Impact of histopathological and serological assessments on early diagnosis of leprosy relapse.

This study aimed to identify laboratory factors predicting leprosy relapse (LR) after multi-drug therapy (MDT). A case-control study included 80 patients treated with MDT at a national reference center over 12 years. The Relapse Group had 40 patients who relapsed after an average of 89.2 months post-MDT, while the Control Group had 40 patients who remained asymptomatic for an average of 113.1 months. Significant predictors of LR included neural/perineural lymphocytic infiltrate (OR = 4.67; p = 0.0076) and foamy granulomas (OR = 15.55; p = 0.0005), increasing odds by 4.7 and 15.6 times, respectively. The Relapse Group had a mean histological bacillary index (hBI) of 3.23+ compared to 1.8 in the Control Group (p = 0.004). An hBI ≥3+ had 72% sensitivity and 65% specificity for detecting LR (AUC = 0.72; p = 0.0002). Elevated anti-phenolic glycolipid I (anti-PGL-I) IgM antibody levels (ELISA index, EI ≥1) were also associated with LR (OR = 4.67; p = 0.0031). An EI ≥3.6 had 71% sensitivity and 62% specificity (AUC = 0.70; p = 0.0012). Multivariate analysis indicated that neural/perineural infiltrate, foamy granulomas, hBI ≥ 1+, and EI ≥ 1 significantly predicted LR, with up to 94.32% probability. Conclusively, these factors can identify individuals at high probability of LR after MDT.

Accuracy of urinary dipstick for glucose and protein determination in canine cerebrospinal fluid.

OBJECTIVE: To evaluate the precision of urinary dipstick (UD) to assess protein and glucose concentrations in canine CSF samples compared to the standard methods. METHODS: Cerebrospinal fluid protein and glucose were measured in 22 samples from dogs with neurological diseases affecting the CNS using UD and biochemistry (pyrogallol red and glucose oxidase reaction, respectively). Results were converted into scores to allow comparison between methods. The proportion of divergence between methods and its CI were calculated. The sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and accuracy (Ac) of UD were determined for 2 cutoff levels of CSF protein (15 and 30 mg/dL) and glucose (40 and 100 mg/dL). RESULTS: The proportion of divergence between methods was 64% (95% CI, 44% to 84%) for CSF protein (representing 14 of 22 erroneous samples), of which 92.9% (13 of 14) had a UD score lower than biochemistry. For CSF glucose, 73% (16 of 22 erroneous samples; 95% CI, 54% to 91%) had divergence between methods, of which 87.5% (14 of 16) had a UD score higher than biochemistry. Urinary dipstick had better results when the cutoff level was 15 mg/dL for protein (Se, 78.9%; Sp, 66.7%; PPV, 93.7%; NPV, 33.3%; Ac, 77.3%) and 40 mg/dL for glucose (Se, 89.5%; Sp, 33.3%; PPV, 89.5%; NPV, 33.3%; Ac, 81.8%) concentrations. CONCLUSIONS: Urinary dipstick was unreliable in estimating canine CSF protein and glucose concentrations. CLINICAL RELEVANCE: The UD underestimated protein and overestimated glucose levels in the canine CSF, which could have a significant diagnostic impact and should discourage its use as a bedside test.

Evaluation of nonpolar lipid extract antigen-based enzyme-linked immunosorbent assay for the serodiagnosis of tuberculosis.

This study assessed the diagnostic potential of nonpolar lipid extracts in enzyme-linked immunosorbent assays (ELISAs) for tuberculosis (TB) serodiagnosis. Nonpolar lipid extracts were harvested from Mycobacterium tuberculosis (Mtb) knockout in mce1 operon (∆mce1) and its parental wild type (WT) strains. IgM and IgG anti-nonpolar lipid serum levels were measured in TB patients (n=45), healthy individuals with positive (n=22) and negative (n=44) interferon-gamma release assay (IGRA) results, and symptomatic respiratory (SR) patients with negative TB tests (n=9). IgG anti-WT lipid distinguished TB patients from IGRA-positive individuals with 60% sensitivity and 77.3% specificity. Conversely, IgG anti-∆mce lipid levels didn't vary significantly across groups. Interestingly, most SR patients exhibited significantly higher IgM and IgG anti-WT lipid titers than the IGRA-positive and -nega groups. While the overall diagnostic potential of Mtb nonpolar lipids was limited, the impaired immunogenecity of Δmce1 lipid extract suggests that some missing lipid classes in this extract can potentially induce antibody production in TB patients.

Laboratory validation of a simplified DNA extraction protocol followed by a portable qPCR detection of M. tuberculosis DNA suitable for point of care settings.

