Combined CTP- IGF-1 Score: A New Score for Assessment of Disease Severity in HCV Related Liver Cirrhosis

Abstract Background: Liver is the largest endocrine organ in the body. It is a key organ in insulin mediated metabolism, growth hormone and insulin like growth factors (IGF) pathway. Liver cirrhosis is the end result of many chronic diseases including hepatitis C virus infection. Child-Turcotte-Pugh (CTP) score is the standard used in assessment of hepatic reserve but it has its drawbacks in the form of subjective variables, hepatic encephalopathy and ascites. The aim of this work is to assess IGF-1 in patients with liver cirrhosis, correlate it with CTP score and assess value of modified combined CTP-IGF-1 score. Patients and Methods: 170 patients with CLD (liver cirrhosis) and 72 healthy controls in the study groups were enrolled in the study. All patients were subjected to thorough history, clinical examination and laboratory assessment. IGF-1 was measured and all patients were evaluated using CTP and CTP-IGF-1 scores. Results: IGF1 showed highly significant low values in the study group in comparison to controls (42.15 ± 27.976 and 66.31 ± 33.084 ng/ml respectively, p <0.001). It showed also highly significant negative correlation to CTP score in the study group (p < 0.001) with progressive decrements with CTP score stage progression where IGF1 levels were 48.32 ± 28.611, 40.28 ± 25.869 and 18.80 ± 15.953 ng/ml (mean ± standard deviation) in relation to CTP score groups A, B and C respectively (p value < 0.001). The combined CTP-IGF-1 score in comparison to the classic CTP score showed improved area under curve (0.848 and 0.854), sensitivity (71.2% and 88%), negative predictive value (41.7% and 53.7%), false negative results (49 and 19) and accuracy (75.73% and 83.98%) but decreased specificity (97.22% and 61.1%), positive predictive value (99.2% and 91.5%) and higher false positive results (1 and 14) respectively. Conclusion: IGF-1 show progressive decrements with progression of liver cirrhosis and is negatively correlated with CTP score. Addition of IGF-1 to CTP score to formulate combined score improves the AUC, sensitivity, negative predictive value and the accuracy of CTP score and decreases the false negative results.

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Evaluation of the Carba NP Test for Rapid Detection of Carbapenemase-Producing Enterobacteriaceae and Pseudomonas aeruginosa

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00878-13 ◽

2013 ◽

Vol 57 (9) ◽

pp. 4578-4580 ◽

Cited By ~ 147

Author(s):

Nathalie Tijet ◽

David Boyd ◽

Samir N. Patel ◽

Michael R. Mulvey ◽

Roberto G. Melano

Keyword(s):

Pseudomonas Aeruginosa ◽

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Rapid Detection ◽

False Negative ◽

Bacterial Extract ◽

Content Type ◽

Negative Results ◽

False Negative Results

ABSTRACTThe Carba NP test was evaluated against a panel of 244 carbapenemase- and non-carbapenemase-producingEnterobacteriaceaeandPseudomonas aeruginosaisolates. We confirmed the 100% specificity and positive predictive value of the test, but the sensitivity and negative predictive value were 72.5% and 69.2%, respectively, and increased to 80% and 77.3%, respectively, using a more concentrated bacterial extract. False-negative results were associated with mucoid strains or linked to enzymes with low carbapenemase activity, particularly OXA-48-like, which has emerged globally in enterobacteria.

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Intraoperative use of transcranial motor/sensory evoked potential monitoring in the clipping of intracranial aneurysms: evaluation of false-positive and false-negative cases

Journal of Neurosurgery ◽

10.3171/2017.8.jns17791 ◽

2019 ◽

Vol 130 (3) ◽

pp. 936-948 ◽

Cited By ~ 3

Author(s):

Jaewoo Chung ◽

Wonhyoung Park ◽

Seok Ho Hong ◽

Jung Cheol Park ◽

Jae Sung Ahn ◽

...

