A Controlled, Blinded Study to Validate the Diagnostic Accuracy and Assess the Clinical Utility of a Host-response Based Diagnostic Tool for Distinguishing Between Bacterial and Viral Etiologies in Pediatric Patients Presenting to the ED With Suspicion of Acute Infection

2020 ◽  
Author(s):  
Keyword(s):  
Diagnostic Accuracy ◽  
Diagnostic Tool ◽  
Host Response ◽  
Clinical Utility ◽  
Pediatric Patients ◽  
Acute Infection ◽  
Blinded Study ◽  
Viral Etiologies

scholarly journals Diagnostic accuracy of symptoms as a diagnostic tool for SARS-CoV 2 infection: a cross-sectional study in a cohort of 2,173 patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Carlos Alfonso Romero-Gameros ◽  
Tania Colin-Martínez ◽  
Salomón Waizel-Haiat ◽  
Guadalupe Vargas-Ortega ◽  
Eduardo Ferat-Osorio ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Diagnostic Tool ◽  
Clinical Decision Making ◽  
Multivariate Logistic Regression Analysis ◽  
Clinical Decision ◽  
Cross Sectional Study ◽  
World Health ◽  
Likelihood Ratios ◽  
Cross Sectional ◽  
Health Organization

Abstract Background The SARS-CoV-2 pandemic continues to be a priority health problem; According to the World Health Organization data from October 13, 2020, 37,704,153 confirmed COVID-19 cases have been reported, including 1,079,029 deaths, since the outbreak. The identification of potential symptoms has been reported to be a useful tool for clinical decision-making in emergency departments to avoid overload and improve the quality of care. The aim of this study was to evaluate the performances of symptoms as a diagnostic tool for SARS -CoV-2 infection. Methods An observational, cross-sectional, prospective and analytical study was carried out, during the period of time from April 14 to July 21, 2020. Data (demographic variables, medical history, respiratory and non-respiratory symptoms) were collected by emergency physicians. The diagnosis of COVID-19 was made using SARS-CoV-2 RT-PCR. The diagnostic accuracy of these characteristics for COVID-19 was evaluated by calculating the positive and negative likelihood ratios. A Mantel-Haenszel and multivariate logistic regression analysis was performed to assess the association of symptoms with COVID-19. Results A prevalence of 53.72% of SARS-CoV-2 infection was observed. The symptom with the highest sensitivity was cough 71%, and a specificity of 52.68%. The symptomatological scale, constructed from 6 symptoms, obtained a sensitivity of 83.45% and a specificity of 32.86%, taking ≥2 symptoms as a cut-off point. The symptoms with the greatest association with SARS-CoV-2 were: anosmia odds ratio (OR) 3.2 (95% CI; 2.52–4.17), fever OR 2.98 (95% CI; 2.47–3.58), dyspnea OR 2.9 (95% CI; 2.39–3.51]) and cough OR 2.73 (95% CI: 2.27–3.28). Conclusion The combination of ≥2 symptoms / signs (fever, cough, anosmia, dyspnea and oxygen saturation < 93%, and headache) results in a highly sensitivity model for a quick and accurate diagnosis of COVID-19, and should be used in the absence of ancillary diagnostic studies. Symptomatology, alone and in combination, may be an appropriate strategy to use in the emergency department to guide the behaviors to respond to the disease. Trial registration Institutional registration R-2020-3601-145, Federal Commission for the Protection against Sanitary Risks 17 CI-09-015-034, National Bioethics Commission: 09 CEI-023-2017082.

MO1008IMPACT OF RAMIPRIL ON ENDOTHELIAL DYSFUNCTION IN CHILDREN ON REGULAR HEMODIALYSIS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Areej Mohamed Ateya ◽  
Reinhold Kreutz ◽  
Ihab Elhakim ◽  
Sara Shaheen ◽  
Radwa Maher ◽  
...  
Keyword(s):  
Placebo Group ◽  
Endothelial Dysfunction ◽  
Serum Potassium ◽  
Vascular Function ◽  
Pediatric Patients ◽  
Acute Infection ◽  
Immunosuppressive Agents ◽  
Maintenance Hemodialysis ◽  
Short Term Treatment ◽  
Regular Hemodialysis

Abstract Background and Aims Endothelial dysfunction is an important risk factor for cardiovascular disease and therefore for increased mortality in end-stage renal disease patients. Asymmetric dimethyl arginine (ADMA), a potent inhibitor of nitric oxide synthase, strongly contributes to endothelial dysfunction. In dialysis patients, ADMA levels are markedly elevated. Previous studies have shown that angiotensin-converting enzyme inhibitors (ACEIs) can significantly reduce ADMA levels in a variety of patients. In contrast, a previous study suggested that short-term treatment with ACEIs may even increase ADMA levels in adult patients on maintenance hemodialysis. However, no study has evaluated the effect of ACEIs in pediatric patients undergoing hemodialysis. Method We conducted a prospective, randomized, double-blinded and placebo-controlled trial (NCT04582097) at two nephrology centers in Cairo, Egypt. Patients below the age of 16 years and on regular hemodialysis for 6 months or longer were eligible for inclusion. Exclusion criteria at screening included uncontrolled hypertension, serum potassium level &gt; 5.5 mmol/L, acute infection or treatment with immunosuppressive agents within the previous month, known intolerance of ACEI treatment and inability to discontinue previous ACEI or angiotensin receptor blocker treatment. A total of 135 eligible patients (mean age, 12.6 years; range 7-15 years; 53.3% males) were randomly (1:1) assigned to once oral daily treatment with identical capsules containing either 2.5 mg ramipril (n=68) or placebo (n=67) for four months. Systolic and diastolic blood pressure (BP) and serum ADMA concentrations were measured as primary efficacy and serum potassium levels as primary safety parameter. Results At baseline, systolic and diastolic BP and ADMA levels were similar between both treatment groups (Table). After four months, both systolic and diastolic BP were significantly lower in the ramipril compared to the placebo group. Treatment with ramipril resulted in a profound reduction in ADMA levels (-77% compared to baseline) while ADMA levels were unchanged in the placebo group after four months (p &lt;0.001). Serum levels of potassium increase in both groups with no reported symptoms of severe hyperkalemia No serious adverse events were reported in neither group. Conclusion Ramipril treatment in pediatric patients on maintenance hemodialysis causes a marked reduction in ADMA levels. This may contribute to improved endothelial vascular function besides its efficacious BP lowering effect.

