scholarly journals OR07-05 Is Urinary Calcium the Only Predictor of Nephrolithiasis in Patients with Asymptomatic Primary Hyperparathyroidism?

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Federica Saponaro ◽  
Filomena Cetani ◽  
Laura Mazoni ◽  
Matteo Apicella ◽  
Marco Scalese ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Predictive Value ◽  
Multivariate Analyses ◽  
International Workshop ◽  
High Specificity ◽  
Risk Profile ◽  
Urinary Calcium ◽  
Youden Index ◽  
Low Sensitivity ◽  
Sensitivity Specificity

Abstract The 4th International Workshop for the management of asymptomatic PHPT included, among the criteria for parathyroidectomy, the presence of hypercalciuria (dUCa> 400 mg/day) and increased biochemical stone risk profile. The aim of the present study was to evaluate the biochemical stone risk profile in 176 consecutive patients (143 females and 33 males) with asymptomatic PHPT. We recorded clinical and biochemical data, including 24 hours urinary measurements of the following parameters: volume and pH, creatinine, calcium, magnesium, sodium, potassium, ammonium, uric acid, oxalate, citrate, phosphate, inorganic sulphate and chloride and kidney ultrasound. In our cohort dUCa> 400mg/day showed a low sensitivity and positive predictive value (PPV) for nephrolithiasis with high specificity (46.2, 32.7, 73.0% respectively), while hypercalciuria by 4 mg/kg/bw (d-UCa>4mg/kg) had a high sensibility, with low PPV and specificity (79.5, 27.7, 40.1%) Daily hypomagnesuria (d-HypoMg), but not any other urinary parameter, was an independent predictor of nephrolithiasis in the univariate (OR 2.97 CI 1.27-7.09 P=0.014) and multivariate analyses adjusting for age, sex, BMI, and eGFR (OR 3.13 CI 1.17-8.42 P=0.02). d-HypoMg was relatively lower in the regression analysis with urinary calcium in patients with nephrolithiasis compared with those without. The mean ratio between (dUCa) and (dUMg) was higher in patients with nephrolithiasis compared with those without (4.6±2.0 vs 3.3±4.1; P<0.001). In the univariate and multivariate analyses the dUCa/dUMg ratio was a significant predictor of nephrolithiasis [OR 4.9 (2.3-10.5); P<0.001; OR 5.3 (2.4-11.6), P<0.001, respectively]. The AUC using the dUCa/dUMg ratio as variables was 0.69 (CI 0.60-0.79; P<0.0001). The best cut-off value, set at the highest Youden index, was equal to 4.0, with a sensitivity of 59.0% and a specificity of 77.4%. In patients with hypercalciuria (>400 mg/24-hour) dUMg was positively correlated with dUCa in those without nephrolithiasis (r=0.50, β=0.2, P=0.002) but not in those with nephrolithiasis (r=0.05, β= 0.014; P=0.8). In patients without hypercalciuria we found that hypomagnesuria remained a predictor of nephrolithiasis using either 400 mg/die (P=0.002, OR 5.12 (1.84-14.24) or 4 mg/kg bw (P=0.014, OR 6.24 (1.45-26.8). Moreover, the OR for nephrolithiasis improved using the combination of d-HypoMg with d-UCa>4mg/kg (OR 8.12, CI 1.92-34.18, P=0.004), but not with dUCa> 400mg/day. The current urinary calcium threshold of >400 mg/24-hour has a low sensitivity in detecting nephrolithiasis; our data suggest that sensitivity, specificity and positive predictive value could be improved including dUMg, dUCa/dUMg ratio and the combination of d-HypoMg with d-UCa>4mg/kg in the stone risk evaluation.

