scholarly journals Diagnostic and Prognostic Validity of Proadrenomedullin among Neonates with Sepsis in Tertiary Care Hospitals of Southern India

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Raja Kannan ◽  
Suchetha S. Rao ◽  
Prasanna Mithra ◽  
B. Dhanashree ◽  
Shantharam Baliga ◽  
...  

Introduction. To evaluate Proadrenomedullin (Pro-ADM) as the diagnostic and prognostic marker in neonatal sepsis. Materials and Methods. In this cross-sectional study, Pro-ADM levels were estimated in 54 neonates with clinical sepsis and positive sepsis screen (cases) and 54 controls without clinical sepsis. Repeat Pro-ADM levels were estimated after 72 hours in cases. Pro-ADM levels were compared with the clinical outcome. Results and Discussion. Median Pro-ADM levels in cases were 31.8 (IQR: 27.8-39.4) pmol/ml which was significantly higher than controls 5.1 (IQR; 3.1-7.7) pmol/ml. From the constructed ROC curve, a value of 14.5 pmol/ml was taken as the cut-off for sepsis. Pro-ADM had 100% sensitivity, specificity, and positive predictive values (PPV) in detecting sepsis at 14.5 pmol/ml. Among cases, a decrease in Pro-ADM level by 10 pmol/ml was associated with 99% survival. Pro-ADM value of 35 pmol/ml had 100% specificity and PPV in predicting mortality. Conclusion. Pro-ADM can be used as a single biomarker for detecting neonatal sepsis, predicting clinical outcome and prognosis.


2016 ◽  
Vol 21 (4) ◽  
pp. 240
Author(s):  
Aqeela Ayub ◽  
Akmal Laeeq Chishti ◽  
Khwaja Amjad Hassen

AbstractObjective:To determine the validity of haematologic markers for sepsis screen (absolute neutrophil count (ANC), immature/total leukocytes ratio (I:T), platelets count (PC), C-reactive protein (CRP) and serum ferri-tin), both individually and in combination for early diagnosis of neonatal sepsis.Methodology:This cross sectional analytical study was conducted in Neonatal Section of Paediatric Medicine Unit II, Mayo Hospital Lahore for one year. One hundred neonates presenting with clinical sepsis were included through non-probability, purposive sampling after written informed consent. Blood sample was collected for full hematologic screening as mentioned above along with blood cultures. Data was entered and analyzed using SPSS Version 17.Results: There were 68 male and 32 females including 31 preterm and 69 term neonates. 45 neonates were <1 day age, 40 neonates 1 10 days age, 15 neonates 11 30 days age. Mean weight of study cases was 2.35 0.69 Kg. Sensitivity, specificity and diagnostic accuracy of ANC were 77.3%, 100% and 90%, for I/T ratio were 81.8%, 81.4% and 81%, for CRP were 75%, 83.9% and 80%, for platelet count were 84.1%, 71.4% and 77%, for serum ferritin were 88.6%, 69.6% and 78% respectively. Sensitivity, specificity and diagnostic accuracy of combination of SF + I:T was 81.8%, 82.1% and 82%, for combination of SF + ANC + I:T were 93.2%, 71.4% and 81% for combination of SF + CRP + I:T were 93.2%, 67.9% and 79%, for combination of SF + I:T + PC were 90.9%, 58.9% and 73%, for combination of SF + CRP + ANC were 95.5%, 69.6% and 81%. Sensitivity, specificity and diagnostic accuracy of combination of all markers were 90.9%, 76.8% and 83% respectively.Conclusion:Results of our study showed that we can safely rely on hematologic markers for confirmation of neonatal sepsis both singly and in combination. We suggest that these tests may help to diagnose neonatal sepsis earlier.Key Words:Neonatal Sepsis, Diagnostic accuracy, Lethargy, Prolong rupture of membrane, Temperature instability, Hematologic markers.



2009 ◽  
Vol 16 (03) ◽  
pp. 432-437
Author(s):  
MASOMEH ASGHARNIA ◽  
Zahra Mohammad Tabar ◽  
MARZIEH MEHRAFZA ◽  
Mary am Shakiba ◽  
MONA OUDI ◽  
...  

