A COMPARATIVE STUDY OF PREOPERATIVE ENDOMETRIAL BIOPSY AND ENDOMETRIAL CURETTAGE FROM HYSTERECTOMY SPECIMEN IN PERIMENOPAUSAL WOMEN WITH ABNORMAL UTERINE BLEEDING

Objective: To assess the diagnostic accuracy of preoperative curettage biopsy samples and to correlate the ndings with post hysterectomy curettage samples for different endometrial pathologies. Methods: This cross-sectional study was conducted from October 2012 to September 2014 in the Department of Pathology in collaboration with the Department of Obstetrics and Gynaecology, Regional Institute of Medical Sciences, Imphal, Manipur. Approval from institutional ethical committee was taken before starting the study. Specimens of all perimenopausal women with abnormal uterine bleeding (AUB) who underwent endometrial biopsy and subsequent hysterectomy were studied in the Department of Pathology. Results: A total of 50 cases of clinically diagnosed patients with abnormal uterine bleeding were studied. Preoperative Endometrial curettage biopsy was followed By curettage post-hysterectomy. Biopsy ndings were correlated with post-hysterectomy curettage ndings. The age group of the patients range from 37 years to 53 years with maximum number of cases in the range of 45 to 50 years (38%). Proliferative endometrium was the most common pattern (56%) obtained by endometrial curettage biopsy as well as in post hysterectomy curettage followed by secretory endometrium. Statistical analysis of endometrial biopsy study of 48 cases showed that it has a high Sensitivity (100%), Negative predicted value (100%), Specicity (97.44%) and Positive predicted value (90.91%). The Accuracy of the test was 98%. Conclusions: While endometrial curettage biopsy using uterine curette is not the gold standard for diagnosing endometrial pathologies in AUB, it is an important diagnostic tool in the investigation for assessment of endometrium as it has few advantages.

A study of the correlation between phenotypic antimicrobial susceptibility testing methods and the associated genotypes determined by whole genome sequencing for a collection of Escherichia coli of bovine origin

Antimicrobial resistance (AMR) has increased at an alarming pace in the recent years. Molecular-based methods such as whole genome sequencing (WGS) offer a potential alternative to the conventional labour-intensive methods traditionally used to characterise AMR phenotypes. The aim of this study was to investigate whether WGS could be used as a predictor of AMR in Escherichia coli isolates of bovine origin. Genomes of 143 E. coli cultured from cattle presenting with diarrhoea or mastitis were sequenced on an Illumina MiSeq platform. AMR genes were identified using the ResFinder and AMRFinder databases. Antimicrobial susceptibility testing by disk diffusion was performed on a panel of 10 antibiotics, covering 7 antimicrobial classes. Minimum inhibitory concentration (MIC) measurements were made using the Sensititre plate with 6 antibiotics, covering 5 antimicrobial classes. Correlation between genotype and phenotype was assessed statistically by means of a two-by-two table analysis and Cohen's kappa (κ) test. The overall κ correlation between WGS and disk diffusion was 0.81, indicating a near perfect agreement, and the average positive predicted value was 77.4 %. Correlation for individual antimicrobial compounds varied, with five yielding near perfect agreement (κ = 0.81-1.00; amoxicillin, florfenicol, gentamicin, tetracycline and trimethoprim-sulfamethoxazole), one showing substantial agreement (κ = 0.65; nalidixic acid), and four showing moderate agreement (κ = 0.41-0.60). The overall κ correlation between WGS and MIC was 0.55 indicating moderate agreement, and the average positive predicted value was 68.6 %. Three antibiotics yielded near perfect agreement (gentamicin, tetracycline and trimethoprim-sulfamethoxazole) and a further three showed fair agreement (κ = 0.21-0.40). WGS is a useful tool that can be used for the prediction of AMR phenotypes, and correlates well with disk diffusion results. MIC measurements may be necessary for antimicrobial compounds with a high proportion of intermediately resistant isolates recorded, such as cephalothin.

