The diagnostic accuracy of spirometry versus peak expiratory flow test for follow-up of adult asthma patients at primary care level.

Background: The asthma burden is growing worldwide, and this is predisposed by environmental and occupational exposures as well as individual risk factors. This study was aimed at a comparison of diagnostic accuracy of spirometry and peak expiratory flow rate (PEFR) in asthma screening of adult patients with lung function abnormalities that present at the level of primary care. Methods: This study was conducted in Shymkent city, South Kazakhstan, the third most populous city of the country with developed industries and high rates of pulmonary diseases. Four hundred and ninety-five adult patients with lung function abnormalities were enrolled in the study and underwent two screening tests (spirometry and PEFR). The diagnosis of asthma was verified by a qualified pulmonologist after performance of screening tests and was based on symptoms, medical history, and laboratory and lung function tests. Results: The sensitivity of spirometry was 0.97 and that of PEFR was 0.95 (p = 0.721), whereas the specificity of spirometry was 0.37 and that of PEFR was 0.28 (p = 0.227). Both tests yielded the same results for the positive predictive value (0.98). The negative predictive value was significantly higher for spirometry versus PEFR (0.23 versus 0.08; p = 0.006). The positive and negative likelihood ratios of the two tests also differed significantly (p = 0.001 and p = 0.006, respectively), whereas the overall accuracy was comparable between the two tests (0.96 for spirometry and 0.94 for PEFR; p = 0.748). Conclusion: Ambulatory PEFR monitoring is non-inferior to the monitoring of the forced expiratory volume in 1 second and could be used for screening purposes on equal grounds with spirometry.

Predictive value of 18F-fluorodeoxyglucose accumulation in visceral fat activity to detect colorectal cancer metastases (prospective observational cohort study).

Background: To evaluate functional visceral adipose tissue (VAT) activity assessed by 18F-fluorodeoxyglucose ( 18F-FDG) positron emission tomography/computed tomography (PET/CT) as a predictive factor of metastases in colorectal cancer (CRC) patients. Methods: We reviewed study protocols and PET/CT data of 534 CRC patients; 474 patients were subsequently excluded for various reasons. The remaining 60 patients with histologically confirmed adenocarcinoma were then prospectively assessed and were exposed to 18F-FDG PET/CT after a surgical treatment and chemoradiotherapy. Age, histology, stage, and tumor grade data were recorded. Functional VAT activity was verified with maximum standardized uptake value (SUV max) using 18F-FDG PET/CT and tested as a predictive factor of later metastases in eight subdomains of abdominal regions (RE - epigastric region, RLH - left hypochondriac region, RRL - right lumbar region, RU - umbilical region, RLL - left lumbar region, RRI - right inguinal region, RP - hypogastric (pubic) region, RLI - left inguinal region) and pelvic cavity (P) in the adjusted regression models. In addition, we studied the best areas under the curve (AUC) for SUV max with the corresponding sensitivity (Se) and specificity (Sp). Results: In both adjusted for age regression models and receiver operating characteristic (ROC) curve analysis, 18F-FDG accumulation in RLH (cut-off SUV max 0.74; Se 75%; Sp 61%; AUC 0.668; p=0.049), RU (cut-off SUV max 0.78; Se 69%; Sp 61%; AUC 0.679; p=0.035), RRL (cut-off SUV max 1.05; Se 69%; Sp 77%; AUC 0.682; p=0.032) and RRI (cut-off SUV max 0.85; Se 63%; Sp 61%; AUC 0.672; p=0.043) could predict later metastases in CRC patients, as opposed to age, sex, primary tumor location, tumor grade and histology. Conclusions: Functional VAT activity was importantly related to later metastases in CRC patients and can be used as their predictive factor.