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Resumen OBJETIVO: Describir las características sociodemográficas, clínicas y patológicas y los resultados obtenidos con la técnica de ganglio centinela con azul patente en la cirugía de cáncer de mama temprano. Además, reportar la experiencia en la identificación del ganglio centinela en cáncer de mama temprano con la técnica con azul patente al 2.5%. MATERIALES Y MÉTODOS: Estudio retrospectivo y analítico consistente en la evaluación de los expedientes clínicos de pacientes diagnosticadas con cáncer de mama temprano, sin sospecha clínica o radiológica de afectación axilar, atendidas entre junio de 2022 y junio de 2023 en el servicio de Ginecología Oncológica de la UMAE Hospital de Ginecoobstetricia, Centro Médico Nacional de Occidente del IMSS. El sitio de inyección del colorante fue subdérmico periareolar, los ganglios identificados se estudiaron en el transoperatorio. Se analizaron el porcentaje de identificación, las tasas de falsos negativos y el valor predictivo negativo del método. RESULTADOS: Se analizaron 95 procedimientos de biopsia de ganglio centinela. Solo se practicó la linfadenectomía axilar en las pacientes con metástasis en el ganglio centinela comprobada en el estudio transoperatorio y en las que no se identificaron ganglios teñidos por no migración del colorante. La edad promedio de las pacientes fue de 57.1 años límites 25 y 78 años. El tamaño del tumor fue menor a 3 cm. A 64 67% pacientes se les hizo la mastectomía en comparación con 31 a quienes se efectuó cirugía conservadora de mama 33%. Se estadificaron como IA 57 de las 95 pacientes; el subtipo molecular más frecuente fue compatible con luminal A en 49%. CONCLUSIONES: La biopsia del ganglio centinela, con azul patente, es una técnica rápida, sencilla, precisa y de bajo costo para identificar daño axilar en etapas tempranas del cáncer de mama. Lo aquí reportado son resultados que corresponden a una primera evaluación de la técnica en nuestro servicio.
Abstract OBJECTIVE: To describe the sociodemographic, clinical and pathological characteristics and results of the patent blue sentinel lymph node technique in early breast cancer surgery. And to report the experience in identifying the sentinel lymph node in early breast cancer using the 2.5% patent blue technique. MATERIALS AND METHODS: Retrospective and analytical study consisting of the evaluation of the clinical records of patients diagnosed with early breast cancer, without clinical or radiological suspicion of axillary involvement, seen between June 2022 and June 2023 at the Oncological Gynaecology Service of the UMAE Hospital de Ginecoobstetricia, Centro Médico Nacional de Occidente of the IMSS. The dye injection site was subdermal periareolar, and the identified lumps were examined in the transoperative period. The percentage of identification, false negative rates and negative predictive value of the method were analysed. RESULTS: Ninety-five sentinel node biopsies were analysed. Axillary lymphadenectomy was performed only in patients with sentinel lymph node metastasis confirmed at surgery and in those in whom no stained nodes were identified due to non-migration of the dye. The mean age of the patients was 57.1 years range 25 to 78 years. The tumour size was less than 3 cm. Sixty-four patients 67% underwent mastectomy, compared with 31 who underwent breast-conserving surgery 33%. Fifty-seven of the 95 patients were staged as AI; the most common molecular subtype was compatible with luminal A in 49%. CONCLUSIONS: Sentinel lymph node biopsy with patent blue is a rapid, simple, accurate and inexpensive technique for identifying axillary disease in early breast cancer. The results reported here represent an initial evaluation of the technique in our service.
