scholarly journals Comparison of Point-of-Care Ultrasonography and Radiography in the Diagnosis of Long-Bone Fractures

Medicina ◽  
2019 ◽  
Vol 55 (7) ◽  
pp. 355 ◽  
Author(s):  
Avci ◽  
Kozaci ◽  
Tulubas ◽  
Caliskan ◽  
Yuksel ◽  
...  
Keyword(s):  
Predictive Value ◽  
Bone Fractures ◽  
Point Of Care ◽  
High Sensitivity ◽  
Long Bone ◽  
Imaging Method ◽  
Fracture Characteristics ◽  
Point Of Care Ultrasonography ◽  
Sensitivity Specificity

Background and objectives: In this study, the accuracy of point-of-care ultrasonography (POCUS) was compared to radiography (XR) in the diagnosis of fractures, the determination of characteristics of the fractures, and treatment selection of fractures in patients admitted to the emergency department (ED) due to trauma and suspected long bone (LB) fractures. Materials and Methods: The patients were included in the study, who were admitted to ED due to trauma, and had physical examination findings suggesting the presence of fractures in LB (humerus, radius, ulna, femur, tibia, and fibula). The patients were evaluated by two emergency physicians (EP) in ED. The first EP examined LBs with POCUS and the second EP examined them with XR. LBs were evaluated on the anterior, posterior, medial, and lateral surfaces and from the proximal joint to the distal one (shoulder, elbow, wrist, hip, knee, and ankle joint) in both longitudinal and transverse axes with POCUS. Results: A total of 205 patients with suspected LB fractures were included in the study. LB fractures were determined in 99 patients with XR and in 105 patients with POCUS. The sensitivity, specificity, positive predictive value, negative predictive value of POCUS in determining the fractures were 99%, 93%, 93%, and 99%, respectively, compared to XR. Compared to XR, POCUS was able to determine 100% of fissure type fractures (kappa (κ) value: 0.765), 83% of linear fractures (κ: 0.848), 92% of fragmented fractures(κ: 0.756), 67% of spiral fractures (κ:0.798), 75% of avulsion type fractures (κ: 0.855), and 100% of full separation type fractures (κ: 0.855).Conclusions: This study has demonstrated that POCUS has a high sensitivity in diagnosing LB fractures. POCUS has a high sensitivity in identifying fracture characteristics. POCUS can be used as an alternative imaging method to XR in the diagnosis of LB fractures and in the determination of fracture characteristics.

scholarly journals Musculoskeletal injuries in a resource-constrained environment: comparing diagnostic accuracy of on-the-spot ultrasonography and conventional radiography for bone fracture screening during the Paris–Dakar rally raid

2015 ◽  
Vol 4 (5) ◽  
pp. 205846011557756 ◽  
Author(s):  
Benjamin Dallaudière ◽  
Ahmed Larbi ◽  
Mathieu Lefere ◽  
Anne Perozziello ◽  
Olivier Hauger ◽  
...  
Keyword(s):  
Predictive Value ◽  
Bone Fractures ◽  
High Sensitivity ◽  
Conventional Radiography ◽  
Styloid Process ◽  
Resource Constrained ◽  
X Ray ◽  
Men 2 ◽  
Significant Difference ◽  
Sensitivity Specificity

Background Ultrasound (US) is a good first-line alternative for the diagnosis of bone fractures in adults as well as children. Our study shows that, compared to X-ray, in a resource-constrained environment, on-site US has a high sensitivity (98%) and specificity (96%) in the diagnosis of bone fractures. Purpose To compare the accuracy of on-the-spot US with conventional radiography in the screening for bone fractures during the Paris–Dakar rally raid. Material and Methods Eighty-three patients (81 men, 2 women) with clinically suspected bone fractures were included in 2013 and 2014. They underwent X-ray and US on the spot, blindly interpreted by two musculoskeletal radiologists. Using X-ray as gold standard, we calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for US, for each anatomic location. The accuracy of US and radiography were also assessed, as were the number of fragments and their degree of displacement (Student’s t-test). Results Compared with X-ray, sensitivity, specificity, PPV, and NPV of on-site US were, respectively, for the presence (or absence) of fractures: 98%, 98%, 100%, and 95%. The accuracy of US was 99%. Only one radial styloid process fracture was misdiagnosed with US. There was no significant difference between US and X-ray ( P > 0.93) concerning the number of fragments and their degree of displacement. Conclusion Bedside musculoskeletal ultrasound performed by trained musculoskeletal radiologists is a useful method in determining and assessing bone fractures in a resource constrained environment.

