Academic literature on the topic '920203 Diagnostic Methods'

Introduction: Diabetes mellitus (DM) is considered one of the largest emerging threats to health and bacterial infections are more frequent in diabetic patients causing sepsis. Several indicators have been proposed as new diagnostic tests to assess sepsis in hospitalized patients. Aim: This study aims was to compare the efficacy of Procalcitonin (PCT) and high sensitive C-reactive protein (hs-CRP) in the diagnosis of sepsis in diabetic patients. Methods: In this cross-sectional study total of 60 age and sex-matched diabetic patients above 18 years were randomly chosen with at least 2 SIRS (Systemic inflammatory response syndrome) criteria from the indoor department of BIRDEM General Hospital. Basic hematological, biochemical, microbiological laboratory data were recorded from laboratory reports. Sepsis and its different stages were determined according to American College of Chest Physicians (ACCP) guidelines. The PCT was measured by sandwich enzyme immunoassay (Bio-Vendor, Germany) and the hs-CRP level was measured using an immune-turbidimetric assay (Beckman, Carlsbad, CA 92010, USA). Results: The patient’s mean age was 51.90±9.89 years where male 51.2% and female 48.8% and 50-60 years age group was the most common 40%. 38 (63.33%) patients were bacteriological culture-positive and 22 (36.67%) patients were bacteriological culture-negative where the most common organism was Klebsiella (28.95%). Statistically, a significant difference was found in PCT values in the bacteriological culture positive and negative group (p<0.05), but there was no significant difference found in hs-CRP values (p>0.05). There was an increasing trend of serum PCT with the developing stages of sepsis. Receiver operating characteristic curve shows the area under the curve for PCT was 0.785 (95% CI; 0.654-0.915), sensitivity 89.47%, specificity 50%, PPV 75.55% and NPV 73.33% with the best cut-off value >753pg/ml which support PCT as a superior and reliable marker of sepsis. Conclusion: Our results suggest that serum PCT is a more reliable diagnostic marker of sepsis than other traditional markers like hs-CRP. Combinatorial use of these biomarkers will help in early diagnosis and also greatly improve outcomes. Bangladesh Crit Care J March 2022; 10 (1): 38-42

Introduction: Diabetes mellitus (DM) is considered one of the largest emerging threats to health and bacterial infections are more frequent in diabetic patients causing sepsis. Several indicators have been proposed as new diagnostic tests to assess sepsis in hospitalized patients. Aim: This study aims was to compare the efficacy of Procalcitonin (PCT) and high sensitive C-reactive protein (hs-CRP) in the diagnosis of sepsis in diabetic patients. Methods: In this cross-sectional study total of 60 age and sex-matched diabetic patients above 18 years were randomly chosen with at least 2 SIRS (Systemic inflammatory response syndrome) criteria from the indoor department of BIRDEM General Hospital. Basic hematological, biochemical, microbiological laboratory data were recorded from laboratory reports. Sepsis and its different stages were determined according to American College of Chest Physicians (ACCP) guidelines. The PCT was measured by sandwich enzyme immunoassay (Bio-Vendor, Germany) and the hs-CRP level was measured using an immune-turbidimetric assay (Beckman, Carlsbad, CA 92010, USA). Results: The patient’s mean age was 51.90±9.89 years where male 51.2% and female 48.8% and 50-60 years age group was the most common 40%. 38 (63.33%) patients were bacteriological culture-positive and 22 (36.67%) patients were bacteriological culture-negative where the most common organism was Klebsiella (28.95%). Statistically, a significant difference was found in PCT values in the bacteriological culture positive and negative group (p<0.05), but there was no significant difference found in hs-CRP values (p>0.05). There was an increasing trend of serum PCT with the developing stages of sepsis. Receiver operating characteristic curve shows the area under the curve for PCT was 0.785 (95% CI; 0.654-0.915), sensitivity 89.47%, specificity 50%, PPV 75.55% and NPV 73.33% with the best cut-off value >753pg/ml which support PCT as a superior and reliable marker of sepsis. Conclusion: Our results suggest that serum PCT is a more reliable diagnostic marker of sepsis than other traditional markers like hs-CRP. Combinatorial use of these biomarkers will help in early diagnosis and also greatly improve outcomes. Bangladesh Crit Care J March 2022; 10 (1): 38-42

