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PubMed1994

DSM-IV field trials for oppositional defiant disorder and conduct disorder in children and adolescents.

OBJECTIVE: The purpose of the field trials for oppositional defiant disorder and conduct disorder was to select valid diagnostic thresholds for these disorders and to compare the psychometric properties of DSM-IV criteria for oppositional defiant disorder and conduct disorder with previous DSM diagnostic formulations. METHOD: Structured diagnostic interviews, standardized clinician's validation diagnoses, and multiple measures of impairment were obtained for 440 clinic-referred children and adolescents aged 4-17 years. RESULTS: A diagnostic threshold of four symptoms of oppositional defiant disorder optimized identification of impaired children, improved agreement somewhat with the clinician's validation diagnosis, and had somewhat better test-retest agreement than DSM-III-R. In the case of conduct disorder, the optimal time window for ascertainment of symptoms was clarified. A diagnostic threshold of three symptoms of conduct disorder maximized accurate identification of impaired children and agreement with the clinician's validation diagnosis and resulted in slightly better test-retest agreement than DSM-III-R. Compared with the DSM-III-R definition, the DSM-IV definition of oppositional defiant disorder was somewhat more prevalent, but the prevalence of conduct disorder was essentially unchanged. CONCLUSIONS: DSM-IV definitions of oppositional defiant disorder and conduct disorder are somewhat better than DSM-III-R definitions in terms of internal consistency and test-retest agreement, and the validity of the DSM-IV definition of oppositional defiant disorder is slightly better than that of DSM-III-R.

Adolescent↗
PubMed1996

Instrument effect on the activated protein C resistance plasma assay performed by a commercial kit.

In order to evaluate the influence of the coagulation instrument on the activated protein C (APC)-resistance plasma assay performed by a commercial kit, we tested 70 plasma samples on 4 different instruments during a simultaneous session run using a same lot of Coatest APC-resistance (Chromogenix). The results were analyzed employing three different modes of expression (aPTT prolongation in the presence of APC, APC-sensitivity ratio, normalized APC-sensitivity ratio) and three different diagnostic threshold values (below the control mean--2 standard deviations or the lowest control value or the 5th percentile of the control values). The inter-instruments variability in the mean values of the control individuals can be limited expressing the results as normalized-APC-sensitivity ratio (range 0.99-1.05). The overall diagnostic yield in thrombotic patients and their relatives depended mainly on the instrument employed and only in some cases on the mode of expression of the results and on the diagnostic threshold value. The sensitivity of the commercial assay on heterozygotes for factor V Leiden diagnosed by gene analysis was overall satisfactory (75-100%) but in some cases a lower diagnostic yield was noticed, depending on the type of instrument employed and/or the type of expression of the results and/or the diagnostic threshold values. Thus the instrument system adopted should be carefully considered in the interpretation of the results using the commercial kit.

Blood Coagulation Tests↗
PubMed2004

Comparison of diagnostic yields of clinical and radiographic caries examinations in children of different age.

AIM: This was to investigate if the pattern of distribution of caries lesions detected by clinical and radiographic examinations at different diagnostic thresholds changed over a 3-year period during the course of eruption of the permanent dentition. It has been hypothesized that the contribution of bitewing radiography to caries detection in posterior teeth may increase when approximal contacts are established during maturation of the dentition. METHODS: Clinical and radiographic caries recordings were made using the non- cavitated/enamel and cavity/dentine thresholds for caries detection among a group of 12-year-old Lithuanian children with a high caries experience. Examinations were repeated in the same children after 3 years. The bitewing radiographs from both examination sessions were coded to ensure unbiased recordings and were read by a single examiner. RESULTS: The diagnostic yields of the clinical and radiographic examination methods did not change after the permanent teeth had fully erupted. At both examination sessions the clinical examination resulted in the detection of significantly more lesions than did the radiographic method at the non-cavitated level (43- 47% lesions detected by clinical means only and 2-26% by radiographic means only). Only for approximal surfaces at the cavity/dentine diagnostic threshold did radiographs contribute to more lesions (15-16% lesions detected by clinical means only and 38-41% by radiographic means only). Establishment of approximal contacts in the permanent dentition did not increase the relative diagnostic yields of bite-wing radiography in this study group. CONCLUSION: The contribution of the two methods to caries diagnosis depends more on the diagnostic threshold selected than on the stage of maturation of the dentition.

