scholarly journals Paradigm shift in acute dizziness: is caloric testing obsolete?

2021 ◽  
Author(s):  
Miranda Morrison ◽  
Athanasia Korda ◽  
Ewa Zamaro ◽  
Franca Wagner ◽  
Marco Caversaccio ◽  
...  
Keyword(s):  
Negative Likelihood Ratio ◽  
Cross Sectional Study ◽  
Outpatient Setting ◽  
Vestibular Neuritis ◽  
Inclusion Criteria ◽  
Cross Sectional ◽  
Caloric Testing ◽  
Tertiary Referral Center ◽  
Lower Accuracy ◽  
Sensitivity Specificity

Objectives: We aimed to investigate the diagnostic accuracy of Caloric Testing and video Head Impulse Testing (vHIT) in differentiating between vestibular neuritis and strokes in acute dizziness. Design: Prospective cross-sectional study. Setting: Emergency department of a tertiary referral center. Participants: 1677 adult patients were screened between 2015 and 2020 for AVS, of which 152 met the inclusion criteria. Inclusion criteria consisted of a state of continuous dizziness, associated with nausea or vomiting, head-motion intolerance, new gait or balance disturbance and nystagmus. Patients were excluded if symptoms lasted <24 hours or if the index ED visit was >72 hours after symptom onset. Eighty-five patients completed testing of which 58 were vestibular neuritis and 27 strokes. Main outcome measures: All patients underwent calorics and vHIT followed by a delayed MRI (gold standard for vestibular stroke confirmation). Results: The sensitivity/specificity for detecting stroke (caloric asymmetry cut-off of 30.9%) was 75% and 86.8% respectively (Negative likelihood ratio (NLR) 0.29) compared to 91.7% and 88.7% for vHIT (NLR 0.094). Best VOR gain cut-off was 0.685. Twenty-five percent of vestibular strokes were misclassified by calorics, 8% by vHIT. Conclusions: Caloric testing demonstrated lower accuracy than vHIT in discriminating stroke from vestibular neuritis in acute dizziness. Asymmetric caloric responses can also occur with vestibular strokes and might put the patient at risk for misdiagnosis. We therefore recommend replacing calorics with vHIT in the acute setting. Caloric testing has still its place as a diagnostic tool in an outpatient setting.

scholarly journals Paradigm shift in acute dizziness: is caloric testing obsolete?

2021 ◽  
Author(s):  
Miranda Morrison ◽  
Athanasia Korda ◽  
Ewa Zamaro ◽  
Franca Wagner ◽  
Marco D. Caversaccio ◽  
...  
Keyword(s):  
Gold Standard ◽  
Negative Likelihood Ratio ◽  
Vestibular Neuritis ◽  
Head Impulse Test ◽  
Inclusion Criteria ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Caloric Testing ◽  
Tertiary Referral Center ◽  
Acute Vestibular Syndrome

Abstract Objective Cold and warm water ear irrigation, also known as bithermal caloric testing, has been considered for over 100 years the ‘Gold Standard’ for the detection of peripheral vestibular hypofunction. Its discovery was awarded a Nobel Prize. We aimed to investigate the diagnostic accuracy of Caloric Testing when compared to the video head impulse test (vHIT) in differentiating between vestibular neuritis and vestibular strokes in acute dizziness. Design Prospective cross-sectional study (convenience sample). Setting All patients presenting with signs of an acute vestibular syndrome at the emergency department of a tertiary referral center. Participants One thousand, six hundred seventy-seven patients were screened between February 2015 and May 2020 for Acute Vestibular Syndrome (AVS), of which 152 met the inclusion criteria and were enrolled. Inclusion criteria consisted of a state of continuous dizziness, associated with nausea or vomiting, head-motion intolerance, new gait or balance disturbance and nystagmus. Patients were excluded if they were younger than 18 years, if symptoms lasted < 24 h or if the index ED visit was > 72 h after symptom onset. Of the 152 included patients 85 completed testing. We assessed 58 vestibular neuritis and 27 stroke patients. Main outcome measures All patients underwent calorics and vHIT followed by a delayed MRI which served as a gold standard for vestibular stroke confirmation. Results The overall sensitivity and specificity for detecting stroke with a caloric asymmetry cut-off of 30.9% was 75% and 86.8%, respectively [negative likelihood ratio (NLR) 0.29] compared to 91.7% and 88.7% for vHIT (NLR 0.094). Best VOR gain cut-off was 0.685. Twenty-five percent of vestibular strokes were misclassified by calorics, 8% by vHIT. Conclusions Caloric testing proved to be less accurate than vHIT in discriminating stroke from vestibular neuritis in acute dizziness. Contrary to classic teaching, asymmetric caloric responses can also occur with vestibular strokes and might put the patient at risk for misdiagnosis. We, therefore, recommend to abandon caloric testing in current practice and to replace it with vHIT in the acute setting. Caloric testing has still its place as a diagnostic tool in an outpatient setting.

