scholarly journals The Sensitivity and Specificity of Touch Preparation for Rapid Diagnosis of Invasive Fungal Sinusitis: A Pilot Study

2019 ◽  
Vol 100 (1) ◽  
pp. 55-59
Author(s):  
Theodore A. Schuman ◽  
Josephine H. Nguyen ◽  
Joshua C. Yelverton ◽  
Jorge A. Almenara ◽  
Celeste N. Powers
Keyword(s):  
Sensitivity And Specificity ◽  
Predictive Value ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Rapid Diagnosis ◽  
Fungal Sinusitis ◽  
Invasive Fungal Sinusitis ◽  
Touch Preparation ◽  
Pathologic Analysis ◽  
Initial Results

Invasive fungal sinusitis is a morbid pathology that typically affects immunocompromised patients and may quickly progress to fulminant disease. The purpose of this study was to measure the sensitivity and specificity of touch preparation of nasal debridement specimens as a rapid diagnostic tool for invasive fungal sinusitis. A retrospective chart review was performed of 22 patients undergoing nasal debridement due to suspicion for invasive fungal sinusitis over a 10-year period. Thirteen patients had touch preparation of nasal specimens followed by routine histologic processing; two of these patients underwent 2, and 1 patient had 3 separate debridements, for a total of 17 touch preparations performed. The sensitivity and specificity of touch preparation were calculated by correlating the initial results with the presence of fungal invasion on final pathologic analysis. The sensitivity of touch preparation was 56% (95% confidence interval [CI]: 0.23-0.85), specificity was 100% (95% CI: 0.60-1.00), positive predictive value was 100% (95% CI: 0.46-1.00), and negative predictive value was 67% (95% CI: 0.35-0.89). This procedure may be a useful adjunct in situations requiring rapid diagnosis of invasive fungal sinusitis but should not be used as the sole criteria for determining the need for surgical intervention.

scholarly journals The Sensitivity and Specificity of Touch Preparation for Rapid Diagnosis of Invasive Fungal Sinusitis: A Pilot Study

2018 ◽  
Vol 97 (1-2) ◽  
pp. E32-E36
Author(s):  
Theodore A. Schuman ◽  
Josephine H. Nguyen ◽  
Joshua C. Yelverton ◽  
Jorge A. Almenara ◽  
Celeste N. Powers
Keyword(s):  
Sensitivity And Specificity ◽  
Predictive Value ◽  
Retrospective Chart Review ◽  
Rapid Diagnosis ◽  
Fungal Sinusitis ◽  
Invasive Fungal Sinusitis ◽  
Touch Preparation ◽  
Pathologic Analysis ◽  
Sole Criterion ◽  
Initial Results

Invasive fungal sinusitis is a morbid pathology that typically affects immunocompromised patients and may quickly progress to fulminant disease. The purpose of this study was to measure the sensitivity and specificity of touch preparation of nasal debridement specimens as a rapid diagnostic tool for invasive fungal sinusitis. A retrospective chart review was performed of 22 patients undergoing nasal debridement due to suspicion for invasive fungal sinusitis over a 10-year period. Thirteen patients had touch preparation of nasal specimens followed by routine histologic processing; 2 of these patients underwent two and 1 patient had three separate debridements, for a total of 17 touch preparations performed. The sensitivity and specificity of touch preparation were calculated by correlating the initial results with the presence of fungal invasion on final pathologic analysis. The sensitivity of touch preparation was 56% (95% confidence interval [CI]: 0.23 to 0.85), specificity was 100% (95% CI: 0.60 to 1.00), positive predictive value was 100% (95% CI: 0.46 to 1.00), and negative predictive value was 67% (95% CI: 0.35 to 0.89). This procedure may be a useful adjunct in situations requiring rapid diagnosis of invasive fungal sinusitis but should not be used as the sole criterion for determining the need for surgical intervention.

scholarly journals Chronic Invasive Fungal Rhinosinusitis in Immunocompetent Patients: A Retrospective Chart Review

2020 ◽  
Vol 7 ◽  
Author(s):  
Naif H. Alotaibi ◽  
Omar Abu Omar ◽  
Mays Altahan ◽  
Haifa Alsheikh ◽  
Fawziah Al Mana ◽  
...  
Keyword(s):  
Chart Review ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Csf Leak ◽  
Fungal Sinusitis ◽  
Invasive Fungal Sinusitis ◽  
Fungal Rhinosinusitis ◽  
Invasive Fungal Rhinosinusitis ◽  
Chronic Invasive ◽  
Immunocompetent Patients

