ACCURACY OF THE UPPER LIP BITE TEST;

Objective: To compare the accuracy of Upper lip bite test with modified Mallampati classification for predicting the difficultlaryngoscopic intubation. Study Design: Cross sectional Study. Place and duration of study: The study was carried out at Department ofAnaesthesiology, Intensive Care and Pain management, Combined Military hospital, Rawalpindi from September 2008 to August 2009.Patients and Methods: Four hundred patients undergoing elective surgery meeting the inclusion/exclusion criteria were enrolled afterwritten informed consent. The airways of the patients were evaluated by using the modified Mallampati classification (MMP) and theUpper lip bite test (ULBT). MMP class 3 or 4 and ULBT class 3 were considered as indicators of difficult intubation. The laryngeal view wasgraded by Cormack and Lehane classification (Gold standard). Grade 1 or 2 was considered to represent easy intubation and grade 3 or 4to represent difficult intubation. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy werecalculated for both the tests separately by using the 2×2 table. Results: ULBT had a higher accuracy of 94%, specificity of 99.2% andpositive predictive value 70% compared to MMP accuracy of 82.7%, specificity of 84.4% and positive predictive value of 22.7%.Conclusions: The diagnostic accuracy of the Upper lip bite test was more than the modified Mallampati classification. We suggest that itbe compared with the other prevailing tests as well which are often used to assess difficult intubations.

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Comparison of Upper Lip Bite Test with Modified Mallampati Test and Thyromental Distance for Prediction of Difficult Intubation

Nepal Journal of Medical Sciences ◽

10.3126/njms.v5i1.36792 ◽

2020 ◽

Vol 5 (1) ◽

pp. 2-9

Author(s):

Sabin Koirala ◽

Bigen Man Shakya ◽

Moda Nath Marhatta

Keyword(s):

Difficult Intubation ◽

Predictive Value ◽

Elective Surgery ◽

Cross Sectional Study ◽

Upper Lip ◽

Cross Sectional ◽

Airway Assessment ◽

Total Percentage ◽

Bedside Test ◽

Sensitivity Specificity

Introduction: The prediction of difficult intubation using simple bedside test is of great importance to prevent mismanagement of airway. This study was conducted to compare Upper Lip Bite Test (ULBT) with Modified Mallampati Test (MMT) and Thyromental Distance (TMD) for the prediction of difficult intubation. Method: This was descriptive cross-sectional study conducted in 121 patients of American Society of Anaesthesiologists Physical Status (ASA PS) I and II patients scheduled for elective surgery requiring general anaesthesia with endotracheal tube. The airway assessment of the patients was done one day prior to the surgery using Upper Lip Bite Test (ULBT), Modified Mallampati Test (MMT) and measurement of Thyromental Distance (TMD) . On the day of surgery during laryngoscopy, Cormack-Lehane (CL) grading was recorded. The CL grading of III and IV was labeled as difficult intubation. The Sensitivity, Specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), Likelihood Ratio (LR) of ULBT, MMT and TMD were calculated and compared. Results: The total percentage of difficult intubation, defined by Cormack-Lehane (CL) III and IV was 16.52 %. The sensitivity, specificity, PPV, NPV and accuracy of Upper Lip Bite Test (ULBT) was 50%, 100%, 100%, 91% and 91.74% respectively. ULBT had a significantly higher sensitivity, specificity and PPV when compared to MMT or TMD or MMT and TMD when combined together. Conclusions: Upper Lip Bite Test (ULBT) is better predictor of difficult intubation and it should be used along with other test during airway assessment.

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Reliability of visual assessment of neonatal jaundice among neonates of black descent: a cross-sectional study from Tanzania

BMC Pediatrics ◽

10.1186/s12887-021-02859-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ikunda Dionis ◽

Omary Chillo ◽

George M. Bwire ◽

Calvin Ulomi ◽

Manase Kilonzi ◽

...

