scholarly journals Postanesthetic Cold Sensibility Test as an Indicator for the Efficacy of Inferior Alveolar Nerve Block in Patients with Symptomatic Irreversible Pulpitis of Mandibular Molars

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Mohamed El Sayed ◽  
Kamis Gaballah
Keyword(s):  
Gold Standard ◽  
Pain Perception ◽  
Inferior Alveolar Nerve ◽  
Cold Test ◽  
Standard Test ◽  
Youden Index ◽  
Gold Standard Test ◽  
Sensitivity Specificity ◽  
Pulpal Anesthesia ◽  
Irreversible Pulpitis

Aim of the Work. The goal of the current study was to investigate the capability of the cold test to predict the profound pulpal anesthesia before starting the endodontic treatment of mandibular first molars with symptomatic irreversible pulpitis (SIP). Materials and Methods. This study was conducted on the mandibular first molars of 54 patients (35 males and 19 females) with signs and symptoms of SIP. To anesthetize the affected molars, all patients received a single carpule of 2% lidocaine with 1 : 100000 epinephrine using a standardized inferior alveolar nerve block (IANB) technique. The cold test was conducted before beginning the endodontic procedures and after gaining lip numbness, and the results were reported as either positive or negative response. The root canal preparation (RCP) was then initiated and the patients’ responses were documented (Gold standard test). True pulpal anesthetic failure was described as a pain perception during the access cavity and pulp tissue removal. True pulpal anesthesia was defined as no pain or discomfort during the access cavity and pulp extirpation. The qualitative variables frequencies and percentages of patients with true/false positive and negative responses were determined and then compared using the Chi-square test. The pain perception of male and female patients during the cold test and gold standard was compared using the Fisher exact test. The following diagnostic parameters were calculated using an online statistical calculator: sensitivity, specificity, predictive values, accuracy, and Youden index. In addition, a receiver operating characteristic curve (ROC) was constructed and the area under the curve (AUC) was calculated. Results. The overall percentage of actual failure of pupal anesthesia was 57%. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and Youden index for the cold test were 0.87, 0.91, 0.93, 0.84, 0.89, and 0.78, respectively. There was no statistically significant difference between male and female patients regarding their responses to cold testing and the gold standard test ( P > 0.05 ). Besides, the patients’ reactions to the cold test were significantly matched with their reactions to the gold standard test ( P < 0.05 ). The area under the ROC was mostly 0.9. Conclusion. The cold test could be a valuable and accurate method for predicting the potential pupal anesthesia before beginning the endodontic treatment of mandibular molars with symptomatic irreversible pulpitis, particularly after obtaining postanesthetic soft tissue numbness.

Multiplex PCR, Clinical Amsel’s Criteria and Microbiological Nugent Score for Diagnosis of Bacterial Vaginosis and Detection of its Virulence

2021 ◽  
Vol 30 (2) ◽  
pp. 145-152
Author(s):  
Eman H. Salem ◽  
Heba M. Abo shady ◽  
Sanaa S. Hamam
Keyword(s):  
Bacterial Vaginosis ◽  
Multiplex Pcr ◽  
Gold Standard ◽  
Standard Test ◽  
Pcr Detection ◽  
Health Concern ◽  
Nugent Score ◽  
Gold Standard Test ◽  
Sensitivity Specificity ◽  
Better Than

