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1.
Clin Biochem ; 75: 53-61, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31677994

RESUMO

BACKGROUND: Biotin and streptavidin are commonly used reagents in clinical immunoassays. Several cases of biotin interference with immunoassay testing for patients taking biotin supplements have been reported, yet, not all analytes and platforms susceptible to biotin interference have been characterized. The objectives of this study are to characterize biotin interference with 21 immunoassays using the Ortho Clinical Diagnostics Vitros 5600, evaluate a biotin-depletion method, and apply risk mitigation strategies for biotin interference during routine clinical testing at our institution. METHODS: Residual serum without and with increasing concentrations of exogenous biotin were used to evaluate biotin interference with 21 immunoassays using the Vitros 5600. Biotin-depletion was evaluated by comparing measured analyte concentrations in serum with and without exogenous biotin and streptavidin-microparticle pretreatment. Focused education for healthcare professionals about biotin interference was performed in February 2018. Samples with suspected biotin interference were investigated using this biotin-depletion method, and analyte testing by alternate methodology for select samples. RESULTS: Exogenous biotin in serum caused dose-dependent negative biases in 15 immunometric assays, and dose-dependent positive biases in 6 competitive immunoassays. Streptavidin-microparticle pretreatment of serum containing exogenous biotin demonstrated recoveries 100 ±â€¯15% of expected values for all 21 analytes. Physicians identified 21 samples suspicious for biotin interference over 11 months, and streptavidin-microparticle pretreatment verified 11 cases of biotin interference. CONCLUSIONS: Analytical bias caused by biotin interference is dependent on biotin concentration but independent of analyte concentration for immunometric methods using the Vitros 5600, and dependent on both biotin and analyte concentration for competitive immunoassays. Multi-disciplinary education and a lab streptavidin-microparticle pretreatment method help mitigate risk of erroneous results due to biotin interference for patient safety.


Assuntos
Artefatos , Biotina/administração & dosagem , Biotina/efeitos adversos , Suplementos Nutricionais/efeitos adversos , Imunoensaio/normas , Segurança do Paciente , Centros Médicos Acadêmicos , Métodos Analíticos de Preparação de Amostras , Biotina/sangue , Reações Falso-Negativas , Pessoal de Saúde/educação , Humanos , Estreptavidina/química
2.
Oral Dis ; 26(1): 81-88, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31323154

RESUMO

OBJECTIVES: Oral autoimmune bullous disorders show clinical overlap with diseases such as lichen planus and others that may cause desquamative gingivitis. As direct immunofluorescence is expensive, we sought to determine if routine histology alone would be sufficient to distinguish between oral autoimmune bullous disorders and mimics. METHODS: We searched the records for patients with a suspected oral autoimmune bullous disorder who underwent biopsies for concurrent routine histologic evaluation and direct immunofluorescence and who had at least one follow-up visit. Cases were separated into high and low suspicion subgroups based on clinical findings. RESULTS: Within 148 cases, the sensitivity of routine histology alone was 0.810, with a negative predictive value of 0.889. However, the specificity was 0.989 with a positive predictive value of 0.979. Of the high suspicion cases, 57 (47.1%) were found to be consistent with an oral autoimmune bullous disorder, with a total of 11 histologic false negatives. 8 cases, all in the high suspicion subgroup, showed indeterminate direct immunofluorescence results. There were no histologic false negatives or inconclusive direct immunofluorescence results in the low suspicion subgroup. CONCLUSIONS: In patients with a low clinical suspicion for an oral autoimmune bullous disorder, it is reasonable and more cost-effective to evaluate the lesion with routine histology alone.


