Sensibilidad y especificidad de las escalas diagnósticas en la apendicitis aguda. Estudio prospectivo / Sensitivity and specificity of the diagnostic scales in acute appendicitis. Prospective study

La Apendicitis Aguda se manifiesta cuando existe inflamación del apéndice cecal, representando una de las más notables causas de abdomen agudo con pronóstico quirúrgico en el mundo. Existen sistemas de puntuaciones que se han generado para su comprobación, mediante técnicas no invasivas, de fácil aplicación y reproducción; destacando entre ellas las escalas de ALVARADO, RIPASA, AIR, entre otras. Objetivo: Comparar la sensibilidad y especificidad de las escalas AIR Vs. RIPASA para el diagnóstico de la Apendicitis Aguda en el Hospital General Nacional "Dr. Ángel Larralde", período enero 2020 ­ diciembre 2022. Materiales: Estudio observacional, descriptivo y evaluativo, prospectivo y de corte transversal. Muestra fue intencional no probabilística, cumpliendo con los criterios de inclusión. Para la recolección de datos, se empleó la observación directa como técnica y como instrumentos las escalas AIR y RIPASA. Resultados: Muestra conformada por 192 pacientes, sin predisposición de géneros. Sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo y exactitud diagnóstica AIR: 70%; 58,33%; 73,68%; 53,84%; 65,62%; RIPASA: 88,88%; 42,85%; 66,66%; 75%; 68,75%. Conclusiones: La exactitud diagnóstica para la escala de RIPASA fue ligeramente mayor que para AIR (68,75% vs. 65,62%), permitiendo afirmar que, en el grupo de estudio, resultó más conveniente la aplicación de la escala de RIPASA en pacientes sanos para el diagnóstico correcto de Apendicitis Aguda(AU)

Acute Appendicitis manifests when there is inflammation of the cecal appendix, representing one of the most notable causes of acute abdomen with surgical prognosis in the world. There are scoring systems that have been generated for verification, using non-invasive techniques that are easy to apply and reproduce; highlighting among them the scales of ALVARADO, RIPASA, AIR, among others.Objective : To compare the sensitivity and specificity of the AIR Vs. RIPASA scales for the diagnosis of Acute Appendicitis at the National General Hospital "Dr. Ángel Larralde", period January 2020 ­ December 2022. Materials: Observational, descriptive and evaluative, prospective and cross-sectional study. Sample was intentional, non-probabilistic, meeting the inclusion criteria. For data collection, direct observation was used as a technique and the AIR and RIPASA scales as instruments.Results : Sample made up of 192 patients, with no gender predisposition. Sensitivity, specificity, positive predictive value, negative predictive value, and AIR diagnostic accuracy: 70%; 58.33%; 73.68%; 53.84%; 65.62%; RIPASE: 88.88%; 42.85%; 66.66%; 75%; 68.75%.Conclusions : The diagnostic accuracy for the RIPASA scale was slightly higher than for AIR (68.75% vs. 65.62%), allowing us to affirm that, in the study group, the application of the RIPASA scale was more convenient in healthy patients for the correct diagnosis of Acute Appendicitis(AU)

Non-invasive prenatal testing for the diagnosis of congenital abnormalities: Insights from a large multicenter study in southern China

Although non-invasive prenatal testing (NIPT) is widely used to detect fetal abnormalities, the results of NIPT vary by population, and data for the screening efficiency of NIPT positive predictive value (PPV) from different populations is limited. Herein, we retrospectively analyzed the NIPT results in a large multicenter study involving 52,855 pregnant women. Depending on gestational age, amniotic fluid or umbilical cord blood was extracted for karyotype and/or chromosome microarray analysis (CMA) in NIPT-positive patients, and the PPV and follow-up data were evaluated to determine its clinical value. Among the 52,855 cases, 754 were NIPT-positive, with a positivity rate of 1.4%. Karyotype analysis and/or CMA confirmed 323 chromosomal abnormalities, with a PPV of 45.1%. PPV for trisomy 21 (T21), trisomy 18 (T18), trisomy 13 (T13), sex chromosomal aneuploidies (SCAs), and copy number variations (CNVs) were 78.9, 35.3, 22.2, 36.9, and 32.9%, respectively. The PPVs for T21, T18, and T13 increased with age, whereas the PPVs for SCAs and CNVs had little correlation with age. The PPV was significantly higher in patients with advanced age and abnormal ultrasound. The NIPT results are affected by population characteristics. NIPT had a high PPV for T21 and a low PPV for T13 and T18, and screening for SCAs and CNVs showed clinical significance in southern China.