Child↗
PubMed1997

Receiver operating characteristic curves for analysis of the results of cervicovaginal smears. A useful quality improvement tool.

OBJECTIVES: To assess the value of receiver operating characteristic curves (ROCs) as a tool for improvement in the evaluation of cervicovaginal smear results. DESIGN: We reviewed the results of cervicovaginal smear interpretation for 1 year by 10 different cytopathologists working in the same laboratory (total number of cases, 45,356) and compared them with results of histologic evaluation of corresponding biopsies (n = 2090, 4.6%), the latter taken to be the gold standard. Receiver operating characteristic curves were generated for the laboratory as a whole and for individual cytopathologists. RESULTS: Analysis of these receiver operating characteristic curves was surprisingly informative. They showed that cytopathologists with different diagnostic thresholds could be distinguished from each other. A difference in diagnostic threshold could be distinguished from a difference in diagnostic accuracy. CONCLUSIONS: We conclude that while receiver operating characteristic curves for cervicovaginal smear interpretation have limitations, the results can be used for quality improvement.

Female↗
PubMed2006

Diagnosis of polycystic ovaries by three-dimensional transvaginal ultrasound.

OBJECTIVE: To study diagnostic thresholds for polycystic ovary (PCO). DESIGN: Retrospective cohort study. SETTING: Academic hospital. PATIENT(S): Normoandrogenic ovulatory women and patients with polycystic ovary syndrome (PCOS). INTERVENTION(S): Two-dimensional (2D) and three-dimensional (3D) transvaginal ultrasound. MAIN OUTCOME MEASURE(S): The mean follicle number per ovary (FNPO) of both ovaries and the maximum number follicles in a single sonographic plane (FSSP) of either ovary were determined using 3D transvaginal ultrasound. Ovarian volume was determined using 2D transvaginal ultrasound. RESULT(S): Twenty-nine normoandrogenic ovulatory women were compared with 10 patients with PCOS. Diagnostic thresholds for PCO with 100% specificity as determined by receiver operator characteristic (ROC) curves were > or =20 for mean FNPO, > or =10 for maximum FSSP, and > or =13 cm3 for ovarian volume. Both 2D and 3D transvaginal ultrasound were highly accurate in the diagnosis of PCO as determined by areas under the curve (AUC) that were >90% for all three measures. CONCLUSION(S): Mean FNPO and maximum FSSP by 3D transvaginal ultrasound have comparable high accuracy for diagnosis of PCO. The diagnostic threshold with 100% specificity for mean FNPO is > or =20, which is greater than suggested by the Rotterdam Consensus Workshop in 2003. Use of the consensus standard, consequently, may result in overdiagnosis of PCO. A threshold of > or =20 mean FNPO using 3D transvaginal ultrasound may be appropriate to minimize false-positive diagnoses of PCO.

Adult↗
PubMed1998

Long-term test-retest reliability of personality disorder diagnoses in opiate dependent patients.

This investigation reports the two year test-retest reliability of DSM-III-R personality disorder (PD) diagnoses in a sample of 219 patients with opiate dependence admitted to methadone treatment. Different MA/PhD interviewers at each assessment used a semistructured diagnostic interview for PD, the Structured Interview for DSM-III-R Personality Disorders (SIDP-R), to make their diagnoses. The reliability of any PD diagnosis versus no PD was fair (kappa = .51). The reliability for any specific PD (weighted kappa = .31) was poor. Antisocial (kappa = .45) and sadistic (kappa = .42), were the only specific PDs for which at least fair reliability was achieved. At the cluster level, only Cluster B had fair reliability (kappa = .47). The intraclass correlation coefficients between number of criteria for the specific PDs at the two evaluation points were consistently higher (range .22 to .62.) than were the corresponding kappas for categorical diagnoses. In that the base rates for most of the PDs were low and agreement for the specific PDs typically exceeded 90%. Increasing the base rate by lowering the diagnostic threshold, or examining more severe cases by raising the diagnostic threshold, did not consistently effect reliability. Reasons for the low kappa coefficients and the implications for PD research are discussed.

