scholarly journals Diagnostic Accuracy of the Aldosterone–to–Active Renin Ratio for Detecting Primary Aldosteronism

2019 ◽  
Vol 3 (9) ◽  
pp. 1748-1758 ◽  
Author(s):  
Stefan Pilz ◽  
Martin H Keppel ◽  
Christian Trummer ◽  
Verena Theiler-Schwetz ◽  
Marlene Pandis ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Sensitivity And Specificity ◽  
Roc Curve ◽  
Primary Aldosteronism ◽  
Care Center ◽  
Tertiary Care ◽  
Study Data ◽  
Index Test ◽  
Plasma Aldosterone Concentration ◽  
Active Renin

Abstract Context The aldosterone–to–active renin ratio (AARR) is the recommended screening test for primary aldosteronism (PA), but prospective study data on its sensitivity and specificity are sparse. Objective To investigate the diagnostic accuracy of the AARR for detecting PA. Design Prospective diagnostic accuracy study. Setting This study was conducted from February 2009 to August 2015 at the outpatient clinic of the Department of Endocrinology and Diabetology of the Medical University of Graz, Austria. Participants Four hundred patients with arterial hypertension who were referred to a tertiary care center for screening for endocrine hypertension. Intervention Participants had a determination of the AARR (index test) and a second AARR determination followed by a saline infusion test (SIT) after 2 to 6 weeks. PA was diagnosed in individuals with any AARR ≥3.7 ng/dL/µU/mL [including a plasma aldosterone concentration (PAC) of ≥9 ng/dL] who had a PAC ≥10 ng/dL after the SIT. We did not substantially alter antihypertensive drug intake. Main Outcome Measures Primary outcome was the receiver-operating characteristic (ROC) curve of the AARR in diagnosing PA. Results A total of 382 participants were eligible for analyses; PA was diagnosed in 18 (4.7%) patients. The area under the ROC curve of the AARR in detecting PA was 0.973 (95% CI, 0.956 to 0.990). Sensitivity and specificity for a positive AARR in diagnosing PA were 100% (95% CI, 81.5% to 100.0%) and 89.6% (95% CI, 86.0% to 92.5%), respectively. Conclusions The AARR has good diagnostic accuracy for detecting PA.

scholarly journals Cytological evaluation of breast lesion and its histopathological correlation in a tertiary care center

2018 ◽  
Vol 6 (2) ◽  
pp. 66-71
Author(s):  
Manish Kumar Das ◽  
Ashok Koirala
Keyword(s):  
Diagnostic Accuracy ◽  
Sensitivity And Specificity ◽  
Breast Lesion ◽  
Care Center ◽  
Tertiary Care ◽  
Malignant Lesion ◽  
Breast Lesions ◽  
Age Group ◽  
Duct Carcinoma ◽  
Cytological Evaluation

Background : Breast cancer is one of the commonest cancers in female. FNAC is safe and cost affective screening test for breast lump having both high sensitivity and specificity. Our aim is evaluation of diagnostic accuracy of fine needle aspiration cytology [FNAC] in diagnosis of breast lesions.Material and Methods: All male and female patients with breast lesion were subjected to cytological evaluation of which many were followed up with histopathological evaluation to assess the diagnostic accuracy of FNAC.Results : Out of 1088 cases diagnosed on FNAC, 703 cases (64.61%) were benign and 232 cases (21.3%) were found to be malignant. In our study the most common benign lesion was fibroadenoma and commonest malignant lesion was Duct carcinoma. Maximum cases of breast lesions in females were in the age group of 21- 30 years followed by age group of 31- 40 years. While maximum cases in males were in the age group of 31-40 years & 61-70 years. The sensitivity and specificity of FNAC for cyto-histo correlation were found to be 97.16% and 92.83% respectively.Conclusion : FNAC is a highly sensitive and specific test for diagnosis and categorization of breast lesions into different categories of neoplastic and non-neoplastic breast lesions.Journal of Nobel Medical College  Volume 6, Number 2, Issue 11, July-December 2017, 66-71

