Home About us Contact
|
Home About us Contact | ||
|
|
||
Acceptable Sensitivity (acceptable + sensitivity)
Selected AbstractsGestational diabetes: fasting capillary glucose as a screening test in a multi-ethnic, high-risk populationDIABETIC MEDICINE, Issue 8 2009M. M. Agarwal Abstract Aims, In populations at high risk of gestational diabetes mellitus (GDM), screening every pregnant woman by an oral glucose tolerance test (OGTT) is very demanding. The aim of this study was to determine the value of the fasting capillary glucose (FCG) as a screening test for GDM. Methods, FCG was measured by a plasma-correlated glucometer in 1465 pregnant women who underwent a one-step diagnostic 75-g OGTT for universal screening of GDM. Results, One hundred and ninety-six (13.4%) women had GDM as defined by the criteria of the American Diabetes Association. The area under the receiver operating characteristic curve (AUC) of the FCG was 0.83 (95% confidence interval 0.80,0.86). A FCG threshold of 4.7 mmol/l (at an acceptable sensitivity of 86.0%) independently could rule-out GDM in 731 (49.9%) women, while the FCG could rule-in GDM (100% specificity) in 16 (1.1%) additional women; therefore, approximately half of the women would not need to continue with the cumbersome OGTT. Conclusions, Screening using a FCG significantly reduces the number of OGTTs needed for the diagnosis of GDM. Wider assessment, particularly in low-risk populations, would confirm the potential value of the FCG as a screening test for GDM. [source] Evaluation of decision criteria for detection of spinal cord compression based on cervical myelography in horses: 38 cases (1981,2001)EQUINE VETERINARY JOURNAL, Issue 1 2004J. Van Biervliet Summary Reasons for performing study: Different criteria have been described based on height reduction of the total myelographic contrast column and components of it as tests for compression of the spinal cord due to cervical stenotic myelopathy (CSM). Fifty percent height reduction of the dorsal myelographic column (DMC), <2 mm empiric height of the DMC and a 40% reduction of the ratio of stenosis calculated based on the height reduction of the entire dural diameter (DD) have been described as decision criteria for considering the test result positive. The reasons for selecting these decision criteria or their accuracies have rarely been reported. Objectives: To evaluate the accuracy of diagnostic criteria based on reduced height of the total myelographic column and components of it for diagnosing extradural spinal cord compression using different decision criteria, and make recommendations for consistent myelographic interpretation in horses suspected of having CSM. Methods: Four measurements were obtained by 2 readers in a retrospective sample population of 38 horses in which both cervical myelography and histopathological examination of the cervical spinal cord were performed. The prevalence of CSM in the sample was 50%. At intervertebral sites, the minimum heights of the DD and DMC were measured. At intravertebral sites, the maximum heights of the entire DD and DMC were obtained. Percent height reductions of the DMC and DD were determined as the ratio of minimum intervertebral height to maximum intravertebral height within the next cranial vertebra. Histological examination was used as the gold standard for determining the actual site of spinal cord compression. Sensitivity and specificity for the diagnostic criteria were estimated at each site in neutral and flexed neck positions using several different decision criteria. Conclusions: At C6-C7, in neutral or flexed neck position and using 20% reduction of DD, the test was highly sensitive and specific for CSM. At other sites, reduced height of the myelographic column generally was not accurate for diagnosing extradural spinal cord compression. Using 20% reduction of DD in neutral position at the mid-cervical sites, the test had only low sensitivity and high specificity. Flexion of the neck appeared to increase detection of spinal cord compression in the mid-cervical region, but also substantially increased the frequency of false-positive diagnoses. Potential relevance: By using the reported sensitivity and specificity estimates, readers may decide on a decision criterion for diagnosis of extradural spinal cord compression due to CSM. However, in planning a surgical correction, it is difficult to define a decision criterion that combines acceptable sensitivity and specificity, especially at the mid-cervical sites. [source] Early response as predictor of final remission in elderly depressed patientsINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 11 2009Rob M. Kok Abstract Background Several studies have attempted to predict the final response or remission based on improvement during the early course of treatment of major depression. There is however a great variation in cut offs used to define early response and in the optimal week to predict final results. Objective To compare different cut offs at different time points early in the treatment of elderly depressed patients. Method A 12 week randomised, controlled trial in 81 elderly inpatients with DSM,IV major depression comparing venlafaxine with nortriptyline. At least 20, 25, 30 or 50% improvement was analysed after 1, 3 and 5 weeks using the Hamilton Depression Rating Scale and the Montgomery Asberg Depression Rating Scale. We plotted sensitivity against 1,specificity and calculated areas under the curve (AUCs). Results The highest percentage of correctly classified patients is found using at least 50% decrease as cut off in week 5, with acceptable sensitivity (81.8%) and specificity (87.4%). In week 5, the AUCs were 0.891 (95% CI 0.798,0.984) and 0.866 (95% CI 0.789,0.983) for the HAM-D and MADRS, respectively. Conclusions Combining the results from our study and the other studies addressing this issue, we suggest that the treatment should be changed in the elderly if after 3,4 weeks less than 30% improvement