Adult↗
PubMed1999

Transthoracic needle aspiration biopsy for the diagnosis of localised pulmonary lesions: a meta-analysis.

BACKGROUND: Persisting controversy surrounds the use of transthoracic needle aspiration biopsy (TNAB) stemming from its uncertain diagnostic accuracy. A systematic review and meta-analysis was therefore conducted to evaluate the accuracy of TNAB for the diagnosis of solitary or multiple localised pulmonary lesions. METHODS: Searches for English literature papers in Index Medicus (1963-1965) and Medline (1966-1996) were performed and the bibliographies of the retrieved articles were systematically reviewed. Articles evaluating the accuracy of TNAB in series of consecutive patients presenting with solitary or multiple pulmonary lesions were considered. Only papers in which >/=90% of patients were given a final diagnosis according to an appropriate reference standard were included in the meta-analysis. RESULTS: A total of 48 studies were included and five meta-analyses were conducted according to four diagnostic thresholds. From the pooled sensitivity and specificity corresponding to each diagnostic threshold, associated likelihood ratios (LRs) were derived for malignant disease as follows: (1) malignant versus all other categories, LR = 72; (2) malignant or suspicious versus all others, LR = 49; (3) suspicious versus all categories but malignant, LR = 15; (4) benign versus all others, LR = 0.07; and (5) specific benign diagnosis versus all others, LR = 0.005. Differences in methodological quality of the studies, needle types, or whether a cytopathologist participated in the procedure failed to explain the heterogeneity of the results found in almost every meta-analysis. Given a 50% probability of malignancy prior to the TNAB, post-test probabilities of malignancy upon receiving the results would be malignant, 99%; suspicious, 94%; non-specific benign, 7%; and benign with a specific diagnosis, 0.6%. CONCLUSIONS: Given the intermediate pre-test probabilities that would probably lead to performing TNAB, findings of "malignant" or of a specific diagnosis of a benign condition provide definitive results. Findings of "suspicious" markedly increase the probability of malignancy, and "benign" markedly decreases it but may not be considered definitive.

Biopsy, Needle↗
PubMed2001

An accurate and precise methodology for routine determination of the false-negative rate of Papanicolaou smear screening.

BACKGROUND: Although the false-negative rate (FNR) is the most important quality control measure for Papanicolaou smear screening, accurate, precise, and feasible methods for determining this value are lacking. METHODS: The author undertook an analysis and review of the literature. RESULTS: The best estimates of the FNR using atypical squamous cells of undetermined significance (ASCUS) as a threshold range from 17% to 61%. Sources of error in the accuracy of this measure that must be accounted for include the FNR of the review method, differences in diagnostic thresholds between the original diagnostic method and the review method, and differences in diagnostic accuracy between the original diagnostic method and the review method. Statistically precise (valid to within 10%) measurement of this value in laboratories with an ASCUS+ rate of 7% can be made from interlaboratory rescreening of approximately 1200-1500 randomly selected normal and abnormal slides along with both laboratories rediagnosing without rescreening 300-400 benign cellular change and ASCUS slides to determine the difference in diagnostic threshold. Consensus for each slide is not required with this method. Changing the threshold to low grade squamous intraepithelial lesion (best estimate FNR, 14-58%) requires review of significantly more slides to achieve the same statistical level of precision. CONCLUSIONS: Detailed analysis of the sources of error in determining the FNR allow creation of methods that are relatively unbiased, feasible, and testable and whose accuracy and precision can be determined.

False Negative Reactions↗
PubMed1996

Resuscitation from out-of-hospital cardiac arrest: implications for cardiac enzyme estimation.