The Authors’ Reply: Diagnostic accuracy of the McGill thyroid nodule score in pediatric patients: methodological issues

2018 ◽  
Vol 90 (2) ◽  
pp. 385-385 ◽  
Author(s):  
Ana Creo ◽  
Fares Alahdab ◽  
Alaa Al Nofal ◽  
Kristen Thomas ◽  
Amy Kolbe ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Thyroid Nodule ◽  
Pediatric Patients ◽  
Methodological Issues

Translation: Beyond Diagnostic Accuracy: The Clinical Utility of Diagnostic Tests

2013 ◽  
Vol 3 (4) ◽  
pp. 269
Author(s):  
Patrick M.M. Bossuyt ◽  
Johannes B. Reitsma ◽  
Kristian Linnet ◽  
Karel G.M. Moons
Keyword(s):  
Diagnostic Accuracy ◽  
Diagnostic Tests ◽  
Clinical Utility

scholarly journals Diagnostic accuracy and clinical utility of a simplified low cost method of counting CD4 cells with flow cytometry in Malawi: diagnostic accuracy study

BMJ ◽  
2007 ◽  
Vol 335 (7612) ◽  
pp. 190-190 ◽  
Author(s):  
Calman A MacLennan ◽  
Michael K P Liu ◽  
Sarah A White ◽  
Joep J G van Oosterhout ◽  
Felanji Simukonda ◽  
...  
Keyword(s):  
Flow Cytometry ◽  
Diagnostic Accuracy ◽  
Clinical Utility ◽  
Low Cost ◽  
Diagnostic Accuracy Study ◽  
Cd4 Cells ◽  
Accuracy Study

scholarly journals The use of hippocampal volumetric measurements to improve diagnostic accuracy in pediatric patients with mesial temporal sclerosis

2017 ◽  
Vol 19 (6) ◽  
pp. 720-728 ◽  
Author(s):  
Gloria J. Guzmán Pérez-Carrillo ◽  
Christopher Owen ◽  
Katherine E. Schwetye ◽  
Spencer McFarlane ◽  
Ananth K. Vellimana ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Pediatric Patients ◽  
Intractable Epilepsy ◽  
Mesial Temporal Sclerosis ◽  
Local Regression ◽  
Clinical Workflow ◽  
Percentage Difference ◽  
Sensitivity Specificity ◽  
Volumetric Measurements

OBJECTIVEMany patients with medically intractable epilepsy have mesial temporal sclerosis (MTS), which significantly affects their quality of life. The surgical excision of MTS lesions can result in marked improvement or even complete resolution of the epileptic episodes. Reliable radiological diagnosis of MTS is a clinical challenge. The purpose of this study was to evaluate the utility of volumetric mapping of the hippocampi for the identification of MTS in a case-controlled series of pediatric patients who underwent resection for medically refractory epilepsy, using pathology as a gold standard.METHODSA cohort of 57 pediatric patients who underwent resection for medically intractable epilepsy between 2005 and 2015 was evaluated. On pathological investigation, this group included 24 patients with MTS and 33 patients with non-MTS findings. Retrospective quantitative volumetric measurements of the hippocampi were acquired for 37 of these 57 patients. Two neuroradiologists with more than 10 years of experience who were blinded to the patients' MTS status performed the retrospective review of MR images. To produce the volumetric data, MR scans were parcellated and segmented using the FreeSurfer software suite. Hippocampal regions of interest were compared against an age-weighted local regression curve generated with data from the pediatric normal cohort. Standard deviations and percentiles of specific subjects were calculated. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined for the original clinical read and the expert readers. Receiver operating characteristic curves were generated for the methods of classification to compare results from the readers with the authors' results, and an optimal threshold was determined. From that threshold the sensitivity, specificity, PPV, and NPV were calculated for the volumetric analysis.RESULTSWith the use of quantitative volumetry, a sensitivity of 72%, a specificity of 95%, a PPV of 93%, an NPV of 78%, and an area under the curve of 0.84 were obtained using a percentage difference of normalized hippocampal volume. The resulting specificity (95%) and PPV (93%) are superior to the original clinical read and to Reader A and Reader B's findings (range for specificity 74%–86% and for PPV 64%–71%). The sensitivity (72%) and NPV (78%) are comparable to Reader A's findings (73% and 81%, respectively) and are better than those of the original clinical read and of Reader B (sensitivity 45% and 63% and NPV 71% and 70%, respectively).CONCLUSIONSVolumetric measurement of the hippocampi outperforms expert readers in specificity and PPV, and it demonstrates comparable to superior sensitivity and NPV. Volumetric measurements can complement anatomical imaging for the identification of MTS, much like a computer-aided detection tool would. The implementation of this approach in the daily clinical workflow could significantly improve diagnostic accuracy.

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