GAIA Dysfunctional Labor Level of Diagnostic Certainty

Mucormycosis (MCR) has been increasingly described in patients with coronavirus disease 2019 (COVID-19) but the epidemiological factors, presentation, diagnostic certainty, and outcome of such patients are not well described. We review the published COVID-19-associated mucormycosis (CAMCR) cases (total 41) to identify risk factors, clinical features, and outcomes. CAMCR was typically seen in patients with diabetes mellitus (DM) (94%) especially the ones with poorly controlled DM (67%) and severe or critical COVID-19 (95%). Its presentation was typical of MCR seen in diabetic patients (mostly rhino-orbital and rhino-orbital-cerebral presentation). In sharp contrast to reported COVID-associated aspergillosis (CAPA) cases, nearly all CAMCR infections were proven (93%). Treating physicians should have a high suspicion for CAMCR in patients with uncontrolled diabetes mellitus and severe COVID-19 presenting with rhino-orbital or rhino-cerebral syndromes. CAMR is the convergence of two storms, one of DM and the other of COVID-19.

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Diagnostic and prognostic implications of 2018 guideline for the diagnosis of idiopathic pulmonary fibrosis in clinical practice

Scientific Reports ◽

10.1038/s41598-021-95728-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Jooae Choe ◽

Byoung Soo Kwon ◽

Kyung-Hyun Do ◽

Hee Sang Hwang ◽

Jin Woo Song ◽

...

Keyword(s):

Clinical Practice ◽

Idiopathic Pulmonary Fibrosis ◽

Pulmonary Fibrosis ◽

Interobserver Agreement ◽

Usual Interstitial Pneumonia ◽

High Specificity ◽

Fluid Analysis ◽

Diagnostic Certainty ◽

Prognostic Stratification ◽

Prognostic Implications

AbstractThe purpose of this study was to evaluate the implications of the 2018 updated guideline for the diagnosis of idiopathic pulmonary fibrosis (IPF) in clinical practice compared to 2011 guideline. This study involved 535 patients including 339 IPF and 196 non-IPF, and we retrospectively evaluated CT classifications of usual interstitial pneumonia (UIP) by two guidelines. Interobserver agreement of 2018 criteria showed moderate reliability (κ = 0.53) comparable to 2011 (κ = 0.56) but interobserver agreement for probable UIP was fair (κ = 0.40). CT pattern of indeterminate for UIP was associated with better prognosis compared with the other groups (adjusted hazard ratio [HR] = 0.36, p < 0.001). Compared to possible UIP, probable UIP demonstrated a lower positive predictive value (PPV, 62.9% vs 65.8%). In analysis of patients with CT patterns of non-definite UIP, diagnosing IPF when CT pattern showed probable UIP with lymphocyte count ≤ 15% in BAL fluid, and either male sex or age ≥ 60 years showed a high specificity of 90.6% and a PPV of 80.8% in the validation cohort. The 2018 criteria provide better prognostic stratification than the 2011 in patients with possible UIP. BAL fluid analysis can improve the diagnostic certainty for IPF diagnosis in patients with probable UIP CT pattern.

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Growth and nutritional status, and their association with lung function: a study from the international Primary Ciliary Dyskinesia Cohort

European Respiratory Journal ◽

10.1183/13993003.01659-2017 ◽

2017 ◽

Vol 50 (6) ◽

pp. 1701659 ◽

Cited By ~ 20

Author(s):

Myrofora Goutaki ◽

Florian S. Halbeisen ◽

Ben D. Spycher ◽

Elisabeth Maurer ◽

Fabiën Belle ◽

...

