scholarly journals Evaluation of the Diagnostic Performance of Physical Examination Combined with Transvaginal Ultrasonography in Patients with Endometriosis

2019 ◽  
pp. 1
Author(s):  
Talha Tiryaki ◽  
Tolga Karacan ◽  
Seyma Yesiralioglu ◽  
Eser Ozyurek ◽  
Huseyin Kiyak ◽  
...  
Keyword(s):  
Physical Examination ◽  
Diagnostic Performance ◽  
Positive Likelihood Ratio ◽  
High Sensitivity ◽  
Transvaginal Ultrasonography ◽  
Asymptomatic Group ◽  
Subjective Impression ◽  
Symptomatic Group ◽  
Asymptomatic Patients ◽  
Number Of Patients

<p><strong>Objective:</strong> Owing to its high sensitivity and specificity, and because it is widely available, transvaginal ultrasonography is the first-line imaging test of choice used for the diagnosis of endometriosis. Ultrasonographic findings evaluated in conjunction with symptoms and signs may improve the diagnosis of endometriosis. Therefore, we hypothesized that transvaginal ultrasonography combined with physical examinations performed by physicians could predict endometriosis better in patients with symptoms suggestive of endometriosis compared with asymptomatic patients at presentation.</p><p><strong>Study Design:</strong> In this retrospective cohort study, the first subjective impression obtained from the history, physical examination, and transvaginal ultrasonography performed by the physician during the first visit in the outpatient clinic was taken into consideration. Patients who underwent surgery with the indication of ovarian mass were divided into two groups according to their admission types; symptomatic and asymptomatic.</p><p><strong>Results:</strong> The number of patients reported to have endometriosis histopathologically was 138;132 were in the premenopausal period (symptomatic group n=101, asymptomatic group n=31) and 6 were in the postmenopausal period (symptomatic group n=1, asymptomatic group n=5). The positive predictive value and positive likelihood ratio of the combination of pelvic examination and transvaginal ultrasonography in premenopausal symptomatic and asymptomatic patients, and postmenopausal symptomatic and asymptomatic patients were 97.8%, 11.5; 47.3%, 6.9; 25.0%, 4.6; and 11.1%, 2.3, respectively.</p><p><strong>Conclusion:</strong> The diagnostic performance of transvaginal ultrasonography in combination with physical examination in patients with asymptomatic endometriosis cannot reach the diagnostic accuracy of physical examination combined with transvaginal ultrasonography in patients with endometriosis who present with symptoms.</p>

scholarly journals Evaluation of the Diagnostic Performance of Physical Examination Combined with Transvaginal Ultrasonography in Patients with Endometriosis

2019 ◽  
pp. 1
Author(s):  
Talha Tiryaki ◽  
Tolga Karacan ◽  
Seyma Yesiralioglu ◽  
Eser Ozyurek ◽  
Huseyin Kiyak ◽  
...  
Keyword(s):  
Physical Examination ◽  
Diagnostic Performance ◽  
Positive Likelihood Ratio ◽  
High Sensitivity ◽  
Transvaginal Ultrasonography ◽  
Asymptomatic Group ◽  
Subjective Impression ◽  
Symptomatic Group ◽  
Asymptomatic Patients ◽  
Number Of Patients