Corneal transplantation during the COVID-19 pandemic: An operational guide

Purpose: To provide an operational guide for corneal transplantation during the COVID-19 pandemic aimed to maintain surgery and avoid spreading of SARS-CoV-2. Methods: Prospective observational case series study in patients requiring corneal graft manage toward separate free and restricted pathways for those COVID-19 negative or positive, respectively. Results: During the national lockdown, 30 consecutive patients underwent endothelial ( n = 16), penetrating ( n = 9), and anterior lamellar keratoplasty ( n = 5). Two patients followed the COVID-19 restricted pathway, as they were considered positive while waiting for test results. Nine patients were hospitalized one night in the hospital. On admission to the hospital before surgery, at surgery, the day after surgery and at 7 and 30 days all patients and health-care personnel showed no symptoms and resulted negative at risks factors/exposure to the SARS-CoV-2 infection and occurrence of COVID-19. Nucleic acid testing resulted not detectable in all patients and SARS-CoV-2 antibodies quantification showed IgG and IgM below the positive predicted value in 29 patients. One patient showed IgM above the cut-off of significance (1.21 and 1.03 preoperative and 1-month postoperative, respectively) that were considered irrelevant because of the absence of symptoms and exposure risks. Conclusions: The concept of donor emergency (i.e. short-term availability of transplant tissues), makes corneal transplantation an always-urgent activity because it is related to the availability of the corneal tissue from a donor. Modest adjustments to ophthalmic clinic and eye surgery organization are required to maintain surgery and care of eye patients in a safe environment.

Use of ICD-10 diagnosis codes to identify seropositive and seronegative rheumatoid arthritis when lab results are not available

Background Rheumatoid factor (RF) and anti-cyclic citrullinated peptide (CCP) antibody tests are often measured at the time of rheumatoid arthritis (RA) diagnosis but may not be repeated and therefore not available in electronic health record (EHR) data; lab test results are unavailable in most administrative claims databases. ICD10 coding allows discrimination between rheumatoid factor positive (M05) (“seropositive”) and seronegative (M06) patients, but the validity of these codes has not been examined. Methods Using the ACR’s Rheumatology Informatics System for Effectiveness (RISE) EHR-based registry and U.S. MarketScan data where some patients have lab test results, we assembled two cohorts. Seropositive RA was defined having a M05 diagnosis code on the second rheumatologist encounter, M06 similarly identified seronegative RA, and RF and anti-CCP lab test results were the gold standard. We calculated sensitivity (Se) and positive predicted value (PPV) of the M05/M06 diagnosis codes. Results We identified 43,581 eligible RA patients (RISE) and 1185 (MarketScan) with RF or anti-CCP lab test results available. Using M05 as the proxy for seropositive RA, sensitivity = 0.76, PPV = 0.82 in RISE, and Se = 0.73, PPV = 0.84 in MarketScan. Results for M06 as a proxy for seronegative RA were comparable in RISE, albeit somewhat lower in MarketScan. Over 3 consecutive visits, approximately 90% of RA patients were coded consistently using either M05 or M06 at each visit. Conclusion Under ICD10, M05 and M06 diagnosis codes are reasonable proxies to identify seropositive and seronegative RA with high sensitivity and positive predictive values if lab test results are not available.

Predictive value of spirometry in early detection of lung disease in adults: a cohort study