Validity of hearTest Smartphone-Based Audiometry for Hearing Screening in Workers Exposed to Noise

2020 ◽  
Author(s):  
Luma Cordeiro Rodrigues ◽  
Silvia Ferrite ◽  
Ana Paula Corona
Keyword(s):  
Hearing Loss ◽  
High Specificity ◽  
Hearing Screening ◽  
Youden Index ◽  
Hearing Level ◽  
Predictive Values ◽  
Auditory Thresholds ◽  
The Mean ◽  
Low Sensitivity ◽  
Sensitivity Specificity

Abstract Purpose This article investigates the validity of a smartphone-based audiometry for hearing screening to identify hearing loss in workers exposed to noise. Research Design This is a validation study comparing hearing screening with the hearTest to conventional audiometry. The study population included all workers who attended the Brazilian Social Service of Industry to undergo periodic examinations. Sensitivity, specificity, the Youden index, and positive (PPV) and negative predictive values (NPV) for hearing screening obtained by the hearTest were estimated according to three definitions of hearing loss: any threshold greater than 25 dB hearing level (HL), the mean auditory thresholds for 0.5, 1, 2, and 4 kHz greater than 25 dB HL, and the mean thresholds for 3, 4, and 6 kHz greater than 25 dB HL. Note that 95% confidence intervals were calculated for all measurements. Results A total of 232 workers participated in the study. Hearing screening with the hearTest presented good sensitivity (93.8%), specificity (83.9%), and Youden index (77.7%) values, a NPV (97.2%), and a low PPV (69.0%) for the identification of hearing loss defined as any auditory threshold greater than 25 dB HL. For the other definitions of hearing loss, we observed high specificity, PPV and NPV, as well as low sensitivity and Youden index. Conclusion The hearTest is an accurate hearing screening tool to identify hearing loss in workers exposed to noise, including those with noise-induced hearing loss, although it does not replace conventional audiometry.

Drawing the line in the Edinburgh Postnatal Depression Scale (EPDS): a vital decision

2011 ◽  
Vol 23 (1) ◽  
Author(s):  
Dagmar Lagerberg ◽  
Margaretha Magnusson ◽  
Claes Sundelin
Keyword(s):  
Positive Predictive Value ◽  
Predictive Value ◽  
Postnatal Depression ◽  
Edinburgh Postnatal Depression Scale ◽  
Depression Scale ◽  
Child Interaction ◽  
Mother Child Interaction ◽  
Problem Behaviours ◽  
Low Sensitivity ◽  
Sensitivity Specificity

Abstract Background: The Edinburgh Postnatal Depression Scale (EPDS) is widely used in early child health care. This study examined the appropriateness of the recommended EPDS cut-off score 11/12. Methods: Two main analyses were performed: 1. Associations between EPDS scores and maternal health behaviour, stress, life events, perceived mother-child interaction quality and child behaviour. 2. Screening parameters of the EPDS, i.e., sensitivity, specificity and positive predictive value. EPDS scores were available for 438 mothers and maternal questionnaires for 361 mothers. Results: Already in the EPDS score intervals 6–8 and 9–11, there were notable adversities, according to maternal questionnaires, in stress, perceived quality of mother-child interaction, perceived child difficultness and child problem behaviours. Using maternal questionnaire reports about sadness/distress postpartum as standard, the recommended EPDS cut-off score 11/12 resulted in a very low sensitivity (24%). The cut-off score 6/7 yielded a sensitivity of 61%, a specificity of 82% and a positive predictive value of 61%. Conclusions: In terms of both clinical relevance and screening qualities, an EPDS cut-off score lower than 11/12 seems recommendable.

scholarly journals The slipping slipper sign: a simple test with high specificity and positive predictive value for peripheral neuropathy among diabetic patients

2012 ◽  
Vol 2 (2) ◽  
pp. 51 ◽  
Author(s):  
Krystal A.T. Gayle ◽  
Marshall K. Tulloch-Reid ◽  
Rainford J. Wilks ◽  
Trevor S. Ferguson
Keyword(s):  
Peripheral Neuropathy ◽  
Positive Predictive Value ◽  
Diabetic Neuropathy ◽  
Predictive Value ◽  
High Specificity ◽  
Diabetic Patients ◽  
Simple Test ◽  
Diabetes Clinic ◽  
Sensitivity Specificity ◽  
Single Question