Assuntos
Doenças Autoimunes/diagnóstico , Técnica Direta de Fluorescência para Anticorpo , Doenças da Boca/diagnóstico , Idoso , Reações Falso-Negativas , Feminino , Gengivite , Humanos , Masculino , Pessoa de Meia-Idade
3.
Med. mycol. case rep ; 26: 64-66, Dec. 2019. ilus, tab
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IIERPROD, Sec. Est. Saúde SP | ID: biblio-1025285

RESUMO

The detection of cryptococcal capsular antigen (CrAg) is very sensitive and specific, however false-negative results have been reported, mostly in cerebrospinal fluid. We report the case of an HIV-infected patient with CD4=42 cells/mL, asthenic, negative serum CrAg lateral flow assay (LFA) and culture-proven cryptococcaemia. Despite the high accuracy of LFA, false-negative result is possible. Careful clinical evaluation and close follow-up are relevant


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Infecções por HIV , Criptococose , Reações Falso-Negativas , Antígenos de Fungos
4.
Medicine (Baltimore) ; 98(40): e17451, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577771

RESUMO

INTRODUCTION: Prostate-specific antigen (PSA) is the main tool for early detection, risk stratification and monitoring of prostate cancer (PCa). However, there are controversies about the use of PSA as a population screening test because of the high potential for overdiagnosis and overtreatment associated. The net benefit of screening is unclear and according to the available recommendations, it should be offered to well-informed men with an adequate health status and a life-expectancy of at least 10 years or to men at elevated risk of having PCa. In addition, the factors that influence test results are unclear, as is impact of false positive or negative results on patient health.Our objective is to assess the clinical and analytical factors associated with the presence of false positive and false negative results and the diagnostic/therapeutic process followed by these patients. METHODS AND ANALYSIS: A prospective observational cohort study will be carried out. We will include a cohort of patients with a positive PSA result (1.081 patients) and a sample of patients with negative results (572 patients); both will be followed for 2 years by reviewing medical records to assess the variables associated with these results, as well as characteristics of patient management after a positive PSA value. We will include those patients with a PSA determination from 2 hospitals in the Valencian Community. Patients who have been previously diagnosed with prostate cancer or who are being followed for previous high PSA values will be excluded. DISCUSSION: The study will estimate the frequency of false positive and false negative PSA results in routine clinical practice, and allow us to quantify the potential harm caused. STUDY REGISTRATION: Clinicaltrials.gov (https://clinicaltrials.gov/): NCT03978299, June 7, 2019.


Assuntos
Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/diagnóstico , Protocolos Clínicos , Estudos de Coortes , Detecção Precoce de Câncer , Reações Falso-Negativas , Reações Falso-Positivas , Humanos , Masculino
5.
Gynecol Oncol ; 155(1): 21-26, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31409487

RESUMO

OBJECTIVE: To compare two published risk stratification models (Milwaukee Model vs. Mayo Criteria) to predict lymphatic dissemination (LD) in endometrioid endometrial cancer (EC). METHODS: Patients with stage I-III EC undergoing surgery from 1/1/2004-9/30/2013 were retrospectively reviewed and classified as low-risk vs at-risk for LD using two independent risk models. LD was defined as positive nodes at surgery or lymph node recurrence within 2 years of surgery after negative lymph node dissection (LND) or when LND was not performed. False positive (FP) and false negative (FN) rates for each risk model were calculated. RESULTS: Among 1103 patients, 81 (7.3%) had LD (72 positive LN and 9 LN recurrences), and most (90.2%) had stage I EC. The Milwaukee Model yielded a low at-risk rate for LD (38.1%) but a high FN rate (13.6%, 95% CI 7.0-23.0). The traditional Mayo Criteria using a cut-off of 2 cm for tumor diameter (TD) had a higher at-risk rate for LD (69.5%) but a FN rate of 0% (95% CI, 0-4.5). Modifying the Mayo Criteria using a TD cutoff of ≤3 cm identified fewer women at-risk (56.8% vs. 69.5%) and had a lower FP rate (53.6% vs. 67.1%), but had a higher FN rate (3.7%, 95% CI, 0.8-10.4). CONCLUSIONS: The Milwaukee Model had the lowest at-risk rate of LD but an unacceptable FN rate. Modifying the Mayo Criteria by increasing the TD cutoff from the traditional ≤2 cm to ≤3 cm would spare an estimated 13.5% of patients LND, but the accompanying FN rate is unacceptably high. The traditional Mayo Criteria for low-risk EC remains the most sensitive in determining which patients LND can be omitted.


