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PubMed1998

The predictive value of developmental testing of extremely jaundiced African infants.

The predictive value of the Neonatal Neurological Examination (NNE) adapted from Prechtl (1977) and the Infant Motor Screen (IMS) from Nickel (1989) at 4 months was studied in severely jaundiced infants in Zimbabwe. Fifty infants were examined with the NNE, 41 with the IMS and 43 with the Bayley Scales of Infant Development (BSID) (Bayley 1969). Five infants had choreoathetosis and six had a motor delay at age 1 year. The NNE and IMS proved to be sensitive instruments particularly when two infants who became malnourished after the neonatal period were excluded. Logistic regression was used to investigate the relation between the BSID and five selected predictors from the NNE. This resulted in a correct classification of 93%. By using only the predictors acoustic blink and traction response, 80% of the infants were correctly classified but the number of false negatives was reduced from three to one.

Black People↗
PubMed1985

[Allergy to chymopapain: value of predictive tests before chemonucleolysis].

It is possible to treat vertebral disc hernias by chemonucleolysis because of the enzymatic properties of chymopapain extracted from Carica papaya. But, 1% of the general population would seem to have a latent sensitivity to this protein, and would thus be at risk of presenting life-threatening anaphylactic shock. Recent clinical studies have identified different risk factors: atopy, previous food and drug allergies. A case is here reported of a 35 year old woman with a history of urticaria following anti-tetanus serum and penicillin injections, who frequently ate exotic fruit, and who was intolerant to alcohol. HBDT and prick tests confirmed both drug allergies. A prick test to chymopapain 1 mg X ml-1 gave a borderline result; the HBDT was positive, with 45% degranulation. Both these tests had been previously assessed by a study of 20 volunteers in good general health: negative prick tests in all 20, and negative HBDT in 19 out of the 20, with chymopapain concentrations ranging from 10 micrograms X ml-1 to 1 micrograms X ml-1. The one volunteer with a positive HBDT probably had latent sensitivity to the enzyme. The great sensitivity of both prick tests and HBDT in detecting IgE specific for food proteins is recalled. It is suggested that a routine predictive immuno-allergological assessment be carried out, with prick tests to the standard airbone allergens (to find a possible atopy), and a prick-test with 1 mg X ml-1 chymopapain, and a HBDT to the enzyme. A sample of serum should be kept for possible RAST and FAST carried out later.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Evaluation of the potential role of serodiagnosis of tuberculosis in a clinic in Bolivia by decision analysis.

Decision analysis was used to examine the potential effect on cost and expected quality of care of the introduction of serodiagnosis by enzyme-linked immunosorbent assay (ELISA) of tuberculosis at the Instituto de Torax in La Paz, Bolivia. Previously published data collected at that facility were used as the basis for this analysis. Decision trees were constructed including test availability, test result, test predictive values, and the consequences of correct or incorrect treatment decisions. Five diagnostic algorithms were assessed. ELISA was found to make a contribution to the diagnosis of tuberculosis similar to that of sputum smear. Chest roentgenography improved the quality of patient care, but it did so at substantially increased cost. While ELISA did not add to the diagnosis when sputum smear was available, it might be of great use where sputum smear is not available.

Decision Support Techniques↗
PubMed1984

Changes in plasma GH levels and clinical activity during bromocriptine therapy in acromegaly. The value of predictive tests.

Twenty-seven patients with active acromegaly despite previous treatment by surgery and/or radiotherapy received bromocriptine in a dose of 10-20 mg daily for a period of 6-9 months. The results of chronic bromocriptine treatment were evaluated by measurement of plasma growth hormone (GH) levels during the day and by subjective and objective criteria of clinical activity. The results of chronic bromocriptine treatment were also compared with four biochemical criteria obtained before treatment e.g. basal plasma prolactin (Prl) levels and the plasma GH response to oral administration of 2.5 mg bromocriptine respectively iv administration of 200 micrograms TRH and 500 micrograms somatostatin. The main observations may be summarized as follows: 1) The mean pre-treatment GH levels during the day ranged from 6-207 mU/1. Hyperprolactinaemia was present in 6 patients. 2) During bromocriptine treatment mean plasma GH levels decreased to less than 50% in 11 patients (GH responders) whereas in 19 patients changes of mean plasma GH and of subjective criteria of clinical activity were concordant. 3) Glucose tolerance improved significantly (P less than 0.01) in 10 GH-responders and the urinary hydroxyproline/creatinine ratio decreased significantly (P less than 0.05) in 8 GH-responders. 4) Five out of 6 patients with hyperprolactinaemia belonged to the group of GH-responders. 5) A single dose of 2.5 mg bromocriptine induced a more than 50% decrease of plasma GH in 8 of 11 GH-responders and in 5 of 16 GH non-responders.(ABSTRACT TRUNCATED AT 250 WORDS)

Acromegaly↗
PubMed1988

Tubal function and surgery in chronic otitis media. A study on the predictive value of testing tubal function, Valsalva's manoeuvre and volume of ear spaces.