Keyword(s):

Negative Predictive Value ◽

Predictive Value ◽

False Positive ◽

Intracranial Aneurysms ◽

Evoked Potential ◽

False Negative ◽

Motor Weakness ◽

Negative Results ◽

False Negative Results ◽

Sensory Evoked

OBJECTIVESomatosensory and motor evoked potentials (SEPs and MEPs) are often used to prevent ischemic complications during aneurysm surgeries. However, surgeons often encounter cases with suspicious false-positive and false-negative results from intraoperative evoked potential (EP) monitoring, but the incidence and possible causes for these results are not well established. The aim of this study was to investigate the efficacy and reliability of EP monitoring in the microsurgical treatment of intracranial aneurysms by evaluating false-positive and false-negative cases.METHODSFrom January 2012 to April 2016, 1514 patients underwent surgery for unruptured intracranial aneurysms (UIAs) with EP monitoring at the authors’ institution. An EP amplitude decrease of 50% or greater compared with the baseline amplitude was defined as a significant EP change. Correlations between immediate postoperative motor weakness and EP monitoring results were retrospectively reviewed. The authors calculated the sensitivity, specificity, and positive and negative predictive values of intraoperative MEP monitoring, as well as the incidence of false-positive and false-negative results.RESULTSEighteen (1.19%) of the 1514 patients had a symptomatic infarction, and 4 (0.26%) had a symptomatic hemorrhage. A total of 15 patients showed motor weakness, with the weakness detected on the immediate postoperative motor function test in 10 of these cases. Fifteen false-positive cases (0.99%) and 8 false-negative cases (0.53%) were reported. Therefore, MEP during UIA surgery resulted in a sensitivity of 0.10, specificity of 0.94, positive predictive value of 0.01, and negative predictive value of 0.99.CONCLUSIONSIntraoperative EP monitoring has high specificity and negative predictive value. Both false-positive and false-negative findings were present. However, it is likely that a more meticulously designed protocol will make EP monitoring a better surrogate indicator of possible ischemic neurological deficits.

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Transhepatic forceps biopsy after PTCD for histological assessment of bile duct stenoses or occlusions

Zeitschrift für Gastroenterologie ◽

10.1055/a-0821-7060 ◽

2019 ◽

Vol 57 (02) ◽

pp. 133-138

Author(s):

Eva-Marie Warnken ◽

Michael Uder ◽

Hubert Stein ◽

Michael Wucherer ◽

Michael Lell ◽

...

Keyword(s):

Predictive Value ◽

False Negative ◽

Short Term ◽

Microsoft Excel ◽

Ct Guided ◽

Forceps Biopsy ◽

Negative Results ◽

False Negative Results ◽

Pet Ct ◽

Ct Guided Biopsy

Abstract Purpose The goal of this study was to evaluate the experience of 11 years of wire-guided forceps biopsy via PTCD in patients with obstructive jaundice. Materials and methods In a retrospective approach, 56 biopsies in 51 patients were analyzed (22 female, 29 male). Data was collected from 2006 to 2016. Mean age was 71 years (range: 34 – 86 years). Data was extracted from dig. Patients’ records (KIS, PACS, RIS) to be analyzed in Microsoft Excel. Results All 56 procedures were technically successful. Stenosis in anastomoses were benign due to scarring in 7 patients and in 9 due to papillitis or others. In 4 patients, results in anastomosis were malignant. In 19 patients without anastomosis, CCC was the diagnosis, thereof 10 klatskin, 9 stenosis in other locations, followed by gastric, pancreatic, and colon carcinoma in 5, 3, and 2 patients. Three patients had a CUP (multimetering in case of more than 1 related category). Overall results were 35 mal. and 16 benign, 76.8 % of all proc. had a correct histopathologic result, and 23.2 % were false negative. Sensitivity was 65.8 %, which results in negative predictive value of 58.1 %. There was no false positive and so specificity was 100 %, as was the positive predictive value. False negative results (no malignancy but clinically and imaging suspect) were corrected by rerunning the procedure, by CT-guided biopsy or by 1 PET-CT. In 1 case the surg. sample brought the result. Minor complications occurred in 8 patients: shivering in 1 case, distinct but hemodynamically not relevant hemobilia in 5 cases, 2 portovenal bleedings. All bleedings were short-term and self-limiting. Conclusion Despite good feasibility, low peri- and post-interv. risk and high validity the forceps biopsy via PTCD is not widely used. For experienced interventionalists, it is an effective method for obtaining histology.