<p><strong>Objective:</strong> Owing to its high sensitivity and specificity, and because it is widely available, transvaginal ultrasonography is the first-line imaging test of choice used for the diagnosis of endometriosis. Ultrasonographic findings evaluated in conjunction with symptoms and signs may improve the diagnosis of endometriosis. Therefore, we hypothesized that transvaginal ultrasonography combined with physical examinations performed by physicians could predict endometriosis better in patients with symptoms suggestive of endometriosis compared with asymptomatic patients at presentation.</p><p><strong>Study Design:</strong> In this retrospective cohort study, the first subjective impression obtained from the history, physical examination, and transvaginal ultrasonography performed by the physician during the first visit in the outpatient clinic was taken into consideration. Patients who underwent surgery with the indication of ovarian mass were divided into two groups according to their admission types; symptomatic and asymptomatic.</p><p><strong>Results:</strong> The number of patients reported to have endometriosis histopathologically was 138;132 were in the premenopausal period (symptomatic group n=101, asymptomatic group n=31) and 6 were in the postmenopausal period (symptomatic group n=1, asymptomatic group n=5). The positive predictive value and positive likelihood ratio of the combination of pelvic examination and transvaginal ultrasonography in premenopausal symptomatic and asymptomatic patients, and postmenopausal symptomatic and asymptomatic patients were 97.8%, 11.5; 47.3%, 6.9; 25.0%, 4.6; and 11.1%, 2.3, respectively.</p><p><strong>Conclusion:</strong> The diagnostic performance of transvaginal ultrasonography in combination with physical examination in patients with asymptomatic endometriosis cannot reach the diagnostic accuracy of physical examination combined with transvaginal ultrasonography in patients with endometriosis who present with symptoms.</p>

scholarly journals Clinical Characteristics of Asymptomatic Patients with SARS-CoV-2 in Zhejiang: An Imperceptible Source of Infection

2020 ◽  
Vol 2020 ◽  
pp. 1-5 ◽  
Author(s):  
Wei Dai ◽  
Xinmiao Chen ◽  
Xiaoting Xu ◽  
Zhefeng Leng ◽  
Wenwen Yu ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Clinical Symptoms ◽  
Laboratory Data ◽  
Clinical Manifestations ◽  
Transmission Risk ◽  
Asymptomatic Group ◽  
Symptomatic Group ◽  
Source Of Infection ◽  
Asymptomatic Patients ◽  
Novel Coronavirus

Objective. Coronavirus disease 2019 (COVID-19), caused by the novel coronavirus SARS-CoV-2, was first identified in December 2019 in Wuhan, China, and has since spread globally, resulting in an ongoing pandemic. However, the study of asymptomatic patients is still rare, and the understanding of its potential transmission risk is still insufficient. In this study, epidemiological investigations were conducted in the Zhejiang province to understand the epidemiology and clinical characteristics of asymptomatic patients with COVID-19. Methods. This retrospective study was carried out on 22 asymptomatic patients and 234 symptomatic patients with COVID-19 who were hospitalized in Zhejiang Duodi Hospital from January 21 to March 16, 2020. The characteristics of epidemiology, demography, clinical manifestations, and laboratory data of mild patients were compared and analyzed. Results. The median age was 28 years in asymptomatic patients and 48 years in symptomatic patients. The proportion who were female was 77.3% in asymptomatic patients and 36.3% in symptomatic patients (p<0.001). The proportion of patients with coexisting diseases was 4.5% in asymptomatic patients and 38.0% in symptomatic patients (p=0.002). The proportion of patients with increased CRP was 13.6% in the asymptomatic group and 61.1% in the symptomatic group (p<0.001). The proportion of patients received antiviral therapy was 45.5% in the asymptomatic group and 97.9% in the symptomatic group (p<0.001). The proportion of patients received oxygen therapy was 22.7% in the asymptomatic group and 99.1% in symptomatic patients (p<0.001). By March 16, 2020, all patients were discharged from the hospital, and no symptoms had appeared in the asymptomatic patients during hospitalization. The median course of infection to discharge was 21.5 days in asymptomatic patients and 22 days in symptomatic patients. Conclusions. Asymptomatic patients are also infectious; relying only on clinical symptoms, blood cell tests, and radiology examination will lead to misdiagnosis of most patients, leading to the spread of the virus. Investigation of medical history is the best strategy for screening asymptomatic patients, especially young people, women, and people without coexisting disease, who are more likely to be asymptomatic when infected. Although the prognosis is good, isolation is critical for asymptomatic patients, and it is important not to end isolation early before a nucleic acid test turns negative.

