scholarly journals The predictive value of urine specific gravity in the diagnosis of vasovagal syncope in children and adolescents

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Ping Liu ◽  
Xingfang Zeng ◽  
Wanzhen Mei ◽  
Yuwen Wang ◽  
Runmei Zou ◽  
...  
Keyword(s):  
Specific Gravity ◽  
Children And Adolescents ◽  
Sensitivity And Specificity ◽  
Roc Curve ◽  
Predictive Value ◽  
Vasovagal Syncope ◽  
Urine Specific Gravity ◽  
Tilt Test ◽  
Control Group ◽  
Neurally Mediated Syncope

Abstract Background Vasovagal syncope (VVS) is a kind of common neurally mediated syncope in children and adolescents. Decreased blood volume is one of the pathogenesis of VVS. The diagnosis of VVS is mainly based on head-up tilt test (HUTT), but some complications may easily occur when HUTT induces syncope. To find a simple and safe VVS diagnosis method can improve the VVS diagnosis efficiency. Aims of the study This was a prospective study. The study will explore the predictive value of urine specific gravity (USG) in the diagnosis of VVS in children and adolescents. Patients and methods Ninety-seven cases (43 males and 54 females, aged 4 to 16 years old, with an average age of 10.91 ± 2.18 years old) hospitalized due to unexplained premonitory syncope or syncope and diagnosed with VVS through HUTT from September 2014 to September 2018 were selected as VVS group. During the same period, 91 cases of children and adolescents, including 45 males and 46 females, aged from 5 to 15 years old, who underwent a healthy examination were matched as a control (control group). USG was measured in both groups. Results The USG of VVS group was significantly lower than that of the control group (P < 0.01), and USG of females was lower than that of males in VVS group (P = 0.045). The sensitivity and specificity of USG in predicting VVS were evaluated by ROC curve. The area under the ROC curve was 0.751, standard error was 0.035, and 95% CI (0.683, 0.819) suggested that USG was of moderate predictive value in the diagnosis of VVS. As cut-off value of USG was 1.0185, the sensitivity and specificity and diagnostic coincidence rate of VVS were 74.39, 66.04 and 69.68%, respectively. Conclusion There are less USG in children and adolescents with VVS, especially lower USG in females. Therefore, USG has predictive value in the diagnosis of VVS in children and adolescents.

scholarly journals The predictive value of low urine specific gravity in the diagnosis of vasovagal syncope in children and adolescents

2020 ◽  
Author(s):  
Ping Liu ◽  
Xingfang Zeng ◽  
Hong Yang ◽  
Wanzhen Mei ◽  
Yuwen Wang ◽  
...  
Keyword(s):  
Specific Gravity ◽  
Children And Adolescents ◽  
Sensitivity And Specificity ◽  
Roc Curve ◽  
Predictive Value ◽  
Vasovagal Syncope ◽  
Urine Specific Gravity ◽  
Control Group ◽  
Tilt Table ◽  
Head Up Tilt

Abstract Background Vasovagal syncope (VVS) is a kind of common neurogenic syncope in children and adolescents. Decreased blood volume is one of the pathogenesis of VVS. The study will explore the predictive value of low urine specific gravity (USG) in the diagnosis of VVS in children and adolescents. Methods 97 cases, 43 males and 54 females, aged 4 to 16 years old, with an average age of 10.91 ± 2.18 years old, due to unexplained premonitory syncope or syncope were selected. They were diagnosed with VVS through head-up tilt table test. During the same period, 91 cases of children and adolescents, including 45 males and 46 females, aged from 5 to 15 years old, who underwent a healthy examination were matched as a control (control group). USG was measured in both groups. Results The USG of VVS group was significantly lower than that of the control group (P < 0.01). The sensitivity and specificity of USG prediction in the diagnosis of VVS were evaluated by ROC curve. The area under the ROC curve was 0.751, standard error was 0.035, and 95% CI (0.683, 0.819) suggested that USG was of moderate predictive value in the diagnosis of VVS. Setting USG as < 1.0185, the sensitivity and specificity and diagnostic coincidence rate of VVS were 74.39%, 66.04% and 69.68%, respectively. Conclusion Low USG has predictive value in the diagnosis of VVS in children and adolescents.