This study evaluated the ability of the slipping slipper sign (defined as unknowingly losing a slipper while walking) to identify diabetic neuropathy in Jamaican patients. A single question was used to ascertain the presence of the slipping slipper sign (SSS) among 69 patients attending a diabetes clinic. Nurses assessed pain, vibration and pressure perception among the same patients in order to detect diabetic neuropathy. The sensitivity, specificity and positive predictive value for the SSS were calculated. Eight participants (men=5, women=3) reported positive SSS. The SSS had a sensitivity of 28.6%, specificity of 100% and positive predictive value (PPV) 100% for neuropathy on at least one of the three tests. These findings indicate that the SSS has high specificity and PPV for diabetic neuropathy but the sensitivity is low. The sign may be a useful adjuvant to conventional methods of screening for severe neuropathy

scholarly journals Clinical Performance of the Spot Vision Photo Screener before and after Induction of Cycloplegia in Children

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Konuralp Yakar
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Clinical Performance ◽  
High Specificity ◽  
Screening Criteria ◽  
Predictive Values ◽  
Before And After ◽  
Sensitivity Specificity ◽  
Vision Screener

Aim. To compare the clinical performance of the Spot Vision Screener used to detect amblyopia risk factors (ARFs) in children before and after induction of cycloplegia; the children were referred because they met the screening criteria of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS). Methods. The Spot Vision Screener and a standard autorefractometer were used to examine 200 eyes of 100 children aged 3–10 years, before and after cycloplegia induction, in terms of ARFs. Sensitivity, specificity, and positive and negative predictive values for the detection of significant refractive errors were measured using the AAPOS referral criteria. It was explored that Spot Screener data were affected by cycloplegia. The extent of agreement between cycloplegic/noncycloplegic photoscreening data and cycloplegic autorefraction measurements was assessed using Wilcoxon and Spearman correlation analyses. Results. The Spot’s sensitivity was improved from 60.9% to 85.3% and specificity from 94.9% to 87.4% with cycloplegia compared to cycloplegic standard autorefractometer results. The positive predictive value of Spot was 75.7%, and the negative predictive value was 90.4% without cycloplegia. With cycloplegia, the positive predictive value of Spot was 63.6% and the negative predictive value was 95.8%. Conclusions. The Spot Screener afforded moderate sensitivity and high specificity prior to cycloplegia. The sensitivity and negative predictive value improved after induction of cycloplegia. Examiners should be aware of the effects of cycloplegia on their findings.

scholarly journals Factors Impacting the Performance Characteristics of Bile Duct Brushings: A Clinico-Cytopathologic Analysis of 253 Patients

2018 ◽  
Vol 142 (7) ◽  
pp. 863-870 ◽  
Author(s):  
Ezgi Hacihasanoglu ◽  
Bahar Memis ◽  
Burcin Pehlivanoglu ◽  
Vaidehi Avadhani ◽  
Alexa A. Freedman, ◽  
...  
Keyword(s):  
Bile Duct ◽  
Predictive Value ◽  
High Specificity ◽  
Daily Practice ◽  
Performance Characteristics ◽  
Lower Sensitivity ◽  
Current State ◽  
Risk Of Malignancy ◽  
Low Sensitivity ◽  
Sensitivity Specificity