scholarly journals Use of β-D-glucan in diagnosis of suspected Pneumocystis jirovecii pneumonia in adults with HIV infection

2021 ◽  
pp. 095646242110222
Author(s):  
Thomas Juniper ◽  
Chris P Eades ◽  
Eliza Gil ◽  
Harriet Fodder ◽  
Killian Quinn ◽  
...  
Keyword(s):  
Predictive Value ◽  
Diagnostic Tests ◽  
Elevated Serum ◽  
Clinical Information ◽  
High Sensitivity ◽  
Pneumocystis Pneumonia ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Alternative Diagnosis ◽  
Positive Threshold ◽  
Sensitivity Specificity

Objectives: An elevated serum (1-3)-β-D-glucan (BDG) concentration has high sensitivity for a diagnosis of Pneumocystis pneumonia (PCP) in people with HIV (PWH). At the current manufacturer-recommended positive threshold of 80 pg/mL (Fungitell), specificity for PCP is variable and other diagnostic tests are required. We evaluated the utility of serum BDG for diagnosis of suspected PCP in PWH at three inner-London hospitals to determine BDG concentrations for diagnosis and exclusion of PCP. Methods: From clinical case records, we abstracted demographic and clinical information and categorised patients as having confirmed or probable PCP, or an alternative diagnosis. We calculated sensitivity, specificity and positive predictive value (PPV) of serum BDG concentrations >400 pg/mL and negative predictive value (NPV) of BDG <80 pg/mL. Results: 76 patients were included; 29 had laboratory-confirmed PCP, 17 had probable PCP and 30 had an alternative diagnosis. Serum BDG >400 pg/mL had a sensitivity of 83%, specificity of 97% and PPV 97% for diagnosis of PCP; BDG <80 pg/mL had 100% NPV for exclusion of PCP. Conclusions: In PWH with suspected PCP, BDG <80 pg/mL excludes a diagnosis of PCP, whereas BDG concentrations >400 pg/mL effectively confirm the diagnosis. Values 80–400 pg/mL should prompt additional diagnostic tests.

scholarly journals Evaluation of Production Lots of a Rapid Point-of-Care Lateral Flow Serological Test Intended for Identification of IgM and IgG against the N-Terminal Part of the Spike Protein (S1) of SARS-CoV-2

Viruses ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1043
Author(s):  
Tove Hoffman ◽  
Linda Kolstad ◽  
Bengt Rönnberg ◽  
Åke Lundkvist
Keyword(s):  
Predictive Value ◽  
Serological Test ◽  
Point Of Care ◽  
External Validation ◽  
High Sensitivity ◽  
Lateral Flow ◽  
Spike Protein ◽  
Individual Level ◽  
Lateral Flow Test ◽  
Production Errors

The potential of rapid point-of-care (POC) tests has been subject of doubt due to an eventual risk of production errors. The aim was therefore to evaluate the two separate production lots of a commercial POC lateral flow test, intended for the detection of IgM and IgG against the SARS-CoV-2 spike protein (S1). Control samples consisted of serum from individuals with confirmed SARS-CoV-2 infection and pre-COVID-19 negative sera gathered from a biobank. The presence of anti-S1 IgM/IgG in the sera was verified by an in-house Luminex-based serological assay (COVID-19 SIA). One hundred samples were verified as positive for anti-S1 IgG and 74 for anti-S1 IgM. Two hundred samples were verified as negative for anti-S1 IgM/IgG. For the two lots of the POC-test, the sensitivities were 93.2% and 87.8% for IgM and 93.0% and 100% for IgG. The specificities were 100% for IgM and 99.5% for IgG. The positive predictive value was 100% for IgM and 98.9% and 99.0% for IgG. The negative predictive value was 97.6% and 95.7% for IgM, and 96.6% and 100% for IgG. The evaluated POC-test is suitable to assess anti-SARS-CoV-2 S1 IgM and IgG, as a measure of previous virus exposure on an individual level. The external validation of separate lots of rapid POC-tests is encouraged to ensure high sensitivity before market introduction.