Diagnostic accuracy of the aldosterone to active renin ratio in detecting primary aldosteronism: the graz endocrine causes of hypertension (GECOH) study

2019 ◽  
Author(s):  
Stefan Pilz ◽  
Martin Keppel ◽  
Christian Trummer ◽  
Verena Theiler-Schwetz ◽  
Marlene Pandis ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Primary Aldosteronism ◽  
Active Renin

A comparison between 25-gauge and 22-gauge Franseen needles for endoscopic ultrasound-guided sampling of pancreatic and peripancreatic masses: a randomized non-inferiority study

Endoscopy ◽  
2021 ◽  
Author(s):  
Dongwook Oh ◽  
Joonseog Kong ◽  
Sung Woo Ko ◽  
Seung-Mo Hong ◽  
Hoonsub So ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Endoscopic Ultrasound ◽  
Care Center ◽  
Tertiary Care ◽  
Standard Of Care ◽  
Fine Needle Biopsy ◽  
Needle Aspiration ◽  
Adverse Event Rate ◽  
Current Standard ◽  
Fine Needle

Abstract Background Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) and fine-needle biopsy (FNB) are the current standard of care for sampling pancreatic and peripancreatic masses. Recently, a 22G EUS-FNB needle with Franseen geometry was developed, and this device was also introduced in a 25G platform. We compared the performance of the 25G and 22G Franseen needles for EUS-guided sampling of pancreatic and peripancreatic solid masses. Methods We conducted a parallel-group randomized non-inferiority trial at a tertiary-care center from November 2018 to May 2019. The primary outcome was the quality of the histologic core assessed using the Gerke score. The optimal histologic core is indicated by a Gerke score of 4 or 5, which enables optimal histologic interpretation. The overall diagnostic accuracy and adverse event rate were also evaluated. Results 140 patients were enrolled and randomized (1:1) to the 25G and 22G groups. Tissue acquisition by EUS-FNB was successful in all patients. The optimal histologic core procurement rate was 87.1 % (61/70) for the 25G needle vs. 97.1 % (68/70) for the 22G; difference −10 % (95 % confidence interval −17.35 % to −2.65 %). High quality specimens were more frequently obtained in the 22G group than in the 25G group (70.0 % [49/70] vs. 28.6 % [20 /70], respectively; P < 0.001). The overall diagnostic accuracy did not differ between the groups (97.4 % for 25G vs. 100 % for 22G). Conclusions The 25G Franseen needle was inferior to the 22G needle in histologic core procurement. Therefore, for cases in which tissue architecture is pivotal for diagnosis, a 22G needle, which procures relatively higher quality specimens than the 25G needle, should be used.

Usefulness of some current balance tests for identifying individuals with disequilibrium due to vestibular impairments

2009 ◽  
Vol 18 (5-6) ◽  
pp. 295-303
Author(s):  
Helen S. Cohen ◽  
Kay T. Kimball
Keyword(s):  
Sensitivity And Specificity ◽  
Care Center ◽  
Tertiary Care ◽  
High Sensitivity ◽  
Community Dwelling ◽  
Functional Mobility ◽  
Vestibular Disorders ◽  
Timed Up And Go ◽  
Balance Tests ◽  
Walking Balance