scholarly journals Comparison of cortisol levels in patients with vasovagal syncope and postural tachycardia syndrome

2021 ◽  
Vol 38 (1) ◽  
Author(s):  
Humaira Fayyaz ◽  
Shazadi Ambreen ◽  
Hammad Raziq ◽  
Azmat Hayyat
Keyword(s):  
Vasovagal Syncope ◽  
Serum Cortisol ◽  
Tilt Test ◽  
Control Group ◽  
Postural Tachycardia Syndrome ◽  
P Value ◽  
Cross Sectional ◽  
Postural Tachycardia ◽  
Significant Difference ◽  
Cortisol Levels

Objectives: To compare the levels of cortisol in patients of vasovagal syncope (VVS) and postural tachycardia syndrome (POTS). Methods: A cross-sectional analytical study was conducted at Islamic International Medical College, Rawalpindi and Electrophysiology Department at (AFIC). This study included 80 subjects, comprising of 35 patients in each group of vasovagal syncope and postural tachycardia syndrome and 10 healthy subjects. Patients with complaint of syncope was evaluated for vasovagal syncope and postural tachycardia syndrome using Head Up Tilt Test (HUTT). Blood samples of all the participants were taken and serum cortisol was analyzed using ELISA method. Results were analyzed on SPSS Statistics 21 using ANOVA with a p-value of ≤0.05 regarded as significant. Results: Hormonal analysis shows that cortisol levels in the vasovagal, postural tachycardia syndrome and in control group was 153±16.7pg/ml, 160.17±pg/ml, and 69.65±5.8pg/ml respectively. Cortisol levels were significantly higher in both vasovagal and POTS groups as compared to controls with a p-value of 0.04 and 0.023 respectively. However, there was no significant difference between vasovagal and POTS patients with p value 0.570. Conclusion: It is concluded from the study that cortisol responses of VVS and POTS were positive. doi: https://doi.org/10.12669/pjms.38.1.4122 How to cite this:Khan HF, Ambreen S, Raziq H, Hayat A. Comparison of cortisol levels in patients with vasovagal syncope and postural tachycardia syndrome. Pak J Med Sci. 2022;38(1):---------. doi: https://doi.org/10.12669/pjms.38.1.4122 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.

How valuable is P-wave dispersion in the determination of carboxyhemoglobin levels?

2013 ◽  
Vol 33 (5) ◽  
pp. 466-472
Author(s):  
MT Sener ◽  
Y Anci ◽  
K Kalkan ◽  
MZ Kir ◽  
M Emet
Keyword(s):  
Roc Curve ◽  
Predictive Value ◽  
Complete Blood Count ◽  
Wave Dispersion ◽  
P Wave ◽  
Control Group ◽  
Co Poisoning ◽  
P Wave Dispersion ◽  
Cohb Level ◽  
Positive Correlations

Objective: To determine whether or not wave/interval dispersions in electrocardiography (ECG) are increased, and to define whether wave and interval dispersions are correlated with carboxyhemoglobin (COHb) levels. Methods: ECG, complete blood count, and biochemical parameters were taken from 87 patients with carbon monoxide (CO) poisoning as well as 90 control patients with similar age, gender, and body mass index distribution. COHb levels were recorded in CO-poisoning patients. The COHb levels and the relationships with ECG parameters were studied. Results: Pmax, Pmin, Pd, PRmax, PRmin, PRd, QTmax, QTmin, QTd, cQTmax, cQTmin, cQTd, Tmax, Tmin, and Td in ECG were higher in intoxicated patients than the control group ( p < 0.05 for all). Pearson’s correlation analyses showed moderately significant positive correlations between COHb level and Pmax ( r = 0.224; p = 0.037) and Pd ( r = 0.222; p = 0.039). The receiver–operator characteristic (ROC) curve showed that a Pd value of 38 ms determined by ECG separates patients with a COHb ≥ 20% with area under the ROC curve of 0.78 (95%CI = 0.71–0.83), a sensitivity of 67.9% (95%CI = 59.4–75.6), a specificity of 95% (95%CI = 83.0–99.2], a positive predictive value of 97.9% (95%CI = 92.5–99.7), and a negative predictive value of 46.3% (95%CI = 35.3–57.7.) Conclusion: A significant increase in wave/interval dispersions in the ECG of CO-poisoning patients compared with controls may show that not only a part is affected but both atrium and the ventricles as a whole are affected by hypoxic ischemia. When COHb levels of the patients are unavailable, P dispersion on ECG may show CO poisoning level of the patient.