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ABSTRACT Background: The use of inflammatory markers in order to accurate the diagnosis, decrease the reoperation rate and enable earlier interventions during the postoperative period of a colorectal surgery is increasingly necessary, with the purpose of reducing morbimortality, nosocomial infections, costs and time of a readmission. Objective: To analyze C-reactive protein level on the third postoperative day of an elective colorectal surgery and compare the marks between reoperated and non-reoperated patients and to establish a cutoff value to predict or avoid surgical reoperations. Methods: Retrospective study based on the analysis of electronic charts of over 18-year-old patients who underwent an elective colorectal surgery with primary anastomoses during the period from January 2019 to May 2021 by the proctology team of Santa Marcelina Hospital Department of General Surgery with C-reactive protein (CRP) dosage taken on the third postoperative day. Results: We assessed 128 patients with a mean age of 59.22 years old and need of reoperation of 20.3% of patients, half of these due to dehiscence of colorectal anastomosis. Comparing CRP rates on the third postoperative day between non-reoperated and reoperated patients, it was noted that in the former group the average was of 153.8±76.2 mg/dL, whereas in reoperated patients it was 198.7±77.4 mg/dL (P<0.0001) and the best CRP cutoff value to predict or investigate reoperation risk was 184.8 mg/L with an accuracy of 68% and negative predictive value of 87.6%. Conclusion: CRP levels assessed on the third postoperative day of elective colorectal surgery were higher in patients who were reoperated and the cutoff value for intra-abdominal complication of 184.8mg/L presented a high negative predictive value.
RESUMO Contexto: O uso de marcadores sanguíneos para tentar acurar o diagnóstico, reduzir a taxa de readmissão e possibilitar intervenções mais precoces no pós operatório de cirurgia colorretal é cada vez mais necessário, a fim de almejar reduzir a morbimortalidade, infecções nosocomiais, custos e tempo de uma reinternação. Objetivo: Analisar o nível da proteíne C reativa (PCR) no terceiro dia de pós-operatório de cirurgia colorretal eletiva e comparar os valores entre pacientes reoperados e não reoperados e estabelecer um valor de corte para prever ou afastar re-intervenção cirúrgica. Metodos: Estudo retrospectivo através da análise de prontuários eletrônicos de pacientes maiores que 18 anos submetidos a cirurgia colorretal de forma eletiva com anastomoses primárias no período de janeiro de 2019 a maio de 2021 pelo serviço de Coloproctologia do Departamento de Cirurgia Geral do Hospital Santa Marcelina com dosagem da PCR no 3º pós-operatório. Resultados: Foram avaliados 128 pacientes com média de idade de 59,22 anos e necessidade de reoperação em 20,3% dos pacientes, sendo metade desses por deiscência de anastomose colorretal. Ao se comparar os valores de PCR no 3º pós operatório entre os pacientes não reoperados e os reoperados, observou-se que nos primeiros a média foi de 153,8±76,2 mg/dL, enquanto nos pacientes reoperados foi de 198,7±77,4 mg/dL (P<0,0001) e, o melhor valor de corte de PCR para predizer ou investigar o risco de reoperação, foi 184,8 mg/dL com uma acurácia de 68% e valor preditivo negativo de 87,6%. Conclusão: Os níveis de PCR avaliados no 3º pós-operatório de cirurgia colorretal eletiva foram maiores em pacientes reoperados e o valor de corte para complicações intra-abdominal de 184,8 mg/L apresentou elevado valor preditivo negativo.