BACKGROUND: diagnosis of precipitating myocardial infarction is essential for management of victims of out-of-hospital cardiac arrest, since investigations and treatment are determined by the underlying cause. Skeletal muscle and myocardial damage from external cardiac massage and defibrillation may complicate biochemical diagnosis of myocardial infarction. OBJECTIVES: (a) to examine the relationship between cumulative defibrillation energy and serum levels of cardiac troponin T and MB creatine kinase (MB-CK) mass in out-of-hospital cardiac arrest survivors without electrocardiographic evidence of myocardial infarction; (b) to reassess diagnostic thresholds for myocardial infarction using MB-CK mass and troponin T in this setting. METHODS: 77 victims of out-of-hospital cardiac arrest were studied. Serum was obtained for MB-CK mass, CK and troponin T estimation on the first 4 days of admission. Patients were divided into three groups using electrocardiographic criteria: group 1, myocardial infarction; group 2, no evidence of infarction; and group 3, equivocal electrocardiograms. Correlation coefficients were calculated for highest recorded levels of the biochemical markers versus defibrillation energy. Receiver-operating characteristic plots were used to determine optimum biochemical diagnostic thresholds for subjects in groups 1 and 2. RESULTS: using predefined criteria, 27 patients had myocardial infarction, 34 did not have myocardial infarction and 16 had equivocal electrocardiograms. Significant correlations were found for defibrillation energy versus log troponin T (r = 0.42, P < 0.05), log MB-CK mass (r = 0.51, P < 0.01) and total CK (r = 0.68, P < 0.001) in group 2. Within groups 1 and 2, MB-CK mass and troponin T provided additional diagnostic value over MB-CK fraction (P < 0.001). Diagnostic accuracy was not improved by adjusting for shock energy. The optimum threshold value was 4 ng/ml for troponin T (sensitivity 88%, specificity 95%), 60 ng/ml for MB-CK mass (sensitivity 88%, specificity 88%) and 8% of total CK for MB-CK fraction (sensitivity 74%, specificity 82%). These values should be interpreted with caution, since this study is limited by the exclusion of patients with uncertain electrocardiographic diagnoses into group 3. CONCLUSIONS: skeletal muscle and myocardial damage occurs in survivors of out-of-hospital cardiac arrest and is related to the duration of resuscitation. This complicates biochemical diagnosis of underlying myocardial infarction. Specific high diagnostic threshold values for MB-CK and troponin T are needed to optimise diagnostic accuracy. The use of MB-CK fraction leads to greater diagnostic error because of the variability of muscle CK release after resuscitation.

Aged↗
PubMed2026

Genotype-Informed Characterization of Mild Renal Hypouricemia.

INTRODUCTION: Renal hypouricemia is caused by pathogenic variants in SLC22A12 and SLC2A9. Current diagnostic thresholds based on serum uric acid (UA) (SUA < 2 mg/dl) and fractional excretion of UA (FEUA > 10%) may overlook individuals with monoallelic variants and mild hypouricemia, whose clinical implications remain incompletely defined. This study evaluated genotype-phenotype correlations across individuals with 0, 1, or 2 pathogenic alleles in a referral-based genetic testing cohort from Galicia (Western Europe). METHODS: We analyzed probands referred for suspected renal hypouricemia, their relatives, and additional carriers not previously suspected of the condition. Genetic, biochemical, and clinical data were integrated to characterize SUA and FEUA distributions by genotype and to identify overlooked cases. RESULTS: Among 21 probands, 15 carried pathogenic or likely pathogenic variants (71% diagnostic yield), including 3 variants not previously linked to renal hypouricemia. Monoallelic carriers frequently showed mild hypouricemia (SUA: 2-3.3 mg/dl), whereas biallelic carriers had SUA < 2 mg/dl. SUA and FEUA showed an allele-dose pattern, although FEUA availability was limited. Additional carriers identified outside renal hypouricemia suspicion had compatible biochemical profiles when data were available, suggesting underrecognition in clinical practice. CONCLUSION: In this referral-based cohort, monoallelic pathogenic or likely pathogenic variants in SLC22A12 and SLC2A9 were frequently associated with mild hypouricemia, supporting FEUA assessment and follow-up when low SUA is persistent or clinically suggestive. Current diagnostic thresholds may miss some of these individuals, supporting genotype-informed refinement of serum urate criteria to improve detection and monitoring.

SLC22A12↗
PubMed1991

Mixed anxiety and depression.