scholarly journals Value of Examination Under Fluoroscopy for the Assessment of Sacroiliac Joint Dysfunction

2015 ◽  
Vol 5;18 (5;9) ◽  
pp. E781-E786
Author(s):  
Burton D Beakley
Keyword(s):  
Sensitivity And Specificity ◽  
Roc Curve ◽  
Predictive Value ◽  
Joint Pain ◽  
Clinical Symptoms ◽  
Small Sample ◽  
Joint Disease ◽  
Pain Clinic ◽  
Predictive Values ◽  
Si Joint

Background: Pain emanating from the sacroiliac (SI) joint can have variable radiation patterns. Single physical examination tests for SI joint pain are inconsistent with multiple tests increasing both sensitivity and specificity. Objective: To evaluate the use of fluoroscopy in the diagnosis of SI joint pain. Study Design: Prospective double blind comparison study Setting: Pain clinic and radiology setting in urban Veterans Administration (VA) in New Orleans, Louisiana. Methods: Twenty-two adult men, patients at a southeastern United States VA interventional pain clinic, presented with unilateral low back pain of more than 2 months’ duration. Patients with previous back surgery were excluded from the study. Each patient was given a Gapping test, Patrick (FABERE) test, and Gaenslen test. A second blinded physician placed each patient prone under fluoroscopic guidance, asking each patient to point to the most painful area. Pain was provoked by applying pressure with the heel of the palm in that area to determine the point of maximum tenderness. The area was marked with a radio-opaque object and was placed on the mark with a fluoroscopic imgage. A site within 1 cm of the SI joint was considered as a positive test. This was followed by a diagnostic injection under fluoroscopy with 1 mL 2% lidocaine. A positive result was considered as more than 2 hours of greater than 75% reduction in pain. Then, in 2-3 days this was followed by a therapeutic injection under fluoroscopy with 1 mL 0.5% bupivacaine and 40 mg methylprednisolone. Results: Each patient was reassessed after 6 weeks. The sensitivity and specificity in addition to the positive and negative predictive values were determined for both the conventional examinations, as well as the examination under fluoroscopy. Finally, a receiver operating characteristic (ROC) curve was constructed to evaluate test performance. The sensitivity and specificity of the fluoroscopic examination were 0.82 and 0.80 respectively; Positive predictive value and negative predictive value were 0.93 and 0.57 respectively. The area under ROC curve was 0.812 which is considered a “good” test; however the area under ROC for the conventional examination were between 0.52 -0.58 which is considered “poor to fail”. Limitations: Variation in anatomy of the SI joint, small sample size. Conclusions: Multiple structures of the SI joint complex can result in clinical symptoms of pain. These include intra-articular structures (degenerative arthritis, and inflammatory conditions) as well as extraarticular structures (ligaments, muscles, etc.). Key words: Sacroilliac joint disease, radicular pain, thigh thrust test, compression test, distraction test, Gaenslen test, Patrick test (FABER test)

scholarly journals Predicting Disease in Transition Dairy Cattle Based on Behaviors Measured Before Calving

