scholarly journals The Diagnostic Value of Urinary Secretory Antigen Target of 6 kDa in Childhood Pulmonary Tuberculosis

2021 ◽  
Vol 9 (B) ◽  
pp. 841-846
Author(s):  
Agustin Iskandar ◽  
Ella Melissa Lawanto ◽  
Maimun Zulhaidah ◽  
Ery Olivianto ◽  
Kusworini Handono ◽  
...  
Keyword(s):  
Clinical Signs ◽  
Signs And Symptoms ◽  
Diagnostic Value ◽  
Specific Protein ◽  
Childhood Tuberculosis ◽  
Sputum Smear ◽  
Roc Curve Analysis ◽  
Cross Sectional ◽  
Positive Skin ◽  
Pulmonary Tb

Introduction. Childhood tuberculosis (TB) is difficult to diagnosed and is  based together on  clinical and microbiology examinations. Since in children  signs and symptoms of TB are not typical and sputum is  difficult to be obtained,  Mycobacterium tuberculosis (Mtb) antigen detection  could  be considered  as a non invasive method for early detection of childhood TB. ESAT-6 is a low molecular weight specific protein that plays an important role in Mtb virulence. Aim. To determine the diagnostic value of urinary ESAT-6 for the diagnosis of childhood tuberculosis. Methodology.This was a cross-sectional study, with consecutive sampling collection . in children aging between  0-14 years suspected for pulmonary TB based on the clinical presence of  :cough lasting  more than 2 weeks, fever without clear ethiology, loss of body weight or poor weight gain, fatigue, malaise with positive history of contact with sputum smear from adult TB patients. Diagnosis of pulmonary TB was based on clinical presentation plus tuberculin positive skin test, chest x-ray, AFB staining and/or sputum culture. Subjects who met the inclusion criteria but unconfirmed by clinical and microbiological were considered as control (non-TB group). Urinary ESAT-6 level was analyzed by using ELISA. Cut off value and AUC was determined using ROC Statistical Analysis (SPSS 20.0). Sensitivity and specificity was measured from 2x2 crosstable. Result. Between the 61 studied children with suspected TB, 46/61 (75%) were finally diagnosed with TB, with 34/46 (74%) microbiologically confirmed cases either by sputum microscopy 31/34 (91%) or culture 3/34 (9%), whereas 15/61 (25%) subjects were not-confirmed cases (non-TB group). The mean value of urinary ESAT-6 level was higher in TB than non-TB group, Mean (SD) [4.855(6.714)] ng/mLvs [1.503(0.946)] ng/mL; p=<0.001(Mann-Whitney test). At ROC curve analysis ,the cut off value of urinary ESAT-6 in subjects TB  confirmed both with clinical plus microbiology evaluation  as reference standard was 1,91 ng/mL, with sensitivity 72% and specificity 67%. While the cut off value of ESAT-6 in TB subjects confirmed group only by clinical signs was 2.45 ng/mL, with sensitivity 65% and specificity 67%. Conclusion. For  TB Diagnosis in Children, Urinary ESAT-6 urine could be considered  of   value  when  utilized in addition to microbiological tests and clinical examination.

scholarly journals The Optimum Cut-off Value of the Nelwan Score to Diagnose Typhoid Fever in Adults

2021 ◽  
Author(s):  
Erni Juwita Nelwan ◽  
Luh Putu Listya Paramita ◽  
Robert Sinto ◽  
Fransiscus Nikodemus Hosea ◽  
Pringgodigdo Nugroho ◽  
...  
Keyword(s):  
Typhoid Fever ◽  
Clinical Presentation ◽  
Clinical Signs ◽  
Gastrointestinal Symptoms ◽  
Signs And Symptoms ◽  
Diagnostic Value ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Clinical Signs And Symptoms ◽  
Sensitivity Specificity

