scholarly journals The diagnosis of delirium in 80 emergency unit patients

1998 ◽  
Vol 56 (2) ◽  
pp. 176-183
Author(s):  
AFONSO CARLOS NEVES ◽  
RICARDO DE CASTRO CINTRA SESSO ◽  
HENRIQUE BALLALAI FERRAZ ◽  
SÍLVIO FRANCISCO ◽  
JOÃO BAPTISTA DOS REIS-FILHO
Keyword(s):  
Correct Diagnosis ◽  
Diagnostic Testing ◽  
Final Diagnosis ◽  
Initial Diagnosis ◽  
University Hospital ◽  
Emergency Unit ◽  
Predictive Values ◽  
Kappa Test ◽  
History Of ◽  
Sensitivity Specificity

We evaluated the initial and final diagnosis of 80 patients with delirium arriving at the emergence unit of a university hospital in a large Brazilian city over a period of 30 months up to December 1991. The diagnosis was based on the DSM-IIIR criteria. Patients with a known history of head trauma or epileptic seizure and patients younger than 13 years were excluded. Only patients with a disease of up to 7 days were included.The patients were subdivided into four etiologic groups: vascular; associated with the use of alcohol; infectious-parasitic; miscellaneous.The results showed a rate of correct diagnosis ranging from 65 to 80% with the use of kappa test (standard good to excelent). Sensitivity, specificity, positive predictive and negative predictive values had results showing different conditions for initial diagnosis in each group. This study can help the initial diagnosis of delirium and the choice for diagnostic testing.

scholarly journals Hysteroscopy as a standard procedure for assessing endometrial lesions among postmenopausal women

2007 ◽  
Vol 125 (6) ◽  
pp. 338-342 ◽  
Author(s):  
Camila Toffoli Ribeiro ◽  
Júlio César Rosa-e-Silva ◽  
Marcos Felipe Silva-de-Sá ◽  
Ana Carolina Japur de Sá Rosa-e-Silva ◽  
Omero Benedicto Poli Neto ◽  
...  
Keyword(s):  
Endometrial Thickness ◽  
Standard Procedure ◽  
University Hospital ◽  
Histopathological Analysis ◽  
Benign Lesions ◽  
Predictive Values ◽  
Asymptomatic Patients ◽  
Cavity Design ◽  
Diagnostic Hysteroscopy ◽  
Sensitivity Specificity

CONTEXT AND OBJECTIVES: Endometrial cancer is the most prevalent type of malignant neoplasia of the genital tract. The objective of this study was to calculate the sensitivity, specificity, accuracy and positive and negative predictive values for diagnostic hysteroscopy, in comparison with histopathological tests, for all lesions of the endometrial cavity. DESIGN AND SETTING: Retrospective descriptive study at the public tertiary-level university hospital of Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. METHODS: Diagnostic hysteroscopy was indicated in the following instances: endometrial thickness > 4 mm in asymptomatic patients; postmenopausal bleeding; and irregular endometrium or endometrium difficult to assess from ultrasound, with or without vaginal bleeding. Ultrasound evaluations were carried out no more than three months prior to hysteroscopy. RESULTS: There were 510 patients, with a mean age of 61.1 ± 2.0 years and mean time elapsed since the menopause of 12.7 ± 2.5 years. Endometrial biopsies were performed on 293 patients (57.5%). Histopathological analysis showed that 18 patients presented endometrial carcinoma or typical or atypical hyperplasia, and none of them presented endometrial thickness of less than 8 mm. No significant differences were found between the median thicknesses of the various benign lesions (p > 0.05). In our data, the sensitivity, specificity, accuracy and positive and negative predictive values for cancer or hyperplasia were 94.4%, 97.0%, 96.8%, 68% and 99.6%, respectively. CONCLUSIONS: Our results suggest that hysteroscopy is valuable as a diagnostic tool for malignant/hyperplastic and benign lesions, except for submucous myomas, for which the sensitivity was only 52.6%.

