Diagnosis of Newly Delivered Mothers for Periodontitis with a Novel Oral-Rinse aMMP-8 Point-of-Care Test in a Rural Malawian Population

A novel qualitative point-of-care test of activated matrix metalloproteinase-8 (aMMP-8) using noninvasive oral rinse sampling procedures has been developed for the early detection of collagen breakdown indicating periodontal tissue destruction. The main object of this study was to assess the reliability of the test in a low-income setting to identify participants with history of periodontal destruction detected as alveolar bone loss (ABL) in radiographs. This cross-sectional study included 486 women who had recently delivered in rural Malawi. The aMMP-8 test and dental panoramic radiographs were taken within 48 h of delivery. The performance of the test in comparison to radiological examinations was tested by following the standards for reporting of diagnostic accuracy studies protocol (STARD) with respective statistical measures and 95% confidence intervals. From the 486 eligible participants, 461 mothers with complete data, aged from 15 to 46 years (mean 24.8, SD 6.0) were included in the analysis. ABL was identified in 116 of 461 participants. There was 56% agreement between the aMMP-8 test results and detected ABL (yes or no) in radiographs. Calculated sensitivity of the test was 80% (72–87%), specificity 48% (43–54%), positive predictive value 34% (31–37%), negative predictive value 88% (83–91%), positive likelihood ratio 1.55 (1.35–1.77), and negative likelihood ratio 0.41(0.28–0.60). The aMMP-8 test sensitivity and negative predictive value to identify the ABL cases were relatively high, but there was additionally a high rate of test-positive results in participants without ABL, especially in young mothers, leading to low overall agreement between the test results and radiological bone loss. Further longitudinal studies are needed to examine if the test positive subjects are in risk of future bone loss before the detectable signs of periodontitis in radiographs.

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TUBERCULOUS PERICARDITIS AND PLEURITIS;

The Professional Medical Journal ◽

10.29309/tpmj/2017.24.05.1379 ◽

2017 ◽

Vol 24 (05) ◽

pp. 656-664

Author(s):

Hamid Mahmood ◽

Talmeez Zaib ◽

Zafar Hayat Maken ◽

Ammara Waqar ◽

Yasir Hassan ◽

...

Keyword(s):

Negative Predictive Value ◽

Predictive Value ◽

Point Of Care ◽

High Sensitivity ◽

Smear Microscopy ◽

Diagnostic Validity ◽

Standard Material ◽

Point Of Care Test ◽

Resource Limited ◽

Attractive Point

Background: Diagnosis of Tubercles Pericarditis and Pleuritis remains thegreatest challenge for clinicians. WHO has recommended GeneXpert MTB/RIF assay as ascreening test for substitution of conventional methods for the initial diagnosis and prognosisof the extra pulmonary and pulmonary tuberculosis in developing countries. Objectives: Tofind out the diagnostic validity of GeneXpert assay for detection of Myco-bacterium tuberculosisin the pericardial and pleural effusions samples, keeping MTB culture as “Gold Standard”.Material and Methods: Total number of 286 samples of effusions (pericardial 128, pleural 158)were received, and processed for Zn smear microscopy, LJ culture, GeneXpert MTB/RIF assayaccording standard protocols. Efficacy for the detection of MTB was evaluated comparatively.Results: Out of 286effusions samples AFB was detected by Zn smear in 11 (3.8%) samples whileGeneXpert detected MTB in 43 (15.0%) and LJ culture 51 (17.8%). Zn smear showed sensitivity18.2%, specificity, 98.1%, Positive predictive value 81.8%, Negative predictive value 85.4 %, incomparison GeneXpert showed high sensitivity 84.3%, specificity 100%, with Positive predictivevalue 100%, and Negative predictive value 96.7%. Conclusion: GeneXpert assay is innovativetool in resource limited settings for prompt detection of MTB along with drug résistance. It isdefinitely an attractive point of care test, with High sensitivity and specificity along with turnouttime of two hours which facilitates timely diagnoses and appropriate management of tuberclePleuritis and Pericarditis.

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Validation of the SavvyCheckTM Vaginal Yeast Test for Screening Pregnant Women for Vulvovaginal Candidosis: A Prospective, Cross-Sectional Study

Journal of Fungi ◽

10.3390/jof7030233 ◽

2021 ◽

Vol 7 (3) ◽

pp. 233

Author(s):

Philipp Foessleitner ◽

Herbert Kiss ◽

Julia Deinsberger ◽

Julia Ott ◽

Lorenz Zierhut ◽

...