Objective: We report cases of Chronic Invasive Fungal Sinusitis (CIFS) in patients considered as immunocompetent at tertiary care center (King Faisal Specialist Hospital), to analyze their clinical, biological, radiological features, and management.Material and methods: A retrospective chart review of CIFS in immunocompetent patients. The inclusion criteria as the following: immunocompetent patients of any age with histopathological findings of CIFS. Immunocompromised patients, acute Invasive Fungal Sinusitis (IFS), non-invasive fungal rhinosinusitis, and no positive histological findings were excluded.Results: Seventeen (17) patients were included. The species isolated included: Aspergillus (most frequent) & Mucor. Surgical treatment approaches were described. Complications reported include CSF leak, blindness, recurrence, and death.Conclusions: Early diagnosis and management of CIFS improve clinical outcomes.

Invasive Fungal Sinusitis following Liver or Bone Marrow Transplantation

1994 ◽  
Vol 8 (2) ◽  
pp. 77-84 ◽  
Author(s):  
Perry J. Johnson ◽  
William M. Lydiatt ◽  
James V. Huerter ◽  
Frederic P. Ogren ◽  
Julie M. Vose ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Transplantation ◽  
Marrow Transplantation ◽  
Effective Means ◽  
Management Strategies ◽  
Retrospective Chart Review ◽  
Signs And Symptoms ◽  
Fungal Sinusitis ◽  
Hematopoietic Growth Factors ◽  
Invasive Fungal Sinusitis

Invasive fungal infection of the nose and paranasal sinuses occurs almost exclusively in immunocompromised patients and is increasingly recognized as a complication of organ transplantation. We performed a retrospective chart review of 955 bone marrow and 749 liver transplant patients to identify risk factors, presenting signs and symptoms, methods of diagnosis, and successful management strategies. We report on five cases following bone marrow transplantation and one case following liver transplantation. Neutropenia is the single most important risk factor in the development of and recovery from invasive fungal sinusitis. Early diagnosis, combined with antifungal agents, hematopoietic growth factors, and aggressive surgical debridement is the most effective means of management.

scholarly journals Performance of the Quantitative Latex Immunoturbidimetric D-dimer Assay for the Diagnosis of Acute Pulmonary Embolism at Rafik Hariri University Hospital

2020 ◽  
Vol 7 (3) ◽  
pp. 125-128
Author(s):  
Rida Salman ◽  
Mira Alsheikh ◽  
Rim Ismail
Keyword(s):  
Pulmonary Embolism ◽  
Negative Predictive Value ◽  
Ct Angiography ◽  
Sensitivity And Specificity ◽  
Predictive Value ◽  
Retrospective Chart Review ◽  
Latex Agglutination ◽  
University Hospital ◽  
Acute Pe ◽  
D Dimer

Background and aims: The diagnostic workup for pulmonary embolism (PE) includes D-dimer assay and computed tomographic angiography. Several D-dimer assays have been approved for PE diagnosis with different sensitivity and specificity. We aimed to study the sensitivity and specificity of the quantitative latex agglutination D-dimer assay used in a referral teaching hospital in Lebanon for the diagnosis of acute PE. Methods: Using a retrospective chart review, we studied 300 patients who had D-dimer test at Rafik Hariri University Hospital in the period between January 1, 2012 and December 31, 2013. Accordingly, 93 patients had a CT angiography after being suspected to have acute PE. A statistical table 2*2 was used to compare the results of CT angiography and D-dimer test. Results: Thirteen patients (13.97%) had PE and 60 patients (64.51%) had positive D-dimer test. Quantitative latex agglutination D-dimer assay had a sensitivity of 69%, specificity of 36%, and negative predictive value of 88%. False positive ratio was also 64%. Moreover, the receiver operating characteristic (ROC) curve was obtained with an area under the curve measuring 0.527. Conclusion: Quantitative latex agglutination D-dimer assay has a high negative predictive value; thus, it can exclude a PE diagnosis if it is associated with low clinical pretest probability.

Response to Intravenous Immunoglobulin Predicts Splenectomy Response in Children With Immune Thrombocytopenic Purpura

PEDIATRICS ◽  
2003 ◽  
Vol 111 (1) ◽  
pp. 87-90
Author(s):  
Derick Holt ◽  
Justin Brown ◽  
Kelly Terrill ◽  
Robert Goldsby ◽  
Rebecka L. Meyers ◽  
...  
Keyword(s):  
Intravenous Immunoglobulin ◽  
Immune Thrombocytopenic Purpura ◽  
Predictive Value ◽  
Chart Review ◽  
Objective Response ◽  
Retrospective Chart Review ◽  
Poor Response ◽  
Thrombocytopenic Purpura ◽  
Excellent Response ◽  
Chronic Itp

