scholarly journals An algorithm to safely manage oral food challenge in an office-based setting for children with multiple food allergies

2021 ◽  
Vol 5 (1) ◽  
pp. 030-037
Author(s):  
Cottel Nathalie ◽  
Dieme Aïcha ◽  
Orcel Véronique ◽  
Chantran Yannick ◽  
Bourgoin-Heck Mélisande ◽  
...  
Keyword(s):  
Negative Predictive Value ◽  
Predictive Value ◽  
Validation Cohort ◽  
Hospital Setting ◽  
Food Challenge ◽  
Oral Food Challenge ◽  
Low Risk ◽  
Food Allergies ◽  
Machine Learning Approach ◽  
High Positive Predictive Value

Background: In France, from 30% to 35% of children suffer from multiple food allergies (MFA). The gold standard to diagnosis a food allergy is the oral food challenge (OFC) which is conducted in a hospital setting due to risk of anaphylaxis. The aim of this study was to evaluate an algorithm to predict OFCs at low risk of anaphylaxis that could safely be performed in an office-based setting. Methods: Children with MFA and at least one open OFC reactive or non-reactive to other allergens were included. The algorithm was based on multiple clinical and biological parameters related to food allergens, and designed mainly to predict “low-risk” OFCs i.e., practicable in an office-based setting. The algorithm was secondarily tested in a validation cohort. Results: Ninety-one children (median age 9 years) were included; 94% had at least one allergic comorbidity with an average of three OFCs per child. Of the 261 OFCs analyzed, most (192/261, 74%) were non-reactive. The algorithm failed to correctly predict 32 OFCs with a potentially detrimental consequence but among these only three children had severe symptoms. One hundred eighty-four of the 212 “low-risk” OFCs, (88%) were correctly predicted with a high positive predictive value (87%) and low negative predictive value (44%). These results were confirmed with a validation cohort giving a specificity of 98% and negative predictive value of 100%. Conclusion: This study suggests that the algorithm we present here can predict “low-risk” OFCs in children with MFA which could be safely conducted in an office-based setting. Our results must be confirmed with an algorithm-based machine-learning approach.

Abstract 094: Predicting the Risk of Apparent Treatment Resistant Hypertension: A Retrospective, Longitudinal, Cohort Study in an Urban Hypertension Referral Clinic Setting

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
Michael G Buhnerkempe ◽  
Albert Botchway ◽  
Carlos Nolasco-Morales ◽  
Vivek Prakash ◽  
Lowell Hedquist ◽  
...  
Keyword(s):  
Negative Predictive Value ◽  
Risk Score ◽  
Resistant Hypertension ◽  
Predictive Value ◽  
Low Risk ◽  
Uncontrolled Hypertension ◽  
Treatment Resistant ◽  
Index Visit ◽  
Drug Classes

Background: Apparent treatment resistant hypertension (aTRH) is associated with increased prevalence of secondary hypertension and adverse pressure-related clinical outcomes. We previously showed that cross-sectional prevalence estimates of aTRH are lower than its true prevalence as patients with uncontrolled hypertension undergoing intensification/optimization of therapy will, over time, increasingly satisfy diagnostic criteria for aTRH. Methods: aTRH (SBP and/or DBP at or above a clinically defined goal BP [140/90, 130/85, 130/80, or 125/75 mmHg] over two consecutive office visits when on ≥ 3 antihypertensive drug classes, including a diuretic; or SBP and DBP below goal when on ≥ 4 drug classes, including a diuretic) was assessed in an urban referral hypertension clinic in 924 patients ≥ 30 years old (57.7 ± 12.6) with at least two follow-up visits over 240 days. Patients were mostly African-American (86%; 795/924) and female (65%; 601/924). A minority (28.7%; 265/924) were taking diuretics at their index visit, and analyses were stratified according to this use. Risk for aTRH was estimated using logistic regression with patient characteristics at index visit as predictors. Performance of this risk score at discriminating aTRH status over follow-up was assessed using AUC and was internally validated using bootstrapping. Results: Amongst those on diuretics, 80/265 (30.2%) developed aTRH; the risk score discriminated well (AUC = 0.79, bootstrapped 95% CI [0.73, 0.84]). In patients not on a diuretic, 151/659 (22.9%) developed aTRH, and the risk score showed moderate, but significantly lower, discriminative ability (AUC = 0.71 [0.66, 0.74]; p < 0.001). In the diuretic and non-diuretic cohorts, 43/265 (16.2%) and 101/265 (38.1%) of patients, respectively, had estimated risks for development of aTRH < 10%. Of these low-risk patients, 42/43 (97.7%) and 97/101 (96.0%) did not develop aTRH (negative predictive value, diuretics – 0.95 [0.93, 1.00], no diuretics – 0.96 [0.91, 1.00]). Conclusions: We created a novel clinical score that discriminates well between those who will and will not develop aTRH, especially amongst those taking diuretics initially. Irrespective of diuretic treatment status, a low risk score had very high negative predictive value.

