Usefulness of a new indicator test for the diagnosis of peripheral and autonomic neuropathy in patients with diabetes mellitus.

AIMS: The aim of the present study was to assess the performance of a new indicator test (NIT), based on the measurement of sweat production after exposure to dermal foot perspiration, in the diagnosis of both peripheral sensorimotor polyneuropathy (PSN) and autonomic neuropathy in patients with diabetes. METHODS: One hundred and seventeen diabetic patients were examined. PSN was assessed using the neuropathy symptoms score, the neuropathy disability score and the vibration perception threshold. Cardiac autonomic neuropathy (CAN) was assessed using the battery of the four classical standardized tests proposed by Ewing et al., Diabetes Care 1985; 8: 491-498. Sudomotor dysfunction was assessed using the NIT. Results: Fifty patients (42.7%) had PSN and 44 patients (37.6%) had CAN. Of the 50 patients with PSN, 43 had a positive NIT (sensitivity 86%) and, out of the 67 patients without PSN, a negative NIT was obtained in 45 patients (specificity 67%). The positive and the negative predictive value of the NIT in detecting PSN were 66.2 and 86.5%, respectively. The sensitivity and specificity of NIT in detecting CAN was 59.1 and 46.5%, respectively. In the case of severe CAN, the sensitivity was increased to 80.9% and the specificity to 50%. CONCLUSIONS: The NIT has good sensitivity and negative predictive value for diagnosis of PSN and can be used as a screening method for detection of this complication in patients with diabetes. In addition, the test has a low sensitivity for detection of autonomic neuropathy in patients with milder forms of CAN.     

MICRO-CONTROLLED THERMAL STIMULATOR FOR DETECTING FINE FIBER CHANGES IN PATIENTS WITH DIABETES MELLITUS: A DIAGNOSTIC ACCURACY STUDY

AimTo evaluate sensitivity and specificity of the micro-controlled thermal stimulator (MTS) for detecting pathological changes in fine fiber of neuropathy patients with DM.MethodsA diagnostic accuracy study including 84 patients, aged 15–75 years was conducted. A patient’s foot was subjected to dermatological, musculoskeletal, vascular, and neurological evaluations. The latter was performed through the perception of a sharp touch with a toothpick (pinprick), thermal sensitivity (cold and hot temperature sensations measured using Diapason Handle and MTS, respectively), vibratory sensitivity (128 Hz Diapason Handle), 10 g Semmes-Weinstein monofilament, and a reflex test. Statistical analyses were performed using Stata® software version 13.0. The sensitivity, specificity, positive and negative predictive values, likelihood ratios, AUC, Kappa index, and accuracy of the diagnostic instruments were evaluated.ResultsOf the 84 volunteers, 66.7% were female, with an average age of 54 years. We observed that 17% of the total patients were positive for pain sensations in the foot, 13% for cold-temperature sensations, and 21% for hot-temperature sensations. The MTS (hot temperature) obtained 97.6% sensitivity and 90% specificity, agreeing on 87.5% (Kappa index) with the Diapason Handle (cold temperature) (AUC > 0.937; p < 0.05).ConclusionMTS is an accurate, sensitive, and specific instrument for the evaluation of diabetic neuropathy as compared with the tuning fork as the standard method and, consequently, it could be of help for the early diagnosis of diabetic neuropathy.     

One‐stop microvascular screening service: an effective model for the early detection of diabetic peripheral neuropathy and the high‐risk foot

Aims

To evaluate the feasibility of a one‐stop microvascular screening service for the early diagnosis of diabetic distal symmetrical polyneuropathy, painful distal symmetrical polyneuropathy and the at‐risk diabetic foot.

Methods

People with diabetes attending retinal screening in hospital and community settings had their feet examined by a podiatrist. Assessment included: Toronto Clinical Neuropathy Score evaluation; a 10‐g monofilament test; and two validated, objective and quick measures of neuropathy obtained using the point‐of‐care devices ‘DPN‐Check’, a hand‐held device that measures sural nerve conduction velocity and amplitude, and ‘Sudoscan’, a device that measures sudomotor function. The diagnostic utility of these devices was assessed against the Toronto Clinical Neuropathy Score as the ‘gold standard’.

Results

A total of 236 consecutive people attending the retinal screening service, 18.9% of whom had never previously had their feet examined, were evaluated. The prevalence of distal symmetrical polyneuropathy, assessed using the Toronto Clinical Neuropathy Score, was 30.9%, and was underestimated by 10‐g monofilament test (14.4%). The prevalence of distal symmetrical polyneuropathy using DPN‐check was 51.5% (84.3% sensitivity, 68.3% specificity), 38.2% using Sudoscan foot electrochemical skin conductance (77.4% sensitivity, 68.3% specificity), and 61.9% using abnormality in either of the results (93.2% sensitivity, 52.8% specificity). The results of both devices correlated with Toronto Clinical Neuropathy Score (P<0.001). A new diagnosis of painful distal symmetrical polyneuropathy was made in 59 participants (25%), and 56.6% had moderate‐ or high‐risk foot. Participants rated the service very highly.