False positives of screening in large-scale population with low infection rate of an infectious diseasea： a modeling analysis / 上海预防医学

ObjectiveTo explore the positive predictive value （PPV） and false positive （FP） number of screening test in mass testing when the prevalence of infection is low. MethodsAssuming a population of 20 million with the prevalence of disease infection ranging from 0.1% to 5.0%， PPV， true positive （TP） and FP numbers were calculated under different scenarios of combination of sensitivity （99.0%， 99.5%， and 100.0%） with specificity （97.0%， 97.5%， 98.0%， 98.5%， 99.0%， 99.5%， and 99.9%）. ResultsFor low infection prevalence （≤5.0%）， specificity has a greater impact on PPV than sensitivity； with the decrease of infection prevalence， the increase in PPV elevates when the specificity increases. When the infection prevalence is >1.0%， the closer the specificity is to 99.9%， the closer the PPV is to 100.0%. However， when the infection prevalence is <1.0%， the maximum PPV is only about 90.0%. When the infection rate is 0.1%， a screening test with more than 99.0% sensitivity could detect about 20 thousand TP cases in a population of 20 million. Additionally， the FP and PPV are estimated to be 599 thousand and 3.2% if the specificity is 97.0%， and 20 thousand and 50.0% if the specificity is 99.9%. When the infection rate is 1.0%， a screening test with ≥99.0% sensitivity and ≥97.0% specificity could detect about 0.198‒0.200 million TP cases； and the number of FP decreases from 594 thousand to 20 thousand when the specificity increases from 97.0% to 99.9%. When the infection rate is 5.0%， a screening test with ≥99.0% sensitivity and ≥97.0% specificity could detect about 0.99‒1.00 million TP cases； and the number of FP decreases from 570 thousand to 19 thousand when the specificity increases from 97.0% to 99.9%. When the infection prevalence is ≤5.0% in a total population of 20 million， there are about 20，000 FP cases even if the sensitivity and specificity reach the maximum values of 100.0% and 99.9%， respectively. ConclusionWhen the population is large and the infection prevalence is low， in addition to improving the specificity of the screening test in mass testing， the problem of a large number of false positives cannot be ignored.

The importance of disease prevalence in clinical decision making: a real practice study on COVID-19 antigen test in Curacao

ABSTRACT The performance of a test can be suboptimal, but in appropriate setting such a test is still useful for clinical decision making. We investigated the role of Antigen Rapid Diagnostic Test (Ag-RDT) for clinical decision making in an Emergency Department (ED) in Curacao during peak of COVID-19 pandemic. Ag-RDT was performed in the naso- and oropharynxswabs from patients with respiratory insufficiency presented to the ED. Ag-RDT was performed in 153 patients, of which 64 (41.8%) showed positive results. Comparing Ag-RDT results with molecular tests, its sensitivity was 68.8% (95% CI 57.4 to 78.7), and specificity of 94.6% (95% CI 84.9 to 98.9). The positive and negative predictive value were 95.1% (95% CI 86.5 to 98.3) and 66.3 (95% CI 58.6 to 73.3), respectively. All patients with Ag-RDT positive test were admitted to the cohorted COVD-19 department of the hospital. By using Ag-RDT, 35.9% of rapid PCR tests (that are more costly and laborious to perform) could be avoided at cost of 5.8% patients with false positive result. In conclusion, in real practice, disease prevalence is as important as test's performance for clinical decision making. The conclusion may also be applicable for other diagnostic tests than COVID-19 diagnostic.

Positive Predictive Value of Sonographic BI-RADS Final Assessment Categories for Breast Lesions

@#Introduction: We want to evaluate the sensitivity, specificity, positive (PPV) and negative predictive values (NPV) of BI-RADS ultrasound, as well as PPV and NPV of BI-RADS ultrasound lexicon. Methods: A total of 517 ultrasound-guided breast biopsy cases were performed within three years. A total of 324 cases remained after 193 cases were excluded from this study. The sensitivity, specificity, accuracy, PPV and NPV of overall BI-RADS and PPV for each BI-RADS categories were calculated from the data when compared with histopathological examination (HPE) finding. One observer evaluated four criteria of BI-RADS ultrasound lexicon; margin, echogenicity, posterior artefact and internal echo from static sonographic images to determine the PPV and NPV of sonographic BI-RADS lexicon based on HPE correlation. Results: There were 236 (72.8%) benign and 88 (27.1%) malignant lesions. The overall BI-RADS has a sensitivity of 93.18%, specificity of 66.95%, accuracy of 74.07% with PPV and NPV of 51.25% and 96.34% respectively. The PPV of each BI-RADS categories were; BI-RADS 2 (9.09%), BI-RADS 3 (3.27%), BI-RADS 4 (39.02%) and BI-RADS 5 (91.89%). The highest predictive value for malignancy was irregular margin (52.3%) and for benign was well-defined margin (89.7%). Criteria for margin and posterior artefact had a significant association with HPE (p<0.0001) in differentiating between malignant and benign breast lesions in breast ultrasound. Conclusion: Overlapping benign and malignant sonographic breast lesion descriptors tend to influence radiologist’s decision to overcall final BI-RADS categories. The margin and posterior artefact are the important criteria in BI-RADS lexicon in differentiating benign and malignant breast lesion.