Keyword(s):

Pregnant Women ◽

Predictive Value ◽

Point Of Care ◽

Cross Sectional Study ◽

Control Group ◽

Gram Stain ◽

Cross Sectional ◽

Point Of Care Test ◽

Increased Risk ◽

Vulvovaginal Candidosis

Pregnant women have an increased risk of vulvovaginal candidosis. Recurrent candidosis is under debate as a contributor to preterm birth, and vertical transmission may cause diaper dermatitis and oral thrush in the newborn. Apart from cultural methods, the gold standard for diagnosing candidosis is Gram staining, which is time-consuming and requires laboratory facilities. The objective of this prospective study was to validate a point-of-care vaginal yeast detection assay (SavvyCheckÔ Vaginal Yeast Test) and to evaluate it in asymptomatic pregnant women. We enrolled 200 participants, 100 of whom had vulvovaginal candidosis according to Gram stain (study group) and 100 were healthy pregnant controls (control group). Of these, 22 participants (11%) had invalid test results. The point-of-care test of the remaining 85 and 93 study participants in the study and control groups, respectively, showed a sensitivity of 94.1%, specificity of 98.9%, positive predictive value of 90.3%, and negative predictive value of 99.4% when compared with Gram stain. In conclusion, we found a high correlation between the SavvyCheckÔ Vaginal Yeast Test and Gram-stained smears during pregnancy. This suggests a potential role of this point-of-care test as a screening tool for asymptomatic pregnant women in early gestation.

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Fecal viral DNA shedding following clinical panleukopenia virus infection in shelter kittens: a prospective, observational study

Journal of Feline Medicine and Surgery ◽

10.1177/1098612x211023056 ◽

2021 ◽

pp. 1098612X2110230

Author(s):

Kyrsten J Janke ◽

Linda S Jacobson ◽

Jolene A Giacinti ◽

J Scott Weese

Keyword(s):

Small Sample Size ◽

Point Of Care ◽

Small Sample ◽

Enteric Pathogens ◽

Test Results ◽

Viral Dna ◽

Virus Shedding ◽

Feline Panleukopenia Virus ◽

Viral Shedding ◽

Point Of Care Test

Objectives The aims of this study were to determine the magnitude and duration of fecal viral DNA shedding after diagnosis of feline panleukopenia (FP) in a group of shelter cats using quantitative real-time PCR (qPCR); to assess the utility of a negative point-of-care test or the resolution of diarrhea and systemic signs as proxy measures for qPCR positivity; and to investigate patterns of additional enteric pathogens in relation to feline panleukopenia viral shedding duration. Methods Feline panleukopenia virus (FPV) infection in clinically affected shelter cats was confirmed by a commercial qPCR test. Observations were made on days 0, 3, 7, 14 and 21 post-diagnosis. Fecal flotation, FPV qPCR and the canine parvovirus IDEXX SNAP Parvo ELISA (SNAP) test were performed on fecal samples. Results Forty cats and kittens with confirmed panleukopenia were initially enrolled. Sixteen kittens were sampled until day 14, and 12 were followed to day 21. Median DNA viral copy numbers fell below the diagnostic cut-off by day 7, with 13/16, 6/16, 1/16 and 0/12 testing PCR-positive on days 3, 7, 14 and 21, respectively. The SNAP test was positive in 12/16 kittens on day 0 and only 3/16 on day 3. SNAP test results, diarrhea and systemic signs were inconsistent in relation to qPCR positivity post-diagnosis. Additional enteric pathogens were common. The presence of additional pathogen types was suggestive of a longer PCR shedding duration, but this was not tested statistically owing to the small sample size. Conclusions and relevance These findings suggest that cats should be isolated for at least 14 days after a diagnosis of FP, but that release from isolation after this point is reasonable, in association with a multifaceted infection control strategy. The study findings did not support using SNAP test results, diarrhea or systemic signs as proxy measures for virus shedding.