scholarly journals Component-Resolved Diagnosis in Food Allergies

Medicina ◽  
2019 ◽  
Vol 55 (8) ◽  
pp. 498 ◽  
Author(s):  
Elisabetta Calamelli ◽  
Lucia Liotti ◽  
Isadora Beghetti ◽  
Valentina Piccinno ◽  
Laura Serra ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Unmet Needs ◽  
Food Challenge ◽  
Specific Ige ◽  
Oral Food Challenge ◽  
Food Allergies ◽  
Specificity And Sensitivity ◽  
Sensitization Pattern ◽  
Molecular Components ◽  
Work Up

Component-resolved diagnostics (CRD) in food allergies is an approach utilized to characterize the molecular components of each allergen involved in a specific IgE (sIgE)-mediated response. In the clinical practice, CRD can improve diagnostic accuracy and assist the physician in many aspects of the allergy work-up. CRD allows for discriminatory co-sensitization versus cross-sensitization phenomena and can be useful to stratify the clinical risk associated with a specific sensitization pattern, in addition to the oral food challenge (OFC). Despite this, there are still some unmet needs, such as the risk of over-prescribing unnecessary elimination diets and adrenaline auto-injectors. Moreover, up until now, none of the identified sIgE cutoff have shown a specificity and sensitivity profile as accurate as the OFC, which is the gold standard in diagnosing food allergies. In light of this, the aim of this review is to summarize the most relevant concepts in the field of CRD in food allergy and to provide a practical approach useful in clinical practice.

scholarly journals Electrocardiographic Fragmented Activity (II): A Machine Learning Approach to Detection

2019 ◽  
Vol 9 (17) ◽  
pp. 3565 ◽  
Author(s):  
Francisco-Manuel Melgarejo-Meseguer ◽  
Francisco-Javier Gimeno-Blanes ◽  
María-Eladia Salar-Alcaraz ◽  
Juan-Ramón Gimeno-Blanes ◽  
Juan Martínez-Sánchez ◽  
...  
Keyword(s):  
Negative Predictive Value ◽  
Predictive Value ◽  
Companion Paper ◽  
Gaussian Kernel ◽  
Support Vector ◽  
Common Disease ◽  
Ecg Signals ◽  
Fragmented Qrs ◽  
Machine Learning Approach ◽  
Electrocardiogram Ecg