Background: bacterial vaginosis is universally the commonest vaginal infection in reproductively active females. It causes major consequences as preterm labor, predisposing to sexually-transmitted infections and HIV infections. Although it is a public health concern, no one knows exactly its pathogenesis when some say that it is just disturbance in vaginal floral balance predisposing to clinical symptoms and signs, where the predominant Lactobacilli in vagina become replaced by other facultative and anaerobic bacteria. Objective: To evaluate different diagnostic tests, Amsel’s criteria and PCR and their ability to diagnose bacterial vaginosis in comparison to the gold standard test, Nugent score in terms of sensitivity, specificity, NPV and PPV. Also test for prevalence of BV among included females. Methodology: screening was done for all females in presence or absence of Amsel’s criteria. Wet mount along with Gram stained films were examined in Microbiology lab and Nugent score was calculated for every patient. Cervico-vaginal aspirate samples were collected for detection of G. vaginalis, Lactobacilli and Sialidase enzyme by multiplex PCR. Results: Using Nugent score patients were categorized into bacterial vaginosis (BV) group (32%), non-BV group (51%) and 17 % were in intermediate group. Sensitivity, specificity, PPV and NPV of whole Amsel’s criteria (100, 80.4, 76.2 and 100 % respectively) were better than using any criterion alone. Using multiplex PCR, detection of G. vaginalis (100%) and sialidase gene (93.7%) were higher in BV group and Lactobacilli gene (100%) higher in non-BV group with statistically high significant difference. Multiplex PCR detection of G. vaginalis has sensitivity (100%), specificity (92.2%), PPV (88.9%) and NPV (100%) for diagnosis of BV in relation to the gold standard test, Nugent score. Conclusion: using Amsel’s criteria as a whole is better than using individual criteria for diagnosing BV with highest sensitivity, specificity, NPV and PPV. Combined PCR detection of G. vaginalis and sialidase gene can predict occurrence of virulent BV infection. BV is associated with significant loss of protective Lactobacilli.

scholarly journals Diagnostic Value of Immature-to-Total Neutrophil Ratio in Neonatal Sepsis

2019 ◽  
Vol 8 (4) ◽  
pp. 166-170
Author(s):  
Husnain Ali ◽  
Ejaz Hussain ◽  
Imran Mahmood Khan ◽  
Iqtada Haider Shirazi ◽  
Muhammad Imran ◽  
...  
Keyword(s):  
Blood Culture ◽  
Diagnostic Accuracy ◽  
Neonatal Sepsis ◽  
Predictive Value ◽  
Gold Standard ◽  
Diagnostic Value ◽  
Standard Test ◽  
Negative Blood Culture ◽  
Gold Standard Test ◽  
Sensitivity Specificity

Background: Neonatal sepsis is the third most common reason of neonatal mortality in Pakistan. Blood culture, the gold standard test for diagnosis of neonatal sepsis, is time consuming. Therefore, rapid diagnostic tests with good specificity and sensitivity is needed for accurate and early diagnosis of this condition. The objective of this study was to determine the diagnostic value of abnormal (≥ 0.2) immature-to-total-neutrophil ratio in neonatal sepsis.Material and Methods: This cross-sectional study was carried out on 288 neonates, aged 0-28 days, admitted with suspected sepsis. Detailed history of the neonates was recorded including gender, age, birth weight, maternal age, gestational age and clinical features. Blood culture and Peripheral blood films were done in each case. Differential leucocyte counts, total Polymorphoneutrophil count (PMN), immature neutrophil count, mature neutrophil count and calculation of I/T ratio was carried out in the Pathology Department of PIMS, Islamabad. The study outcome was divided into three groups on the basis of positive or negative blood culture and I/T ratio as normal, probable sepsis and proven sepsis group. Data was analyzed by SPSS version 21.0. Diagnostic value of I/T ratio was determined in NS by calculating values of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) by considering the blood culture as the gold standard test of NS.Results: The mean age and weight of the neonates at the time of admission was 1.1 (± 0.6) days and 2.51 (± 0.40) kg, respectively. About 60% of the neonates were males and 118(41%) neonates had I/T ratio of ≥ 0.2. On the basis of positive or negative blood culture and I/T ratio, 82 (28.5%) neonates were diagnosed as proven sepsis, 43 (14.9%) neonates had probable sepsis and remaining 163 (56.6%) neonates were declared as normal. Out of 82 neonates with positive blood cultures, 75 (91.5%) had I/T ratio ≥ 0.2, while 7 (8.5%) had I/T ratio ≤ 0.2. The sensitivity, specificity, positive and negative predictive value and diagnostic accuracy of abnormal I/T ratio to diagnose neonatal sepsis was 91%, 79%, 64%, 96% and 83%, respectively.Conclusions: Due to substantially high diagnostic accuracy of I/T ratio ≥ 0.2, we recommend it as a useful, rapid and cost-effective tool in accurate diagnosis of neonatal sepsis.