Objective. Response to intravenous immunoglobulin (IVIG) has been shown to predict response to splenectomy in adults with immune thrombocytopenic purpura (ITP). However, reports in children have been inconsistent. We sought to determine whether response to IVIG is predictive of response to splenectomy in children. Methods. Thirty-two assessable children were identified by a retrospective chart review. Response was graded according to previously published criteria as follows: “excellent” (platelets >150 000 within 1 week), “good” (platelets between 50 000 and 150 000), and “poor” (platelets <50 000). “Response” refers to both splenectomy and IVIG, and response to splenectomy was counted only when it was durable. Results. Twenty-one of 23 patients who had a good or excellent response to IVIG also had an excellent response to splenectomy. Six of 9 patients who had a poor response to IVIG also had a poor response to splenectomy. Response to IVIG was a sensitive predictor of response to splenectomy in 88% of patients. Response to IVIG had a specificity of 75%, a positive predictive value of 91%, and a negative predictive value of 67%. Response to prednisone and length of time to splenectomy were not correlated with splenectomy response. Conclusions. These results suggest that response to IVIG is predictive of response to splenectomy in children with chronic ITP. This correlation may be of value in deciding whether a splenectomy should be performed in children with chronic ITP.

Clinical and Histopathologic Predictors of Disaccharidase Deficiency in Duodenal Biopsy Specimens

2019 ◽  
Vol 152 (6) ◽  
pp. 742-746 ◽  
Author(s):  
Robyn C Reed ◽  
M Cristina Pacheco
Keyword(s):  
Predictive Value ◽  
Gold Standard ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Mucosal Injury ◽  
Clinical Suspicion ◽  
Duodenal Biopsy ◽  
Biopsy Specimens ◽  
Active Inflammation ◽  
Intraepithelial Lymphocytosis

Abstract Objectives Disaccharidase (DS) activity in duodenal biopsy specimens is the gold standard for diagnosing DS deficiency. We investigated strategies to reduce the need for DS testing and whether clinical or histopathologic factors predict DS deficiency. Methods A retrospective chart review analyzed 1,678 DS results in children, biopsy indication(s), and duodenal histopathology. Results One or more DSs were abnormal in 42.8%. Sufficient lactase predicted sucrase, palatinase, and maltase sufficiency (negative predictive value 97.7%). Three patients had sucrase-isomaltase deficiency (0.2%). DS deficiency was more common in biopsy specimens for positive celiac serology (78.0%). Villous blunting, intraepithelial lymphocytosis, and active inflammation predicted DS deficiency; a combination of any two had an 81.4% positive predictive value. Conclusions Utilization could be reduced by only testing cases with normal duodenal histopathology and ongoing clinical suspicion for DS deficiency after reviewing pathology. In cases with suspected celiac disease and/or mucosal injury, DS deficiency is common and likely secondary, limiting test utility.

Occult Malignancy in Adult Tonsillectomy for Benign Indication

2020 ◽  
pp. 000348942095247
Author(s):  
Noah Syme ◽  
Stefan Brettfeld ◽  
Ashley Dorneden ◽  
Von Samedi ◽  
Therese Bocklage ◽  
...  
Keyword(s):  
Literature Review ◽  
Chart Review ◽  
Tertiary Care ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Pooled Analysis ◽  
Level Of Evidence ◽  
Occult Malignancy ◽  
Pathologic Analysis ◽  
Adult Tonsillectomy

Objective: National pathology guidelines recommend full pathologic analysis for all adult tonsillectomy specimens. We evaluated the available data on occult malignancy in adult tonsillectomy for benign indication, and created a screening system to reduce the risk of missed malignancies if routine histopathologic examination were to be discontinued. Study design: Retrospective chart review and systematic review of the literature. Setting: Tertiary care academic hospital and multi-hospital private healthcare system. Subjects and methods: A systematic literature review identified case series of adult tonsillectomy. Retrospective chart review at our institutions from 2000 to 2016 produced an additional case series. The pooled rate of occult malignancy was determined, and re-analyzed using criteria based on preoperative risk factors designed to identify patients requiring full pathologic analysis. The predicted effects of prospective application of the proposed criteria were calculated. Pooled occult malignancy prevalence was estimated. Results: Literature review and our own case series yielded 12,094 total cases. Occult malignancy prevalence in the combined data was 0.033%, representing four occult malignancies. Three out of the four would have been selected for full pathology preoperatively with use of the proposed criteria. Statistical analysis indicates that the predicted frequency of occult malignancy incidence in cases negative for the criteria is 0.01%, or 1/10,000. Conclusion: Application of the proposed criteria to adults undergoing tonsillectomy for benign indication identifies a subset of patients with an estimated incidence of occult malignancy similar to that reported for pediatric tonsillectomy, and potentially may permit safe elimination of pathologic analysis of their tonsil specimens. Level of Evidence: Pooled analysis of case series from the literature and a single institution, level 4.