Keyword(s):

Lung Function ◽

Primary Ciliary Dyskinesia ◽

Repeated Measurements ◽

World Health ◽

Z Score ◽

Multilevel Regression ◽

Growth And Nutrition ◽

Diagnostic Certainty ◽

Z Scores ◽

Ciliary Dyskinesia

Chronic respiratory disease can affect growth and nutrition, which can influence lung function. We investigated height, body mass index (BMI), and lung function in patients with primary ciliary dyskinesia (PCD).In this study, based on the international PCD (iPCD) Cohort, we calculated z-scores for height and BMI using World Health Organization (WHO) and national growth references, and assessed associations with age, sex, country, diagnostic certainty, age at diagnosis, organ laterality and lung function in multilevel regression models that accounted for repeated measurements.We analysed 6402 measurements from 1609 iPCD Cohort patients. Height was reduced compared to WHO (z-score −0.12, 95% CI −0.17 to −0.06) and national references (z-score −0.27, 95% CI −0.33 to −0.21) in male and female patients in all age groups, with variation between countries. Height and BMI were higher in patients diagnosed earlier in life (p=0.026 and p<0.001, respectively) and closely associated with forced expiratory volume in 1 s and forced vital capacity z-scores (p<0.001).Our study indicates that both growth and nutrition are affected adversely in PCD patients from early life and are both strongly associated with lung function. If supported by longitudinal studies, these findings suggest that early diagnosis with multidisciplinary management and nutritional advice could improve growth and delay disease progression and lung function impairment in PCD.

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The influence of digital PET/CT on diagnostic certainty and interrater reliability in [68Ga]Ga-PSMA-11 PET/CT for recurrent prostate cancer

European Radiology ◽

10.1007/s00330-021-07870-5 ◽

2021 ◽

Author(s):

Ian Alberts ◽

Jan-Niklas Hünermund ◽

Christos Sachpekidis ◽

Clemens Mingels ◽

Viktor Fech ◽

...

Keyword(s):

Prostate Cancer ◽

Interrater Reliability ◽

True Positive Rate ◽

True Positive ◽

Recurrent Prostate Cancer ◽

Pathological Lesions ◽

Diagnostic Certainty ◽

Pet Ct ◽

Positive Rate ◽

Digital Pet

Abstract Objective To investigate the impact of digital PET/CT on diagnostic certainty, patient-based sensitivity and interrater reliability. Methods Four physicians retrospectively evaluated two matched cohorts of patients undergoing [68Ga]Ga-PSMA-11 PET/CT on a digital (dPET/CT n = 65) or an analogue scanner (aPET/CT n = 65) for recurrent prostate cancer between 11/2018 and 03/2019. The number of equivocal and pathological lesions as well as the frequency of discrepant findings and the interrater reliability for the two scanners were compared. Results dPET/CT detected more lesions than aPET/CT (p < 0.001). A higher number of pathological scans were observed for dPET/CT (83% vs. 57%, p < 0.001). The true-positive rate at follow-up was 100% for dPET/CT compared to 84% for aPET/CT (p < 0.001). The proportion of lesions rated as non-pathological as a total of all PSMA-avid lesions detected for dPET/CT was comparable to aPET/CT (61.8% vs. 57.0%, p = 0.99). Neither a higher rate of diagnostically uncertain lesions (11.5% dPET/CT vs. 13.7% aPET/CT, p = 0.95) nor discrepant scans (where one or more readers differed in opinion as to whether the scan is pathological) were observed (18% dPET/CT vs. 17% aPET/CT, p = 0.76). Interrater reliability for pathological lesions was excellent for both scanner types (Cronbach’s α = 0.923 dPET/CT; α = 0.948 aPET/CT) and interrater agreement was substantial for dPET/CT (Krippendorf’s α = 0.701) and almost perfect in aPET/CT (α = 0.802). Conclusions A higher detection rate for pathological lesions for dPET/CT compared with aPET/CT in multiple readers was observed. This improved sensitivity was coupled with an improved true-positive rate and was not associated with increased diagnostic uncertainty, rate of non-specific lesions, or reduced interrater reliability. Key Points • New generation digital scanners detect more cancer lesions in men with prostate cancer. • When using digital scanners, the doctors are able to diagnose prostate cancer lesions with better certainty • When using digital scanners, the doctors do not disagree with each other more than with other scanner types.