scholarly journals Prevalence of feline coronavirus antibodies in cats in Bursa province, Turkey, by an enzyme-linked immunosorbent assay

2009 ◽  
Vol 11 (10) ◽  
pp. 881-884 ◽  
Author(s):  
Annamaria Pratelli ◽  
Kadir Yesilbag ◽  
Marcello Siniscalchi ◽  
Ebru Yalçm ◽  
Zeki Yilmaz
Keyword(s):  
Immunosorbent Assay ◽  
Predictive Value ◽  
Gold Standard ◽  
Population Based ◽  
Standard Test ◽  
Enzyme Linked Immunosorbent Assay ◽  
Serum Samples ◽  
High Association ◽  
Gold Standard Test ◽  
Feline Coronavirus

Feline sera from Bursa province (Turkey) were assayed for coronavirus antibody using an enzyme-linked immunosorbent assay (ELISA). The study was performed on 100 sera collected from cats belonging to catteries or community shelters and to households. The serum samples were initially tested with the virus neutralisation (VN) test and the results were then compared with the ELISA. The VN yielded 79 negative and 21 positive sera but the ELISA confirmed only 74 as negative. The ELISA-negative sera were also found to be free of feline coronoviruses-specific antibodies by Western blotting. Using the VN as the gold standard test, ELISA had a sensitivity of 100% and a specificity of 93.6%, with an overall agreement of 95%. The Kappa (κ) test indicated high association between the two tests (κ=0.86, 95% confidence interval (CI) 0.743–0.980). The positive predictive value (PPV) was 0.8, and the negative predictive value (NPV) was 0.93. The prevalence of FCoV II antibodies in the sampled population based on the gold standard was 62% (95% CI 0.44–0.77) among multi-cat environments, and 4% (95% CI 0.01–0.11) among single cat households.

scholarly journals To evaluate the diagnostic value of protein: creatinine ratio in a single voided urine sample for quantitation of proteinuria compared to those of a 24-hour urine sample in patients with preeclampsia

2014 ◽  
Vol 9 (2) ◽  
pp. 45-53
Author(s):  
S Hossain ◽  
A Ghosh ◽  
A Chatterjee ◽  
G Sarkar ◽  
SS Mondal
Keyword(s):  
Urine Sample ◽  
Gold Standard ◽  
Diagnostic Value ◽  
Standard Test ◽  
Creatinine Ratio ◽  
Urine Protein ◽  
Predictive Values ◽  
Urine Protein Excretion ◽  
Protein Excretion ◽  
Gold Standard Test

Objective: This study was done to evaluate the diagnostic value of protein: creatinine ratio in a single voided urine sample for quantitation of proteinuria compared to those of a 24 hour urine sample in patients with preeclampsia. Methods: A prospective simple random sample study was done on the hypertensive pregnant women attending the antenatal clinic or admitted in Department of Obstetrics and Gynaecology. It included all women being evaluated for preeclampsia, regardless of the alerting sign or symptom, suspected severity or co-morbid conditions. The main measures were the urinary protein to urinary creatinine ratio by random (spot) direct measurement and the 24-h urinary protein excretion by a 24-h urine collection. The data obtained was statistically analyzed. Results: Out of the 78 patients with gestational hypertension included in our study 48 patients had significant proteinuria (e”300mg/day). Only 2 patients had proteinuria of the range of greater than 3500mg. Among the patients, 50 had a positive protein: creatinine ratio (e”0.3) while 28 patients had a negative protein: creatinine ratio (<0.3). The P: C ratio was able to correctly identify 44 out of 48 patients with significant proteinuria (when the comparison is made with the gold-standard test; i.e., 24-hour urine protein). It could also identify 24 out of 30 patients without significant proteinuria as compared to the gold-standard test. In this study, the Protein: Creatinine ratio with a sensitivity of 91.67%, a specificity of 80%, positive predictive values 88% and the negative predictive values 85.71%. Conclusions: Our data suggests that the protein: creatinine ratio in single voided urine is a highly accurate test (p value < 0.0000001) for discriminating between insignificant and significant proteinuria. Based on the above findings we conclude that a random urine protein excretion predicts the amount of 24- hour urine protein excretion with high accuracy. This could be a reasonable alternative to the 24-hour urine collection for detection of significant proteinuria in hospitalised pregnant women with suspected preeclampsia. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-2, 45-53 DOI: http://dx.doi.org/10.3126/jcmsn.v9i2.9687