Assuntos
Carcinoma Endometrioide/patologia , Carcinoma Endometrioide/cirurgia , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/cirurgia , Linfonodos/patologia , Linfonodos/cirurgia , Estudos de Coortes , Reações Falso-Negativas , Feminino , Humanos , Excisão de Linfonodo , Metástase Linfática , Pessoa de Meia-Idade , Modelos Estatísticos , Gradação de Tumores , Estadiamento de Neoplasias , Estudos Retrospectivos , Risco , Biópsia de Linfonodo Sentinela
6.
Forensic Sci Int ; 302: 109887, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31404811

RESUMO

Every scientific technique features some error, and legal standards for the admissibility of scientific evidence (e.g., Daubert v. Merrill Dow Pharmaceuticals, Inc., 1993; Kumho Tire Co v. Carmichael, 1999) guide trial courts to consider known error rates. However, recent reviews of forensic science conclude that error rates for some common techniques are not well-documented or even established (e.g., NAS, 2009; PCAST, 2016). Furthermore, many forensic analysts have historically denied the presence of error in their field. Therefore, it is important to establish what forensic scientists actually know or believe about errors rates in their disciplines. We surveyed 183 practicing forensic analysts to examine what they think and estimate about error rates in their various disciplines. Results revealed that analysts perceive all types of errors to be rare, with false positive errors even more rare than false negatives. Likewise, analysts typically reported that they prefer to minimize the risk of false positives over false negatives. Most analysts could not specify where error rates for their discipline were documented or published. Their estimates of error in their fields were widely divergent - with some estimates unrealistically low.


Assuntos
Reações Falso-Negativas , Reações Falso-Positivas , Ciências Forenses , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
7.
Bone Joint J ; 101-B(8): 970-977, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31362542

RESUMO

AIMS: The aim of this study was to evaluate the diagnostic accuracy of the synovial alpha-defensin enzyme-linked immunosorbent assay (ELISA) for the diagnosis of prosthetic joint infection (PJI) in the work-up prior to revision of total hip (THA) and knee arthroplasty (TKA). PATIENTS AND METHODS: Inclusion criteria for this prospective cohort study were acute or chronic symptoms of the index joint without specific exclusion criteria. Synovial fluid aspirates of 202 patients were analyzed and semiquantitative laboratory alpha-defensin ELISA was performed. Final diagnosis of PJI was established by examination of samples obtained during revision surgery. RESULTS: Sensitivity and specificity of the alpha-defensin ELISA for PJI were 78.2% (95% confidence interval (CI) 66.7 to 88.5) and 96.6% (95% CI 93.0 to 99.3). Positive and negative predictive values were 89.6% (95% CI 80.6 to 97.8) and 92.2% (95% CI 87.5 to 96.1). The test remained false-negative in 22% of septic revisions, most of which were due to coagulase-negative staphylococci all occurring in either late-chronic or early-postoperative PJI. CONCLUSION: The routine use of synovial fluid alpha-defensin laboratory ELISA in the preoperative evaluation of symptomatic THAs and TKAs is insufficient to accurately diagnose PJI. Particularly in cases involving low-virulence organisms, such as coagulase-negative staphylococci, there remains a need for tests with a higher sensitivity. Cite this article: Bone Joint J 2019;101-B:970-977.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Ensaio de Imunoadsorção Enzimática/métodos , Prótese de Quadril/efeitos adversos , Prótese do Joelho/efeitos adversos , Infecções Relacionadas à Prótese/diagnóstico , alfa-Defensinas/metabolismo , Biomarcadores/metabolismo , Reações Falso-Negativas , Feminino , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Positivas/diagnóstico , Humanos , Masculino , Estudos Prospectivos , Reoperação , Sensibilidade e Especificidade , Líquido Sinovial/metabolismo
8.
Indian J Cancer ; 56(3): 269-270, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31389393

