Comparing the diagnostic accuracy of computed tomography vs transoesophageal echocardiography for infective endocarditis − A meta-analysis

Objective: To investigate the comparative diagnostic accuracy of cardiac computed tomography (CT) and transoesophageal echocardiography (TEE) for detecting infective endocarditis. Methods: Original publications published in English language before July, 2021 were thoroughly search in PubMed, CENTRAL (Cochrane Central Register of Controlled Trials), and Google Scholar literature databases. Studies were included if they used CT and/or TEE as an index test, presented data on valvular complications related to infective endocarditis, and used surgical findings as to the reference standard. Results:­­­ Literature screening identified fifteen studies that fulfilled the inclusion criteria. Meta-analysis showed that CT sensitivity for detecting valvular abscesses was higher than that of TEE [0.88 (95% confidence interval [CI]: 0.82 to 0.94; 11 studies involving 842 subjects) versus 0.74 (95% CI: 0.65 to 0.84) P = 0.015; 12 studies involving 917 subjects]. TEE showed statistically significantly greater sensitivity than CT for detecting valvular vegetation [0.91 (95% CI: 0.84 to 0.97, 11 studies involving 971 subjects) versus 0.80 (95% CI: 0.69 to 0.82), 12 studies involving 915 subjects, P =0.019. In case of leaflet detection, TEE showed statistically significantly higher sensitivity than CT (0.76 vs 0.46, P =0.010). Conclusion: CT performs statistically significantly better than TEE for detecting abscesses while TEE provides statistically significant superior results for detecting vegetation. There is a need for well-designed prospective studies to further corroborate these findings. doi: https://doi.org/10.12669/pjms.38.3.5139 How to cite this:Jing L, Song Y. Comparing the diagnostic accuracy of computed tomography vs transoesophageal echocardiography for infective endocarditis − A meta-analysis . Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.5139 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ROLE OF MAGNETIC RESONANCE IMAGING IN NODAL AND METASTATIC STAGING OF PROSTATE CANCER: A SYSTEMATIC REVIEW AND META-ANALYSIS

Objective: To evaluate the usage of MRI in prostate cancer staging, especially in nodal involvement (N-staging) and metastasis (M-staging) of prostate cancer. Methods: This is a systematic review and meta-analysis assessing role of MRI in nodal and metastasis staging of prostate cancer. Search of studies were done through search engine using Pubmed, Cochrane, and EBSCO Host and manual searching. Quality of eligible studies were assessed using a revised version of Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) and analyzed in pooled analysis according to nodal involvement or metastasis staging, modality of diagnosis used as the index test and gold standard used using STATA version 13. Results: Total 26 studies corresponding with study’s eligibility criteria were found. Overall, usage of MRI has a sensitivity of 47% (95% CI 35% - 60%; I2 83.08%) and a specificity of 93% (95% CI 89% - 96%, I2 82.21%) in nodal involvement staging of prostate cancer, while using of MRI in M-staging of prostate cancer shows a sensitivity of 94% (95% CI 86% - 97%) and a specificity of 99% (95% CI 97% - 99%). Using lymphotrophic superparamagnetic nanoparticle (LSN) - enhanced MRI gives higher sensitivity than using MRI without LSN for N-staging of prostate cancer. Conclusion: The usage of MRI in prostate cancer staging has a moderate sensitivity and relatively high specificity in detecting lymph node. Moreover, it plays an important role and even can be used as a modality of choice in assisting bone metastatic prostate cancer detection.

Physical and chemical quality of forage feed pellets with different types of materials and compositions