Context.— Literature on factors impacting bile duct brushings (BDBs) performance characteristics remain limited. Objective.— To capture the current state of daily practice with BDB sign-out. Design.— Two hundred fifty-three of 444 BDBs signed out by more than 7 cytopathologists, with histopathologic and/or clinical follow-up of at least 18 months, were examined. Results.— One hundred thirty-five of 253 BDBs (53%) had histologically confirmed malignancies, 22 (9%) had cancer-related deaths, and 96 (38%) were benign. Cytologic diagnoses in the 444 BDBs were nondiagnostic (11 [2.5%]), negative (284 [64%]), atypical (62 [13.9%]), suspicious (34 [7.7%]), and malignant (53 [11.9%]). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of malignancy detection were 35%, 100%, 100%, 58%, and 66%, respectively. When atypical, suspicious, and malignant (ASM) categories were combined, sensitivity increased (58%), specificity and PPV dropped (97%), and accuracy increased (73%). Carcinoma type (bile-duct versus pancreatic-ductal) had no effect on accuracy (P = .60) or diagnostic class (P = .84), nor did time of performance (first 7.5 versus latter 7.5 years, P = .13). Interestingly, ThinPrep + cell block (n = 41) had higher sensitivity (61%) and lower specificity (80%) than ThinPrep only (versus 51% and 100%, respectively). Sensitivity and specificity were higher (47% and 100%) in nonstented than stented specimens (59% and 97%). Relative risk of malignancy for “suspicious” (2.30) and “atypical” (2.28) categories was lower but not very different from that of “malignant” category (2.41). Conclusions.— Bile duct brushings had fairly low sensitivity but high specificity and PPV with no false positives. Sensitivity almost doubled and specificity dipped minimally when ASM categories were combined, highlighting the need for better classification criteria for atypical/suspicious cases. Higher specificity, PPV, NPV, and accuracy but lower sensitivity in stented BDBs suggest that they be called malignant only when evidence is overwhelmingly convincing.

scholarly journals Correlation of Ultrasound and RIPASA Scoring System in the Diagnosis of Acute Appendicitis

2018 ◽  
Vol 5 ◽  
Author(s):  
Anand Rai Bansal ◽  
Suvendu Sekhar Jena ◽  
Sanjeev Kumar
Keyword(s):  
Acute Appendicitis ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Study Design ◽  
Predictive Value ◽  
Scoring System ◽  
Negative Appendicectomy ◽  
Low Sensitivity ◽  
Sensitivity Specificity

Objective: Correlation of Ultrasound and RIPASA scoring system in the diagnosis of acute appendicitis. Study Design: 50 patients presenting to emergency underwent ultrasound and evaluation as per RIPASA scoring system followed by emergency appendicectomy. The sensitivity, specificity, positive and negative predictive value calculated for each goups. Results: The sensitivity, specificity, Positive Predictive Value and Negative Predictive Value for ultrasound were 75.51%, 100%, 100% and 7.69% respectively and that for RIPASA scoring system were 93.9%, 100% 100% and 25% respectively. The negative appendicectomy rate was 2%. Conclusion: RIPASA scoring system may be used for correctly diagnosing acute appendicitis but low sensitivity of ultrasound precludes its routine use and may be used as a complementary tool in diagnosing acute appendicitis. Keywards: Acute Appendictis, RIPASA, Ultrasound.

scholarly journals Neural Network based - Arrhythmia Monitoring Device: A Pivotal Clinical Trial

2020 ◽  
Vol 9 (3S) ◽  
pp. 346-349 ◽  
Keyword(s):  
Neural Network ◽  
Clinical Trial ◽  
Heart Rate ◽  
Positive Predictive Value ◽  
Diagnostic Tool ◽  
Predictive Value ◽  
High Specificity ◽  
Holter Monitoring ◽  
Monitoring Device ◽  
Low Sensitivity