RESUMO

Sentinel lymph node biopsy (SLNB) was introduced in the 1990s, as a minimally invasive procedure for staging the axilla with less morbidity to the traditional axillary lymph node dissection and is now standard management of the axilla in the early breast cancer. SLNB using the combined technique of blue dye and radioisotope is currently the recommended method for lymphatic mapping, and studies have shown high identification rates (IR) (>95%) and low false-negative rates (FNR) 5-10%. However, there are several reports raising awareness regarding patent blue V dye-induced peri-operative anaphylaxis. The main aim of this article is to highlight the emergence of patent blue dye as a new allergen and present evidence regarding the utility of alternative safer methods of evaluation of early breast cancer without compromising IR.


Assuntos
Neoplasias da Mama/diagnóstico , Reações Falso-Negativas , Corantes de Rosanilina/normas , Biópsia de Linfonodo Sentinela/normas , Linfonodo Sentinela/patologia , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Corantes/normas , Feminino , Humanos , Prognóstico , Linfonodo Sentinela/cirurgia
9.
Nucl Med Commun ; 40(9): 940-946, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31343613

RESUMO

OBJECTIVE: To compare the diagnostic performance of Fluciclovine PET/CT and 99mTc-MDP bone scan in detecting bone metastases in patients with metastatic prostate cancer. METHODS: Patients with metastatic prostate cancer who had both Fluciclovine PET/CT and bone scan within 3-month interval between October 2017 and October 2018 in our center were retrospectively reviewed. Exclusion criteria included separate concurrent cancer, or prostate-specific antigen were more than two-fold difference with an absolute difference >1 ng/ml between the two image studies. All abnormal bone lesions on either scan were compared. The findings were verified by available pathology and 4-month clinical follow-up. RESULTS: A total of 106 patients with 106 dual scans were included in this study. 80/106 (75%) had concordant findings, whereas 26/106 (25%) had discordant findings. Of the discordant findings, 13/26 (50%) had false-positive findings on bone scan but negative on Fluciclovine PET/CT, 3/26 (11.5%) had positive lesions on Fluciclovine PET/CT but negative on bone scan, 8/26 (30.8%) had more positive lesions on Fluciclovine PET/CT than bone scan, and 2/26 (7.7%) with false-positive lesions on Fluciclovine PET/CT but negative on bone scan. The sensitivity, specificity, positive predictive value and negative predictive value for bone scan were 79%, 86%, 45% and 96%, respectively; and 100%, 98%, 89% and 100% in Fluciclovine PET/CT, respectively. DISCUSSION: Our results demonstrated that Fluciclovine PET/CT detected more bone metastases than bone scan. Importantly, there were no lesions identified by bone scan that was missed by Fluciclovine PET/CT. With the extra capacity of detecting soft tissue metastasis in PET/CT, Fluciclovine PET/CT may render bone scan unnecessary to investigate metastatic prostate cancer.


Assuntos
Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/secundário , Osso e Ossos/diagnóstico por imagem , Ácidos Carboxílicos , Ciclobutanos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Neoplasias da Próstata/patologia , Medronato de Tecnécio Tc 99m , Idoso , Idoso de 80 Anos ou mais , Biópsia , Neoplasias Ósseas/patologia , Osso e Ossos/patologia , Reações Falso-Negativas , Reações Falso-Positivas , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
10.
Cancer Sci ; 110(9): 2941-2959, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31343810