Guideline adherence for diagnosis of liver cancer in veterans.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 89-89 ◽  
Author(s):  
Yvonne Sada ◽  
Eric David ◽  
Hashem El-Serag ◽  
Hardeep Singh ◽  
Jessica Davila
Keyword(s):  
Median Time ◽  
Guideline Adherence ◽  
Gold Standard ◽  
Diagnostic Delay ◽  
Standard Test ◽  
Diagnostic Process ◽  
Liver Mass ◽  
Missed Appointments ◽  
Gold Standard Test ◽  
Work Up

89 Background: The incidence of hepatocellular cancer (HCC) is rising. Practice guidelines provide the recommended approach for HCC diagnosis, but adherence to diagnostic guidelines is unknown. Methods: In a national sample of veterans with confirmed HCC, we performed a retrospective chart review of patients with cirrhosis and a new liver mass on imaging between 2005 and 2011. Clinical data was used to assess adherence to American Association for the Study of Liver Diseases guidelines. Patients with inadequate data to assess guideline adherence (missing liver mass size, imaging technique, or diagnostic report) were excluded. We identified factors that contributed to guideline non-adherence. Initial liver mass date was the first date a liver mass was reported on imaging (CT, MRI, or ultrasound). Gold standard test date was the date a diagnosis of HCC could have been made by guideline recommended testing and criteria. Diagnosis date was the date a provider documented the diagnosis. Results: We reviewed charts for 380 patients. Overutilization of diagnostic tests after a gold standard test occurred in 112 patients (31%), and 17 (4%) had insufficient tests. Guidelines were not followed in 124 (33%). Of these 124, 68 (55%) had liver masses that increased in size during diagnostic work-up. The most common factors associated with guideline non-adherence were unnecessary testing such as biopsy after a gold standard image (43%) and the presence of a contraindication to a guideline recommended image or biopsy (12%). Patient factors (missed appointments, declining work-up) accounted for only 3% of cases. Median time between the initial liver mass and gold standard test was 15 days (IQR: 0-99). Median time between the initial liver mass and diagnosis was 50 days (IQR: 12-191). Most diagnoses were made by gastroenterology (51%), followed by primary care (19%), and oncology (10%). Conclusions: One-third of patients with HCC were not diagnosed based on guidelines. These concerns include confidence in diagnosis (lack of recognizing HCC diagnosis despite gold standard evidence) and over testing, which both lead to diagnostic delay. Our findings warrant further evaluation of contributory factors to develop interventions that improve the diagnostic process for HCC.

The Clinical Evaluation: A Necessary Tool for the Dysphagia Sleuth

2015 ◽  
Vol 24 (1) ◽  
pp. 18-25 ◽  
Author(s):  
James L. Coyle
Keyword(s):  
Gold Standard ◽  
Clinical Problem ◽  
Standard Test ◽  
Diagnostic Process ◽  
Comprehensive Treatment ◽  
Short Term ◽  
Speech Language Pathologist ◽  
Gold Standard Test ◽  
Very High ◽  
Health Experts