Identification And Assessment Of Prediabetes-A Rural Indian Study (A Correlative Study Between Questionnaire And Biochemical Analysis)

Objective: To identify and prevent the vulnerable prediabetic population becoming diabetic patients in the future using the Indian Diabetic Risk Score (IDRS) and to evaluate the performance of the IDRS questionnaire for detecting prediabetes and predicting the risk of Type 2 Diabetes Mellitus in Chidambaram rural Indian population. Methods: A cross-sectional descriptive study was carried out among patients attending a master health check-up of RMMCH hospital located at Chidambaram. The IDRS was calculated by using four simple measures of age, family history of diabetes, physical activity, and waist measurement. The relevant blood test, like Fasting plasma glucose (FBS), Glycated hemoglobin (HbA1C) test, were observed for identifying prediabetes. Subjects were classified as Normoglycemic, prediabetics, and diabetics based on the questionnaire and diagnostic criteria of the Indian Council of Medical Research (ICMR) guidelines. Results: In the study, sensitivity and specificity of IDRS score were found to be 84.21% and 63.4% respectively for detecting prediabetes in community with the positive predictive value of 51.6% and negative predictive value of 89.6% and prevalence of prediabetes in the Chidambaram rural population is 31.6% among the 60 participants. Conclusion: The Indian diabetic risk score questionnaire designed by Ma­dras diabetic research federation is a useful screening tool to identify unknown type 2 diabetes mellitus. The question­naire is a reliable, valuable, and easy to use screening tool which can be used in a primary care setup.

Measles In Larut, Matang And Selama: Analysis And Evaluation Of Clinical Case Definitions For 2015-2019

@#An accurate system of identifying measles cases is critical for the measles surveillance system. The objectives were: 1) To determine the incidence rate of measles in Larut, Matang and Selama district in Perak from 2015 to 2019 2) To evaluate the measles clinical case definition by comparing the performance of the measles clinical case definition in predicting laboratory-confirmed measles case. A cross-sectional analysis was carried out looking at all suspected and laboratory-confirmed measles cases in Larut, Matang and Selama District registered on the online measles surveillance reporting system between 2015 to 2019. The sensitivity, specificity, positive predictive value and negative predictive value of the clinical case definition as confirmed by the laboratory result were calculated. The incidence rate for suspected measles showed an increasing trend from 3.96 per 100,000 population in 2015 to 28.82 per 100,000 population in 2019. For laboratory-confirmed measles cases, the incidence rate showed more variation with an increase to 36.11 per million population in 2017 from 5.67 per million population in 2015. The incidence rate later decreased to 10.99 per million population in 2018 and increased again to 24.47 per million population in 2019. The sensitivity of the clinical case definition in confirming measles was 86.67% (95% CI: 69.28%, 96.24%) , specificity 47.52% (95% CI: 41.56%, 53.52%), positive predictive value 14.95% (95% CI 12.81%, 17.36%) and negative predictive value 97.10% (93.03%, 98.83%). Measles incidence is increasing in trend. The clinical case definition is an effective tool to rule out measles in cases that failed to meet the criteria due to the high negative predictive value of the definition. However, for cases that meet the clinical case definition, laboratory confirmation or epidemiological link to a confirmed case is needed.