RESUMO

A sensitive and specific diagnosis biomarker, in principle scalable to most cancer types, is needed to reduce the prevalent cancer mortality. Meanwhile, the investigation of diagnosis determinants of a biomarker will facilitate the interpretation of its screening results in clinic. Here we design a large-scale (1558 enrollments), multicenter (multiple hospitals), and cross-validation (two datasets) clinic study to validate plasma Hsp90α quantified by ELISA as a pan-cancer biomarker. ROC curve shows the optimum diagnostic cutoff is 69.19 ng/mL in discriminating various cancer patients from all controls (AUC 0.895, sensitivity 81.33% and specificity 81.65% in test cohort; AUC 0.893, sensitivity 81.72% and specificity 81.03% in validation cohort). Similar results are noted in detecting early-stage cancer patients. Plasma Hsp90α maintains also broad-spectrum for cancer subtypes, especially with 91.78% sensitivity and 91.96% specificity in patients with AFP-limited liver cancer. In addition, we demonstrate levels of plasma Hsp90α are determined by ADAM10 expression, which will affect Hsp90α content in exosomes. Furthermore, Western blotting and PRM-based quantitative proteomics identify that partial false ELISA-negative patients secret high levels of plasma Hsp90α. Mechanism analysis reveal that TGFß-PKCγ gene signature defines a distinct pool of hyperphosphorylated Hsp90α at Theronine residue. In clinic, a mechanistically relevant population of false ELISA-negative patients express also higher levels of PKCγ. In sum, plasma Hsp90α is a novel pan-cancer diagnosis biomarker, and cancer diagnosis with plasma Hsp90α is particularly effective in those patients with high expression of ADAM10, but may be insufficient to detect the patients with low ADAM10 and those with hyperphosphorylated Hsp90α.


Assuntos
Biomarcadores Tumorais/sangue , Proteínas de Choque Térmico HSP90/sangue , Neoplasias/diagnóstico , Proteína ADAM10/genética , Proteína ADAM10/metabolismo , Adolescente , Adulto , Secretases da Proteína Precursora do Amiloide/genética , Secretases da Proteína Precursora do Amiloide/metabolismo , Animais , Biomarcadores Tumorais/metabolismo , Linhagem Celular Tumoral , Criança , Pré-Escolar , Conjuntos de Dados como Assunto , Ensaio de Imunoadsorção Enzimática , Exossomos/metabolismo , Reações Falso-Negativas , Feminino , Proteínas de Choque Térmico HSP90/metabolismo , Humanos , Lactente , Recém-Nascido , Masculino , Proteínas de Membrana/genética , Proteínas de Membrana/metabolismo , Camundongos , Pessoa de Meia-Idade , Neoplasias/sangue , Neoplasias/patologia , Fosforilação , Estudos Prospectivos , Curva ROC , Treonina/metabolismo , Ensaios Antitumorais Modelo de Xenoenxerto , Adulto Jovem
11.
Pan Afr Med J ; 32: 135, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31303908

RESUMO

Fine needle aspiration cytology (FNAC) findings are the basis upon which decision and type surgery is made. Therefore the diagnostic accuracy and utility of FNAC being such an integral tool in management of thyroid lesions must be evaluated for cyto-histologic discrepancy from time to time as a quality assurance measure. The objective was to compare thyroid fine-needle aspiration cytology (FNAC) with final histopathological findings at in patients undergoing thyroidectomy. This was a cross-sectional retrospective study at Aga Khan university hospital, Nairobi. Cyto-histologic discrepancy was found in 19(25%) of cases with false positive and negative rates at 9% and 16%. False positive results constituted 7(9%) while 12(16%) were false negative findings. The higher cyto-histological discordancy than seen previous studies could be due to sampling error and cytological mis-interpretation. Our study found higher than expected cyto-histologic discrepancy.


Assuntos
Glândula Tireoide/cirurgia , Nódulo da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Biópsia por Agulha Fina/métodos , Estudos Transversais , Reações Falso-Negativas , Reações Falso-Positivas , Hospitais Universitários , Humanos , Quênia , Estudos Retrospectivos , Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/patologia
12.
Radiol Med ; 124(12): 1306-1314, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31317380