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Study of ascitic fluid cytology in ovarian tumors

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20175382 ◽

2017 ◽

Vol 5 (12) ◽

pp. 5227 ◽

Cited By ~ 1

Author(s):

Chandralekha Janagam ◽

Bhagyalakshmi Atla

Keyword(s):

Ascitic Fluid ◽

Predictive Value ◽

False Positive ◽

False Negative ◽

Ovarian Tumors ◽

Peritoneal Cytology ◽

Negative Results ◽

Benign Ovarian Tumours ◽

False Negative Results ◽

Fluid Cytology

Background: The objectives of this study were to examine the validity of ascitic fluid cytology in the detection of pathological findings, to examine the percentage of false positive and false negative results in the cytology of ascitic fluid and to determine the validity of peritoneal cytology in relation to the histopathological type of the ovarian tumour.Methods: This retrospective study, over a period of 6 months, included 106 peritoneal cytology findings. The experimental group included 106 cytology findings obtained from patients who presented with an abdominal lump/mass with ascites and diagnosed with ovarian tumors clinically. They included 88 benign ovarian tumours (83%) and 18 malignant ovarian tumors (17%). Patients with other causes of ascites were excluded from the study.Results: The sensitivity of peritoneal cytology is 90%, specificity is 96.5%, positive predictive value is 85.7%, and negative predictive value is 97.6%. In 1.8% of patients, the peritoneal cytology showed false negative results, while in 2.8%, the results were false positive. False negative results were found in one case of teratoma with squamous cell carcinoma and one case of yolk sac tumor. False positive results were found in 2 cases of tuberculous-salpingo- oophoritis and one case of chronic salpingo-oophoritis due to reactive mesothelial proliferation, mistaken for adenocarcinoma.Conclusions: Peritoneal cytology of ascitic fluid is highly specific and sensitive for detection of ovarian malignancies, particularly in grade 3 and grade 4 disease, since most of the patients with ovarian malignancies present to us at advanced stage of the disease.

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Soft Salt-Mannitol Agar–Cloxacillin Test: a Highly Specific Bedside Screening Test for Detection of Colonization with Methicillin-Resistant Staphylococcus aureus

Journal of Clinical Microbiology ◽

10.1128/jcm.36.4.986-989.1998 ◽

1998 ◽

Vol 36 (4) ◽

pp. 986-989 ◽

Cited By ~ 10

Author(s):

Nuria Mir ◽

Miguel Sánchez ◽

Fernando Baquero ◽

Blanca López ◽

Celia Calderón ◽

...

Keyword(s):