We review evidence from community, primary care, and psychiatric samples to determine whether there are a group of patients who have mixed symptoms of anxiety and depression that are below diagnostic thresholds for either group of disorders. A review of the data strongly suggests that such a group of patients exists and that, despite lacking sufficient symptoms to meet diagnostic thresholds from the revised 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1987), they often have significant impairment in social and vocational functioning. Because many of these patients also suffer from medically unexplained somatic symptoms, they may be more likely to frequently use nonpsychiatric medical care. Longitudinal studies suggest that persons with mixed anxiety-depression symptoms may represent a population who are at increased risk for more severe mood and anxiety disorders.

Anxiety Disorders↗
PubMed2001

Evaluation of amylase and lipase in the diagnosis of acute pancreatitis.

BACKGROUND: The diagnosis of acute pancreatitis relies heavily on a raised amylase. METHODS: In the present study patients were prospectively categorized, without knowledge of pancreatic enzyme levels, into acute pancreatitis (AP; n = 51), disease controls (n = 35), indeterminate as to pancreatitis (n = 189) or exclusions (non-pancreatitis diseases where amylase may be elevated; n = 53). RESULTS: Enzyme levels were analysed by receiver operator characteristics (ROC) curves, with specificity > 80%. Day 1 serum lipase gave the greatest diagnostic accuracy (area under ROC curve = 0.128; P = 0.041 vs serum amylase). At the calculated diagnostic threshold of 208 U/L, lipase gave a sensitivity of 67% and a specificity of 97%. Other diagnostic thresholds (day 1) were: serum total amylase, 176 U/L (ROC 0.104, sensitivity 45%, specificity 97%), urinary total amylase, 550 U/L (ROC 0.108, sensitivity 62%, specificity 97%) and serum pancreatic isoamylase, 41 U/L (ROC 0.107, sensitivity 63%, specificity 85%). At delayed diagnosis (3 days) no enzyme was superior to lipase. The combination of lipase and amylase did not increase diagnostic accuracy. CONCLUSION: Serum lipase is recommended for diagnosis of AP, both early and late in the disease. Although highly specific when elevated, all pancreatic enzymes have low sensitivity for diagnosis.

Acute Disease↗
PubMed2005

Epidemiological and clinical aspects of bipolar disorders: controversies or a common need to redefine the aims and methodological aspects of surveys.

Data from surveys of large samples showed the lifetime prevalence rates of bipolar disorder around 1.5%. A main question is whether the low prevalence rates of bipolar disorders are not an artefact of the over-diagnosis of depression and under-diagnosis of bipolar-II.Analysis of the clinician's logical inferential diagnostic process, confirms that the patient does not represent the sole source of useful information because many patients do not experience hypomania as distress but rather as recovery from depression or as a period during which they felt truly well.Epidemiological data are derived from interviews carried out by lay staff which only reflect the patient's point of view.The clinical monitoring study carried out alongside the ESEMED project found for the diagnosis of mood disorders, a Kappa agreement (versus clinical interview) which ranged from 0.23 in Spain to 0.49 in France.If we consider exactly what a Kappa of 0.4 implies for a disorder with an "identified" prevalence rate of 2%, we discover that the prevalence rate may have been under-diagnosed approximately 1.5-fold, so 67% of cases may not have been identified and 50% of the identified cases may be false positives.It is legitimate to surmise that the prevalence reported by recent (extremely costly) epidemiological surveys may be doubtful.Which direction should epidemiology take in dealing with the serious matter of bipolar disorders?Recently, some community surveys were carried out in the USA using the Mood Disorder Questionnaire. In the ensuing debate, one side claimed that the instrument was scarcely accurate when used in the general population, gave rise to numerous false positives and that the high prevalence reported was therefore a mere artefact. The other side defended the results reported by the research studies, on the basis that "positive" cases were homogeneous with regard to the high level of subjective distress, low social functioning and employment and with the high recourse to health care structures.It is quite probable that the problem lies at the root of the matter, in the definition of the gold standard.In the present state of our knowledge on course and response to treatment, the current diagnostic thresholds applied for mixed states and hypomanic episodes seem to be unsatisfactory.It is inconceivable that the diagnostic gold standard should be determined only on the basis of a structured interview of patients alone. But unless there is clinical consensus on the diagnostic threshold for hypomania and mixed states, there can be no consensus on the findings of epidemiological research.