Tuberculosis, caused by Mycobacterium tuberculosis, is a treatable and curable disease, and yet remains one of the leading causes of death worldwide. Diagnosis is essential to reducing the number of cases and starting treatment, but costly tests and equipments that require complex infrastructure hamper their widespread use as a tool to contain the disease in vulnerable populations as well countries lacking resources. Therefore, it becomes necessary to develop new technological approaches to molecular methods as well as screening tests that can be rapidly conducted among people presenting to a health facility to differentiate those who should have further diagnostic evaluation for TB from those who should undergo further investigation for non-TB diagnoses. The present study aimed to evaluate two experimental DNA extraction methods from clinical samples (FTA card versus sonication) followed by analysis in a portable qPCR instrument (the Q3-plus). The FTA card-based protocol showed 100% sensitivity and specificity, while the sonication protocol showed 80% sensitivity and 89% specificity when compared to the traditional gold standard culture. The portable protocol, comprised by the FTA card method and the portable instrument Q3-Plus, showed sensitivity and specificity of 92% and 61%, respectively, when compared to culture, and 75% and 81%, respectively, when compared to the standard TB case classification. The ROC curve showed an AUC of 0.78 (p<0.001) for the portable protocol and 0.93 (p<0.001) for the GeneXpert Ultra. The limit of detection (LOD) for Mycobacterium tuberculosis (H37Rv strain) detection in spiked samples obtained using the portable protocol (FTA card and Q3-Plus) was 19.3 CFU/mL. As an added benefit, using the FTA card facilitates sample handling, transport, and storage. It is concluded that the use of the FTA card protocol and the Q3-Plus yields similar sensitivity and specificity as the gold standard diagnostic tests and case classification. We suggest that the platform is suitable to use as a point of care tool, assisting in the screening of tuberculosis in hard-to-reach or resource-limited areas.

Novel isothermal nucleic acid amplification method for detecting malaria parasites.

Malaria, a parasitic disease caused by Plasmodium spp. and transmitted by Anopheles mosquitoes, remains a major global health issue, with an estimated 249 million cases and 608,000 deaths in 2022. Rapid and accurate diagnosis and treatment are crucial for malaria control and elimination. However, limited access to sensitive molecular tests means that microscopic examination and rapid diagnostic tests (RDT) are the most used methods in endemic areas, despite their lower diagnostic accuracy. Therefore, there is a need for developing sensitive, simple, accurate, and rapid diagnostic tools suitable for field conditions. Herein, we aimed to explore the potential of the enzymatic recombinase amplification assay (ERA® Technology) as a remote laboratory test by evaluating and validating the GENEYE® ERA Plasmodium detection kit in Brazilian endemic areas. A cross-sectional cohort study was conducted between June and August of 2023 in the Brazilian Amazon. The study enrolled 323 participants residing in three malaria-affected regions: Cruzeiro do Sul and Mâncio Lima (Acre State) and Guajará (Amazonas State). The participants were tested for malaria by microscopy, rapid diagnostic tests (RDT), nested PCR (nPCR), quantitative real-time PCR (qPCR), and ERA. The sensitivity, specificity, and predictive values were assessed using nPCR as a gold standard. Plasmodium prevalence was 21.7%, 18.8%, 19.2%, 21.7%, and 21.7% by nPCR, microscopy, RDT, qPCR, and ERA respectively. Using nPCR as the standard, qPCR, and ERA showed a sensitivity of 100%. In comparison, microscopy and RDT showed a sensitivity of 87.1% and 88.6%, a negative predictive value (NPV) of 96.56 and 96.93, and kappa values of 0.91 and 0.92, respectively. For Plasmodium falciparum, the sensitivity of qPCR and ERA was 100% while the sensitivity of microscopy and RDT was 96.9% and 93.7%, and the NPV was 99.66 and 99.32, respectively. For Plasmodium vivax, only ERA showed the same sensitivity of nPCR. The sensitivity, NPV, and kappa values were 78.85%, 97.27, and 0.87 for qPCR and microscopy, and 84.21%, 97.94, and 0.9 for RDT. The data presented here show that the GENEYE® ERA Plasmodium detection kit offers a promising alternative to traditional malaria diagnostic methods. Its high sensitivity, specificity, fast processing time, and operational simplicity position it as a valuable point-of-care diagnostic tool, particularly in resource-limited and remote malaria-endemic areas. KEY POINTS: • GENEYE® ERA kit detects Plasmodium in under 25 min, no DNA purification needed. • The kit matches or exceeds the compared methods in sensitivity and specificity. • The kit is suitable for accurate testing in low-infrastructure, point-of-care settings.

APENDIC-RADS: an ultrasound reporting system for the diagnosis of acute appendicitis.

OBJECTIVE: Abdominal ultrasonography is widely used to evaluate suspected cases of appendicitis. Objective descriptions of the direct and indirect signs of appendicitis result in varied assessments of its likelihood. This study introduces the Appendix Imaging Reporting and Data System (APENDIC-RADS) to standardize the reporting of appendix ultrasound findings. METHODS: This single-center retrospective study included consecutive patients of all ages who underwent abdominal ultrasonography for the investigation of acute appendicitis. The primary outcome was histopathological confirmation of acute appendicitis post-surgery. The imaging findings were classified into five categories: APENDIC-RADS 0, where the appendix cannot be visualized; APENDIC-RADS 1, indicating a normal appendix; APENDIC-RADS 2, describing an appendix that is likely normal but only partially visualized; APENDIC-RADS 3, appendicitis cannot be ruled out due to uncertain features and APENDIC-RADS 4, acute appendicitis. RESULTS: A total of 747 patients were assessed for suspected acute appendicitis using ultrasonography. Of the diagnosed patients, 52% were male, primarily exhibiting symptoms such as nausea and/or vomiting (60%), right iliac fossa pain (54%), and sudden decompression in the right iliac fossa (24%). Stratification into APENDIC-RADS categories revealed a significant variation in the incidence of acute appendicitis, with incidence rates of 4.5% for category 0 and 0.7%, 2.2%, 11.5%, and 93.5% for categories 1 to 4, respectively (p<0.001). The APENDIC-RADS showed excellent discriminative ability, evidenced by an area under the receiver operating characteristic curve of 0.950 (95%CI=0.899-1). CONCLUSION: APENDIC-RADS categorization demonstrated excellent performance in standardizing the ultrasound-determined probability of acute appendicitis. Its implementation could improve physician communication and standardization of patient management.