scholarly journals Carotid Stenting in Asymptomatic Carotid Stenosis: The Calgary Experience

2010 ◽  
Vol 37 (5) ◽  
pp. 568-573 ◽  
Author(s):  
N. Shobha ◽  
M. A. Almekhlafi ◽  
A. Pandya ◽  
P. L. Couillard ◽  
W. F. Morrish ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Medical Center ◽  
Carotid Stenting ◽  
Minor Stroke ◽  
Safe Procedure ◽  
Asymptomatic Group ◽  
Symptomatic Group ◽  
Asymptomatic Patients

Background:Although carotid endarterectomy is considered the ‘gold standard’ for standard risk symptomatic patients, the treatment of choice for asymptomatic patients remains controversial. Carotid stenting has demonstrated real-world outcomes consistent with established guidelines for carotid endarterectomy in asymptomatic high-surgical risk patients in recent prospective multicenter trials. We describe our experience with asymptomatic patients who underwent carotid stenting at our center in a routine clinical setting.Methods:This is a retrospective, longitudinal cohort study of patients who underwent carotid angioplasty and stenting at the Foothills Medical Center, Calgary, Canada between 1997 and 2007. The qualifying events were categorized as symptomatic and asymptomatic. The procedures were performed by four experienced neurointerventionists. The primary outcome was stroke or death at 30-day follow- up.Results:243 patients underwent 255 carotid stenting procedures. Their ages ranged from 50 to 83 years; the mean age was 72.0 ± 9.3 years; 67(26.3%) were women. Forty one patients (16.1%) were asymptomatic; 214 patients (83.9%) were symptomatic. The patients in the asymptomatic group were significantly younger - 66.0 ± 8.8 years compared to patients in the symptomatic group 73.2 ± 8.9 years (p<0.0001). Intraprocedurally one minor stroke (2.4%) occurred in the asymptomatic group. At 30-day follow-up, no deaths or further strokes were noted in the asymptomatic group; while eight deaths, six major and seven minor strokes occurred in the symptomatic group (p=0.22).Conclusion:Carotid stenting appears to be a safe procedure in asymptomatic patients with severe carotid stenosis in routine clinical settings as witnessed in this single center study.

scholarly journals Evaluation of the validity of Ag PANBIO-COVID19 in the diagnosis of SARS-CoV-2 infection in asymptomatic or mildly infected patients

2021 ◽  
Author(s):  
Paula Gras-Valenti ◽  
Inmaculada Vidal ◽  
Inés Montiel-Higuero ◽  
Isabel Escribano ◽  
Natividad Algado-Selles ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Diagnostic Tests ◽  
Diagnostic Testing ◽  
High Viral Load ◽  
Reference Standard ◽  
Rt Pcr ◽  
Asymptomatic Group ◽  
Symptomatic Group ◽  
Asymptomatic Patients

Objective. To assess the validity of SARS-CoV-2 Antigen (Ag) detection for the diagnosis of SARS-CoV-2 infection in mildly infected or asymptomatic patients. Material and methods. Observational study to evaluate diagnostic tests. Non-hospitalized patients with indication for diagnostic testing for SARS-CoV-2 infection were included. The diagnostic test to be evaluated was the determination of Ag and as a reference standard to determine the presence of viral RNA the RT-PCR was used. Results. A total of 494 patients were included. Of these 71.5% (353/494) had symptoms and 28.5% (141/494) were asymptomatic (presurgery screening (35/494) and confirmed case-contact (106/494). The overall sensitivity of the Ag test was 61.1% and the specificity was 99.7%. The sensitivity and specificity in the asymptomatic group were 40% and 100% respectively, and in the symptomatic group 63.5% and 99.6% respectively. In turn, the sensitivity and specificity in the group of symptomatic patients varied according to the time of symptom evolution: in patients with recent symptoms, they were 71.4% and 99.6% respectively, while in patients with symptoms of more than 5 days of evolution, they were 26.7% and 100% respectively. In all groups studied, the presence of antigen is associated with a high viral load (Ct<30 cycles). Conclusions. The use of Ag detection test is not indicated for the diagnosis of SARS-CoV-2 infection in asymptomatic patients or with symptoms of more than 5 days of evolution, but it could be useful in patients with symptoms of 1-5 days of evolution.