RESUMO

The purpose of this study was to determine whether MRE performed with diffusion-weighted imaging (DWI) sequences is comparable to contrast-enhanced MRE in the detection of active small-bowel inflammation in pediatric patients with Crohn's disease (CD). We included in our study 68 patients with diagnosis of CD between April 2015 and June 2018 that underwent MRE examination. Examination protocol includes coronal and axial FISP, T2-w half-Fourier RARE and DWI sequences, a baseline coronal T1-w fat-saturated ultrafast (GRE) sequence followed by contrast 3D T1-w GRE. All images were assessed by two radiologists who graded each of bowel segments for the presence of inflammation on a four-point confidence scale on the basis of wall thickening and wall signal on DWI and ADC maps and comparing their results with post-contrast images. When considering all bowel segments, we found 41 true positive and 25 true negative on DWI. One false positive case corresponded to the absence of inflammatory histopathology changes at the level of the terminal ileum in a 15-year-old male, and one false negative case was in a 10-year-old female with only jejunal lesion. The corresponding sensitivity, specificity, PPV, NPV and accuracy were 97.6% (95% CI 67.7-99.7), 96.1% (95% CI 66.7-98.5), 97.6% (95% CI 70.8-98.4), 96.1% (95% CI 64.2-90.6) and 97% (95% CI 84.2-97.5), respectively. Analyzing the gadolinium-enhanced set, 35 true positive and 25 true negative results were found. One false positive case was found, and it was the same as with DWI. The corresponding sensitivity, specificity, PPV, NPV and accuracy were 83.3% (95% CI 65.9-86.7), 96.1% (95% CI 68.7-88.9), 97.2% (95% CI 84.3-98.7), 78.1% (95% CI 27.9-72.1) and 88.2% (95% CI 41.2-85.6), respectively. Sensitivity for the detection of active IBD lesion was significantly better with DWI than with CE-T1-w imaging (p = 0.002), whereas the specificity was similar (p = 0.743). Our study has shown that DWI sequences have a high accuracy in detecting the bowel segment affected by CD. These results emphasize the utility to include the DWI/ADC in standard MR enterography protocols and suggest that DWI could replace T1-weighted post-contrast sequences.


Assuntos
Doença de Crohn/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Aumento da Imagem/métodos , Intestinos/diagnóstico por imagem , Adolescente , Criança , Meios de Contraste , Doença de Crohn/patologia , Reações Falso-Negativas , Reações Falso-Positivas , Feminino , Gadolínio , Humanos , Doenças Inflamatórias Intestinais/diagnóstico por imagem , Masculino , Estudos Prospectivos , Sensibilidade e Especificidade
13.
Work ; 63(4): 571-579, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31282460

RESUMO

BACKGROUND: Beginning in 2017, successfully passing the four-part pre-enlistment Occupational Physical Assessment Test (OPAT) became a requirement for all U.S. Army recruits. To ensure the test accurately identifies individuals who are qualified for their job, it was necessary to examine classification errors. OBJECTIVE: The objectives were to 1) determine the accuracy of OPAT cut-scores for combat arms Soldiers, and 2) determine which events contribute to the individuals that are misclassified as passing or failing the OPATMETHODS:A total of 741 trainees were tested on the OPAT within two weeks of entering their initial entry training. At the end of their training, trainees were tested on simulations of the most physically demanding tasks of their job. RESULTS: There was a high classification concordance (76.5%) between success on the OPAT and job task simulations. False positives (6.7%) were misclassified because they did not perform as well on the strength-dominant task simulations. While the interval aerobic run was the greatest contributor to false negatives (16.8%), previous studies indicated high performance on this event as a potential key indicator of injury and attrition risk. CONCLUSIONS: The findings provide insight on how the accuracy of the OPAT, and similar pre-employment tests, could be improved.