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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)
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Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Apendicitis/complicaciones , Apéndice , Dolor Abdominal , Abdomen AgudoRESUMEN
ObjectiveTo explore the changing trend of negative predictive value and number of false negatives in screening tests under the condition of low infection rate of infectious diseases. MethodsAssuming that the population is 20 million, to calculate the negative predictive value, numbers of true negatives and false negatives of the combination of different sensitivity (75.0%, 80.0%, 85.0%, 90.0%, 95.0%, 99.0%) and specificity (90.0%, 95.0%, 99.0%, 99.9%) when the disease infection rate of the population is 0.10%, 1.0% and 5.0% respectively. ResultsWhen the population infection rate is 0.1%, with the screening test sensitivity ≥75.0% and specificity ≥90.0%, the number of true negatives in 20 million people is about 17.98‒19.96 million. When the sensitivity is 75.0%, the negative predictive value is 99.972%‒99.975%, and the number of false negatives is 5 000; When the sensitivity increases to 99.0%, the negative predictive value is 99.999%, and the number of false negatives decreases to 200. When the population infection rate is 1.0%, a screening test with sensitivity ≥75.0% and specificity ≥90.0% can detect about 17.82‒19.78 million true negatives in 20 million population. When the sensitivity is 75.0%, the negative predictive value is 99.720%‒99.748%, and the number of false negatives is 50 000; When the sensitivity increases to 99.0%, the negative predictive value increases to 99.990%, and the number of false negatives decreases to 2 000. When the population infection rate is 5.0%, with sensitivity ≥75.0% and specificity ≥90.0%, the number of true negatives in 20 million people is about 17.10‒18.98 million; when the sensitivity is 75.0%, the negative predictive value is 98.559%‒98.700%, and the number of false negatives can reach 250 000; When the sensitivity is 99.0%, the negative predictive value increases to 99.942%‒99.947%, and the number of false negatives decreases to 10 000. The lower the infection rate of the population, the fewer false negatives will appear in the screening. ConclusionThe number of false negatives in large-scale screenings increases exponentially with the increase of infection rate. Screenings should be carried out as early as possible in a pandemic of infectious diseases, so as to control the spread of the pandemic as soon as possible.
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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.
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@#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.
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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.
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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.
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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.
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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.
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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.
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A treadmill ECG stress test (TMT) often forms part of the popular health check packages recommended for people who are asymptomatic on the premise that it can detect disease at an early stage and treatment be prescribed to prevent or reduce future morbidity and mortality. Such a recommendation does not take into account the properties of this procedure as a diagnostic test. It has an average sensitivity and specificity of 68% and 77%, respectively. However, these figures depend on the probability of coronary artery disease (CAD) in the test subject. In asymptomatic persons with few or no risk factors, the likelihood of a false positive is high and will result in psychological stress and/or expensive and possibly invasive test. Recommendation for a TMT should be made by a physician after evaluating the subject to have at least an intermediate risk of having CAD.
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Introducción: la eficacia de un medio diagnóstico se refiere a la capacidad para detectar al verdadero paciente enfermo. La sensibilidad, especificidad y valores predictivos positivo y negativo son indicadores de la validez de un medio diagnóstico. Otra manera de obtener la probabilidad de enfermar es a través de la estimación de las razones de verosimilitud positiva y negativa. Objetivo: describir conceptos generales e interpretación de sensibilidad, especificidad, valores predictivos y umbrales diagnósticos. Métodos: se realizó una revisión de artículos y libros sobre las propiedades básicas de un medio diagnóstico para poder interpretarlos de manera correcta y con ello optimizar su uso en el ámbito clínico. Conclusiones: trabajo que servirá como guía para los profesionales de la salud que se debaten constantemente con la necesidad de hacer un diagnóstico correcto para tratar oportunamente a los pacientes y evitarles complicaciones y cuando sea posible evitar la muerte(AU)
Introduction: The effectiveness of a diagnostic means refers to the ability to detect the true sick patient. The sensitivity, specificity and positive and negative predictive values are indicators of the validity of a diagnostic means. Another way to obtain the probability of getting sick is through the estimation of positive and negative likelihood ratios. Objective: To describe general concepts and interpretation of sensitivity, specificity, predictive values and diagnostic thresholds. Methods: A review of articles and books on the basic properties of a diagnostic means was made in order to interpret them correctly and thereby optimize their use in the clinical setting. Conclusions: Our paper will serve as a guide for health professionals who are constantly debating the need to make correct diagnosis to treat patients timely and to avoid complications and, to avoid death when possible(AU)
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Humanos , Masculino , Femenino , Diagnóstico Clínico/diagnóstico , Técnicas y Procedimientos Diagnósticos/normas , Estándares de ReferenciaRESUMEN
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)
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Humanos , Estado Prediabético/epidemiología , Factores de Riesgo , Índice Glucémico , Diabetes Mellitus/epidemiología , Prueba de Tolerancia a la Glucosa/métodos , Epidemiología Descriptiva , Estudios Transversales , Valor Predictivo de las Pruebas , Sensibilidad y EspecificidadRESUMEN
Objective:To find the better imaging method for the diagnosis of sialolithiasis by comparing the 3 different imaging methods.Methods:32 cases of salivary calculus were examined by sonography,X-ray and cone beam computed tomography(CBCT),the sensitivity,specificity,positive predictive value,negative predictive value were compared among the 3 methods.Results:The sensitivity and negative predictive value of cone beam computed tomography(95.8% and 80%) was significantly higher than those of sonography(83.3%,50.0%) and X-ray(58.3%,20%)(P < 0.05).Of three imaging methods there was no statistical difference in specificity and positive predictive value.Conclusion:CBCT is more sensitive than sonography or X-ray in the diagnosis of sialolithiasis.