Evaluation of the effect of BioFire FilmArray nested multiplex polymerase chain reaction method on rapid pathogen identification and antimicrobial stewardship in sepsis.

OBJECTIVE: In this study, we aimed to assess the effect of the BioFire FilmArray Blood Culture Identification 2 panel on agent identification and antimicrobial stewardship in patients with a critical state of sepsis secondary to bloodstream infection. METHODS: This study was designed as a prospective observational study. Patients who developed sepsis and septic shock secondary to bloodstream infection in the intensive care unit were included in the study. Concordance in both monomicrobial and polymicrobial results of Blood Culture Identification 2 panel and conventional blood culture, test result times, and antibiotherapy changes according to Blood Culture Identification 2 panel results were evaluated. RESULTS: In monomicrobial samples, sensitivity and specificity were 97.1% (95%CI 84.6-99.3) and 100% (95%CI 66.3-100), respectively, for gram-negative pathogens and 85.7% (95%CI 42.1-99.6) and 100% (95%CI 90.2-100), respectively, for gram-positive pathogens. In polymicrobial samples, Blood Culture Identification 2 panel results were 79% in concordance with conventional blood culture results. In this study, when the final turnaround time of the Blood Culture Identification 2 panel was compared with culture results, the Blood Culture Identification 2 panel was on average 1 day, 5 h, and 35 min faster than the culture (p<0.01). CONCLUSION: Blood Culture Identification 2 testing is a reliable tool for rapid pathogen and antimicrobial susceptibility detection in critically ill sepsis patients. The use of the Blood Culture Identification 2 panel in patients with sepsis and/or septic shock, where the transition to targeted antibiotherapy is critical, may improve patient outcomes.

Diagnostic Accuracy of Screening Tests for Diabetic Peripheral Neuropathy: An Umbrella Review.

Peripheral neuropathy is a common cause of morbidity in diabetes. Despite recent advancements in early diagnosis methods, there is a need for practical, highly sensitive, and cost-effective screening methods in clinical practice. This study summarizes evidence from systematic reviews and meta-analyses on the diagnostic accuracy of validated screening methods for diabetic peripheral neuropathy. Two independent reviewers assessed methodological quality and bias using AMSTAR and ROBIS tools. Seven reviews with 19,531 participants were included. The monofilament test showed inconsistent sensitivity (S: 0.53-0.93) and specificity (Sp: 0.64-1.00), along with high variability in its application. Neuropad exhibited high S (86%, 95% CI 79-91). However, variations in the interpretation of results across the included studies may have impacted its Sp (65%, 95% CI 51-76). The Ipswich touch test exhibited adequate diagnostic accuracy (S: 0.77, Sp: 0.96, DOR: 75.24) but lacked comparison with gold standard tests. In vibration perception studies, the biothesiometer outperformed the tuning fork (S: 0.61-0.80 vs. 0.10-0.46). In general, heterogeneity was observed due to varied reference tests, thresholds, and patient differences. The development of automated analysis methods, as well as determination of predictive value of the combination of screening tools, is needed for further studies. Based on the study results, we suggest that clinicians should select screening tools tailored to their patient population, clinical setting, and available resources, as no single test can be universally recommended for all clinical scenarios.

Clinical predictor of volume hypoperfusion in patients treated with extended window mechanical thrombectomy: an external validation study.

INTRODUCTION: Treatment of ischemic stroke has expanded beyond the 6-hour window, but identification of eligible patients requires advanced imaging, which is often unavailable. This study aimed to validate a prediction model using the NIHSS score (a measure of stroke severity) to estimate hypoperfusion volume and determine eligibility for DEFUSE 3 treatment criteria. MATERIALS AND METHODS: Data from ischemic stroke patients with less than 24 hours' evolution were analyzed. A previously developed prediction rule based on the NIHSS score was used to estimate the volume of hypoperfused tissue with Tmax>6s, a marker for eligibility for the DEFUSE 3 treatment criteria. This estimated volume was compared with actual perfusion volumes obtained by magnetic resonance imaging or computed tomography with AI segmentation. Sensitivity, specificity and predictive values for determining DEFUSE 3 eligibility were calculated. RESULTS: Sixty-one patients were included (age: 71.9 ± 14.8 years, female: 60%, NIHSS: 16.5 ± 7.4 points). The prediction rule showed high accuracy in determining DEFUSE 3 eligibility with a sensitivity of 0.96, specificity of 0.93, positive predictive value of 0.98 and negative predictive value of 0.87. DISCUSSION: Estimating hypoperfusion volume directly from the NIHSS score using a simple prediction rule provides a reliable and readily available method for identifying patients potentially eligible for DEFUSE 3 treatment. Rapid and reliable estimation of hypoperfusion volume could improve access to advanced stroke care in settings with limited imaging resources.

