scholarly journals Rigid Sigmoidoscopic Examination, an Investigation Down but Not Out: A 5-Year Single-Center Experience on 9418 Patients

2019 ◽  
Vol 10 (01) ◽  
pp. 044-048 ◽  
Author(s):  
Sandeep V. Nair ◽  
Thazhath Mavali Ramachandran ◽  
Prajob Prasad Geevarghese ◽  
N. Sunil Kumar ◽  
Shine J Pakalomattom
Keyword(s):  
Predictive Value ◽  
Diagnostic Yield ◽  
Rectal Ulcer ◽  
Solitary Rectal Ulcer Syndrome ◽  
Sigmoidoscopic Examination ◽  
Medical College ◽  
Single Center Experience ◽  
Bleeding Per Rectum ◽  
Inflammatory Bowel ◽  
Sensitivity Specificity

ABSTRACT Background: Rigid sigmoidoscopy (RS) in the present era of flexible sigmoidoscopies is falling out of favor although it continues to be used in some centers as an outpatient (OP) department procedure. Aims: This study aims to determine the utility of RS for diagnosis of rectosigmoidal pathologies in the OP setting with emphasis on neoplastic lesions. Methods: We retrospectively studied the RS records and histopathology reports (HPRs) of 5 years (July 2013–June 2018) done in the Department of Gastroenterology at Medical College Calicut. Results: During the study period, 9418 RS examinations were done, and a total of 6921 abnormalities were picked up, giving a diagnostic yield of 73.5%. Most common indication was bleeding per rectum (PR) (51%), followed by constipation (29%). The most common lesion found was hemorrhoids 39.8% followed by proctitis 13.7%, neoplasms 9.7%, and others 10.3% while 26.5% studies were normal. HPRs showed 7.7% to be malignant, 5.8% were adenoma, 12.2% were inflammatory bowel disease ulcerative colitis (IBD UC), 2.2% were solitary rectal ulcer syndrome, 1.2% nonspecific colitis, 1.7% nonneoplastic polyps, 2.7% were normal, and 1.4% were inconclusive. Of the 4812 patients with complaints of bleeding PR, 4739 (98.5%) had a diagnosis after RS, of which hemorrhoids (72.7%) was the most common cause followed by proctitis (14.2%), neoplasm (9%), and others (4.1%). The sensitivity, specificity, positive predictive value, and negative predictive value of RS in detecting neoplasia was 98.2%, 96.8%, 66.1%, and 99.9%, respectively, when HPR was gold standard. RS was found to be effective for assessing activity in IBD UC. Conclusion: RS is a simple, cheap, and effective tool for diagnosing various rectosigmoid pathologies. RS can be used as an effective screening test for rectosigmoid pathologies, especially neoplasia and IBD UC.

scholarly journals Fecal Calprotectin in Combination With Standard Blood Tests in the Diagnosis of Inflammatory Bowel Disease in Children

2021 ◽  
Vol 8 ◽  
Author(s):  
Shaun S. C. Ho ◽  
Michael Ross ◽  
Jacqueline I. Keenan ◽  
Andrew S. Day
Keyword(s):  
Inflammatory Bowel Disease ◽  
Platelet Count ◽  
Bowel Disease ◽  
Predictive Value ◽  
Screening Test ◽  
Fecal Calprotectin ◽  
Non Invasive ◽  
Blood Tests ◽  
Inflammatory Bowel ◽  
Sensitivity Specificity