Animals ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. 928
Author(s):  
Mohammad W. Sahar ◽  
Annabelle Beaver ◽  
Marina A. G. von Keyserlingk ◽  
Daniel M. Weary
Keyword(s):  
Dairy Cattle ◽  
Sensitivity And Specificity ◽  
Roc Curve ◽  
Predictive Value ◽  
Predictive Ability ◽  
Training Dataset ◽  
Test Dataset ◽  
Increased Risk ◽  
High Prevalence ◽  
Random Method

Dairy cattle are particularly susceptible to metritis, hyperketonemia (HYK), and mastitis in the weeks after calving. These high-prevalence transition diseases adversely affect animal welfare, milk production, and profitability. Our aim was to use prepartum behavior to predict which cows have an increased risk of developing these conditions after calving. The behavior of 213 multiparous and 105 primiparous Holsteins was recorded for approximately three weeks before calving by an electronic feeding system. Cows were also monitored for signs of metritis, HYK, and mastitis in the weeks after calving. The data were split using a stratified random method: we used 70% of our data (hereafter referred to as the “training” dataset) to develop the model and the remaining 30% of data (i.e., the “test” dataset) to assess the model’s predictive ability. Separate models were developed for primiparous and multiparous animals. The area under the receiver operating characteristic (ROC) curve using the test dataset for multiparous cows was 0.83, sensitivity and specificity were 73% and 80%, positive predictive value (PPV) was 73%, and negative predictive value (NPV) was 80%. The area under the ROC curve using the test dataset for primiparous cows was 0.86, sensitivity and specificity were 71% and 84%, PPV was 77%, and NPV was 80%. We conclude that prepartum behavior can be used to predict cows at risk of metritis, HYK, and mastitis after calving.

scholarly journals The Effect of Oral Intake during the Immediate Pre-Colonoscopy Time Period on Volume Depletion in Patients who Receive Sodium Picosulfate

2017 ◽  
Vol 45 (4) ◽  
pp. 485-489 ◽  
Author(s):  
G. S. Labuschagne ◽  
R. W. Morris
Keyword(s):  
Blood Pressure ◽  
Treatment Group ◽  
Specific Gravity ◽  
Pulse Rate ◽  
Oral Intake ◽  
Urine Specific Gravity ◽  
Control Group ◽  
Volume Depletion ◽  
Sodium Picosulfate ◽  
Carbohydrate Solution

Sodium picosulfate, used in combination with magnesium oxide and citric acid for bowel cleansing, can result in dehydration. We investigated whether enhanced carbohydrate fluid intake pre-colonoscopy could mitigate this effect. We enrolled 398 elective colonoscopy patients in a prospective, controlled, single-blinded study. The control group (n=194) fasted routinely (minimum seven hours) whilst the treatment group (n=197) drank 1,200 ml carbohydrate solution leading up to admission (up until two hours pre-colonoscopy). On admission a patient survey was completed, and urine specific gravity obtained. Supine blood pressure and pulse rate were measured, and repeated within three minutes of standing. The carbohydrate group had reduced symptoms and signs of dehydration, including thirst (34% versus 65%, P <0.001), dry mouth (45% versus 59%, P=0.008), dizziness (10% versus 20%, P=0.010), lower mean urine specific gravity (1.007 versus 1.017, P <0.001), lower incidence of orthostatic hypotension (2.6% versus 11%, P <0.001), and lower mean erect pulse rate (78 versus 81/minute, P=0.047). The postural change in systolic blood pressure was less in the treatment group (mean −0.4 mmHg, median −1 mmHg [interquartile range, IQR −7 to 7]) than in the control group (mean −4.1 mmHg, median −1 mmHg [IQR −12 to 3], P=0.028). These findings indicate that hydration with carbohydrate solution in patients taking sodium picosulfate has clinical benefit.

