Electrophysiological and fundoscopic detection of intracranial hypertension in craniosynostosis

Aims To assess the diagnostic accuracy of fundoscopy and visual evoked potentials (VEPs) in detecting intracranial hypertension (IH) in patients with craniosynostosis undergoing spring-assisted posterior vault expansion (sPVE). Methods Children with craniosynostosis undergoing sPVE and 48-hour intracranial pressure (ICP) monitoring were included in this single-centre, retrospective, diagnostic accuracy study. Data for ICP, fundoscopy and VEPs were analysed. Primary outcome measures were papilloedema on fundoscopy, VEP assessments and IH, defined as mean ICP > 20 mmHg. Diagnostic indices were calculated for fundoscopy and VEPs against IH. Secondary outcome measures included final visual outcomes. Results Fundoscopic examinations were available for 35 children and isolated VEPs for 30 children, 22 of whom had at least three serial VEPs. Sensitivity was 32.1% for fundoscopy (95% confidence intervals [CI]: 15.9–52.4) and 58.3% for isolated VEPs (95% CI 36.6–77.9). Specificity for IH was 100% for fundoscopy (95% CI: 59.0–100) and 83.3% for isolated VEPs (95% CI: 35.9–99.6). Where longitudinal deterioration was suspected from some prVEPs but not corroborated by all, sensitivity increased to 70.6% (95% CI: 44.0–89.7), while specificity decreased to 60% (95% CI: 14.7–94.7). Where longitudinal deterioration was clinically significant, sensitivity decreased to 47.1% (23.0–72.2) and specificity increased to 100% (47.8–100). Median final BCVA was 0.24 logMAR (n = 36). UK driving standard BCVA was achieved by 26 patients (72.2%), defined as ≥0.30 logMAR in the better eye. Conclusion Papilloedema present on fundoscopy reliably indicated IH, but its absence did not exclude IH. VEP testing boosted sensitivity at the expense of specificity, depending on method of analysis.

Real-Time PCR Assay for the Detection of Dermatophytes: Comparison between an In-House Method and a Commercial Kit for the Diagnosis of Dermatophytoses in Patients from Dakar, Senegal

Background. PCR assays have been developed for the diagnosis of dermatophytes, yet data in African populations are scarce. Objective. This study aimed to compare two PCR assays for the diagnosis of dermatophytosis in outpatients at the Aristide Le Dantec University Hospital in Dakar, Senegal. Patients and methods. A total of 105 samples, including 24 skin, 19 nail and 62 hair samples collected from 99 patients were included in this study. Each sample was subjected to conventional diagnosis (CD), including direct microscopy and culture, and two real-time PCR assays: one in-house (IH)-PCR, used at the University Hospital of Marseille and the Eurobio Scientific commercial kit (CK): designed for the specific detection of six dermatophytes not including Microsporum audouinii. Results. Of the 105 specimens, 24.8%, 36.2% and 20% were positive by CD, IH-PCR and CK-PCR, respectively. The IH-PCR and CK-PCR exhibited 88.9% and 65.4% sensitivity, respectively. With a 36.6 diagnostic odd ratio and 1.41 needed to diagnose, the IH-PCR displayed better diagnostic indices than the CK-PCR. It is notable that, when considering the species that it claims to detect, when it came to skin and nail samples, CK-PCR sensitivity increased to 77%. Conclusions. The pan-dermatophyte IH-PCR performed better in the diagnosis of dermatophytosis in this African population than the CK-PCR, which is not designed to detect M. audouinii. Nevertheless, both assays exhibited similarly good diagnostic indices for tinea corporis and tinea unguium, both of which are localisations where M. audouinii is more rarely involved than in tinea capitis.

Carbohydrate Antigen 125 Supplements Carbohydrate Antigen 19-9 for the Prediction of Invasive Intraductal Papillary Mucinous Neoplasms of the Pancreas

BackgroundIntraductal papillary mucinous neoplasm (IPMN) is a disease with malignant potential. IPMNs of the pancreas are mainly managed according to radiographic indications, which lack accuracy in defining grades of IPMNs. Therefore, other indications such as serological biomarkers should be employed to predict the invasiveness of IPMNs.MethodsWe investigated preoperative serum levels of CA19-9, CA125 and CEA of 381 surgical patients with a definite pathological diagnosis of IPMN from July 2010 to December 2019 at Shanghai Cancer Center. We calculated the Youden indices of each point of receiver operating characteristic (ROC) curves to find the most appropriate cut-off values of CA19-9, CA125 and CEA in recognizing malignant IPMNs. Serological biomarker differences were correlated with grades and biological behaviours of IPMNs. Diagnostic indices of these serum biomarkers were calculated.ResultsMalignant group had higher serum levels of CA19-9, CA125 and CEA. According to ROC curves, the most appropriate cut-off value of CA125 were readjusted to 13.5 U/ml while the cut-off values of CA19-9 and CEA remained 37 U/ml and 5.3 ng/l as them mostly be employed. Besides, CA19-9 elevation was significantly associated with vascular invasion and perineural infiltration. We found CA125 may predict invasive IPMN in CA19-9 negative subgroup according to ROC curve. ConclusionsSerological biomarkers are useful and sensitive indications for recognizing invasive IPMNs. CA19-9 has the upmost diagnostic indices among all regularly used serum biomarkers in differentiating malignant and benign IPMNs. CA19-9 should be combined with CA125 to form a more favourable biomarker panel for IPMNs malignancy prediction.