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Abstract 3266: Oral rinse point of care test to predict head and neck cancer

10.1158/1538-7445.am2017-3266 ◽

2017 ◽

Author(s):

Michael J. Donovan ◽

Kris Curtis ◽

Greg Ginn ◽

Elizabeth J. Franzmann

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Point Of Care ◽

Oral Rinse ◽

Point Of Care Test

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Repeated Testing Necessary: Assessing Negative Predictive Value of SARS-CoV-2 qPCR in a Population of Young Adults

10.1101/2021.03.10.21253292 ◽

2021 ◽

Author(s):

Elaine E. Thompson ◽

Joseph Rosenthal ◽

James Wren ◽

Erik Seetao ◽

Niels H. Olson

Keyword(s):

Negative Predictive Value ◽

Predictive Value ◽

Test Results ◽

Retrospective Evaluation ◽

Repeated Testing ◽

Aircraft Carrier ◽

Theodore Roosevelt ◽

Community Risk ◽

Community Risk Factors ◽

Test Result

AbstractDetermining when individuals should be released from quarantine is critical for successfully managing a COVID-19 outbreak and local protocols frequently call for testing during the quarantine period, generally after a reasonable incubation period, which raises a question about the interpretation of test results during the quarantine period. We report the negative predictive value of SARS-CoV-2 qPCR tests based on a retrospective longitudinal analysis of 5349 qPCR tests collected from 1227 US service members infected with COVID-19 aboard the USS Theodore Roosevelt (CVN-71) aircraft carrier. In our retrospective evaluation of recovering qPCR-positive quarantined crew members undergoing repeated testing, the negative predictive value is 80% for tests occurring as late as seven weeks following an initial positive qPCR test result. Repeated qPCR testing is necessary to ensure that a once-infected person is no longer shedding viral RNA. When deciding the stringency of exit criteria, we recommend considering local operational and community risk factors.

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OR25-06 Morning ACTH Levels as a Reliable Biomarker for Excluding Autonomous Cortisol Secretion in Incidetally Discovered Adrenal Adenomas. A Prospective Cohort

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1308 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Roberto Ignacio Olmos ◽

Stefano Pietro Macchiavello ◽

Anand Vaidya ◽

Consuelo Robles ◽

Javiera Gutierrez ◽

...

Keyword(s):

Negative Predictive Value ◽

Likelihood Ratio ◽

Predictive Value ◽

Prospective Cohort ◽

Adrenal Adenoma ◽

Negative Likelihood Ratio ◽

Inverse Association ◽

Cortisol Secretion ◽

Morning Cortisol ◽

Autonomous Cortisol Secretion

Abstract Adrenal incidentalomas are common with a prevalence of 3-10% and in up to 30% of cases may have probable autonomous cortisol secretion. Hypercortisolism is associated with substantial cardiometabolic morbimortality and can physiologically decrease ACTH levels. Objective: To determine the sensitivity, specificity, and positive and negative predictive values of ACTH levels in evaluating autonomous cortisol secretion in a prospective cohort of incidentally discovered adrenal adenomas. Methods: We prospectively evaluated 224 consecutive adult subjects with incidentally discovered adrenal masses on computed tomography. Finally, 168 participants with radiographic adenoma criteria underwent systematic hormonal assessment, including measurements of morning cortisol and ACTH on day 1, and a 1 mg dexamethasone suppression test (DST) on day 2. Hypercortisolism was excluded if the DST was < 1.8 mcg/dL. Autonomous cortisol secretion was defined as a DST > 5.0 mcg/dL and DST levels of 1.8-5.0 mcg/dL were considered to be possibly autonomous hypercortisolism. We evaluated the correlation of ACTH levels with clinical, radiographic, and endocrine variables. In order to identify the most sensitive threshold value for diagnosing autonomous cortisol secretion, we determined ROC curves and negative likelihood ratio (NLR). Concordance of repeated ACTH was assessed using Bland Altman analysis. Results: The characteristics of the cohort were mean age 56 (+/- 11.8) years, 76% female, adenoma size 19 (+/- 7) mm, and 13% bilateral adenomas. Mean ACTH was 15 (+/- 11) pg/ml (range 5-72) and the mean DST was 2.2 (+/- 3.0) ug/dL (range 0.4-25.9). Fifty-four (32%) participants had a DST ≥1.8mcg/dL and 13 (8%) a DST≥5.0 mcg/dL. We found no correlation between ACTH levels and age, gender or body mass index. ACTH was inversely associated with adrenal adenoma diameter (r=-3.3 p=0.002) and volume (r=-2.9 p=0.008). There was an inverse association between ACTH and DST values (r=-3.1 p=0.01). In the subgroup of patients with a second ACTH measurement we found high concordance, with mean difference of 0.16+/-3.6 pg/ml (p=0.83). ROC analysis showed that an ACTH ≥20 pg/ml had a sensitivity of 98% to exclude hypercortisolism, with a negative predictive value of 97% and a negative likelihood ratio of 0.06. The only case with DST≥1.8 and ACTH≥20 had Cushing′s phenotype with both an adrenal adenoma and a pituitary ACTH-producing adenoma. Systematic evaluation of morning cortisol and ACTH allowed the detection of 5 cases of false negative low DST values due to the use of non-oral corticosteroids. Conclusion: In this cohort, an ACTH ≥20pg/ml excluded autonomous cortisol secretion with excellent sensitivity and negative predictive value, providing strong reassurance that there is no clinically relevant hypercortisolism. Therefore, subjects with a normal DST and ACTH ≥20pg/ml should be candidates for relaxed surveillance.