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Objetivo: validar los procedimientos de examen que establece la Guía de Práctica Clínica propuesta para el tamizaje de trastornos visuales en edad pediátrica a nivel de las consultas de cuidados de salud. Métodos: se realizó un estudio descriptivo, prospectivo y transversal en una muestra de 633 pacientes de 3 a 5 años de edad, en consulta de Oftalmología del Hospital Pediátrico Marfán, de febrero del año 2014 a enero de 2015. Participaron dos Especialistas en Pediatría de Atención Primaria y una Licenciada en Psicología, quienes realizaron el tamizaje establecido en la Guía de Práctica Clínica; dos especialistas en Oftalmología: uno como observador profesional, quien supervisó y controló que se cumpliera la aplicación del cribaje con el protocolo establecido, y el otro -junto con una Licenciada en Óptica y Optometría- realizó las pruebas seleccionadas como criterios de verdad. El estudio de la capacidad predictiva de los procedimientos de examen de la Guía de Práctica Clínica propuesta se realizó a partir de cuatro variables: agudeza visual, estereopsis, alineación ocular y examen del reflejo de fondo de ojo. Los datos se procesaron utilizando el software Statistic y Epidat 4. Resultados: se alcanzaron globalmente valores de sensibilidad de 88,15 por ciento; especificidad 97,21 por ciento, valor predictivo positivo 79,07 por ciento, valor predictivo negativo 98,57 por ciento y fuerza de concordancia muy buena, con K= 0,813. Conclusiones: los resultados obtenidos hacen fiable que la Guía de Práctica Clínica propuesta es un instrumento válido para ser recomendada en la pesquisa de trastornos visuales en las condiciones de la sociedad cubana en este grupo de edad(AU)
Objective: to validate the examination procedures established by the Clinical Practice Guideline suggested for the screening of visual disorders at pediatric ages in the primary health care. Methods: a descriptive, prospective and cross-sectional study of a sample of 633 patients aged 3-5 years was conducted at Marfan teaching pediatric hospital from February 2014 to January 2015. Two primary health care pediatricians and a psychologist performed the screening set by the clinical practice guideline; one ophthalmologist supervised and controlled the application of screening in line with the set protocol whereas the other, aided by an optometrist, made the selected tests as truth criteria. The study of the predictive capacity of the exam procedures in the suggested clinical practice guideline was based on four variables, i.e. visual acuity, stereopsis, eye alignment and fundus reflex examination. Data processing used Statistic software and Epidat 4. Results: the overall values for sensitivity was 88.15 percent, specificity 9.21 percent, positive and negative predictable values reached 79.07 percent and 98.57 percent, respectively. The agreement force was very good, with K= 0.813. Conclusions: the results confirm that the suggested Clinical Practice Guideline should be recommended as a valid tool to detect visual disorders at pediatric ages under the present conditions of the Cuban society(AU)
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Humanos , Preescolar , Interpretación Estadística de Datos , Guía de Práctica Clínica , /estadística & datos numéricos , Trastornos de la Visión/diagnóstico , Estudios Transversales , Epidemiología Descriptiva , Estudios Prospectivos , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: The Korean-Mini-Mental Status Examination (K-MMSE) is a dementia-screening test that can be easily applied in both community and clinical settings. However, in 20% to 30% of cases, the K-MMSE produces a false negative response. This suggests that it is necessary to evaluate the accuracy of K-MMSE as a screening test for dementia, which can be achieved through comparison of K-MMSE and Seoul Neuropsychological