Accuracy of Ultrasound for Determination of Fetal Gender

2021 ◽  
Vol 15 (6) ◽  
pp. 1237-1239
Author(s):  
A. Ammar ◽  
M. A. Z. Husnain ◽  
M. Arshad ◽  
T. M. Mirza ◽  
Z. Arshad ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Ultrasound Examination ◽  
Cross Sectional Study ◽  
Military Hospital ◽  
Inclusion Criteria ◽  
Cross Sectional ◽  
Predictive Values ◽  
Fetal Gender ◽  
Sensitivity Specificity

Aim: To evaluate the accuracy of ultrasound in determining the phenotypic foetal gender in all three trimesters. Study design: Cross sectional study. Place and duration of study: Department of Diagnostic Radiology Combined Military Hospital Lahore from 1st January 2020 to 30th April 2020. Methodology: Three hundred and seventy two patients in the inclusion criteria were selected. Ages of patients, gestational ages of foetuses and their genders were determined according to the ultrasonographic signs using ultrasound examination. Patients were contacted 3 weeks after the estimated date of delivery and phenotypic sex recorded. Results: Mean age was 34 years. Median gestational age was 21 weeks 3 days. Accuracy of gender determination by ultrasound in 1st, 2nd and 3rd trimesters was 62%, 97% and 95% respectively. Sensitivity and specificity of ultrasound in 1st trimester for males are 66% and 72%; and for females are 72% and 66% respectively. Positive and negative predictive values for male are 69% and 71%; and for female are 71% and 69% respectively. Sensitivity and specificity of ultrasound in 2nd trimester for males are 95% and 100%; and for females are 100% and 95% respectively. Positive and negative predictive values for male are 100% and 94%; and for female are 94% and 100% respectively. Sensitivity and specificity of ultrasound in 3rd trimester for males are 94% and 96%; and for females are 96% and 94% respectively. Positive and negative predictive values for male are 97% and 93%; and for female are 93% and 97% respectively. Conclusion: There is a high accuracy of ultrasound in determination of fetal gender in second and third trimesters. Keywords: Ultrasound, Gender, Trimester, Sensitivity, Specificity, Predictive Value

scholarly journals Evaluation of the diagnostic accuracy of a hemoglobin S and C screening test: Sickle Scan

2021 ◽  
Vol 15 (1) ◽  
pp. 234-240
Author(s):  
L. Adjé ◽  
V. Yapo ◽  
M. Yayo-Ayé ◽  
S. Bognini ◽  
M. Meledje ◽  
...  
Keyword(s):  
Likelihood Ratio ◽  
Screening Tool ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Reference Method ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Hemoglobin S ◽  
Hemoglobin C ◽  
Sensitivity Specificity