Desmoid tumor of the anterior abdominal wall in a female (Clinical case)

2018 ◽  
pp. 116-118
Author(s):  
M.V. Makarenko ◽  
◽  
D.O. Govseyev ◽  
S.V. Gridchin ◽  
N.H. Isaeva ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Desmoid Tumor ◽  
Clinical Case ◽  
Anterior Abdominal Wall ◽  
Correct Diagnosis ◽  
Final Diagnosis ◽  
Histological Findings ◽  
History Of ◽  
Slow Growing ◽  
Wall Tumor

Desmoid tumors (also called desmoids fibromatosis) are rare slow growing benign and musculoaponeurotic tumors. Although these tumors have a propensity to invade surrounding tissues, they are not malignant. These tumors are associated with women of fertile age, especially during and after pregnancy and postoperative surgeries. Our clinical case is interesting because of the rarity of the pathology and the difficulties in setting the correct diagnosis. The patient, with a history of laparoscopic myomectomy (2012), was preparing for a routine surgery for the endometrioma of the anterior abdominal wall, according to the results of the ultrasound and computed tomography. After surgical treatment, the final diagnosis was changed, based on the histological findings. Key words: desmoid tumor, abdominal wall tumor, fibroid.

scholarly journals Introducing teledermoscopy of possible skin cancers in general practice in Southern Denmark

2020 ◽  
Vol 37 (4) ◽  
pp. 513-518
Author(s):  
Tine Vestergaard ◽  
Sumangali C Prasad ◽  
Annette Schuster ◽  
Rasa Laurinaviciene ◽  
Anette Bygum ◽  
...  
Keyword(s):  
General Practice ◽  
Diagnostic Accuracy ◽  
Health Care Systems ◽  
Final Diagnosis ◽  
Skin Lesions ◽  
University Hospital ◽  
Predictive Values ◽  
Face To Face ◽  
Skin Cancers ◽  
Care Systems

Abstract Background The increasing incidence of skin cancers poses a burden to health care systems. General practitioners (GPs) play an important role in triaging these diseases and referring relevant patients to specialists. It is challenging to distinguish benign from malignant skin lesions, and GPs may benefit from diagnostic support from teledermoscopy (TD). Objectives To assess whether the introduction of TD in general practice was feasible and might reduce the number of unnecessary referrals to specialists and to assess the diagnostic accuracy and confidence of participating GPs. Methods Fifty general practices in Southern Denmark participated. Adult patients presenting to their GP with suspected skin cancer could be included. Images including dermoscopy were taken by the GP and sent for evaluation by specialized dermatologists at a university hospital. Patients were simultaneously referred for a face-to-face evaluation at the university hospital. Diagnoses proposed by the GPs and by TD were compared to the final diagnoses obtained by histopathology or, if not available, face-to-face evaluation. Results Five hundred and nineteen patients with 600 suspected skin cancers were included. The final diagnosis was benign in 72.3%. The photo quality was good or fair in 90.5%. GPs reported uncertainty about their diagnoses in 41.5% of cases. The GPs’ positive predictive values for any malignancy and for malignant melanoma were 49.5% and 26.3%, respectively. On evaluation by TD, 31.5% of lesions did not need further in-person assessment. Conclusion Useful images of suspicious skin lesions were obtained from general practice, and GPs could benefit from TD to improve their diagnostic accuracy and confidence.

Reliability of history of acetaminophen ingestion in intentional drug overdose patients

2010 ◽  
Vol 30 (1) ◽  
pp. 44-50 ◽  
Author(s):  
Yedidia Bentur ◽  
Yael Lurie ◽  
Ada Tamir ◽  
Daniel C Keyes ◽  
Fuad Basis
Keyword(s):  
Drug Overdose ◽  
The Other ◽  
Limited Resources ◽  
Suicidal Patient ◽  
History Taking ◽  
Predictive Values ◽  
Detailed History ◽  
History Of ◽  
The Difference ◽  
Sensitivity Specificity

