Evaluación Bidimensional y Tridimensional de la Vía Aérea Superior

Indexación: Scopus; Scielo.The aim of this study was to validate and correlate the two-dimensional (2D) with the three-dimensional (3D) measures of the upper airway assessment. Lateral cephalograms and cone beam CT of 100 adult subjects were used to perform a 2D and 3D assessment of the upper airway. Spearman correlation coefficient was used to determine whether there was correlation between variables. Additionally, specificity, sensitivity, negative predictive value and positive predictive value was calculated for the 2D assessment of the upper airway. Correlation between all two and three dimensional variables was found. In the nasopharynx and oropharynx, a weak correlation (r <0.51) was found; in the oropharynx a moderate one (0.50 <r <0.76). The validity tests of the 2D assessment resulted in a 73% sensitivity, 45% specificity, 93% negative predictive value and 14% positive predictive value for the nasopharynx; 100% sensitivity, 51% specificity, 100% negative predictive value and 6% positive predictive value in the oropharynx and 100% sensitivity, 71% specificity, 100% negative predictive value and 13% positive predictive value in the hypopharynx. There is a weak correlation between the 2D and 3D assessment of the upper airway. However, the lateral cephalogram has a high sensitivity and high negative predictive value, therefore, an additional complementary examination would not be necessary if the 2D assessment of the upper airway throws a normal result.http://ref.scielo.org/mpkrn

The role of targeted viral load testing in diagnosing virological failure in children on antiretroviral therapy with immunological failure.

Objectives  To determine the improvement in positive predictive value of immunological failure criteria for identifying virological failure in HIV-infected children on antiretroviral therapy (ART) when a single targeted viral load measurement is performed in children identified as having immunological failure. Methods  Analysis of data from children (<16 years at ART initiation) at South African ART sites at which CD4 count/per cent and HIV-RNA monitoring are performed 6-monthly. Immunological failure was defined according to both WHO 2010 and United States Department of Health and Human Services (DHHS) 2008 criteria. Confirmed virological failure was defined as HIV-RNA >5000 copies/ml on two consecutive occasions <365 days apart in a child on ART for ≥18 months. Results  Among 2798 children on ART for ≥18 months [median (IQR) age 50 (21-84) months at ART initiation], the cumulative probability of confirmed virological failure by 42 months on ART was 6.3%. Using targeted viral load after meeting DHHS immunological failure criteria rather than DHHS immunological failure criteria alone increased positive predictive value from 28% to 82%. Targeted viral load improved the positive predictive value of WHO 2010 criteria for identifying confirmed virological failure from 49% to 82%. Conclusion  The addition of a single viral load measurement in children identified as failing immunologically will prevent most switches to second-line treatment in virologically suppressed children

Applicability of Winthrop Score for the Diagnosis of Influenza A in the Emergency Department of Hospital Pablo Arturo Suárez, January to March of 2018

Introduction: In 2010, the Department of Infectious Diseases at Winthrop University Hospital designed a score system for the diagnosis of Legionella pneumonia. In this study, we applied the score to patients with acute respiratory symptoms suspected of having type A influenza. The identification of patients at medium to high risk of Influenza A allows for early initiation of treatment.Objective: To study the applicability of the Winthrop score for the diagnosis of Influenza A.Methodology: A prospective cohort study was performed in 2018 at Hospital Pablo Arturo Suárez, in Quito, Ecuador. Patients 0 to 100 years old presenting to the emergency department with influenza-like illness in January-March of 2018 were included in the study. Winthrop score results were then compared with the result of the reverse transcription polymerase chain reaction (RT-PCR) for influenza A, the gold standard for diagnosis. Sensitivity, specificity, positive and negative predictive values, and likelihood ratios were used to establish the diagnostic performance of this point system for influenza A within the sample at large and in subgroup analyses by age (&lt;5 years, 5-65 years, and &gt;65 years) and comorbidities.Results: 149 patients were enrolled in the study period. The study population included 81 males (54.4%) and the majority of patients were less than 5 years of age (N=85, 57.0%). Furthermore, almost one-third of the patients were less than one year old (N=38, 25.5%). According to the Winthrop point system, 68.5% of the cases had a low probability of having influenza (n = 102), 8.7% of cases had a medium probability (n = 13) and 22.8 % of cases had a high probability (n = 34). The RT-PCR test for influenza was positive for 26.2% of patients (n = 39). The Winthrop point system had a sensitivity of 97.4%, specificity of 91.8%, positive predictive value of 80.8%, negative predictive value of 99.0%, positive likelihood ratio of 11.9, and negative likelihood ratio of 35.8 in the total study population. For children under 5 years, a sensitivity of 100%, specificity of 96.3%, positive predictive value of 77.7%, negative predictive value of 100%, positive likelihood ratio of 27, and negative likelihood ratio of 0. In patients older than 6 years, a sensitivity of 96.9%, specificity of 89%, positive predictive value of 84.21%, negative predictive value of 98%, positive likelihood ratio of 8.8, and negative likelihood ratio of 29.4. Testing in patients over 65 years had a sensitivity of 100%, specificity of 90%, positive predictive value of 87.5%, negative predictive value of 100%, positive likelihood ratio of 10 and negative likelihood ratio of 0. Finally, patients with comorbidities had a sensitivity of 90%, specificity of 88.24%, positive predictive value of 81.82%, negative predictive value of 93.75%, positive likelihood ratio of 7.65, and negative likelihood ratio of 8.82.Conclusions: The Winthrop score performed well in predicting Influenza A in patients with acute respiratory symptoms. This score may be useful in settings were Influenza A PCR testing is unavailable