Hypertrophic cardiomyopathy, according to its prevalence, is a comparatively common disease related to the risk of suffering sudden cardiac death, heart failure and stroke. This illness is characterized by the excessive deposition of collagen among healthy myocardium cells. This situation, which is medically known as fibrosis, constitutes effective conduction obstacles in the myocardium electrical path, and when severe enough, it can be outlined as additional peaks or notches in the QRS, clinically entitled as fragmentation. Nowadays, the fragmentation detection is performed by visual inspection, but the fragmented QRS can be confused with the noise present in the electrocardiogram (ECG). On the other hand, fibrosis detection is performed by magnetic resonance imaging with late gadolinium enhancement, the main drawback of this technique being its cost in terms of time and money. In this work, we propose two automatic algorithms, one for fragmented QRS detection and another for fibrosis detection. For this purpose, we used four different databases, including the subrogated database described in the companion paper and incorporating three additional ones, one compounded by more accurate subrogated ECG signals and two compounded by real and affected subjects as labeled by expert clinicians. The first real-world database contains QRS fragmented records and the second one contains records with fibrosis and both were recorded in Hospital Clínico Universitario Virgen de la Arrixaca (Spain). To deeply analyze the scope of these datasets, we benchmarked several classifiers such as Neural Networks, Support Vector Machines (SVM), Decision Trees and Gaussian Naïve Bayes (NB). For the fragmentation dataset, the best results were 0.94 sensitivity, 0.88 specificity, 0.89 positive predictive value, 0.93 negative predictive value and 0.91 accuracy when using SVM with Gaussian kernel. For the fibrosis databases, more limited accuracy was reached, with 0.47 sensitivity, 0.91 specificity, 0.82 predictive positive value, 0.66 negative predictive value and 0.70 accuracy when using Gaussian NB. Nevertheless, this is the first time that fibrosis detection is attempted automatically from ECG postprocessing, paving the way towards improved algorithms and methods for it. Therefore, we can conclude that the proposed techniques could offer a valuable tool to clinicians for both fragmentation and fibrosis diagnoses support.

The Febrile Infant

PEDIATRICS ◽  
1994 ◽  
Vol 94 (3) ◽  
pp. 397-399 ◽  
Author(s):  
Paul L. McCarthy
Keyword(s):  
Negative Predictive Value ◽  
Predictive Value ◽  
Current Issue ◽  
Low Risk ◽  
Serious Illness ◽  
The Past ◽  
Risk Criteria ◽  
Febrile Infant ◽  
Diagnostic Certainty ◽  
Rule Out

There have now been three large prospective studies of febrile infants published within the past 3 years.1-3 Each reports on over 500 patients. Two of the reports, that of Baskin et al1 and that of Jaskiewicz et al,3 in the current issue of Pediatrics, focus on infants meeting low-risk criteria for serious bacterial illness. These two studies ask the question: "If the febrile infant meets these selected low-risk criteria, then with what degree of diagnostic certainty can the examining physician rule out a serious illness?" Statistically, this index of diagnostic certainty is termed negative predictive value. Jaskiewicz et al studied 511 low-risk febrile infants and used 437 of these patients to calculate negative predictive value, which was 98.9%.

scholarly journals Comparing WHO C-Model generated C-Section probabilities to actual delivery outcomes in a tertiary care centre

2017 ◽  
Vol 7 (1) ◽  
pp. 229
Author(s):  
Amita Ray ◽  
Arun Gopi ◽  
Sujoy Ray
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Vaginal Delivery ◽  
Predictive Value ◽  
Model Comparison ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Tertiary Care Centre ◽  
High Positive Predictive Value ◽  
Sensitivity Specificity

Background: A model which takes into account several relevant factors and gives the probability of C-Section in a woman would have the advantage of preparing for such an event. The identification of women at high risk of C-Section (>50% risk) would provide the opportunity for understanding risks involved in pursuing a vaginal delivery whereas if the risk of C-Section was less (<50%) it would prove useful in counselling for a vaginal delivery. We used the WHO C-Model with the aim to find the predictability of this model in our facility and the overuse of C-section in the 10 Robson’s Groups.Methods: A retrospective observational study in which all women who gave birth at our hospital from June 2016 to May 2017 were included and C-Section probability was calculated using the C-Model. Comparison with the actual mode of delivery was done to find the sensitivity, specificity, positive and negative predictive value of the model and the overuse of C-Section in the Robson’s Groups.Results: Out of the 314 C-Sections done only 45 women had a >50% probability, giving the model a sensitivity of 14.33%, specificity of 98.8%, positive predictive value of 90% and negative predictive value of 60.56%. Robson’s Groups 5 and 3 demonstrated the greatest overuse of C-Sections.Conclusions: The WHO Model when applied to this centre showed a high positive predictive value for C-Sections but the negative predictive value or the ability to correctly predict a vaginal delivery was much less.