Introduction: Fecal calprotectin (FC) is a useful non-invasive screening test but elevated levels are not specific to inflammatory bowel disease (IBD). The study aimed to evaluate the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of FC alone or FC in combination with other standard blood tests in the diagnosis of IBD.Methods: Children aged <17 years who had FC (normal range <50 μg/g) measured and underwent endoscopy over 33 months in Christchurch, New Zealand were identified retrospectively (consecutive sampling). Medical records were reviewed for patient final diagnoses.Results: One hundred and two children were included; mean age was 12.3 years and 53 were male. Fifty-eight (57%) of the 102 children were diagnosed with IBD: 49 with Crohn's disease, eight with ulcerative colitis and one with IBD-unclassified. FC of 50 μg/g threshold provided a sensitivity of 96.6% [95% confident interval (CI) 88.3–99.4%] and PPV of 72.7% (95% CI 61.9–81.4%) in diagnosing IBD. Two children with IBD however were found to have FC <50 μg/g. Sensitivity in diagnosing IBD was further improved to 98.3% (95% CI 90.7–99.1%) when including FC >50 μg/g or elevated platelet count. Furthermore, PPVs in diagnosing IBD improved when FC at various thresholds was combined with either low albumin or high platelet count.Conclusion: Although FC alone is a useful screening test for IBD, a normal FC alone does not exclude IBD. Extending FC to include albumin or platelet count may improve sensitivity, specificity, PPV and NPV in diagnosing IBD. However, prospective studies are required to validate this conclusion.

scholarly journals Comparison of RMI 3 and RMI 4 in pre-operative evaluation of ovarian masses

2019 ◽  
Vol 8 (9) ◽  
pp. 3602
Author(s):  
Badugu Rao Bahadur ◽  
Gangadhara Rao Koneru ◽  
Prabha Devi Kodey ◽  
Jyothi Melam
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Malignant Tumors ◽  
Clinical Approach ◽  
Ovarian Mass ◽  
Medical College ◽  
Operative Evaluation ◽  
Sensitivity Specificity ◽  
Final Confirmation

Background: To differentiate ovarian mass as benign or malignant could change clinical approach. Finding a screening and diagnostic method for ovarian cancer is challenging due to high mortality and insidious symptoms. Risk malignancy index (RMI) has the advantage of rapid and exact triage of patients with ovarian mass.Methods: Prospective study carried for 2 years at NRI Medical College and General Hospital, Chinakakani, Mangalagiri, Andhra Pradesh, India. 79 patients with ovarian mass were investigated and risk malignancy index (RMI-3 and RMI-4) calculated. Final confirmation was done based on histopathological report. Sensitivity, specificity, positive predictive value and negative predictive value were calculated for RMI 3 and RMI 4 taking histopathology as control and comparison was done.Results: (n=79); 50 (63.29%) cases were benign and 29 (36.70%) were malignant based on histopathology. RMI 4 is more sensitive (68.96%) than RMI 3 (62.06%), but RMI 3 is more specific (94%) than RMI 4 (92%).The positive predictive value of RMI-3 and RMI-4 were 85.71%  and 83.33% respectively. The negative predictive value for RMI-4 and RMI-3 were 83.63% and 81.03% respectively.Conclusions: With increasing age, chance of malignancy increases. RMI 4 was more sensitive than RMI-3, however less specific than RMI 3 in differentiating benign and malignant tumors. The positive predictive value is slightly more for RMI 3, than RMI 4. Negative predictive value is slightly more for RMI 4, than RMI 3. 

scholarly journals Solitary Rectal Ulcer Syndrome: Uncommon Cause of Rectal Bleeding in Children

2008 ◽  
Vol 47 (172) ◽  
Author(s):  
Sudhamshu KC ◽  
D Sharma ◽  
B Bashnet ◽  
AK Mishra
Keyword(s):  
Rectal Bleeding ◽  
Adult Population ◽  
Rectal Polyp ◽  
Rectal Ulcer ◽  
Pediatric Age ◽  
Proctoscopic Examination ◽  
Solitary Rectal Ulcer ◽  
Solitary Rectal Ulcer Syndrome ◽  
Common Causes ◽  
Bleeding Per Rectum

Rectal polyp and hemorrhoids are common causes of bleeding per rectum in pediatric age group.However, there are some other causes which should be considered in differential diagnosis. We haveacquainted a case of rectal bleeding due to solitary rectal ulcer in a child of 10 year. Colonoscopicexamination was required for diagnosis as proctoscopic examination and digital rectal examinationmissed the diagnosis, probably due to poor co-operation by the patient and rare nature of the disease.Although well recognized in the adult population, the pediatric experience with this condition islimited.Key word: children, rectal bleeding, solitary rectal ulcer

scholarly journals Efficacy of OPD based rigid sigmoidoscopy in diagnosing the patients with bleeding per rectum