Keyword(s):

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Predictive Value ◽

Neonatal Jaundice ◽

Visual Assessment ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Independent Variables ◽

Sensitivity Specificity

Abstract Background Jaundice is common among neonates and if untreated can lead to kernicterus. Diagnosing neonatal jaundice (NJ) using Kramer’s method (visual assessment) is considered user-friendly in resource-limited areas. However, there are conflicting findings on reliability of the Kramer’s method in the diagnosis of NJ, particularly of black descent. Therefore, study aimed to determine the accuracy of Kramer’s method in comparison to the total serum bilirubin (TSB) test in the diagnosis of NJ among neonates of black descent in Tanzania. Methods A cross-sectional study was conducted between June and July 2020 at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania. A total of 315 neonates were recruited consecutively. In each neonate, jaundice was assessed using Kramer’s method and TSB test. NJ A total of 315 neonates were recruited i. A 2 X 2 table was created for the determination of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive and negative likelihood ratios (+LR/−LR), and diagnostic accuracy (effectiveness) of Kramer’s method. Cohen kappa (κ) was used to analyze the agreement between Kramer’s method and TSB. Association between independent variables and presence of jaundice were assessed using the chi-square test and the p < 0.05 was considered to be statistically significant. Results The prevalence of NJ was 49.8% by Kramer’s method and 63.5% by TSB. The Sensitivity, Specificity, PPV, and NPV of Kramer’s method were 70.5, 86.1, 89.8, and 62.6%, respectively. The +LR and –LR were 5.07 and 0.34, respectively. The diagnostic accuracy of Kramer’s method was 76.1%. There was a moderate agreement between Kramer’s method and TSB results (κ = 0.524, P<0.001). No significant relationship was observed between the independent variables and the presence of NJ. Conclusion Kramer has a good positive predictive value. However, due to low sensitivity and NPV one cannot say that overall predictive ability is good. Also, clinical assessment by Kramer’s method should not be used for screening of NJ. Further studies are needed to investigate the utility of other non-invasive techniques in detecting NJ among neonates of black descent.

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Interleukin 21 as a diagnostic marker of rheumatoid arthritis.

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.08.1897 ◽

2019 ◽

Vol 26 (08) ◽

pp. 1229-1232

Author(s):

Khadija Kiran ◽

Amtul Huda ◽

Zuhair Bhatti

Keyword(s):

Rheumatoid Arthritis ◽

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Diagnostic Marker ◽

Cross Sectional Study ◽

P Value ◽

Cross Sectional ◽

Medical College ◽

Sensitivity Specificity

To investigate the role of IL-21 as diagnostic marker in diagnosis of rheumatoid arthritis. Study Design: Cross sectional study. Setting: Department of Physiology and Orthopedic Gujranwala Medical College, Gujranwala. Period: October 2017 to October 2018 in one year duration. Materials and Methods: A total of 150 patients were included in the study, main variables assessed in this study were positive predictive value negative predictive value, sensitivity, specificity and accuracy of IL-21 in diagnosis of rheumatoid arthritis. SPSS version 23 was used to analyze the data. P value less than or equal to 0.05 was taken as significant. Study was started after permission from hospital ethical committee and patients were informed in detail about disease and procedure to be done. Non probability consecutive sampling was used. Results: The estimated sensitivity was 93.6%. The estimated specificity was 50%. Positive predictive value was 96.3% and negative predictive value was 35.7%. The overall accuracy was 90.6% for diagnosing rheumatoid arthritis. Conclusion: IL-21 induces MMP3 in rheumatoid arthritis patients, identification of IL-21 from synovium of patients indicates the presence of rheumatoid arthritis. We observed 90.6% diagnostic accuracy of IL-21 for rheumatoid patients taking RA factor as gold standard of diagnostic tool.