Evaluation of fetal fibronectin rapid bedside test as a predictor of preterm labour: a prospective study

Background: Preterm birth defined as birth before 37 weeks of gestation is a significant public health issue. Identification of patients at risk of preterm labour while ruling out those who are not is a fundamental but challenging goal for clinicians. This study was done to evaluate bed side dipstick test for detecting fetal fibronectin in cervico-vaginal secretions as a predictor of preterm delivery in symptomatic and asymptomatic high risk group.Methods: This was a hospital based prospective, double blinded study. We enrolled 100 pregnant women presenting with or without symptoms of preterm delivery, between 20 and 35 weeks of gestation. A rapid bed side dipstick test was performed to detect FFN in cervico-vaginal secretions of all enrolled women (symptomatic and asymptomatic high risk women) and results were evaluated for prediction of preterm labour. Qualitative data were analyzed by using Chi-square and Fisher’s exact test and quantitative data were analyzed by using unpaired Student’s t test and Mann-Whitney test. P value < 0.05 was considered significant.Results: In symptomatic group sensitivity, specificity, PPV and NPV of FFN test in predicting delivery within 48 hours, 7days 14days and preterm delivery was 100%, 63.2%, 46.2%, 100%; 100%, 72.7%, 65.4%, 100%; 100%, 75%, 69.2%, 100%; 80%, 76%, 76.9%, 79.2% respectively. In asymptomatic high risk group, sensitivity, specificity, PPV and NPV of FFN test in predicting preterm delivery (<37weeks) was 0%, 87.5%, 0%, 77.8%.Conclusions: The high negative predictive value may be of value in avoiding unnecessary interventions with potentially hazardous medications and identifying symptomatic women who are not in true labour and also allaying anxiety of asymptomatic high risk women.

Diagnostic Accuracy of Fine Needle Aspiration Cytology in Neck Swellings

Introduction: Neck swellings are commonest incidentalfindings that are present in all age groups. Objective of thecurrent research was to study the diagnostic accuracy offine needle aspiration cytology in neck swellings keepinghistopathology as gold standard.Material and methods: This is a prospective study conductedfrom January 2017 to December 2017 comprising of 70 casesof neck lesions who underwent FNAC at Adesh HospitalBathinda. Histopathological diagnosis was considered asgold standard. Efficacy of FNAC was determined in termsof sensitivity, specificity, Positive predictive value, NegativePredictive value and diagnostic accuracy.Results: Sensitivity, specificity, Positive predictive value,Negative Predictive value and diagnostic accuracy were83.33%, 100%, 100%, 98.46% and 98.57%.Conclusion: FNAC should be treated as a first-line diagnostictest for neck swellings. As maximum number of cases ofhead and neck lesions are nonneoplastic, FNAC can avoidunnecessary surgeries.

Clinical value of CT axial scan combined with multiplanar reconstruction imaging in preoperative diagnosis of elderly patients with intestinal perforation / 中国基层医药

Objective@#To evaluate the clinical value of CT axial scan combined with multiplanar reconstruction(MPR) imaging in preoperative diagnosis of elderly patients with intestinal perforation.@*Methods@#From March 2017 to March 2019, 127 patients with suspected intestinal perforation in Dajiangdong Hospital were enrolled.The patients were examined by CT axial scan and MPR, 119 patients confirmed intestinal perforation by postoperative pathological diagnosis.According to the requirements of this study, one radiologist analyzed the CT axial scan image independently, and the other analyzed the CT axial scan combined with the MPR image also.The positive rate of CT axial scan analysis and the positive rate of CT axial scan combined with MPR image analysis were calculated.The pathological diagnosis was used as the gold standard, the positive rate of CT axial scan and the real perforation rate were compared, the positive rate of CT axial scan combined with MPR and the real perforation rate were compared, the positive rates of CT axial scan and CT axial scan combined with MPR were compared.The positive predictive values, negative predictive values, sensitivity, specificity and accuracy of CT axial scan and CT axial scan combined with MPR were calculated.@*Results@#Of 127 patients with suspected intestinal perforation, 86 cases were diagnosed and located by CT axial scan, with the positive rate 67.72%, 113 cases were diagnosed and located by CT axial scan and MPR, with the positive rate 88.98%.Finally, 119 cases were confirmed by pathological diagnosis, with the positive rate 93.70%.The difference between the positive rate of CT axial scan and the perforation rate of pathological diagnosis was statistically significant (67.72% vs.93.70%, χ2=27.537, P<0.001). There was no statistically significant difference between the positive rate of CT axial scan combined with MPR and the perforation rate of pathological diagnosis(88.98% vs.93.70%, χ2=1.792, P=0.181). The positive rate of CT axial scan was 67.72%, and the positive rate of CT axial scan combined with MPR was 88.98%, the difference was statistically significant (χ2=16.918, P<0.001). The positive predictive rate of CT axial scan was 95.35%, the negative predictive rate was 9.76%, the sensitivity was 68.91%, the specificity was 50.00%, and the accuracy was 67.72%.The positive predictive rate of CT axial scan combined with MPR was 99.12%, the negative predictive rate was 50.00%, the sensitivity was 94.12%, the specificity was 87.50%%, and the accuracy rate was 93.70%.@*Conclusion@#The combination of CT axial scan and MPR can improve the accuracy of preoperative diagnosis in elderly patients with intestinal perforation, which is worthy of clinical application.