A Negative Antinuclear Antibody Does Not Indicate Autoantibody Negativity in Myositis: Role of Anticytoplasmic Antibody as a Screening Test for Antisynthetase Syndrome

2016 ◽  
Vol 44 (2) ◽  
pp. 223-229 ◽  
Author(s):  
Rohit Aggarwal ◽  
Namrata Dhillon ◽  
Noreen Fertig ◽  
Diane Koontz ◽  
Zengbiao Qi ◽  
...  
Keyword(s):  
Lupus Erythematosus ◽  
Predictive Value ◽  
Antinuclear Antibody ◽  
High Sensitivity ◽  
Epithelial Cell Line ◽  
Antisynthetase Syndrome ◽  
Control Groups ◽  
Serum Samples ◽  
Cytoplasmic Staining ◽  
Sensitivity Specificity

Objective.To evaluate the utility of anticytoplasmic autoantibody (anti-CytAb) in antisynthetase antibody–positive (anti-SynAb+) patients.Methods.Anti-SynAb+ patients were evaluated for antinuclear antibody (ANA) and anti-CytAb [cytoplasmic staining on indirect immunofluorescence (IIF)] positivity. Anti-SynAb+ patients included those possessing anti-Jo1 and other antisynthetase autoantibodies. Control groups included scleroderma, systemic lupus erythematosus, Sjögren syndrome, rheumatoid arthritis, and healthy subjects. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy of anti-CytAb, and ANA were assessed. Anti-CytAb and ANA testing was done by IIF on human epithelial cell line 2, both reported on each serum sample without knowledge of the clinical diagnosis or final anti-SynAb results.Results.Anti-SynAb+ patients (n = 202; Jo1, n = 122; non-Jo1, n = 80) between 1985–2013 with available serum samples were assessed. Anti-CytAb showed high sensitivity (72%), specificity (89%), NPV (95%), and accuracy (86%), but only modest PPV (54%) for anti-SynAb positivity. In contrast, ANA showed only modest sensitivity (50%) and poor specificity (6%), PPV (9%), NPV (41%), and accuracy (12%). Positive anti-CytAb was significantly greater in the anti-SynAb+ patients than ANA positivity (72% vs 50%, p < 0.001), and 81/99 (82%) ANA-negative patients in the anti-SynAb+ cohort had positive anti-CytAb. In contrast, the control groups showed high rates for ANA positivity (93.5%), but very low rates for anti-CytAb positivity (11.5%). Combining anti-CytAb or Jo1 positivity showed high sensitivity (92%) and specificity (89%) for identification of anti-SynAb+ patients.Conclusion.Assessing patients for anti-CytAb serves as an excellent screen for anti-SynAb+ patients using simple IIF. Cytoplasmic staining should be assessed and reported for patients suspected of having antisynthetase syndrome and a negative ANA should not be used to exclude this diagnosis.

scholarly journals XPERT MYCOBACTERIUM TUBERCULOSIS/RIFAMPICIN ASSAY: A BOON IN TUBERCULOSIS DIAGNOSTICS

2016 ◽  
Vol 9 (5) ◽  
pp. 225 ◽  
Author(s):  
Sevitha Bhat ◽  
Kavya Ramamurthy ◽  
Shalini Shenoy ◽  
Aseem Rangnekar
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Predictive Value ◽  
High Sensitivity ◽  
Mortality And Morbidity ◽  
Indicator Tube ◽  
Promising Tool ◽  
Causes Of Mortality ◽  
Conventional Microscopy ◽  
Tb Diagnostics ◽  
Sensitivity Specificity