2018 ◽  
Vol 6 (1) ◽  
pp. 261
Author(s):  
Hardik Parmar ◽  
Arun R. ◽  
Sahdevsinh Chauhan ◽  
Akshay Sutaria
Keyword(s):  
Clinical Examination ◽  
Diagnostic Yield ◽  
Outpatient Department ◽  
Sigmoidoscopic Examination ◽  
High Diagnostic Yield ◽  
Routine Blood ◽  
Bleeding Per Rectum ◽  
Very High

Background: The aim of study was to evaluate the patients with bleeding per rectum by rigid sigmoidoscopy and to know the various causes of bleeding per rectum in our OPD population and to select the best approach to treat the underlying pathology.Methods: A total 63 patients with bleeding per rectum in whom cause could not be ascertained by routine methods like proctoscopy were considered from outpatient department form January 2017 to June 2018 for the study. Out of 63 patients, rigid sigmoidoscopy done in 31 patients and results were documented. All 31 patients were undergone for complete clinical examination and rigid sigmoidoscopic examination in the surgical OPD and routine blood, urine and stool investigations were also done.Results: Out of 31 cases in which sigmoidoscopic examination has been done, definitive source of bleeding is identified in 22 cases (70.97%) and in 9 cases (29.03%), the source of bleeding could not be detected by rigid sigmoidoscope.Conclusions: Rigid sigmoidoscopy has a very high diagnostic yield (approximately 71% in this study) in patients with bleeding per rectum which could not be detected by routine ano proctoscopy. Hence rigid sigmoidoscopy would be recommended in the workup of patients presenting with bleeding per rectum and it also serves an equally important function in excluding serious colonic lesions like malignancy and enables us to reassure the patient.

scholarly journals Accuracy of High Resolution Sonography in Diagnosis of Fibroadenosis Compared with Histopathological Diagnosis

2018 ◽  
Vol 8 (3) ◽  
pp. 139-142
Author(s):  
Mashah Binte Amin ◽  
Tarana Yasmin ◽  
Khaleda Parvin Rekha ◽  
Rushaida Haque Leeba ◽  
Nasima Akhter ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Linear Array ◽  
Histopathological Diagnosis ◽  
Fibrocystic Disease ◽  
Medical College ◽  
Breast Condition ◽  
Sensitivity Specificity ◽  
Test Result

Background: Fibrocystic breast condition is a common, non-cancerous condition that affects premenopausal woman between 20 and 50 years of age. Because of non-specific nature of clinical presentation, diagnosis is not that easy. Linear array sonography has been helpful for detection of mammary dysplasia.Objective: The purpose of this study was to determine the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of superficial sonography in the diagnosis of chronic cystic mastitis.Materials and Methods: This study was carried out in department of Radiology & Imaging of Enam Medical College and Hospital during June 2013 to October 2017. Sonography was done in 1350 women suspected of having fibrocystic disease. Among them FNAC was done only in 1020 cases. Ultrasonographic findings and histopathological reports were analyzed using SPSS 13.0.Results: According to our study the sensitivity of superficial sonography was 92.4%, specificity 88.8%, positive predictive value 93.8%, negative predictive value 86.4% and accuracy 91% in the diagnosis of fibrocystic changes.Conclusion: With the validity test result, it can be concluded that high frequency sonography provides an accurate diagnosis of fibroadenosis.J Enam Med Col 2018; 8(3): 139-143

scholarly journals Magnetic Resonance Imaging Evaluation of Spinal Tumors and Its Comparison with Histopathological Findings