Cerebral blood flow of children with vasovagal syncope

2014 ◽  
Vol 25 (2) ◽  
pp. 267-273 ◽  
Author(s):  
Barsan Tugba ◽  
Kilic Zubeyir ◽  
Uzuner Nevzat ◽  
Yildirim Ali ◽  
Ucar Birsen ◽  
...  
Keyword(s):  
Blood Flow ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Flow Rate ◽  
Vasovagal Syncope ◽  
Blood Flow Rate ◽  
Tilt Test ◽  
Control Group ◽  
Group 2 ◽  
Group 1

AbstractIntroduction: We aimed to evaluate changes in the cerebral blood supply in children during vasovagal syncope and to clarify the diagnostic value of transcranial Doppler for vasovagal syncope. Materials and methods: Patients were divided into three groups. Group 1 consisted of 31 patients who were symptomatic and whose head-up tilt test was positive. Group 2 comprised 21 patients who were symptomatic but whose tilt test was negative. Group 3 included 22 healthy children. For the diagnosis of vasovagal syncope, the tilt test was applied. For the subjects of the patient and control groups, the tilt test was repeated. The flow rates of bilateral middle cerebral arteries were continuously and simultaneously recorded with temporal window transcranial Doppler. Results: There were no statistically significant differences between the three groups with respect to age and gender distribution (p>0.05). When the bed was at an upright position, the maximum blood flow rate of the right middle cerebral artery was lower in Group 1 than in Group 2, although the decrease was more significant in comparison to the healthy control group (p<0.05). The minimum blood flow rate of the right middle cerebral artery was lower in Group 1 than the Group 2, although the decrease was more significant in comparison with the healthy control group (p<0.05). The maximum blood flow rate of the left middle cerebral artery was significantly lower in Group 1 than in the control group (p<0.05). Conclusion: Minimum and maximum blood flow rates are significantly decreased in patients tilt test (+) patients with vasovagal syncope during orthostatic stress.

scholarly journals Risk Factors of Large Artery Atherosclerotic Ischemic Stroke Based on Carotid Contrast-Enhanced Ultrasonography

2020 ◽  
Author(s):  
Shaoqi Chen ◽  
Xiya Du ◽  
Zhongkeng Yao ◽  
Qingzi Chen ◽  
Xuerui Tan
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Sensitivity And Specificity ◽  
Roc Curve ◽  
Control Group ◽  
Large Artery ◽  
Operating Characteristics ◽  
Carotid Artery Plaque ◽  
Contrast Enhanced ◽  
Contrast Enhanced Ultrasonography

Abstract Background Ischemic stroke is a serious public health issue with a continuously increasing incidence worldwide. This study explores the risk factors of large artery atherosclerotic (LAA) ischemic stroke based on carotid contrast-enhanced ultrasonography (CEUS). Methods A total of 110 patients with LAA ischemic stroke and 34 patients without stroke were included. All participants underwent standard ultrasonography and CEUS, from which carotid artery plaque characteristics were obtained. The predicted performance of artery plaques was evaluated using the area under the receiver operating characteristics (ROC) curve and sensitivity and specificity at the optimal cut-off point. Results Subjects with LAA ischemic stroke were more likely to have a history of hypertension than the control group (P = 0.009). The area under the ROC curve (AUROC) for plaque echogenicity was 0.609 (95% CI, 0.524–0.689). With a cut-off value of ≤ class II (echolucent or predominantly hypoechogenic plaque), the sensitivity and specificity were 84.55% and 32.35%, respectively. The AUROC for plaque thickness was 0.676 (95% CI, 0.593–0.751). With a cut-off value of > 2.4 mm, the sensitivity and specificity were 41.82% and 88.24%, respectively. The AUROC for intraplaque neovascularization was 0.807 (95% CI, 0.733–0.868). With a cut-off value of > grade 2 (extensive appearance of bubbles within plaque), the sensitivity and specificity were 70.91% and 82.35%, respectively. Conclusions Hypertension, echolucent (or predominantly hypoechogenic) plaque, plaque thickness, and degree of intraplaque neovascularization are significantly relevant to LAA ischemic stroke in adults. These results may be helpful for clinical prediction of ischemic stroke risk.

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