scholarly journals Oral Lesions: Poor Markers of Virologic Failure in HIV-Infected Patients on Antiretroviral Therapy

2013 ◽  
Vol 2013 ◽  
pp. 1-7
Author(s):  
Irene Tami-Maury ◽  
James Willig ◽  
Pauline Jolly ◽  
Sten H. Vermund ◽  
Inmaculada Aban ◽  
...  
Keyword(s):  
Viral Load ◽  
Antiretroviral Therapy ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Virologic Failure ◽  
Baseline Viral Load ◽  
Oral Lesions ◽  
Kaplan Meier ◽  
Baseline Factors ◽  
Sensitivity Specificity

The objective of this study was to assess the use of HIV-oral lesions (OLs) as markers of virologic failure (VF) in response to antiretroviral therapy (ART). Concurrent virologic status was compared between 744 individuals with and without OL (X2). Time to VF between OL groups was compared (Kaplan-Meier), and baseline factors associated with VF were determined (Cox Hazard models). Sensitivity, specificity, positive predictive value, and negative predictive value were also computed. At baseline and 12 months, individuals with OL were more likely to have viral load ≥10,000 copies/ml compared to patients without OL (P<0.01). Time to VF between patients with baseline OL (mean: 17 months, 95% CI 16–18) and patients without baseline OL (mean: 19 months, 95% CI: 18–20) was statistically different. Patients who were African-American (HR 1.356; 95% CI: 1.045–0.759), ART-experienced (HR 2.298; 95% CI: 1.743–3.030), had mental disorders (HR 1.410; 95% CI: 1.078–1.843), and had high baseline viral load (HR 2.82; 95% CI: 1.661–3.137), were more likely to have VF after the first six months of ART. OL had a moderate positive predictive value for concurrent VF at 6 months (45.5%) and 18 months (33.3%), but a strong positive predictive value at 12 months (80.0%) and 24 months (100.0%). Findings of this study suggest that OLs could be poor predictors of VF in HIV-infected patients on ART therapy.

scholarly journals Baseline Viral Load Predicts Antiretroviral Therapy Outcomes Among HIV-Infected Patients: An Observational Cohort Study

2021 ◽  
Author(s):  
Chao Zhou ◽  
Wei Zhang ◽  
Rong-Rong Lu ◽  
Lin Ouyang ◽  
Hui Xing ◽  
...  
Keyword(s):  
Viral Load ◽  
Antiretroviral Therapy ◽  
Mortality Rate ◽  
Virologic Failure ◽  
Early Stage ◽  
Strong Predictor ◽  
Early Mortality ◽  
Baseline Viral Load ◽  
Art Initiation ◽  
Overall Mortality

Abstract Background Many factors are associated with human immunodeficiency virus (HIV) antiretroviral therapy (ART) outcomes. Viral load (VL) is a strong predictor of disease progression among HIV-infected patients. The aim of this study was to evaluate the influence of baseline VL on treatment-related mortality and virologic failure. Methods This retrospective study observed HIV-infected patients who were initiated on ART between 2012 and 2018 in Chongqing, China. Mortality assessment included the early mortality rate (deaths within the first 12 months) and the overall mortality rate (deaths during entire observation period). Virologic failure was defined as VL ≥ 200 copies/mL at 12 (range 9–15) months after treatment initiation. Cox proportional hazards regression and logistic regression models were used to evaluate the effects of baseline VL on mortality and virologic failure. Results The cohort included 9791 HIV patients; 50.1% of patients had baseline VL test at ART initiation, and only 18.4% had a baseline VL level of < 10,000 copies/mL. ART initiation at higher VL was significantly associated with the early mortality (10,000–99,999 copies/mL: AHR = 2.4; ≥100,000 copies/mL: AHR = 3.4) and the overall mortality (≥ 100,000 copies/mL: AHR = 1.7). Patients with VL ≥ 100,000 copies/mL and without baseline VL at ART initiation had higher virologic failure rate (AOR = 3.5 and AOR = 3.2, respectively). Conclusions ART initiation with higher VL was significantly associated with a greater risk of mortality and virologic failure, especially in the early stage of treatment. Baseline VL is essential for medical staff as it allows monitoring of treatment effect and allows for interventions to reduce HIV transmission. Continued efforts are needed to enhance the coverage of baseline VL testing.

scholarly journals Foundational Statistical Principles in Medical Research: Sensitivity, Specificity, Positive Predictive Value, and Negative Predictive Value

Medicina ◽  
2021 ◽  
Vol 57 (5) ◽  
pp. 503
Author(s):  
Thomas F. Monaghan ◽  
Syed N. Rahman ◽  
Christina W. Agudelo ◽  
Alan J. Wein ◽  
Jason M. Lazar ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Medical Literature ◽  
Disease Prevalence ◽  
Positive Test Result ◽  
Predictive Values ◽  
Sensitivity Specificity ◽  
Test Result ◽  
Test Probability

