Evaluating the validity of dengue clinical-epidemiological criteria for diagnosis in patients residing in a Brazilian endemic area

2020 ◽  
Vol 114 (8) ◽  
pp. 603-611
Author(s):  
Elis Regina da Silva Ferreira ◽  
Ana Carolina de Oliveira Gonçalves ◽  
Alice Tobal Verro ◽  
Eduardo A Undurraga ◽  
Maurício Lacerda Nogueira ◽  
...  
Keyword(s):  
Laboratory Tests ◽  
Clinical Characteristics ◽  
Endemic Area ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Laboratory Diagnosis ◽  
Substantial Variation ◽  
Logistic Regressions ◽  
Criteria For Diagnosis ◽  
Sensitivity Specificity

Abstract Background We evaluated the validity of clinical diagnosis compared with laboratory diagnosis of dengue in a retrospective sample of patients in São José do Rio Preto, Brazil. Methods Our sample included 148 299 clinically (56.3%) or laboratory-diagnosed (43.7%) dengue cases. We compared the sensitivity, specificity, positive and negative predictive value (PPV and NPV) of dengue patients’ demographic and clinical characteristics with laboratory-based diagnosis. We used logistic regressions to estimate the correlation between clinical and laboratory diagnosis of dengue and a full set of dengue signs and symptoms. Results We found substantial variability in sensitivity and specificity of signs and symptoms ranging from 0.8–81.1 and 21.5–99.6, respectively. Thrombocytopenia exhibited the highest PPV (92.0) and lowest NPV (42.2) and was the only symptom showing agreement with laboratory-confirmed dengue (φ = 0.38). The presence of exanthema and thrombocytopenia led to a greater likelihood of concordant clinical and laboratory diagnoses (exanthema: OR: 4.23; 95% CI: 2.09 to 8.57; thrombocytopenia: OR: 4.02; 95% CI: 1.32 to 12.27). Conclusions We found substantial variation in sensitivity, specificity, PPV and NPV of dengue signs and symptoms. For accuracy, clinical and laboratory diagnosis of dengue should be performed concurrently. When laboratory tests are not available, we suggest focusing on the clinical manifestations most associated with dengue.

scholarly journals A systematic review and meta-analysis of pregnancy and COVID-19: Signs and symptoms, laboratory tests, and perinatal outcomes

2020 ◽  
Author(s):  
Soheil Hassanipour ◽  
Saeed Bagheri Faradonbeh ◽  
Khalil Momeni ◽  
Zahra Heidarifard ◽  
Mohammad-Javad Khosousi ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Laboratory Tests ◽  
Post Partum ◽  
Meta Analysis ◽  
Clinical Manifestations ◽  
Perinatal Outcomes ◽  
Signs And Symptoms ◽  
Lymphocyte Ratio ◽  
Laboratory Test Results ◽  
Common Sign

Background: Coronavirus Disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 appeared in December 2019 in Wuhan, China. Objective: To investigate the clinical manifestations including signs and symptoms, laboratory results, and perinatal outcomes in pregnant women with COVID-19. Materials and Methods: Scholarly databases such as PubMed via LitCovid hub, Embase, Scopus, Web of sciences, and Google scholar were searched on April 7, 2020. Meta-analysis was performed via comprehensive meta-analysis software using the Mantel-Haenszel method. The event rate with 95% CI was calculated for each variable. Results: Ten studies were selected. The pooled prevalence for fever, post-partum fever, cough, myalgia, fatigue, dyspnea, sore throat, and diarrhea were 66.8%, 37.1%, 35%, 24.6 %, 14.9%, 14.6%, 11.5%, and 7.6%, respectively. Laboratory test results were 49.8% for lymphopenia, 47.7% for leukocytosis, 83.7% for elevated neutrophil ratio, 57% for elevated C-reactive protein, and 71.4% for decreased lymphocyte ratio. The rate of cesarean section for delivery in all cases was 84%. Of the newborns of the corona positive mothers, only one had a positive test result. Also, there was only one death due to a decreased lymphocyte ratio. Conclusion: Fever was the most common sign and symptom in pregnant women with COVID-19. Among the laboratory tests, the highest amount was related to elevated neutrophil ratio. It seems that due to the differences between pregnant women and the general population, special measures should be considered to treat these patients. Key words: COVID-19, Pregnancy, Diagnosis, Signs and symptoms, Meta-analysis.