Background: Patients admitted emergently with a primary diagnosis of acute gastric ulcer have significant complications including morbidity and mortality. The objective of this study was to assess the risk factors of mortality including the role of surgery in gastric ulcers. Methods: Adult (18–64-year-old) and elderly (≥65-year-old) patients admitted emergently with hemorrhagic and/or perforated gastric ulcers, were analyzed using the National Inpatient Sample database, 2005–2014. Demographics, various clinical data, and associated comorbidities were collected. A stratified analysis was combined with a multivariable logistic regression model to assess predictors of mortality. Results: Our study analyzed a total of 15,538 patients, split independently into two age groups: 6338 adult patients and 9200 elderly patients. The mean age (SD) was 50.42 (10.65) in adult males vs. 51.10 (10.35) in adult females (p < 0.05). The mean age (SD) was 76.72 (7.50) in elderly males vs. 79.03 (7.80) in elderly females (p < 0.001). The percentage of total deceased adults was 1.9% and the percentage of total deceased elderly was 3.7%, a difference by a factor of 1.94. Out of 3283 adult patients who underwent surgery, 32.1% had perforated non-hemorrhagic ulcers vs. 1.8% in the non-surgical counterparts (p < 0.001). In the 4181 elderly surgical patients, 18.1% had perforated non-hemorrhagic ulcers vs. 1.2% in the non-surgical counterparts (p < 0.001). In adult patients managed surgically, 2.6% were deceased, while in elderly patients managed surgically, 5.5% were deceased. The mortality of non-surgical counterparts in both age groups were lower (p < 0.001). The multivariable logistic regression model for adult patients electing surgery found delayed surgery, frailty, and the presence of perforations to be the main risk factors for mortality. In the regression model for elderly surgical patients, delayed surgery, frailty, presence of perforations, the male sex, and age were the main risk factors for mortality. In contrast, the regression model for adult patients with no surgery found hospital length of stay to be the main risk factor for mortality, whereas invasive diagnostic procedures were protective. In elderly non-surgical patients, hospital length of stay, presence of perforations, age, and frailty were the main risk factors for mortality, while invasive diagnostic procedures were protective. The following comorbidities were associated with gastric ulcers: alcohol abuse, deficiency anemias, chronic blood loss, chronic heart failure, chronic pulmonary disease, hypertension, fluid/electrolyte disorders, uncomplicated diabetes, and renal failure. Conclusions: The odds of mortality in emergently admitted geriatric patients with acute gastric ulcer was two times that in adult patients. Surgery was a protective factor for patients admitted emergently with gastric perforated non-hemorrhagic ulcers.