The aimed of this study was to determine the physical (durability) and chemical quality of forage feed pellets with different raw materials and compositions. This study used two (2) weed raw materials with different forms, namely in the form of fresh and in the form of hay that has been milled. Each raw material was formulated and processed in the same way, a mixture of forage and rice bran, consisted of 90%: 20% and 80%: 20% (calculated based on dry matter, mixed in as fed), pelleted, then dried in the sunshine. Each treatment has three (3) replications. Dried forage pellets were tested with the PDI (pellet durability index) test and chemical quality test (proximate) in the Forage and Pasture Science Laboratory. The experimental design used a Randomized Completely Block Design where there were blocks of material types and blocks of material composition. The variables observed were physical quality in the form of PDI and chemical quality in the form of dry matter (DM), organic matter (OM), crude protein (CP), crude fibre (CF), extract ether (EE) and nitrogen-free extract (NFE). The data were statistically analysed with program SPSS version 26. If there was a significant difference, it was continued with the least significant different (LSD) test. The conclusion of this study was that the physical quality of forage pellets (PDI number) made from weed (Synedrella nodiflora) or Legetan was affected by composition, but neither hay nor fresh weed material affected its quality. The type of raw material in the form of hay and fresh affects the chemical quality of forage pellets in the form of DM, OM, CP, CF and NFE, but does not affect EE. EE was influenced by the composition of the pellets

Recent developments in reactivity testing of supplementary cementitious materials

Identification and rapid characterization of novel supplementary cementitious materials (SCMs) is a critical need, driven by shortfalls in conventional SCMs. In this study, we present a discussion of recently developed reactivity tests – the R3 test, the modified R3 test, the lime strength test, and the bulk resistivity index test. These tests measure reactivity parameters such as heat release, bound water, calcium hydroxide consumption, strength, and bulk resistivity. All tests can screen inert from reactive materials. To additionally differentiate pozzolanic and latent hydraulic materials, two parameters, for example, calcium hydroxide consumption and heat release, are needed. The influences of SCM bulk chemistry, amorphous content, and fineness on measured reactivity are outlined. Reactivity test outputs can predict strength and durability of cement paste/mortar/concrete; however, caution must be exercised as these properties are influenced by a variety of other factors independent of reactivity. Thoughts are provided on using reactivity tests to screen materials for concrete durability.

TESTING THE EFFECTIVENESS OF ORGANIC ACIDS AS A PRESERVATIVE OF ANIMAL FEED INGREDIENTS

This research was conducted in the Laboratory of Feed Industry Technology, Faculty of Animal Husbandry, Bogor Agricultural University, Bogor. The purpose of this study was to determine the effectiveness of using organic acids as preservatives in feed ingredients in the form of pollard and wheat bran based on physical parameters. This study used a completely randomized design with 2 factorials in the form of feed type and organic acid type with 3 replications, samples were stored for 6 weeks and then data were collected in the form of moisture content, pile angle, pile density and specific gravity. The results showed that organic acids affected the moisture content but had no effect on pile density, pile angle and specific gravity. The type of feed affects the value of moisture content, pile angle, pile density and specific gravity. Based on the results of the effectiveness index test, it is known that the total yield value on pollard with 1% lauric acid is 0.64, sorbic acid is 0.35 and propionic acid is 0.77, while wheat bran with lauric acid is 1.07 at -1 sorbic acid. .39 and in propionic acid 2.64. The conclusion of this research is that propionic acid can be used as a preservative for pollard and wheat bran

Autokorelasi Spasial Demam Berdarah Dengue di Kota Tasikmalaya

Tasikmalaya city is a high endemic dengue area which contributes to the high number ofdengue cases in West Java province. This study aims to analyze the geographic distribution patternof dengue infection at the village level and identify high-risk urban villages in Tasikmalaya City. Thisstudy analyzed the surveillance data of dengue cases in 2016–2020 which was routinely managed bythe Tasikmalaya City Health Office. Variables analyzed included date, patient’s name and address(villages). The map data in the form of a shape file (shp.) were obtained from BPS in 2019. The spatialautocorrelation analysis uses two approaches, (the global Moran Index and LISA). The results showedthat DHF cases in the Tasikmalaya city tend to increase in the last 5 years (2016–2020). The highestnumber of annual and monthly dengue cases occurred in 2020, (1,744 cases and 307 cases) withthe incidence rate peaked at 262.6561 per 100,000 population. The global Moran index test using asignificance level of 5 showed that there is a spatial autocorrelation between adjacent sub-districts ofdengue cases in Tasikmalaya city every year for the last 5 years (2016–2020, and cumulative). Thevalue of the global moran index (I) shows a positive correlation between urban villages to the numberof annual dengue cases for the last 5 years and is cumulative. It can be concluded that there aresimilarities in the characteristics of DHF cases in adjacent villages or the relationship between DHFcases tends to be spatially clustered.

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

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.