The objective of this study was to determine the reliability of denial of acetaminophen ingestion in intentional drug overdose patients. All intentional drug overdose patients admitted to an emergency department who were able to provide a history were included. A detailed history was obtained on names, timing and number of medications ingested, and serum acetaminophen was assayed. Multidrug ingestion was defined as the reporting of ≥2 medications. Patients were considered ‘reliable’ if they reported acetaminophen ingestion and had detectable acetaminophen levels or the other way around. Validity parameters of acetaminophen history were assessed by sensitivity, specificity and positive and negative predictive values. A total of 154 patients were included. History was significantly more reliable in patients who denied ingestion of acetaminophen (n = 107) compared with patients who reported it (n = 47; 95.3% vs 65.9%, respectively; p < 0.0001, 95% CI of the difference 17.5%—41.2%). No suicidal patient who denied both acetaminophen and multidrug ingestions had a detectable acetaminophen level (negative predictive value 1, 95% CI 0.93—1.0). It is suggested that denial of both acetaminophen and multidrug ingestions by intentional drug overdose patients after a thorough history taking can be considered reliable for acetaminophen history. In facilities with limited resources, these patients may not require routine acetaminophen screening.

scholarly journals Reliability and Validity of the Modified Dental Anxiety Scale in Turkish Patients

2005 ◽  
Vol 33 (2) ◽  
pp. 252-259 ◽  
Author(s):  
D İlgüy ◽  
M İlgüy ◽  
S Dinçer ◽  
G Bayirli
Keyword(s):  
Dental Treatment ◽  
Dental Anxiety ◽  
Reliability And Validity ◽  
Anxiety Scale ◽  
Predictive Values ◽  
History Of ◽  
Sensitivity Specificity ◽  
Turkish Patients

We aimed to determine dental anxiety among Turkish patients and assess the sensitivity, specificity, positive/negative predictive values and reliability of the Modified Dental Anxiety Scale (MDAS) and Corah's Dental Anxiety Scale (DAS). Patients referred to our clinic for dental treatment who had a history of dental anxiety were included in the study. 294 randomly selected patients (mean age 38.8 years) completed a questionnaire combining Corah's DAS and MDAS. They were retested 15 days later. The prevalence of dental anxiety was found to be 9.9% (29/294) for Corah's DAS at the cut-off point ≥ 15 and 8.8% (26/294) for the MDAS at the cut-off point ≥ 19. Both dental anxiety scales gave acceptable sensitivity, specificity, positive and negative predictive values at these cut-off points.

Magnetic Resonance Imaging in the Diagnosis of Glomus Tumours of the Hand

2005 ◽  
Vol 30 (5) ◽  
pp. 535-540 ◽  
Author(s):  
M. M. AL-QATTAN ◽  
A. AL-NAMLA ◽  
A. AL-THUNAYAN ◽  
F. AL-SUBHI ◽  
A. F. EL-SHAYEB
Keyword(s):  
Predictive Value ◽  
Final Diagnosis ◽  
Senior Author ◽  
Glomus Tumour ◽  
Resonance Imaging ◽  
Predictive Values ◽  
Final Histological Diagnosis ◽  
Sensitivity Specificity ◽  
The Cost ◽  
Negative Imaging

This paper studies the sensitivity, specificity and predictive values of MRI in the diagnosis of glomus tumours of the hand and investigates the final diagnosis and outcome in cases with false positive or negative imaging tests. A total of 42 cases with the clinical diagnosis of a glomus tumour were included in the study. All patients underwent MRI and the results of MRI were correlated with the final histological diagnosis of the excised lesion. MRI had a sensitivity of 90%, a specificity of 50%, a positive predictive value of 97% and a negative predictive value of 20%. The four cases in which the MRI was negative all proved histologically to be glomus tumours. All four tumours were small (2–3 mm in diameter) and the lack of delineation of the lesions by MRI was attributed to their small size. Despite negative MRIs, surgical exploration identified the glomus tumours. Based on the results of the current study and the cost of MRI, the senior author has stopped ordering pre-operative MRIs in patients clinically diagnosed with a glomus tumour.

scholarly journals PROKALSITONIN SEBAGAI PENANDA PEMBEDA INFEKSI BAKTERI DAN NON BAKTERI

