Diagnosis of Subclinical Keratoconus with a Combined Model of Biomechanical and Topographic Parameters

This study sought to develop a diagnostic model with aberrometry and biomechanical variables for subclinical keratoconus. The design was a cross-sectional study. The topographic data were obtained with a rotating Scheimpflug camera (Pentacam HR), and biomechanical data were obtained with Corvis ST. The study included 81 eyes distributed in 61 healthy corneas and 20 subclinical keratoconus (SCKC), defined as eyes with suspicious topographic findings, normal slit-lamp examination, and a manifestation of keratoconus. Analyses of the topographic and biomechanical data were performed, and a classifying model of SCKC was elaborated. The model for the diagnosis of SCKC includes posterior coma to 90°, Ambrósio’s Relational Thickness in the horizontal profile (ARTh), and velocity when the air pulse is off (A2 velocity). The sensitivity was 89.5%, specificity 96.7%, accuracy 94.9%, and precision 89.5%. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve for the model was 0.951. Diagnosis of subclinical keratoconus depends on the aberrometry variable posterior coma to 90° and the biomechanical variables A2 velocity and ARTh.

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Predictive model for early diagnosis of keratoconus

10.21203/rs.2.21162/v1 ◽

2020 ◽

Author(s):

GRACIA CASTRO-LUNA ◽

ANTONIO PÉREZ-RUEDA

Keyword(s):

Early Diagnosis ◽

Central Corneal Thickness ◽

Corneal Thickness ◽

Cross Sectional Study ◽

Bivariate Analysis ◽

Diagnostic Model ◽

Sectional Study ◽

Cross Sectional ◽

Recorded Data ◽

Topographic Parameters

Abstract Background To describe the topographic, pachymetric and aberrometry characteristics in patients with keratoconus, subclinical keratoconus/forme fruste and normal corneas. Calculate a diagnostic model of subclinical keratoconus/forme fruste. Methods The design was a cross-sectional study. It included 205 eyes from 188 patients distributed in 82 normal corneas, 40 subclinical keratoconus/forme fruste and 83 established keratoconus The topographic, pachymetric and aberrometry variables obtained by rotary Scheimpflug camera (Pentacam® type) were analyzed. A descriptive and bivariate analysis of the recorded data was performed. A diagnostic model of subclinical keratoconus/forme fruste was calculated. Results Statistically significant differences were obtained when comparing normal corneas with subclinical keratoconus/forme fruste in variables of vertical asymmetry and corneal thickness.The regression model was calculated with the minimum corneal thickness and the anterior coma to 90º and posterior coma to 90º. Conclusions The diagnosis of subclinical keratoconus/forme fruste depends on the central corneal thickness, and two aberrometric topographic parameters the anterior coma to 90º and posterior coma to 90º.

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Proposal and validation of a new grading system for pterygium (SLIT2)

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-315831 ◽

2020 ◽

pp. bjophthalmol-2020-315831

Author(s):

Darren Shu Jeng Ting ◽

Yu-Chi Liu ◽

Moushmi Patil ◽

Angel Jung Se Ji ◽

Xiao Ling Fang ◽

...

Keyword(s):

Body Length ◽

Disease Recurrence ◽

Cross Sectional Study ◽

Grading System ◽

Slit Lamp ◽

Sectional Study ◽

Cross Sectional ◽

Rater Reliability ◽

Slit Lamp Examination ◽

Independent Assessment

Background/aimsTo propose and validate a new pterygium grading system based on slit-lamp evaluation.MethodsThis prospective cross-sectional study included 217 patients with pterygium. All patients underwent slit-lamp examination, and slit-lamp photographs were independently graded by two graders twice. A total of eight parameters were evaluated and all parameters were assigned with a score of 1–4 (normal–severe). Intra-rater and inter-rater reliability as determined by weighted Cohen’s kappa analysis.ResultsA total of 868 independent assessment, based on 217 slit-lamp images, were performed by two graders. For conjunctival assessment, the intra-rater reliability was excellent for body thickness (κ=0.81–0.89) and size at limbus (κ=0.87–0.92), substantial-to-excellent for body vascularity (κ=0.72–0.86), and moderate-to-excellent for body length (κ=0.57–0.81), whereas the inter-rater reliability was excellent for size at limbus (κ=0.86), substantial for body thickness (κ=0.72–0.73) and body vascularity (κ=0.66–0.75), and moderate for body length (κ=0.54–0.57). For corneal assessment, the intra-rater reliability was excellent for all four parameters (κ=0.84–0.90) whereas the inter-rater reliability was excellent for head length (κ=0.86–0.87), substantial-to-excellent for head vascularity (κ=0.78–0.82), substantial for Stocker’s line (κ=0.79–0.80) and head thickness (κ=0.67–0.69). The grading system was named SLIT2, which included Stocker’s line, Size at limbus, Length of head/body, Injection/vascularity of body/head, and Thickness of body/head.ConclusionThe proposed SLIT2 grading system, consisting of eight components, may serve as a reliable tool to standardise the reporting of pterygium severity and disease recurrence for clinical and research applications.