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Prevalence and identification of anxiety disorders in pregnancy: the diagnostic accuracy of the two-item Generalised Anxiety Disorder scale (GAD-2)

BMJ Open ◽

10.1136/bmjopen-2018-023766 ◽

2018 ◽

Vol 8 (9) ◽

pp. e023766 ◽

Cited By ~ 18

Author(s):

Selina Nath ◽

Elizabeth G Ryan ◽

Kylee Trevillion ◽

Debra Bick ◽

Jill Demilew ◽

...

Keyword(s):

Anxiety Disorder ◽

Positive Predictive Value ◽

Anxiety Disorders ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Likelihood Ratio ◽

Predictive Value ◽

Stratified Sampling ◽

Generalised Anxiety Disorder ◽

Population Prevalence

ObjectiveTo estimate the population prevalence of anxiety disorders during pregnancy and investigate the diagnostic accuracy of the two-item Generalised Anxiety Disorder scale (GAD-2) for a) GAD and b) any anxiety disorder.DesignCross-sectional survey using a stratified sampling design. Sampling weights were used in the analysis to adjust for the bias introduced by the stratified sampling.SettingInner-city maternity service, South London.Participants545 pregnant women were interviewed after their first antenatal appointment; 528 provided answers on the GAD-2 questions.Main outcome measuresDiagnosis generated by the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th edition (SCID).ResultsPopulation prevalence of anxiety disorders was 17% (95% CI 12% to 21%): 5% (95% CI 3% to 6%) for GAD, 4% (95% CI 2% to 6%) for social phobia, 8% (95% CI 5% to 11%) for specific phobia and 2% (95% CI 1% to 4%) for obsessive-compulsive disorder. Post-traumatic stress disorder (PTSD) prevalence was unclear due to higher levels of reluctance to respond to PTSD interview questions but sensitivity analyses suggest population prevalence maybe up to 4% (95% CI 2% to 6%). Weighted sensitivity of GAD-2 for GAD (cut-off ≥3) was 69%, specificity 91%, positive predictive value 26%, negative predictive value 98% and likelihood ratio 7.35. For any anxiety disorder the weighted sensitivity was 26%, specificity 91%, positive predictive value 36%, negative predictive value 87% and likelihood ratio 2.92.ConclusionsAnxiety disorders are common but GAD-2 generates many false positives and may therefore be unhelpful in maternity services.

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Lung ultrasound in ruling out COVID-19 pneumonia in the ED: a multicentre prospective sensitivity study

Emergency Medicine Journal ◽

10.1136/emermed-2020-210973 ◽

2021 ◽

pp. emermed-2020-210973

Author(s):

Carmine Cristiano Di Gioia ◽

Nicola Artusi ◽

Giovanni Xotta ◽

Marco Bonsano ◽

Ugo Giulio Sisto ◽

...