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Reliability and validity of a Brazilian version of the Hypomania Checklist (HCL-32) compared to the Mood Disorder Questionnaire (MDQ)

Brazilian Journal of Psychiatry ◽

10.1590/s1516-44462010000400015 ◽

2010 ◽

Vol 32 (4) ◽

pp. 416-423 ◽

Cited By ~ 20

Author(s):

Odeilton Tadeu Soares ◽

Doris Hupfeld Moreno ◽

Eduardo Calmon de Moura ◽

Jules Angst ◽

Ricardo Alberto Moreno

Keyword(s):

Bipolar Disorder ◽

Major Depressive Disorder ◽

Depressive Disorder ◽

Mood Disorder ◽

Psychometric Properties ◽

Internal Consistency ◽

Major Depressive ◽

Brazilian Version ◽

Diagnostic Certainty ◽

Mood Disorder Questionnaire

OBJECTIVE: Bipolar disorders are often not recognized and undertreated. The diagnosis of current or past episodes of hypomania is of importance in order to increase diagnostic certainty. The Hypomania Checklist-32 is a self-applied questionnaire aimed at recognizing these episodes. As part of the international collaborative effort to develop multi-lingual versions of the Hypomania Checklist-32, we aimed to validate the Brazilian version and to compare its psychometric properties with those of the Mood Disorder Questionnaire. METHOD: Adult outpatients with bipolar disorder I (n = 37), bipolar disorder II (n = 44) and major depressive disorder (n = 42) of a specialized mood disorder unit were diagnosed according to DSM-IV-TR using a modified version of the SCID. We analyzed the internal consistency and discriminative ability of the Hypomania Checklist-32 Brazilian version in relation to the Mood Disorder Questionnaire. RESULTS: The internal consistency of the Brazilian Hypomania Checklist-32, analyzed using Cronbach's alpha coefficient, was 0.86. A score of 18 or higher in the Hypomania Checklist-32 Brazilian version distinguished between bipolar disorder and major depressive disorder, with a sensitivity of 0.75 and a specificity of 0.58, compared to 0.70 and 0.58, respectively, for the Mood Disorder Questionnaire (score > 7). The Hypomania Checklist-32 Brazilian version showed a dual factor structure characterized by "active/elated" and "risk-taking/irritable" items. Hence, the Hypomania Checklist-32 Brazilian version was found to have a higher sensitivity but the same specificity as the Mood Disorder Questionnaire. CONCLUSION: The Brazilian version of the Hypomania Checklist-32 has adequate psychometric properties and helps discriminating bipolar disorder from major depressive disorder (but not bipolar disorder I from bipolar disorder II) with good sensitivity and specificity indices, similar to those of the Mood Disorder Questionnaire.

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Nonepileptic seizures: an updated review

CNS Spectrums ◽

10.1017/s109285291600002x ◽

2016 ◽

Vol 21 (3) ◽

pp. 239-246 ◽

Cited By ~ 46

Author(s):

David L. Perez ◽

W. Curt LaFrance

Keyword(s):