In 141 ears with central tympanic membrane (TM) perforation preoperative tubal studies as well as volume determination of the air-filled ear spaces was performed. Tubal patency was checked with Valsalva's manoeuvre and pressure equilibration function with Toynbee's test and aspiration-deflation tests respectively. At postoperative control 74.5% of the ears had intact movable TM (healed), 5.7% had intact but immovable or retracted TM and 19.8% had perforation (defect). There was no difference between the healed and defect ears regarding results in aspiration-deflation tests. A positive Valsalva's manoeuvre was significantly more frequent in the healed ears. Ears with a small air-filled volume and negative Valsalva's manoeuvre showed significantly lower healing rate than ears with positive Valsalva's manoeuvre and a large air-filled volume.

Adult↗
PubMed1991

Quantification of alphafetoprotein (AFP) endocytosis by PHA-activated peripheral blood mononuclear cells (PBMC) from HIV-infected individuals. A useful test of predictive value for the progression of AIDS.

Serum alphafetoprotein (AFP) is actively taken up, through receptor-mediated endocytosis, by many embryo-fetal cells during ontogenic development but also by neoplastic cells, as well as by normal peripheral T lymphocytes after mitogenic activation. We have previously shown that the ability to internalize AFP is impaired in mitogen-activated T cells from several groups of (HIV+)-seropositive individuals and that this expression roughly correlates with the progression of the disease. It is not clear whether this impaired AFP-endocytosis results from an HIV-mediated inhibition of AFP-receptor expression or if it is the consequence of a target signal transduction impairment due to HIV-infection. In the present work we have explored both possibilities by studying AFP-endocytosis in peripheral blood mononuclear cells (PBMC) from seropositive (HIV+)-asymptomatic heterosexual individuals and in in vitro HIV-infected PBMC from healthy donors, either quiescent or stimulated with phytohemagglutin (PHA). Our results suggest that this novel abnormality of T-cells associated with HIV-infection reflects an unusual proliferative response of PBMC to mitogenic stimuli.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Results of sphincteroplasty in patients with spastic sphincter of Oddi. Predictive value of operative biliary manometry and provocation tests.

The predictive value of different preoperative provocation tests and operative biliary manometry was studied in a series of 22 patients undergoing sphincteroplasty for suspected spastic sphincter of Oddi (SPO). The result of the operation was good in 59%, 54%, and 71% of patients in groups with a positive codein test, a positive endoscopic retrograde cholangiopancreatography filling pain sign, and positive fentanyl test, respectively. Common bile duct pressure (CBDP) did not differ significantly between the SPO spasm group and control patients, but in the fentanyl test the CBDP elevation was significantly higher (p less than 0.01) than in controls (7.7 versus 3.3 mm Hg). It was concluded that the operative fentanyl test seems to be useful in predicting the response to surgery (sphincteroplasty) in patients with post-cholecystectomy biliary-type pain and suspected SPO spasm.

Adult↗
PubMed1990

A comparative study of fecal occult blood tests for early detection of gastrointestinal pathology.

The question of what the most accurate and efficient fecal occult blood testing method is for the early detection of pathological gastrointestinal tract bleeding continues to be intensely debated. In this prospective study, the following five uniquely different slide tests were investigated in 120 patients who underwent gastrointestinal tract investigation: (1) a combination monoclonal antibody guaiac test (Monohaem); (2) an immunologic assay, enzyme-linked immunosorbent assay, with (3) a highly sensitive guaiac test (Fecatwin S/Feca enzyme immunoassay), (4) a popular guaiac test (Coloscreen III) (comparable with Hemoccult II), and (5) Coloscreen III/VPI (ie, with vegetable peroxidase) inhibitor. Computerized data show efficiency values for detection of fecal occult blood by Coloscreen III-Fecatwin S-Monohaem combined, 93%; Coloscreen III-Monohaem combined, 91%; Monohaem, 87%; Coloscreen III/VPI, 82%; Coloscreen III, 79 percent; enzyme-linked immunosorbent assay, 77%; and Fecatwin S, 68%. Results of sensitivity, specificity, false-positive and false-negative test results, tests' predictive value, simplicity, and costs of tests in this clinically based study suggests that the concomitant use of the monoclonal, monospecific test for human hemoglobin and an appropriately sensitive guaiac test is a potentially valuable approach to mass screening and early detection of occult bleeding gastrointestinal tract pathology, including colorectal cancer.

