An Evaluation of the Arcus Corneae For Age Estimation

Although the arcus corneae (AC) has long been used as an age indicator for forensic purposes, its diagnostic value has not been evaluated. To evaluate the AC as a predictor of chronological age, the author has studied the correlation of AC with respect to age of the deceased. A cross-sectional study was conducted of 342 Thai corpses at the Maharat Nakhon Ratchasima Hospital, Thailand. AC was graded into three levels: no AC, incomplete ring, and complete ring. One-way analysis of variance, chi-square test, binomial logistic regression, sensitivity, specificity, predictive values, and likelihood ratios were used for analysis. The Cohen’s kappa was used to determine the intraobserver and interobserver reliability. The prevalence of AC and the probability of complete AC were significant higher in corpses aged 60 years and above than in those under 60 years. Consequently, this study confirmed that the prevalence of AC was significantly correlated with the age of Thai individuals. If the complete AC is used as an indicator of age of 60 years and above, complete AC has high sensitivity (92.56%) but low specificity (72.85%), low positive predictive value (65.12%), but high negative predictive value (94.71%). For diagnostic value, the presence of AC can be used for age screening but not for absolute confirmation. The absence of AC indicates young age, incomplete AC indicates middle age, and complete AC indicates old age. The high intraobserver and interobserver reliability provides assurance of the value of AC as a means to estimate personal age.

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Assessment of nutritional status of children aged 34-92 months using various nutritional status indices and validity of age independent indices

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20194740 ◽

2019 ◽

Vol 6 (6) ◽

pp. 2593

Author(s):

Nayantara R. Gandra ◽

Kalavathy Jasmine Masillamoni

Keyword(s):

Nutritional Status ◽

Predictive Value ◽

Gold Standard ◽

High Sensitivity ◽

Cross Sectional Study ◽

Cross Sectional ◽

Nutritional Status Of Children ◽

Sensitivity Specificity ◽

Age Independent ◽

Weight For Age

Background: Even though there are many programs run by Government to tackle the problem of malnutrition in India, problem of malnutrition is still there. Malnutrition leads to infections and even can lead to death of child in severe cases. The mortality rate is very high compared to other countries. The objective of the study to study validity of age independent various nutritional status indices in comparison to gold standard of weight for ageMethods: Present study was institution based cross sectional study carried out at SDA high school, from January 2019 to July 2019 among 58 school children aged 34-92 months of age. Anthropometric measurements like weight, height, head circumference, chest circumference, mid arm circumference were recorded as per the standard guidelines. Weight for height, weight of age, Kanawati Index, Jeliffe’s ratio, Rao index, and Dugdales index was calculated. Gold standard used was weight for age. Sensitivity, specificity, positive predictive value and negative predictive value were calculated for these indices.Results: Majority of the children belonged to 48-60 months and 61-72 months i.e. 29.3% each. Males were more than females. Prevalence of malnutrition was 60.3%, 48.3%, 51.7%, 91.4%, and 56.8% based on weight for age, Kanawati index, Rao index, Jeliffe’s ratio and Dugdale’s index respectively. Dugdale’s index was found to have high sensitivity (85.7%) and specificity (86.9%) compared to all other indices.Conclusions: Among age independent indices of nutritional status available, Dugdales index can be used as it has been found that it has remarkably higher sensitivity and specificity compared to other age independent indices of nutritional status.

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Influence of intraoperative findings on immediate flow through radial-cephalic arteriovenous wrist fistulas for hemodialysis access

Jornal Vascular Brasileiro ◽

10.1590/1677-5449.001518 ◽

2018 ◽

Vol 17 (3) ◽

pp. 208-214

Author(s):

Afonso César Polimanti ◽

Rafael Vilhena de Carvalho Fürst ◽

Sidnei José Galego ◽

Alexandre Sacchetti Bezerra ◽

Fernando Adami ◽

...

Keyword(s):