Three Dimensional Reconstruction of the Components of the Carotid Plaque From Standard CT Medical Images

2011 ◽  
Author(s):  
Dipankar Biswas ◽  
Francis Loth ◽  
Susan McCormick ◽  
Hisham Bassiouny
Keyword(s):  
Carotid Arteries ◽  
Three Dimensional ◽  
Plaque Burden ◽  
Asymptomatic Group ◽  
Symptomatic Group ◽  
Asymptomatic Patients ◽  
Dimensional Reconstruction ◽  
Manual Selection ◽  
The Mean ◽  
Human Carotid

The present study compares plaque and calcium volumes between sixteen diseased human carotid arteries. Half were from symptomatic patients, and half were from asymptomatic patients. In-house software was developed for the 3-D reconstruction of the plaque components from computerized tomography (CT) images. Results revealed higher mean total volume (TV) in the symptomatic group compared to the asymptomatic group. In contrast, the mean ratio of calcium volume (CV) to TV was lower for the symptomatic group compared to the asymptomatic group. This shows that symptomatic patients have a significantly greater plaque burden with minimal plaque calcification. The process of acquiring the data helped understand what tools/features are needed to conduct this work. One important feature of this software is the ability to create automated regions of interest (ROI) in addition to simple manual selection/modification of the ROIs in a GUI environment.

Interpretation of Normal and Abnormal Tympanogram Findings in Eustachian Tube Dysfunction

2020 ◽  
pp. 019459982096523
Author(s):  
Sean M. Parsel ◽  
Graham D. Unis ◽  
Spenser S. Souza ◽  
Heather Bartley ◽  
Jeffrey M. Bergeron ◽  
...  
Keyword(s):  
Eustachian Tube ◽  
Medical Center ◽  
Cross Sectional Study ◽  
Eustachian Tube Dysfunction ◽  
Asymptomatic Group ◽  
Cross Sectional ◽  
Symptomatic Group ◽  
Asymptomatic Patients ◽  
Patient Reported ◽  
Tube Dysfunction

Objective To characterize the relationship between objective tympanogram values and patient-reported symptoms and associations with common comorbid conditions. Study Design Cross-sectional study with prospective data collection. Setting Tertiary medical center. Methods Patients undergoing routine audiometric evaluation between October 2018 and June 2019 were included. Participants with temporomandibular joint dysfunction, inner ear hydrops, and similar conditions were excluded. Symptoms were assessed with the 7-item Eustachian Tube Dysfunction Questionnaire. Demographics and medical comorbidities were recorded from the medical record. Analysis of tympanometric peak pressure (TPP), demographics, and comorbidities was performed to determine associations with clinically significant eustachian tube dysfunction (ETD) symptoms. Results A total of 250 patients were included with similar demographics: 101 (40.4%) in the asymptomatic group and 149 (59.6%) in the symptomatic group. The median (interquartile range) TPP was –10 (20) daPa and –25 (100) daPa in the asymptomatic and symptomatic groups, respectively. A diagnosis of rhinitis was more likely to be associated with significant ETD symptoms (adjusted odds ratio, 2.61; 95% CI, 1.23-5.63). A subgroup analysis revealed that symptomatic patients with normal TPP values were negatively skewed as compared with asymptomatic patients. This symptomatic group had a higher prevalence of rhinitis and chronic rhinosinusitis than the asymptomatic group. Conclusion Patients with symptoms of ETD may have a TPP within a range typically considered normal per conventional standards. This suggests that the currently accepted interpretation of tympanometry findings may be insensitive for the diagnosis of less severe cases of ETD.