ABSTRACTObjectives: Mycobacterium tuberculosis (MTB) remains one of the most significant causes of mortality and morbidity in developing countriesespecially India. India has the highest burden of TB, with an estimated incidence figure of 2.1 million cases out of the 9 million cases of TB globally.Diagnosis of TB relies on conventional microscopy and culture with drawbacks related to sensitivity, specificity, turn around time (TAT). The aim ofthis study was to evaluate the performance of Xpert MTB/rifampicin (RIF) assay (GX) for MTB detection in pulmonary and extrapulmonary clinicalsamples.Methods: A total of 209 clinical specimens (182: pulmonary and 27: extrapulmonary) were processed using auramine smear, culture by mycobacteriagrowth indicator tube and GenXpert.Results: The sensitivity of GenXpert was 62.63% for pulmonary and 55% for extrapulmonary samples. The sensitivity and specificity of GX were100% for the smear positive cases. The sensitivity, specificity, positive predictive value, and negative predictive value of the GX for smear negativecases were 67.8%, 97.5%, 90.4%, and 89.6%, respectively. RIF resistance was detected in 3.8% the samples.Conclusion: GenXpert, with short TAT, high sensitivity, specificity and less technical expertise required is a promising tool in TB diagnostics for thefuture.Keywords: GenXpert, Tuberculosis diagnosis, Molecular method, Rifampicin resistance.

scholarly journals Role of MRI in the Diagnosis of Injury to the Lisfranc Ligament Complex

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0029
Author(s):  
Christopher Kreulen ◽  
Eric Giza ◽  
Eva Escobedo ◽  
Cyrus Bateni ◽  
Michael Doherty
Keyword(s):  
Magnetic Resonance ◽  
Mr Imaging ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
High Sensitivity ◽  
Lisfranc Injury ◽  
Radiology Reports ◽  
Lisfranc Ligament ◽  
Sensitivity Specificity

Category: Sports Introduction/Purpose: Subtle Lisfranc ligamentous injuries are difficult to diagnose and magnetic resonance is becoming a useful tool. The purpose of this study is to evaluate the efficacy of magnetic resonance (MR) imaging for the diagnosis of injuries of the Lisfranc ligament complex. Methods: The radiology database was searched between Jan 1, 2010 and Mar 10, 2015 to identify patients over the age of 18 years who had MR imaging of the foot for suspected injury of the Lisfranc ligament complex. MR images were reviewed by 2 fellowship trained musculoskeletal radiologists, whom were blinded to the original radiology reports. Findings were categorized as: no injury or injury present. Injury was deemed to be present if 2 of the 3 components of C1-M2 ligament showed disruption or signal alterations on T1 and T2 weighted images. Disagreements were resolved by consensus. Correlation was made with surgical findings whenever performed. In patients not undergoing surgery, the presence or absence of injury was determined by clinical examination performed by an orthopedic surgeon and follow-up. Sensitivity, specificity, positive predictive value(PPV), and negative predictive value (NPV) of MR for diagnosis of Lisfranc ligament complex injury was determined. Results: Of 60 patients, 9 were excluded due to a lack of follow-up. Lisfranc injury was determined to be present on MR in 26 patients and 18 underwent surgery. Injury was confirmed in 16, and 2 were intact. 2 patients underwent closed reduction and were clinically determined to be injured. 6 of the injured 26 patients were sprained and not injured/torn on clinical evaluation. Of the 25 patients determined to have no injury on MR, 24 were intact clinically. 1 patient had a Lisfranc injury on follow-up. Sensitivity, specificity, PPV and NPV of MR for detection of significant Lisfranc injury were 94.7% (CI: 73.9% to 99.9%), 75% (CI: 56.6% to 88.5%), 69.2% (CI: 55% to 80.5%) and 96% (CI: 77.9% to 99.4%) respectively. Conclusion: MR has a high sensitivity and negative predictive value for diagnosis of injury to the Lisfranc ligament complex. MR of the foot should be considered in patients with clinical suspicion of injury to the Lisfranc ligament complex, and it is highly accurate in excluding such injuries.

