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Diagnostic Power (diagnostic + power)
Selected AbstractsNear patient blood ketone measurements and their utility in predicting diabetic ketoacidosisDIABETIC MEDICINE, Issue 2 2005S. Harris Abstract Aim To assess the utility of near patient blood ketone measurements in predicting diabetic ketoacidosis (DKA) among a group of hyperglycaemic unwell patients presenting to a hospital emergency department. Methods Near patient blood ,-hydroxybutyrate (,-OHB) testing has recently been introduced as a new tool in our hospital Accident and Emergency department (A&E) for patients with a finger-prick glucose of > 11 mmol/l. We reviewed the records of the first 50 patients to have a ,-OHB measurement to establish if they developed DKA or received treatment with intravenous insulin within 48 h of presentation. We then compared the diagnostic power of ,-OHB measurements with other clinical, physiological and biochemical markers of DKA. Results Nine patients had DKA, eight had a compensated metabolic acidosis secondary to raised serum ketones, and 33 had no evidence of DKA during the following 48 h. The median (range) ,-OHB levels in each group were 6.0 (3.1,6.0) mmol/l, 3.4 (1.2,5.7) mmol/l, and 0.1 (0.0,1.2) mmol/l, respectively. A ,-OHB level of , 3.0 mmol/l had a sensitivity of 100% and specificity of 88% for DKA. All those with ,-OHB level > 3.0 mmol/l required treatment with intravenous insulin. Conclusion Measuring ,-OHB when a hyperglycaemic patient is identified could offer a simple method of identifying at an early stage those patients at highest risk of DKA (,-OHB > 3.0 mmol/l), and redirecting the search for a diagnosis in others (,-OHB < 1.0 mmol/l). [source] Ethyl glucuronide in hair.ADDICTION, Issue 6 2009A sensitive, specific marker of chronic heavy drinking ABSTRACT Aims This study aims to define a cut-off concentration for ethyl glucuronide in hair to determine if there was a history of heavy drinking. Settings Pavia, Italy. Participants We analysed hair samples from 98 volunteers among teetotallers, social drinkers and heavy drinkers, whose ethanol daily intake (EDI) was estimated by means of a written questionnaire. Measurements Ethyl glucuronide hair concentration (HEtG) was measured by liquid chromatography-tandem mass spectrometry (lower limit of quantification: 3 pg/mg) using a fully validated method. Findings The HEtG level providing the best compromise between sensitivity (0.92) and specificity (0.96) at detecting an EDI of 60 g or higher during the last 3 months was 27 pg/mg. None of the factors examined among those known to affect ethanol metabolism and/or the diagnostic power of other markers of ethanol use or hair analyses, including age, gender, body mass index, tobacco smoke, prevalent beverage, hair colour, cosmetic treatments and hygienic habits was found to influence marker performance significantly. However, the slight differences in HEtG performance observed for some factors (e.g. body mass index, smoke and hair treatments) require further studies on larger groups of individuals in order to assess their influence more precisely. Conclusions Our results confirm further that HEtG is a sensitive and specific marker of chronic heavy drinking. [source] Quantitative determination of the diagnostic accuracy of the synovitis score and its componentsHISTOPATHOLOGY, Issue 3 2010Elisabeth Slansky Slansky E, Li J, Häupl T, Morawietz L, Krenn V & Pessler F (2010) Histopathology,57, 436,443 Quantitative determination of the diagnostic accuracy of the synovitis score and its components Aims:, To assess the diagnostic accuracy of a three-component synovitis score and to determine the relative contribution of each of its components to its overall discriminatory power. Methods and results:, The synovitis score was determined in 666 synovial specimens: normal synovium, n = 33; post-traumatic arthropathy (PtA), n = 29; osteoarthritis (OA), n = 221; psoriatic arthritis (PsA), n = 42; and rheumatoid arthritis (RA), n = 341. The discriminatory abilities of the score and its components were quantified with binary and multicategory receiver operating characteristic (ROC) analysis. The score differentiated all arthropathies accurately from normal tissue (area under the ROC curve, AUC: 0.87,0.98) and RA from OA or PtA (AUC: 0.85 for both), but could not distinguish well within pairs of inflammatory or degenerative arthropathies. AUCs of the intimal hyperplasia and stromal cellularity components correlated with the AUCs of the complete score markedly more strongly (r = 0.94 and 0.91, respectively) than the inflammatory infiltration component (r = 0.60). Multicategory ROC analysis ranked the score several-fold higher than any of its components, and the components in the order stromal cellularity>intimal hyperplasia>infiltration. Conclusion:, Combining three distinct histological parameters into a three-component score produces greatly increased overall diagnostic power. The discriminatory ability of the score stems more from measuring proliferative than infiltrative aspects of synovitis. [source] Altered Autonomic Cardiac Control Predicts Restenosis After Percutaneous Coronary InterventionPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2 2006MATTHIAS GOERNIG Background: Early and late restenosis in up to 30% remains a major problem for long-term success after percutaneous coronary intervention (PCI). Compared