Introducción: El tratamiento del accidente cerebrovascular isquémico se ha ampliado más allá de la ventana de 6 horas, pero la identificación de pacientes elegibles requiere imágenes avanzadas, que a menudo no están disponibles. Este estudio tuvo como objetivo validar un modelo de predicción utilizando la escala NIHSS (una medida de la gravedad del accidente cerebrovascular) para estimar el volumen de hipoperfusión y determinar la elegibilidad para los criterios de tratamiento DEFUSE 3. Materiales y métodos: Se analizaron datos de pacientes con accidente cerebrovascular isquémico con menos de 24 horas de evolución. Se utilizó una regla de predicción previamente desarrollada basada en la escala NIHSS para estimar el volumen de tejido hipoperfundido con Tmax>6s, un marcador de elegibilidad para los criterios de tratamiento DEFUSE 3. Este volumen estimado se comparó con los volúmenes de perfusión reales obtenidos por resonancia magnética o tomografía computarizada con segmentación de inteligencia artificial. Se calcularon la sensibilidad, especificidad y valores predictivos para determinar la elegibilidad de DEFUSE 3. Resultados: Se incluyeron 61 pacientes (edad: 71.9 ± 14.8 años, mujeres: 60%, NIHSS: 16.5 ± 7.4 puntos). La regla de predicción mostró una alta precisión en la determinación de la elegibilidad de DEFUSE 3 con una sensibilidad de 0.96, especificidad de 0.93, valor predictivo positivo de 0.98 y valor predictivo negativo de 0.87. Discusión: Estimar el volumen de hipoperfusión directamente a partir de la escala NIHSS utilizando una regla de predicción simple proporciona un método confiable y fácilmente disponible para identificar a los pacientes potencialmente elegibles para el tratamiento DEFUSE 3. La estimación rápida y confiable del volumen de hipoperfusión podría mejorar el acceso a la atención avanzada del accidente cerebrovascular en entornos con recursos de imágenes limitados.

Serotype-Specific Dengue Virus IgG Assay Using EDIII-Based Recombinant Proteins and Its Application in an Endemic Population in Northeast Brazil.

Dengue is the most prevalent arboviral disease globally, with Brazil currently experiencing a significant rise in cases. Dengue virus (DENV) typically co-circulates with other clinically and antigenically similar flaviviruses, such as Zika virus (ZIKV). The clinical diagnosis is difficult and accurate serological analysis represents an unmet challenge. Traditionally, serological analysis of DENV infection focuses on the acute phase via detection of NS1 or IgM. Developing IgG DENV-specific assays has been defiant due to the co-circulation of four antigenically distinct serotypes and a strong cross-reactivity with other arboviruses, particularly with ZIKV. The goal of this study was to produce recombinant domain III of the Envelope (EDIII) proteins of each DENV serotype and ZIKV and evaluate the ability to detect specific IgG antibodies. The antigens were tested on the ELISA platform to measure DENV-specific IgG in mice and patients infected with ZIKV and DENV. The assay differentiated serotype-specific IgG responses in susceptible mice (AG129) experimentally infected with DENV or ZIKV. In addition, the test demonstrated a robust performance achieving 87.8% sensitivity and 91.4% specificity when tested against 648 well-characterized sera collected from humans infected with DENV and/or ZIKV. The test was further applied to serum samples collected from 318 healthy individuals from an endemic region in Northwest/Central Brazil, without a previous diagnosis of DENV, and revealed that 65% of the samples reacted with at least one DENV serotype antigen, including 123 monotypic samples (88 for DENV-1) and 90 samples reacting with multiple antigens. Collectively, these results indicate that the IgG DENV-EDIII ELISA is a valuable tool for assessing the serological status of populations in endemic areas, particularly in regions where other flaviviruses, particularly ZIKV, co-circulate and offer support to establish public health policies against the disease.

Advances in Artificial Intelligence for automated knee osteoarthritis classification using the IKDC system.

INTRODUCTION: Knee osteoarthritis is one of the most prevalent and debilitating musculoskeletal diseases, with a high incidence among the elderly population. Early detection and accurate classification can improve clinical outcomes for affected patients. OBJECTIVE: This study investigates the use of artificial intelligence (AI) and computer vision for automated detection and classification of knee osteoarthritis using the IKDC classification system. The aim was to develop an automated system for this purpose and evaluate its accuracy in classifying disease severity. MATERIALS AND METHODS: A public dataset containing radiographic knee images with varying degrees of osteoarthritis, previously classified according to the IKDC scale, was utilized. Images were processed using LandingLens software, an advanced computer vision platform facilitating AI model development and implementation. A machine learning model based on the ConvNext architecture-a convolutional neural network-was trained on 1901 images and evaluated using 380 test images. RESULTS: The model demonstrated an overall accuracy of 95.16% in classifying knee osteoarthritis according to the IKDC scale, with a sensitivity of 95.11%. Class-specific accuracies were 92.40% for class A, 93.20% for class B, 98.45% for class C, and 95.69% for class D. These results highlight the model's capability to distinguish between different severity grades of osteoarthritis with high accuracy. CONCLUSION: This study underscores the efficacy of AI and computer vision in automating knee osteoarthritis detection, providing a precise and reliable tool for physicians in disease diagnosis. Integrating these technologies into clinical practice has the potential to enhance efficiency and consistency in patient evaluation, potentially leading to improved clinical outcomes and more personalized medical care. LEVEL OF EVIDENCE: Level III.