Clinical Characteristics of Pediatric Patients with Ocular Toxocariasis in China

2016 ◽  
Vol 235 (2) ◽  
pp. 97-105 ◽  
Author(s):  
Yalu Liu ◽  
Qi Zhang ◽  
Jing Li ◽  
Xunda Ji ◽  
Yu Xu ◽  
...  
Keyword(s):  
Rural Areas ◽  
Clinical Characteristics ◽  
Pediatric Patients ◽  
Age Of Onset ◽  
Age Groups ◽  
Clinical Signs ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Enzyme Linked Immunosorbent Assay ◽  
Ocular Toxocariasis

Objective: The aim of the study was to analyze the clinical characteristics of pediatric patients with ocular toxocariasis. Methods: Ocular toxocariasis was diagnosed and treated in 46 children from Shanghai and surrounding provinces. The diagnosis of ocular toxocariasis was confirmed immunologically by performing an enzyme-linked immunosorbent assay on serum and/or intraocular fluid. All pediatric patients and their guardians completed a questionnaire concerning their cases and living habits. Results: The mean age of onset was 6 ± 3 years. Most children (85%) resided in rural areas, and 91% of the children had contact with adult dogs or puppies. At the first visit, visual acuity (VA) was <20/200 in 36 cases, and we detected peripheral granuloma in 36 patients. In our study, the most common signs were vitritis, vitreous strands, and tractional retinal detachment. The Optomap 200Tx device detected granuloma with an 85% sensitivity, which is much higher than that of other techniques. We treated 40 cases (87%) with topical corticosteroids, while 28 patients (61%) were treated with systemic corticosteroids. Only 18 children (39%) required surgical intervention. All patients were examined and treated by the same ophthalmologists. Conclusions: Preschool children in China are more often affected by toxocariasis compared with other age groups. The most common signs included unilateral granuloma and ocular inflammation. In our study, clinical manifestations were severe and complicated. At the first visit, VA was <20/200 in most patients. Ocular toxocariasis was diagnosed on the basis of clinical signs and symptoms; the diagnosis was confirmed by immunological testing. Techniques using the Optomap 200Tx device can facilitate the early detection and lead to better visual prognosis.

scholarly journals Validity of selected clinical signs and symptoms in diagnosis of Schistosoma mansoni infection

1991 ◽  
Vol 33 (1) ◽  
pp. 12-17 ◽  
Author(s):  
Maria Fernanda F. de Lima e Costa ◽  
Roberto S. Rocha ◽  
Daniel Colley ◽  
Giovanni Gazzenelli ◽  
Naftale Katz
Keyword(s):  
Schistosoma Mansoni ◽  
Endemic Area ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Predictive Values ◽  
Clinical Signs And Symptoms ◽  
Sensitivity Specificity

Sensitivity, specificity and positive predictive values of selected clinical signs and symptoms in the diagnosis of Schistosoma mansoni infection were evaluated in 403 individuals (69% of inhabitants over 1 year of age) in an endemic area in Brazil (Divino). Highest sensitivity (13%) was found for blood in stools. Specificity over 90% was found for blood in stools, palpable liver with normal consistency and palpable hardened liver at middle clavicular (MCL) or middle sternal lines (MSL). Hardened liver at MSL (83%) or MCL (75%), and blood in stools (78%) presented higher positive predictive values for S. mansoni infection, while palpable liver with normal consistency at MCL (45%) or MSL (48%) presented smaller values. Enlarged liver without specification of its consistency has been traditionally used as an indicator of the infection in areas where malaria or Kalazar are not endemic. Our results demonstrate that the probability that a person with blood in stools or hardened palpable liver is infected is higher than among those with palpable liver with normal consistency.