New tools for the rapid diagnosis of hemoglobinosis could encourage the extension of their screening in Africa. Our goal was to assess the analytical performances of a rapid hemoglobin S and C detection test, the Sickle Scan. This was a cross-sectional study carried out in March 2019 at the Yopougon Teaching Hospital. The subjects followed for hemoglobinosis as well as the subjects seeking out an electrophoresis of their hemoglobin were included. We carried out the hemogram, the electrophoresis of hemoglobin at alkaline pH (reference method) coupled with the metabisulfite sickling test (Emmel test) and the rapid detection test to be evaluated. This immunochromatographic test is capable of detecting hemoglobins A, S, and C, and to infer the hemoglobin phenotype from there. The study recruited 191 individuals. The test detected hemoglobins S and C with a sensitivity of 99.4% and 97.7% respectively; a specificity of 93.3% and 99.3%. The positive likelihood ratio for hemoglobins S and C was 15 and 144 respectively. The negative likelihood ratio was 0.01 for hemoglobin S, and 0.02 for hemoglobin C. The intrinsic characteristics obtained make this test an interesting screening tool for hemoglobinosis S and C. Keywords: Diagnostic test, hemoglobinosis, Abidjan, sensitivity, specificity.

Comparison of Heffner Criteria and Light Criteria in Differentiating Exudative and Transudative Pleural Effusion

2020 ◽  
Vol 22 (3) ◽  
pp. 141-145
Author(s):  
Krishna Chandra Devkota ◽  
S Hamal ◽  
PP Panta
Keyword(s):  
Pleural Effusion ◽  
Cross Sectional Study ◽  
Pleural Space ◽  
Sectional Study ◽  
Inclusion Criteria ◽  
Cross Sectional ◽  
Medical College ◽  
The Common ◽  
The Mean ◽  
Exudative Pleural Effusion

Pleural effusion is present when there is >15ml of fluid is accumulated in the pleural space. It can be divided into two types; exudative and transudative pleural effusion. Tuberculosis and parapneumonic effusion are the common cause of exudative pleural effusion whereas heart failure accounts for most of the cases of transudative pleural effusion. This study was a hospital based cross sectional study performed at Nepal Medical College during the period of January 2016-December 2016. A total of 50 patients who fulfilled the inclusion criteria were enrolled. Pleural effusion was confirmed by clinical examination and radiology. After confirmation of pleural effusion, pleural fluid was aspirated and was analysed for protein, LDH, cholesterol. The Heffner criteria was compared with Light criteria to classify exudative or transudative pleural effusion. Among 50 patients, 30 were male and 20 were female. The mean age of patient was 45.4±21.85 years. The sensitivity and specificity of using Light criteria to detect the two type of pleural effusion was 100% and 90.9%, whereas using Heffner criteria was 94.87%, 100% respectively(P<0.01). There are variety of causes for development of pleural effusion and no one criteria is definite to differentiate between exudative or transudative effusion. In this study Light criteria was more sensitive whereas Heffner criteria was more specific to classify exudative pleural effusion. Hence a combination of criteria might be useful in case where there is difficulty to identify the cause of pleural effusion.

scholarly journals Assessment of Saudi Parents’ Beliefs and Behaviors towards Management of Child Fever in Saudi Arabia—A Cross-Sectional Study

2021 ◽  
Vol 18 (10) ◽  
pp. 5217
Author(s):  
Mohamed N. Al Arifi ◽  
Abdulrahman Alwhaibi
Keyword(s):  
Saudi Arabia ◽  
Side Effects ◽  
Febrile Seizures ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Inclusion Criteria ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Electronic Thermometer ◽  
And Behavior

Objective: Fever alone can lead to rare serious complications in children, such as febrile seizures. The aim of this study is to assess the knowledge, beliefs, and behavior of parents toward fever and its management. Methods: A cross-sectional study using an online questionnaire was applied over a period of 3 months, from January to March 2018, to parents who were living in Saudi Arabia. The inclusion criteria were a parent who is a resident of Saudi Arabia, with at least one child aged 6 years or less, while incomplete questionnaires, having a child aged more than 6 years, or parents who were not living in Saudi Arabia were excluded. Results: A total of 656 parents completed the questionnaire. More than two-thirds of the subjects were female, the majority of whom were aged between 25–33 years old. The best-reported place to measure the temperature of children was the armpit (46%), followed by the ear (28%) and the mouth (10.7%). More than half of the parents considered their children feverish at a temperature of 38 °C. The majority of parents (79.7%) reported that the most serious side effects of fever were seizure, brain damage (39.3%), coma (29.9%), dehydration (29.7%), and death (25%). The most common method used to measure a child’s temperature was an electronic thermometer (62.3%). The most common antipyretic was paracetamol (84.5%). Conclusions: Our study demonstrates the good knowledge of parents in identifying a feverish temperature using the recommended route and tools for measuring body temperature.