Evaluation of the diagnostic performance of a semi-quantitative lateral flow assay for the detection of Cryptococcus antigen in serum and cerebrospinal fluid specimens.

Cryptococcosis predominantly affects immunocompromised individuals, particularly those with advanced HIV disease, with meningitis being the most severe form and linked to high mortality. Diagnosis typically relies on rapid Cryptococcus antigen (CrAg) testing, and antigen titer quantification helps in early detection and assessing disease severity. However, conventional titer methods are often more expensive than qualitative antigen detection. This study assessed the diagnostic performance of a semi-quantitative lateral flow assay (CrAgSQ LFA, IMMY™) for CrAg detection in serum and cerebrospinal fluid (CSF) collected between 2014 and 2022. The CrAgSQ LFA was compared to the standard CrAg LFA (IMMY™) and Clarus Cryptococcal Ag enzyme immunoassay (EIA-CrAg, IMMY™). The CrAgSQ LFA demonstrated 100% sensitivity and specificity in both serum and CSF, with perfect agreement (kappa 1.00) with the CrAg LFA. When comparing the CrAgSQ LFA with the titer measurement results obtained using CrAg LFA, titers ranged as follows: in category 1+, from 1:2 to 1:20; in 2+, from 1:5 to 1:40; in 3+, from 1:20 to 1:2560; and in 4+, from 1:320 to 1:2560. Titer results for the CrAgSQ LFA aligned well with CrAg LFA, and operator agreement was strong, with weighted kappa values of 0.926 and 0.966. The CrAg-EIA showed a sensitivity of 84% and specificity of 100% using the manufacture cutoff (>0.265), which improved to 96% sensitivity with an optimized cutoff value (>0.145). Overall, the CrAgSQ LFA demonstrated high accuracy and reliability, suggesting it could be a valuable tool for diagnosing cryptococcosis in the Americas.

Guidelines recommend rapid Cryptococcus antigen (CrAg) testing, and antigen quantification can be used for early meningitis detection and as a biomarker for disease severity and prognosis. Here we evaluated a semi-quantitative lateral flow assay for the detection of CrAg in serum and CSF.

Diagnostic value of contrast-enhanced ultrasound combined with serum procalcitonin in tuberculous lymph nodes and metastatic lymph nodes.

OBJECTIVE: To investigate the value of Contrast-Enhanced Ultrasound (CEUS) combined with Procalcitonin (PCT) in differentiating Tuberculous Lymph Nodes (TLN) from Metastatic Lymph Nodes (MLN). METHODS: This prospective cohort study included 207 consecutive patients diagnosed with CTL. All patients underwent routine ultrasound and CEUS prior to pathology or laboratory confirmation. Serum indicators were measured by Enzyme-Linked Immunosorbent Assay (ELISA). Predictive modeling was performed by multifactorial logistic regression. Evaluate the diagnostic and calibration performance of the predictive model by drawing Receiver Operating Characteristic (ROC) curves and calibration curves, and using Area Under the Curve (AUC) and Hosmer-Lemeshow (H-L) tests. RESULTS: The diagnosis of MLN was confirmed pathologically or laboratory in 102 of 207 patients (49.27 %), and 50.8 % were confirmed to be TLN. According to imaging findings of CEUS, TLN was more commonly associated with enhanced concentric performance in the arterial phase (67.65 % vs. 40.95 %) and heterogeneous enhancement pattern in lymph nodes (70.59 % vs. 52.38 %). Peak Intensity (PI) of lesions was higher in patients with MLN. Increased age-enhanced concentric performance in the arterial phase, increased PI, and serum PCT greater than 5.39 ng/mL were independent risk factors for MLN. The prediction model of serum PCT combined with CEUS had a higher diagnostic value for MLN. The H-L test indicated a satisfactory model fit (all p > 0.05), and the calibration curve closely approximates the ideal diagonal. CONCLUSION: CEUS combined with serum PCT has better clinical application value in the differential diagnosis of TLN and MLN.

Predictive efficacy of immature granulocytes in acute complicated appendicitis.

