Usefulness of Grey Scale and Doppler transvaginal sonography in diagnosis of ovarian torsion

2020 ◽  
Vol 14 (2) ◽  
pp. 97-102
Author(s):  
Khalid Rehman `Yousaf ◽  
Shahzad Saeed ◽  
Saman Chaudhry ◽  
Rabia Bashrat ◽  
Abadullah Khalid ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Ovarian Function ◽  
Imaging Modality ◽  
Ovarian Torsion ◽  
Transvaginal Sonography ◽  
Predictive Values ◽  
Grey Scale ◽  
Sensitivity Specificity

Background: Ovarian torsion diagnosis is a great challenge as delay in diagnosis can cause severe morbidity. Early accurate diagnosis is crucial to preserve ovarian function. Ultrasonography being the primary imaging modality plays a vital role in the evaluation of suspected ovarian torsion by helping surgeons reach the correct diagnosis, thus avoiding unnecessary intervention. This study aims to determine the diagnostic accuracy of isolated and combined sonographic features of ovarian torsion on grey scale and Doppler transvaginal ultrasonography. Patients and methods: From radiology database, from January 2016 till December 2019, sonographic signs of ovarian torsion in 113 women with suspected ovarian torsion on ultrasonography and subsequent surgical diagnosis were evaluated. Ultrasound findings were compared with surgical findings to determine the accuracy, sensitivity, specificity, and positive and negative predictive values of individual and combined ultrasound signs. Results: Diagnostic accuracy of ultrasound for ovarian torsion was 85.8%. Abnormal ovarian Doppler flow was the most accurate individual sonographic sign with accuracy, sensitivity, specificity and positive predictive value of 85.8%, 83.5%, 100% and 100% respectively followed by ovarian enlargement and ovarian edema. Combined ultrasound signs resulted in higher sensitivity and positive predictive values, and lower specificity and negative predictive values for ovarian torsion. Increasing the number of sonographic parameters increased the specificity but decreased sensitivity. High accuracy, sensitivity, positive predictive value, specificity and negative predictive value was seen when combination of three or two sonographic parameters was used as diagnostic criteria. Conclusion: Transvaginal sonography is a convenient, reliable and extremely useful imaging modality for preoperative diagnosis of ovarian torsion with high specificity, sensitivity, positive predictive value and diagnostic accuracy helping treating physicians to take prompt decisions regarding timely surgical intervention. However, due to low negative predictive values, absence of sonographic signs does not rule out ovarian torsion and high index of clinical suspicion remains of utmost importance.

scholarly journals A comparative study of RIPASA score and ALVARADO score in diagnosis of acute appendicitis

2018 ◽  
Vol 5 (3) ◽  
pp. 796
Author(s):  
Vamsavardhan Pasumarthi ◽  
C. P. Madhu
Keyword(s):  
Acute Appendicitis ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Roc Curve ◽  
Predictive Value ◽  
Scoring System ◽  
Alvarado Score ◽  
Predictive Values ◽  
Sensitivity Specificity ◽  
Ripasa Score

Background: The RIPASA Score is a new diagnostic scoring system developed for the diagnosis of Acute Appendicitis which showed higher sensitivity, specificity and diagnostic accuracy compared to ALVARADO Score, particularly when applied to Asian population. Not many studies have been conducted to compare RIPASA and ALVARADO scoring systems. Hence, author want to compare prospectively Alvarado and RIPASA score by applying them to the patients attending the hospital with right iliac fossa pain that could probably be acute appendicitis.Methods: A prospective analysis of 116 cases admitted with RIF pain during a 2 years period was performed. Patients between 15-60 years were scored as per Alvarado and RIPASA scoring system. Histopathological reports of the cases were collected and compared with the scores. ROC curve area analysis was performed to examine diagnostic accuracy of RIPASA and ALVARADO scores.Results: The sensitivity of ALVARADO score is estimated to be 52.08 for a cut off of 6. The specificity is 80%, positive predictive value is 92.59, negative predictive value is 25.81. The Diagnostic accuracy of ALVARADO scoring is found to be 56.9. The sensitivity, specificity, positive predictive value and negative predictive values of RIPASA scoring system are 75%, 65%, 91.14%, 35.14%. The diagnostic accuracy of RIPASA score is 73.28.Conclusions: The difference in the diagnostic accuracy between ALVARADO and RIPASA scoring system is significant indicating that the RIPASA score is a much better diagnostic tool for the diagnosis of acute appendicitis. When the ROC curve was observed the area under the curve is high for RIPASA scoring system.

