Chronic Constrictive Pericarditis

Constrictive pericarditis (CP) is a rare clinical entity that can pose diagnostic problems. The diagnosis of CP requires a high degree of clinical suspicion. The gold standard for diagnosis is cardiac catheterization with analysis of intracavitary pressure curves, which are high and, in end diastole, equal in all chambers. We present a patient with unexplained dyspnea, recurrent right-side pleural effusion, and ascites. Analysis of the ascitic fluid revealed a high protein content and an elevated serum-ascites gradient. Echocardiography, computed tomography, and cardiac catheterization revealed the diagnosis of CP. He underwent complete pericardiectomy and to date hasmade a good recovery.The diagnosis of CP is often neglected by admitting physicians, who usually attribute the symptoms to another disease process. This case exemplifies the difficulty in diagnosing this condition, as well as the investigation required, and provides a discussion of the benefit and outcomes of prompt treatment

Verbal Autopsy: Reliability and Validity Estimates for Causes of Death in the Golestan Cohort Study in Iran

BACKGROUND: Verbal autopsy (VA) is one method to obtain valid estimates of causes of death in the absence of valid medical records. We tested the reliability and validity of a VA questionnaire developed for a cohort study in Golestan Province in northeastern Iran. METHOD: A modified version of the WHO adult verbal autopsy was used to assess the cause of death in the first 219 Golestan Cohort Study (GCS) subjects who died. The GCS cause of death was determined by two internists who independently reviewed all available medical records. Two other internists ("reviewers") independently reviewed only the VA answers and classified the cause of death into one of nine general categories; they repeated this evaluation one month later. The reliability of the VA was measured by calculating intra-reviewer and inter-reviewer kappa statistics. The validity of the VA was measured using the GCS cause of death as the gold standard. RESULTS: VA showed both good validity (sensitivity, specificity, PPV, and NPV all above 0.81) and reliability (kappa>0.75) in determining the general cause of death independent of sex and place of residence. The overall multi-rater agreement across four reviews was 0.84 (95%CI: 0.78-0.89). The results for identifying specific cancer deaths were also promising, especially for upper GI cancers (kappa = 0.95). The multi-rater agreement in cancer subgroup was 0.93 (95%CI: 0.85-0.99). CONCLUSIONS: VA seems to have good reliability and validity for determining the cause of death in a large-scale adult follow up study in a predominantly rural area of a middle-income country

Kappa (κ) statistics for reliability and validity testing of VA interview in 149 documented deaths.

<p>A1: reviewer A first diagnosis, A2: reviewer A second diagnosis, B1: reviewer B first diagnosis, B2: reviewer B second diagnosis, GS: gold standard.</p

The distribution of causes of death in all 219 deceased and the subset of 149 deceased with supporting medical documents.

<p>The distribution of causes of death in all 219 deceased and the subset of 149 deceased with supporting medical documents.</p

Kappa statistics for reliability and validity testing of VA interview in 219 deaths.

<p>A1: reviewer A first diagnosis, A2: reviewer A second diagnosis, B1: reviewer B first diagnosis, B2: reviewer B second diagnosis, GS: gold standard.</p

Validation characteristics of VA interviews in diagnosing cause of death for 4 selected causes in 219 deaths.

<p>A1: review with the lowest kappa according to <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011183#pone-0011183-t002" target="_blank">table 2</a> (Reviewer A's first review).</p><p>A2: review with the highest kappa according to <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011183#pone-0011183-t002" target="_blank">table 2</a> (Reviewer A's second review).</p

Validation results for VA reviews in diagnosing cause of death for 4 selected causes in 149 documented deaths.

<p>A1: review with the lowest kappa according to <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011183#pone-0011183-t002" target="_blank">table 2</a> (Reviewer A's first review).</p><p>A2: review with the highest kappa according to <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011183#pone-0011183-t002" target="_blank">table 2</a> (Reviewer A's second review).</p