Abstract The introduction of the serum free light chain (sFLC) changed the diagnostic paradigm for patients with B cell disorders. IMWG guideline recommends the assay as a replacement for 24h urine at diagnosis, however with the exception of oligosecretory disease the assay is not recommended as a tool to monitor patients. One rationale for this recommendation is that to date, studies have compared the concentrations of FLC as measured by the two tests rather than determine which test provides the more reliable clinical assessment. Here we compare the sensitivities of FLC and 24h urine and comment on the reliability of each to monitor patients. Sequential sera from 25 LCMM (14 FLCκ, 11 FLCλ; stage I: 10, II: 10, III: 5) and 157 IIMM patients (79 IgGκ, 34 IgGλ, 26 IgAκ, 18 IgAλ; Stage I: 46, II: 75, III: 35, 1 missing) enrolled onto the IFM 2007-02 MM trial were analysed. Serum FLCκ and FLCλ levels were measured by Freelite® in samples collected at presentation, after cycles 2 and 4 of therapy and post ASCT. Results were compared to previously published sFLC reference ranges (sFLCκ 3.3-19.4 mg/L, sFLCλ 5.7-26.3 mg/L, sFLCκ/λ ratio 0.26-1.65), SPEP, UPEP sIFE and uIFE. IMWG guidelines were used to define measurable disease and to assess response the therapy. Quadratic Weighted Kappa (WK) analysis was performed to assess agreement in responses assigned by sFLC and urine tests. All 25 LCMM patients had abnormal sFLC ratios (14 FLCκ, 11 FLCλ) and measurable disease at presentation (iFLC 3620 (689-22000) mg/L). Similarly, all patients were positive by uIFE and had measurable disease by UPE (1940 (490-42000) mg/24h). However, in keeping with previous reports quantitative correlation between the two assays was poor (r=0.27). Responses assigned by sFLC and UPEP were concordant in 11/25 (44%) patients, although in 4/11 (40%) timing of the response was different (UPEP 89 (58-118) days; sFLC 226 (216-227) days). In the remaining 14/25 patients the responses assigned using the two tests differed. In 7/14 patients UPEP and uIFE became negative whilst the FLC ratio remained abnormal; in 1/7 patient sIFE confirmed the presence of the M protein. In 3 patients FLC identified relapse, while UPEP was negative or indicated response. In a further 2 patients FLC identified no response whilst UPEP initially identified a response and subsequent relapse. Overall, a moderate concordance was identified between the responses assigned by sFLC and urine tests (WK (95% CI): 0.59 (0.36-0.82)). At presentation, 154/157 (98%) IIMM patients had abnormal FLC ratios (FLCκ ratio 57 (2-33191); FLCλ ratio 0.009 (0.00003-0.25)), whereas only 85/157 (54%) patients were positive by uIFE and 67/157 (43%) by UPEP. 98/157 (62%) had measurable disease using sFLC (κFLC 491 (101-15600) mg/L; λFLC 441 (101-14100) mg/L), and 55/157 (35%) had measurable disease by UPEP (1000 (210-9200) mg/24h). 53/157 (34%) patients had measurable disease by both methods. The correlation between sFLC and UPEP measurements was poor (r=0.36) as was the correlation between intact immunoglobulin measurements by SPEP and sFLC (r=-0.06) or UPEP (r=-0.26). In 53 IIMM patients with measurable disease by both FLC and UPEP, sFLC ratios normalised in 14/53 patients (in 8/14 sIFE remained positive) while uIFE became negative in 33/53 patients (20/33 remained sIFE positive). WK showed better agreement for response assignment between intact immunoglobulin and sFLC measurements (WK (95% CI): 0.63 (0.48-0.79); substantial agreement) than with urine tests (0.49 (0.27-0.72); moderate agreement). Additionally, there was an association between depth of response by sFLC pre- and post-transplant: patients achieving >VGPR before transplant were more likely to achieve >VGPR post-transplant compared with patients who achieved <VGPR prior to transplant (96.2% vs. 63.2%, respectively; p=0.001). Finally 5/157 IIMM patients were oligosecretory and had measurable levels of disease by both UPEP and sFLC, but not by SPEP. In all 5 patients UPEP became negative by cycle 2; however, an abnormal sFLC ratio and positive sIFE indicated persistent disease. sFLC was a more sensitive tool and showed a greater degree of concordance with IFE and SPEP than UPEP in LCMM and IIMM patients respectively during patient monitoring. Furthermore, >90% reduction in sFLC prior to transplant was associated with post-transplant response in IIMM patients. Larger studies with patient outcome are required to validate our findings. Disclosures No relevant conflicts of interest to declare.