2018 ◽  
Vol 26 (2) ◽  
pp. 162-166
Author(s):  
Gopal Chandra Saha ◽  
Prodip Kumar Biswas ◽  
Md Motlabur Rahman ◽  
Mohammed Shahadat Hossain ◽  
Mohammad Zaid Hossain ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Spinal Tumor ◽  
Spinal Tumour ◽  
Spinal Tumors ◽  
Histopathological Findings ◽  
Medical College ◽  
Diagnostic Usefulness ◽  
Sensitivity Specificity

Objective: The objective of the study was to assess the diagnostic usefulness of MRI in evaluation of spinal tumors.Methodology: This cross-sectional study was carried out in Dhaka Medical College Hospital, Dhaka. The data was collected from July 2011 to June 2013 and total 51 patients were included in the study. Data was collected from MRI diagnosed spinal tumors who attended at Radiology and Imaging department of DMCH from OPD and indoor patients. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MRI for evaluation of spinal tumors were detected.Results: Out of 51 patients 26 (51%) was intradural extramedullary, 13 (25.5%) was extradural and 12 (23.5%) was intramedullary. Distribution of patients according to MR diagnosis. Among the 51 patients 40 were diagnosed spinal tumor and 11 were not spinal tumor by MRI. Among the 40 spinal tumuor diagnosed 12 (23.5%) were schwannoma, 02 (3.9%) were neuro fibroma, 11(21.6%) were meningioma, 07(13.7%) were ependymoma, 05(9.8%) were astrocytoma, 02(3.9%) were metastasis and 1 (2.0%) was osteoblastoma. Out of all cases 40 were diagnosed as spinal tumour by MRI and among them 39 were confirmed by histopathological evaluation. They were true positive. One case was diagnosed as having spinal tumour by MRI but not confirmed by histopathological findings. That was false positive. Out of 11 cases of non tumour which were confirmed by MRI, 3 were confirmed as spinal tumour and 8 were non-tumour by histopathological findings. They were false negative and true negative respectively. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the MRI in the diagnosis of spinal tumour were 92.86%, 88.89%, 97.50%, 72.73% and 92.15% respectively.Conclusion: The present study conducted to assess the diagnostic usefulness of MRI in evaluation of spinal tumors among the Bangladeshi population. Study revealed high sensitivity, specificity and accuracy of the MRI in the diagnosis of spinal tumour. MRI should be the initial procedure in the evaluation of suspected tumors of the spine.J Dhaka Medical College, Vol. 26, No.2, October, 2017, Page 162-166

Molecular testing (strand displacement assay) for identification of urethral gonorrhoea in men: can it replace culture as the gold standard?

2005 ◽  
Vol 16 (6) ◽  
pp. 430-432 ◽  
Author(s):  
H L Wheeler ◽  
C J Skinner ◽  
A Khunda ◽  
C Aitken ◽  
D Perpanthan ◽  
...  
Keyword(s):  
Predictive Value ◽  
Diagnostic Yield ◽  
Molecular Testing ◽  
Strand Displacement ◽  
Specific Test ◽  
Strand Displacement Amplification ◽  
Conventional Culture ◽  
Study Population ◽  
Displacement Assay ◽  
Sensitivity Specificity

The objective was to evaluate the performance of Becton Dickinson's BD Probe TecTM (BDPT) strand displacement amplification (SDA) test for the detection of Neisseria gonorrhoeae on urethral specimens from men with urethritis compared with conventional culture and to show that SDA improves the diagnostic yield of gonorrhoea infections (GC). Anonymized retrospective testing of stored urethral swab samples from men attending genitourinary services in East London was performed using SDA. The prevalence of GC culture positive infections in this sample was 20/152 (13%). The sensitivity, specificity, positive predictive value and negative predictive value for the BDPT-SDA system compared with culture were 100%, 95%, 77% and 100%, respectively. In this study population, the BDPT-SDA assay was a highly sensitive and specific test for the diagnosis of N. gonorrhoeae from urethral swabs in men. Therefore, SDA can be used to complement culture in the diagnosis of N. gonorrhoeae infection. No ethics committee approval was obtained as all samples were anonymized.