Violence Against Women During COVID-19 Pandemic

2021 ◽  
pp. 088626052199795
Author(s):  
Marwan Akel ◽  
Jana Berro ◽  
Clara Rahme ◽  
Chadia Haddad ◽  
Sahar Obeid ◽  
...  
Keyword(s):  
Violence Against Women ◽  
Married Couples ◽  
Self Esteem ◽  
Cross Sectional Study ◽  
Economic Factors ◽  
Sectional Study ◽  
Inclusion Criteria ◽  
Cross Sectional ◽  
Living Together ◽  
Stress Score

The objectives of this study were to correlate several factors - including depression, anxiety, stress and self-esteem levels in both men and women - with the occurrence of domestic violence against women (VAW) during quarantine. This cross-sectional study was carried out in April 2020, in the midst of the COVID-19 pandemic when lockdown procedures were implemented; 86 married couples participated in this study amounting to 172 responses in total. A different questionnaire was set for women and men; the couple filled out their respective questionnaire simultaneously, but privately where one did not see the answers of the other. Inclusion criteria included married couples of all ages that are living together during the lockdown of COVID-19. The results of this study showed that a higher total abuse score was found in 39 females (45.3%; CI: 0.34 - 0.56). Being a Muslim female (Beta =24.80) and females having higher anxiety (Beta=0.97) were significantly associated with higher total abuse scores, whereas higher stress score in female (Beta=-0.61) was significantly associated with lower total abuse scores. In conclusion, this study focuses on VAW as a serious problem while demonstrating its further emergence during quarantine. This study also focused on the effects brought on by lockdown policies, including social and economic factors, and their implications in the increase of VAW during this pandemic.

scholarly journals Beijing Friendship Hospital Osteoporosis Self-Assessment Tool for Elderly Male (BFH-OSTM) vs Fracture Risk Assessment Tool (FRAX) for identifying painful new osteoporotic vertebral fractures in older Chinese men: a cross-sectional study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ning An ◽  
Ji Sheng Lin ◽  
Qi Fei
Keyword(s):  
Assessment Tool ◽  
Roc Curves ◽  
Cross Sectional Study ◽  
Self Assessment ◽  
Cross Sectional ◽  
Fracture Group ◽  
Friendship Hospital ◽  
Fracture Risk Assessment Tool ◽  
Older Chinese ◽  
Sensitivity Specificity

Abstract Background To compare the validation of four tools for identifying painful new osteoporotic vertebral compression fractures (PNOVCFs) in older Chinese men: bone mineral density (BMD), Asian osteoporosis self-assessment tool (OSTA), World Health Organization fracture risk assessment tool (FRAX) (without BMD) and Beijing Friendship Hospital Osteoporosis Self-Assessment Tool (BFH-OSTM). Methods A cross sectional study was conducted from 2013 to 2019. A total of 846 men aged ≥50 were included and were divided into two groups: Fracture Group (patients with PNOVCFs underwent percutaneous vertebroplasty surgery) and Non-Fracture Group (community dwelled subjects for healthy examination). All subjects accepted a dual-energy X-ray BMD test and a structured questionnaire. The results of BMD, OSTA, FRAX and BFH-OSTM scores were assessed and receiver-operating characteristic (ROC) curves were generated to compare the validity of four tools for identifying PNOVCFs. Optimal cutoff points, sensitivity, specificity, and areas under the ROC curves (AUCs) were determined. Results There were significant differences including BMD T score (femoral neck, total hip and L1-L4), OSTA, FRAX and BFH-OSTM scores between Fracture group and Non-fracture group. Compared to BMD and OSTA, BFH-OSTM and FRAX had better predictive value, the sensitivity, specificity and AUC value are 0.841, 81.29%, 70.67% and 0.796, 74.85%, 78.52%, respectively. Compared with FRAX, the BFH-OSTM has a better AUC value. Conclusions Both BFH-OSTM and FRAX can be used to identify POVCFs, However, BFH-OSTM model may be a more simple and effective tool to identify the risk of POVCFs in Chinese elderly men.