scholarly journals Foundational Statistical Principles in Medical Research: Sensitivity, Specificity, Positive Predictive Value, and Negative Predictive Value

Medicina ◽  
2021 ◽  
Vol 57 (5) ◽  
pp. 503
Author(s):  
Thomas F. Monaghan ◽  
Syed N. Rahman ◽  
Christina W. Agudelo ◽  
Alan J. Wein ◽  
Jason M. Lazar ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Medical Literature ◽  
Disease Prevalence ◽  
Positive Test Result ◽  
Predictive Values ◽  
Sensitivity Specificity ◽  
Test Result ◽  
Test Probability

Sensitivity, which denotes the proportion of subjects correctly given a positive assignment out of all subjects who are actually positive for the outcome, indicates how well a test can classify subjects who truly have the outcome of interest. Specificity, which denotes the proportion of subjects correctly given a negative assignment out of all subjects who are actually negative for the outcome, indicates how well a test can classify subjects who truly do not have the outcome of interest. Positive predictive value reflects the proportion of subjects with a positive test result who truly have the outcome of interest. Negative predictive value reflects the proportion of subjects with a negative test result who truly do not have the outcome of interest. Sensitivity and specificity are inversely related, wherein one increases as the other decreases, but are generally considered stable for a given test, whereas positive and negative predictive values do inherently vary with pre-test probability (e.g., changes in population disease prevalence). This article will further detail the concepts of sensitivity, specificity, and predictive values using a recent real-world example from the medical literature.

Diagnostic accuracy of monofilament test to detect diabetic neuropathy

2021 ◽  
Vol 10 (1) ◽  
pp. 20-25
Author(s):  
Sujan Shrestha ◽  
Mamen Prasad Gorhaly ◽  
Manil Ratna Bajracharya
Keyword(s):  
Peripheral Neuropathy ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Diabetic Peripheral Neuropathy ◽  
Perception Threshold ◽  
Sensitivity Specificity ◽  
Vibration Perception ◽  
Monofilament Test

Background Diabetic peripheral neuropathy (DPN) is a significant independent risk factor for diabetic foot, and an effective screening instrument is required to diagnose DPN early to prevent future ulceration and amputation. This study aims to determine the diagnostic accuracy of monofilament test to detect diabetic peripheral neuropathy. Methods This cross-sectional study was conducted in National Academy of Medical Sciences, Bir hospital, Mahabouddha, Kathmandu from February 2016 to January 2017. A total of 96 diabetic patients attending inpatient and outpatient Department were selected. Diabetic peripheral neuropathy was assessed by measurement of loss of protective sensation (LOPS) by monofilament test and compared with vibration perception threshold by standard biothesiometer. The sensitivity, specificity, positive predictive value and negative predictive value of monofilament test were calculated. Results The prevalence of diabetic peripheral neuropathy was 26%. The sensitivity, specificity, positive predictive value and negative predictive value of monofilament test were found to be 92.0%, 95.8%, 88.5% and 97.1% respectively. There was strong association between LOPS by monofilament and vibration perception threshold by biothesiometer. Conclusion This study showed a strong diagnostic accuracy of monofilament test to detect DPN when compared with biothesiometer. As monofilament test is a cheap, easily available, and portable, it can be used in the periphery where biothesiometer is not available.  

DIAGNOSTIC ACCURACY OF GRAY SCALE ULTRASONOGRAPHY VERSUS COLOR DOPPLER IN SUSPECTED CASES OF ACUTE APPENDICITIS

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Tahir Iqbal ◽  
Muhammad Usman Shahid ◽  
Ishfaq Ahmad Shad ◽  
Shahzad Karim Bhatti ◽  
Syed Amir Gilani ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Color Doppler ◽  
Diagnostic Tools ◽  
Gray Scale ◽  
Versus Color ◽  
Sensitivity Specificity