A Comparison of Echocardiogram Screening for Pulmonary Hypertension in Asymptomatic and Symptomatic Patients with Sickle Cell Disease

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4801-4801
Author(s):  
Rowena R Thomas-Dewing ◽  
John Chambers ◽  
Nicholas Hart ◽  
Jo Howard
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Peak Velocity ◽  
Cell Disease ◽  
Asymptomatic Group ◽  
Time To Peak ◽  
Symptomatic Group ◽  
Asymptomatic Patients ◽  
The Us ◽  
History Of

Abstract Background: Pulmonary hypertension (PHT) is an increasingly recognised complication of sickle cell disease (SCD), even in asymptomatic patients. Studies from the US have shown a prevalence of PHT of between 20–30% and this has been associated with an increased mortality. The prevalence of PHT in the UK sickle cell disease population is unknown. Method: We identified adult patients with a diagnosis of SCD (HbSS, HbSC, HbSB0thalassaemia and HbSB+ thalassaemia) who had screening for PHT using transthoracic echocardiography over a one year period. We compared the echocardiographic findings of symptomatic and asymptomatic patients. Direct measurements of tricuspid regurgitant jet velocity (TRVmax) were recorded, as has been done in previous similar studies with a peak TRV of ≥ 2.5m/s indicating risk of PHT. In order to increase specificity and sensitivity of the echocardiogram recording and as TRVmax is not always measurable other indirect indicators of PHT were also recorded, including ‘time from start of flow to peak velocity’ which is measured by placing the pulsed sample in the centre of the main PA or pulmonary valve annulus; a time of &gt;105ms excluded PHT while a time &lt;80ms made PHT highly likely. Systolic function of the right ventricle was quantified using long-axis measurements: TAPSE (tricuspid annular plane systolic excursion) using a TAPSE &lt;18mmHg as an abnormal threshold and ‘Doppler tissue S velocity’ was measured by placing the Doppler tissue sample in the RV free wall at the tricuspid annulus and recording the peak systolic velocity. A velocity of &lt;10m/s was consistent with a reduced RV ejection fraction or PHT. Results: 32 asymptomatic patients and 40 symptomatic patients had echocardiogram screening for PHT. The asymptomatic group had a mean age (± SD) 36.5 years(± 10.2), 17 patients were men, 20 patients had HbSS, 10 patients had HbSC, 1 patient had HbSB0thalassaemia and 1 patient had HbSB+ thalassaemia. 3/32 (9.4%) of patients had abnormal echocardiograms with a TRV of 2.5, 2.5 and 2.6 m/s respectively. One patient with a TRV = 2.5m/s had a history of chest crisis and was on hydroxyurea. The symptomatic group had a mean age (± SD) 35.8 years (± 11.2), 13 patients were men, 31 patients had HbSS, 8 patients had HbSC, 1 patient had HbSB0thalassaemia. 2 patients who had TRV ≥ 2.5m/s were excluded from analysis as had pulmonary stenosis. 7/38 (18.4%) patients had TRV ≥ 2.5m/s (range 2.5 to 2.7m/s). Of these 7 patients, 6 had HbSS, 1 had HbSC, only one was on hydroxyurea, and only one had a history of chest crisis. In 2 further patients in whom TRV was not measurable, other echocardiographic features were used to identify PHT; 1 patient had a ‘time to peak velocity’ of 58ms and 1 patient had a TAPSE of 17mmHg and a ‘time to peak velocity’ of 80ms. Both patients had HbSS, 1 had a history of chest crisis and none were on hydroxyurea. Conclusion: In the asymptomatic group, 9.4% of patients had abnormal echocardiograms, which were suggestive of PHT. In the symptomatic group, 24% patients had echocardiograms suggestive of PHT with 7 patients having a peak TRV ≥ 2.5m/s and a further 2 patients being identified using other echocardiogram criteria. We conclude that the prevalence of PHT in the asymptomatic group was low but in the symptomatic group, the prevalence of PHT was comparable to figures in the US. In addition, transthoracic doppler echocardiographic screening for PHT should include other criteria apart from TRV.