2018 ◽  
Vol 17 (2) ◽  
pp. 76
Author(s):  
Bastiana Bastiana ◽  
Aryati Aryati ◽  
Dominicus Husada ◽  
M.Y. Probohoesodo
Keyword(s):  
Bacterial Infection ◽  
Roc Analysis ◽  
Final Diagnosis ◽  
Receiver Operating Curve ◽  
Fluorescent Assay ◽  
Infection Group ◽  
Cross Sectional ◽  
Predictive Values ◽  
Significant Difference ◽  
Sensitivity Specificity

Early diagnosis of an infection and prompt administration of an antibiotic can dramatically reduce morbidity and mortality.Procalcitonin (PCT), a precursor of calcitonin, has been proposed as a marker of bacterial infection. The aim of this study is to assess theefficiency of procalcitonin in children for the diagnosis of bacterial vs. non bacterial infection. This was a prospective, cross-sectional study.The subjects were enrolled consecutively, consisting of feverish children (temperature ³38.5° C) admitted to the Pediatric EmergencyDepartment with ages up to 12 years old. The subjects were divided into two groups according to their final diagnosis, bacterial and nonbacterial infection. Serum PCT concentration was measured by enzyme linked fluorescent assay (ELFA) method. Sensitivity, specificity,positive predictive and negative predictive values, and receiver operating curve (ROC) of PCT were calculated. Out of 54 patients,24 (44.4%) had a final diagnosis of bacterial infection. PCT showed a wide concentration range in the bacterial infection group (median:1.09 ng/mL, lower (L)=0.05 ng/mL, upper (U)=128.7 ng/mL) compared with non bacterial infection group (0.21 ng/mL; L=0.05ng/mL; U=12.15 ng/mL). There was a significant difference in PCT between the 2 groups (p=0.020). ROC analysis demonstrated anarea under curve (AUC) of 0.686 (95% CI, 0.534 to 0.838). Using a cut-off point of 0.5 ng/mL, the sensitivity, and specificity, positivepredictive and negative predictive values of PCT were 66.7%, 76.7%, 69.6%, 74.2%, respectively. In this study, PCT may be useful fordifferentiation of bacterial vs. non bacterial infection in children.

scholarly journals Role Of C-Reactive Protein in Diagnosis of Acute Appendicitis

2021 ◽  
Vol 10 (4) ◽  
pp. 210-214
Author(s):  
Mirza Tassawar Hussain ◽  
Muhammad Kashif Khan ◽  
Syed Shamsuddin ◽  
Aabid Ali ◽  
Erum Khan ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Correct Diagnosis ◽  
C Reactive Protein ◽  
Diagnostic Dilemma ◽  
Senior Registrar ◽  
Predictive Values ◽  
Reactive Protein ◽  
Highly Sensitive ◽  
Sensitivity Specificity

Background: Appendicitis is a common surgical emergency and diagnostic dilemma. Making the correct diagnosis is often difficult as the clinical presentation varies according to the age of the patient and the position of appendix. The objective of this study was to identify clinical applicability of C- reactive protein, as a diagnostic test for appendicitis. Methods: This prospective study was carried out in Federal government Polyclinic hospital, Islamabad from January to July 2019, 114 patients underwent appendectomy for clinically diagnosed acute appendicitis. The decision to operate the patient was given by senior registrar. The blood samples for C-reactive protein were drawn before taking the patient to the operating theatre. Removed appendices were sent for histopathological confirmation of diagnosis. The C-reactive protein was then compared with the results of histopathology to determine its validity. The data was entered and analysed in SPSS 23. Results: The sensitivity, specificity, positive and negative predictive values of C-reactive protein in patients with clinical diagnosis of acute appendicitis were found to be 94%, 78%, 93% and 74 % respectively. Conclusion: CRP is helpful in making diagnosis of acute appendicitis. It is highly sensitive but has a relatively low specificity.  

scholarly journals Diagnostic yield of transbronchial needle aspiration for lymphoma