in depression score has been achieved. Copyright © 2009 John Wiley & Sons, Ltd. [source] Chronic hepatitis: Role of diffusion-weighted imaging and diffusion tensor imaging for the diagnosis of liver fibrosis and inflammationJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 1 2008Bachir Taouli MD Abstract Purpose To determine the diagnostic performance of liver apparent diffusion coefficient (ADC) measured with conventional diffusion-weighted imaging (CDI) and diffusion tensor imaging (DTI) for the diagnosis of liver fibrosis and inflammation. Materials and Methods Breathhold single-shot echo-planar imaging CDI and DTI with b-values of 0 and 500 second/mm2 was performed in 31 patients with chronic liver disease and 13 normal volunteers. Liver biopsy was performed in all patients with liver disease with a median delay of two days from MRI. Fibrosis and inflammation were scored on a 5-point scale (0,4). Liver ADCs obtained with CDI and DTI were compared between patients stratified by fibrosis stage and inflammation grade. Receiver operating characteristic (ROC) curve analyses were conducted to evaluate the utility of the ADC measures for prediction of fibrosis and inflammation. Results Patients with liver fibrosis and inflammation had significantly lower liver ADC than subjects without fibrosis or inflammation with CDI and DTI. For prediction of fibrosis stage , 1 and stage , 2, area under the ROC curve (AUC) of 0.848 and 0.783, sensitivity of 88.5% to 73.7%, and specificity of 73.3% to 72.7% were obtained, for ADC ,1.40 × 10,3 mm2/second and ,1.30 × 10,3 mm2/second (using CDI), respectively. For prediction of inflammation grade , 1, AUC of 0.825, sensitivity of 75.0%, and specificity of 78.6% were obtained using ADC , 1.30 × 10,3 mm2/second (using CDI). CDI performed better than DTI for diagnosis of fibrosis and inflammation. Conclusion Liver ADC can be used to predict liver fibrosis and inflammation with acceptable sensitivity and specificity. J. Magn. Reson. Imaging 2008;28:89,95. © 2008 Wiley-Liss, Inc. [source] Coronary risks after high-dose ,-globulin in children with Kawasaki diseasePEDIATRICS INTERNATIONAL, Issue 5 2000Yoshiyuki Morikawa Abstract Objectives: The goals of the present study were to develop a predictive coronary risk scoring system after intravenous ,-globulin (IVGG) therapy of any dose for the different preparations currently used in the treatment of children with Kawasaki disease and to determine the predictive value of the system. The previously reported scoring systems were based on treatment with high-dose IVGG therapy at limited doses and were determined using investigative methods. Methods: Four hundred and fifty-one patients were randomized into one of three groups and received either i.v. polyethylene glycol-treated human immunoglobulin at a dose of either 200 (n=147) or 400 mg/kg per day (n=152) or freeze-dried sulfonated human immunoglobulin at 200 mg/kg per day (n=152) for 5 consecutive days. We documented 31 cases of coronary abnormalities (CA). Univariate and multivariate logistic regression was performed using 49 clinical variables and the resulting predictive model was validated. Results: The duration of fever (odds (1 day)/odds (, 5 days)=0.158; 95% confidence interval (CI) 0.0385,0.648), hemoglobin (odds (Q1=10.3)/odds (Q3=11.6) = 3.97; 95% CI 1.92,8.20), IgG (odds (Q1=1900)/odds (Q3=2658)=2.72, 95% CI 1.18,6.25) and IgA (odds (Q1=72)/odds (Q3=160) =0.415; 95% CI 0.253,0.680) levels after completion of ,-globulin infusion were independent predictors. The model is quasi-cross validated and has acceptable sensitivity and selectivity. The estimated risk and observed occurence of CA coincide. Conclusions: Determinants of the risk of CA after IVGG therapy are a longer duration of fever, a lower IgG level, a higher IgA level and a lower hemoglobin level after IVGG infusion. This model is applicable for IVGG doses from 1 to 2 g/kg and for at least two different ,-globulin preparations. [source] Screening of an Echinococcus granulosus cDNA library with IgG4 from patients with cystic echinococcosis identifies a new tegumental protein involved in the immune escapeCLINICAL & EXPERIMENTAL IMMUNOLOGY, Issue 3 2005E. Ortona Summary The worldwide problem of chronic Echinococcus granulosus disease calls for new parasite-derived immunomodulatory molecules. By screening an E. granulosus cDNA library with IgG4 from patients with active cystic echinococcosis, we identified a cDNA that encodes a predicted partial protein that immunofluorescence studies localized in the protoscolex tegument and on the germinal layer of cyst wall. We named this protein EgTeg because the 105 amino acid sequence scored highest against a family of Schistosoma tegumental proteins. Evaluating the role of EgTeg in the human early inflammatory response we found that EgTeg significantly inhibited polymorphonuclear cell (PMN) chemotaxis. Cytometric analysis of intracellular cytokines disclosed a significantly higher percentage of cells producing IL-4 than IFN-, (P = 0·001, Student's t-test) in T lymphocytes from patients with cystic echinococcosis stimulated with EgTeg. EgTeg induced weak Th1-dependent proliferation in 42% of patients' peripheral blood mononuclear cells. In immunoblotting (IB) analysis of total IgG and IgG subclass responses to EgTeg in patients with cystic echinococcosis, patients with other parasitoses, patients with cystic lesions and healthy controls, total IgG specific to EgTeg yielded high sensitivity (73%) but low specificity (44%) precluding its use in immunodiagnosis. Conversely, IgG4 specific to EgTeg gave acceptable sensitivity (65%) and high specificity (89%) suggesting its use in immunodiagnosis to confirm ultrasound documented cysts suggestive of E. granulosus. Because the new tegumental antigen EgTeg inhibits chemotaxis, induces IL-4-positive T lymphocytes and noncomplement fixing antibodies (IgG4) it is an immunomodulatory molecule associated with chronic infection. [source] | ||||||||||