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Clinical and laboratory data-based nomograms for neurosyphilis diagnosis in non-HIV syphilis patients: a cross-sectional study.

10.21203/rs.3.rs-123296/v1 ◽

2020 ◽

Author(s):

Wenjing Ge ◽

Yang Zhang ◽

Chao Peng ◽

Dongdong Li ◽

Lijie Gao ◽

...

Keyword(s):

Psychiatric Symptoms ◽

Laboratory Data ◽

Cross Sectional Study ◽

Western China ◽

Diagnostic Model ◽

Sectional Study ◽

Combined Model ◽

Cross Sectional ◽

Basic Model ◽

Diagnostic Models

Abstract Background: The diagnosis of neurosyphilis (NS) is challenging due to the requirement of lumbar puncture and time-consuming cerebrospinal fluid tests. Therefore, a convenient high-accuracy diagnostic nomogram for NS is warranted. Methods: This cross-sectional study (108 patients) aimed to construct diagnostic models for diagnosing NS with data gathered between September 2015 and January 2020 at Western China Hospital of Sichuan University. We constructed two types of diagnostic models using 108 training samples: 1) symptoms and toluidine red unheated serum test (TRUST) (basic model) and 2) the combined model of symptoms, serum TRUST, and findings of CSF routine tests including CSF protein concentration and CSF glucose concentration (combined model). The clinical usefulness of the diagnostic models was assessed through the comparison of a receiver operating characteristic (ROC) and decision curve analysis (DCA), which adopted bootstrap resampling 500 times. Results: A total of 108 patients were analysed (82% males, mean age: 46 years). Of those, 76 were diagnosed as having reactive neurosyphilis under the criteria of positive results in both CSF treponemal and non-treponemal tests. Psychiatric symptoms and serum TRUST were the strongest diagnostic indicators in serum. A diagnostic model was constructed to readily provide the probability of diagnosis at point of care and presented as two nomograms. The basic model reached 79% specificity, 74% sensitivity and 0.82 Area Under the Curves (AUC) (95% CI, 0.72-091), while the combined model showed 82% specificity, 90% sensitivity and 0.88 AUC (95% CI, 0.80-0.94). The integrated discrimination improvement(IDI) index was 0.05 in comparison of two models. Conclusions: A convenient model using serum TRUST titre and presence of psychiatric symptoms was developed to indicate diagnostic results in patients suspected of NS. Two simple nomograms can be offered to clinicians to facilitate their assessment of patient diagnosis, strengthen the diagnostic decision making, enhance patient stratification, and inform patients in the clinic. Trial registration: This research was retrospectively registered in Ethics committee on biomedical research, West China Hospital of Sichuan University.

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A model of visual limitation in patients with keratoconus

Scientific Reports ◽

10.1038/s41598-020-76489-1 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Antonio Pérez-Rueda ◽

Gracia Castro-Luna

Keyword(s):