to bare metal stents, the use of drug-eluting stents reduces restenosis below 10%, but implant coasts have to be considered. In restenosis noninvasive testing lacks diagnostic power. We applied a new approach to identify patients with a high risk for restenosis after PCI by combining heart rate (HR) and blood pressure variability (BPV) analyses. Methods: In 52 patients with clinical suspicion of restenosis and history of PCI, we investigated patterns of cardiovagal autonomic regulation prior to cardiac catheterization. The patients were separated in (i) patients with restenosis (CAD+R) and (ii) patients without restenosis (CAD,R), where restenosis is defined as a stenosis greater than 75% of luminal diameter in at least one main vessel. The following parameters/methods were evaluated: Canadian Cardiovascular Society grade (CCS-grade), vessel disease score (CAD-level), left ventricular ejection fraction (LVEF), heart rate variability (HRV), BPV, baroreflex sensitivity (BRS), as well as HR turbulence and blood pressure (BP) potentiation caused by premature ventricular complexes. Results: Whereas age, LVEF, CAD-level, CCS-grade, and mean BP did not differ between CAD+R and CAD,R, significant differences were found in (i) BPV: diastolic LF/P, systolic, and diastolic UVLF, (ii) in BRS: slope of tachycardic sequences, and (iii) in extrasystolic parameters: heart rate turbulence onset (HRTO) and potentiation of systolic BP (SBPP). Standard HRV parameters did not show significant differences between the groups. Using the two parameters diastolic LF/P (threshold >0.2) and HRTO (threshold >0) restenosis were predicted in 83.4%. Conclusions: These results demonstrate that indicators of sympathetic activation or vagal depression identify restenosis in patients after PCI, thus opening a perspective for a new noninvasive monitoring. [source] Methodology of retinal straylight assessmentACTA OPHTHALMOLOGICA, Issue 2007TJTP VAN DEN BERG Purpose: The psychophysical technique of "Compensation Comparison", embedded in the C-Quant instrument for clinical assessment of retinal straylight will be demonstrated. Retinal straylight is the cause of complaints such as glare hindrance and contrast loss. It results from disturbances in the optical media. Its assessment helps to decide on surgery of (early) cataract, or to evaluate corneal or vitreal problems. Methods: The subject's task is to compare in 20 short presentations two flickering half fields, and to indicate with push buttons which one flickers more strongly. Added value in comparison to visual acuity was assessed in 2422 active drivers of the European GLARE study. Repeatability of the obtained straylight value was tested for 17 naive subjects and several groups of patients. Absolute measurement precision of the C-Quant was tested using a scattering sample with known straylight value in front of the eyes of the 17 naive subjects. Results: Many individuals were found to suffer from increased straylight that is undetected in visual acuity: in 6% of cases with decimal visual acuity > 0.5 straylight was increased more than 4 times compared to normal. A psychometric function was derived and fitted to the patient responses, resulting in a straylight value including a reliability estimate. Repeated measures standard deviation for the method is about 0.07 log units, to be compared with differences of 1.0 log units or more units with (early) cataract or corneal disturbances. The check using known scatter samples showed virtually perfect (0.01 log units difference) correspondence. Conclusions: Absolute precision and repeated measures standard deviation is very good compared with differences in the population. Straylight measurement promises important extra diagnostic power. [source] Evaluation of faecal calprotectin as a valuable non-invasive marker in distinguishing gut pathogens in young children with acute gastroenteritisACTA PAEDIATRICA, Issue 9 2010Josef Sıkora Abstract Aim:, The aim of the study is to evaluate faecal calprotectin (f-CP) in children ,3 years of age with acute gastroenteritis (AG) as an early predictor of bacterial inflammation. Methods:, We prospectively analysed f-CP levels and diagnostic workup in 107 consecutive children (66 AG, 41 controls). Results:, Children with bacterial AG (BAG) was found to have higher diarrheal frequency (p < 0.01), fever (p < 0.01), erythrocyte sedimentation rate (p < 0.001), white blood count (p < 0.01) and C-reactive protein (CRP) (p < 0.001) compared with viral AG (VAG). Vomiting was frequent in VAG (p < 0.001). f-CP negatively correlated with age in controls (r = ,0.5998). BAG demonstrated significantly higher f-CP levels [median, 219 ,g/g, interquartile range (IQR): 119,350.2] compared with VAG (49.3 ,g/g, IQR: 8.8,131.1) as well as controls (26.5 ,g/g, IQR: 14.9,55.1) (p < 0.001). VAG and control f-CP levels were similar. f-CP was the best-rated marker of BAG with a diagnostic accuracy of 92%. Receiver,operator characteristic analysis revealed an area under curve of 0.95 for identifying BAG; sensitivity and specificity of f-CP were 93% and 88%, respectively, at an adjusted cut-off point of 103.9 ,g/g faeces. Combined f-CP and CRP yield improved diagnostic accuracy of 94% for BAG. Conclusion:, f-CP facilitates early discrimination between bacterial and viral causes of AG in young children. Combining f-CP with CRP increases the diagnostic power of diagnosing BAG. [source] | ||||||||||