Effects of Observer Variation on Performance in Probabilistic Diagnosis of Jaundice

1981 ◽  
Vol 20 (03) ◽  
pp. 163-168 ◽  
Author(s):  
G. Llndberg
Keyword(s):  
Physical Examination ◽  
System Performance ◽  
Transition Matrix ◽  
Bayes Theorem ◽  
Observer Variation ◽  
Kappa Statistics ◽  
Diagnostic Categories ◽  
Number Of Patients ◽  
Probability Transition Matrix ◽  
Probabilistic Diagnosis

A system for probabilistic diagnosis of jaundice has been used for studying the effects of taking into account the unreliability of diagnostic data caused by observer variation. Fourteen features from history and physical examination were studied. Bayes’ theorem was used for calculating the probabilities of a patient’s belonging to each of four diagnostic categories.The construction sample consisted of 61 patients. An equal number of patients were tested in the evaluation sample. Observer variation on the fourteen features had been assessed in two previous studies. The use of kappa-statistics for measuring observer variation allowed the construction of a probability transition matrix for each feature. Diagnostic probabilities could then be calculated with and without the inclusion of weights for observer variation. Tests of system performance revealed that discriminatory power remained unchanged. However, the predictions rendered by the variation-weighted system were diffident. It is concluded that taking observer variation into account may weaken the sharpness of probabilistic diagnosis but it may also help to explain the value of probabilistic diagnosis in future applications.

Features of Thrombi and Diagnostic Accuracy of Impedance Plethysmography in Symptomatic and Asymptomatic Deep Vein Thrombosis

1993 ◽  
Vol 70 (02) ◽  
pp. 266-269 ◽  
Author(s):  
Giancarlo Agnelli ◽  
Benilde Cosmi ◽  
Stefano Radicchia ◽  
Franca Veschi ◽  
Enrico Boschetti ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Diagnostic Accuracy ◽  
High Sensitivity ◽  
Impedance Plethysmography ◽  
Surveillance Programme ◽  
Vein Thrombosis ◽  
Asymptomatic Patients ◽  
High Prevalence ◽  
The Mean ◽  
Deep Vein

SummaryImpedance plethysmography (IPG) has high sensitivity and specificity in patients with symptomatic deep vein thrombosis (DVT) while it fails to detect asymptomatic DVT. The aim of this study was to determine whether the features of thrombi such as location, size and occlusiveness could explain the different accuracy of IPG in symptomatic and asymptomatic DVT patients. One-hundred and seventeen consecutive outpatients with a clinical suspicion of DVT and 246 consecutive patients undergoing hip surgery were admitted to the study. In symptomatic patients IPG was performed on the day of referral, followed by venography, while in asymptomatic patients IPG was performed as a surveillance programme, followed by bilateral venography.A venography proved DVT was observed in 37% of the symptomatic patients and 34% of the asymptomatic limbs. A significantly higher proportion of proximal DVTs was found in symptomatic patients than in asymptomatic patients (78% vs 46%; p = 0.001). The mean Marder score, taken as an index of thrombus size, was significantly higher in symptomatic patients than in asymptomatic patients (19.0 vs 9.6; p = 0.0001). A significantly higher proportion of occlusive DVTs was observed in symptomatic than in asymptomatic patients (69% vs 36%; p = 0.001).We conclude that the unsatisfactory diagnostic accuracy of IPG in asymptomatic DVT is due to the high prevalence of distal, small and non occlusive thrombi. Such thrombi are unlikely to cause a critical obstruction of the venous outflow and therefore to produce a positive IPG.

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