OBJECTIVE: Acute appendicitis is the most common cause of acute abdomen. It is important to differentiate between complicated and uncomplicated appendicitis before surgery in the emergency department. Recently, immature granulocytes have become one of the biomarkers used as predictors of inflammation. The aim of this study was to determine whether immature granulocyte levels are a biomarker that can predict whether acute appendicitis is complicated or not in patients admitted to the emergency department. METHODS: Patients aged 18 years and older who presented to the emergency department between May 1, 2023, and April 30, 2024, and were diagnosed with appendicitis were included in the study. Patients with a histopathologic diagnosis of acute appendicitis were divided into two groups: acute simple appendicitis (n=149) and acute complicated appendicitis (n=103). Demographic characteristics, imaging results, and laboratory results were recorded. RESULTS: White blood cell, neutrophil count and percentage, lymphocyte count and percentage, immature granulocyte count and percentage, direct bilirubin, C-reactive protein, and procalcitonin values were found to be significantly higher in the complicated appendicitis group than in the uncomplicated group (p-values; 0.001, <0.001, <0.001, <0.001, 0.001, <0.001, <0.001, <0.001, <0.001, 0.016, <0.001, and 0.001, respectively). The immature granulocyte percentage was 92% specific for the diagnosis of complicated appendicitis at a cut-off value of 0.6. CONCLUSION: The immature granulocyte percentage may be useful as a predictive biomarker in the diagnosis of complicated acute appendicitis with a specificity of 92%. Additionally, the immature granulocyte percentage has a higher discrimination power than the immature granulocyte count, C-reactive protein, and procalcitonin.

Sensibilidade e especificidade dos critérios epidemiológicos para definição de caso de sífilis congênita em coorte retrospectiva no Brasil / Sensitivity and specificity of epidemiological criteria for the case definition of congenital syphilis in a retrospective cohort in Brazil / Sensibilidad y especificidad de los criterios epidemiológicos para la definición de los casos de sífilis congénita en una cohorte retrospectiva en Brasil

[RESUMO]. Objetivo. Avaliar a sensibilidade e a especificidade dos critérios para definição de sífilis congênita modificados em 2017, que excluíram o tratamento do parceiro sexual como condição para tratamento materno adequado. Método. No presente estudo de coorte retrospectivo, realizou-se o monitoramento epidemiológico de 503 crianças nascidas no ano de 2018, residentes em Porto Alegre, Brasil. Foram monitoradas 412 crianças notificadas como casos de sífilis congênita, incluindo os abortos e natimortos; e 91 crianças expostas à sífilis na gestação que deixaram de ser consideradas casos após a exclusão do parceiro para adequação do tratamento materno. O estudo envolveu observação do tratamento ao nascer, acompanhamento laboratorial não treponêmico até os 18 meses ou treponêmico após 18 meses e avaliação sintomatológica da doença para encerramento da coorte. Resultados. Identificaram-se 286 casos e 126 não casos pelo critério de caso de notificação. Entre os expostos, que não preenchiam os critérios para fins de notificação, foram identificados três casos e 88 não casos (P < 0,001). Considerando a definição atual de caso de sífilis congênita para fins de notificação, a sensibilidade foi de 98,9% (IC95%: 97,0 a 99,7), e a especificidade, 41,0% (IC95%: 34,4 a 48,0). Por sua vez, o encerramento dos casos por monitoramento teve sensibilidade de 69,4% (IC95%: 64,7 a 73,8) e especificidade de 96,7% (IC95%: 90,7 a 99,3). Conclusão. A definição vigente de caso de sífilis congênita para fins de notificação mostrou-se sensível, porém menos específica. Sugere-se sua revisão tendo em vista a possibilidade de perda de diagnósticos verdadeiros positivos.

[ABSTRACT]. Objective. To assess the sensitivity and specificity of the modified criteria for case definition of congenital syphilis implemented in 2017, which excluded treatment of the sexual partner as a necessary condition for adequate maternal treatment. Methods. This retrospective cohort study involved epidemiological monitoring of 503 children born in 2018 and living in Porto Alegre, Brazil: 412, including miscarriages and stillbirths, had been reported as congenital syphilis cases; 91, who had been exposed to syphilis during pregnancy, were no longer considered cases after partner treatment was excluded as a criterion for adequate maternal treatment. The study involved observation of treatment at birth, laboratory follow-up with non-treponemal tests up to age 18 months or treponemal tests after age 18 months, and symptom-based screening for cohort closure. Results. A total of 286 cases and 126 non-cases were identified using the criteria for reportable cases. Among those exposed but who did not meet the criteria for reportable cases, three cases and 88 non-cases were identified (p < 0.001). Considering the current case definition of congenital syphilis for reporting purposes, the sensitivity was 98.9% (95%CI: 97.0 to 99.7), and the specificity, 41.0% (95%CI: 34.4 to 48.0). The monitoring strategy for case closure had a sensitivity of 69.4% (95%CI: 64.7 to 73.8) and a specificity of 96.7% (95%CI: 90.7 to 99.3). Conclusion. The current case definition of congenital syphilis case for reporting purposes proved sensitive, but less specific. We suggest that it be reviewed in light of the possibility of missing true-positive diagnoses.