Predictive Value ◽

Venous Access ◽

Cross Sectional Study ◽

Arterial Calcification ◽

Chi Square ◽

Cross Sectional ◽

Predictive Values ◽

Multiple Characteristics ◽

Chi Square Test ◽

Flow Through

Abstract Background Adequate flow through a newly created arteriovenous fistula depends on multiple characteristics of the vessels and patient comorbidities. Several studies have related preoperative findings to failure, but few have analyzed the influence of intraoperative findings. Objectives To evaluate the predictive value of intraoperative findings on the immediate outcome of radial-cephalic arteriovenous wrist fistulas (RCAVF) by collecting data that are easily measured intraoperatively. Methods We designed a cross-sectional study, in which a single surgeon performed 101 RCAVF in 100 patients at a single center. We analyzed the immediate postoperative flow, assessed by thrill intensity immediately after fistula creation, against patient demographics and intraoperative data. The following variables were analyzed: age, sex, comorbidities, length of vein visible at preoperative examination, macroscopic arterial calcification, maximum vein diameter, and length of stenosis-free vein, measured by cannulation with a urethral catheter during the procedure. The chi-square test was used both to eliminate possible bias introduced by side of venous access (left or right), and to determine predictive values of immediate thrill. Results Side of access was not associated with any significant differences in variables. Absence of macroscopic arterial calcification, successful venous catheterization using a 6 French catheter or larger, and ability to advance it more than 10 centimeters along the lumen of the proximal vein were correlated with adequate immediate postoperative thrill (p = 0.004, p < 0.001, and p = 0.005, respectively). Conclusions In this series of 101 RCAVF, both the diameter of the catheter and its progress through the proximal vein and also absence of arterial calcification had positive predictive value for achieving adequate immediate thrill after vascular access construction.

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The Diagnostic Value of Neutrophil-Lymphocyte Ratio in Diagnosis of Autism Spectrum Disorders

INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY ◽

10.24293/ijcpml.v26i3.1597 ◽

2020 ◽

Vol 26 (3) ◽

Author(s):

Nurmalia Purnama Sari ◽

Yudianita K. ◽

M. Rafli Haiqal ◽

M. Fadill Akbar

Keyword(s):

Predictive Value ◽

Developmental Disorders ◽

Neurodevelopmental Disorder ◽

Diagnostic Value ◽

Cross Sectional Study ◽

Autism Spectrum ◽

Cross Sectional ◽

Neutrophil Lymphocyte Ratio ◽

Markers Of Inflammation ◽

Sensitivity Specificity

Autism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder, progressive disruption of brain development and synaptic connections, which causes impaired communication and behavioral disorders. However, the etiology is unknown. A damaged perinatal environment causes chronic nerve inflammation in genetically susceptible children of ASD, dysregulation of the immune system, which leads to ASD. The ratio of Neutrophil to Lymphocyte (NLR) as one of the markers of inflammation is frequently associated with inflammation-related psychiatric diseases and is potentially used as a diagnostic instrument. A cross-sectional study was carried out from June to November 2019 by using medical records of Outpatients with growth and development disorders and ASD and involving 69 children. The diagnosis of ASD was confirmed by the fifth edition Diagnostic and Manual of Mental Disorders criteria (DSM-V). A routine hematology test was carried out with a flow cytometry method. Diagnostic tests were performed in 43 children with developmental disorders (mean NLR 1.01±0.07) and 26 ASD children (mean NLR 1.02±0.06), with a cut-off value of 0.68. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of NLR were 84.62%; 27.9%; 41.51%; 25%; and 50.2%, respectively. Neutrophil to lymphocyte is sensitive to diagnose ASD but its accuracy is low. Immune dysfunction and complex neurodevelopmental disorders that are affected by chronic inflammation play a role in the occurrence of ASD. Other inflammatory markers are needed to improve the accuracy of laboratory tests to diagnose ASD.

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Visual Inspection with Acetic Acid-an Acceptable Option in Screening of Cervical Cancer.

Annals of King Edward Medical University ◽

10.21649/akemu.v24is.2574 ◽

2018 ◽

Vol 24 (S) ◽

pp. 879-883

Author(s):

Summera Aslam ◽

Ahmed Zunair Wasim ◽

Lubna Javed ◽

Tayyiba Wasim

Keyword(s):