scholarly journals Inherited platelet disorders including Glanzmann thrombasthenia and Bernard-Soulier syndrome

Hematology ◽  
2013 ◽  
Vol 2013 (1) ◽  
pp. 268-275 ◽  
Author(s):  
Reyhan Diz-Küçükkaya
Keyword(s):  
Laboratory Tests ◽  
Clinical Manifestations ◽  
Laboratory Diagnosis ◽  
Molecular Characteristics ◽  
Functional Abnormality ◽  
Excessive Bleeding ◽  
Glanzmann Thrombasthenia ◽  
Platelet Disorders ◽  
And Function ◽  
Bernard Soulier Syndrome

Abstract Inherited platelet disorders (IPDs) are a heterogeneous group of diseases affecting platelet production, morphology, and function. The degree of thrombocytopenia and functional abnormality of platelets determines the clinical manifestations. Although severe deficiencies may cause excessive bleeding beginning in early childhood, most of IPDs have mild bleeding tendencies and therefore are not always easy to distinguish from acquired platelet disorders. The diagnosis of IPD may require extensive laboratory investigation, because current routine laboratory tests are not satisfactory for differential diagnosis in some cases, and most of the specific tests are not readily available in many countries. This review summarizes the classification and clinical and molecular characteristics of known IPDs, including Bernard-Soulier syndrome and Glanzmann thrombasthenia, with a focus on current challenges in the laboratory diagnosis and management of bleeding in these patients.

scholarly journals Genetic, structural and clinical analysis of spastic paraplegia 4

2021 ◽  
Author(s):  
Parizad Varghaei ◽  
Mehrdad A Estiar ◽  
Setareh Ashtiani ◽  
Simon Veyron ◽  
Kheireddin Mufti ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
De Novo ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Clinical Analysis ◽  
Copy Number Variations ◽  
Compound Heterozygous ◽  
Homozygous Mutation ◽  
Spastic Paraplegia ◽  
Synonymous Mutations

Background: Spastic paraplegia type 4 (SPG4), resulting from heterozygous mutations in the SPAST gene, is the most common form among the heterogeneous group of hereditary spastic paraplegias (HSPs). Objective: To study genetic and clinical characteristics of SPG4 across Canada. Methods: The SPAST gene was analyzed in a total of 696 HSP patients from 431 families by either HSP-gene panel sequencing or whole exome sequencing (WES). We used Multiplex ligation-dependent probe amplification to analyze copy number variations (CNVs), and performed in silico structural analysis of selected mutations. Clinical characteristics of patients were assessed, and long-term follow-up was done to study genotype-phenotype correlations. Results: We identified 157 SPG4 patients from 65 families who carried 41 different SPAST mutations, six of which are novel and six are CNVs. We report novel aspects of mutations occurring in Arg499, a case with homozygous mutation, a family with probable compound heterozygous mutations, three patients with de novo mutations, three cases with pathogenic synonymous mutation, co-occurrence of SPG4 and multiple sclerosis, and novel or rarely reported signs and symptoms seen in SPG4 patients. Conclusion: Our study demonstrates that SPG4 is a heterogeneous type of HSP, with diverse genetic features and clinical manifestations. In rare cases, biallelic inheritance, de novo mutation, pathogenic synonymous mutations and CNVs should be considered.

scholarly journals Clinical Characteristics of Inpatients with Anaphylaxis in China

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Rui Tang ◽  
Han-Yi Xu ◽  
Ju Cao ◽  
Shi Chen ◽  
Jin-Lu Sun ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Multiple Organ ◽  
Female Ratio ◽  
Multisystem Involvement ◽  
Organ Systems ◽  
Number Of Patients ◽  
Male Patients ◽  
Male To Female