The goal of this study was to determine which of several clinical balance tests best identifies patients with vestibular disorders. We compared the scores of normals and patients on the Berg Balance Scale (Berg), Dynamic Gait Index (DGI), Timed Up and Go (TUG), Computerized Dynamic Posturography Sensory Organization Test (SOT), and a new obstacle avoidance test: the Functional Mobility Test (FMT). The study was performed in an out-patient balance laboratory at a tertiary care center. Subjects were 40 normal adults, and 40 adults with vestibular impairments. The main outcome measures were the sensitivity of tests to patients and specificity to normals. When adjusted for age the Berg, TUG, DGI and FMT had moderate sensitivity and specificity. SOT had moderately high sensitivity and specificity. SOT and FMT, combined, had high sensitivity and moderate specificity. Therefore, the kinds of tests of standing and walking balance that clinicians may use to screen patients for falling are not as good for screening for vestibular disorders as SOT. SOT combined with FMT is better. When screening patients for vestibular disorders, when objective diagnostic tests of the vestibular system, itself, are unavailable, tests of both standing and walking balance, together, give the most information about community-dwelling patients. These tests may also indicate the presence of sub-clinical balance problems in community-dwelling, asymptomatic adults.

scholarly journals Comparison between conventional tube method and gel card technique for blood crossmatching: A study in a tertiary care center of north India

2020 ◽  
Vol 11 (4) ◽  
pp. 6500-6503
Author(s):  
Ragini Singh ◽  
Prachi Garg ◽  
Anoop Kumar ◽  
Sucheta ◽  
Meenal Babra
Keyword(s):  
Blood Transfusion ◽  
Sensitivity And Specificity ◽  
Care Center ◽  
Tertiary Care ◽  
Test Tube ◽  
North India ◽  
Advantages And Disadvantages ◽  
Time Required ◽  
Spin Tube ◽  
Cross Matching

The cross-matching of blood can be performed by various methods like saline tube method and gel card technique. Saline tube method is most commonly used in blood banks, whereas the latest method used is Gel card technique for cross-matching. Both techniques have their advantages and disadvantages. The main aim of this study was the comparison of gel card and conventional tube test for sensitivity and specificity, time and efficacy. This prospective study was done at the Department of Blood Transfusion, BPS GMC Khanpur Kalan, Sonipat, Haryana. A total of 500 samples collected at the Department of Blood Transfusion, were cross-matched using conventional tube method (spin tube method) with and without using AHG and Gel card Method. 497 (99.4%) samples were compatible, and 3 (0.6%) samples were incompatible with Gel card method, but by test tube method 492 (98.4%) samples were consistent, and 05(1.6%) were false positive (FP). Incompatibility of those 05 samples (FP) disappeared after incubation with AHG reagent at 37°C saline tube method. The sensitivity and specificity of both gel card method and saline tube method with AHG methods is 100% whereas the specificity of saline tube method without AHG is 98.9%. The average time taken by Gel card method was 20-30 minutes for a single compatibility test whereas in conventional spin tube method with the use of AHG (IAT) average time required was 90 minutes and without AHG it was 45-60minutes. The sensitivity and specificity of the spin tube method and the gel card method are comparable to each other. But the gel card method is easy to perform, rapid, reliable procedure and results can be recorded. In contrast, spin saline tube method is more time consuming, and results cannot be preserved. Thus gel card technique can be preferred over the spin tube method.

scholarly journals Hyperparathyroidism in Patients with Primary Aldosteronism: Cross-Sectional and Interventional Data from the GECOH Study

2012 ◽  
Vol 97 (1) ◽  
pp. E75-E79 ◽  
Author(s):  
Stefan Pilz ◽  
Katharina Kienreich ◽  
Christiane Drechsler ◽  
Eberhard Ritz ◽  
Astrid Fahrleitner-Pammer ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Mineralocorticoid Receptor ◽  
Care Center ◽  
Tertiary Care ◽  
Experimental Studies ◽  
Mineralocorticoid Receptor Antagonists ◽  
Receptor Antagonists ◽  
Vitamin D Metabolism ◽  
Cross Sectional ◽  
The Impact