2016 ◽  
Vol 22 (3) ◽  
pp. 67
Author(s):  
B Sonnekus ◽  
J Steenkamp ◽  
M Louw ◽  
C F N Koegelenberg
Keyword(s):  
Predictive Value ◽  
Diagnostic Yield ◽  
Cost Effective ◽  
Final Diagnosis ◽  
Needle Aspiration ◽  
Tracheobronchial Tree ◽  
Transbronchial Needle Aspiration ◽  
Predictive Values ◽  
Hilar Adenopathy ◽  
Sensitivity Specificity

<p>Background. Transbronchial needle aspiration (TBNA) is a minimally invasive bronchoscopic technique that is cost-effective and safe for diagnosing mediastinal and hilar adenopathy in lung cancer, other malignancies, sarcoidosis and infectious processes such as tuberculosis. Few studies have analysed the sensitivity, specificity and predictive values of TBNA for diagnosing lymphoma.</p><p>Objective. To evaluate the diagnostic yield of TBNA for diagnosing mediastinal and hilar adenopathy in suspected lymphoma.</p><p>Methods. We performed a retrospective analysis of collected data of patients with mediastinal and hilar adenopathy adjacent to the tracheobronchial tree detected by thoracic computed tomography, who underwent TBNA at Tygerberg Hospital between July 2010 and June 2013. We included 25 patients with suspected or proven lymphoma. Histology was used as the gold standard.</p><p>Results. Adequate samples for cytological evaluation were obtained for 22 (88%) patients. Cytological diagnosis was possible for 8 (32%). For 17 (68%) who could not be diagnosed by TBNA alone, histology provided final diagnosis. Rapid on-site examination (ROSE) was performed in 23 (92%). In 17/23 (74%) cases, these had similar results to formal cytology. Only 4 (16%) had flow cytometry requested. Twelve (48%) had lymphoma confirmed on histology. TBNA cytology had 100% specificity and positive predictive value for suspicion of lymphoma. Sensitivity was 33% and negative predictive value 62%.</p><p>Conclusion. TBNA is an appropriate first-line diagnostic procedure in evaluating mediastinal and hilar lymphadenopathy in suspected lymphoma. Biopsy should be the immediate second-line procedure when ROSE/cytology is suspicious of lymphoma or shows atypical cells. Patients with negative TBNA cytology, but high clinical or radiological suspicion of lymphoma, should be further investigated.</p>

scholarly journals Diagnostic accuracy of the defining characteristics of the excessive fluid volume diagnosis in hemodialysis patients

2015 ◽  
Vol 23 (6) ◽  
pp. 1057-1064 ◽  
Author(s):  
Maria Isabel da Conceição Dias Fernandes ◽  
Miclécia de Melo Bispo ◽  
Érida Maria Diniz Leite ◽  
Marcos Venícios de Oliveira Lopes ◽  
Viviane Martins da Silva ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Fluid Volume ◽  
University Hospital ◽  
Northeastern Brazil ◽  
Pulmonary Congestion ◽  
Cross Sectional ◽  
Predictive Values ◽  
Nursing Diagnosis ◽  
Breath Sounds ◽  
Sensitivity Specificity

Objective: to evaluate the accuracy of the defining characteristics of the excess fluid volume nursing diagnosis of NANDA International, in patients undergoing hemodialysis. Method: this was a study of diagnostic accuracy, with a cross-sectional design, performed in two stages. The first, involving 100 patients from a dialysis clinic and a university hospital in northeastern Brazil, investigated the presence and absence of the defining characteristics of excess fluid volume. In the second step, these characteristics were evaluated by diagnostic nurses, who judged the presence or absence of the diagnosis. To analyze the measures of accuracy, sensitivity, specificity, and positive and negative predictive values were calculated. Approval was given by the Research Ethics Committee under authorization No. 148.428. Results: the most sensitive indicator was edema and most specific were pulmonary congestion, adventitious breath sounds and restlessness. Conclusion: the more accurate defining characteristics, considered valid for the diagnostic inference of excess fluid volume in patients undergoing hemodialysis were edema, pulmonary congestion, adventitious breath sounds and restlessness. Thus, in the presence of these, the nurse may safely assume the presence of the diagnosis studied.

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