There is controversy about the necessity of clinical (bedside) swallowing examinations. Some argue that screening provides enough information to thoroughly manage a case. In instances in which the risk of an adverse event is very high, screening legitimizes short-term intervention to temporarily mitigate that risk. But comprehensive treatment based on screening is always an unguided and imprecise strategy because screening cannot identify the nature of the problem or the method that best treats the problem. As physicians and public health experts know, the diagnostic process begins with case-finding procedures that predict the presence of risk, and progresses through increasingly precise methods until the clinical problem is resolved. Sometimes the more costly gold standard examination is unnecessary. And sometimes the gold standard test is unavailable because the patient is seen in a system in which the infrastructure and expertise for conducting diagnostic instrumental testing are inaccessible, or because of wait lists, or funding issues. Such situations require the speech-language-pathologist (SLP) to determine how to gather the most and best information available under these constraints. This article will discuss the clinical examinations' role in the diagnostic process and refute the claim that it is unnecessary.

scholarly journals Anesthetic Efficacy in Irreversible Pulpitis: A Randomized Clinical Trial

2016 ◽  
Vol 27 (4) ◽  
pp. 381-386 ◽  
Author(s):  
Carlos E. Allegretti ◽  
Roberta M. Sampaio ◽  
Anna C. R. T. Horliana ◽  
Paschoal L. Armonia ◽  
Rodney G. Rocha ◽  
...  
Keyword(s):  
Success Rate ◽  
Nerve Block ◽  
Inferior Alveolar Nerve ◽  
Inferior Alveolar Nerve Block ◽  
Posterior Teeth ◽  
Mandibular Molars ◽  
School Of Dentistry ◽  
Mandibular Posterior Teeth ◽  
Pulpal Anesthesia ◽  
Irreversible Pulpitis

Abstract Inferior alveolar nerve block has a high failure rate in the treatment of mandibular posterior teeth with irreversible pulpitis. The aim of this study was to compare the anesthetic efficacy of 4% articaine, 2% lidocaine and 2% mepivacaine, all in combination with 1:100,000 epinephrine, in patients with irreversible pulpitis of permanent mandibular molars during a pulpectomy procedure. Sixty-six volunteers from the Emergency Center of the School of Dentistry, University of São Paulo, randomly received 3.6 mL of local anesthetic as a conventional inferior alveolar nerve block (IANB). The subjective signal of lip numbness, pulpal anesthesia and absence of pain during the pulpectomy procedure were evaluated respectively, by questioning the patient, stimulation using an electric pulp tester and a verbal analogue scale. All patients reported the subjective signal of lip numbness. Regarding pulpal anesthesia success as measured with the pulp tester, the success rate was respectively 68.2% for mepivacaine, 63.6% for articaine and 63.6% for lidocaine. Regarding patients who reported no pain or mild pain during the pulpectomy, the success rate was, respectively 72.7% for mepivacaine, 63.6% for articaine and 54.5% for lidocaine. These differences were not statistically significant. Neither of the solutions resulted in 100% anesthetic success in patients with irreversible pulpitis of mandibular molars.

scholarly journals Partial clinical remission in type 1 diabetes: a comparison of the accuracy of total daily dose of insulin of <0.3 units/kg/day to the gold standard insulin-dose adjusted hemoglobin A1c of ≤9 for the detection of partial clinical remission

2017 ◽  
Vol 30 (8) ◽  
Author(s):  
Rachel L. Lundberg ◽  
Katherine R. Marino ◽  
Aastha Jasrotia ◽  
Louise S. Maranda ◽  
Bruce A. Barton ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Gold Standard ◽  
Clinical Remission ◽  
Insulin Dose ◽  
Standard Test ◽  
Total Daily Dose ◽  
Gold Standard Test ◽  
Daily Dose ◽  
New Onset

AbstractBackground:It is unclear whether the gold standard test for the detection of partial clinical remission (PCR) in new-onset type 1 diabetes (T1D), the insulin-dose adjusted Hemoglobin AMethods:A retrospective analysis of 204 subjects of ages 2–14 years, mean age 7.9±3.2 years, (male 7.8±3.4 years, [n=98]; female 7.9±3.0 years, [n=106], p=0.816) with new-onset T1D. Anthropometric and biochemical data were collected for the first 36 months of disease. PCR was defined by both IDAAResults:There were 86 (42.2%) (age 9.1±3.0 years; male 57%) remitters by IDAAConclusions:There were no significant differences in the number of remitters, duration of PCR, or the time of peak remission defined by IDAA

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