negative predictive values, diagnostic odds ratio (DOR), and the area under the receiver operating characteristic curve (AUC). Results Twelve studies involving 1740 patients and 1741 shoulders were identified. The pooled sensitivity, specificity, DOR, and AUC of MRA to diagnose bursal-sided partial-thickness RCTs were 0.77 (95% CI, 0.67–0.85), 0.98 (95% CI, 0.95–0.99), 73.01 (95% CI, 35.01–152.26), and 0.88 (95% CI, 0.85–0.91), respectively. The pooled sensitivity, specificity, DOR, and AUC of MRI were 0.77 (95% CI, 0.66–0.86) and 0.96 (95% CI, 0.81–0.99), and 37.12 (95% CI, 8.08–170.64) and 0.82 (95% CI, 0.78–0.85), respectively. Conclusions This meta-analysis reveals that MRA and MRI have similar diagnostic value for the diagnosis of bursal-sided partial-thickness rotator cuff tears.

Abdominal Circumference Alone versus Estimated Fetal Weight after 24 Weeks to Predict Small or Large for Gestational Age at Birth: A Meta-Analysis

2017 ◽  
Vol 34 (11) ◽  
pp. 1115-1124 ◽  
Author(s):  
José Yordan ◽  
Bradley Holbrook ◽  
Pranita Nirgudkar ◽  
Ellen Mozurkewich ◽  
Nathan Blue
Keyword(s):  
Gestational Age ◽  
Meta Analysis ◽  
Screening Method ◽  
Case Series ◽  
Fetal Weight ◽  
Abdominal Circumference ◽  
Large For Gestational Age ◽  
Predictive Values ◽  
Sensitivity Specificity ◽  
Estimated Fetal Weight

Objective We compared the sensitivity and specificity of abdominal circumference (AC) alone versus estimated fetal weight (EFW) to predict small for gestational age (SGA) or large for gestational age (LGA) at birth. Study Design We searched the literature for studies assessing an ultrasonographic AC or EFW after 24 weeks to predict SGA or LGA at birth. Case series or studies including anomalous fetuses or multiple gestations were excluded. We computed the sensitivity, specificity, and positive and negative predictive values of any AC or EFW cutoff analyzed by at least two studies. Results We identified 2,460 studies, of which 40 met inclusion criteria (n = 36,519). Four studies assessed AC alone to predict SGA (n = 5,119), and six assessed AC to predict LGA (n = 6,110). Sixteen assessed EFW to predict SGA (n = 13,825), and 22 evaluated EFW to predict LGA (n = 18,896). To predict SGA, AC and EFW < 10th percentile have similar ability to predict SGA. To predict LGA, AC cutoffs were comparable to all EFW cutoffs, except that AC > 35 cm had better sensitivity. Conclusion After 24 weeks, AC is comparable to EFW to predict both SGA and LGA. In settings where serial EFWs are inaccessible, a simpler screening method with AC alone may suffice.

scholarly journals Low sensitivity of ParaHIT-f rapid malaria test among patients with fever in rural health centers, Northern Tanzania

2011 ◽  
Vol 5 (03) ◽  
pp. 204-208 ◽  
Author(s):  
Eliningaya John Kweka ◽  
Asanterabi Lowassa ◽  
Shandala Msangi ◽  
Epiphania E Kimaro ◽  
Ester E Lyatuu ◽  
...  
Keyword(s):  
Rapid Test ◽  
Health Centers ◽  
Diagnostic Tools ◽  
Test Results ◽  
Predictive Values ◽  
Rural Tanzania ◽  
Northern Tanzania ◽  
Low Sensitivity ◽  
Sensitivity Specificity ◽  
Malaria Test