Behavioral Therapy ◽

Epileptiform Activity ◽

Epileptic Seizures ◽

Clinical History ◽

Conversion Disorder ◽

Future Research ◽

Treatment Interventions ◽

Diagnostic Certainty ◽

Typical Event ◽

Nonepileptic Seizures

Psychogenic nonepileptic seizures (PNES) are a functional neurological disorder/conversion disorder subtype, which are neurobehavioral conditions at the interface of neurology and psychiatry. Significant advancements over the past decade have been made in the diagnosis, management, and neurobiological understanding of PNES. This article reviews published PNES research focusing on semiologic features that distinguish PNES from epileptic seizures, consensus diagnostic criteria, the intersection of PNES and other comorbidities, neurobiological studies, evidence-based treatment interventions, and outcome studies. Epidemiology and healthcare utilization studies highlight a continued unmet medical need in the comprehensive care of PNES. Consensus guidelines for diagnostic certainty are based on clinical history, semiology of witnessed typical event(s), and EEG findings. While certain semiologic features may aid in the diagnosis of PNES, the gold standard remains capturing a typical event on video electroencephalography (EEG) showing the absence of epileptiform activity with history and semiology consistent with PNES. Medical-neurologic and psychiatric comorbidities are prevalent in PNES; these should be assessed in diagnostic evaluations and integrated into treatment interventions and prognostic considerations. Several studies, including a pilot, multicenter, randomized clinical trial, have now demonstrated that a cognitive behavioral therapy–informed psychotherapy is an efficacious treatment for PNES, and additional efforts are necessary to evaluate the utility of pharmacologic and other psychotherapy treatments. Neuroimaging studies, while requiring replication, suggest that PNES may occur in the context of alterations within and across sensorimotor, emotion regulation/processing, cognitive control, and multimodal integration brain systems. Future research could investigate similarities and differences between PNES and other somatic symptom disorders.

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Diagnosing and Treating Dysfunctional Labor

Labor and Delivery Care ◽

10.1002/9781119971566.ch5 ◽

2011 ◽

pp. 81-110

Keyword(s):

Dysfunctional Labor

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Diagnostic Performance and Reliability of the Standardized Computed Tomography Reporting System for Acute Appendicitis: Experience in a Tertiary Care Academic Center

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2021.07.12434 ◽

2021 ◽

Vol 104 (7) ◽

pp. 1102-1108

Keyword(s):

Computed Tomography ◽

Acute Appendicitis ◽

Diagnostic Accuracy ◽

Predictive Value ◽

Diagnostic Performance ◽

Interobserver Agreement ◽

Reporting System ◽

Lower Quadrant ◽

Suspected Appendicitis ◽

Diagnostic Certainty

Background: Computed tomography (CT) is generally accepted as a modality of choice for imaging workup in patients with suspected appendicitis. A standardized CT reporting system, CT certainty score, has been proposed to improve diagnostic accuracy and to reduce ambiguous CT reports. Objective: To assess the diagnostic performance and the reliability of the standardized CT reporting system for acute appendicitis in Thai adults. Materials and Methods: The present study was a retrospective data review of 421 adult patients who had CT scans of the appendix between January 2016 and December 2017. The clinical and imaging data were extracted and analyzed. The pathological result was used as a standard of reference. The diagnostic performance and interobserver agreement of the standardized CT reporting system were estimated. Results: One hundred sixty-three patients, with a mean age of 41.7 years, had clinical diagnoses of acute appendicitis. Using standardized CT report, radiologists were highly accurate at diagnosing appendicitis [area under curve (AUC) 0.988 (95% CI 0.98 to 1.00); p<0.001]. The estimated sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 95.1% (95% CI 90.6 to 97.9), 95.7% (95% CI 92.5 to 97.9), 93.4% (95% CI 88.7 to 96.2), 96.9% (95% CI 93.0 to 97.2), 95.5% (95% CI 93.0 to 97.3), respectively. The interobserver agreement was greater than 80% for all binary objective findings and more than 90% agreement on the presence or absence of greater-than-3-mm wall thickness, appendicolith, periappendiceal air, and right lower quadrant fluid collection. The use of CT certainty score had interobserver agreement of 78% (κ=0.69; 95% CI 0.62 to 0.77). Conclusion: Using a standardized CT reporting system yielded a high diagnostic accuracy and high reproducibility of supportive CT findings for appendicitis in at-risk patients. The standardized CT reporting system can improve diagnostic certainty, accuracy, and guide patient management. Keywords: Appendicitis; Certainty score; Computed tomography; Standardized reporting system

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