Diagnostic accuracy of multidetector computed tomography scan in mediastinal masses assuming histopathological findings as gold standard

Purpose: Aim of the study was to: 1) present MDCT characteristics of different mediastinal mass lesions, 2) estimate proportion of benign and malignant mediastinal mass lesions based on MDCT findings, and 3) find out the diagnostic accuracy with sensitivity, specificity, positive predictive value, and negative predictive value of MDCT in mediastinal mass lesions assuming histopathology as gold standard. Material and methods: This study was an analysis of 60 patients who underwent MDCT scan for characterisation of mediastinal mass lesion, and subsequently imaging findings were verified with pathological diagnosis. Results: Out of 60 patients 65% were malignant and 35% were benign. Metastatic carcinoma was the leading diagnosis. Sensitivity of MDCT in this study came out to be 94%, specificity is 90%, with a positive predictive value of 94% and negative predictive value of 90% with diagnostic accuracy of 93%. Conclusions: Mediastinal mass lesion can be accurately diagnosed with MDCT which is a non-invasive and easily available modality requiring clinical data for accurate diagnosis and management. Co-relation of MDCT findings with other imaging findings is complex and requires adequate clinical data for optimum diagnostic confidence

How successful is color flow mapping and pulsed Doppler studies in predicting histologically confirmed benign and malignant adnexal masses in perimenopausal women

Background: Adnexal masses in perimenopausal women presents a specific diagnostic challenge because benign masses outnumbers malignant masses. Majority of adnexal masses are benign but 25% are malignant. The objective of this study was to see the effectiveness of transvaginal colour Doppler in predicting malignancy in adnexal masses in perimenopausal women.Methods: Clinically detected adnexal masses were subjected to transabdominal ultrasound scan (for basic characterization of mass into solid, cystic, mixed) then transvaginal scan and neovascularization, resistivity index (RI) was measured. Subsequently all patients underwent laparotomy. Histopathological reports obtained, and correlation done between USG and histopathology.Results: Among cystic masses neovascularization was present in 4 cases, among them benign and malignant masses were equal in number. Among mixed masses neovascularization was present in 17 cases 9 were malignant 8 benign, among solid masses all cases where neovascularization was detected were malignant. Neovascularization was absent in 12 cystic masses and 11 mixed masses, and all were benign. Kappa value calculated for tumour status and neovascularization is 0.610 which is substantially agreement with neovascularization as predictor of malignancy. Sensitivity, specificity, positive predictive value and negative predictive value of neovascularization for cystic masses are 100, 85, 50, 100(%) respectively. Sensitivity, specificity, positive predictive value and negative predictive value of neovascularization for mixed masses are 100, 57.89, 52.94, 100(%) respectively. Sensitivity and positive predictive value of neovascularization for solid masses is 100(%). Sensitivity specificity positive predictive value and negative predictive value of RI for cystic masses: 100, 92.8, 66.6, 100 (%) respectively. Sensitivity specificity positive predictive value and negative predictive value of RI for mixed masses: 77.7, 89.4, 77.7, 89.4(%). Sensitivity positive predictive value of RI for solid masses 100%.ROC curve analysis shows cut off value for differentiating between benign and malignant masses is 0.4. Less than 0.4 has more chance of malignancy.Conclusions: Transvaginal Doppler ultrasound must be done preoperatively for adnexal mass characterization

Positive Predictive Value of ICD-10 Diagnosis Codes for COVID-19

PURPOSE: To examine the positive predictive value (PPV) of International Classification version 10 (ICD-10) diagnosis codes for Coronavirus disease 2019 (COVID-19). PATIENTS AND METHODS: Medical record review of all patients assigned a diagnosis code of COVID-19 (DB342A or DB972A) at six Danish departments of infectious diseases from February 27 through May 4, 2020. Confirmed COVID-19 diagnosis was defined as either: 1) definite, a positive polymerase chain reaction (PCR) for severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) on a respiratory sample combined with symptoms suggestive of COVID-19: 2) probable, clinical presentation of COVID-19 without detection of SARS-CoV-2 and no alternative diagnoses considered more likely; or 3) possible, clinical presentation of COVID-19 without detection of SARS-CoV-2, and the patient was discharged or deceased before further investigations were carried out. We computed the PPV with 95% confidence intervals (CI) as the number of patients with confirmed (i.e., definite, probable, and possible) COVID-19 divided by the number of patients assigned a diagnosis code for COVID-19. RESULTS: The study included 710 patients with a median age of 61 years (interquartile range [IQR] 47–74) and 285/710 (40%) were female. COVID-19 was confirmed in 706/710 (99%) with 705/710 (99%) categorized as definite, 1/710 (0.1%) as probable, and 0 patients as possible COVID-19. The diagnosis was disproven in 4/710 (0.6%) patients who were hospitalized due to bacterial pneumonia (n = 2), influenza (n = 1), and urinary tract infection (n = 1). The overall PPV for COVID-19 was 99% (95% CI 99–100) and remained consistently high among all subgroups including sex, age groups, calendar period, and stratified by diagnosis code and department of infectious diseases (range 97–100%). CONCLUSION: The overall PPV of diagnosis codes for COVID-19 in Denmark was high and may be suitable for future registry-based prognosis studies of COVID-19