Visual Acuity ◽

Logistic Regression ◽

Operating Characteristic ◽

Spherical Aberration ◽

Area Under The Curve ◽

Binary Logistic Regression ◽

Cross Sectional Study ◽

Binary Logistic Regression Model ◽

Cross Sectional ◽

Corrected Visual Acuity

Abstract This paper aims to calculate a relevance model of visual limitation (V.L.) in keratoconus patients based on refractive and topographic parameters. A cross-sectional study was carried out in Torrecárdenas Hospital, Almería, Spain, between February 2018 and July 2019. It included 250 keratoconus patients. Two groups were created according to a grading system of V.L. based on RETICS (Red Temática de Investigación Cooperativa en Salud) classification: keratoconus patients with no V.L. (best spectacle-corrected visual acuity (BSCVA) ≤ 0.05 logMAR) and keratoconus patients with V.L. (BSCVA > 0.05 logMAR). Correlations and a binary logistic regression were established. V.L. was correlated with maximum curvature (r = 0.649, p < 0.001) and root mean square higher-order aberrations (HOARMS) (r = 0.625, p < 0.001). Binary logistic regression included V.L. as the dependent variable and spherical equivalent, HOARMS, spherical aberration and interaction between the anterior and posterior vertical coma as independent variables. The model was a good fit. Area under the curve (A.U.C.) of receiver operating characteristic (R.O.C.) curve was 0.924, sensitivity 91.90%, specificity 83.60%, accuracy 88.94%; and precision 91.17%. Binary logistic regression model of V.L. is a good fit model to predict the early loss of visual acuity in keratoconus patients.

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Physical activity as an indicator of predictive functional disability in elderly

Revista Latino-Americana de Enfermagem ◽

10.1590/s0104-11692012000200007 ◽

2012 ◽

Vol 20 (2) ◽

pp. 259-265 ◽

Cited By ~ 10

Author(s):

Jair Sindra Virtuoso Júnior ◽

Sheilla Tribess ◽

Thais Reis Silva De Paulo ◽

Cristiane Alves Martins ◽

Vicente Romo-Perez

Keyword(s):

Physical Activity ◽

Older Adults ◽

Operating Characteristic ◽

Functional Disability ◽

Cross Sectional Study ◽

Physical Activities ◽

Sectional Study ◽

Cross Sectional ◽

Important Indicator ◽

Receiver Operating Characteristic Curves

To analyze the time spent on physical activity in female and male individuals as a predictor of the absence of functional disability in older adults, a cross-sectional study was conducted with 624 individuals. Receiver Operating Characteristic curves (ROC) were constructed and compared to areas of physical activity by gender and the absence of functional disability. We identified cutoffs of physical activity (minutes / week) to predict the absence of functional disability (CI 95%). It was found that there is a higher area under the ROC curve for the time spent on physical activities in females. It was observed that 280 minutes / week (women) or 410 minutes / week (men) were the best cutoff points for predicting the absence of functional disability. Time spent on physical activity practices can serve as an important indicator to sort priority groups for certain interventions.

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The prevalence of lower eyelid epiblepharon and its association with refractive errors in Chinese preschool children: a cross-sectional study

10.21203/rs.3.rs-51866/v3 ◽

2020 ◽

Author(s):

Deyi Zhuo ◽

Si Chen ◽

Xiaofang Ren ◽

Bingsong Wang ◽

Linbo Liu ◽

...

Keyword(s):

Preschool Children ◽

Lower Eyelid ◽

Population Based ◽

Cross Sectional Study ◽

Refractive Errors ◽

Slit Lamp ◽

Sectional Study ◽

Cross Sectional ◽

High Prevalence ◽

Beijing China

Abstract Background: To assess the prevalence and demographics of lower eyelid epiblepharon in Chinese preschool children and to evaluate its association with refractive errors.Methods: In this population-based, cross-sectional study, a total of 3,170 children aged 3 to 6 years from Beijing, China underwent examinations including weight, height, cycloplegic autorefraction and slit-lamp examination of external eyes. The prevalence of lower eyelid epiblepharon in preschool children was evaluated and its association with age, sex, body mass index (BMI), and refractive errors was analyzed using logistic regression analysis.Results: The prevalence of lower eyelid epiblepharon was 26.2%, which decreased with age, with prevalence in 3-, 4-, 5-, and 6-year-olds of 30.6%, 28.0%, 15.0%, and 14.3%, respectively. Boys had a higher risk of having epiblepharon than girls (OR = 1.41; 95%CI, (1.20-1.66)) and no significant correlation was detected between BMI and epiblepharon after adjusting for age and sex (p = 0.062). Epiblepharon was significantly associated with a higher risk of refractive errors, including astigmatism (OR = 3.41; 95% CI, (2.68-4.33)), myopia (OR = 3.55; 95% CI, (1.86-6.76)), and hyperopia (OR = 1.53; 95% CI, (1.18-1.99)). Conclusions: There is a high prevalence of lower eyelid epiblepharon in Chinese preschool children, particularly among boys and younger children. Preschoolers with lower eyelid epiblepharon are subject to a higher risk of developing astigmatism, myopia, and hyperopia, than those without. Increased attention should be paid to this eyelid abnormality in the preschool population.