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Ratio of height to thyromental distance: a comparison with Mallampati and Upper lip Bite test for predicting difficult intubation in Pakistani population

Journal of the Pakistan Medical Association ◽

10.47391/jpma.1215 ◽

2021 ◽

pp. 1-15

Author(s):

Saman Tauheed Ali ◽

Khalid Samad ◽

Syed Amir Raza ◽

Muhammad Qamarul Hoda

Keyword(s):

Predictive Value ◽

Characteristic Curve ◽

Cross Sectional Study ◽

Difficult Laryngoscopy ◽

University Hospital ◽

Upper Lip ◽

Cross Sectional ◽

Elective Surgical Procedures ◽

Lehane Grade ◽

Sensitivity Specificity

Objectives: We conducted this study to compare the accuracy of three diagnostic tests; ratio of height to thyromental distance (RHTMD), Modified Mallampati Test (MMT) and Upper Lip Bite Test (ULBT) in predicting difficult laryngoscopy using Cormack and Lehane grade as gold standard.Methods: This study was conducted in Aga Khan University Hospital, Karachi. Based on calculated sample size, 383 patients who required endotracheal intubation for elective surgical procedures were enrolled with consecutive sampling techniques during August 2014 to August 2015 for this cross-sectional study. Primary investigator used RHTMD, ULBT, and MMT for assessing the airway and correlated with laryngoscopic view.Results: A total of 383 patients were incorporated in this research, out of which 59(15.4%) classified as difficult laryngoscopy based on Cormack and Lehane (CL) grading. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of RHTMD (84.7%, 90.1%, 60.9%, 97%, 89.3%) and ULBT (83.1%, 89.2%, 58.3%, 96.7%, 88.3%) values were highest as compared to MMT (30.5%, 84.3%, 26.1%, 86.9%, 79.9%). The area under a receiver-operating characteristic curve (AUC of ROC curve) for ULBT and RHTMD was significantly more than for MMT (P<0.01). RHTMD and ULBT both are acceptable alternatives for prediction of difficult laryngoscopy as a simple, single bed-side test. Continuous...

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Investigating cell blood counter and abdominal radiography accuracy in diagnosis of acute suppurative appendicitis among patients under surgery

Biomedical Research and Therapy ◽

10.15419/bmrat.v5i11.501 ◽

2018 ◽

Vol 5 (11) ◽

pp. 2827-2831

Author(s):

Mohammad Kazem Shahmoradi ◽

Hormoz Mahmoudvand ◽

Sedigheh Nadri ◽

Massumeh Niazi ◽

Mahin Adeli ◽

...

Keyword(s):

Acute Appendicitis ◽

Positive Predictive Value ◽

Predictive Value ◽

Complete Blood Count ◽

Cross Sectional Study ◽

Abdominal Radiography ◽

Cross Sectional ◽

X Ray ◽

High Positive Predictive Value ◽

Sensitivity Specificity

Background: Acute appendicitis is the most common surgical emergencies; while unusual symptoms have a differential diagnosis. This study aimed to determine the diagnostic accuracy of CBC and abdominal X-ray in acute suppurative appendicitis. Methods: This cross-sectional study was performed on 198 patients. For all patients, complete blood count and abdominal X-ray were recorded. The pathological report after surgery was the gold standard for diagnosis. Then indicators of the validity of tests CBC, X-ray and neutrophil to lymphocyte ratio, consisted of positive predictive value (PPV) and negative predictive value (NPV), sensitivity, specificity, were analyzed. Results: Out of patients, 133 of patients were male (67.2%), and 65 (32.8%) were female with mean age of 29.13 years. Acute appendicitis confirmed in 77.8% of pathological study, and 17.7% was the normal appendix. Leukocytosis, NLR and abdominal X-ray tests, each have a sensitivity of 89.5%, 78.5% and 100%, specificity of 31.4%, 31.4% and 31.8%, PPV 85.8%, 84.2% and 53.9%, NPV 39.2%, 23.9% and 100%, respectively. There was a significant relationship between appendicitis and WBC> 10.000 and abdominal radiography findings. Conclusion: Due to the sensitivity of performing CBC and leukocytosis and NLR is at an acceptable level, especially with a relatively high positive predictive value, could be concluded that the positivity of these tests for confirming the diagnosis in suspected cases might be helpful and can help to strengthen the clinical diagnosis. Our results in relation to the x-ray of the abdomen suggest its usefulness in the diagnosis of appendicitis.