Assuntos
Avaliação de Desempenho Profissional/métodos , Militares , Exame Físico/métodos , Aptidão Física , Adolescente , Avaliação de Desempenho Profissional/normas , Reações Falso-Negativas , Reações Falso-Positivas , Estudos de Viabilidade , Feminino , Humanos , Masculino , Exame Físico/normas , Valor Preditivo dos Testes , Estados Unidos , Guerra , Adulto Jovem
15.
Clin Nucl Med ; 44(10): 842-843, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31348084

RESUMO

This 33-year-old man presented with hemorrhagic stroke manifesting with left hemiparesis and right ptosis. Angiography revealed no patent carotids. The anterior and middle cerebral arteries were filling collaterally through the posterior vertebrobasilar pathway. The presumptive diagnosis was moyamoya disease. The etiology of the bleeding was right basilar tip aneurysm that subsequently had partial coil placement. Months later, the neck of the aneurysm perforated and second coiling was performed. Later on follow-up, patient developed left hand tremor. A radionuclide DATscan revealed total absence of right-sided basal ganglia activity. A possible etiology was occlusion of the middle cerebral artery's lenticulostriate branches.


Assuntos
Gânglios da Base/diagnóstico por imagem , Nortropanos , Adulto , Angiografia Cerebral , Reações Falso-Negativas , Humanos , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Masculino
17.
Int J Pediatr Otorhinolaryngol ; 124: 90-93, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31174024

RESUMO

OBJECTIVE: This study sought to summarize the clinical characteristics of foreign body aspiration(FBA) in children with negative multi-detector Computed Tomography(MDCT) results and to explore the essential points which determined the patients to undergo bronchoscopy. METHODS: The medical records of 48 pediatric patients admitted to the department of respiratory medicine in our hospital from January 2011 to October 2018 and diagnosed with foreign body aspiration and negative chest MDCT results were retrospectively analyzed. They were compared with the patients of FBA whose MDCT findings suggested indirect signs, such as atelectasis or emphysema. RESULTS: Of the 48 patients, 33 were boys (68.8%) and 15 girls (31.2%), with a mean age of 35.3 months(range, 7-156 months). Cough (47 cases, 97.9%), fever (25 cases, 52.1%) and wheezing (23 cases,47.9%)were the main symptoms.39 patients (81.3%) had abnormal physical signs. None of the MDCT or three dimension(3D) images based on MDCT revealed foreign bodies in these children, while the results were: signs of lung infection without atelectasis or emphysema 52.1%(25 cases), increase of lung markings16.7%(8 cases),bronchiectasis 6.3%(3 cases), or normal 27.1%(13 cases). 41 Patients were successfully removed their foreign bodies(A further 5 had the FB removed from the tracheobronchial tree but it was then swallowed before retrieval. The remaining 2 cases had to be referred to another hospital for further management), most of which were organic. The shapes of foreign bodies were small granular (23 cases, 56.1%), sheet or powder (18 cases, 43.9%). The control group was 13 patients of FBA whose MDCT findings suggested indirect signs of atelectasis or emphysema during the same time. The result of comparison showed the clear history of FBA was statistically different between the two groups. CONCLUSIONS: Foreign body aspiration could not be ruled out with negative MDCT in patients clinically suspected. Typical foreign body aspiration history and ineffective conservative treatment could provide important basis of performing bronchoscopy. Complicated with lung infection and the shape of foreign bodies may affect the false negative results of MDCT.


Assuntos
Brônquios , Corpos Estranhos/diagnóstico por imagem , Pneumopatias/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Aspiração Respiratória/diagnóstico por imagem , Infecções Respiratórias/diagnóstico por imagem , Adolescente , Bronquiectasia/diagnóstico por imagem , Bronquiectasia/etiologia , Broncoscopia , Criança , Pré-Escolar , Tosse/etiologia , Reações Falso-Negativas , Feminino , Febre/etiologia , Corpos Estranhos/complicações , Humanos , Imagem Tridimensional , Lactente , Masculino , Atelectasia Pulmonar/diagnóstico por imagem , Atelectasia Pulmonar/etiologia , Enfisema Pulmonar/diagnóstico por imagem , Enfisema Pulmonar/etiologia , Aspiração Respiratória/complicações , Sons Respiratórios/etiologia , Estudos Retrospectivos
19.
BMC Res Notes ; 12(1): 316, 2019 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-31167646