Intensive Care Unit ◽

Staphylococcus Aureus ◽

Intensive Care ◽

Predictive Value ◽

Color Change ◽

False Negative ◽

Clinical Samples ◽

Methicillin Resistant ◽

Negative Results ◽

False Negative Results

The early detection of colonization with methicillin-resistantStaphylococcus aureus (MRSA) of patients in intensive-care units is an essential step in the strategy for preventing MRSA epidemics. In this study, tubes containing soft salt-mannitol agar with cloxacillin (6 μg/ml) (SSMAC) were prepared for inoculation of clinical samples at patients’ bedsides by personnel of an intensive-care unit. A total of 1,914 swabs from different sample sites of 81 patients were dipped into SSMAC tubes, and after 24 h of incubation (in an incubator located near the intensive-care unit), an evident color change was considered by the intensive-care-unit personnel to be an MRSA alarm. Sixty-three (3.3%) SSMAC tubes were considered positive for MRSA, 1,827 (95.4%) were considered negative, and 24 (1.2%) were considered intermediate. Compared with values for parallel conventional surveillance cultures for MRSA, excluding tubes with intermediate results, the SSMAC test had a sensitivity of 72.7%, a specificity of 99.2%, a positive predictive value of 76.2%, and a negative predictive value of 99.0%. When intermediate tubes were considered positive, the corresponding values were 75.3, 98.2, 63.2, and 99.0%, respectively. The sensitivity and specificity values of the test to identify MRSA-colonized patients were 89.4 and 100%, respectively. Oropharyngeal and naris specimens were the most reliable samples for MRSA detection. False-negative results were frequent in bronchial aspirates with low (<103 to 106CFU/ml) MRSA counts. False-positive results were mainly due to methicillin-resistant Staphylococcus haemolyticus. The SSMAC tube is a useful, rapid, and inexpensive tool for the early identification of MRSA-colonized patients and, consequently, for the implementation of measures to prevent the spread of MRSA.

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Validity of protein-creatinine and protein-osmolality ratios in the estimation of massive proteinuria in children with nephrotic syndrome

Paediatrica Indonesiana ◽

10.14238/pi47.4.2007.139-43 ◽

2007 ◽

Vol 47 (4) ◽

pp. 139

Author(s):

M. Sukmawati ◽

K. Suarta

Keyword(s):

Nephrotic Syndrome ◽

Predictive Value ◽

Diagnostic Tests ◽

Quantitative Methods ◽

False Negative ◽

Creatinine Ratio ◽

Negative Results ◽

False Negative Results ◽

Sensitivity Specificity ◽

Posttest Probability

Background Children with nephrotic syndrome have massiveproteinuria, a rate of excretion equal to or greater than 40 mg/hour/m 2 body surface. The ability to quantitate massive urinaryprotein excretion is very important for both diagnostic andprognostic purposes. Quantification of proteinuria using 24-hoururine collection (Esbach) is difficult to do especially in children;moreover, many false-positive and false-negative results arereported for any semi-quantitative methods such as dipstick andsulfosalicylic acid measurement.Objective To determine the accuracy of protein-creatinine ratio(PCR) and protein-osmolality ratio (POR) in quantification ofmassive proteinuria in children with nephrotic syndrome.Methods Diagnostic tests were conducted on children withnephrotic syndrome aged 2-12 years with Esbach as a referencestandard. Sensitivity, specificity, positive predictive value (PPV),negative predictive value, (NPV), pre and posttest probabilitywere compared between PCR and POR.Results Study patients consisted of 47 children, 38 (81%) withmassive proteinuria. PCR has sensitivity of 92%, specificity of78%, PPV of 95%, NPV of 70% and posttest probability of 95%.POR has sensitivity of 76%, specificity of 78%, PPV of 94%, NPVof 44% and posttest probability of 94%.Conclusion Both PCR and POR are accurate to determine massiveproteinuria in children with nephrotic syndrome.

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Characterization of Focal Liver Lesions using CEUS and MRI with Liver-Specific Contrast Media: Experience of a Single Radiologic Center

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/s-0043-105264 ◽

2017 ◽

Vol 38 (06) ◽

pp. 619-625 ◽

Cited By ~ 19

Author(s):

Lukas Beyer ◽

Florian Wassermann ◽

Benedikt Pregler ◽

Katharina Michalik ◽

Janine Rennert ◽

...