Antibodies, Monoclonal↗
PubMedDate not supplied

Predictive value and informational value of diagnostic test results.

If clinical quality assurance and cost-effectiveness of diagnostic testing are to be measured, some sort of measurement of the clinical value of a test result is needed. The predictive value of a test result is not a real measure of its clinical value, and, particularly, when used in the later stages of a diagnostic workup, it can be misleading. Using the same data that go into a calculation of predictive value, the clinical value can be determined according to the amount of useful information that is provided by a test result. Cost-effectiveness can be expressed as dollars per bit of diagnostic information.

Clinical Laboratory Techniques↗
PubMed1983

[Predictive value of the exercise test after primary infarction].

The predictive value of exercise stress testing was assessed by correlating the results with coronary angiography in a group of 100 patients 50 with inferior and 50 with anterior wall infarction. The following observations were made: --The exercise ECG was positive in 57 p. 100 of cases, more commonly in the inferior infarction group (74 p. 100), ST depression representing over 3/4 of the responses to exercise. On the other hand, the test was only positive in 40 p. 100 of anterior wall infarctions, ST depression again being the most commonly recorded response (65 p. 100). --The overall incidence of post-infarction angina was 45 p. 100; it was more common after inferior (70 p. 100) than anterior infarction (22 p. 100). --Multivessel disease was also more severe in the inferior infarction group (86 p. 100) than in anterior infarction (46 p. 100). However, ventricular aneurysms were twice as common in the anterior infarction group. --Exercise testing detected 80 p. 100 of cases with multivessel disease, especially when the LAD artery was involved, in the inferior infarction group. In the anterior infarction group, almost 50 p. 100 of patients with multivessel disease were not diagnosed. Despite an overall sensitivity of 73 p. 100 the predictive value of exercise stress testing was excellent (84 p. 100). In conclusion, in the presence of persisting angina after myocardial infarction coronary angiography should be performed to determine the severity of the multivessel disease. Exercise stress testing is a useful but imperfect method of detecting this high risk group. Its predictive value is however better in inferior (94 p. 100) than in anterior wall infarction (65 p. 100). Persisting angina was found to be a parameter of very high specificity (100 p. 100) for the presence of multivessel disease.

Adult↗
PubMed2003

Improving the positive predictive value of exercise testing in women.

OBJECTIVE: To identify exercise test variables that can improve the positive predictive value of exercise testing in women. DESIGN: Cohort study. SETTING: Regional cardiothoracic centre. SUBJECTS: 1286 women and 1801 men referred by primary care physicians to a rapid access chest pain clinic, of whom 160 women and 406 men had ST depression of at least 1 mm during exercise testing. The results for 136 women and 124 men with positive exercise tests were analysed. MAIN OUTCOME MEASURES: The proportion of women with a positive exercise test who could be identified as being at low risk for prognostic coronary heart disease and the resulting improvement in the positive predictive value. RESULTS: Independently of age, an exercise time of more than six minutes, a maximum heart rate of more than 150 beats/min, and an ST recovery time of less than one minute were the variables that best identified women at low risk. One to three of these variables identified between 11.8% and 41.2% of women as being at low risk, with a risk for prognostic disease of between 0-11.5%. The positive predictive value for the remaining women was improved from 47.8% up to 61.5%, and the number of normal angiograms was potentially reducible by between 21.1-54.9%. By the same criteria, men had higher risks for prognostic disease. CONCLUSIONS: A strategy of discriminating true from false positive exercise tests is worthwhile in women but less successful in men.

Age Factors↗
PubMed2005

Fetal upper arm volume in predicting intrauterine growth restriction: a three-dimensional ultrasound study.