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Surgeon Performed Ultrasound in Assessing Thyroid Nodule Using American College of Radiology Tirads and Total Malignancy Score (TMS): A Validation Cross Sectional Study

IIUM Medical Journal Malaysia ◽

10.31436/imjm.v20i3.1832 ◽

2021 ◽

Vol 20 (3) ◽

Author(s):

Adi Syazni Muhammed ◽

Randeep Singh ◽

Shahrun Niza Abdullah Suhaimi ◽

Nani Harlina Muhammad Latar

Keyword(s):

Diagnostic Accuracy ◽

Thyroid Nodule ◽

Predictive Value ◽

Scoring System ◽

Thyroid Nodules ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Diagnostic Reliability ◽

Sensitivity Specificity

INTRODUCTION: This study aims to evaluate the diagnostic reliability of the American College of Radiology Thyroid Imaging Report and Data System (ACR-TIRADS) and Total Malignancy Score (TMS) scoring system, in differentiating benign and malignant thyroid nodules. MATERIALS AND METHODS: This is a cross-sectional study involving patients with thyroid nodules treated at Hospital Canselor Tuanku Muhriz from October 2017 until October 2019. Ultrasound findings were scored according to the ACR[1]TIRADS and TMS scoring system. They were then correlated with the FNAC or histopathology report. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of both scoring system were calculated for analysis. RESULTS: A total of 150 patients with 223 thyroid nodules were included. 17% or 38 nodules were found to be malignant. The sensitivity, specificity, PPV, NPV and accuracy of ACR-TIRADS and TMS were 97.37% vs. 84.21 % , 52.97% vs. 62.70%, 29.84% vs. 31.68%, 98.99% vs. 95.08% and 61% vs. 66% respectively. According to the ACR-TIRADS, only hypoechoic nodules was a strong predictor of malignancy. Comparatively, in the TMS, strong predictors of malignancy include single nodule, hypoechogenicity, irregular margin, and nodules with peri and intranodular vascularity. CONCLUSION: Both ACR-TIRADS and TMS score had good diagnostic accuracy in predicting malignant thyroid nodule. TMS is comparable and not inferior to ACR[1]TIRADS however, the latter is more practical for use as growth and Doppler characteristic are not included in the assessment.

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Isolation of Candida albicans among HIV Patients Presenting with Oral Thrush in Abuja, Nigeria

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2019/v30i130157 ◽

2019 ◽

pp. 1-8

Author(s):

Yunusa, Thairu ◽

Ukonu, Agwu Bob ◽

Aisha Mashood Adeoye

Keyword(s):

