ABSTRACT
Presentation to the emergency department with renal colic has been reported as between 6.7 and 27.9 per 1000 emergency department visits. Clinicians rely on various radiological investigations for the prompt and accurate diagnosis of urolithiasis. This review assesses the validity of the colour Doppler ultrasonographic twinkling artefact (TA) sign as a diagnostic tool for the presence of urolithiasis. A systematic search of the Cochrane Database of Systematic Reviews, Embase, PubMed, Scopus and Web of Science databases was performed (October 2018) using specific search terms. PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analyses) guidelines and the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2) tool were applied to rank and evaluate selected studies. Twenty-two articles that included 4389 participants were assessed. The median sample size was 102.5 (interquartile range: 47-292.5) and the age range of participants was 4-91 years. Meta-analysis of the studies that provided sufficient data resulted in a pooled sensitivity and specificity for the ultrasonographic TA sign of 88.16 [95% confidence interval (CI): 87.07-89.19%] and 79.22% (95% CI: 73.41-84.26%) respectively, with an estimated summary effect of 3.84 (95% CI: 1.08-6.60, P 0.006) in log odds ratio terms. There was significant interstudy heterogeneity as suggested by an I-statistic of 94.51% (95% CI: 94.51-99.58) and an estimated τ parameter of 7.21 (SE: 7.44). Despite the suboptimal pooled sensitivity and specificity of the TA sign and the large heterogeneity between published studies, the current body of evidence suggests that the colour Doppler ultrasonographic TA sign may be useful as a complementary tool in the diagnostic workup of patients with suspected urolithiasis.
Subject(s)
Point-of-Care Systems , Ultrasonography , Urolithiasis/diagnostic imaging , Artifacts , Humans , Urolithiasis/diagnosisABSTRACT
BACKGROUND: Healthcare workers (HCWs) are constantly vulnerable to occupational blood and body fluid exposures (OBBFEs). Exposed HCWs experience emotional, physical and psychological trauma. Less experienced HCWs, such as intern doctors, are more prone to OBBFEs. OBJECTIVES: The aim of this study was to investigate the prevalence and practices pertaining to OBBFEs amongst a select group of intern doctors in the Gauteng province of South Africa. METHODS: A quantitative cross-sectional descriptive study using a questionnaire based on a practical model was used. Intern doctors were recruited from four major hospitals in Gauteng. RESULTS: A total of 175 intern doctors participated in the study. There was a total of 182 (mean = 1.04, standard deviation [s.d] 0.88) reported OBBFEs amongst 136 (77.7%) subjects. The exposures occurred predominantly whilst subjects were working in surgery (n = 50, 27.5%), obstetrics and gynaecology (n = 49, 26.9%) and internal medicine (n = 48, 26.4%) departments; were superficial wounds (n = 69, 37.9%); were acquired during vascular puncture or intravenous line insertion (n = 69, 37.9%); and occurred when subjects were working >12 h shifts (n = 101, 55.5%). Human immunodeficiency virus (HIV) post-exposure prophylaxis (PEP) was initiated in 141 (77.5%) out of the 182 exposures. Only 90 (63.8%) subjects completed the recommended 28-day course of PEP. Two (1.1%) subjects reported that they had acquired HIV infection as a consequence of the OBBFE. CONCLUSION: Occupational blood and body fluid exposures are common amongst intern doctors. It is recommended that regular training, health education and monitoring compliance should be incorporated during the induction of medical intern doctors in hospitals. The availability of PEP regimens with better tolerability will encourage compliance.
ABSTRACT
OBJECTIVES: An incidental and sometimes humorous finding on an Antero-Posterior (AP) pelvis X-ray view is that of the John Thomas Sign (JTS), which is defined as positive, when the penile shadow points towards the side of a hip or pelvic fracture in male patients. Despite previous research reports and studies performed on the JTS sign, uncertainty with regards to its clinical relevance still remains. The objective of this review was to assess the clinical validity and accuracy of this sign by performing a systematic review and meta-analysis. METHODS: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search was performed (May 2017), using the following databases: BMJ best practice, Cochrane Database of Systematic Reviews, EMBASE, PubMed and Scopus. Studies comparing the predictability of the JTS were critically appraised. The summary effect (and 95% CI) was estimated using a random effect model and the Restricted Maximum Likelihood Method. The pooled sensitivity as well as the summary effect log odds ratio was determined. Selected studies were further ranked for quality and relevance using the Critical Appraisal Skills Program (CASP) (Oxford 2013) tool. RESULTS: In total, nine articles were isolated and assessed. A total of 1942 participants were included. The mean sample size amongst these included studies was 243 participants with a median of 198 participants. Since the necessary data needed for the Meta-analysis was only present in the 6/9 studies assessed, these 6 were analyzed further. The JTS was positive in 1089 out of 1439 patients with a pooled sensitivity of 75.7% (95%CI, 73.4%-77.9%). There was a large variation in the sensitivity and specificity amongst studies, accounting for a non-significant summary Odds Ratio effect of -0.03. CONCLUSIONS: Based on this review, there is insufficient statistical evidence to support the reliability of the JTS to predict the laterality in the case of a hip fracture on the standard AP pelvis x-ray.