AbstractIntroductionTyphoid fever can be challenging to diagnose since clinicians often depend merely on clinical presentation. Clinical scores are useful to provide more accurate diagnosis. Variables in Nelwan Score are derived from clinical signs and symptoms of suspected cases for typhoid. Diagnostic value of Nelwan Score based on a cut-off value has never been evaluated.MethodsA cross sectional study was conducted between July 2017 and January 2018 in five hospitals and two Primary Health Centers in Jakarta and Tangerang. The inclusion criteria were patients with 3-14 days of fever and gastrointestinal symptoms between July 2017 and January 2018. Diagnosis are confirmed by blood culture, rectal swab culture, or PCR. Cut-off analysis was performed by using Receiver Operating Characteristic (ROC) curve and diagnostic value was analyzed to generate sensitivity, specificity, predictive value and likelihood ratio.ResultFrom 233 subjects involved, 4.72% of them were confirmed to have typhoid fever. The optimal cut-off value of Nelwan Score is 10 with AUC 71.3%. This cut-off value has sensitivity 81.8%, specificity 60.8%, PPV 9.3%, NPV 98.5%, LR + 2.086, and LR – 0.299.ConclusionNelwan Score with cut-off value of 10 provides a good diagnostic performance as a screening tool for patients with suspected typhoid fever clinical presentation.

STUDY OF ABSOLUTE, IMMATURE NEUTROPHIL COUNT AND CRP AS DIAGNOSTIC MARKERS FOR EARLY ONSET NEONATAL SEPSIS.

2021 ◽  
pp. 25-26
Author(s):  
Pooja Poswal ◽  
Manisha Rohilla ◽  
Sunil Arora ◽  
Irbinder Kour Bali
Keyword(s):  
Blood Culture ◽  
Neutrophil Count ◽  
Neonatal Sepsis ◽  
Hematological Parameters ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Cost Effective ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Clinical Signs And Symptoms

Introduction: Neonatal Sepsis is difcult to differentiate from other conditions due to non- specic clinical signs and symptoms. Inammation in neonates shows variations in hematological parameters. Our study is to evaluate the hematological parameters and C-reactive protein estimation in neonatal sepsis for early diagnosis. Material And Methods: It was a cross-sectional study including 80 neonates admitted in the neonatal care unit, 40 (proven sepsis) and 40 probable cases); blood culture being the gold standard. Hematological parameters, immature to total neutrophil ratio (I/T ratio), Absolute neutrophil count (ANC), CRP and Blood culture were done as per standard protocols. Results: ANC had highest sensitivity of 90% followed by I/T ratio (87.5%) and CRP (77.5%). The sensitivity and specicity for the combination of ANC and I/T ratio was 78.3% and 83.6% respectively. Conclusion: ANC, I/T Ratio and CRP are quick, simple and cost-effective routine laboratory tests which help in neonatal sepsis prediction and to start proper and timely antibiotic therapy.

scholarly journals Association of Socio-Demographic Profile with Prevalence of Multi Drug Resistant Tuberculosis among Retreated Pulmonary Tuberculosis Patients in North India

2018 ◽  
Vol 16 (1) ◽  
pp. 1-5
Author(s):  
A. Chaudhary ◽  
T. Mahmood ◽  
A.D. Shukla ◽  
A. Shreenivasa ◽  
Verma Arvind ◽  
...  
Keyword(s):  
Cross Sectional Study ◽  
North India ◽  
Sputum Smear ◽  
Cross Sectional ◽  
Pulmonary Tb ◽  
Demographic Profile ◽  
Resistant Tuberculosis ◽  
Multi Drug Resistant Tuberculosis ◽  
Mdr Tb ◽  
Education Status