Context: Experimental studies suggest that aldosterone induces hypercalciuria and might contribute to hyperparathyroidism. Objective: We aimed to test for differences in PTH levels and parameters of calcium and vitamin D metabolism in patients with primary aldosteronism (PA) compared with patients with essential hypertension (EH) and to evaluate the impact of PA treatment on these laboratory values. Design, Setting, and Participants: The Graz Endocrine Causes of Hypertension study includes hypertensive patients referred for screening for endocrine hypertension at a tertiary care center in Graz, Austria. Main Outcome Measures: Differences in PTH levels between patients with PA and EH. Results: Among 192 patients, we identified 10 patients with PA and 182 with EH. PTH levels (mean ± sd in picograms per milliliter) were significantly higher in PA patients compared with EH (67.8 ± 26.9 vs. 46.5 ± 20.9; P = 0.002). After treatment of PA with either adrenal surgery (n = 5) or mineralocorticoid receptor antagonists (n = 5), PTH concentrations decreased to 43.9 ± 14.9 (P = 0.023). Serum 25-hydroxyvitamin D concentrations were similar in both groups. Compared with EH, serum calcium concentrations were significantly lower (2.35 ± 0.10 vs. 2.26 ± 0.10 mmol/liter; P = 0.013), and there was a nonsignificant trend toward an increased spot urine calcium to creatinine ratio in PA [median (interquartile range) 0.19 (0.11–0.31) vs. 0.33 (0.12–0.53); P = 0.094]. Conclusions: Our results suggest that PA contributes to secondary hyperparathyroidism. Further studies are warranted to evaluate whether PTH has implications for PA diagnostics and whether mineralocorticoid receptor antagonists have a general impact on PTH and calcium metabolism.

scholarly journals MON-221 Seated Saline Suppression Testing Is Comparable to Captopril Challenge Test for the Diagnosis of Primary Aldosteronism: A Prospective Study

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Jinbo Hu ◽  
Bin Liu ◽  
Ying Song ◽  
Wenwen He ◽  
Qingfeng Cheng ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Prospective Study ◽  
Multiple Regression ◽  
Sensitivity And Specificity ◽  
Primary Aldosteronism ◽  
Sodium Intake ◽  
Challenge Test ◽  
Regression Analyses ◽  
False Diagnosis ◽  
A Prospective Study

Abstract Abstract: Objective: Saline suppression testing (SST) and captopril challenge test (CCT) are commonly used confirmatory tests for primary aldosteronism (PA). Seated SST (SSST) is reported to be superior to recumbent SST (RSST). Whether SSST is better than CCT remains unclear. Therefore we conducted a prospective study to compare the diagnostic accuracy of SSST and CCT. Methods: Hypertensive patients with high risk of PA were consecutively included. Patients with aldosterone-renin ratio≥1.0 ng•dl-1/μIU•ml-1 were asked to complete SSST, CCT and fludrocortisone suppression test (FST). Using FST as the reference standard (plasma aldosterone concentration [PAC] post-FST ≥6.0 ng•dl-1), area under the receiver-operator characteristic curves (AUC), sensitivity and specificity of SSST and CCT were calculated, and multiple regression analyses were conducted to identify potential factors for false diagnosis. Results: A total of 183 patients diagnosed as PA and 48 as essential hypertension completed the study. Using PAC post-SSST and PAC post-CCT to confirm PA, SSST and CCT had comparable AUCs (AUCSSST 0.83 [0.78,0.88] vs. AUCCCT 0.86 [0.81,0.90], P=0.308). Setting PAC post-SSST and post-CCT at 8.5 ng•dl-1 and 11 ng•dl-1, respectively, the sensitivity and specificity of SSST [0.71 (95%CI 0.64 to 0.77) and 0.82(0.68,0.90)] and CCT [0.73(0.66,0.79) and 0.80(0.66,0.89)] were not significantly different. In the multiple regression analyses, 1SD increment of sodium intake resulted in 40% lower risk of false diagnosis in SSST. Conclusions: SSST and CCT have comparable diagnostic accuracy. Insufficient sodium intake decreases the diagnostic efficiency of SSST but not CCT. Since the CCT is simpler and cheaper, it is preferable to the SSST.

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