Sensitivity, which denotes the proportion of subjects correctly given a positive assignment out of all subjects who are actually positive for the outcome, indicates how well a test can classify subjects who truly have the outcome of interest. Specificity, which denotes the proportion of subjects correctly given a negative assignment out of all subjects who are actually negative for the outcome, indicates how well a test can classify subjects who truly do not have the outcome of interest. Positive predictive value reflects the proportion of subjects with a positive test result who truly have the outcome of interest. Negative predictive value reflects the proportion of subjects with a negative test result who truly do not have the outcome of interest. Sensitivity and specificity are inversely related, wherein one increases as the other decreases, but are generally considered stable for a given test, whereas positive and negative predictive values do inherently vary with pre-test probability (e.g., changes in population disease prevalence). This article will further detail the concepts of sensitivity, specificity, and predictive values using a recent real-world example from the medical literature.

scholarly journals 3124 Early Electrographic Seizure Detection by Neuro ICU Nurses via Bedside Real-Time Quantitative EEG

2019 ◽  
Vol 3 (s1) ◽  
pp. 38-38
Author(s):  
Safa Kaleem ◽  
Christa B. Swisher
Keyword(s):  
Positive Predictive Value ◽  
Real Time ◽  
Predictive Value ◽  
Quantitative Eeg ◽  
University Hospital ◽  
Duke University ◽  
Study Population ◽  
Time To Detection ◽  
Sensitivity Specificity ◽  
Improve Patient

OBJECTIVES/SPECIFIC AIMS: 1. Determine positive predictive value, negative predictive value, sensitivity, and specificity of Neuro ICU nurse interpretation of real-time bedside qEEG. 2. Determine difference in time to detection of first seizure between Neuro ICU nurse qEEG interpretation and EEG fellow reads of cEEG. 3. Determine what qualities of seizures make detection by neuro ICU nurses more or less likely – e.g. duration of seizures, type of seizures, spatial extent of seizures. METHODS/STUDY POPULATION: Recruit neuro ICU nurses taking care of 150 patients admitted to the Neuro ICU at Duke University Hospital who are initiated on cEEG monitoring. Nurses will be consented for their participation in the study. Neuro ICU nurses will evaluate the qEE RESULTS/ANTICIPATED RESULTS: From literature estimates of a 20% seizure prevalence in critical care settings, we hope to have 30 patients with seizures and 120 without. Based on prior study in the Duke Neuro ICU, we hypothesize that Neuro ICU nurses will have sensitivity and DISCUSSION/SIGNIFICANCE OF IMPACT: This is the first prospective study of neuro ICU nurse interpretation of real-time bedside qEEG in patients with unknown NCSE/NCS presence. If nurse sensitivity, specificity, and positive predictive value are clinically useful, which we deem would be so at a sensitivity of 70% or greater, with acceptable false alarm rate, nurse readings of qEEG could significantly decrease the time to treatment of seizures in the Neuro ICU patient population, and perhaps could improve patient outcomes.

Drawing the line in the Edinburgh Postnatal Depression Scale (EPDS): a vital decision

2011 ◽  
Vol 23 (1) ◽  
Author(s):  
Dagmar Lagerberg ◽  
Margaretha Magnusson ◽  
Claes Sundelin
Keyword(s):  
Positive Predictive Value ◽  
Predictive Value ◽  
Postnatal Depression ◽  
Edinburgh Postnatal Depression Scale ◽  
Depression Scale ◽  
Child Interaction ◽  
Mother Child Interaction ◽  
Problem Behaviours ◽  
Low Sensitivity ◽  
Sensitivity Specificity

Abstract Background: The Edinburgh Postnatal Depression Scale (EPDS) is widely used in early child health care. This study examined the appropriateness of the recommended EPDS cut-off score 11/12. Methods: Two main analyses were performed: 1. Associations between EPDS scores and maternal health behaviour, stress, life events, perceived mother-child interaction quality and child behaviour. 2. Screening parameters of the EPDS, i.e., sensitivity, specificity and positive predictive value. EPDS scores were available for 438 mothers and maternal questionnaires for 361 mothers. Results: Already in the EPDS score intervals 6–8 and 9–11, there were notable adversities, according to maternal questionnaires, in stress, perceived quality of mother-child interaction, perceived child difficultness and child problem behaviours. Using maternal questionnaire reports about sadness/distress postpartum as standard, the recommended EPDS cut-off score 11/12 resulted in a very low sensitivity (24%). The cut-off score 6/7 yielded a sensitivity of 61%, a specificity of 82% and a positive predictive value of 61%. Conclusions: In terms of both clinical relevance and screening qualities, an EPDS cut-off score lower than 11/12 seems recommendable.