Methods: An observational cross sectional study, which includes 116 patients of sputum smear positive pulmonary TB of age 18 or above. Further, detailed history taking regarding different demographic profile was done. Also, they were subjected to CB-NAAT and rifampicin resistant cases were considered as MDR-TB. Results: Proportion of MDR-TB was 31.89% among retreatment TB cases. 56.75 % (n=21) of MDR-TB cases were between the age group of 21-40 years. Proportion of MDR-TB was higher among males (75.67%), married (59.45%) and rural dwellers 59.45%. Proportion was 61.76% among patients with BMI <16; 31.57% with BMI 16-16.99, 28.57% with BMI 17-18.49 and 5.7% with BMI 18.50-24.99. MDRTB proportion was less 29.72% (n=11) in patients with history of TB contact in family. Pulmonary TB including MDR-TB was more common among illiterates (37.83% among MDR). Conclusion: Proportion of MDR-TB was high among retreatment cases in north India. Among them low BMI and education status are modifiable factor and this study signifies that MDR-TB burden can be reduced by improving health and education status of patient.

scholarly journals Detection of Mycobacterium tuberculosis by Microscopic Technique of Sputum AFB and ICT (Cocktail Antigen) TB

2019 ◽  
Author(s):  
Retno Martini Widhyasih ◽  
Annisa Husnun Hanifah ◽  
Chairlan Chairlan ◽  
Dewi Inderiati
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Microscopic Examination ◽  
False Negative ◽  
High Specificity ◽  
Culture Method ◽  
Sputum Smear ◽  
Cross Sectional ◽  
Pulmonary Tb ◽  
Long Time ◽  
Analytic Design

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. The diagnosis of pulmonary TB in general still relies on microscopic examination with a sputum smear for Acid Fast Basil (AFB). Microscopic examination to detect M. tuberculosis has high specificity, but the sensitivity is 35-70%. The sputum culture method is the gold standard for the diagnosis of pulmonary TB but requires a long time, which is 6-8 weeks. In recent years ICT (Immuno Chromatography Test) has been introduced to identify potential and useful TB antigens to help diagnose pulmonary TB. Antigens detected were ESAT-6, CFP-10, CFP-21, and MPT-64. This study aims to compare the results of the examination of specimens of suspect TB sputum with the ICT method and AFB. This study based on observational with analytic design cross-sectional on 56 samples of Stored Biological Material suspects TB that were examined by the AFB method and the ICT method (Cocktail Antigen). Statistical test results Fisher Exact (α = 0.05) showed no difference between microscopic examination of smear sputum and ICT (Cocktail Antigen) TB (p = 1,000). Nevertheless, the use of ICT reagents for the diagnosis of pulmonary TB still needs to be further investigated, especially to find out the exact causes of false positive and false negative reactions.

scholarly journals Dual-Energy Computed Tomography Lung in patients of Pulmonary Tuberculosis

2020 ◽  
Vol 10 ◽  
pp. 39
Author(s):  
Ahmad Umar Khan ◽  
Sachin Khanduri ◽  
Zikra Tarin ◽  
Syed Zain Abbas ◽  
Mushahid Husain ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pulmonary Tuberculosis ◽  
Imaging Techniques ◽  
Ground Glass Opacity ◽  
Signs And Symptoms ◽  
Dual Energy ◽  
Dual Energy Ct ◽  
High Resolution Computed Tomography ◽  
Cross Sectional ◽  
Pulmonary Tb

Objectives: The objective of this study was to characterize findings of high-resolution computed tomography (HRCT) and dual-energy CT (DECT) (80 keV, 140 keV, and mixed) in pulmonary tuberculosis (TB) patients and to compare and correlate HRCT and DECT findings. Material and Methods: This cross-sectional study was conducted on 67 patients of 18–65 years of age who were suspected cases of pulmonary TB with signs and symptoms of cough, fever, hemoptysis, sputum, night sweats, and weight loss with positive sputum AFB examinations/bronchoalveolar lavage. All the patients subjected to HRCT scan and followed with DECT scan. Comparison of various imaging techniques (DECT 80 keV, DECT 140 keV, and DECT mixed) with HRCT was done for detecting lung findings and data so obtained were subjected to statistical analysis. Results: On comparing the various imaging techniques with HRCT for detecting consolidation, tree in bud pattern, cavitary lesions, ground-glass opacity, bronchiectasis, atelectasis, nodules, granuloma, peribronchial thickening, and fibrosis, the maximum agreement of HRCT was found with DECT 80 keV and minimum agreement was found with DECT 140 keV. Conclusion: The study concluded that DECT 80 keV monochromatic reconstructions among 80 keV, mixed, and 140 keV monochromatic reconstructions in lung parenchyma window settings are a faster and better analytical tool for the assessment of findings of pulmonary TB when compared with HRCT.