Keyword(s):

Contrast Media ◽

Predictive Value ◽

False Negative ◽

Focal Liver Lesions ◽

Liver Lesions ◽

Predictive Values ◽

Negative Results ◽

False Negative Results ◽

Sensitivity Specificity

Abstract Aim The purpose of this study was to compare contrast-enhanced ultrasound (CEUS), magnetic resonance imaging (MRI) using liver-specific contrast agent and a combination of both for the characterization of focal liver lesions (FLL). Methods 83 patients with both benign and malignant liver lesions were examined using CEUS and MRI after the intravenous administration of liver-specific contrast media. All patients had inconclusive results from prior imaging examinations. Histopathological specimens could be obtained in 53 patients. Ultrasound was performed using a multi-frequency curved probe (1 – 6 MHz) after the injection of 1 – 2.4 ml ultrasound contrast media. The sensitivity, specificity, positive predictive value and negative predictive value of CEUS, MRI and a combination of both (CEUS + MRI) were compared. Results The sensitivity, specificity, positive and negative predictive values regarding lesion classification were 90.9 %, 70.6 %, 92.3 % and 66.6 %, respectively, for CEUS; 90.9 %, 82.4 %, 95.2 % and 70.0 %, respectively, for MRI; and 96.9 %, 70.6 %, 92.7 % and 85.7 % respectively, for CEUS + MRI. There were no statistically significant differences. 6 malignant lesions were missed using CEUS or MRI alone (false negatives). The use of both modalities combined reduced the false-negative results to 2. Conclusion CEUS and MRI with liver-specific contrast media are very reliable and of equal informative value in the characterization of focal liver lesions. The number of false-negative results can be decreased using a combination of the two methods.

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Thyroid Nodules with Preoperative Benign Cytology and BRAF V600E Mutations: the Role of Conventional Ultrasound and Shear Wave Elastography

10.21203/rs.3.rs-96936/v1 ◽

2020 ◽

Author(s):

Ying Zhang ◽

Feng Lu ◽

Yi-Feng Zhang ◽

Han-Xiang Wang ◽

Shi Hui ◽

...

Keyword(s):

Risk Factors ◽

Predictive Value ◽

Thyroid Nodules ◽

False Negative ◽

Shear Wave Elastography ◽

Braf V600e ◽

Negative Results ◽

False Negative Results ◽

Conventional Ultrasound ◽

Missed Diagnosis

Abstract Objectives: Ultrasound-guided fine-needle aspiration (FNA) is the most accurate and economical means for the differential diagnosis of thyroid nodules, but false negative results also existed. This study aimed to predict the false negative results of FNA, reduce the missed diagnosis and improve the current management strategy of thyroid nodules. Methods: A total of 1232 consecutive patients with thyroid nodules who received FNA and BRAF V600E detection were adopted. All patients received both CUS (conventional ultrasound) and SWE (shear wave elastography) examinations and characteristics of these thyroid nodules were analyzed to evaluated the diagnostic performances of risk factors for malignancy.Results: Finally, 26 nodules with benign cytology and BRAF V600E mutations were enrolled. Undefined boundary, microcalcification and E max ratio > 1.49 were risk factors for malignancy (P<0.05), and the area under the receiver operating curve (ROC) of above CUS features and elastic value were 0.817 (95% CI: 0.617, 0.940), 0.792 (95% CI: 0.588, 0.925) and 0.792 (95% CI: 0.617, 0.940) respectively. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were 80.0%, 83.3%, 94.1%, 55.6% and 80.7% for undefined boundary, 75.0%, 83.3%, 93.8%, 50.0% and 76.9% for microcalcification and 75.0%, 83.3%, 93.8%, 50.0% and 76.9% for E max ratio > 1.49 respectively. There was no difference between benign and malignant nodules in the patient age, sex and nodule sizes (P>0.05).Conclusions: Undefined boundary, microcalcification and E max ratio > 1.49 were risk factors for malignancy in benign cytology nodules. When FNA results were benign but above characteristics could be found in the thyroid nodules with BRAF V600E mutation, further clinical decisions should be carried out to reduce the missed diagnosis.