Comparison of Working Length Determination in Mandibular Single-Rooted Teeth

2021 ◽  
Vol 8 (2) ◽  
pp. 19-23
Author(s):  
Ruqayya Sana ◽  
Farzana Rehman ◽  
Farzana Rehman ◽  
Rashid Javaid
Keyword(s):  
Sampling Technique ◽  
Cross Sectional Study ◽  
Study Data ◽  
Inclusion Criteria ◽  
Cross Sectional ◽  
Conventional Radiograph ◽  
Anterior Teeth ◽  
Working Length ◽  
The Mean ◽  
Electronic Apex Locator

OBJECTIVES: The objective of this study was to compare working length calculated with conventional radiographs and an electronic apex locator (IPEX II) during the root canal treatment of mandibular anterior teeth. METHODOLOGY: A cross-sectional study was done in the Department of Operative Dentistry, Sardar Begum Dental Hospital, Peshawar during February and March 2018. A consecutive sampling technique was used for sampling. Only 30 patients fulfilled the inclusion criteria of our study. Detailed medical and dental history was taken. Only patient fulfilling inclusion criteria were enrolled in the study. Data were analyzed using SPSS version 20. RESULTS: The mean age for patients was 45.33±5.16. 33% out of 30 patients (10) were male and 20 were females. The mean working length calculated from radiographs was 22.25±1.29 (min 20.09-max 24.10). The mean working length calculated by the electronic apex locator (IPEX II) was 22.17±1.28 (min 20.00-max 24.07). The mean difference between working length calculated by radiograph and electronic apex locator was -0.084mm, which means the working length determined by radiographs and by electronic apex locator has no difference in mandibular anterior teeth with single canals. CONCLUSION: Both the methods can be used effectively in endodontics for single-rooted mandibular teeth, but if both are used in combinations can lead to an improvement in the working length accuracy, which may significantly reduce the number of radiographs exposure, and increase the success and comfort for endodontic patients. KEYWORDS: Working Length, Apex Locator, Conventional Radiograph

scholarly journals Role of transvaginal sonography in the detection of endometrial carcinoma

2014 ◽  
Vol 39 (2) ◽  
pp. 80-85
Author(s):  
MS Showkat ◽  
S Nabi ◽  
L Khondker ◽  
B Bhowmik ◽  
SN Tushar ◽  
...  
Keyword(s):  
Endometrial Carcinoma ◽  
Predictive Value ◽  
Cross Sectional Study ◽  
Transvaginal Sonography ◽  
Histopathological Diagnosis ◽  
Cross Sectional ◽  
Menopausal Women ◽  
Post Menopausal ◽  
Sensitivity Specificity ◽  
Transabdominal Sonography

Transvagival sonography is superior to transabdominal sonography in most cases of pelvic pathology. Objective of this study is to evaluate the clinical usefulness of transvaginal ultrasonography (TVS) in pre, peri and post menopausal women suspected to have endometrial carcinoma. This cross sectional study was done with 40 patients who are clinically suspected having thickened endometrium. The study was carried out January 2007 to November 2008 for a period of two years. The patients having endometrial carcinoma diagnosed by TVS was correlated with histopathological diagnosis following collection of the report from the respective cases. Of total 40 cases, 2(5.0%) cases were endometrial carcinoma and 38(95.0%) were negative for endometrial carcinoma respectively in TVS findings. On the other hand 3(7.5%) cases were endometrial carcinoma and 37 (92.5%) cases were negative for endometrial carcinoma in histopathological findings. The validity of TVS in diagnosis of endometrial carcinoma were studied by calculating sensitivity, specificity, accuracy, positive predictive value and negative predictive value, which were 67 percent, 100 percent, 98 percent, 100 percent and 97 percent respectively. As the TVS findings of the present study correlated well with the histopathology findings and the validity test values were higher than observed by others, it can be concluded that TVS is sensitive and accurate modality in the evaluation of endometrial carcinoma. DOI: http://dx.doi.org/10.3329/bmrcb.v39i2.19647 Bangladesh Med Res Counc Bull 2013; 39: 80-85

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