Abstract Purpose To evaluate cost-effectiveness of an [18F]FDG-PET/CT-driven diagnostic workup as compared to diagnostic surgery, for thyroid nodules with Bethesda III/IV cytology. [18F]FDG-PET/CT avoids 40% of futile diagnostic surgeries for benign Bethesda III/IV nodules. Methods Lifelong societal costs and quality-adjusted life years (QALYs) were assessed for 132 patients participating in a randomised controlled multicentre trial comparing [18F]FDG-PET/CT to diagnostic surgery. The observed 1-year trial results were extrapolated using a Markov model. The probability of cost-effectiveness was estimated using cost-effectiveness acceptability curves, taking uncertainty about sampling, imputation, and parameters into account. Results The observed 1-year cost difference of [18F]FDG-PET/CT as compared to diagnostic surgery was − €1000 (95% CI: − €2100 to €0) for thyroid nodule–related care (p = 0.06). From the broader societal perspective, the 1-year difference in total societal costs was − €4500 (− €9200 to €150) (p = 0.06). Over the modelled lifelong period, the cost difference was − €9900 (− €23,100 to €3200) (p = 0.14). The difference in QALYs was 0.019 (− 0.045 to 0.083) at 1 year (p = 0.57) and 0.402 (− 0.581 to 1.385) over the lifelong period (p = 0.42). For a willingness to pay of €50,000 per QALY, an [18F]FDG-PET/CT-driven work-up was the cost-effective strategy with 84% certainty. Conclusion Following the observed reduction in diagnostic surgery, an [18F]FDG-PET/CT-driven diagnostic workup reduced the 1-year thyroid nodule–related and societal costs while sustaining quality of life. It is very likely cost-effective as compared to diagnostic surgery for Bethesda III/IV nodules. Trial registration number: This trial is registered with ClinicalTrials.gov: NCT02208544 (5 August 2014), https://clinicaltrials.gov/ct2/show/NCT02208544.

Abstract Background Increased pleural fluid adenosine deaminase (ADA) is useful for diagnosing tuberculous pleurisy (TB), but high ADA levels are associated with other diseases. In this study, we compare various disease characteristics in patients with high-ADA pleural effusion. Methods We retrospectively collected data for 456 patients with pleural fluid ADA levels of ≥ 40 U/L from January 2012 to October 2021. Cases were classified as TB (n = 203), pleural infection (n = 112), malignant pleural effusion (n = 63), nontuberculous mycobacteria (n = 22), malignant lymphoma (ML) (n = 18), autoimmune diseases (n = 11), and other diseases (n = 27), and data were compared among those diseases. Predictive factors were identified by comparing data for a target disease to those for all other diseases. A diagnostic flowchart for TB was developed based on those factors. Results The most frequent disease was TB, though 60.0% of patients were diagnosed with other diseases. Median ADA levels in patients with TB were 83.1 U/L (interquartile range [IQR] 67.2–104.1), higher than those of patients with pleural infection (median 60.9 [IQR 45.3–108.0], p = 0.004), malignant pleural effusion (median 54.1 [IQR 44.8–66.7], p < 0.001), or autoimmune diseases (median 48.5 [IQR 45.9–58.2], p = 0.008), with no significant difference from NTM (p = 1.000) or ML (p = 1.000). Pleural fluid lactate dehydrogenase (LDH) levels of < 825 IU/L were beneficial for the diagnosis of TB. Neutrophil predominance or cell degeneration, white blood cell count of ≥ 9200/µL or C-reactive protein levels of ≥ 12 mg/dL helped in diagnosing pleural infection. Pleural fluid amylase levels of ≥ 75 U/L and a pleural fluid ADA/total protein (TP) ratio of < 14 helped in diagnosing malignant pleural effusion. High serum LDH and high serum/pleural fluid eosinophils helped in diagnosing ML and autoimmune diseases, respectively. The flowchart was comprised of the following three factors: pleural fluid LDH < 825 IU/L, pleural fluid ADA/TP of < 14, and neutrophil predominance or cell degeneration, which were decided by a decision tree. The diagnostic accuracy rate, sensitivity, and specificity for the diagnosis of TB were 80.9%, 78.8%, and 82.6%, respectively. Conclusion Cases involving high pleural fluid ADA levels should be investigated using several factors to distinguish TB from other diseases.