RESUMO

OBJECTIVE: We set an experiment to determine the diagnostic performance of the Widal test and stool culture in typhoid-suspected cases attending tertiary hospitals in Dar es Salaam, Tanzania using blood culture as a golden standard. We also evaluated the agreement between Widal, stool and blood culture. RESULTS: This was a cross-sectional study conducted between June and September 2018, in three Regional Referral Hospitals in Dar es Salaam, Tanzania. A total of 158 typhoid-suspected cases were enrolled, after obtaining an informed consent. Of the 158 patients participated in the study, 128 (81%) tested positive for the Widal test and 17 (11%) patients were stool culture positive. Widal test recorded 81.5% sensitivity, 18.3% specificity, 10.1% positive predictive value and 89.7% negative predictive value. Stool culture showed 31.3% sensitivity, 91.5% specificity, 29% positive predictive value and 91.5% negative predictive value. In conclusion, Widal test is not reliable for diagnosis of typhoid fever since false positive and negative results are common. In addition, Widal test recorded poor agreement with the blood culture (kappa = 0.014, p < 0.05) while stool culture had strong agreement with the blood culture (kappa = 0.22, p < 0.05).


Assuntos
Técnicas de Cultura de Células , Testes Diagnósticos de Rotina/estatística & dados numéricos , Salmonella typhi/isolamento & purificação , Febre Tifoide/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Testes de Aglutinação/estatística & dados numéricos , Hemocultura/métodos , Criança , Pré-Escolar , Estudos Transversais , Reações Falso-Negativas , Reações Falso-Positivas , Fezes/microbiologia , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Salmonella typhi/imunologia , Sensibilidade e Especificidade , Tanzânia , Febre Tifoide/imunologia , Febre Tifoide/microbiologia
20.
Int J Radiat Oncol Biol Phys ; 105(2): 423-431, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31158426

RESUMO

PURPOSE: To investigate a Bayesian network (BN)-based method to detect errors in external beam radiation therapy physician orders. METHODS AND MATERIALS: A total of 4431 external beam radiation therapy orders from 2008 to 2017 at the authors' institution were obtained from clinical treatment management systems and divided into 3 groups: single prescription, concurrent boost, and sequential boost. Multiple BNs were developed for each group to detect errors in new orders using joint posterior probabilities of the order parameters, given disease information. Each BN was trained with a group of orders using a Bayesian learning algorithm. A procedure was developed to select the optimal BN for each treatment site in each group and to determine site-specific parameters and error detection thresholds. Potential clinical errors, created both manually and automatically, were applied to test error detection performance. RESULTS: The average true-positive rate (TPR) and false-positive rate (FPR) of error detection were 95.72% and 1.99%, respectively, for the single-prescription cohort with 9 treatment sites. For the concurrent-boost cohort, the TPR and FPR were 92.94% and 14.53%, respectively. For the sequential-boost cohort, the TPR and FPR were 100% and 9.48%, respectively, for the prescribed dose values and 100% and 4.34%, respectively, for the remaining order parameters. For the patient simulation and imaging parameters for 9 treatment sites, the TPR and FPR were 100% and 4.96%, respectively. CONCLUSIONS: The probabilistic BN method was able to perform physician order error detection at a higher accuracy than previously reported in a variety of complex prescription instances, thus warranting further development in incorporating BNs into clinical error detection tools to assist manual physician order checks.


Assuntos
Teorema de Bayes , Erros Médicos/estatística & dados numéricos , Neoplasias/radioterapia , Radiologistas/estatística & dados numéricos , Algoritmos , Estudos de Coortes , Conjuntos de Dados como Assunto , Fracionamento da Dose de Radiação , Reações Falso-Negativas , Reações Falso-Positivas , Humanos , Erros Médicos/prevenção & controle , Neoplasias/patologia , Especificidade de Órgãos , Curva ROC , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador , Erros de Configuração em Radioterapia , Radioterapia Guiada por Imagem , Treinamento por Simulação , Tecnologia Radiológica
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