BackgroundSpirometry is essential to identify cases with obstructive lung diseases (OLDs) in primary care. However, knowledge about the long-term prognostic outcome among younger individuals is sparse.AimTo describe the predictive value of spirometry among individuals in the age groups 30–49 years and 45–64 years.Design & settingA population-based cohort study supplied with data from Danish national registries.MethodSpirometry was performed in 905 adults aged 30–49 years in 1991 and in 1277 adults aged 45–64 years in 2006. The participants were categorised into three groups: forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) <70, 70–75, and >75. They were followed throughout 2017 using Danish national registries. Lung disease was defined as fulfilling at least one of the following: two prescriptions for respiratory medicine were redeemed within a year; one lung-related contact to the hospital; or lung-related death.ResultsIn the 1991 cohort, 21% developed lung diseases and in the 2006 cohort 17% developed lung diseases throughout 2017. The probability of developing lung disease if FEV1/FVC 70–75 was 35% (95% confidence interval [CI] = 25% to 44%) in the 1991 cohort and 23% (95% CI = 17% to 28%) in the 2006 cohort. The positive predicted value (PPV) was higher for both cohorts when focusing on smoking history and self-reported respiratory symptoms.ConclusionThe initial spirometry has a high predictive value to identify cases of future lung diseases. In addition, the group with FEV1/FVC 70–75 had a high risk of developing lung diseases later in life, suggesting this group would be a meaningful target of special interest.

Diagnostic accuracy of ultrasound in evaluation of obstructive jaundice with MRCP as gold standard

Objective: To evaluate the diagnostic accuracy of ultrasound in obstructive jaundice taking MRCP as gold standard. Methods: This cross-sectional study was conducted at Dow Institute of Radiology (DIR), Dow University of Health Sciences (DUHS), Karachi from 2nd May 2018 till 2nd November 2018. Both male and female patients aged 30 to 80 years with suspected obstructive jaundice were included. Patients already diagnosed with obstructive jaundice were excluded. MRCP and ultrasound were performed in suspected patients. Diagnostic accuracy including sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of obstructive jaundice were calculated using contingency tables using MRCP findings as gold standard. Results: Mean age of the patients was 54.73 ± 12.65 years. In causes of obstruction, choledocholothiasis was responsible for 85 (35.1%), stricture 61 (25.2%), carcinoma of head of pancreas 39 (16.1%), periampullary carcinoma 21 (8.7%), cholangiocarcinoma 10 (4.1%) and gallbladder carcinoma 26 (10.7%) of the cases. Diagnostic accuracy of ultrasound in obstructive jaundice taking MRCP findings as gold standard showed sensitivity, specificity, positive predicted value (PPV), negative predicted value (NPV) and overall diagnostic accuracy as 84.57%, 79.10%, 91.36%, 66.25% and 83.06%. Conclusion: Ultrasound has a high sensitivity, moderate specificity, and high diagnostic accuracy in diagnosis of obstructive jaundice. doi: https://doi.org/10.12669/pjms.36.4.1665 How to cite this:Hanif H, Khan SA, Muneer S, Adil SO. Diagnostic accuracy of ultrasound in evaluation of obstructive jaundice with MRCP as gold standard. Pak J Med Sci. 2020;36(4):---------. doi: https://doi.org/10.12669/pjms.36.4.1665 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.

Development of the Lebanese insomnia scale (LIS-18): a new scale to assess insomnia in adult patients

Objective To define the development and validation of the Lebanese Insomnia Scale (LIS-18) to be used for the evaluation of insomnia in Lebanese adult patients. Methods A first cross-sectional study, conducted between August 2017 and April 2018, enrolled 789 participants (sample 1). A second sample was recruited in May 2018 to confirm the results obtained from the first sample. Results Five factors derived from the LIS-18 scale items with an Eigenvalue over 1, explaining a total of 59.64% of the variance (Cronbach’s alpha = 0.821). The first ROC curve, comparing participants with diagnosed insomnia to healthy individuals, showed that the optimal score was seen at a cutoff of 58.00, with a good sensitivity and specificity at this cutoff (93.3 and 88.4%, respectively). A second ROC curve, comparing participants taking drug medication for insomnia vs. those not taking drug, showed that the optimal score was seen at a cutoff of 52.50, with a good sensitivity and specificity at this cutoff (89.5 and 80.0%, respectively). A third ROC curve, comparing participants diagnosed by a physician or taking drug medication for insomnia and healthy control without insomnia drug, showed that the optimal score was seen at 51.50, with good sensitivity and specificity at this cutoff as well (90.0 and 78.10%, respectively). The positive predicted value (PPV) of the LIS-18 score in sample 2 was 93.3%, whereas the negative predicted value (NPV) was 88.4%. Conclusion The results demonstrate that the LIS-18 can be used in clinical practice and research to measure insomnia.