Abstract Background Admittedly, little is known about the epidemiological signatures of familial multiple sclerosis (FMS) in different geographical regions of Iran. Objective To determine the epidemiology and the risk of FMS incidence in several provinces of Iran with a different ethnic population including, Fars, Tehran, Isfahan (Persians), and Mazandaran (Mazanis), Kermanshah (Kurds), and Chaharmahal and Bakhtiari (Lors). Methods This cross-sectional registry-based study was performed on nationwide MS registry of Iran (NMSRI) data collected from 2018 to 2021. This system, registers baseline characteristics, clinical presentations and symptoms, diagnostic and treatments at regional and national levels. Results A total of 9200 patients including, 7003 (76.1%) female and 2197 (23.9%) male, were participated. About 19% of patients reported a family history of MS; the order from highest to lowest FMS prevalence was as follows: Fars (26.5%), Chaharmahal and Bakhtiari (21.1%), Tehran (20.5%), Isfahan (20.3%), Mazandaran (18.0%), and Kermanshah (12.5%). Of all FMS cases, 74.7% (1308 cases) were female and 25.3% (442 cases) were male. FMS occurrence was much more common in females than males (P-value = 0.001). Further, the mean age at onset was 30 years among FMS cases. A substantially higher probability of relapsing-remitting MS and secondary-progressive MS was found among FMS cases than sporadic MS (SMS) (P_value = 0.001). There was no significant difference in Expanded Disability Status Scale (EDSS) scores between FMS and SMS. The majority of FMS cases were observed among first-degree relatives, with the highest rate in siblings. There was a significant association between MS risk and positive familial history in both maternal and paternal aunt/uncle (P_value = 0.043 and P_value = 0.019, respectively). Multiple sclerosis occurrence among offspring of females was higher than males (P_value = 0.027). Conclusions In summary, our findings imply a noteworthy upward trend of FMS in Iran, even more than the global prevalence, which suggests a unique Atlas of FMS prevalence in this multi-ethnic population. Despite the highest rate of FMS within Persian and Lor ethnicities, no statistically significant difference was observed among the provinces.

AbstractThe development and scaling out of flash-dryer innovations for more efficient, small-scale production of high-quality cassava flour (HQCF) and starch is described. The diagnoses of cassava-processing SMEs (small and medium enterprises) revealed their energy expenditures for drying were considerably higher than those of large-scale industrial companies, which was mostly due to suboptimal design of flash-drying systems. As a result, small-scale production of cassava starch and HQCF often incurs high production costs, incompatible with market prices of final products. Taking stock of this situation, RTB scientists have developed several innovations to optimize energy efficiency and costs, including a longer drying pipe, reengineered heat exchanger, larger blower for higher air velocity, and a higher product/air ratio. This was based on numerical modelling to determine the key design features of energy-efficient flash dryers, followed by construction and demonstration of a pilot-scale prototype. As a result, improved small-scale flash dryers are now being scaled out to the private sector in various countries, using the Scaling Readiness framework and achieving 10–15% gains in productivity and incomes. A method for diagnosis of process efficiency is also described, to identify technical bottlenecks and to document and measure the outcomes and impacts during the implementation of scaling-out projects.

The science of nanosystems is used in many fields such as medicine, biomedical, biotechnology, agriculture, environmental pollution control, cosmetics, optics, health, food, energy, textiles, automotive, communication technologies, agriculture, and electronics. Nanomaterials, nanostructures, and nanosystems have recently brought the most popular and innovative approaches to our lives. This new technology is based on the production of invisible particles and the production of new materials by controlling the atomic sequence of these particles. Nanotechnological studies are based on mimicking the principle of atomic sequence in nature. Using a combination of different disciplines, it finds application in almost every field of our lives. Nanospheres, nanorobots, biosensors, quantum dots, and biochips are the main components of nanoparticles. Many new diagnostic and treatment methods are being developed nano-dimensional.