[RESUMEN]. Objetivo. Evaluar la sensibilidad y la especificidad de los criterios de definición de la sífilis congénita modificados en el 2017, en los que se dejó de exigir el tratamiento de la pareja sexual como condición para considerar que la madre ha recibido un tratamiento adecuado. Método. En este estudio de cohorte retrospectivo se realizó un seguimiento epidemiológico de 503 niños nacidos en el 2018, residentes en Porto Alegre, Brasil. Hubo 412 niños notificados como casos de sífilis congénita, incluidos los abortos espontáneos y los mortinatos, y 91 expuestos a sífilis durante el embarazo que dejaron de considerarse casos tras dejar de considerar necesario el tratamiento de la pareja para establecer que la madre había recibido un tratamiento adecuado. El estudio incluyó la observación del tratamiento al nacer, el seguimiento de laboratorio con pruebas no treponémicas hasta los 18 meses o con pruebas treponémicas después de los 18 meses y la evaluación de los síntomas de la enfermedad al cierre de la cohorte. Resultados. Se identificaron 286 casos y 126 que no lo eran según el criterio de notificación establecido. Entre los expuestos que no cumplían los criterios de notificación, se identificaron 3 casos y 88 que no lo eran (p < 0,001). Teniendo en cuenta la definición actual de caso de sífilis congénita a efectos de notificación, la sensibilidad fue del 98,9% (IC 95%: de 97,0 a 99,7) y la especificidad del 41,0% (IC 95%: de 34,4 a 48,0). Por su parte, el cierre de los casos mediante seguimiento tuvo una sensibilidad de 69,4% (IC 95%: de 64,7 a 73,8) y una especificidad de 96,7% (IC 95%: de 90,7 a 99,3). Conclusión. La definición actual de caso de sífilis congénita a efectos de notificación resultó sensible pero menos específica. Se sugiere su modificación ante la posibilidad de perder diagnósticos positivos verdaderos.

Diagnostic accuracy of artificial intelligence-based electrocardiogram algorithm to predict heart failure with reduced ejection fraction: a systematic review and meta-analysis

INTRODUCTION: AI-based EKG has shown good accuracy for diagnosing heart failure. However, due to the heterogeneity of studies regarding cutoff points, its precision for specifically detecting heart failure with reduced ejection fraction (LVEF <40%) is not yet well established. Research question: What it is the sensitivity and specificity of artificial-based electrocardiogram to diagnose heart failure with low ejection fraction(cut-off of 40%) Aims: We conducted a meta-analysis and systematic review to evaluate the accuracy of artificial intelligence electrocardiograms in predicting an ejection fraction below 40%. METHODS: We searched PubMed, Embase and Cochrane Library for studies evaluating the performance of AI EKGs in diagnosing HFrEF. We computed true positives, true negatives, false positives and false negatives events to estimate pooled sensitivity, specificity and area under the curve, using R software version 4.3.1, under a random-effects model. RESULTS: We identified 8 studies,including 136151 patients with a paired artificial intelligence enabled electrocardiogram with an echocardiography. 9349(6.8%) patients had an ejection fraction below 40% according to the echocardiogram. The AI-ECG data yielded areas under the receiver operator of, sensitivity of 0.861(0.815-0.897), and specificity of 0.874(0.834-0.905), and area under the curve of 0.929(0.876-0.949). Mean/median age ranged from 60±9 to 67.8±14.4 years. CONCLUSIONS: In this systematic review and meta-analysis, the use of electrocardiogram-based artificial intelligence models demonstrated high sensitivity and specificity for the diagnosis of heart failure with an ejection fraction below 40%

The role of hormone dosages in the assessment of cervical lesions by FNA: A descriptive analysis of 762 cases.

INTRODUCTION: The use of Hormone Dosage (HD) in Fine Needle Aspiration Biopsy (FNA) needle washout fluid, introduced in the 1990s, initially aimed at measuring Thyroglobulin (TG). Elevated TG concentration in an extrathyroidal cervical lesion suggests metastases of Well-Differentiated Thyroid Carcinomas (WDTC). Over the years, HD has evolved to incorporate Calcitonin (CT) and Parathormone (PTH), improving sensitivity and specificity in diverse clinical scenarios. Despite varying cutoffs in the literature, existing data underscore significant advancements in diagnostic accuracy. METHODS: This paper presents a case series of 762 cervical lesions with FNA cytology and HD in different cervical regions. RESULTS: It was possible to establish the histogenesis of the lesion based on a combination of the FNA cytology and PTH HD findings, so PTH was useful to determine parathyroid origin in all regions, Thyroglobulin (TG) and PTH together provide insights on cell origin in difficult cases. Thyroglobulin (TG) dosage enhances the accuracy of detecting well-differentiated thyroid carcinomas. In post-thyroidectomy by bed lesions, dosages help to determine non-thyroid/parathyroid lesions. DISCUSSION: The case series and review underscore the valuable contribution of HD in fine-needle aspiration for the evaluation of cervical lesions. By integrating HD with cytological, ultrasound, and clinical data, clinicians can enhance the accuracy and specificity of FNA in diagnosing various cervical lesions, ultimately improving patient care and management.

A comparison of the diagnostic capability of Kato-Katz and real-time PCR for the assessment of treatment efficacy of ivermectin and albendazole combination against T. trichiura infections.