scholarly journals Efficacy of gene xpert over other diagnostic modalities of tuberculosis among children

2019 ◽  
Vol 6 (4) ◽  
pp. 1545
Author(s):  
Deepmala Pandey ◽  
Ankur Yadav
Keyword(s):  
Age Groups ◽  
Sputum Smear ◽  
Smear Microscopy ◽  
Chi Square ◽  
Diagnostic Modality ◽  
Cross Sectional ◽  
Exact Test ◽  
Pulmonary Tb ◽  
Pediatric Age Group ◽  
Diagnostic Modalities

Background: Diagnosis of tuberculosis is a challenge especially among children. GeneXpert has been recommended as a diagnostic test in children. Objectives of this study was to efficacy of GeneXpert over other diagnostic modalities of Tuberculosis like Sputum smear microscopy, Mantoux testing, X-ray chest among children.Methods: A cross sectional hospital-based study was conducted over a period of 24 months among 150 children. All the patients who were having suspicion of Tuberculosis on the basis of History & Examination (fulfilling inclusion criteria) had been enrolled in the study. After doing all preliminary investigations clinical diagnosis has been made and Gene X’pert was carried out for all the samples collected. Pearson chi square test and Fishers exact test was applied wherever appropriate.Results: There was statistically no significant (p >0.05) difference of GeneXpert positivity within different age groups of Suspected TB patients. GeneXpert was positive in 80% with symptom of Cough lasting more than 2 weeks, in 78.8% with fever more than 2 weeks, in 88.9% with FTT, in 76.5% with H/O Koch’s contact, in 77.8% with H/O convulsion, in 69% with significant lymphadenopathy. GeneXpert was positive in all suspected TB patients having ZN staining positive for AFB. In clinically TB diagnosed patients, 86.5% were positive for GeneXpert.Conclusions: GeneXpert is a novel diagnostic modality of choice in all suspected Pulmonary & Extra-pulmonary TB cases among children. It can be used as a primary tool in Pulmonary TB with smear negative samples in pediatric age group.

scholarly journals Leprosy in a prison population: A new active search strategy and a prospective clinical analysis

2020 ◽  
Vol 14 (12) ◽  
pp. e0008917
Author(s):  
Fred Bernardes Filho ◽  
Jaci Maria Santana ◽  
Regina Coeli Palma de Almeida ◽  
Glauber Voltan ◽  
Natália Aparecida de Paula ◽  
...  
Keyword(s):  
Search Strategy ◽  
Clinical Symptoms ◽  
Prison Population ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Skin Lesions ◽  
Clinical Analysis ◽  
Skin Area ◽  
Cross Sectional ◽  
Active Search