Keyword(s):

Negative Predictive Value ◽

Likelihood Ratio ◽

Predictive Value ◽

Lung Ultrasound ◽

High Sensitivity ◽

Index Test ◽

Blood Gas ◽

Reference Standard ◽

Arterial Blood ◽

Rule Out

PurposeEarly diagnosis of COVID-19 has a crucial role in confining the spread among the population. Lung ultrasound (LUS) was included in the diagnostic pathway for its high sensitivity, low costs, non-invasiveness and safety. We aimed to test the sensitivity of LUS to rule out COVID-19 pneumonia (COVIDp) in a population of patients with suggestive symptoms.MethodsMulticentre prospective observational study in three EDs in Northeastern Italy during the first COVID-19 outbreak. A convenience sample of 235 patients admitted to the ED for symptoms suggestive COVIDp (fever, cough or shortness of breath) from 17 March 2020 to 26 April 2020 was enrolled. All patients underwent a sequential assessment involving: clinical examination, LUS, CXR and arterial blood gas. The index test under investigation was a standardised protocol of LUS compared with a pragmatic composite reference standard constituted by: clinical gestalt, real-time PCR test, radiological and blood gas results. Of the 235 enrolled patients, 90 were diagnosed with COVIDp according to the reference standard.ResultsAmong the patients with suspected COVIDp, the prevalence of SARS-CoV-2 was 38.3%. The sensitivity of LUS for diagnosing COVIDp was 85.6% (95% CI 76.6% to 92.1%); the specificity was 91.7% (95% CI 86.0% to 95.7%). The positive predictive value and the negative predictive value were 86.5% (95%CI 78.8% to 91.7%) and 91.1% (95% CI 86.1% to 94.4%) respectively. The diagnostic accuracy of LUS for COVIDp was 89.4% (95% CI 84.7% to 93.0%). The positive likelihood ratio was 10.3 (95% CI 6.0 to 17.9), and the negative likelihood ratio was 0.16 (95% CI 0.1 to 0.3).ConclusionIn a population with high SARS-CoV-2 prevalence, LUS has a high sensitivity (and negative predictive value) enough to rule out COVIDp in patients with suggestive symptoms. The role of LUS in diagnosing patients with COVIDp is perhaps even more promising. Nevertheless, further research with adequately powered studies is needed.Trial registration numberNCT04370275.

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Diagnostic accuracy of point-of-care lung ultrasound in COVID-19

Emergency Medicine Journal ◽

10.1136/emermed-2020-210125 ◽

2020 ◽

pp. emermed-2020-210125

Author(s):

Svenja L Haak ◽

Iris JE Renken ◽

L Cara Jager ◽

Heleen Lameijer ◽

Brigitta (Britt) YM van der Kolk

Keyword(s):

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Predictive Value ◽

Point Of Care ◽

Trauma Centre ◽

Point Of Care Ultrasound ◽

Current Standard ◽

Cardiopulmonary Disease ◽

Pulmonary Manifestations

BackgroundA promising modality for diagnosing pulmonary manifestations of COVID-19 in the emergency department (ED) is point-of-care ultrasound (POCUS) of the lungs. The currently used PCR as well as chest X-ray and CT scanning have important disadvantages. The aim of this study is to evaluate the diagnostic accuracy of POCUS in patients with suspected pulmonary manifestations of COVID-19 in the ED.MethodsThis prospective diagnostic accuracy study was conducted at the ED of our non-academic level 1 trauma centre (Isala, Zwolle, the Netherlands). Patients were enrolled between 14 April and 22 April 2020. Patients (aged ≥16 years) with suspected COVID-19 presenting to the ED underwent POCUS. All patients received current standard of care, including PCR (naso-oropharyngeal swab). Outcome of POCUS was compared with PCR or CT scan outcome to determine diagnostic accuracy. Diagnostic accuracy measures were calculated using 2×2 contingency tables.Results100 patients were eligible to participate in this study, data of 93 patients were analysed. 27 (29%) patients were found positive for COVID-19 by PCR or CT. POCUS had a sensitivity of 89% (95% CI 70% to 97%), specificity of 59% (95% CI 46% to 71%), negative predictive value of 93% (95% CI 79% to 98%) and positive predictive value of 47% (95% CI 33% to 61%). In a subgroup of patients without previous cardiopulmonary disease (n=37), POCUS had a sensitivity of 100% (95% CI 70% to 100%), specificity of 76% (95% CI 54% to 90%), negative predictive value of 100% (95% CI 79% to 100%) and positive predictive value of 67% (95% CI 41% to 86%).ConclusionPOCUS of the lungs could serve as a valuable, radiation-free tool for excluding pulmonary manifestations of COVID-19 in patients in the ED at the point of assessment, especially in patients without previous cardiopulmonary disease.Trial registrationDutch Trial Register, No: NTR8544.

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