B a c k g r o u n d : Hysteroscopy is a valuable diagnostic and therapeutic modality in the management of infertility. A i m : To evaluatethe consistency of hysteroscopy based on a histopathological report from endometrial specimens for intrauterine disorders. Materials andMethods: This is a cross-sectional study. The study included 115 infertile patients. All were admitted for investigation of infertile women beforeassisted reproduction in Mehr infertility institute between 2006 and 2007 hysteroscopy, and histological evaluation of endometrial biopsyperformed.We compared the efficacy of hysteroscopy in the diagnosis of benign intrauterine pathology in infertile women in whom the diagnosiswas confirmed by histologic studies. The women had a complete evaluation with preoperative hysteroscopy, and histological analysis of uterinecavity specimens. Sensitivity, specificity, predictive and negative predictive values were calculated for hysteroscopy considering the histologicalstudy as 100%. Results: Sensitivity and specificity of sonography in diagnosing the polyp were stated 81 % and 64% respectively. Sensitivityand specificity of hysteroscopy showed of polyps revealed 85% and 84% respectively. The results indicated that Sensitivity and specificity ofsonography in diagnosing the myoma were 25% and 98% respectively. Sensitivity and specificity of hysteroscopy in diagnosing the myomawere expressed 50% and 93% respectively. C o n c l u s i o n : Hysteroscopy is a safe and rapid direct visualisation of the uterine cavity. We believeit should be replaced by the diagnostic hysteroscopy as a first line infertility investigation.



2015 ◽  
Vol 12 (1) ◽  
pp. 2-6
Author(s):  
Wahida Begum ◽  
Ahmed Hossain ◽  
Waziha A Jahan ◽  
Mahbuba Shirin ◽  
M Abdullah Yusuf ◽  
...  

Background: CT-scan is useful for the detection of hepatic mass. Objective: The purpose of the present study was to see the predictive values of CT scan in the diagnosis of malignant hepatic mass. Methodology: This cross sectional study was carried out in the Department of Radiology and Imaging at Mymensingh Medical College Hospital (MMCH), Mymensingh, Banghabandhu Sheikh Mujib Medical University (BSMMU), Dhaka and Dhaka Medical College Hospital (DMCH), Dhaka during the period of 1st January 2006 to 31st December 2007. Patients admitted in the Department of Medicine and Department of Hepatobiliary of MMCH, BSMMU, and DMCH with the clinical diagnosis of fever, abdominal pain, anorexia, nausea/vomiting, loss of appetite, jaundice, weight loss and ascites were selected as study population. CT scan and histopathology were performed to all the patients. Result: A total number of 50 patients were recruited for this study.. The sensitivity for multiplicity was 71.4%, specificity was 63.6%, accuracy was 68%, PPV was 71.4% and NPV was 63.6%. The sensitivity for hypodensity as a sign of malignancy was 60.7%, specificity was 18.2%, accuracy was 42.0%, PPV was 48.6% and NPV was 26.7%. The sensitivity, specificity, PPV, NPV and accuracy of contrast enhancement were 100.0%, 22.7%, 62.2%, 100.0% and 66.0% respectively. Again the sensitivity, specificity, PPV, NPV and accuracy of detection of pressure effect on biliary apparatus by CT-scan were 100.0%, 22.7%, 62.2%, 100.0% and 66.0% respectively. Again the sensitivity, specificity, PPV, NPV and accuracy of detection of Lymphadenopathy by CT-scan were 35.7%, 95.5%, 90.9%, 53.8% and 62.0% respectively. The sensitivity, specificity, PPV, NPV and accuracy of detection of Portal vein invasion by CT-scan were 14.3%, 100.0%, 100.0%, 47.8% and 52.0% respectively. The sensitivity, specificity, PPV, NPV and accuracy of detection of hepatic vein invasion by CT-scan were 10.7%, 100.0%, 100.0%, 46.8% and 50.0% respectively. The sensitivity, specificity, PPV, NPV and accuracy of detection of inferior vena cava (IVC) invasion by CT-scan were 7.1%, 100.0%, 100.0%, 45.8% and 48.0% respectively. Conclusion: CT is a useful diagnostic tool for the detection of malignant hepatic masses.Journal of Science Foundation, 2014;12(1):2-6