Value of C-reactive protein for predicting neonatal sepsis hospitalized in NICU, Mahosot Hospital, Lao PDR / Lao Medical Journal

Introduction@#Neonatal sepsis is a major cause of morbidity and mortality among newborns. Sepsis accounts for 30-50% of all neonatal deaths in developing countries. C-reactive protein (CRP) has been used to predict neonatal sepsis with high sensitivity and specificity. Currently, blood culture is the gold standard for neonatal sepsis diagnosis, but it takes at least 48 hours to 7 days and not all cases have positive culture in neonatal infection.@*Objective@#To assess the performance of C-reactive protein for predicting neonatal sepsis.@*Methodology@#A prospective and retrospective descriptive study in neonates aged up to 28 days old presenting with symptoms and signs of sepsis and maternal high-risk factor of neonatal sepsis at Pediatric Intensive Care Unit of Mahosot Hospital. C-reactive protein rapid test was considered positive if the test level was ≥6mg/L. Blood culture was used as reference test.@*Result@#Among 725 neonates recruited in the study, 3.9% blood cultures were positive. Among these, 21.4% were Staphylococcus aureus, 14.3% Escherichia coli and 10.7% Klebsiella pneumoniae. Sensitivity, Specificity, Positive and Negative predictive values of CRP in predicting neonatal sepsis were 71.42%, 70.15%, 8.77% and 98.3% respectively.@*Conclusion@#C-reactive protein rapid test could not predict neonatal sepsis very well, but might enable to rule out non-sepsis patients because of its high negative predictive value. This is clinically useful for treatment follow-up and antibiotic use.

Clinical value of C-reactive protein combined with coagulation test in the diagnosis of neonatal late-onset sepsis / 中国基层医药

Objective To investigate the clinical value of C-reactive protein (CRP) combined with prothrombin time (PT) and partially activated thromboplastin time (APTY) in the diagnosis of neonatal late-onset sepsis.Methods From January 2013 to January 2018,100 neonates with sepsis admitted to our department of neonatology in Lishui Maternal and Child Health-Care Center were collected.According to the results of blood culture,neonates with positive blood culture were classified as sepsis group A (53 cases),and neonates with negative blood culture were classified as sepsis group B (47 cases).Another 50 normal newborns born at the same period were included in the control group.The CRP,PT and APTT values of the three groups were detected and compared.The receiver-operating characteristic curves (ROC) were plotted to obtain the area under ROC curve (AUC) and the sensitivity,specificity,positive predictive value and negative predictive value.Another ROC curve was plotted to obtain the area under ROC curve (AUC) and the sensitivity,specificity,positive predictive value,and negative predictive value for a new variable,CPR + PT + APTT,which was established using a binomial logistic regression method.Results The results of CPR,PT and APTT in the control group,sepsis group A and sepsis group B all increased in turn (F=10.616,6.155,5.243,P =0.000,0.000,0.000).CPR + PT + APTT had the largest AUC (0.94),the highest sensitivity (93.42％),the highest specificity (91.66％),the highest positive predictive value (92.60％),and the highest negative predictive value (78.55％) in the four indicators.Conclusion When blood culture fails to diagnose late-onset neonatal sepsis,combined detection of CPR + PT + APTT can provide some clues for its early diagnosis,which is worthy of clinical attention.

Thyroid Imaging Reporting and Data System(TI-RADS):Interobserver variability and positive predictive value for assessment of thyroid nodules / 中华超声影像学杂志

Objective To retrospectively evaluate interobserver variability between radiologists by using lexicon of the Thyroid Imaging Reporting and Data System ( TI-RADS ) to classify lesions on ultrasonography and retrospectively determine the positive predictive value ( PPV) of each TI-RADS level. Methods Five radiologists retrospectively reviewed 188 consecutive thyroid nodules with known pathologic diagnosis of 172 patients from June,2016 to November,2016. Each observer described each lesion with TI-RADS terminology and final TI-RADS level were assigned by adding the points from all categories. Cohen κ statistic was used to assessed the interobserver variability for each ultrasonographic ( US ) descriptors and final TI-RADS level. PPV for all TI-RADS levels were determined for all readers combined. Results For each US descriptor,composition,echogenicity,shape,margin,echogenic foci,their κ were 0.743 (0.713－0.772),0.418 (0.319－0.517),0.468 (0.389－0.547),0.397 (0.291－0.503) and 0.566 (0.514－0.617) respectively ( data in parentheses are 95% confidential intervals). The κ for TI-RADS level was 0.782 (0.749 －0.81). PPV for TI-RADS level 1 to 5 were 0(0/8),0(0/23),14.3% (4/28),29.7%(11/37) and 85.7% (78/91). Conclusions Interobserver agreement with the TI-RADS terminology is substantial for composition, moderate for echogenicity, shape and echogenic foci, fair for margin. Interobserver agreement is substantial for TI-RADS level. Consequently different understanding in US images has little influence in patient management,justifying the use of ACR-TIRADS in clinical practice.