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The prevalence of lower eyelid epiblepharon and its association with refractive errors in Chinese preschool children: a cross-sectional study

10.21203/rs.3.rs-51866/v2 ◽

2020 ◽

Author(s):

Deyi Zhuo ◽

Si Chen ◽

Xiaofang Ren ◽

Bingsong Wang ◽

Linbo Liu ◽

...

Keyword(s):

Preschool Children ◽

Lower Eyelid ◽

Population Based ◽

Cross Sectional Study ◽

Refractive Errors ◽

Slit Lamp ◽

Sectional Study ◽

Cross Sectional ◽

High Prevalence ◽

Beijing China

Abstract Background: To assess the prevalence and demographics of lower eyelid epiblepharon in Chinese preschool children and to evaluate its association with refractive errors. Methods: In this population-based, cross-sectional study , a total of 3,170 children aged 3 to 6 years from Beijing, China underwent examinations including weight, height, cycloplegic autorefraction and slit-lamp examination of external eyes. The adjusted odds ratios (AORs) and 95% confidence intervals (CI) were calculated to evaluate. The prevalence of lower eyelid epiblepharon in preschool children and its association with refractive errors were analyzed. Results: The prevalence of lower eyelid epiblepharon was 26.2%, which decreased with age with 3-, 4-, 5-, and 6-year-old being 30.6%, 28.0%, 15.0%, and 14.3%, respectively. Boys had a higher risk of having epiblepharon than girls with ORs = 1.41 (95%CI, 1.20-1.66) and no significant correlation was detected between BMI and epiblepharon after adjustment of age and sex. Epiblepharon was associated with significantly higher risk of refractive errors including astigmatism (OR = 3.41; 95% CI, (2.68-4.33)), myopia (OR = 3.55; 95%CI, (1.86-6.76)), and hyperopia (OR = 1.53; 95% CI, (1.18-1.99)). Among astigmatic epiblepharon preschoolers, with-the-rule is predominant (80.9%) and epiblepharon severity was associated with astigmatism severity (p = 0.019). Conclusions: There is a high prevalence of lower eyelid epiblepharon in Chinese preschool children, particularly among boys and the youngers. Preschoolers with lower eyelid epiblepharon are subject to higher risk of developing astigmatism, myopia, and hyperopia, than those without. An increased attention should be paid to this eyelid abnormality in preschool population.

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A Comparative Study of the Sarcopenia Screening in Older Patients with Interstitial Lung Disease

10.21203/rs.3.rs-936545/v1 ◽

2021 ◽

Author(s):

Masatoshi Hanada ◽

Noriho Sakamoto ◽

Hiroshi Ishimoto ◽

Takashi Kido ◽

Takuto Miyamura ◽

...

Keyword(s):

Interstitial Lung Disease ◽

Lung Disease ◽

Operating Characteristic ◽

Cross Sectional Study ◽

Screening Tools ◽

Calf Circumference ◽

Sectional Study ◽

Cross Sectional ◽

Receiver Operating Characteristic Curves ◽

Climbing Stairs

Abstract Background: The calf circumference (CalF), the strength, assistance in walking, rising from a chair, climbing stairs, and falls (SARC-F) and the SARC-CalF questionnaires for sarcopenia screening have been used by Asian Working Group for Sarcopenia 2019 (AWGS 2019). The aim of this study was to assess accuracy of these three sarcopenia screening tools in patients with interstitial lung disease. Methods: In this cross-sectional study, stable patients with interstitial lung disease were enrolled. The SARC-F, SARC-CalF, and CalF, used in patients with interstitial lung disease, were compared to the diagnostic criteria proposed by AWGS 2019. The accuracy of screening tools was compared using sensitivity and specificity. Moreover, areas under the receiver operating characteristic curves (AUC) were computed. Results: Seventy eight patients were analyzed, and sarcopenia was identified in 25 (32.1%) patients with interstitial lung disease by the AWGS 2019 criteria. The sensitivity of the CalF was highest (96%) of the three screening tools, while the specificity was 60%. The sensitivity of SARC-F and SARC-CalF were 24% and 68%, while the specificity were 92% and 66%, respectively. The AUCs of CalF, SARC-F, and SARC-CalF in all patients were 0.78, 0.58, and 0.67, respectively. Conclusions: The CalF is most suitable for screening sarcopenia in patients with interstitial lung disease, while SARC-F and SARC-CalF are not.