Tuberculosis and Tuberculin Quality: Best Intentions, Misleading Results

2001 ◽  
Vol 22 (08) ◽  
pp. 481-484 ◽  
Author(s):  
M. Sigfrido Rangel-Frausto ◽  
Samuel Ponce-de-León-Rosales ◽  
Claudia Martinez-Abaroa ◽  
Kaare Hasløv
Keyword(s):  
Medical Students ◽  
High Risk ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Healthcare Workers ◽  
Low Risk ◽  
University Hospital ◽  
High Risk Population ◽  
Risk Population

Abstract Objective: To compare the performance of three purified protein derivative (PPD) formulations: Tubersol (Connaught); RT23, Statens Serum Institut (SSI); and RT23, Mexico, tested in Mexican populations at low and high risk for tuberculosis (TB). Design: A double-blinded clinical trial. Setting: A university hospital in Mexico City. Participants: The low-risk population was first or second-year medical students with no patient contact; the high-risk population was healthcare workers at a university hospital. Methods: Each of the study subjects received the three different PPD preparations. Risk factors for TB, including age, gender, occupation, bacille Calmette-Guerin (BCG) status, and TB exposure, were recorded. A 0.1-mL aliquot of each preparation was injected in the left and right forearms of volunteers using the Mantoux technique. Blind readings were done 48 to 72 hours later. Sensitivity and specificity were calculated at 10 mm of induration using Tubersol as the reference standard. The SSI tested the potency of the different PPD preparations in previously sensitized guinea pigs. Results: The low-risk population had a prevalence of positive PPD of 26%. In the low-risk population, RT23 prepared in Mexico, compared to the 5 TU of Tubersol, had a sensitivity of 51%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 86%. The RT23 prepared at the SSI had a sensitivity of 69%, a specificity of 99%, a positive predictive value of 95%, and a negative predictive value of 90%. In the high-risk population, the prevalence of positive PPD was 57%. The RT23 prepared in Mexico had a sensitivity of 33%, a specificity of 100%, and a positive predictive value of 53%; the RT23 prepared at the SSI had a sensitivity of 91%, a specificity of 98%, a positive predictive value of 98%, and a negative predictive value of 89%. RT23 used in Mexico had a potency of only 23% of that of the control. There was no statistical association among those with a positive PPD, irrespective of previous BCG vaccination (relative risk, 0.97; 95% confidence interval, 0.76-1.3; P=.78). Conclusions: Healthcare workers had twice the prevalence of positive PPD compared to medical students. RT23 prepared in Mexico had a low sensitivity in both populations compared to 5 TU of Tubersol and RT23 prepared at the SSI. Previous BCG vaccination did not correlate with a positive PPD. Low potency of the RT23 preparation in Mexico was confirmed in guinea pigs. Best intentions in a TB program are not enough if they are not followed by high-quality control.

scholarly journals The effectiveness of skin prick test in diagnosing severe paediatric food allergy: A systematic review

2021 ◽  
Author(s):  
Daniel Zhou ◽  
Evelyn Fleming ◽  
Colin Macdougall
Keyword(s):  
Systematic Review ◽  
Food Allergy ◽  
Skin Prick Test ◽  
Predictive Value ◽  
Food Challenge ◽  
Paediatric Population ◽  
Oral Food Challenge ◽  
Prick Test ◽  
Parents And Children ◽  
Skin Prick Tests

There is an increasing incidence of food allergy identified globally in the paediatric population. Diagnosis of suspected cases by oral food challenge (OFC) is time-consuming and often linked to anxiety in parents and children. There is also a risk of triggering an anaphylaxis reaction between 2.4%-34.1% of challenges triggering anaphylaxis. To reduce the number of OFC carried out in allergy-suspected children, the use of skin prick tests (SPT) is a simpler and less expensive method of diagnosis. Although the predictive value of the SPT remains unclear, hence there is a requirement for further studies on the predictive value of the SPT to provide increased clarity of the essential parameters.

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