Screening Battery (SNSB)-II results. METHODS: The study included 713 subjects (male 534, female 179; mean age, 69.3±6.9 years). All subjects were assessed using K-MMSE and SNSB-II tests, the results of which were divided into normal and abnormal in 15 percentile standards. RESULTS: The sensitivity of the K-MMSE was 48.7%, with a specificity of 89.9%. The incidence of false positive and negative results totaled 10.1% and 51.2%, respectively. In addition, the positive predictive value of the K-MMSE was 87.1%, while the negative predictive value was 55.6%. The false-negative group showed cognitive impairments in regions of memory and executive function. Subsequently, in the false-positive group, subjects demonstrated reduced performance in memory recall, time orientation, attention, and calculation of K-MMSE items. CONCLUSION: The results obtained in the study suggest that cognitive function might still be impaired even if an individual obtained a normal score on the K-MMSE. If the K-MMSE is combined with tests of memory or executive function, the accuracy of dementia diagnosis could be greatly improved.
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Femenino , Humanos , Cognición , Trastornos del Conocimiento , Demencia , Diagnóstico , Función Ejecutiva , Incidencia , Tamizaje Masivo , Memoria , Sensibilidad y Especificidad , SeúlRESUMEN
Objective To analyse the negative predictive value of endoscopic ultrasonography (EUS)for detecting pancreatic cancer and to evaluate its clinical value of ruling out malignant cancer. Methods The medical records of patients who were referred to pancreatic EUS with suspected pancreatic cancer and normal EUS findings from January 2005 to December 2013 were reviewed. Moreover,the follow-up data were reviewed to evaluate whether the patient developed pancreatic cancer or other malignancy that could cause the abnormality mentioned above. The follow-up data were obtained by examining the inpatient/outpatient records as well as conducting brief telephone interviews. Results A total of 122 patients were in-cluded in our study. The follow-up data of 108 were accessible,and the mean follow-up period was 52. 4 months. One patient was histopathologically diagnosed as having pancreatic cancer 6 years after the proce-dure,and 107 other patients with a normal pancreatic EUS were free of pancreatic cancer as well as other malignancy during the follow-up period. The negative predictive value of pancreatic EUS was 99. 1%(107/108). Conclusion For patients with suspected pancreatic cancer but normal EUS findings,there is no need for further exploratory surgery. However,if there is a high suspicion of malignancy in the pancreas,a repeat-ed EUS is necessary in case of a false negative EUS result.
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Introducción: La utilidad de las pruebas diagnósticas se basa en la capacidad de separar adecuadamente las personas sanas de las enfermas, y de no producir falsos positivos o negativos. Las propiedades de las pruebas diagnósticas se describen tradicionalmente como sensibilidad, especificidad y valores predictivos. Una forma adicional de considerar la probabilidad de la enfermedad es mediante el cálculo de la razón de probabilidades o likelihood ratio; este permite conocer cuánto más probable es un resultado (positivo o negativo) según la presencia o ausencia de la enfermedad. Objetivo: Describir en términos generales las propiedades de las pruebas diagnósticas. Se explican los conceptos de sensibilidad, especificidad, valores predictivos y likelihood ratio, así como su utilidad y aplicabilidad en la práctica médica. Metodología y desarrollo: Se realizó una revisión de artículos y textos sobre las propiedades de las pruebas diagnósticas, para definir y analizar sus características operativas; posteriormente, se exponen ejemplos para facilitar su entendimiento e interpretación...