Acetic Acid ◽

Cervical Carcinoma ◽

Visual Inspection ◽

Pap Smear ◽

High Sensitivity ◽

Cross Sectional Study ◽

Screening Tests ◽

Cross Sectional ◽

Predictive Values ◽

Sensitivity Specificity

Objectives| To evaluate the accuracy of Visual Inspection with Acetic Acid (VIA) and Papanicolaou (Pap) smear as screening tests for cervical carcinoma and compare it with cervical biopsy as a gold standard. Methods| This was a cross-sectional study conducted at Gynae Unit 3 Services Institute of Medical Sciences from Jan 2016 to December 2016. All the married patients between 18 to 64 years of age were included in the study. Every patient underwent VIA, Pap smear and colposcopic directed biopsy from aceto white area as well as from 2:00 clock and 5:00 clock position. We determined the sensitivity, specificity, positive and negative predictive values of VIA, Pap smear and both tests and compared them with histopathology of biopsy specimen. Results| 476 women were screened in the study. Out of these, 110 (23.10%) patients were VIA positive and 40 (8.40%) patients were positive with Pap smear. Thirty seven (7.77%) patients were positive on both VIA and Pap smear. A total of 43 (9.03%) patients had cervical pre-malignancy on biopsy. The sensitivity of VIA and pap was 97.67%, 94.87% while specificity was 84.29% and 99.31%respectively (p=0.001). The PPV of VIA and pap was 38.18% and 92.5 %( p=0.00) while NPV was 99.7% and 99.5% respectively. The sensitivity and specificity of both tests combined was 94.59% and 99.54% while the PPV and NPV was 94.59% and 99.54% respectively. Diagnostic accuracy of VIA was 85.5%. Conclusion| VIA has high sensitivity and NPV which makes it an effective screening test for cervical carcinoma in developing countries like Pakistan. Pap smear can be combined to VIA positive cases to improve its specificity.

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Diagnostic accuracy of ultrasound in evaluation of obstructive jaundice with MRCP as gold standard

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.36.4.1665 ◽

2020 ◽

Vol 36 (4) ◽

Author(s):

Hina Hanif ◽

Sohail Ahmed Khan ◽

Sobia Muneer ◽

Syed Omair Adil

Keyword(s):

Obstructive Jaundice ◽

Diagnostic Accuracy ◽

Predictive Value ◽

Gold Standard ◽

High Sensitivity ◽

Cross Sectional Study ◽

Cross Sectional ◽

Creative Commons ◽

Positive Predicted Value ◽

Sensitivity Specificity

Objective: To evaluate the diagnostic accuracy of ultrasound in obstructive jaundice taking MRCP as gold standard. Methods: This cross-sectional study was conducted at Dow Institute of Radiology (DIR), Dow University of Health Sciences (DUHS), Karachi from 2nd May 2018 till 2nd November 2018. Both male and female patients aged 30 to 80 years with suspected obstructive jaundice were included. Patients already diagnosed with obstructive jaundice were excluded. MRCP and ultrasound were performed in suspected patients. Diagnostic accuracy including sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of obstructive jaundice were calculated using contingency tables using MRCP findings as gold standard. Results: Mean age of the patients was 54.73 ± 12.65 years. In causes of obstruction, choledocholothiasis was responsible for 85 (35.1%), stricture 61 (25.2%), carcinoma of head of pancreas 39 (16.1%), periampullary carcinoma 21 (8.7%), cholangiocarcinoma 10 (4.1%) and gallbladder carcinoma 26 (10.7%) of the cases. Diagnostic accuracy of ultrasound in obstructive jaundice taking MRCP findings as gold standard showed sensitivity, specificity, positive predicted value (PPV), negative predicted value (NPV) and overall diagnostic accuracy as 84.57%, 79.10%, 91.36%, 66.25% and 83.06%. Conclusion: Ultrasound has a high sensitivity, moderate specificity, and high diagnostic accuracy in diagnosis of obstructive jaundice. doi: https://doi.org/10.12669/pjms.36.4.1665 How to cite this:Hanif H, Khan SA, Muneer S, Adil SO. Diagnostic accuracy of ultrasound in evaluation of obstructive jaundice with MRCP as gold standard. Pak J Med Sci. 2020;36(4):---------. doi: https://doi.org/10.12669/pjms.36.4.1665 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Serum procalcitonin as a biomarker of sepsis

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20213704 ◽

2021 ◽

Vol 8 (10) ◽

pp. 1494

Author(s):

Nyamnyei Konyak ◽

Linda Marangmei ◽

Medo M. Kuotsu ◽

Laishram Chittaranjan Singh ◽

L. Shaini Devi ◽

...

Keyword(s):

Early Diagnosis ◽

Positive Predictive Value ◽

Predictive Value ◽

High Sensitivity ◽

Cross Sectional Study ◽

Sepsis Management ◽

Suspected Sepsis ◽

Cross Sectional ◽

Predictive Values ◽

Procalcitonin Level

Background: The overlap of clinical presentation between sepsis and SIRS has presented diagnostic difficulty in these two close common scenarios. Blood culture remains the gold standard for detection of specific micro-organism, the non-availability of culture report early and difficulty in culture of many organisms is a challenge in differentiation of sepsis from its mimickers. Keeping this background, a simple tool is needed to guide sepsis management while awaiting the culture report. Therefore, the present study is conducted to determine the procalcitonin level in the setting suspicious of sepsis and to differentiate it from SIRS. The objective of the study was to determine Serum procalcitonin level as a biomarker of early diagnosis of sepsis and also to differentiate sepsis from severe inflammatory response syndrome.Methods: Cross sectional study on 79 patients aged above 18 years with suspected sepsis admitted in medicine ward. Serum procalcitonin levels were measured and analysed to look for any association with sepsis.Results: Culture was positive in 41 patients and 38 patients were procalcitonin positive. The sensitivity, specificity, positive predictive value and negative predictive values of serum procalcitonin were found as 96.68%, 94.74%, 95% and 92.30% respectively.Conclusions: There was a significant association between serum procalcitonin and culture positivity. Procalcitonin levels was found to have high sensitivity and high positive predictive value which may aid in the early diagnosis and guide initiation of anti-microbial therapy in sepsis.