Editorial↗
PubMed2003

A comparison of GMS-A/AGECAT, DSM-III-R for dementia and depression, including subthreshold depression (SD)--results from the Berlin Aging Study (BASE).

BACKGROUND: Empirical evaluation of the agreement between different diagnostic approaches is crucial for the understanding of epidemiological results in geriatric psychiatry. OBJECTIVES: In this paper, we analyse differences between widely used diagnostic approaches of dementia and depression and offer evidence that diagnostic thresholds vary substantially on quantitative dimensions, but that conceptual and other differences between approaches must also been taken into account. METHODS: In an epidemiological study of n = 516 persons, aged 70-103 years, we compared psychiatric diagnoses of dementia and depression obtained by GMS-A/HAS-AGECAT, DSM-III-R and clinician's diagnoses of subthreshold depression (SD). RESULTS: For depression, cumulative prevalence of clinician's diagnosis (including SD, GMS-A/HAS-AGECAT and DSM-III-R defined forms) was highest, followed by GMS-A/HAS-AGECAT-diagnosis and DSM-III-R, while for dementia DSM-III-R was followed by GMS-A/HAS-AGECAT. Overall agreement between DSM-III-R and GMS-A/HAS-AGECAT was moderate. Adapting thresholds for AGECAT resulted in slightly better diagnostic efficiency. Diagnostic disagreement was found predominantly for cases with intermediate symptom severity, supporting the hypothesis of differing thresholds between DSM-III-R and GMS-A/HAS-AGECAT, while cases with lower or higher symptom severity were similarly seen as cases or non-cases. CONCLUSION: Disagreement is not only caused by conceptual differences, but also different thresholds of diagnostic algorithms. Adaptation of threshold levels should be feasible, depending on the purpose of the analysis.

Aged↗
PubMed2001

A comparison of radiographic occlusal and approximal caries diagnoses made by 240 dentists.

Radiographs of occlusal (n = 20) and approximal (n = 24) surfaces of extracted teeth were examined by 240 dentists before participating in continuing education courses dealing with caries diagnosis and treatment decisions. The radiographic caries diagnoses were treated in accordance with the receiver operating characteristic (ROC) technique, in which the area beneath the ROC curve (A, value) indicates the quality of the observations. The frequencies of false positives made in dentin radiographically were higher for approximal (20.7%) than for occlusal caries (12.3%). The quality of pooled radiographic diagnoses of occlusal dentin lesions for all observers was significantly better than diagnoses of approximal caries in dentin. A statistically significant relationship between the observer's qualities of diagnosis of caries on approximal and occlusal surfaces (P = 0.045) was found. For diagnosis of dentin caries on approximal surfaces the mean Cohen kappa was 0.74 (standard deviation (s), 0.12; range, 0.39-0.95), and the corresponding values for occlusal surfaces were 0.70 (s, 0.14; range, 0.25-0.98). In the material under study the dentists were at least as good at diagnosing dentin caries occlusally as approximally. To avoid overtreatment, the observer's diagnostic threshold should ideally be adjusted towards strict criteria when a positive diagnosis is synonymous with a filling. The diagnostic thresholds were stricter in diagnosing occlusal surfaces than for approximal surfaces, indicating a more optimal strategy among dentists while diagnosing occlusal dentin lesions in a population with low caries prevalence.

Bicuspid↗
PubMed2002

The spectrum of social phobia in the Zurich cohort study of young adults.

BACKGROUND: The goals of the present study are to describe the prevalence, risk factors, course, and impact of social phobia in a 15-year prospective longitudinal community study; and to examine an expanded conceptualization of social phobia with respect to clinical indicators of severity, as well as gender differences, personality traits, and stability over 15 years. METHODS: The sample is a cohort of 591 young adults aged 18-19 from the general population of Zurich, Switzerland at study entry who have been followed to age 35. RESULTS: Six percent of participants met lifetime criteria for social phobia at the diagnostic level, 12% at the subthreshold level, and 24% had social phobia symptoms alone. Women had higher lifetime rates of diagnostic and subthreshold-level social phobia, whereas there was an equal gender ratio of social phobia symptoms. There was a direct association between strictness of the diagnostic threshold and severity, such that work impairment, social impairment, treatment rate, medication use, and subjective distress decreased from the diagnostic to the symptom level. Similarly, family history of phobias, autonomic lability, and comorbidity decreased across the spectrum. Although there was a substantial degree of longitudinal stability at each level of the spectrum, significant oscillation across levels suggests that the spectrum concept better characterizes the longitudinal course of social phobia. CONCLUSIONS: These findings demonstrate the utility of the social phobia spectrum. Application of the spectrum concept provides coverage of treated but undiagnosed cases of social phobia as well as those who vacillate across the diagnostic threshold over time.