ABSTRACT: BACKGROUND: A common surgical emergency is acute appendicitis. Various diagnostic tools are available to diagnosis acute appendicitis. Radiological investigations play an important role in making accurate and early diagnosis and thus preventing morbidity associated with the disease. OBJECTIVE: To determine the diagnostic accuracy of gray scale ultrasonography versus color Doppler in suspected cases of acute appendicitis. MATERIALS AND METHODS: The study was carried in the department of Radiology of Mayo Hospital, Lahore. A total of 75 patients were enrolled of age 18-40 years, both genders who were suspected cases of acute appendicitis. All patients underwent baseline investigations along with gray scale ultrasonography and color Doppler. All patients were subjected to surgery to confirm the diagnosis and findings were subjected to statistical analysis. RESULTS: The mean age of the patients was 23.25 ±10.55 and mean transverse diameter of appendix was 8.37 ±3.39. There were 62.7% males and 37.3%females. Findings of gray scale ultrasonography and color Doppler were then correlated with surgical findings to calculate the diagnostic accuracy of these modalities. The results revealed that gray scale ultrasonography sensitivity, specificity, positive predictive value, negative predictive value and accuracy was 92.7%, 94.32%, 95%, 91.4% and 93.3% respectively, whereas color Doppler had sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 97.7%, 93.9%, 95.3%, 97% and 96% respectively. Diagnostic accuracy of both modalities together was 98.6%. CONCLUSION: Color Doppler has better diagnostic accuracy than gray scale ultrasonography for diagnosis of acute appendicitis and the combination of both modalities yields diagnostic accuracy that is similar to gold standard.

scholarly journals ACCURACY OF THE UPPER LIP BITE TEST;

2012 ◽  
Vol 20 (01) ◽  
pp. 132-138
Author(s):  
MUHAMMAD ATIF ◽  
MUHAMMAD ABDULLAH ◽  
MUHAMMAD JAVAD YOUSAF ◽  
Khalid Buland
Keyword(s):  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Difficult Intubation ◽  
Predictive Value ◽  
Elective Surgery ◽  
Cross Sectional Study ◽  
Military Hospital ◽  
Upper Lip ◽  
Cross Sectional ◽  
Sensitivity Specificity

Objective: To compare the accuracy of Upper lip bite test with modified Mallampati classification for predicting the difficultlaryngoscopic intubation. Study Design: Cross sectional Study. Place and duration of study: The study was carried out at Department ofAnaesthesiology, Intensive Care and Pain management, Combined Military hospital, Rawalpindi from September 2008 to August 2009.Patients and Methods: Four hundred patients undergoing elective surgery meeting the inclusion/exclusion criteria were enrolled afterwritten informed consent. The airways of the patients were evaluated by using the modified Mallampati classification (MMP) and theUpper lip bite test (ULBT). MMP class 3 or 4 and ULBT class 3 were considered as indicators of difficult intubation. The laryngeal view wasgraded by Cormack and Lehane classification (Gold standard). Grade 1 or 2 was considered to represent easy intubation and grade 3 or 4to represent difficult intubation. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy werecalculated for both the tests separately by using the 2×2 table. Results: ULBT had a higher accuracy of 94%, specificity of 99.2% andpositive predictive value 70% compared to MMP accuracy of 82.7%, specificity of 84.4% and positive predictive value of 22.7%.Conclusions: The diagnostic accuracy of the Upper lip bite test was more than the modified Mallampati classification. We suggest that itbe compared with the other prevailing tests as well which are often used to assess difficult intubations.

scholarly journals Clinical Performance of the Spot Vision Photo Screener before and after Induction of Cycloplegia in Children

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Konuralp Yakar
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Clinical Performance ◽  
High Specificity ◽  
Screening Criteria ◽  
Predictive Values ◽  
Before And After ◽  
Sensitivity Specificity ◽  
Vision Screener

Aim. To compare the clinical performance of the Spot Vision Screener used to detect amblyopia risk factors (ARFs) in children before and after induction of cycloplegia; the children were referred because they met the screening criteria of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS). Methods. The Spot Vision Screener and a standard autorefractometer were used to examine 200 eyes of 100 children aged 3–10 years, before and after cycloplegia induction, in terms of ARFs. Sensitivity, specificity, and positive and negative predictive values for the detection of significant refractive errors were measured using the AAPOS referral criteria. It was explored that Spot Screener data were affected by cycloplegia. The extent of agreement between cycloplegic/noncycloplegic photoscreening data and cycloplegic autorefraction measurements was assessed using Wilcoxon and Spearman correlation analyses. Results. The Spot’s sensitivity was improved from 60.9% to 85.3% and specificity from 94.9% to 87.4% with cycloplegia compared to cycloplegic standard autorefractometer results. The positive predictive value of Spot was 75.7%, and the negative predictive value was 90.4% without cycloplegia. With cycloplegia, the positive predictive value of Spot was 63.6% and the negative predictive value was 95.8%. Conclusions. The Spot Screener afforded moderate sensitivity and high specificity prior to cycloplegia. The sensitivity and negative predictive value improved after induction of cycloplegia. Examiners should be aware of the effects of cycloplegia on their findings.