ABSTRACT
BACKGROUND: Intestinal volvulus is a potentially life-threatening condition that occurs when loops of bowel twist around its supporting mesentery and associated vasculature. Clinicians often rely on various radiological investigations for prompt diagnosis to avoid complications such as bowel infarction. This review assesses the clinical reliability of the ultrasonographic whirlpool sign (WS) in the diagnosis of intestinal volvulus. METHODS: In adherence with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analyses) statement, a systematic search of BMJ Best Practice, Cochrane Database of Systematic Reviews, EMBASE, Google Scholar, PubMed, Scopus and Web of Science databases was performed (August 2017), using relevant search terms. Selected studies were ranked for quality and relevance using the CASP (Critical Appraisal Skills Program) tool. RESULTS: Sixteen articles (1640 participants) were assessed. The mean and median sample size was 102.5 (SD ± 192.23) and 28 (range 7-770), respectively. The WS was positive in 212 of 255 (83.1%) patients with intestinal volvulus. Meta-analysis of the studies that provided sufficient data resulted in a pooled sensitivity and specificity of 87.42% (95% confidence interval (CI): 81.05-92.25) and 98.63% (95% CI: 97.88-99.18), respectively, with an estimated summary effect of 5.28 (95% CI: 4.47-6.08, P < 0.001). There was negligible inter-study heterogeneity, which was suggested by an I2 statistic of 0% (95% CI: 0.00-76.34) and a τ2 parameter of 0 (95% CI: 0.00-5.35). CONCLUSION: Though the pooled sensitivity was less than ideal (87.42%), this review and meta-analysis nevertheless supports the reliability of the ultrasonographic WS as an acceptable indicator of intestinal volvulus.
Subject(s)
Intestinal Volvulus/diagnostic imaging , Ultrasonography, Doppler, Color , Humans , Reproducibility of Results , Sensitivity and SpecificityABSTRACT
PURPOSE: A positive whirlpool sign (WS) is defined as the presence of a spiral-like pattern when the spermatic cord is assessed during ultrasonography (US), using standard, high-resolution ultrasonography (HRUS) and/or color Doppler sonography (CDS), in the presence of testicular torsion. The objective of this review was to assess the validity and accuracy of this sign by performing a comprehensive systematic literature review and meta-analysis. METHODS: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, a comprehensive literature search was performed (August, 2017), using the following databases: BMJ Best Practice, Cochrane Library, Embase, PubMed, Scopus, and Web of Science. Selected studies were further assessed for relevance and quality using the Oxford 2010 Critical Appraisal Skills Program (CASP). RESULTS: Of the studies assessed, a total of 723 participants were included, with a mean of 72.3 (SD 71.9) participants. Of the participants, 226 (31.3%) were diagnosed with testicular torsion (TT). Meta-analysis of the studies that provided sufficient data resulted in a pooled sensitivity and specificity of the WS of 0.73 (95% CI, 0.65-0.79) and 0.99 (95% CI, 0.92-0.99), respectively. Removal of all neonates increased the pooled sensitivity to 0.92 (95% CI, 0.70-0.98) while the pooled specificity remained almost unchanged at 0.99 (95% CI, 0.95-1.00). The estimated summary effect of all studies with sufficient data was 4.34 (95% CI, 1.01-7.67; n = 394; p = 0.001). A large degree of heterogeneity was suggested by an I2 statistic of 88.27% (95% CI, 68.60-98.68%). Removal of neonatal subjects increased the estimated summary effect to 5.32 (95% CI, 1.59-9.05; n = 375; p = 0.001). CONCLUSION: The WS, when correctly diagnosed, may be viewed as a very definitive sign for TT in the pediatric and adult populations. However, its role in neonates is limited.