Diagnostic accuracy of monofilament test to detect diabetic neuropathy

2021 ◽  
Vol 10 (1) ◽  
pp. 20-25
Author(s):  
Sujan Shrestha ◽  
Mamen Prasad Gorhaly ◽  
Manil Ratna Bajracharya
Keyword(s):  
Peripheral Neuropathy ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Diabetic Peripheral Neuropathy ◽  
Perception Threshold ◽  
Sensitivity Specificity ◽  
Vibration Perception ◽  
Monofilament Test

Background Diabetic peripheral neuropathy (DPN) is a significant independent risk factor for diabetic foot, and an effective screening instrument is required to diagnose DPN early to prevent future ulceration and amputation. This study aims to determine the diagnostic accuracy of monofilament test to detect diabetic peripheral neuropathy. Methods This cross-sectional study was conducted in National Academy of Medical Sciences, Bir hospital, Mahabouddha, Kathmandu from February 2016 to January 2017. A total of 96 diabetic patients attending inpatient and outpatient Department were selected. Diabetic peripheral neuropathy was assessed by measurement of loss of protective sensation (LOPS) by monofilament test and compared with vibration perception threshold by standard biothesiometer. The sensitivity, specificity, positive predictive value and negative predictive value of monofilament test were calculated. Results The prevalence of diabetic peripheral neuropathy was 26%. The sensitivity, specificity, positive predictive value and negative predictive value of monofilament test were found to be 92.0%, 95.8%, 88.5% and 97.1% respectively. There was strong association between LOPS by monofilament and vibration perception threshold by biothesiometer. Conclusion This study showed a strong diagnostic accuracy of monofilament test to detect DPN when compared with biothesiometer. As monofilament test is a cheap, easily available, and portable, it can be used in the periphery where biothesiometer is not available.  

DIAGNOSTIC ACCURACY OF GRAY SCALE ULTRASONOGRAPHY VERSUS COLOR DOPPLER IN SUSPECTED CASES OF ACUTE APPENDICITIS

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Tahir Iqbal ◽  
Muhammad Usman Shahid ◽  
Ishfaq Ahmad Shad ◽  
Shahzad Karim Bhatti ◽  
Syed Amir Gilani ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Color Doppler ◽  
Diagnostic Tools ◽  
Gray Scale ◽  
Versus Color ◽  
Sensitivity Specificity

ABSTRACT: BACKGROUND: A common surgical emergency is acute appendicitis. Various diagnostic tools are available to diagnosis acute appendicitis. Radiological investigations play an important role in making accurate and early diagnosis and thus preventing morbidity associated with the disease. OBJECTIVE: To determine the diagnostic accuracy of gray scale ultrasonography versus color Doppler in suspected cases of acute appendicitis. MATERIALS AND METHODS: The study was carried in the department of Radiology of Mayo Hospital, Lahore. A total of 75 patients were enrolled of age 18-40 years, both genders who were suspected cases of acute appendicitis. All patients underwent baseline investigations along with gray scale ultrasonography and color Doppler. All patients were subjected to surgery to confirm the diagnosis and findings were subjected to statistical analysis. RESULTS: The mean age of the patients was 23.25 ±10.55 and mean transverse diameter of appendix was 8.37 ±3.39. There were 62.7% males and 37.3%females. Findings of gray scale ultrasonography and color Doppler were then correlated with surgical findings to calculate the diagnostic accuracy of these modalities. The results revealed that gray scale ultrasonography sensitivity, specificity, positive predictive value, negative predictive value and accuracy was 92.7%, 94.32%, 95%, 91.4% and 93.3% respectively, whereas color Doppler had sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 97.7%, 93.9%, 95.3%, 97% and 96% respectively. Diagnostic accuracy of both modalities together was 98.6%. CONCLUSION: Color Doppler has better diagnostic accuracy than gray scale ultrasonography for diagnosis of acute appendicitis and the combination of both modalities yields diagnostic accuracy that is similar to gold standard.

scholarly journals Reliability of digital panoramic radiography in the diagnosis of carotid artery calcifications

2014 ◽  
Vol 47 (1) ◽  
pp. 28-32 ◽  
Author(s):  
Vilson Lacerda Brasileiro Junior ◽  
Aníbal Henrique Barbosa Luna ◽  
Marcelo Augusto Oliveira de Sales ◽  
Tânia Lemos Coelho Rodrigues ◽  
Priscilla Lopes da Fonseca Abrantes Sarmento ◽  
...  
Keyword(s):  
High Risk ◽  
Carotid Artery ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Carotid Arteries ◽  
Panoramic Radiography ◽  
Digital Panoramic Radiography ◽  
Significant Difference ◽  
Mcnemar’S Test ◽  
Sensitivity Specificity