Arrhythmia or irregular heart beat had wide range of clinical manifestations, from benign arrhythmia that not need any medication to life threatening condition. It can occur permanently or intermittently. Intermittent arrhythmia needs specific diagnostic tools that can record the electrocardiogram continuously. This research was sought to analysed the sensitivity, specificity, Positive Predictive Value, and Negative Predictive Value of arrhythmia monitoring device that based on neural network based artificial intelligent. The pivotal clinical trial was involved a total 103 people (health and stable arrhythmia patients). This research used a diagnostic test by comparing the electrocardiography (ECG) from prototype with standard ECG for diagnose arrhythmia. The Arrhythmia Monitoring System that we developed has three hardware components; smartphones, server for arrhythmia detection and patchable ECG recorder. All three components are connected with internet of things (IoT) technology. The architecture of Arrhythmia software monitoring included ECG signals pre-processing, beats detection, features extraction for detecting VT/VF, and classification for detecting VT/VF. Features extraction such as heart rate variability (HRV) and T wave alternans. We compared the ECG of arrhythmia prototype monitoring device with standard Holter monitoring. We enrolled 103 patients. There was no significant difference of heart rate between arrhythmia prototype monitoring device and standard Holter (87.26 ± 11.2 vs 86.07±9.15, P=0.43). There was significant different of maximum and minimum heart rate between arrhythmia prototype monitoring device and standard holter monitoring (121.3±31.7 vs 131.0±10.8, p= 0.000, and 65.1±13.5 vs 73.07±10.02, p=0.000). This device has low sensitivity 80% (95% CI 75% – 82%) and high specificity 91.8% (95% CI 85% – 92%) for detecting the abnormal ECG. The Positive Predictive Value (PPV) was 63.2% (95% CI 58.8% – 67.52%) and Negative Predictive Value (NVP) was 96.3% (95% CI 94.7% – 98.3%). This device demonstrates an ability to detect PVC and PAC (Sensitivity 71.4% (95% CI 66.4% - 76.4%) and 75% (95% CI 72%-78%), Specificity 97.8% (95% CI 95.8-99.8%) and 91.7% (95% CI 83.4%- 99.7%, respectively). The PPV of this device to detect PVC and PAC was 71.4% (95% CI 66.4%-76.4%) and 72.7%. (95% CI 68.7%-76.7%) The NPV of this device to detect PVC and PAC was 97.8% (95% CI 95.8%-99.85) and 98.9% (95% CI 98.1%-99.7%), respectively. This study found that the device to be a valuable diagnostic tool that has relatively low sensitivity but high specificity for diagnosing Abnormal ECG, PVC and PAC. According to the results of our study, we found that the device to be a valuable diagnostic tool that has relatively high sensitivity and specificity for diagnosing Abnormal ECG, PVC and PAC.

Utility of Squash Cytology in Spinal Lesions with Special Reference to Ki67 Immunostain

2019 ◽  
Vol 63 (5) ◽  
pp. 424-430
Author(s):  
Debashis Chakrabarty ◽  
Shubhamitra Chaudhuri ◽  
Priyanka Maity ◽  
Uttara Chatterjee ◽  
Subhasis Ghosh
Keyword(s):  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
High Specificity ◽  
Histopathological Diagnosis ◽  
Spinal Tumours ◽  
Who Grade ◽  
Spinal Lesions ◽  
Sensitivity Specificity ◽  
A Prospective Study

Background: Squash cytology is of significant importance in intraoperative consultation of central nervous system (CNS) pathology. There are several studies on squash cytology of CNS lesions, and only a few of them deal with spinal lesions alone. Aims: (1) To evaluate intraoperative squash cytology of spinal lesions. (2) To correlate cytological diagnosis with histopathological diagnosis and assess the diagnostic accuracy. (3) To study Ki67 expression on squash smears and determine whether it can assist in grading spinal tumours on cytology. Materials and Methods: A prospective study was conducted on 68 patients with clinico-radiologically diagnosed lesions of the spine. Intraoperative squash smears were stained with haematoxylin-eosin (H&E) stain, Papanicolaou (Pap) stain, and May-Grünwald-Giemsa (MGG) stain. Subsequently, histological diagnosis was made. Ki67 immunostaining was performed on squash smears and histology sections. Results: The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of squash cytology in spinal lesions were 84.6, 100, 100, 23.1, and 80.88%, respectively. On immunocytochemistry, the mean Ki67 labelling indices for grade I, II, and III tumours were 0, 0.33 and 9%, respectively. Conclusion: Squash smear cytology is a rapid intraoperative technique for diagnosing spinal lesions, with high specificity and high positive predictive value. It is more effective in diagnosing neoplasms than non-neoplastic lesions. Ki67 immunostaining can be done on cytology smears to effectively differentiate between WHO grade I and grade II spinal tumours.

scholarly journals Drain Tip Culture: Would It Help Us Predict and Prevent Surgical Site Infection After Spinal Surgery?