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Forns index as a useful noninvasive predictor of esophageal varices in liver cirrhosis

Zinc supplementation improves heme biosynthesis in rats exposed to lead ◽

10.18051/univmed.2016.v35.199-205 ◽

2016 ◽

Vol 35 (3) ◽

pp. 199

Author(s):

Rizqi Arini Siregar ◽

Leonardo Basa Dairi ◽

Gontar Alamsyah Siregar

Keyword(s):

Esophageal Varices ◽

Predictive Value ◽

Cross Sectional Study ◽

Serum Markers ◽

Likelihood Ratios ◽

Cross Sectional ◽

Significant Difference ◽

Cirrhotic Patients ◽

The Difference ◽

Sensitivity Specificity

Background Rupture and bleeding from esophageal varices are major complications of portal hypertension and associated with a high mortality rate. Non-invasive serum markers of liver fibrosis could be used as predictors of esophageal varices in cirrhotic patients. The objective of this study was to assess the performance of Forns index as a noninvasive predictor in diagnosing esophageal varices. Methods A cross-sectional study was done in 51 cirrhotic patients who were admitted to Adam Malik hospital, Medan. Demographic and clinical data were recorded and laboratory tests were performed, so that Forns index could be calculated. The difference between Forns index and size of esophageal varices as determined by endoscopy was tested by independent-t and Mann-Whitney analysis. The diagnostic performance was assessed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, likelihood ratios and areas under the receiver operating characteristic curves (AUROC). Results Of the 51 patients with esophageal varices included in this study, the size of esophageal varices comprised F2 (37.3%), F3 (33.3), and F1 (29.4%). Most patients were of Child-Plug C type (52.6%). There was a significant difference between Forns index and grade of esophageal varices. The AUROC for Forns index was 0.717 (95% CI: 0.561 - 0.872) and the cut-off >7.92 was highly predictive to diagnose large esophageal varices with a sensitivity of 63.9%, specificity of 73.3%, PPV of 85.2%, NPV of 45.8% and accuracy of 71.7%. Conclusion Forns index was significantly increased in large esophageal varices. Forns index is a good noninvasive predictor of esophageal varices in cirrhotic patients.

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Role of transvaginal sonography in the detection of endometrial carcinoma

Bangladesh Medical Research Council Bulletin ◽

10.3329/bmrcb.v39i2.19647 ◽

2014 ◽

Vol 39 (2) ◽

pp. 80-85

Author(s):

MS Showkat ◽

S Nabi ◽

L Khondker ◽

B Bhowmik ◽

SN Tushar ◽

...

Keyword(s):

Endometrial Carcinoma ◽

Predictive Value ◽

Cross Sectional Study ◽

Transvaginal Sonography ◽

Histopathological Diagnosis ◽

Cross Sectional ◽

Menopausal Women ◽

Post Menopausal ◽

Sensitivity Specificity ◽

Transabdominal Sonography

Transvagival sonography is superior to transabdominal sonography in most cases of pelvic pathology. Objective of this study is to evaluate the clinical usefulness of transvaginal ultrasonography (TVS) in pre, peri and post menopausal women suspected to have endometrial carcinoma. This cross sectional study was done with 40 patients who are clinically suspected having thickened endometrium. The study was carried out January 2007 to November 2008 for a period of two years. The patients having endometrial carcinoma diagnosed by TVS was correlated with histopathological diagnosis following collection of the report from the respective cases. Of total 40 cases, 2(5.0%) cases were endometrial carcinoma and 38(95.0%) were negative for endometrial carcinoma respectively in TVS findings. On the other hand 3(7.5%) cases were endometrial carcinoma and 37 (92.5%) cases were negative for endometrial carcinoma in histopathological findings. The validity of TVS in diagnosis of endometrial carcinoma were studied by calculating sensitivity, specificity, accuracy, positive predictive value and negative predictive value, which were 67 percent, 100 percent, 98 percent, 100 percent and 97 percent respectively. As the TVS findings of the present study correlated well with the histopathology findings and the validity test values were higher than observed by others, it can be concluded that TVS is sensitive and accurate modality in the evaluation of endometrial carcinoma. DOI: http://dx.doi.org/10.3329/bmrcb.v39i2.19647 Bangladesh Med Res Counc Bull 2013; 39: 80-85