Adolescent↗
PubMed2000

Evaluation of an immunocapture-agglutination test (Brucellacapt) for serodiagnosis of human brucellosis.

We evaluated the validity and the usefulness of a new test for the diagnosis of human brucellosis based on an immunocapture-agglutination technique. A total of 315 sera from 82 patients with a diagnosis of brucellosis, 157 sera from patients in whom brucellosis was suspected but not confirmed, and 412 sera from people living in rural areas with endemic brucellosis were studied. The seroagglutination test (SAT), Coombs anti-Brucella test, and Brucellacapt test were evaluated. All the initial sera from the 82 patients proved to be positive in Brucellacapt and Coombs tests, while only 75 (91.4%) were positive in the SAT. If a >/=1/160 diagnostic threshold titer was defined for the Brucellacapt test, Coombs test, and SAT, the sensitivities were 95.1, 91.5, and 65.8%, respectively. Taking the same diagnostic threshold titer for the 157 sera from the unconfirmed but suspected patients, the specificities of the Brucellacapt, Coombs, and SAT were 81.5, 96.2, and 100%, respectively; for the 412 control sera, the specificities were 99.0, 99.8, and 100%. The diagnostic efficiency (area below the receiver operating characteristic curve) of Brucellacapt was 0.987852 (95% confidence interval [CI], 0.95109 to 0.99286), very similar to the diagnostic efficiency of the Coombs test (0.97611; 95% CI, 0.94781 to 0.99146) and higher than that of SAT (0.91013; 95% CI, 0.86649 to 0.94317). The results of the Brucellacapt test were compared with those of the Coombs test (correlation coefficient, 0.956; P = 0.000) and SAT (correlation coefficient, 0.866; P = 0.000). The study shows very good correlation between the Brucellacapt and Coombs tests, with a high concordance between titers obtained in the two tests. Nevertheless, lower correlation and concordance were found between the Brucellacapt and Coombs tests when the results for titers of >/=1/160 were compared (0.692; P = 0.000). In acute brucellosis, the Brucellacapt and Coombs tests render positive titers of >/=1/160. When the titers are lower, they increase significantly in the following 30 days, despite the evolution of SAT titers. In contrast, Brucellacapt and Coombs titers are always high (>/=1/640) in brucellosis with long evolution, whether SAT titers are higher or lower than 1/160.

Adolescent↗
PubMed2001

Ability of three IgG-avidity assays to exclude recent cytomegalovirus infection.

At present, the measurement of IgG avidity appears to be the best method for differentiating primary from nonprimary cytomegalovirus (CMV) infection. This study compared the performances of three denaturation assays for the measurement of CMV IgG avidity: an in-house method and the commercially available assays Enzygnost (Dade-Behring, Germany) and Vidas (bioMérieux, France). The ability of these assays to exclude or to detect a recent CMV infection were calculated according to the results obtained in two control groups of pregnant women: 49 who had seroconverted and 80 with past infections. All three assays demonstrated a good ability to detect a recent infection (98-100%). The Dade-Behring test, in its present form, appears to be ineffective in excluding a recent CMV infection (exclusion ability: 30%), while the in-house method (exclusion ability: 96%) and the bioMérieux method (exclusion ability: 82%) performed better. The practical use of the in-house and the bioMérieux assays was evaluated in 80 women with CMV-specific IgG and a positive IgM result but without documented seroconversion. At the recommended diagnostic thresholds, the concordance between these two tests was 70%. Larger studies will allow more precise determination of the capacities of both assays and specification of the diagnostic thresholds or grey areas to be used.

Antibodies, Viral↗