Objective.To analyze the clinical characteristics of inpatients with anaphylaxis and the factors that influenced those characteristics.Methods.Using the patient records from 1990 to 2013 from three highly ranked Chinese hospitals, we retrospectively analyzed the characteristics of 108 inpatients with anaphylaxis (not anaphylaxis admitted).Results.The mean patient age was42±20years old and male-to-female ratio was 1 : 1.3. The number of patients with anaphylaxis increased gradually, and cases diagnosed after 2005 accounted for 68.5% of the 108 total cases. The most common trigger was medications. The most common clinical manifestations included cutaneous, nervous, respiratory, circulatory, and digestive signs and symptoms. Male patients were more likely to experience loss of consciousness. Multisystem involvement was more likely to develop in patients with low BP, whereas it was uncommon in those with anaphylaxis induced by antibiotics or anesthetics. Epinephrine was used as the first-line treatment for 56 cases.Conclusions.Inpatient with anaphylaxis was more common in female patients and the number increased gradually during the study period. The most common trigger was medications. Patients with low BP were prone to having multisystem involvement, whereas the cases of anaphylaxis induced by antibiotics and anesthetics were less likely to involve multiple organ systems.

scholarly journals Subtle Clinical Manifestation in SLE: Clinically and Laboratory Diagnosis and Follow Up

2021 ◽  
Vol 15 (7) ◽  
pp. 2033-2035
Author(s):  
Edward Kurnia Setiawan Limijadi ◽  
Lisyani B. Suromo
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Clinical Manifestation ◽  
Lupus Erythematosus ◽  
Blood Count ◽  
Complete Blood Count ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Laboratory Diagnosis ◽  
Systemic Lupus ◽  
Function Test

Systemic Lupus Erythematosus (SLE) cases in pediatric are uncommon, compared to adult patients, who are mostly undetected at primary healthcare, especially with subtle clinical manifestations. Detection is necessary as early as possible so that further progressivity can be controlled. A 12-year-old child came with a rash on the face confirmed by a physical examination as malar rash and discoid rash. Laboratory results showed a positive antinuclear antibody (ANA) and double-stranded DNA (dsDNA) while complete blood count, liver function test, kidney function test and urinalysis were found within normal limits. Based on those findings we conclude that the diagnosis was SLE with subtle clinical manifestation. Evaluation needs to be done at least every 6 months as a scoring of the activity of disease and organ damage. The evaluation includes signs and symptoms, laboratory work-up such as complete blood count, organ function test, urinalysis, and immunologic parameters. Keywords: systemic lupus erythematosus, pediatric, subtle clinical manifestation

Clinical Characteristics of Cannabis Use Disorder

2018 ◽  
pp. 72-90
Author(s):  
Tammy A. Chung ◽  
Ken C. Winters
Keyword(s):  
Clinical Characteristics ◽  
Signs And Symptoms ◽  
Cannabis Use ◽  
Cannabis Use Disorder ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
The Core ◽  
Treatment Gaps ◽  
Other Substances ◽  
Criteria For Diagnosis

This chapter reviews the signs and symptoms of cannabis use disorder (CUD). Core clinical characteristics of addiction as reflected by the fourth and fifth editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) apply to cannabis, although certain substance use disorder symptoms are less salient to cannabis relative to other substances. The chapter addresses cannabis use prevalence, onset and progression of cannabis use, and heterogeneity in the course of cannabis use. The core features of addiction and the DSM CUD diagnosis are described with reference to the prevalence of CUD based on the fourth edition of the DSM, differences between the fourth and fifth editions for the criteria for diagnosis, and DSM-based cannabis symptoms. The course of CUD and remission and recovery from CUD are also addressed. The chapter closes with a discussion of research and treatment gaps.