Comparison between Pap smear and visual inspection with acetic acid in screening of premalignant cervical intraepithelial lesion and subclinical early cancer cervix

Background: The objective of the study was to compare the sensitivity, specificity, positive predictive value and negative predictive value of VIA and Pap smear in screening of premalignant cervical intraepithelial lesion and subclinical early cancer cervix.Methods: An observational prospective study was done for 350 patients attending the gynecology outpatient clinic of the shatby maternity university hospital for any reasons, VIA and Pap test were done for all patients, then colposcopic guided biopsy from cases with positive colposcopic findings. Histopathological examination was done for collected biopsy. Collected data was statistically analyzed to compare between both tests (PAP and VIA).Results: Our results showed that the sensitivity of PAP test was 83.3%, specificity was 90.7%, positive predictive value was 50.8%, negative predictive value was 97.9% and accuracy was 90% while the VIA test had a sensitivity of 66.7%, specificity was 91%, positive predictive value was 46.1%, negative predictive value was 95.9% and accuracy was 88.5%.Conclusions: Via test has comparable results to Pap test regarding its sensitivity, specificity, positive predictive value, negative predictive value and accuracy and can be used as an alternative primary test to screen premalignant cervical intraepithelial lesion and subclinical early cancer cervix

Benefit of viral load testing for confirmation of immunological failure in HIV patients treated in rural Malawi.

Objective  Viral load testing is used in the HIV programme of Chiradzulu, Malawi, to confirm the diagnosis of immunological failure to prevent unnecessary switching to second-line therapy. Our objective was to quantify the benefit of this strategy for management of treatment failure in a large decentralized HIV programme in Africa. Methods  Retrospective analysis of monitoring data from adults treated with first-line antiretroviral regimens for >1 year and meeting the WHO immunological failure criteria in an HIV programme in rural Malawi. The positive predictive value of using immunological failure criteria to diagnose virological failure (viral load >5000 copies/ml) was estimated. Results  Of the 227 patients with immunological failure (185 confirmed with a repeat CD4 measurement), 155 (68.2%) had confirmatory viral load testing. Forty-four (28.4%) had viral load >5000 copies/ml and 57 (36.8%) >1000 copies/ml. Positive predictive value was 28.4% (95% CI 21.4-36.2%). Repeat CD4 count testing showed that 41% of patients initially diagnosed with immunological failure did no longer meet failure criteria. Conclusions  Our results support the need for confirming all cases of immunological failure with viral load testing before switching to second-line ART to optimize the use of resources in developing countries

Utility of clinical features with fine needle aspiration biopsy for diagnosis of Warthin tumor.

BACKGROUND:Conservative management of Warthin tumor (WT) may be a viable alternative to surgery, but there are concerns of missed malignancies on fine needle aspiration biopsy (FNAB). The purpose of this study is to measure the sensitivity and positive predictive value of FNAB for WT, and to identify clinical features associated with WT that can aid in this diagnosis. METHODS: Retrospective analysis of patients from January 1, 2006 to April 30, 2017 at a tertiary care center in London, Ontario, Canada. All patients with a diagnosis of WT on FNAB or resection were included. Electronic medical records were identified for 177 patients that fit the criteria. Study outcomes included the sensitivity and positive predictive value of FNAB alone for WT, and, when including clinical features associated with WT. RESULTS: The mean age of patients in this study was 63.2 years (SD 10.4); 115 (65%) were male, and 157 (89%) were past or present smokers. The measured sensitivity and positive predictive value of FNAB for WT were 95.8 and 97.2% respectively. Two cases were classified as WT on FNAB but confirmed at resection as mucoepidermoid carcinoma and acinic cell carcinoma. When only patients with multifocal, bilateral or incidental tumors were assessed, sensitivities and positive predictive values for each were 100%. Isolating for inferior pole location also resulted in a positive predictive value of 100%. CONCLUSIONS: The sensitivity and positive predictive value of FNAB for WT in this study are high, with two false negatives on FNAB. Multifocal, bilateral, incidentaloma and inferior pole location were identified as potential clinical features that may increase the diagnostic confidence for WT, strengthening the argument for conservative management in these patients. Overall, this study serves as an initial exploration into whether clinical features may be included with FNAB results to improve the sensitivity and positive predictive value of diagnosing WT. Further research is necessary before these findings can be translated into clinical practice