Isolated demyelinating syndromes: comparison of CSF oligoclonal bands and different MR imaging criteria to predict conversion to CDMS

2001 ◽  
Vol 7 (6) ◽  
pp. 359-363 ◽  
Author(s):  
M Tintoré ◽  
A Rovira ◽  
L Brieva ◽  
E Grivé ◽  
R Jardí ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
High Sensitivity ◽  
Oligoclonal Bands ◽  
High Negative Predictive Value ◽  
Csf Oligoclonal Bands ◽  
Sensitivity Specificity

Aim of the study: To evaluate and compare the capacity of oligoclonal bands (OB) and three sets of MR imaging criteria to predict the conversion of clinically isolated syndromes (CIS) to clinically definite multiple sclerosis (CDMS). Patients and methods: One hundred and twelve patients with CIS were prospectively studied with MR imaging and determination of OB. Based on the clinical follow-up (conversion or not conversion to CDMS), we calculated the sensitivity, specificity accuracy, positive and negative predictive value of the OB, and MR imaging criteria proposed by Paty et al, Fazekas et al and Barkhof et al. Results: CDMS developed in 26 (23.2%) patients after a mean follow-up of 31 months (range 12-62). OB were positive in 70 (62.5%) patients and were associated with a higher risk of developing CDMS. OB showed a sensitivity of 81%, specificity of 43%, accuracy of 52%, positive predictive value (PPV) of 30% and negative predictive value (NPV) of 88%. Paty and Fazekas criteria showed the same results with a sensitivity of 77%, specificity of 51%, accuracy of 57%, positive predictive value of 32% and negative predictive value of 88%. Barkhof criteria showed a sensitivity of 65%, specificity of 70%, accuracy of 69%, PPV of 40% and NPV of 87%. The greatest accuracy was achieved when patients with positive OB and three or four Barkhof's criteria were selected. Conclusions: We observed a high prevalence of OB in CIS. OB and MR imaging (Paty's and Fazekas' criteria) have high sensitivity. Barkhof's criteria have a higher specificity. Both OB and MR imaging criteria have a high negative predictive value.

Sensitivity, Specificity, and Positive Predictive Value of Technetium 99-HMPAO SPECT in Discriminating Alzheimer's Disease from other Dementias

1997 ◽  
Vol 10 (1) ◽  
pp. 15-21 ◽  
Author(s):  
Donna L. Masterman ◽  
Mario F. Mendez ◽  
Lynn A. Fairbanks ◽  
Jeffrey L. Cummings
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Single Photon ◽  
Photon Emission ◽  
High Sensitivity ◽  
Hmpao Spect ◽  
Clinical Diagnoses ◽  
Sensitivity Specificity

Investigators have reported high sensitivity and specificity values for single photon emission computerized tomography (SPECT) when distinguishing Alzheimer's disease (AD) patients from normal elderly controls or from selected patient groups. The role of SPECT in identifying AD among unselected patients with memory complaints requires investigation. We examined 139 consecutive patients with 99Tc-HMPAO SPECT. NINCDS-ADRDA diagnoses were determined blind to SPECT results, and scans were read and classified by visual inspection blind to clinical diagnoses. Bilateral temporoparietal hypoperfusion (TP) occurred in 75% of probable, 65% of possible, and 45% of unlikely AD patients, yielding a sensitivity of 75% and a specificity of 52% when comparing probable AD versus unlikely AD groups. A positive predictive value of 78% was obtained based on a 69% prevalence of AD in our total clinic population. Patients with false-positive results included a variety of dementing illnesses; all patients with bilateral hypoperfusion had dementia. A pattern of TP on SPECT scans is seen in most patients with AD, but could be found in other dementias as well and cannot be regarded as specific to AD. Reduced TP perfusion discriminated between demented and nondemented individuals. Further strategies for SPECT interpretation that improve diagnostic specificity should be sought.