Introduction: Several rapid diagnostic tools for malaria are currently available in local markets. However, diagnostic accuracy varies widely. The present study was conducted to evaluate a cheaply and easily available rapid diagnostic malaria test (ParaHIT-f) in rural Tanzania. Methodology: Participants presenting with fever at health centers in the Kilimanjaro and Manyara regions were eligible. Parasitological thin and thick smears were examined from finger-prick blood samples and compared to ParaHIT-f test results. Sensitivity, specificity and predictive values were calculated using microscopic parasitological examination as the gold standard. Results: In total, 236/743 (31.8%) individuals had a positive malaria microscopy, and 25/715 (3.4%) were positive in the rapid diagnostic test. The sensitivity of ParaHIT-f was 10.7% (95% CI, 6.7-14.7) and specificity was 100% (95% CI, 97.4-102), with positive and negative predictive values (PPV and NPV) of 100% (95% CI, 99.1-100.2) and 70.9% (95% CI, 66.9-74.9) respectively. Sensitivity of ParaHIT-f increased with increasing P. falciparum density (P > 0.003) from 5.8% (95% CI, 0-12.9) at < 100 parasites/μl to 20.5% (95% CI, 13.5-27) at ≥ 100 parasites/μl. Conclusions: Sensitivity of the ParaHIT-f rapid test was very low in this setting, therefore concomitant use of rapid diagnostic tests and microscopy is recommended. In the case of positive test results, confirmation by parasitological techniques is not necessary. Further monitoring of ParaHIT-f in various epidemiological settings in Tanzania is warranted. 

scholarly journals Reliability of Geneological Cemetery Records in Ascertaining Vital Status in an Historical Cohort Study

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Stella Gwini ◽  
Ewan MacFarlane ◽  
Geza Benke ◽  
Malcolm Sim
Keyword(s):  
Cohort Study ◽  
18Th Century ◽  
Historical Cohort ◽  
Predictive Values ◽  
Vital Status ◽  
The Past ◽  
Potential Source ◽  
Death Registry ◽  
Low Sensitivity ◽  
Sensitivity Specificity

ABSTRACTBackground Ascertainment of vital status is a particular challenge in studies of historical cohorts, particularly when the time last known to be alive precedes available and linkable death databases. In Australia, vital status is typically ascertained by linkage to the National Death Index (NDI) which contains detailed information on all deaths occurring after 1 January 1980. While the Australian National Death registry has electronic records dating back to the 18th century searching for deaths prior to this date can only be undertaken on an individual basis by requesting specific death certificates from state/territory registrars of births, deaths and marriages, which is unfeasible for a whole cohort. In the past decade, a number of publically accessible online genealogical databases containing either details of burials/cremations or tombstone inscriptions have become available. While genealogical cemetery records are a potential source of mortality ascertainment, their reliability for this purpose is unknown. We used the Australian NDI, as a gold standard, to assess the reliability of electronic cemetery records in ascertaining vital status in a cohort study. MethodsIn a historical cohort of former workers employed at a Tasmanian cement factory from 1936, Tasmanian electronic cemetery and tombstone inscription databases were checked for ‘fact of death’ for workers last known to be alive after 01 January 1980 (N=867, 31% of the cohort). The same cohort was also linked to the NDI. Sensitivity, specificity, positive and negative predictive values (PPV and NPV) of cemetery records were calculated. ResultsThe NDI identified 78 deaths (9%) while we identified 50 deaths (6%) through cemetery record checks. The sensitivity of cemetery matching was low (53.8%; 95% CI 42.2-65.2) while specificity was 99.0% (95% CI 98.0-99.6). Positive and negative predictive values were also good, 84.0% (95% CI 70.9-92.8) and 95.6% (95% CI 94.0-96.9), respectively. ConclusionsThe results show that deaths identified from electronic cemetery records can be reliable (i.e. high PPV), even though this method correctly identified about half of deaths (i.e. low sensitivity). This methodology can be useful when sources of vital status ascertainment are limited.