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Value and Diagnostic Efficacy of Fetal Morphology Assessment Using Ultrasound in A Poor-Resource Setting

Diagnostics ◽

10.3390/diagnostics9030109 ◽

2019 ◽

Vol 9 (3) ◽

pp. 109 ◽

Cited By ~ 1

Author(s):

Ukweh ◽

Ugbem ◽

Okeke ◽

Ekpo

Keyword(s):

Predictive Value ◽

Performance Metrics ◽

Area Under The Curve ◽

Youden Index ◽

Likelihood Ratios ◽

Diagnostic Efficacy ◽

Predictive Values ◽

Resource Setting ◽

Post Test ◽

Sensitivity Specificity

Background: Ultrasound is operator-dependent, and its value and efficacy in fetal morphology assessment in a low-resource setting is poorly understood. We assessed the value and efficacy of fetal morphology ultrasound assessment in a Nigerian setting. Materials and Methods: We surveyed fetal morphology ultrasound performed across five facilities and followed-up each fetus to ascertain the outcome. Fetuses were surveyed in the second trimester (18th–22nd weeks) using the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) guideline. Clinical and surgical reports were used as references to assess the diagnostic efficacy of ultrasound in livebirths, and autopsy reports to confirm anomalies in terminated pregnancies, spontaneous abortions, intrauterine fetal deaths, and still births. We calculated sensitivity, specificity, positive and negative predictive values, Area under the curve (AUC), Youden index, likelihood ratios, and post-test probabilities. Results: In total, 6520 fetuses of women aged 15–46 years (mean = 31.7 years) were surveyed. The overall sensitivity, specificity, and AUC were 77.1 (95% CI: 68–84.6), 99.5 (95% CI: 99.3–99.7), and 88.3 (95% CI: 83.7–92.2), respectively. Other performance metrics were: positive predictive value, 72.4 (95% CI: 64.7–79.0), negative predictive value, 99.6 (95% CI: 99.5–99.7), and Youden index (77.1%). Abnormality prevalence was 1.67% (95% CI: 1.37–2.01), and the positive and negative likelihood ratios were 254 (95% CI: 107.7–221.4) and 0.23 (95% CI: 0.16–0.33), respectively. The post-test probability for positive test was 72% (95% CI: 65–79). Conclusion: Fetal morphology assessment is valuable in a poor economics setting, however, the variation in the diagnostic efficacy across facilities and the limitations associated with the detection of circulatory system anomalies need to be addressed.

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ACCURACY OF THE UPPER LIP BITE TEST;

The Professional Medical Journal ◽

10.29309/tpmj/2013.20.01.589 ◽

2012 ◽

Vol 20 (01) ◽

pp. 132-138

Author(s):

MUHAMMAD ATIF ◽

MUHAMMAD ABDULLAH ◽

MUHAMMAD JAVAD YOUSAF ◽

Khalid Buland

Keyword(s):

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Difficult Intubation ◽

Predictive Value ◽

Elective Surgery ◽

Cross Sectional Study ◽

Military Hospital ◽

Upper Lip ◽

Cross Sectional ◽

Sensitivity Specificity

Objective: To compare the accuracy of Upper lip bite test with modified Mallampati classification for predicting the difficultlaryngoscopic intubation. Study Design: Cross sectional Study. Place and duration of study: The study was carried out at Department ofAnaesthesiology, Intensive Care and Pain management, Combined Military hospital, Rawalpindi from September 2008 to August 2009.Patients and Methods: Four hundred patients undergoing elective surgery meeting the inclusion/exclusion criteria were enrolled afterwritten informed consent. The airways of the patients were evaluated by using the modified Mallampati classification (MMP) and theUpper lip bite test (ULBT). MMP class 3 or 4 and ULBT class 3 were considered as indicators of difficult intubation. The laryngeal view wasgraded by Cormack and Lehane classification (Gold standard). Grade 1 or 2 was considered to represent easy intubation and grade 3 or 4to represent difficult intubation. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy werecalculated for both the tests separately by using the 2×2 table. Results: ULBT had a higher accuracy of 94%, specificity of 99.2% andpositive predictive value 70% compared to MMP accuracy of 82.7%, specificity of 84.4% and positive predictive value of 22.7%.Conclusions: The diagnostic accuracy of the Upper lip bite test was more than the modified Mallampati classification. We suggest that itbe compared with the other prevailing tests as well which are often used to assess difficult intubations.

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