2021 ◽  
Vol 2 (1) ◽  
Keyword(s):  
Positive Predictive Value ◽  
Surgical Site Infection ◽  
Negative Predictive Value ◽  
Spine Surgery ◽  
Predictive Value ◽  
Spinal Surgery ◽  
Statistical Significance ◽  
High Specificity ◽  
Site Infection ◽  
Low Sensitivity

Background: Systematic cultures of drain tips or drainage fluids are commonly used by surgical teams for the early detection of Surgical Site Infection (SSI), even in the absence of clinical suspicion of infection. However, their prognostic values are controversial. Method: This was a prospective study of patients undergoing spine surgery at our institute during the study period. Patients already diagnosed with spine infection were excluded from the study. At the time of drain removal, the drain tip was cut and sent to microbiology laboratory for bacterial culture. All patients were treated with antimicrobial prophylaxis based on evidence-based guidelines and were monitored for at least 6 months after surgery for the development of Surgical Site Infection (SSI). SSI was defined according to Centers for Disease Control and Prevention criteria. Results: The study comprised of 183 patients including 85 males and 98 females. The rate of Surgical Site Infection in our study was 2.73 % (5 patients). Drain Tip Culture (DTC) was positive in 4 patients (2.18 %). Association of DTC with SSI was found to have high Specificity (98.31 %) and Negative Predictive Value (97.76 %) but low Sensitivity (20 %) and Positive Predictive Value (25 %). Conclusion: Culture of drain tip after spine surgery does not conclusively predict the presence or absence of surgical site infection. However, statistical significance was observed between drain tip culture and surgical site infection with high specificity, high negative predictive value, low sensitivity and low positive predictive value. Keywords: Drain tip culture; Spinal Surgery; Surgical site infection.

scholarly journals The performance of point-of-care antibody test for COVID-19 diagnosis in a tertiary hospital in Bandung, Indonesia

2021 ◽  
Vol 15 (02) ◽  
pp. 237-241
Author(s):  
Nisa Fauziah ◽  
Raspati C Koesoemadinata ◽  
Basti Andriyoko ◽  
Lia Faridah ◽  
Silvita F Riswari ◽  
...  
Keyword(s):  
Blood Sample ◽  
Predictive Value ◽  
Point Of Care ◽  
Antibody Test ◽  
High Specificity ◽  
Tertiary Hospital ◽  
Capillary Blood ◽  
Capillary Blood Sample ◽  
Low Sensitivity ◽  
Sensitivity Specificity

Introduction: We aim to describe the performance of combined IgM and IgG point-of-care antibody test (POC-Ab) (Wondfo®) compared to real-time reverse transcriptase (rRT-PCR) (Allplex™ 2019-nCoV Assay) in detecting coronavirus disease 2019 (COVID-19). Methodology: We compared POC-Ab with rRT-PCR results among patients in a tertiary hospital from January to March 2020 in Bandung, Indonesia. We selected presumptive COVID-19 patients with positive rRT-PCR consecutively and 20 patients with negative rRT-PCR results were selected randomly from the same group of patients as controls. We described the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) with corresponding 95% confidence interval using serum and capillary blood samples. We also tested POC-Ab using non-COVID-19 (confirmed dengue and typhoid) patients’ sera. Results: Twenty-seven patients with positive rRT-PCR result and 20 negative controls were included (68.1% males, mean age 46 (SD: 15.4)). Using the serum, the sensitivity of the POC-Ab was 63.0% (42.4-80.6), specificity was 95.0% (75.1-99.9), PPV was 94.4% (72.7-99.8), NPV was 65.5% (45.7-82.1). A subset of 20 patients was tested using a capillary blood sample. The accuracy of the capillary blood sample is lower compared to serum (50.0% vs. 78.7%). None of the non-COVID-19 sera tested were reactive. Conclusions: POC-Ab for COVID-19 has a high specificity with no false-positive result in non-COVID-19 sera. Therefore, it can be used to guide diagnostic among symptomatic patients in resource limited settings. Given its low sensitivity, patients with high suspicion of COVID-19 but non-reactive result should be prioritized for rRT-PCR testing.

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