Background This study evaluates an active search strategy for leprosy diagnosis based on responses to a Leprosy Suspicion Questionnaire (LSQ), and analyzing the clinical, immunoepidemiological and follow-up aspects for individuals living in a prison population. Methods A cross-sectional study based on a questionnaire posing 14 questions about leprosy symptoms and signs that was distributed to 1,400 prisoners. This was followed by dermatoneurological examination, anti-PGL-I serology and RLEP-PCR. Those without leprosy were placed in the Non-leprosy Group (NLG, n = 1,216) and those diagnosed with clinical symptoms of leprosy were placed in the Leprosy Group (LG, n = 34). Findings In total, 896 LSQ were returned (64%), and 187 (20.9%) of the responses were deemed as positive for signs/symptoms, answering 2.7 questions on average. Clinically, 1,250 (89.3%) of the prisoners were evaluated resulting in the diagnosis of 34 new cases (LG), based on well-accepted clinical signs and symptoms, a new case detection rate of 2.7% within this population, while the NLG were comprised of 1,216 individuals. The confinement time medians were 39 months in the LG while it was 36 months in the NLG (p>0.05). The 31 leprosy cases who responded to the questionnaire (LSQ+) had an average of 1.5 responses. The symptoms “anesthetized skin area” and “pain in nerves” were most commonly mentioned in the LG while “tingling, numbness in the hands/feet”, “sensation of pricks and needles”, “pain in nerves” and “spots on the skin” responses were found in more than 30% of questionnaires in the NLG. Clinically, 88.2% had dysesthetic macular skin lesions and 97.1% presented some peripheral nerve impairment, 71.9% with some degree of disability. All cases were multibacillary, confirming a late diagnosis. Anti-PGL-I results in the LG were higher than in the NLG (p<0.0001), while the RLEP-PCR was positive in 11.8% of the patients. Interpretation Our findings within the penitentiary demonstrated a hidden prevalence of leprosy, although the individuals diagnosed were likely infected while living in their former communities and not as a result of exposure in the prison. The LSQ proved to be an important screening tool to help identify leprosy cases in prisons.

scholarly journals Clozapine-induced myocarditis: electronic health register analysis of incidence, timing, clinical markers and diagnostic accuracy

2021 ◽  
pp. 1-8
Author(s):  
Aviv Segev ◽  
Ehtesham Iqbal ◽  
Theresa A. McDonagh ◽  
Cecilia Casetta ◽  
Ebenezer Oloyede ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Language Processing ◽  
Clinical Signs ◽  
Clinical Manifestations ◽  
Area Under The Curve ◽  
Signs And Symptoms ◽  
Diagnostic Value ◽  
Clinical Markers ◽  
Reactive Protein ◽  
Increased Risk

Background Clozapine is associated with increased risk of myocarditis. However, many common side-effects of clozapine overlap with the clinical manifestations of myocarditis. As a result, there is uncertainty about which signs, symptoms and investigations are important in distinguishing myocarditis from benign adverse effects of clozapine. Clarity on this issue is important, since missing a diagnosis of myocarditis or discontinuing clozapine unnecessarily may both have devastating consequences. Aims To examine the clinical characteristics of clozapine-induced myocarditis and to identify which signs and symptoms distinguish true myocarditis from other clozapine adverse effects. Method A retrospective analysis of the record database for 247 621 patients was performed. A natural language processing algorithm identified the instances of patients in which myocarditis was suspected. The anonymised case notes for the patients of each suspected instance were then manually examined, and those whose instances were ambiguous were referred for an independent assessment by up to three cardiologists. Patients with suspected instances were classified as having confirmed myocarditis, myocarditis ruled out or undetermined. Results Of 254 instances in 228 patients with suspected myocarditis, 11.4% (n = 29 instances) were confirmed as probable myocarditis. Troponin and C-reactive protein (CRP) had excellent diagnostic value (area under the curve 0.975 and 0.896, respectively), whereas tachycardia was of little diagnostic value. All confirmed instances occurred within 42 days of clozapine initiation. Conclusions Suspicion of myocarditis can lead to unnecessary discontinuation of clozapine. The ‘critical period’ for myocarditis emergence is the first 6 weeks, and clinical signs including tachycardia are of low specificity. Elevated CRP and troponin are the best markers for the need for further evaluation.

scholarly journals Clinical symptoms, paraclinical tests and histopathological results in children with acute appendicitis in Zabol southeast of Iran: a cross-sectional study