Comparison of hydrosonography and transvaginal ultrasonography in the detection of intracavitary pathologies in women with abnormal uterine bleeding

2004 ◽  
Vol 14 (1) ◽  
pp. 57-63 ◽  
Author(s):  
M. A. Guven ◽  
T. Bese ◽  
F. Demirkiran
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Transvaginal Sonography ◽  
Normal Endometrium ◽  
Pathologic Findings ◽  
History Of ◽  
Sensitivity Specificity

BackgroundThe aim of the study was to compare the accuracy of hydrosonography with that of transvaginal ultrasonography in detection of intracavitary pathologies in patients with history of abnormal uterine bleeding.Study designProspective, randomized, and unblinded study.Material and methodsA total of 197 women (n = 130 premenopausal and n = 67 postmenopausal) aged between 23 and 71 years (mean age 45.7 ± 8.9) presenting with a history of abnormal uterine bleeding were included into the study. Hydrosonography was carried out by experienced gynecologists, on the same setting in an outpatient clinic immediately after the performance of transvaginal sonography. The finally obtained surgical-pathologic findings were compared with the results obtained from transvaginal sonography and hydrosonography. Sensitivity, specificity, positive, and negative predictive values were calculated for each procedure.ResultsThe surgical-pathologic examination confirmed normal physiologic endometrium in 50 (48%) of 104 women who were said to have normal endometrium on transvaginal sonography. Seventy (75%) of 93 women diagnosed of intracavitary pathologies on transvaginal sonography were confirmed by surgical-pathologic findings. The sensitivity, specificity, positive predictive value, and negative predictive value of transvaginal sonography in the detection of intracavitary pathology were 56, 68, 75, and 48%, respectively. Surgical-pathologic results revealed intracavitary pathologies in 23 (30%) of 76 women who were said to have normal endometrium on hydrosonography. Among 121 women diagnosed of intracavitary pathologies on hydrosonography, 101 (81%) women were confirmed after histological evaluation of the surgical specimens. The sensitivity, specificity, positive predictive value, and negative predictive value of hydrosonography in the detection of intracavitary pathology were 81, 73, 83, and 70%, respectively. Sensitivity and negative predictive value were significantly higher with hydrosonography. There were five cases of endometrial malignancy in which one of the case of malignancy was on polyp and two cases of endometrial hyperplasia with atypia which were not stated on sonographic results.ConclusionHydrosonography is more accurate than transvaginal ultrasography in the detection of intracavitary pathologies in women with abnormal uterine bleeding.

Interpretations of the dial test should be reconsidered. A diagnostic accuracy study reporting sensitivity, specificity, predictive values and likelihood ratios

2018 ◽  
Vol 3 (4) ◽  
pp. 198-204
Author(s):  
Richard Norris ◽  
Christian Kopkow ◽  
Michael James McNicholas
Keyword(s):  
Diagnostic Accuracy ◽  
Likelihood Ratio ◽  
Predictive Value ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Knee Ligament ◽  
Predictive Values ◽  
Medial Knee ◽  
Sensitivity Specificity ◽  
Dial Test

ObjectivesTo determine the accuracy of the dial test, used alone and in combination with additional clinical tests, in the diagnosis of an isolated posterolateral corner (PLC) injury, combined PLC-posterior cruciate ligament (PCL) injury or medial knee injury.MethodsA retrospective analysis of consecutive patients who underwent arthroscopic and/or open knee ligament reconstruction surgery was conducted. The dial test was performed in an outpatient’s clinic as part of a routine knee examination. Examination under anaesthetic and intraoperative findings were used as the reference standard test to determine the diagnostic accuracy of the dial test used alone and in combination with other PCL and medial knee tests. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+) and negative likelihood ratio (LR−) were calculated with corresponding 95% CI.ResultsData from 87 patients were available and included in the data analysis. For an isolated PLC injury, the dial test sensitivity and specificity were 0.20 (95% CI 0.08 to 0.39) and 1.00 (95% CI 0.92 to 1.00). The PPV and NPV were 1.00 (95% CI 0.52 to 1.00) and 0.70 (95% CI 0.59 to 0.80). LR+ and LR− of the dial test detecting isolated PLC injury were infinity (95% CI calculation not possible, infinity) and 0.80 (95% CI 0.41 to 1.57). The diagnostic accuracy of the dial test, when used alone and in combination with other PCL and medial knee tests, was also calculated for combined PLC-PCL and medial knee injuries.ConclusionA negative dial test at 30° of knee flexion can rule out a PLC injury, while a test that is positive at 30° and negative at 90° indicates a PLC injury, without concomitant injury to the PCL or medial knee ligaments. A positive test at both 30° and 90° can indicate isolated PLC, combined PLC-PCL or medial ligament injuries, and other knee examination findings are required to differentially diagnose these injury patterns.Level of evidenceII.