Utilidad de una escala de riesgo para identificar pacientes con disglucemia / Utility of a risk scale to identify patients with dysglycemia

Introducción: la prevalencia de diabetes y prediabetes ha ido en aumento a nivel global y en Cuba. Para identificar individuos en riesgo de disglucemia se han desarrollado varias escalas. Objetivo: evaluar el desempeño de la escala de Bang y otros, para identificar individuos con disglucemia, en una población cubana laboralmente activa. Métodos: se realizó un estudio transversal en 2 902 pacientes, fueron clasificados en portadores o no de disglucemia, a través de las pruebas de glucemia en ayunas, de tolerancia a la glucosa y hemoglobina glucosilada. Se determinó la frecuencia de factores de riesgo de diabetes mellitus tipo 2 comprendidos en la escala de Bang y otros, y en el proceder enfocado en factores de riesgo de American Diabetes Association. Se determinó sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo y Odds Ratio de ambas estrategias. En ambos se calculó el área bajo la curva operativa del receptor. Resultados: se encontró relación entre cada uno de los factores de riesgo previstos en ambos procederes con el diagnóstico de disglucemia. Se encontró sensibilidad de 96,5 por ciento y 79,9 por ciento; especificidad de 20,9 por ciento y 59,1 por ciento; valor predictivo positivo de 10,7 por ciento y 16,1 por ciento; valor predictivo negativo de 98,4 por ciento y 96,8 por ciento; OR de 7,33 y 6,76 y área bajo la curva 0,77 y 0,79 para la escala de Bang y otros, y el procedimiento enfocado en factores de riesgo, respectivamente. Conclusiones: ambos procederes identificaron de forma aceptable el grupo de pacientes con disglucemia(AU)

Introduction: The prevalence of diabetes and prediabetes has been increasing globally and also in Cuba. Several scales have been developed to identify individuals at risk for dysglycemia. Objective: To evaluate the performance of the Bang et al. scale to identify individuals with dysglycemia in a Cuban labor-active population. Methods: A cross-sectional study was carried out on 2 902 patients, classified as having or not suffering from dysglycemia, through fasting glycemia, glucose tolerance test and glycosylated hemoglobin. The frequencies of risk factors for type 2 diabetes mellitus included in the Bang et al. scale and in the risk factor approach of the American Diabetes Association were determined. Sensitivity, specificity, positive predictive value, negative predictive value and Odds Ratio of both strategies were determined. In both, the area under the receiver operating curve was calculated. Results: A relationship was found between each of the predicted risk factors in both procedures with the diagnosis of dysglycemia. Sensitivity was 96.5 percent and 79.9 percent; Specificity of 20.9 percent and 59.1 percent; Positive predictive value of 10.7 percent and 16.1 percent; Negative predictive value of 98.4 percent and 96.8 percent; OR of 7.33 and 6.76 and area under the curve 0.77 and 0.79 for the scale of Bang et al. and the procedure focused on risk factors respectively. Conclusions: Both procedures identified in an acceptable manner the group of patients with dysglycemia(AU)

Fine Needle Aspiration Cytology in the Diagnosis and Management of Thyroid Diseases