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Feasibility of Asynchronous and Automated Telemedicine in Otolaryngology: Prospective Cross-Sectional Study

JMIR Medical Informatics ◽

10.2196/23680 ◽

2020 ◽

Vol 8 (10) ◽

pp. e23680

Author(s):

Dongchul Cha ◽

Seung Ho Shin ◽

Jungghi Kim ◽

Tae Seong Eo ◽

Gina Na ◽

...

Keyword(s):

Medical Records ◽

Clinical Manifestations ◽

Cross Sectional Study ◽

Interrater Agreement ◽

Diagnostic Model ◽

Sectional Study ◽

Perfect Agreement ◽

Cross Sectional ◽

Machine Learning Model ◽

Community Transmission

Background COVID-19 often causes respiratory symptoms, making otolaryngology offices one of the most susceptible places for community transmission of the virus. Thus, telemedicine may benefit both patients and physicians. Objective This study aims to explore the feasibility of telemedicine for the diagnosis of all otologic disease types. Methods A total of 177 patients were prospectively enrolled, and the patient’s clinical manifestations with otoendoscopic images were written in the electrical medical records. Asynchronous diagnoses were made for each patient to assess Top-1 and Top-2 accuracy, and we selected 20 cases to conduct a survey among four different otolaryngologists to assess the accuracy, interrater agreement, and diagnostic speed. We also constructed an experimental automated diagnosis system and assessed Top-1 accuracy and diagnostic speed. Results Asynchronous diagnosis showed Top-1 and Top-2 accuracies of 77.40% and 86.44%, respectively. In the selected 20 cases, the Top-2 accuracy of the four otolaryngologists was on average 91.25% (SD 7.50%), with an almost perfect agreement between them (Cohen kappa=0.91). The automated diagnostic model system showed 69.50% Top-1 accuracy. Otolaryngologists could diagnose an average of 1.55 (SD 0.48) patients per minute, while the machine learning model was capable of diagnosing on average 667.90 (SD 8.3) patients per minute. Conclusions Asynchronous telemedicine in otology is feasible owing to the reasonable Top-2 accuracy when assessed by experienced otolaryngologists. Moreover, enhanced diagnostic speed while sustaining the accuracy shows the possibility of optimizing medical resources to provide expertise in areas short of physicians.

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Trigeminal impairment in treatment-refractory chronic nasal obstruction

Rhinology Journal ◽

10.4193/rhin20.510 ◽

2021 ◽

Vol 0 (0) ◽

pp. 0-0

Author(s):

C. Migneault-Bouchard ◽

F.J.M. Boselie ◽

M. Hugentobler ◽

B.N. Landis ◽

J. Frasnelli

Keyword(s):

Medical Treatment ◽

Nasal Obstruction ◽

Area Under The Curve ◽

Cross Sectional Study ◽

Trigeminal System ◽

Nasal Airflow ◽

Sectional Study ◽

Cross Sectional ◽

Future Studies ◽

Subjective Sensation

BACKGROUND: Patients with anatomically unexplained, chronic nasal obstruction (CNO) that is refractory to medical treatment pose a challenge for clinicians. A surgical solution, addressing mechanical obstacles, is unsuited for these patients. CNO may result from disrupted airflow perception due to activation of the intranasal trigeminal system; therefore, aim of this study is to evaluate if intranasal trigeminal function of these CNO patients is decreased. METHODS: In this retrospective cross-sectional study, we compared 143 CNO patients and 58 healthy volunteers, between 18 to 80 years old. We assessed nasal patency by means of rhinomanometry (RM) and measured susceptibility of intranasal trigeminal system by the trigeminal lateralization task (TLT). RESULTS: TLT scores were significantly lower in CNO patients compared to controls (p less than 0.001), but RM scores were not different between groups. Accordingly, TLT allowed to identify CNO patients with an accuracy of the area under the curve (AUC) of 0.78, while the value for RM was at chance (AUC=0.47). CNO patients showed normal reaction to vasoconstrictive agents with significantly lower RM values after Xylomethazoline application. CONCLUSION: Results suggest that reported nasal obstruction in CNO patients without any obvious anatomical obstacle and resistant to medical treatment may be linked to decreased perception of nasal airflow rather than physical obstruction. In this sub-set of CNO patients, trigeminal testing more adequately reflects the reported obstruction than nasal resistance assessment does. In future studies, the relation of the trigeminal status and the subjective sensation of nasal obstruction needs to be addressed with validated patient rated outcome measures (PROMs).

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