2020 ◽  
Vol 58 (232) ◽  
Author(s):  
Bijay Raj Pandit ◽  
Ashish Vyas

Introduction: Neonatal mortality rate is highest in sub-Saharan Africa and Southern Asia region. The present study is undertaken to find out prevalence of neonatal sepsis, recognize bacterial pathogens, neonatal risk factors, major symptoms, and their antibiotic sensitivity pattern in neonates in tertiary care hospital in southern Nepal. Methods: A descriptive cross-sectional study was carried out in a tertiary care hospital from 2nd January 2017 to 20th February 2018 after approval (Ref: 125/2016-17). The sample size was calculated and convenience sampling was done. Data were collected from hospital records and microbiology laboratory and analyzed by Statistical Package for Social Sciences. Results: Out of 1200 clinically suspected cases, early-onset neonatal sepsis was seen in 290 (79.89%). A positive culture was seen in 363 (30.25%) where maximum bacterial growth was found in 254 (69.98%) males. Preterm gestational age was seen in 265 (73%), low birth weight 284 (78.23%), a vaginal delivery mode in 279 (76.90%), and delivery in hospital in 232 (63.91%). Likewise, Staphylococcus aureus in 229 (63.08%) was found maximum followed by Klebsiella pneumoniae in 48(13.22%). The major symptom observed was Respiratory distress in 245 (20.41%) while culture positive was seen in poor cry in 94 (53.10%). Mainly effective antibiotics against Gram-positive and gram-negative organisms were Linezolid in 250 (94%) and Imipenem in 46 (90.19%), whereas Penicillin-G in 254 (99.21%) and Ampicillin in 38 (94.74%) found resistance towards organisms respectively. Conclusions: The high prevalence of neonatal sepsis in our study reflects a huge challenge to reduce the neonatal mortality rate to 12 by 2030 of Sustainable Development Goals. Bacterial isolates exhibited higher resistance towards commonly used antibiotics.



Author(s):  
K O Elimian ◽  
P R Myles ◽  
R Phalkey ◽  
A Sadoh ◽  
C Pritchard

Abstract Background Improving caregivers’ recognition of childhood malaria and pneumonia is crucial to early treatment and improving outcomes. The objective of this study was to assess the accuracy and reliability of caregivers’ recognition of malaria and pneumonia (lay diagnosis) as compared to the revised IMCI guidelines. Methods A cross-sectional study design was used to recruit 903 children aged 2–59 months who were assessed for malaria and pneumonia by health workers at five primary healthcare centres in Benin City, Nigeria. Accuracy of lay diagnosis as compared to the revised IMCI guidelines was assessed using sensitivity, specificity, positive and negative predictive values and area under the receiver operating characteristic curve (AUROC) values. Results The accuracy of caregivers’ ability to recognise malaria (AUROC: 0.60; 95% CI: 0.57–0.64) and pneumonia (AUROC: 0.54; 95% CI: 0.50–0.58) was, respectively, moderate and poor as compared to the IMCI guidelines. Caregivers were better able to identify children without than those with malaria and pneumonia. Agreement between caregivers and the IMCI guidelines for malaria and pneumonia diagnosis was poor (k = 0.14, 95% CI: 0.09–0.19; P = 0.0001). Conclusion Caregivers’ ability to recognise these childhood diseases as compared to the IMCI guidelines was poor overall, which was partly due to the approach used to ascertain lay diagnosis.



Author(s):  
Ashok Mysore Lakshminarayana ◽  
Shweta Mallikarjun Kumbar ◽  
Manohara Melur Chandregowda ◽  
Kiran Warrier