Haematological Parameters in Early Diagnosis of Clinically Suspected Neonatal Septicemia

2019 ◽  
Vol 31 (1) ◽  
pp. 65-71
Keyword(s):  
Early Diagnosis ◽  
Late Onset ◽  
Cost Effective ◽  
Haematological Parameters ◽  
Predictive Values ◽  
Neonatal Septicemia ◽  
Mature Neutrophil ◽  
Life Threatening ◽  
Low Sensitivity ◽  
Sensitivity Specificity

Neonatal septicemia is a life-threatening yet treatable condition. It is one of the major health problems throughout the world. Blood culture is the gold standard for diagnosis of neonatal septicemia and should be performed in all cases of suspected septicemia prior to starting antibiotics. But in the present study, the use of the haematological parameters was evaluated to determine the early diagnosis of neonatal septicemia. It was carried out in the neonatal unit of Mandalay Children’s Hospital from September 2012 to August 2013. Out of 68 cases of clinically suspected neonatal septicemia, bacterial pathogens were isolated from 33 cases. Early onset neonatal septicemia was more common than late onset. Among 33 cases of culture-proven neonatal septicemia, septicemia is not likely in 1 case (3%) while borderline for septicemia and septicemia in 6 cases (18.2%) is very likely in 26 cases (78.8%) according to haematological scoring system (HSS). HSS assigns a score of one for each of seven haematological parameters. Out of the seven haematological parameters, immature to total neutrophil ratio (I:T) and immature to mature neutrophil ratio (I:M) were the most reliable test for the neonatal septicemia. Thrombocytopenia had low sensitivity. The haematolgical parameters are simple, quick, cost effective and readily available. The sensitivity, specificity and the predictive values of haematological parameters could be enhanced by combination of these parameters rather than the use of single parameter.

scholarly journals Sonographic Features Differentiating Follicular Thyroid Cancer from Follicular Adenoma–a Meta-Analysis

Cancers ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 938
Author(s):  
Martyna Borowczyk ◽  
Kosma Woliński ◽  
Barbara Więckowska ◽  
Elżbieta Jodłowska-Siewert ◽  
Ewelina Szczepanek-Parulska ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Follicular Adenoma ◽  
Journal Articles ◽  
Predictive Values ◽  
Increased Risk ◽  
Follicular Lesions ◽  
Thyroid Adenomas ◽  
Risk Of Malignancy ◽  
Sensitivity Specificity ◽  
Ultrasound Features

Certain ultrasound features are associated with an increased risk of thyroid malignancy. However, they were studied mainly in papillary thyroid cancers (PTCs); these results cannot be simply extrapolated for the differentiation of follicular thyroid adenomas and cancers (FTAs and FTCs). The aim of our study was to perform a meta-analysis to identify sonographic features suggesting malignancy in the case of follicular lesions, potentially differentiating FTA and FTC. We searched thirteen databases from January 2006 to December 2020 to find all relevant, full-text journal articles written in English. Analyses assessed the accuracy of malignancy detection in case of follicular lesions, potentially differentiating FTA and FTC included the odds ratio (OR), sensitivity, specificity, positive and negative predictive values. A random-effects model was used to summarize collected data. Twenty studies describing sonographic features of 10,215 nodules met the inclusion criteria. The highest overall ORs to increase the risk of malignancy were calculated for tumor protrusion (OR = 10.19; 95% confidence interval: 2.62–39.71), microcalcifications or mixed type of calcifications (coexisting micro and macrocalcifications): 6.09 (3.22–11.50), irregular margins: 5.11 (2.90–8.99), marked hypoechogenicity: 4.59 (3.23–6.54), and irregular shape: 3.6 (1.19–10.92). The most crucial feature associated with an increased risk of FTC is capsule protrusion, followed by the presence of calcifications, irrespectively of their type.

scholarly journals Reliability of Cobas Amplicor PCR test in detection of Mycobacterium tuberculosis in respiratory and nonorespiratory specimens