Candida Albicans ◽

Positive Predictive Value ◽

Predictive Value ◽

Cross Sectional Study ◽

High Morbidity ◽

Cross Sectional ◽

Oral Thrush ◽

Sensitivity Specificity ◽

Age Range ◽

Hiv Seropositive

Background: Candida infections are known contributors to the high morbidity and mortality rates seen in HIV positive patients. Methodology: This was a descriptive cross-sectional study. The study was carried out at the Microbiology research laboratory, department of Medical Microbiology, University of Abuja Teaching Hospital, Gwagwalada. The population is made up of two hundred and ten (210) patients who presented with oral thrush between fifteen years and seventy years which comprises of 160 HIV seropositive and 50 non age and sex matched HIV seronegative patients. Culture, Microscopy and ELISA methods were used for isolation of Candida albicans. An interviewer-administered, structured questionnaire was used as the study tool. Results: The mean age for the isolation of Candida albicans was 30 ± 18.7 years, with the highest proportion of isolates within the age range of 21-30 years accounting for 27.1% of the study population recruited and the lowest proportion of isolates being 41-50 years accounting for 8.0%. From the 210 subjects with Candida albicans in the study, one hundred and sixty (160) representing 76.2 were isolated from HIV seropositive clients and Candida albicans isolation rate among HIV seronegative population was 23.8%. Conclusion: The sensitivity, specificity and positive predictive value of using Grams reaction methods in the diagnosis of Candida albicans was 22.9%, 95.2% and 82.6%. The sensitivity, specificity and positive predictive value of using ELISA methods was 25.7%, 86.7% and 65.9%. In this study, there was preponderance of Candida albicans isolate among the young and the old in HIV seropositive patients but largely isolated from older patients among HIV seronegative patients.

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ROLE OF DOPPLER INDICES IN THE PREDICTION OF ADVERSE PERINATAL OUTCOME IN PREECLAMPSIA

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71i4.4567 ◽

2021 ◽

Vol 71 (4) ◽

pp. 1209-1213

Author(s):

Shakra Tabasam ◽

Zaib Malik ◽

Asifa Siraj ◽

Sadaf Afroz

Keyword(s):

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Predictive Value ◽

Perinatal Outcome ◽

Military Hospital ◽

Reference Standard ◽

Adverse Perinatal Outcome ◽

Doppler Study ◽

Sensitivity Specificity

Objective: To determine diagnostic accuracy of systolic/diastolic ratio and cerebro-placental index in predicting adverse perinatal outcome among patients in preeclampsia. Study Design: Cross-sectional validation study. Place and Duration of Study: Department of Obstetrics and Gynaecology, Pak Emirates Military Hospital, Rawalpindi, from Jun to Dec 2017. Methodology: A total of 191 patients with preeclampsia were included. Doppler ultrasound (including doppler wave forms obtained from free floating portion of umbilical artery and doppler waveform from middle cerebral artery at the level of circle of Willis) examination was done after gestational age 30 weeks and Doppler study repeated at 2-4 weeks interval depending on severity of preeclampsia and abnormalities of waveform. Cases were followed and results of last Doppler examination within 10 days of delivery were considered and perinatal outcome noted. Results: The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of systolic/diastolic ratio in predicting adverse perinatal outcome among patients in preeclampsia, keeping actual adverse perinatal outcome as reference standard was 82.35%, 86.52%, 87.50%, 81.05% and 84.29% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of cerebro-placental index in predicting adverse perinatal outcome among patients in preeclampsia, keeping actual adverse perinatal outcome as reference standard was 78.67%, 92.24%, 86.76%, 86.99% and 86.91% respectively. Conclusion: The diagnostic accuracy of systolic/diastolic ratio, cerebro-placental index in predicting adverse perinatal outcome among patients in preeclampsia is quite high.

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Sequential Screening with Cytology and Colposcopy in Detection of Cervical Neoplasia

Journal of SAFOG with DVD ◽

10.5005/jp-journals-10006-1009 ◽

2009 ◽

Vol 1 (3) ◽

pp. 45-48 ◽

Cited By ~ 1

Author(s):

BR Desai ◽

PR Malur ◽

Dalal Anita ◽

Durdi Geeta ◽

Sherigar Bhavana ◽

...