Objective The present study evaluated the reliability of digital panoramic radiography in the diagnosis of carotid artery calcifications. Materials and Methods Thirty-five patients under high-risk for development of carotid artery calcifications who had digital panoramic radiography were referred to undergo ultrasonography. Thus, 70 arteries were assessed by both methods. The main parameters utilized to evaluate the panoramic radiography reliability in the diagnosis of carotid artery calcifications were accuracy, sensitivity, specificity and positive predictive value of this method as compared with ultrasonography. Additionally, the McNemar's test was utilized to verify whether there was a statistically significant difference between digital panoramic radiography and ultrasonography. Results Ultrasonography demonstrated carotid artery calcifications in 17 (48.57%) patients. Such individuals presented with a total of 29 (41.43%) carotid arteries affected by calcification. Radiography was accurate in 71.43% (n = 50) of cases evaluated. The degree of sensitivity of this method was 37.93%, specificity of 95.12% and positive predictive value of 84.61%. A statistically significant difference (p < 0.001) was observed between the methods evaluated in their capacity to diagnose carotid artery calcifications. Conclusion Digital panoramic radiography should not be indicated as a method of choice in the investigation of carotid artery calcifications.

scholarly journals The slipping slipper sign: a simple test with high specificity and positive predictive value for peripheral neuropathy among diabetic patients

2012 ◽  
Vol 2 (2) ◽  
pp. 51 ◽  
Author(s):  
Krystal A.T. Gayle ◽  
Marshall K. Tulloch-Reid ◽  
Rainford J. Wilks ◽  
Trevor S. Ferguson
Keyword(s):  
Peripheral Neuropathy ◽  
Positive Predictive Value ◽  
Diabetic Neuropathy ◽  
Predictive Value ◽  
High Specificity ◽  
Diabetic Patients ◽  
Simple Test ◽  
Diabetes Clinic ◽  
Sensitivity Specificity ◽  
Single Question

This study evaluated the ability of the slipping slipper sign (defined as unknowingly losing a slipper while walking) to identify diabetic neuropathy in Jamaican patients. A single question was used to ascertain the presence of the slipping slipper sign (SSS) among 69 patients attending a diabetes clinic. Nurses assessed pain, vibration and pressure perception among the same patients in order to detect diabetic neuropathy. The sensitivity, specificity and positive predictive value for the SSS were calculated. Eight participants (men=5, women=3) reported positive SSS. The SSS had a sensitivity of 28.6%, specificity of 100% and positive predictive value (PPV) 100% for neuropathy on at least one of the three tests. These findings indicate that the SSS has high specificity and PPV for diabetic neuropathy but the sensitivity is low. The sign may be a useful adjuvant to conventional methods of screening for severe neuropathy

scholarly journals ACCURACY OF THE UPPER LIP BITE TEST;

2012 ◽  
Vol 20 (01) ◽  
pp. 132-138
Author(s):  
MUHAMMAD ATIF ◽  
MUHAMMAD ABDULLAH ◽  
MUHAMMAD JAVAD YOUSAF ◽  
Khalid Buland
Keyword(s):  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Difficult Intubation ◽  
Predictive Value ◽  
Elective Surgery ◽  
Cross Sectional Study ◽  
Military Hospital ◽  
Upper Lip ◽  
Cross Sectional ◽  
Sensitivity Specificity

Objective: To compare the accuracy of Upper lip bite test with modified Mallampati classification for predicting the difficultlaryngoscopic intubation. Study Design: Cross sectional Study. Place and duration of study: The study was carried out at Department ofAnaesthesiology, Intensive Care and Pain management, Combined Military hospital, Rawalpindi from September 2008 to August 2009.Patients and Methods: Four hundred patients undergoing elective surgery meeting the inclusion/exclusion criteria were enrolled afterwritten informed consent. The airways of the patients were evaluated by using the modified Mallampati classification (MMP) and theUpper lip bite test (ULBT). MMP class 3 or 4 and ULBT class 3 were considered as indicators of difficult intubation. The laryngeal view wasgraded by Cormack and Lehane classification (Gold standard). Grade 1 or 2 was considered to represent easy intubation and grade 3 or 4to represent difficult intubation. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy werecalculated for both the tests separately by using the 2×2 table. Results: ULBT had a higher accuracy of 94%, specificity of 99.2% andpositive predictive value 70% compared to MMP accuracy of 82.7%, specificity of 84.4% and positive predictive value of 22.7%.Conclusions: The diagnostic accuracy of the Upper lip bite test was more than the modified Mallampati classification. We suggest that itbe compared with the other prevailing tests as well which are often used to assess difficult intubations.

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