Background: Gastroesophageal varices due to portal hypertension in patients with liver cirrhosis is an important cause of morbidity and mortality. Gold standard investigation for varices is esophagogastroduodenoscopy and patients are advised to undergo regular follow up based on the risk stratification. But the invasive nature, risk of procedure-related complication and lack of accessibility and affordability makes it important to identify simpler methods to screen patients. Platelet count/spleen diameter (PSD) ratio has been validated as a marker for oesophageal varices (OV) in multiple studies but with varying results. The present study was conducted to evaluate the accuracy of PSD ratio in OV.Methods: A cross-sectional study was conducted in patients diagnosed with liver cirrhosis. Clinical examination, relevant laboratory investigations, abdominal ultrasound and endoscopy were performed and data were recorded. PSD was calculated. Receiver-operator characteristics curves were plotted to determine cut-off values. Sensitivity, specificity, positive and negative predictive values were calculated.Results: Total 100 patients were included in this study, out of which 25% of patients did not have varices on endoscopy. The mean PSD was for patients without varices 1242.82 (253.45) and 883.51 (582.38467) for patients with OV. The area-under-curve was 0.823, 95% CI=0.734-0.912, p value=0.000001. The cut-off value for PSD was calculated from the ROC analysis was 1077. The sensitivity, specificity, positive and negative predictive values were 76%, 88%, 95% and 55% respectively.Conclusions: PSD ratio is not an efficient parameter for detection of varices in patients with liver cirrhosis. The current evidence does not support its role as a screening test for identification of patients with OV.



Author(s):  
Jackson Chipaila ◽  
◽  
Alex Makupe ◽  
Evans Malyangu ◽  
Daniel Maswahu ◽  
...  

Introduction: Thyroid nodules are one of the common surgical presentations in Africa and are of great concern because of their potential to be malignant. Zambia is not excluded from these common surgical conditions. However, there are no pre-operative cellular or intra-operative tissue diagnoses of the thyroid nodules done before thyroidectomy making it difficult to plan for an optimal and definitive management. Fine needle aspiration cytology (FNAC) is known to play a pivotal role in the screening and management of thyroid swellings. This study serves to assess the diagnostic accuracy of FNAC on thyroid nodules in patients at two tertiary hospitals in Zambia in order to establish a basis for introducing its use in the management of thyroid nodules at the institutions. Objectives: To evaluate the accuracy of FNAC, as compared to histopathology, in the diagnosis of thyroid nodules at University Teaching Hospital (UTH) and Ndola Central Hospital (NCH) in Zambia. Methods: This was a prospective cross-sectional study conducted in UTH and NCH surgery department from June 2014 to March 2015. Seventy-three patients, who presented with palpable thyroid nodules and underwent thyroidectomy, were enrolled in the study. The FNAC diagnosis of the patients was compared to the histopathology finding following thyroidectomy. Results: Females made up the majority of the patients (n=67, 91.8%). The ages of the patients ranged from 18 to 78 years. The mean age was 44.3 years and the peak age of incidence was in the fourth decade. All patients were clinically euthyroid at the time of enrolment. The FNAC findings included 23 cases reported as unsatisfactory (31.5%); 29 cases benign (39.7%); 2 cases atypical (2.7%); 6 cases suspicious (8.2%); and 13 cases malignant (17.8%). Histopathology findings were available from all 73 tissue samples of participants, of which 55 (75.3%) and 18 (24.7%) were reported as benign and malignant respectively. Of the 18 malignant cases identified by histology, the most common cancer was follicular carcinoma (n=9, 50%), followed by papillary carcinoma (n=6, 33.3%) and undifferentiated carcinoma (n=3, 16.7%). FNAC, in this study, had sensitivity, specificity, negative and positive predictive values, and accuracy of 83.33%, 89.09%, 94.23 and 71.42%, and 87.67% respectively. Conclusion: In this study, FNAC of thyroid nodules had a high sensitivity, specificity, predictive values and accuracy, and can therefore be recommended to be adopted as a pre-operative tool for screening of thyroid nodules.



2021 ◽  
Vol 15 (10) ◽  
pp. 3381-3383
Author(s):  
Naheem Ahmed ◽  
Khawaja Tahir Aziz ◽  
Rashada Bibi ◽  
Munazza Nazir ◽  
Sadaf Nawaz ◽  
...  