2009 ◽  
Vol 66 (12) ◽  
pp. 992-997
Author(s):  
Zorica Lepsanovic ◽  
Dejana Savic ◽  
Branka Tomanovic
Keyword(s):  
Mycobacterium Tuberculosis ◽  
High Sensitivity ◽  
High Specificity ◽  
Diagnostic Methods ◽  
Nucleic Acid Amplification ◽  
Culture Methods ◽  
Predictive Values ◽  
Polymerase Chain ◽  
Low Sensitivity ◽  
Sensitivity Specificity

Background/Aim. Traditional methods for detection of mycobacteria, such as microscopic examination for the presence of acid-fast bacilli and isolation of the organism by culture, have either a low sensitivity and/or specificity, or take weeks before a definite result is available. Molecular methods, especially those based on nucleic acid amplification, are rapid diagnostic methods which combine high sensitivity and high specificity. The aim of this study was to determine the usefulness of the Cobas Amplicor Mycobacterium tuberculosis polymerase chain reaction (CAPCR) assay in detecting the tuberculosis cause in respiratory and nonrespiratory specimens (compared to culture). Methods. Specimens were decontaminated by the N-acetyl-L-cystein- NaOH method. A 500 ?L aliquot of the processed specimen were used for inoculation of L?wenstein-Jensen (L-J) slants, a drop for acid-fast staining, and 100 ?L for PCR. The Cobas Amplicor PCR was performed according to the manufacturer's instructions. Results. A total of 110 respiratory and 355 nonrespiratory specimens were investigated. After resolving discrepancies by reviewing medical history, overall sensitivity, specificity, and positive and negative predictive values for CA-PCR assay compared to culture, were 83%, 100%, 100%, and 96.8%, respectively. In comparison, they were 50%, 99.7%, 87.5%, and 98%, respectively, for the nonrespiratory specimens. The inhibition rate was 2.8% for respiratory, and 7.6% for nonrespiratory specimens. Conclusion. CA-PCR is a reliable assay that enables specialists to start treatment promptly on a positive test result. Lower value for specificity in a group of nonrespiratory specimens is a consequence of an extremely small number of mycobacteria in some of them.

Procalcitonin as an alternative tumor marker of medullary thyroid carcinoma. A meta-analysis

2021 ◽  
Author(s):  
Luca Giovanella ◽  
Maria Luisa Garo ◽  
Luca Ceriani ◽  
Gaetano Paone ◽  
Alfredo Campenni ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Data Extraction ◽  
Meta Analysis ◽  
Standard Of Care ◽  
Likelihood Ratios ◽  
Predictive Values ◽  
Medullary Thyroid ◽  
Time Restrictions ◽  
Sensitivity Specificity

Abstract Objective This study aimed to determine the procalcitonin (ProCT) diagnostic accuracy in prediction and treatment monitoring of medullary thyroid carcinoma (MTC). Data Sources Electronic databases were searched for observational studies published until May 2021 without language or time restrictions. Study Selection Studies comparing ProCT and calcitonin accuracy were included. After removing duplicates and exclusion of not-eligible articles, relevant articles were screened independently by two reviewers. Eleven studies (4.5% of the identified studies) met the selection criteria. Data Extraction Two reviewers independently extracted data and assessed data quality and validity through QUADAS-2. Data Synthesis A meta-analysis was performed on sufficiently clinically and statistically homogeneous eleven studies (n = 5817 patients, 335 MTC patients). HSROC and bivariate methods were applied. Serum ProCT was found to be a highly accurate test for MTC diagnosis and monitoring. The pooled sensitivity, specificity, positive and negative likelihood ratios, AUC, and positive and negative predictive values for ProCT were 0.90 (95%CI: 0.71-0.97), 1.00 (95%CI: 0.85-1.00), 288 (95%CI: 5.6-14929.3), 0.10 (95%CI: 0.03-0.33), 0.97 (95%CI: 0.95-0.98), 99% and 2%. Conclusions The high accuracy, compounded with favorable analytical characteristics, give ProCT great potential to replace calcitonin as a new standard of care in the management of MTC.

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