Evaluation of efficacy of serum and broncho-alveolar lavage Galactomannan estimation by ELISA in high-risk persistent febrile neutropenic patients

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 16505-16505
Author(s):  
M. Sengar ◽  
L. Kumar ◽  
S. Thulkar ◽  
V. Kochupillai
Keyword(s):  
High Risk ◽  
Predictive Value ◽  
Diagnostic Yield ◽  
Miliary Tuberculosis ◽  
Screening Tools ◽  
High Resolution Computed Tomography ◽  
Ct Guided ◽  
Chest X Ray ◽  
Neutropenic Patients ◽  
Sensitivity Specificity

16505 Background: Chest infections constitute 36% of all infections in our acute leukemia patients. Conclusively establishing the diagnosis of invasive fungal aspergillosis (IPA), an important cause pulmonary infiltrates and mortality in high-risk febrile neutropenic patients, however, is difficult. We therefore evaluated the value of ELISA for Galactomannan (Gm) antigen and correlated the results with radiological findings. Methods: Twenty patients with persistent high-risk febrile neutropenia were assessed with chest X-ray, high resolution computed tomography (HRCT) chest and bronchoalveolar lavage (BAL) from the affected segment on day 5 of fever. Microbial cultures of blood, sputum and BAL and Galactomannan estimation in serum and BAL were done. IPA was defined as per the Mycoses Study Group criteria. Sensitivity, specificity and negative and positive predictive value of Galactomannan assay and diagnostic yield of each investigation was determined. Results: Diagnostic yield of CXR was 10%, blood culture, mainly gram negative bacilli, 15%, and BAL 20% (Aspergillus - 10%). Based on microbiology, radiology and cytopathology IPA was diagnosed in 16 cases (proven -1, probable -2, possible -13) and miliary tuberculosis, bacterial pneumonia and nocardiosis constituted the remaining. Nodules and halo sign were the most frequent (60%) CT findings in IPA. Sensitivity, specificity and positive and negative predictive value for serum were 78%, 100%, 100% and 64%, respectively, and for BAL, were 87.5%, 100%, 100% and 75%, respectively. Conclusions: CT-guided BAL and serial serum GM estimations are valuable non-invasive screening tools for IPA in high-risk persistent febrile neutropenic patients. No significant financial relationships to disclose.

scholarly journals Interleukin 21 as a diagnostic marker of rheumatoid arthritis.

2019 ◽  
Vol 26 (08) ◽  
pp. 1229-1232
Author(s):  
Khadija Kiran ◽  
Amtul Huda ◽  
Zuhair Bhatti
Keyword(s):  
Rheumatoid Arthritis ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Diagnostic Marker ◽  
Cross Sectional Study ◽  
P Value ◽  
Cross Sectional ◽  
Medical College ◽  
Sensitivity Specificity

To investigate the role of IL-21 as diagnostic marker in diagnosis of rheumatoid arthritis. Study Design: Cross sectional study. Setting: Department of Physiology and Orthopedic Gujranwala Medical College, Gujranwala. Period: October 2017 to October 2018 in one year duration. Materials and Methods: A total of 150 patients were included in the study, main variables assessed in this study were positive predictive value negative predictive value, sensitivity, specificity and accuracy of IL-21 in diagnosis of rheumatoid arthritis. SPSS version 23 was used to analyze the data. P value less than or equal to 0.05 was taken as significant. Study was started after permission from hospital ethical committee and patients were informed in detail about disease and procedure to be done. Non probability consecutive sampling was used. Results: The estimated sensitivity was 93.6%. The estimated specificity was 50%. Positive predictive value was 96.3% and negative predictive value was 35.7%. The overall accuracy was 90.6% for diagnosing rheumatoid arthritis. Conclusion: IL-21 induces MMP3 in rheumatoid arthritis patients, identification of IL-21 from synovium of patients indicates the presence of rheumatoid arthritis. We observed 90.6% diagnostic accuracy of IL-21 for rheumatoid patients taking RA factor as gold standard of diagnostic tool.

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