BACKGROUND: Trichuris trichiura is humans' second most prevalent soil-transmitted helminth (STH) infection after Ascaris lumbricoides, affecting approximately 460 million people worldwide. Despite its sub-optimal sensitivity, especially in low prevalence and infection intensity settings, the modified Kato-Katz (K-K) is still recommended as a diagnostic method by the World Health organization (WHO) guidelines. METHODOLOGY/PRINCIPAL FINDINGS: Within a randomized clinical trial (RCT) comprising four treatment arms with two different anthelmintics, the present study reports an important secondary research objective to determine the diagnostic agreement between K-K and real-time PCR evaluating treatment efficacy against T. trichiura. The parasitological results were analyzed, including cure rates (CR) of a subgroup of 94 participants positive at baseline for T. trichiura eggs for both techniques. The single-dose albendazole (ALB) arm resulted in significantly lower CRs than experimental arms of albendazole/ivermectin (ALB/IVM) combinations. The overall diagnostic agreement between both techniques was 88.7% [κ = 0.8 (P<0.001)]. Concordance between eggs per gram and Ct values was moderate, with the discordance source likely stemming from lighter infection intensities. CONCLUSIONS AND SIGNIFICANCE: These findings indicate that real-time PCR is a suitable alternative for CR estimation in helminthiasis clinical trials. It also highlights the need to identify the most accurate diagnostic tools for RCTs, that would benefit from guiding principles to achieve harmonization across studies and are not necessarily the same as those used for epidemiological surveys. TRIAL REGISTRATION: Clinical Trials.gov (NCT04041453).

[Validity of visual inspection with acetic acid versus cervical cytology]. / Validez de la inspección visual con ácido acético frente a citología cervical.

Background: Precancerous lesions, conditions associated with exposure to human papillomavirus (HPV), threaten women's health at different stages of life, from adolescence to old age. It has been observed that a low-cost strategy, such as visual inspection with acetic acid (VIA), reveals cervical lesions, while establishing interventions that allow modifying the course of the disease, thus improving women's quality of life. Objective: To determine the validity of VIA in comparison with cervical cytology for the detection of precancerous lesions. Material and methods: Descriptive, observational, cross-sectional, prospective, analytical study. The type of sampling was non-probabilistic. The sample consisted of 638 participants. Data were collected with a data collection form and analyzed quantitatively with the SPSS software. The study complied with the provisions of the General Health Law on Research in Mexico and was approved by the local research committee of the Mexican Institute for Social Security (IMSS, according to its initials in Spanish). Results: VIA compared with cervical cytology showed a sensitivity of 75%, a specificity of 98%, a positive predictive value of 47%, a negative predictive value of 99%, a positive post-test probability of 97%, and a concordance of 61%. Conclusion: VIA showed an acceptable sensitivity and can be used as a screening test in conjunction with cytology.

Introducción: las lesiones precancerosas, condiciones asociadas a la exposición al virus del papiloma humano (VPH), amenazan la salud de la mujer en diferentes etapas de la vida, desde la adolescencia a la vejez. Se ha observado que una estrategia de bajo costo, como la inspección visual con ácido acético (IVAA), revela lesiones cervicouterinas, al tiempo que se establecen intervenciones que permiten modificar el curso de la enfermedad, lo cual mejora la calidad de vida de la mujer. Objetivo: determinar la validez de la inspección visual con ácido acético en comparación con la citología cervical para detección de lesiones precancerosas. Material y métodos: estudio descriptivo, observacional, transversal, prospectivo, analítico. El tipo de muestreo fue no probabilístico. La muestra estuvo compuesta por 638 participantes. Los datos se recolectaron con una ficha de recolección de datos y se analizaron de forma cuantitativa con el programa SPSS. El estudio se apegó a lo dispuesto en la Ley General de Salud en Materia de Investigación en México y contó con la aprobación del Comité Local de Investigación del Instituto Mexicano del Seguro Social (IMSS). Resultados: la IVAA comparada con la citología cervical mostró una sensibilidad de 75% y una especificidad de 98%, un valor predictivo positivo de 47%, un valor predictivo negativo de 99%, una probabilidad post-test positivo de 97% y una concordancia de 61%. Conclusión: la IVAA presentó una sensibilidad aceptable y puede ser utilizada como prueba de cribado en conjunto con la citología.

Diagnostic accuracy of the flexion-rotation test and cut-off value in acute whiplash-associated disorders: A secondary analysis of a cross-sectional study.

BACKGROUND: Headache is common in people with whiplash-associated disorders (WAD). Upper-cervical structures may be involved in the presence of headache, and the flexion-rotation test (FRT) has been widely studied to assess cervicogenic headaches. OBJECTIVES: To evaluate the diagnostic accuracy of the FRT for the presence of headache in people with WAD, and its cut-off value. METHODS: In this secondary analysis from a previously published study 47 people with WAD were consecutively recruited, 28 with and 19 without headache. FRT was assessed by a single blinded evaluator, with production of headache during the test as the reference standard. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were assessed through cross-tabulation. The cut-off value was calculated based on the Youden's Index. The positivity of the test was defined based on: a) range of motion (ROM) <32°; and ROM <32° combined with headache provocation. RESULTS: Differences between groups were significant for both most and least restricted sides of FRT in terms of ROM (p < 0.001). For the most restricted side, moderate sensitivity and specificity was found (82.1% [95%CI = 68.4%, 95.8%] and 63.2% [95%CI = 40.8%, 85.6%], respectively) when only ROM was considered. When headache provocation was included, sensitivity and specificity were 78.6% (95%CI = 63.1%, 93.7%) and 68.4% (95%CI = 47.5%, 88.5%), respectively. A cut-off value of 31.5° was found. CONCLUSION: Moderate diagnostic accuracy through both ways of assessing the FRT was found for this test to detect the presence of whiplash-associated headache from upper cervical origin. The FRT may be considered positive if ROM is less than 31.5°.