Keyword(s):

Cervical Cancer ◽

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Pap Smear ◽

Cross Sectional Study ◽

Diagnostic Efficacy ◽

Cross Sectional ◽

Sequential Screening ◽

Sensitivity Specificity

ABSTRACT Background Pap smear is the most commonly used screening test for cervical cancer, however it has disadvantage of having low sensitivity. Colposcopy has higher sensitivity as compared to Pap smear but low specificity. Sequential screening with both Pap smear and colposcopy can overcome these problems. Aim The study was aimed to find out the diagnostic efficacy of both Pap smear and colposcopy. It was also intended to find out the advantages of sequential use of Pap smear and colposcopy in screening for cervical cancer. Design It was a cross-sectional study conducted in colposcopy clinic of KLE's Dr. Prabhakar Kore Hospital and MRC, Belgaum from November 2006 to September 2008. Material and methods A total of 190 patients with complaints of postcoital bleeding, intermenstrual bleeding, postmenopausal bleeding, persistent vaginal discharge or those found to have an unhealthy cervix on per speculum examination were included in the study. In all the 190 cases Pap smear, colposcopic evaluation and colposcopic directed biopsy were performed. Statistical analysis Sensitivity, specificity, positive predictive value, negative predictive value of both Pap smear and colposcopy were calculated with histopathology as a gold standard, keeping LSIL as a disease threshold for test positivity. Results Pap smear was positive in 14.21% (27/190) cases, colposcopy was positive in 37.89% (72/190) cases. Biopsy confirmed LSIL and higher lesions in 31.57% cases. The sensitivity, specificity, positive predictive value and negative predictive value of Pap smear were 41.66%, 96.92%, 86.21% and 78.26% respectively and 80%, 81.54%, 66.66% and 89.83% respectively for colposcopy. Combined colposcopy and Pap smear could accurately diagnose 53/60 biopsy confirmed cases of LSIL and higher lesions with an accuracy of 88.33%. Conclusion Sequential use of Pap smear and colposcopy in screening for cervical cancer increases the accuracy of the test.

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Diagnostic accuracy of ultrasound in evaluation of obstructive jaundice with MRCP as gold standard

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.36.4.1665 ◽

2020 ◽

Vol 36 (4) ◽

Author(s):

Hina Hanif ◽

Sohail Ahmed Khan ◽

Sobia Muneer ◽

Syed Omair Adil

Keyword(s):

Obstructive Jaundice ◽

Diagnostic Accuracy ◽

Predictive Value ◽

Gold Standard ◽

High Sensitivity ◽

Cross Sectional Study ◽

Cross Sectional ◽

Creative Commons ◽

Positive Predicted Value ◽

Sensitivity Specificity

Objective: To evaluate the diagnostic accuracy of ultrasound in obstructive jaundice taking MRCP as gold standard. Methods: This cross-sectional study was conducted at Dow Institute of Radiology (DIR), Dow University of Health Sciences (DUHS), Karachi from 2nd May 2018 till 2nd November 2018. Both male and female patients aged 30 to 80 years with suspected obstructive jaundice were included. Patients already diagnosed with obstructive jaundice were excluded. MRCP and ultrasound were performed in suspected patients. Diagnostic accuracy including sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of obstructive jaundice were calculated using contingency tables using MRCP findings as gold standard. Results: Mean age of the patients was 54.73 ± 12.65 years. In causes of obstruction, choledocholothiasis was responsible for 85 (35.1%), stricture 61 (25.2%), carcinoma of head of pancreas 39 (16.1%), periampullary carcinoma 21 (8.7%), cholangiocarcinoma 10 (4.1%) and gallbladder carcinoma 26 (10.7%) of the cases. Diagnostic accuracy of ultrasound in obstructive jaundice taking MRCP findings as gold standard showed sensitivity, specificity, positive predicted value (PPV), negative predicted value (NPV) and overall diagnostic accuracy as 84.57%, 79.10%, 91.36%, 66.25% and 83.06%. Conclusion: Ultrasound has a high sensitivity, moderate specificity, and high diagnostic accuracy in diagnosis of obstructive jaundice. doi: https://doi.org/10.12669/pjms.36.4.1665 How to cite this:Hanif H, Khan SA, Muneer S, Adil SO. Diagnostic accuracy of ultrasound in evaluation of obstructive jaundice with MRCP as gold standard. Pak J Med Sci. 2020;36(4):---------. doi: https://doi.org/10.12669/pjms.36.4.1665 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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