The clinical features of combined central and peripheral demyelination and antibodies against the node of Ranvier

2021 ◽  
pp. 135245852110281
Author(s):  
Xiaodan Hou ◽  
Yan Liang ◽  
Pan Cui ◽  
Junwei Hao
Keyword(s):  
Peripheral Nerves ◽  
Laboratory Tests ◽  
Clinical Characteristics ◽  
Clinical Manifestations ◽  
Node Of Ranvier ◽  
Intravenous Immunoglobulins ◽  
Modified Rankin Scale ◽  
Motor Weakness ◽  
Myelin Associated Glycoprotein ◽  
Abnormal Visual

Background: Combined central and peripheral demyelination (CCPD) is a disease of inflammatory demyelination that affects central and peripheral nerves simultaneously or temporally separated. Objectives: This study evaluated the clinical characteristics and the existence of antinodal/paranodal antibodies in patients with CCPD. Methods: We reviewed the clinical manifestations, laboratory tests, electrophysiological examinations, neuroimaging findings, treatment, and prognosis of 31 patients with CCPD. Using a live cell–based assay, we tested antinodal/paranodal antibodies. Results: The most common symptoms were motor weakness (83.3%), hyporeflexia (63.3%), and sphincter disturbance (58.1%). In total, 16.6% of patients had impaired vision symptoms, whereas 33.3% of patients had abnormal visual-evoked potentials (VEPs). A total of 21.1% (4/19) of patients were positive for anti-AQP4 (aquaporin 4) antibodies, 20.0% (2/10) of patients were positive for anti-NF155 (neurofascin-155) antibodies, and 10.0% (1/10) of patients were positive for anti-MAG (myelin-associated glycoprotein) antibodies. The effective rates of intravenous corticosteroids, intravenous immunoglobulins, and rituximab were 72.2%, 37.5%, and 100%, respectively. At the illness peak, 75% of patients with CCPD had an mRS (modified Rankin Scale) score of 4 or greater. In remission, 37.5% had an mRS score of 4 or greater. Conclusion: The clinical manifestations of patients with CCPD are highly heterogeneous. We recommend testing antinodal/paranodal antibodies for patients with CCPD.

scholarly journals Epidemiological and Clinical Characteristics of COVID-19: A Retrospective Multi-Center Study in Pakistan

2021 ◽  
Vol 9 ◽  
Author(s):  
Mehmood Ahmad ◽  
Bilal Mahmood Beg ◽  
Arfa Majeed ◽  
Sadaf Areej ◽  
Sualeha Riffat ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Clinical Aspects ◽  
Chi Square ◽  
Chi Square Test ◽  
History Of ◽  
Novel Coronavirus ◽  
Multi Center Study ◽  
Center Study

The emergence of a pathogen responsible for a mysterious respiratory disease was identified in China and later called a novel coronavirus. This disease was named COVID-19. The present study seeks to determine the epidemiological and clinical characteristics of COVID-19 in Pakistan. This report will exhibit a linkage between epidemiology and clinical aspects which in turn can be helpful to prevent the transmission of the virus in Pakistan. A retrospective, multiple center study was performed by collecting the data from patients' with their demographics, epidemiological status, history of co-morbid conditions, and clinical manifestations of the disease. The data was collected from 31 public-sector and 2 private hospitals across Pakistan by on-field healthcare workers. A Chi-square test was applied to assess the relationship between categorical data entries. A total of 194 medical records were examined. The median age of these patients was found to be 34 years. A total of 53.6% active cases were present including 41.2% males and 12.4% females till the end of the study. Adults accounted for most of the cases (94.3%) of COVID-19. Fever (86.60%), cough (85.05%), fatigue (36.60%), dyspnea (24.74%), and gastrointestinal discomfort (10.31%) were among the most frequently reported signs and symptoms by the patients. However, 4.12% of the total patient population remained asymptomatic. The median duration of hospital stay was found to be 14 (0–19) days. The earliest source of the spread of the virus may be linked to the foreigners traveling to Pakistan. Spread among men was more as compared to women. A few cases were found to be positive, due to the direct contact with pets or livestock. Hypertension (7.73%), diabetes (4.64%), cardiovascular conditions (2.58%) were the most common co-morbidities. The percentage mortality was 2.50% with the highest mortality among elders.

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