Background: Swellings of thyroid are frequently encountered in surgical practice. With clinical evaluation it is difficult to distinguish early malignant lesions from common benign goiters. Surgical excision is the only means by which a definitive diagnosis is obtained based on HPE. An alternative approach is called for other than surgery as most cases are benign. FNAC is a simpler and safer procedure carried out in the OPD with minimal equipment and has good patient compliance. The present study aims at correlating the cytological diagnosis with the final histological diagnosis to evaluate the sensitivity, specificity and accuracy of FNAC smears, thereby its role in preoperative diagnosis in planning proper management. Aim: To determine the accuracy and the role of fine needle aspiration cytology (FNAC) as a diagnostic modality in the diagnosis and treatment of thyroid diseases. Materials and methods: A proforma was drafted for the study of all patients presenting with history of palpable thyroid swelling and undergo surgery in our hospital. Clinical presentations, FNAC and histopathology of all cases were documented. Results: 100 cases who presented with thyroid swellings were studied and their histopathological diagnosis was compared with the FNAC. Of the 86 cases which were seen benign by FNAC, 82 were confirmed by histopathology. Of the 18 cases which were proved to be malignant by histopathology 14 were only seen as malignant by FNAC. The sensitivity of FNAC in the diagnosis of benign lesions was found to be 77.78%, specificity was 100%, positive predictive value 100% and accuracy is 96%. Conclusion: Most of our patients were between third and fourth decade, with females being predominant. Most cases were benign of which multinodular goiter being the most dominant pathology (25%). Among the malignancies, majority being papillary carcinoma (78.94%). The R. Maheshwari, Rakesh Fernando. Fine Needle Aspiration Cytology in the Diagnosis and Management of Thyroid Diseases. IAIM, 2017; 4(9): 75-81. Page 76 sensitivity, specificity and predictive value of positive smears being 77.78%, 100%, and 100% respectively. FNAC was of greater help in the preoperative management of thyroid swellings. Multinodular goiters and colloid goiters were distinguished easily by FNAC but confusion prevailed in cases of follicular adenomas. In patients who cannot be followed up regularly clinical suspicion should be one of the indications for surgery despite of FNAC being negative. FNAC is simpler, safer, quicker and more informative, when compared with other sophisticated methods in the diagnosis of thyroid lesions.

Application of brainstem auditory evoked potentials in diagnosis of brain death / 中国中西医结合急救杂志

Objective To evaluate the diagnostic validity of application of brainstem auditory evoked potential (BAEP) as an ancillary test in patients with brain death.Methods A prospective observational study was conducted. Adult patients (≥ 18 years) with brain death were consecutively admitted to the Department of Intensive Care Unit (ICU) of Beijing Tiantan Hospital Affiliated to Capital Medical University from July 2015 to June 2017, and they further underwent BAEP monitoring. The following findings: absence of all waveforms at bilateral sides, absence of all waveforms except wave-Ⅰonly present at bilateral orunilateral side were set as the positive criteria of BAEP for the diagnosis of brain death, and its diagnostic sensitivity (SEN), positive predictive value (PPV) and false negative rate (FNR) were further assessed.Results A total of 47 patients were enrolled in the study, and the 43 complete BAEP results were analyzed. The SEN, PPV and FNR of the above 3 types of diagnostic criteria (absence of all waveforms, and unilateral or bilateral presence of wave-Ⅰ only) were 100% [95% confidence interval (95%CI) 90-100], 100% (95%CI 89-100), and 0% (95%CI 0-9), respectively.Conclusion As an ancillary test, BAEP has extremely high validity for the diagnosis of patients with brain death, thus it should be used more extensively in clinical practice.

Determining if Positive Predictive Value using Laboratory Risk Indicator for Necrotising Fasciitis is Applicable in Malaysian Patients with Necrotising Fasciitis

Introduction: Necrotising fasciitis (NF) is a rapidly progressive infection of the subcutaneous tissue and fascia which spreads rapidly. The scoring system of Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) developed by Wong et al has been proposed as a tool for distinguishing NF and other soft tissue infections (STI) in Singapore. We set out to establish whether the LRINEC score is applicable in our Malaysian setting. Materials and Methods: A cross sectional study of all patients admitted to our hospital diagnosed with NF or To Rule Out NF (TRO NF) between January 1st 2016 to 30th June 2016. The sensitivity, specificity, positive and negative predictive values were then calculated for LRINEC score of ≥ 6 and ≥ 8. Results: Fourty-four patients were identified with the diagnosis of NF or TRO NF in the study. Twenty-seven patients (61.4%) were deemed post-operatively as having NF and 17 patients (38.6%) not having NF. A sensitivity of 59.3% and specificity of 47.1% when a LRINEC score of ≥ 6 was taken with positive predictive value (PPV) of 64.0% and the negative predictive value (NPV) of 42.1%. When score ≥ 8 was taken, the sensitivity was 48.1% and specificity of 58.8% with PPV of 65% and NPV of 41.7%. Conclusion: The low sensitivity and low PPV achieved in this study as well as other studies makes the LRINEC score unsuitable to be used solely to distinguish NF with other soft tissue infections.