scholarly journals Sensitivity, Specificity and Predictive Values of Cytological and Microbiological Findings of Endometrial Biopsy, Cytobrush and Low Volume Uterine Lavage in Relation to Endometrial Histology in Barren Mares

2020 ◽  
Vol 15 (04) ◽  
pp. 75-79
Author(s):  
Agnus Mathew ◽  
DM Patel ◽  
KK Hadiya
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Endometrial Biopsy ◽  
Microbial Culture ◽  
K Value ◽  
Predictive Values ◽  
Low Volume ◽  
Sensitivity Specificity ◽  
Uterine Lavage

This study was carried out on 10 infertile barren mares to evaluate the sensitivity, specificity, predictive values and agreement (kappa value) of cytological and microbiological findings of three diagnosing techniques of endometritis, viz., endometrial biopsy (EB), cytobrush (CB) and low volume uterine lavage (LVL) in relation to endometrial histology. When histological examinations from EB were used as “the best standard,” the sensitivity of cytology from EB, CB and LVL technique was 0.33, 0.50 and 0.50; specificity 0.75, 1.00 and 0.75; positive predictive value 0.66, 1.00 and 0.75, and negative predictive value was 0.42, 0.57 and 0.50, respectively. The sensitivity of bacteriology from EB, CB and LVL technique was 0.83, 0.83 and 1.00; the specificity was 0.75, 0.75 and 0.50; positive predictive value 0.83, 0.83 and 0.75, and the negative predictive value was 0.75, 0.75 and 1.00, respectively. In all the cases, the sensitivity of the bacteriology was found to be higher than the sensitivity of cytology. When the results of cytological and bacteriological examinations were combined, no any increase in the sensitivity was found. Bacteriology and cytology from CB showed the highest positive predictive value demonstrating that a positive result is an accurate indication of endometritis. Sensitivity values were always higher if smears were evaluated according to PMNs to epithelial cell ratio, and the highest values were observed in specimens collected from CB and LVL. The evaluation of cytological smears based on counting PMNs in relation to epithelial cells was a better method for diagnosis of endometritis than counting the number of PMNs per high power microscopic field (k value 0.07-0.47 vs. 0.00). The agreement of the diagnosis of endometritis between the three techniques of the collection was from fair to poor and between the different criteria adopted to evaluate smears was always poor. However, the agreement of the diagnosis of endometritis by the microbial culture was moderate between the three techniques of the collection (k value 0.55-0.58).

scholarly journals Diagnostic accuracy of the Tzanakis score for acute appendicitis in a resource-limited setting: A tertiary hospital-based survey

2018 ◽  
Vol 23 (3) ◽  
pp. 100-103
Author(s):  
Ajak Makor ◽  
Josephat Jombwe ◽  
Moses Galukande ◽  
Alex E. Elobu
Keyword(s):  
Acute Appendicitis ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Histological Examination ◽  
Predictive Value ◽  
Resource Limited Setting ◽  
Negative Appendectomy ◽  
Predictive Values ◽  
Resource Limited ◽  
Limited Setting

Background: The management of acute appendicitis remains challenging with high peri-operative morbidity and mortality due diagnostic delay or high negative appendicetomy rates due to aggressive surgical approaches. CT scan is accurate for pre-operative diagnosis but not available or affordable in all settings. There remains a need for an affordable yet accurate tool for diagnosing acute appendicitis in the resource limited setting. Methods: To determine the diagnostic accuracy of Tzanakis score in the preoperative evaluation of patients with acute appendicitis, we conducted a descriptive cross-sectional study at Mulago Hospital in Kampala, Uganda. Eligible consenting patients diagnosed with acute appendicitis consecutively underwent Tzanakis scoring and appendicectomy. Appencieal samples were sent for histological examination. Sensitivity, specificity, positive predictive value, negative predictive values, and diagnostic accuracy of the Tzanakis scoring system were calculated, relative to histological examination. Results: We enrolled 160 participants of mean age 30.4 years with male:female ratio of 2:1. The Tzanakis score had sensitivity of100% (95% CI 98-100), positive predictive value 97 % (95% CI 95-99), specificity of 64% (95% CI 31-89), negative predictive value of 100%, and overall diagnostic accuracy of 98% with 3% negative appendectomy rate. Conclusions: The Tzanakis score is found to be a sensitive and specific tool that should be considered for preoperative diagnosis of acute appendicitis in resource limited settings. Keywords: appendicitis; appendicectomy; acute abdomen; diagnosis; Tzanakis score; Uganda 

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