Diabetic Exudate Detection in Color Retinal Images

Diabetic retinopathy is a vascular complication of long-term diabetes. It causes damage to the small blood vessels positioned in the retina. These damaged blood vessels affect the macula and lead to vision loss. Exudates are one of the early signs of diabetic retinopathy disease in the retinal image, which occurs due to built-up of lipidic accumulation within the retina. In this paper, an image processing method is presented for diabetic exudates detection. First, high performance pre-processing is applied not only for de-noising and normalization but also to remove artefacts and reflection that could mislead exudates detection. Then, morphological operations are applied for the final candidate segmentation. Eight region features are extracted from the exudate region then random forest classifier is applied to differentiate between exudates and non-exudates region. The proposed method is evaluated using e_ophtha_EX dataset, achieving 80% sensitivity and 77% positive predicted value.

Evaluating diagnostic value of clinical symptoms and signs for chronic sinusitis by CT-scan in patients admitted to Ardabil city hospital, Iran

Background: Chronic rhinosinusitis (CRS) refers to inflammatory nasal and para nasal sinuses which last at least 12 weeks. Despite its high prevalence, it is not easy to diagnose, and clinical criteria and simple radiographs are not so sensitive. The aim of this study was to investigate the diagnostic value of clinical symptoms and signs for chronic sinusitis by Ct-scan in patients admitted to Ardabil city hospital, Iran.Methods: This descriptive cross-sectional study has been done on 83 patients with CRS symptoms who referred to ENT of Ardabil city hospital. The necessary checklist included information such as age, gender, clinical symptoms and CT scan findings were completed and analyzed by statistical methods in SPSS version 21.Results: Of all 83 patients, 55.4% were female and most of patients were in age group 30-39 years with 30.1%. Of all patients, 29 (35%) had positive findings in CT scan of which 72.4% were female. The highest rate of sinus involvement was in the ethmoid sinus. The highest positive predicted value was for nose congestion with OR=2.26 and the lowest was for facial pain and toothache each with OR=0.1.Conclusions: In general, clinical symptoms have a small predictive value in the diagnosis of sinusitis and should be evaluated with CT scan findings (15.7%).

CRITERION-BASED VALIDITY OF THE DEPRESSION SCALE OF LATVIAN CLINICAL PERSONALITY INVENTORY

The main aim of this study was to evaluate the criterion validity and to estimate the cut-off score of the Depression scale (DS) and short Depression scale (DSs) for a new self-report measure – Latvian Clinical Personality Inventory (LCPI). Usefulness of DS and DSs for identifying patients with major depression were analysed based on psychometric analysis of data acquired from psychiatric inpatient sample with depressive disorder (n = 37) in comparison to randomised stratified community subsample (n = 176) selected from the overall test development sample (N = 888). The present study was carried within the framework of the National Research Program (BIOMEDICINE) 2014 – 2017 (sub-project Nr.5.8.2.). It was shown that all 24 item of DS show good to excellent discrimination power. Cronbach’s alpha was 0.97 for DS and 0.95 for DSs in test development sample. For DS, the optimal cut-off score was 26 points (sensitivity 95%, specificity 91%, and positive predicted value of 69%). For DSs, the optimal cut-off was 12 points (sensitivity 92%, specificity 89%, and positive predicted value 63%). DS and DSs of LCPI is proved to have good criterion validity in detecting depression and to be a reliable and valid instrument for assessment of depression symptoms in patients with depression and in general population. Subjects scoring at least 26 on DS or 12 points on DSs constitute a target group for further diagnostic assessment in order to determine appropriate treatment.