scholarly journals Sensitivity and Specificity of Electroencephalography (EEG) Among Patients Referred to an Electrophysiology Lab in Bangladesh

2015 ◽  
Vol 23 (2) ◽  
pp. 215-222 ◽  
Author(s):  
Ahmed Hossain Chowdhury ◽  
Rajib Nayan Chowdhury ◽  
Sharif Uddin Khan ◽  
Swapon Kumar Ghose ◽  
Amit Wazib ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Predictive Value ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Clonic Seizure ◽  
Epileptiform Discharge ◽  
Care Hospital ◽  
College Hospital ◽  
Medical College ◽  
Clinical Seizure

Objective: To measure the changes in electro encephalogram (EEG) along with its sensitivity and specificity with clinical seizure among epilepsy patients referred to an electrophysiology lab in a tertiary care hospital of Bangladesh.Methods: This retrospective chart review was carried out in the electrophysiology laboratory of Dhaka Medical College Hospital from January 2011 to December 2013, which included 1154 patients. EEG was obtained through scalp electrodes following international 10/20 system. Information regarding patients was collected from the laboratory register with the help of a checklist. The EEG findings and clinical seizure events were then compared.Result: Among the 1154 patients, age varied from birth to 75 years. The mean age at presentation was 17±11.4 years and most of the patients were less than 10 years old (44.4%). The male predominated in our study (59.2%). Clinically diagnosed seizure was present in 970 patients (84.1%), among which Generalized tonic clonic seizure (GTCS) was the most common clinical type of seizure, followed by secondary generalized seizure in 19.4% (n=224) and focal seizure in 2% (n=30) patients and 6.8% (n=79) patients had pseudoseizure. Among the abnormal EEG (59%), generalized epileptiform discharge was found in 29%, whereas focal and secondary generalized discharge was found in 30%. The most common site of origin of epileptiform discharge was temporal lobe (28.3%). The overall sensitivity of EEG was 66% (ranged from 62% to 68% with a confidence interval (CI) at 95%) and specificity was 79% (72- 84% at 95% CI). The positive predictive value was 58% (55-61% at 95% CI) and negative predictive value was 41% (38-44% at 95% CI).Conclusion: Our study brings out the fact that EEG has a reasonable sensitivity and specificity as a diagnostic test and the superiority being the higher specificity of EEG.J Dhaka Medical College, Vol. 23, No.2, October, 2014, Page 215-222

scholarly journals External validation of 4C ISARIC mortality score in the setting of a Saudi Arabian ICU. Retrospective study

2021 ◽  
Author(s):  
Shahzad A. Mumtaz ◽  
Saima A. Shahzad ◽  
Intekhab Ahmed ◽  
Mohammed A. Alodat ◽  
Mohamed Gharba ◽  
...  
Keyword(s):  
Predictive Value ◽  
Chart Review ◽  
External Validation ◽  
Retrospective Chart Review ◽  
Saudi Arabian ◽  
Healthcare Systems ◽  
Mortality Prediction ◽  
Discriminatory Ability ◽  
Optimal Criterion ◽  
Medical City

AbstractCOVID-19 pandemic has burdened healthcare systems, necessitating the development of mortality prediction scores to guide clinical decisions and resource allocation. 4C ISARIC mortality score was developed and validated on a British cohort.ObjectivesExternal validation of the score in the setting of a large Saudi Arabian ICU.MethodRetrospective chart review of COVID-19 patients admitted to ICU of King Saud Medical City, Riyadh, Saudi Arabia. Collecting data to calculate the score, then fitting a ROC curve against known patients’ outcome.ResultsCohort included 1493 patients with 38% mortality, AUC of the score was 0.81 (95% CI: 0.79 – 0.83, p < 0.001), correctly classifying 72.67% of the cohort. Cut-off value of > 9 had sensitivity of 70.5% (95% CI: 66.6 – 74.3), specificity 73.97% (95% CI: 71 – 76.8), positive predictive value 62.4% (95% CI: 59.5 – 65.2), and negative predictive value 80.2% (95% CI: 78.2 – 82.4).Conclusion4C ISARIC mortality risk score performed well with a good discriminatory ability for critically ill patients admitted to ICU in our setting. Cut-off > 9 was the optimal criterion.

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