Diagnostic Test Accuracy of First-Void Urine Human Papillomaviruses for Presence Cervical HPV in Women: Systematic Review and Meta-Analysis

First-void urine usually contains exfoliated cells of the debris and mucus from the female genital organs and cervix, i.e., high concentration of human papillomavirus deoxyribonucleic acid (HPV DNA). We conducted a meta-analysis of published data and determined an accuracy of HPV detection in first-void urine compared to the women’s cervix. According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we carried out a comprehensive literature search. Eligible articles published from 2011 until 2021 were gathered by searching Embase, PubMed and Cochrane Library Central databases. The patient selection, index test, standard test, and patient flow were the factors involved in quality evaluation. A meta-analysis of 15 studies (3412 women) based on 5054 potential records was conducted. Pooled sensitivity for high-risk HPV detection in urine of 78% (70–84%) and specificity of 89% (81–94%) were calculated. Any HPV detection in urine of 87% (74–94%) and 91% (83–96%) were pooled sensitivity and specificity, respectively. HPV 16 and 18 had a pooled sensitivity of 77% (76–77%) and specificity of 98% (98–98%). Meta-analysis indicated variations between the pooled specificities and sensitivities. In meta-regression analysis, a heterogeneity in accuracy by using covariates (bias in patient selection, purpose, sample timing, storage temperature and HPV detection method) were not detected. Our meta-analysis demonstrates the accuracy of detection of HPV in urine for the presence of cervical HPV. Although progress is continuously made in urinary HPV detection, further studies are needed to evaluate and to improve the accuracy of the first-void urine test in order to be comparable with other screening methods.

CSF Neurofilament Light Chain Concentrations Predict Outcome in Bacterial Meningitis

Background and ObjectivesNeurofilament light chain (NfL) is a biomarker for neuroaxonal damage and has been found to be elevated proportionally to the degree of neuronal damage in neurologic diseases. The objective of this study was to determine the prognostic accuracy of NfL concentrations on unfavorable outcome in adults with community-acquired bacterial meningitis.MethodsWe measured NfL concentration CSF samples from a prospective cohort study of adults with community-acquired bacterial meningitis in The Netherlands and determined associations between NfL CSF concentrations, clinical characteristics, and outcome in multivariate analyses. We identified independent predictors of an unfavorable outcome (Glasgow Outcome Scale scores 1–4) by logistic regression.ResultsCSF NfL concentrations were evaluated in 429 episodes of 425 patients with community-acquired bacterial meningitis. The median age of 429 episodes was 62 years (interquartile range, 50–69 years). Of note, 290 of 422 (68%) episodes presented with an altered mental status (Glasgow Coma Scale score < 14). Most common causative pathogens were Streptococcus pneumoniae (73%), Neisseria meningitidis (7%), and Listeria monocytogenes (5%). The overall case fatality rate was 62 of 429 (15%), and unfavorable outcome occurred in 57 (37%) of 429 episodes. In multivariate analysis, predictors of unfavorable outcome were older age (OR 1.03, 95% CI 1.01–1.05), cranial nerve palsy (OR 4, 95% CI 1.6–10.3), high serum C-reactive protein concentration (OR 1.3, 95% CI 1.01–1.05), and high CSF NfL concentration (OR 1.5, 95% CI 1.07–2.00). CSF NfL concentrations were higher in patients presenting with focal cerebral deficits (717 pg/mL [416–1,401] vs 412 pg/mL [278–731]; p < 0.001). The area under the curve (AUC) for predicting unfavorable outcome in bacterial meningitis of CSF NfL concentration was 0.69 (95% CI, 0.64–0.74).DiscussionCSF NfL concentration is independently associated with unfavorable outcome in adults with community-acquired bacterial meningitis, suggesting that CSF NfL concentration may be a useful biomarker for prognostic assessment in bacterial meningitis.Classification of EvidenceCan the level of NfL in CSF (the index test) predict unfavorable outcome in patients with bacterial meningitis, in a cohort of bacterial meningitis patients with a favorable and unfavorable outcome? This study provides Class II evidence that NfL level in CSF is a moderate predictor, with the AUC for predicting unfavorable outcome in bacterial meningitis being 0.69 (95% CI, 0.64–0.74).