Objective: To determine the frequency of neonatal thrombocytopenia among patients presented with sepsis at tertiary care Hospital. Methodology: This cross-sectional study was conducted at the Department of pediatrics SKBZ/CMH Muzaffarabad, during six months from September 2018 to March 2019. All the diagnosed septic neonates, age < 28 days and either gender were included. Their basic demographic data like age and gender, along with their contact details were taken. The sample of blood was sent in blood culture bottles to hospital laboratory to confirm bacterial growth, that was diagnosed as sepsis. Blood sample was sent to the hospital also to diagnose thrombocytopenia. Reports were consulted by the pathologist. All the data were collected by a structured study proforma. All data were entered and analyzed with the help of SPSS version 22. Results: The mean age of patients was 8.92 ± 5.40 days with minimum and maximum age as 1 and 27 days. There were 117(47.56%) males and 129(52.44%) female cases. A total of 40(16.26%) cases had their maternal hypertension, 54(21.95%) neonates had gram + and 157(63.82%) neonates had Gram negative. A total of 63(25.61%) cases had thrombocytopenia while 183(74.39%) neonates were seen without thrombocytopenia. The frequency of thrombocytopenia was statistically insignificant according to gender and types of culture (p->0.05). Conclusion: It is concluded that frequency of thrombocytopenia in neonatal sepsis was found in a quarter of the cases. In neonatal sepsis, thrombocytopenia must be ruled out at patient’s presentation and must be treated as early as possible as thrombocytopenia is an independent risk factor for sepsis-associated mortality. Keywords: Incidence, thrombocytopenia, neonatal sepsis



2015 ◽  
Vol 22 (11) ◽  
pp. 1494-1498
Author(s):  
Rajia Liaqat ◽  
Najiya Barkat ◽  
Asif Hanif

Objectives: The objective of this study was to determine the diagnostic utility ofp53 in differentiating oral squamous papilloma and squamous cell carcinoma. Study Design:A cross-sectional study. Setting: Pathology Department of Shaukat Khanum Memorial CancerHospital and Research Center Lahore. Period: Six months (6-10-10 to 6-04-11). Patients andMethods: A total of 100 oral biopsies fulfilling the inclusion criteria were collected. The expressionof P53 was observed in biopsies of squamous papilloma and squamous cell carcinoma. Datawas entered and analyzed on SPSS version 20 and was analyzed in same package. Sensitivity,specificity, positive predictive and negative predictive values were calculated along theirconfidence intervals at 95% level. Results: One hundred oral lesions were studied, of which 90cases were of squamous cell carcinoma and 10 cases were of squamous papilloma. Majorityof the patients were male (60%). Mean age was 46 years. P53 IHC stain had sensitivity of 92%and specificity of 80% and diagnostic utility of 91% in lesions of squamous cell carcinoma.Conclusion: P53 is positively expressed in oral squamous cell carcinoma and is negativein squamous papilloma. Hence evaluation of p53 expression can be a useful adjunct in thediagnosis of squamous cell carcinoma, especially in cases where it is difficult to distinguishbetween these two entities on morphological grounds.



2021 ◽  
Vol 15 (6) ◽  
pp. 1237-1239
Author(s):  
A. Ammar ◽  
M. A. Z. Husnain ◽  
M. Arshad ◽  
T. M. Mirza ◽  
Z. Arshad ◽  
...  

Aim: To evaluate the accuracy of ultrasound in determining the phenotypic foetal gender in all three trimesters. Study design: Cross sectional study. Place and duration of study: Department of Diagnostic Radiology Combined Military Hospital Lahore from 1st January 2020 to 30th April 2020. Methodology: Three hundred and seventy two patients in the inclusion criteria were selected. Ages of patients, gestational ages of foetuses and their genders were determined according to the ultrasonographic signs using ultrasound examination. Patients were contacted 3 weeks after the estimated date of delivery and phenotypic sex recorded. Results: Mean age was 34 years. Median gestational age was 21 weeks 3 days. Accuracy of gender determination by ultrasound in 1st, 2nd and 3rd trimesters was 62%, 97% and 95% respectively. Sensitivity and specificity of ultrasound in 1st trimester for males are 66% and 72%; and for females are 72% and 66% respectively. Positive and negative predictive values for male are 69% and 71%; and for female are 71% and 69% respectively. Sensitivity and specificity of ultrasound in 2nd trimester for males are 95% and 100%; and for females are 100% and 95% respectively. Positive and negative predictive values for male are 100% and 94%; and for female are 94% and 100% respectively. Sensitivity and specificity of ultrasound in 3rd trimester for males are 94% and 96%; and for females are 96% and 94% respectively. Positive and negative predictive values for male are 97% and 93%; and for female are 93% and 97% respectively. Conclusion: There is a high accuracy of ultrasound in determination of fetal gender in second and third trimesters. Keywords: Ultrasound, Gender, Trimester, Sensitivity, Specificity, Predictive Value



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