As fetuses with intrauterine growth restriction (IUGR) may have increased risks with perinatal morbidity and mortality, prenatal diagnosis of IUGR is a very important issue in perinatology. To assess the efficacy of fetal upper arm volume in predicting IUGR, we undertook a prospective, cross-sectional study using quantitative three-dimensional (3D) ultrasound (US). In total, 40 fetuses with IUGR and 442 fetuses without IUGR were included for the upper arm volume assessment in utero by 3D US. All the fetuses were singletons and were followed up to delivery to establish whether they were complicated with IUGR or not. Our results showed that fetal upper arm volume assessed by 3D US can differentiate fetuses with IUGR from fetuses without IUGR well. The best predicting threshold for IUGR is at the 10th percentile by upper arm volume. Using the 10th percentile as the cutoff, the sensitivity of fetal upper arm volume in predicting IUGR was 97.5%, with specificity 92.8%, predictive value of positive test 54.9%, predictive value of negative test 99.8% and accuracy 93.1%. Furthermore, upper arm volume is the best parameter for detecting IUGR among the common fetal biometric indices, such as biparietal diameter (BPD), occipitofrontal diameter (OFD), head circumference (HC), abdominal circumference (AC), femur length (FL) and estimated fetal weight (EFW). In conclusion, fetal upper arm volume assessed by quantitative 3D US can be used to predict fetuses with IUGR antenatally. We believe fetal upper arm volume assessment by 3D US would be a useful test in detecting fetuses with IUGR.

Arm↗
PubMed1990

A comparison of serum mucoprotein with serum alpha 1 acid glycoprotein, haptoglobin, and alpha 1 antitrypsin assays in monitoring inflammatory bowel disease.

Serum mucoprotein level is a monitor for inflammatory bowel disease activity although its method of measurement is laborious. An easier assay of alpha 1 acid glycoprotein is described. The ability of the two proteins to differentiate active from non-active cases was evaluated and the results compared with acute inflammatory reactants such as alpha 1 antitrypsin and haptoglobin. Amongst 79 patients with inflammatory bowel disease linear discriminant analysis was used to segregate overlapping ranges for patients with and without active disease and thus enabling the evaluation of sensitivity and specificity of each test. Predictive values of 78.6% for mucoprotein and 76.7% for alpha 1 acid glycoprotein were achieved and were due to the fact that there is a very strong linear correlation between these two proteins (r = 0.83, p less than 0.01). Furthermore the mucoprotein fraction is predominantly comprised of alpha 1 acid glycoprotein by as much as 91.5%. alpha 1 antitrypsin and haptoglobin showed poor predictive values. Pairing up all the proteins each with mucoprotein improved the sensitivity, specificity, and predictive value slightly. As a single test alpha 1 acid glycoprotein gave highest specificity, proved easy to assay and was automatable. It was therefore recommended as a substitute for serum mucoprotein in routine assays and as an effective monitor and predictor of inflammatory bowel disease.

Colitis, Ulcerative↗
PubMed1990

Detection of bovine leukemia virus antibodies in bulk tank milk using an ELISA test: improvement of the predictive value of results by repeated testing.

In 9457 dairy farms located in an area with low prevalence of bovine leukemia virus (BLV) infection, bulk tank milk was examined to detect for the presence of antibodies using an ELISA test. If the result was positive or doubtful, serum of all animals in the farm was tested and bulk tank milk was tested again five times every 8-12 days. The results were used to establish decision rules in the event of a positive or doubtful result during mass screening.

Animals↗
PubMed1994

Sensitivities and predictive values of paraclinical tests for diagnosing multiple sclerosis.

The sensitivities and predictive values of visual, somatosensory, and brain auditory evoked potentials (EPs), cerebrospinal fluid oligoclonal banding (CSF-OB) and magnetic resonance imaging (MRI) were evaluated for the early diagnosis of clinically definite multiple sclerosis (CDMS). Paraclinical evidence of asymptomatic lesions allows a diagnosis of CDMS. Eighty-two patients in whom MS was suspected but diagnosis of CDMS was not possible entered the study prospectively. Paraclinical examinations were performed at entry. Patients were examined and underwent EPs every 6 months, and MRI yearly. After a mean follow-up of 2.9 years, 28 patients (34%) had developed CDMS (McDonald-Halliday criteria). The initial MRI was strongly suggestive of MS in 19 of these (68%), while 27 (96%) had at least one MS-like abnormality in the initial MRI. CSF-OB and EPs had lower sensitivities. CDMS developed during follow-up in 19 of the 36 patients (53%) who had an initial MRI strongly suggestive of MS but in only 1 of the 25 who had normal MRI when first studied. These results support previous conclusions that MRI is the most sensitive test for detecting white matter asymptomatic lesions, and the most predictive for the diagnosis of CDMS.

Adolescent↗