The Clinical Effectiveness of School Screening Programme for Idiopathic Scoliosis in Malaysia

Introduction: There is no large population size study on school screening for scoliosis in Malaysia. This study is aimed to determine the prevalence rate and positive predictive value (PPV) of screening programme for adolescent idiopathic scoliosis. Materials and Methods: A total of 8966 voluntary school students aged 13-15 years old were recruited for scoliosis screening. Screening was done by measuring the angle of trunk rotation (ATR) on forward bending test (FBT) using a scoliometer. ATR of 5 degrees or more was considered positive. Positively screened students had standard radiographs done for measurement of the Cobb angle. Cobb angle of >10° was used to diagnose scoliosis. The percentage of radiological assessment referral, prevalence rate and PPV of scoliosis were then calculated. Results: Percentage of radiological assessment referral (ATR >5°) was 4.2% (182/4381) for male and 5.0% (228/4585) for female. Only 38.0% of those with ATR >5° presented for further radiological assessment. The adjusted prevalence rate was 2.55% for Cobb angle >10°, 0.59% for >20° and 0.12% for >40°. The PPV is 55.8% for Cobb angle >10°, 12.8% for >20° and 2.6% for > 40°. Conclusions: This is the largest study of school scoliosis screening in Malaysia. The prevalence rate of scoliosis was 2.55%. The positive predictive value was 55.8%, which is adequate to suggest that the school scoliosis screening programme did play a role in early detection of scoliosis. However, a cost effectiveness analysis will be needed to firmly determine its efficacy.

Evaluation of two kinds of chemiluminescence detection of Treponema pallidum antibody-positive samples / 国际检验医学杂志

Objective To analyze the true‐positive results ( ≥ 95% ) S/CO value of Treponema pallidum specific antibody (anti‐TP) positive samples caused by 2 different chemiluminescence detection assay in comparison with Treponema Pallidum Particle As‐say (TPPA) .Methods We collected the Treponema pallidum specific antibody positive samples of outpatient and hospitalization from October 2014 to January 2016 in Peking union medical college hospital as the research objects .There were 145 positive cases of Abbott laboratories (S/CO value of 1 .02 to 39 .29) ,24 positive cases of Roche (S/CO value of 1 .4 to 33 .07) .The 169 cases of Treponema pallidum specific antibody positive samples were detected with two methods of chemiluminescence detection at the same time ,TPPA was performed as repetition and confirmed test .Gathering and sorting the statistics of the positive predictive value seg‐mented ordered by specimen S/CO value ,to determine 95% or higher S/CO value of true positive results .Results After retested and confirmed by TPPA of the 169 positive cases ,the Abbott positive coincidence rate was 78 .7% ,the Roche positive coincidence rate was 81 .3% .When the S/CO value of Abbott ≥ 8 and the S/CO value of Roche ≥ 14 ,the positive predictive value was 100% . Conclusion When the S/CO value of Abbott ≥ 8 and the S/CO value of Roche ≥ 14 ,the S/CO value can be used as the true posi‐tive results( ≥ 95% ) .Abbott laboratories results S/CO value ≥ 8 ,Roche test results S/CO value ≥ 13 ,it is a 95% or higher S/CO limit of true positive results .

How high is too high in cutoff levels from 50-g glucose challenge test

OBJECTIVE: To determine the highest 50-g glucose challenge test (GCT) value that indicates no further diagnostic test is needed to confirm a diagnosis of gestational diabetes mellitus (GDM) under the criteria of National Diabetes Data Group (NDDG) or the Carpenter and Coustan (C&C) and fasting glucose thresholds from the International Association of Diabetes and Pregnancy Study Group (IADPSG). METHODS: We collected the 50-g GCT results from 16,560 pregnancies and identified 2,457 gravidas with positive 50-g GCT (≥130 mg/dL) values who underwent the 100-g glucose tolerance test. We investigated GDM prevalence in pregnancies with positive 50-g GCT according to the respective diagnostic thresholds and determined the 50-g GCT cutoff values with 100% positive predictive value for GDM under each diagnostic threshold. RESULTS: Twelve point five percent (306/2,457), 20.0% (492/2,457), and 9.6% (235/2,457) met the diagnostic criteria of GDM with the application of NDDG, C&C criteria, and fasting glucose thresholds from IADPSG (≥92 mg/dL), respectively. We also found that the prevalence of GDM increased with increasing 50-g GCT values using each diagnostic criterion. Importantly, we identified that all subjects with a 50-g GCT value ≥223, ≥217, or ≥228 mg/dL can be exclusively diagnosed as having gestational diabetes according to the criteria of NDDG, C&C, and fasting glucose thresholds from IADPSG, respectively. CONCLUSION: We propose that women with a 50-g GCT screening value ≥228 mg/dL can be reliably omitted from further confirmative tests for GDM, such as 100- or 75-g glucose tolerance test.