2017 ◽  
Vol 5 (7) ◽  
pp. 2836
Author(s):  
Mehran Hesaraki
Keyword(s):  
Acute Appendicitis ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Cross Sectional Study ◽  
Intestinal Loop ◽  
Negative Appendectomy ◽  
Sectional Study ◽  
Cross Sectional ◽  
Clinical Signs And Symptoms ◽  
Histopathological Results

Background: This article aimed to assessment clinical signs and symptoms, paraclinical tests and histopathological results in children with acute appendicitis.Methods: A cross-sectional study conducted on 100 children with acute appendicitis in an urban hospital in southeast of Iran from January to December 2016. Participants were selected by simple random sampling method. Clinical signs and symptoms, paraclinical tests and histopathological results recorded in checklists. The data were analyzed using SPSS 22.Results: Mean age of the patients was 10.26±3.25, fourthly-eight of patients (58.5%) were males and 34 patients (41.5%) were females. The most frequent clinical signs and symptoms were acute suppurative appendicitis with peri appendicitis (45.83%) and acute suppurative appendicitis (39.58%). The most frequent results in ultrasound reports were Intestinal loop thickness greater than 6 mm without peristalsis (positive report) (46.34%) and Invisible appendix (nega Hesaraki tive report) (13.41%).Conclusions: The results of this study showed that abdominal pain and RLQ tenderness were the most common signs and symptoms and WBC left-shift was the most common laboratory finding. Since the rate of negative appendectomy in this study was consistent with surgical results and other articles, it is concluded that diagnostic accuracy of preoperative appendectomy was acceptable and most children with acute appendicitis underwent appendectomy.

scholarly journals What are the optimal cut-off points of anthropometric indices for prediction of overweight and obesity? Predictive validity of waist circumference, waist-to-hip and waist-to-height ratios

2020 ◽  
Vol 10 (2) ◽  
pp. 142-147 ◽  
Author(s):  
Helda Tutunchi ◽  
Mehrangiz Ebrahimi-Mameghani ◽  
Alireza Ostadrahimi ◽  
Mohammad Asghari-Jafarabadi
Keyword(s):  
Waist Circumference ◽  
Roc Curve ◽  
Predictive Ability ◽  
Diagnostic Value ◽  
Cross Sectional Study ◽  
Overweight And Obesity ◽  
Roc Curve Analysis ◽  
Anthropometric Indices ◽  
Cross Sectional ◽  
Anthropometric Indicators

Background: Planning for obesity prevention is an important global health priority. Our aim in this study was to find the optimal cut-off points of waist circumference (WC), waist- to- hipratio (WHR) and waist- to- height ratio (WHtR), as three anthropometric indices, for prediction of overweight and obesity. We also aimed to compare the predictive ability of these indices to introduce the best choice. Methods: In this cross-sectional study, a total of 500 subjects were investigated. Anthropometric indicators were measured using a standard protocol. We considered body mass index (BMI) as the simple and most commonly used index for measuring general obesity as the comparison indicator in the present study to assess the diagnostic value for other reported obesity indices.We also performed receiver operating characteristic (ROC) curve analysis to define the optimal cut-off points of the anthropometric indicators and the best indices for overweight and obesity. Results: The proposed optimal cut-offs for WC, WHtR, and WHR were 84 cm, 0.48 and 0.78for women and 98 cm, 0.56 and 0.87 for men, respectively. The area under the ROC curve ofWHtR (women: AUC=0.97, 95% CI: 0.96-0.99 vs. men: AUC=0.97, 95%CI: 0.96-0.99) and WC(women: AUC=0.97, 95% CI, 0.95-0.99 vs. men: AUC=0.98, 95% CI: 0.97-0.99) were greater than WHR (women: AUC=0.79, 95% CI =0.74-0.85 vs. men: AUC=0.84, 95% CI=0.79-0.88). Conclusion: This study demonstrated that the WC and WHtR indicators are stronger indicators compared to the others. However, further studies using desirable and also local cutoffs against more accurate techniques for body fat measurement such as computerized tumor (CT) scans and dual-energy x-ray absorptiometry (DEXA) are required.

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