The predictive value of videostroboscopy in the assessment of premalignant lesions and early glottis cancers

2017 ◽  
Vol 71 (4) ◽  
pp. 14-18 ◽  
Author(s):  
Anna Rzepakowska ◽  
Ewelina Sielska-Badurek ◽  
Ewa Osuch-Wójcikiewicz ◽  
Michał Sobol ◽  
Kazimierz Niemczyk
Keyword(s):  
Predictive Value ◽  
Vocal Fold ◽  
Histopathological Examination ◽  
High Sensitivity ◽  
Vocal Folds ◽  
Invasive Cancer ◽  
Premalignant Lesions ◽  
Good Tool ◽  
Malignant Lesions ◽  
Sensitivity Specificity

Objective: To assess the sensitivity and specificity of larngovideostroboscopy (LVS) in the diagnosis of precancerous and malignant lesions of the vocal folds. Material and methods: In 175 patients (128 men and 47 women), aged 19-88 years, mean age 61.5, who were admitted to the clinic with diagnosed premalignant conditions of vocal fold mucosa (leukoplakia, chronic hypertrophic inflammatory lesions) and thickening or tumor on the vocal fold, there was performed LVS before the laryngeal microsurgery. The LVS study included: localization of the leasion, movement of the vocal folds, mucosal wave, shape of glottis clousure, amplitude and symmetry of vocal fold vibration. In the evaluation, a point scale was applied for the individual functional parameters. The scale ranged from 0 to 14. Patients with impaired vocal fold motion or absent mucosal wave were positive on LVS for malignant lesions. Those with limitted mucosal wave were positive on LVS for dysplastic lesions. The results were compared with the final histopathological examination and the sensitivity, specificity, accuracy, positive (PPV) and negative (NPV) predictive value were calculated. Results: On the basis of histopathological examination, benign lesions (normal or inflammatory mucosa) accounted for 20% of diagnoses, hypertrophy and parakeratosis for 28%, low and middle grade dysplasia accounted for 10% and malignant lesions (high-grade dysplasia, pre-invasive cancer, Invasive cancer) was diagnosed in 42% of patients. The overall mean score for LVS was 4.5 and 8.0, respectively for benign and malignant lesions. Sensitivity, specificity, accuracy, PPV and NPV of LVS in detecting malignant lesions were respectively - 95.6%, 23.8%, 61.1%, 57.6% and 83.3% and in detecting both premalignant and malignant lesions were respectively – 90.7%, 31.4%, 78.9%, 84.1% and 45.8%. Conclusions: Because of the high sensitivity of LVS in detecting precancerous and malignant lesions, this method is a very good tool for screening of pathology within the larynx.

scholarly journals Isothermal Amplification of Nucleic Acids Coupled with Nanotechnology and Microfluidic Platforms for Detecting Antimicrobial Drug Resistance and Beyond

2021 ◽  
Author(s):  
Seyedeh Zahra Alamolhoda ◽  
Nosratollah Zarghami ◽  
Houman Kahroba ◽  
Ahmad Mehdipour ◽  
Mohammad Pourhassan-Moghaddam ◽  
...  
Keyword(s):  
Nucleic Acids ◽  
Point Of Care ◽  
High Sensitivity ◽  
Molecular Techniques ◽  
Isothermal Amplification ◽  
High Tech ◽  
Antimicrobial Drug Resistance ◽  
Resource Limited ◽  
Accessible Point ◽  
Sensitivity Specificity

Antibiotic resistance is one of the serious health-threatening issues globally, the control of which is indispensable for rapid diagnosis and treatment because of the high prevalence and risks of pathogenicity. Traditional and molecular techniques are relatively expensive, complex, and non-portable, requiring facilities, trained personnel, and high-tech laboratories. Widespread and timely-detection is vital to the better crisis management of rapidly spreading infective diseases, especially in low-tech regions and resource-limited settings. Hence, the need for inexpensive, fast, simple, mobile, and accessible point-of-care (POC) diagnostics is highly demanding. Among different biosensing methods, the isothermal amplification of nucleic acids is favorite due to their simplicity, high sensitivity/specificity, rapidity, and portability, all because they require a constant temperature to work. Isothermal amplification methods are utilized for detecting various targets, including DNA, RNA, cells, proteins, small molecules, ions, and viruses. In this paper, we discuss various platforms, applications, and potentials of isothermal amplification techniques for biosensing of antimicrobial resistance. We also evaluate the potential of these methods, coupled with the novel and rapidly-evolving platforms offered by nanotechnology and microfluidic devices.

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