Interactive 3-D visual analysis of ERA5 data: improving diagnostic indices for marine cold air outbreaks and polar lows

Recent advances in visual data analysis are well suited to gain insights into dynamical processes in the atmosphere. We apply novel methods for three-dimensional (3-D) interactive visual data analysis to investigate marine cold air outbreaks (MCAOs) and polar lows (PLs) in the recently released ERA5 reanalysis data. Our study aims at revealing 3-D perspectives on MCAOs and PLs in ERA5 and at improving the diagnostic indices to capture these weather events in long-term assessments on seasonal and climatological timescales. Using an extended version of the open-source visualization framework Met.3D, we explore 3-D perspectives on the structure and dynamics of MCAOs and PLs and relate these to previously used diagnostic indices. Motivated by the 3-D visual analysis of selected MCAO and PL cases, we conceptualize alternative index variants that capture the vertical extent of MCAOs and their distance to the dynamical tropopause. The new index variants are evaluated, along with previously used indices, with a focus on their skill as a proxy for the occurrence of PLs. Testing the association of diagnostic indices with observed PLs in the Barents and the Nordic seas for the years 2002–2011 shows that the new index variants based on the vertical structure of cold air masses are more skilful in distinguishing the times and locations of PLs, compared with conventional indices based on sea–air temperature difference only. We thus propose using the new diagnostics for further analyses in climate predictions and climatological studies. The methods for visual data analysis applied here are available as an open-source tool and can be used generically for interactive 3-D visual analysis of atmospheric processes in ERA5 and other gridded meteorological data.

How to Analyze the Diagnostic Performance of a New Test? Explained with Illustrations

Diagnostic tests are pivotal in modern medicine due to their applications in statistical decision-making regarding confirming or ruling out the presence of a disease in patients. In this regard, sensitivity and specificity are two most important and widely utilized components that measure the inherent validity of a diagnostic test for dichotomous outcomes against a gold standard test. Other diagnostic indices like positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, accuracy of a diagnostic test, and the effect of prevalence on various diagnostic indices have also been discussed. We have tried to present the performance of a classification model at all classification thresholds by reviewing the receiver operating characteristic (ROC) curve and the depiction of the tradeoff between sensitivity and (1–specificity) across a series of cutoff points when the diagnostic test is on a continuous scale. The area under the ROC (AUROC) and comparison of AUROCs of different tests have also been discussed. Reliability of a test is defined in terms of the repeatability of the test such that the test gives consistent results when repeated more than once on the same individual or material, under the same conditions. In this article, we have presented the calculation of kappa coefficient, which is the simplest way of finding the agreement between two observers by calculating the overall percentage of agreement. When the prevalence of disease in the population is low, prospective study becomes increasingly difficult to handle through the conventional design. Hence, we chose to describe three more designs along with the conventional one and presented the sensitivity and specificity calculations for those designs. We tried to offer some guidance in choosing the best possible design among these four designs, depending on a number of factors. The ultimate aim of this article is to provide the basic conceptual framework and interpretation of various diagnostic test indices, ROC analysis, comparison of diagnostic accuracy of different tests, and the reliability of a test so that the clinicians can use it effectively. Several R packages, as mentioned in this article, can prove handy during quantitative synthesis of clinical data related to diagnostic tests.

Speculative Carcinogenicity Assessment of Polycyclic Aromatic Hydrocarbons Found in Some Anti-Diarrheal Herbal Drugs Sold in Ondo State of Nigeria

The conviction that herbal drugs have enormous health benefits has led to increase the rate of their consumption by Nigerians. The aim of this study was to assess the carcinogenic property of some popularly consumed anti-diarrheal herbal drugs via polycyclic aromatic hydrocarbons (PAHs) quantification. Three prevalent anti-diarrhea herbal drugs , Odunmo herbal drug (Hibiscus rosa-sinensis and Bacopamonnieri), Orogun herbal mixture (Hibiscus sabdariffaI and Hedera helix), and Alora herbal syrup (Aloe vera and Hibiscus sabdariffaI) were bought for the purpose of this study and they were coded as samples A, B, and C, respectively. The ultrasonic extraction of the herbal drugs was carried out using standard procedures. The crude extracts obtained were purified using a chromatographic method. The concentrations of PAHs were quantified using gas chromatography flame ionization detector (GCFID). The diagnostic indices, group distribution, toxicity equivalence and exposure dosage were estimated. The cancer risk values were theoretically speculated based on concentrations of PAHs in the tested herbal drugs, associated with the published estimates of each concentration to cause cancer and the calculated exposure doses of the anti-diarrhea herbal drug samples were within three age groups (children, Preteen and adult). The highest concentration of total PAHs was observed in sample A (58.2815mg/kg) and the lowest concentration in sample B (44.1898mg/kg), but the concentration of total PAHs in sample C was 47.4169 mg/kg. The highest percentage of carcinogenic PAHs in the anti-diarrheal herbal drugs was found in sample C (48.66%) and the lowest in sample B (38.17%). The diagnostic indices confirmed a pyrogenic source of PAHs. Group distribution of PAHs showed that the herbal drugs are weakly carcinogenic due to high concentrations of low and moderate molecular weight PAHs. The cancer risk estimated for all the age groups where below the limit established by the United State Environmental Protection Agency (USEPA) for cancer (1 x 10-6). This ascertained that the use of these herbal drugs cannot cause cancer. However, consumers of these herbal drugs should take necessary precautions as excessive intake can lead to dangerous health implications.