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Contribution of the 13C-Urea Breath Test to the Detection of Helicobacter pylori Gastritis in Children

PEDIATRICS ◽

10.1542/peds.90.4.608 ◽

1992 ◽

Vol 90 (4) ◽

pp. 608-611 ◽

Cited By ~ 1

Author(s):

Y. Vandenplas ◽

U. Blecker ◽

T. Devreker ◽

E. Keppens ◽

J. Nijs ◽

...

Keyword(s):

Predictive Value ◽

Gold Standard ◽

Breath Test ◽

False Negative ◽

Urea Breath Test ◽

Negative Results ◽

False Negative Results ◽

13C Urea Breath Test ◽

H Pylori ◽

Noninvasive Tests

Serology, 13C-urea breath test, histology, Campylobacter-like organism testing, and culture were performed in 95 consecutive children to evaluate the contribution of these tests to the detection of Helicobacter pylori infection. In analyses considering any combination of three positive tests as "gold standard" for diagnosing H pylori infection, 26 children were Helicobacter positive (27%), which is only one patient more than the number of children with only a positive culture. The accuracy of culture was excellent when "any combination of three positive tests" was used as the gold standard (sensitivity 96%, specificity 100%, positive predictive value 100% [false positivity 0%], negative predictive value 99% [false-negative results 1%]). The results of invasive and noninvasive tests were comparable. When culture was considered as "gold standard," the sensitivity of serology and 13C-urea breath test was 96%; the specificity was 96% and 93%, respectively; the positive predictive value was 89% and 83% (false-positive results in 11% and 17%); and the negative predictive value for both was 99% (false-negative results in 1%). It is concluded that culture can be used as gold standard, but that noninvasive tests such as serology and/or 13C-urea breath test can be used to diagnose H pylori infection in children, since each has at least 95% sensitivity and 92% specificity.

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Evaluation of the Rapidec Carba NP Test for Detection of Carbapenemases in Enterobacteriaceae

Journal of Clinical Microbiology ◽

10.1128/jcm.02327-15 ◽

2015 ◽

Vol 53 (12) ◽

pp. 3828-3833 ◽

Cited By ~ 35

Author(s):

Michael Hombach ◽

Barbara von Gunten ◽

Claudio Castelberg ◽

Guido V. Bloemberg

Keyword(s):

Positive Predictive Value ◽

Broad Spectrum ◽

Incubation Time ◽

Predictive Value ◽

False Negative ◽

Content Type ◽

Negative Results ◽

False Negative Results ◽

Bacterial Inoculum ◽

Sensitivity Specificity

This study evaluated the performance of the Rapidec Carba NP test, which was introduced recently into the market for the detection of carbapenemase production in a broad spectrum of β-lactamase-producingEnterobacteriaceaeclinical isolates. In total, 252 clinicalEnterobacteriaceaeisolates that had been genetically characterized with respect to carbapenemase, extended-spectrum β-lactamase (ESBL), and AmpC genes were analyzed; 51/252 isolates (20.2%) were genetically confirmed to be carbapenemase producers, whereas 201/252 isolates (79.8%) were genetically negative for the presence of carbapenemase genes. The Rapidec Carba NP test was applied according to the manufacturer's instructions, and results were read after 30 and 120 min of incubation. The overall sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the Rapidec Carba NP test were 90.2%, 100%, 100%, and 97.6%, respectively, when the manufacturer's instructions were followed. Four of 5 false-negative results occurred with OXA-48-like enzymes. After an incubation time of 30 min, the sensitivity was 49%. The sensitivity increased to 100% when the recommended bacterial inoculum was doubled and the test was read strictly after 120 min of incubation. The Rapidec Carba NP test is a useful tool for the reliable confirmation of carbapenemase-producingEnterobacteriaceaeisolates. The test should be read strictly after 120 min of incubation and the inoculum should be larger than recommended by the manufacturer.

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