Introduction: The usefulness of diagnostic tests consists of the ability to detect and separate a person with a disease from a healthy person, and not to produce false positives or negatives. The properties of diagnostic tests have traditionally been described using sensitivity, specificity, and positive and negative predictive values. An additional way to consider the probability of a disease is by calculating the likelihood ratio which helps to estimate how many times more (or less) likely patients with a disease are to have a particular result than patients without the disease. Objective: To describe the main properties of diagnostic tests. Important concepts, such as sensitivity, specificity, predictive value and likelihood ratio are explained, as well as their usefulness and applicability in clinical practice. Method: Articles and texts have been reviewed to define and analyze the operative characteristics of diagnostic tests. Similarly, examples are given to facilitate understanding and interpretation...
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Pruebas Diagnósticas de Rutina , Valor Predictivo de las PruebasRESUMEN
OBJECTIVO: Avaliar a sensibilidade da ecografia endorectal, em nossa experiência, no estadiamento do cancro do recto comparando com o resultado anatomopatológico. MATERIAL E MÉTODOS: Estudo retrospectivo, realizado entre Janeiro de 2005 e Agosto de 2009. Calculou-se a sensibilidade, a especificidade, o valor preditivo positivo e negativo para cada estadio T e N. Por meio da elaoração de curvas ROC avaliou-se a precisão do estadiamento ecoendoscópico e por meio do teste de McNemar comparou-se com o resultado anatomopatológico. RESULTADOS: Dos 112 doentes, 76 cumpriram os critérios de inclusão. Obtivemos uma eficácia de 75 a 97 por cento para uT e de 75 por cento para uN. Verificou-se sensibilidade, especificidade, valor preditivo positivo e negativo, respectivamente, de 63;98;92 e 89 por cento para uT1; 71;76;54 e 88 por cento para uT2; 67;81;73 e 76 por cento para uT3; 100;97;60 e 100 por cento para uT4; e 39;91;62 e 78 por cento para uN. As curvas ROC indicaram que a ecografia endorectal é um bom teste para o estadiamento do T e razoável para o N. O teste de McNemar revelou que não há diferenças significativas entre o estadiamento ecoendoscópico e anatomopatológico (p>0,05). CONCLUSÕES: Conclui-se que a ecografia endorectal é uma importante ferramenta no estadiamento do cancro do recto, apresentando boa correlação com o resultado anatomopatológico.
OBJECTIVE: This study aimed to evaluate endorectal ultrasound sensibility, in our experience, in rectal cancer staging comparing with pathologic result. METHODS: A retrospective study between January 2005 and August 2009. We calculated sensibility, specificity, positive and negative predictive value for T and N. Through ROC curves we evaluated endoscopic ultrasound accuracy and through McNemar test we compared it with the anatomopathological result. RESULTS: Of 112 patients, 76 met the inclusion criteria. We obtained an efficiency of 75 to 97 percent for uT and 75 percent in uN. There was a sensibility, specificity, positive and negative predictive value, respectively of 63, 98, 92 and 89 percent for uT1, 71 percent and 76, 54 and 88 for uT2, 67, 81; 73 and 76 percent for uT3, 100, 97, 60 and 100 percent uT4, and 39, 91, 62 and 78 percent for uN. The ROC curves indicated that endorectal ultrasound is a good test for T staging and reasonable for N staging. The McNemar test revealed no significant differences between endoscopic ultrasound and histological staging (p>0.05). CONCLUSIONS: We concluded that endorectal ultrasound is an important tool in rectal cancer staging, showing a good correlation with histopathological results.