Interactive 3-D visual analysis of ERA 5 data: improving diagnostic indices for marine cold air outbreaks

We inspect the 3-D structure of Marine Cold Air Outbreaks (MCAOs) and Polar Lows (PLs) in ERA5 data with the aim of improving diagnostic indices to capture these weather events in long-term assessments on seasonal and climatological time-scales. For this study, we designed a workflow that starts with the interactive 3-D visual exploration of single MCAO and PL events, using an extended version of the open-source visualization framework Met.3D, followed by the design and 5 statistical testing of new diagnostic indices in long-term assessments. Results from the interactive visual data exploration provide insights into the complex 3-D shape and dynamics of MCAOs and PLs in ERA5 data. Motivated by the visual analysis of single cases, we extend widely-used diagnostics by conceptualizing a simple index to capture the vertical extent of the lower-level instability induced by MCAOs. Testing the association of diagnostic indices with observed PLs in the Barents and the Nordic Seas (STARS data) shows that, the new MCAO index introduced here has an important advantage: it is a more 10 skillful indicator for distinguishing the times and locations of PLs, compared with previously-used indices. We thus propose the new index for further analyses in seasonal climate predictions and climatological studies. The methods for interactive 3-D visual data analysis presented here are available as a generic open-source tool for investigating atmospheric processes in ERA5 and other gridded meteorological data.

THE EFFECT OF TRYPANOSOMOSIS ON PLASMA PROTEIN LEVELS IN INDIGENOUS CATTLE

A field survey involving 180 adult white Fulani cattle was carried out in the Guinea Savannah and Derived Savannah vegetational zones of South Western Nigeria to determine the effect of natural trypanosomal infection on plasma protein levels. Enzyme-linked immunosorbent examination were used as diagnostic indices. The results showed a prevalence of 36.7% mixed infection in the animals sampled. It was also observed that the albumin level was lowered, globulin level increased and the total protein level was slightly on the increase. Trypanosomal infection in this study therefore affects the concentration of total and differential plasma protein levels in indigenous cattle.

Interactive 3-D visual analysis of ERA 5 data: improving diagnostic indices for Marine Cold Air Outbreaks

<p>We present the application of interactive 3-D visual analysis techniques using the open-source meteorological visualization framework Met.3D <strong>[1]</strong> for investigating ERA5 reanalysis data. Our focus lies on inspecting atmospheric conditions favoring the development of extreme weather events in the Arctic. Marine Cold Air Outbreaks (MCAOs) and Polar Lows (PLs) are analyzed with the aim of improving diagnostic indices for capturing extreme weather events in seasonal and climatological assessments. We adopt an integrated workflow starting with the interactive visual exploration of single MCAO and PL events, using an extended version of Met.3D, followed by the design and testing of new diagnostic indices in a climatological assessment. Our interactive visual exploration provides insights into the complex 3-D shape and dynamics of MCAOs and PLs. For instance, we reveal a slow wind eye of a PL that extends from the surface up into the stratosphere. Motivated by the interactive visual analysis of single cases of MCAOs, we design new diagnostic indices, which address shortcomings of previously used indices, by capturing the vertical extent of the lower-level static instability induced by MCAOs. The new indices are tested by comparison with observed PLs in the Barents and the Nordic Seas (as reported in the STARS data set). Results show that the new MCAO index introduced here has an important advantage compared with previously used MCAO indices: it is more successful in indicating the times and locations of PLs. We thus propose the new index for further analyses in seasonal climate predictions and climatological studies. The methods for interactive 3-D visual data analysis presented here are made freely available for public use as part of the open-source tool Met.3D. We thereby provide a generic tool that can be used for investigating atmospheric processes in ERA5 data by means of interactive 3-D visual data analysis. Met.3D can be used, for example, during an initial explorative phase of scientific workflows, as a complement to standard 2-D plots, and for detailed meteorological case-analyses in 3-D.</p><div><br><div> <p>[1] http://met3d.wavestoweather.de, https://collaboration.cen.uni-hamburg.de/display/Met3D/</p> </div> </div>