Conclusions

Combined, eye, foot and renal screening is feasible, has a high uptake, reduces clinic visits, and identifies painful distal symmetrical polyneuropathy and the at‐risk foot. Combined large‐ and small‐nerve‐fibre assessment using non‐invasive, quantitative and quick point‐of‐care devices may be an effective model for the early diagnosis of distal symmetrical polyneuropathy.     

Humoral immune response against 38‐ and 16‐kDa mycobacterial antigens in childhood tuberculosis

Several enzyme‐linked immunosorbent assays (ELISAs) based on mycobacterial antigens have been tried for the rapid diagnosis of tuberculosis (TB). In this study, the value of the 16 and 38‐kDa mycobacterial antigens in the diagnosis of TB was investigated in pediatric patients in Izmir, Turkey in whom they were found using clinical and/or bacteriological methods. A commercial ELISA kit was used for measuring IgG against 38 and 16‐kDa recombinant antigens. The humoral immune response was analyzed in a group of 32 TB patients (24 pulmonary, 3 lymphadenitis and 2 pleuritis, 2 meningitis and a disseminated TB) and in control groups consisting of 20 healthy children and 20 pulmonary diseases other than TB cases. The sensitivity, specificity, positive predictive value, and the negative predictive value of the test were found to be 25%, 90%, 66.7%, and 60%, respectively, in the TB cases. The ELISA test shows very good specificity, but low level of sensitivity and negative predict value. It was thought that it might be used in combination with other methods to increase diagnostic accuracy, especially for culture‐negative TB pediatric cases, which are difficult to diagnose. Pediatr Pulmonol. 2009; 44:839–844. © 2009 Wiley‐Liss, Inc.     

Sensitivity and specificity of a new indicator test (Neuropad) for the diagnosis of peripheral neuropathy in type 2 diabetes patients: a comparison with clinical examination and nerve conduction study

OBJECTIVE: The objective of this study was to evaluate the sensitivity and specificity of a new indicator test (Neuropad) for the diagnosis of peripheral neuropathy in type 2 diabetes patients as compared with clinical examination and nerve conduction study (NCS). PATIENTS AND METHODS: This study included 120 type 2 diabetes patients (58 men) with a mean age of 67.3 +/- 5.9 years and a mean diabetes duration of 13.1 +/- 3.2 years. Diabetic neuropathy was diagnosed through the Neuropathy Disability Score. An NCS was performed on radial, ulnar, sural, and common and deep peroneal nerves. Patients were also examined with the new indicator test. The "time to complete color change of the test" from blue to pink was recorded. The test was considered abnormal in patients who exhibited a time to complete color change of the test exceeding 600 s in at least one foot. RESULTS: Neuropathy was diagnosed by clinical examination in 83 (69.2%) patients. The sensitivity of the indicator test for clinical neuropathy was 95.2%, and its specificity was 67.6%. The sensitivity of NCS for clinical neuropathy was 94%, and its specificity was 62.1%. The sensitivity of the indicator test for abnormal NCS was 97.8%, and its specificity was 96.4%. CONCLUSIONS: The new indicator test has a very high sensitivity not only for the diagnosis of clinical neuropathy but also for the diagnosis of neurophysiological neuropathy. Specificity is moderately high for the diagnosis of clinical neuropathy, while it is particularly high for the diagnosis of neurophysiological neuropathy. The indicator test has a validity comparable to that of NCS for the diagnosis of diabetic neuropathy. Finally, the time to complete color change of the test is associated with the severity of nerve conduction impairment.     

Diagnostic value of 16-slice multidetector computed tomography in symptomatic patients with suspected significant obstructive coronary artery disease

We investigated the diagnostic value and limitations of 16-slice multidetector computed tomography (MDCT) to detect significant obstructive coronary artery disease in symptomatic patients. A total of 43 symptomatic patients underwent conventional coronary angiography and 16-slice multidetector computed tomography for the detection of significant obstructive coronary artery disease. The diagnostic value and limitations of 16-slice multidetector computed tomography to detect significant coronary stenoses were determined by analyzing all coronary arteries and proximal segments, both including and excluding unevaluable segments. Analysis of all 592 coronary artery segments demonstrated moderate sensitivity (67%) and positive predictive value (69%), with a high specificity (95%) and negative predictive value (94%) for the detection of significant coronary artery stenoses. When the unevaluable segments had been excluded, with the analysis of all evaluable segments, proximal segments, and evaluable proximal segments, sensitivity increased (71%, 77%, and 83%, respectively), and high specificity (95%, 96%, and 96%, respectively) and negative predictive value (95%) were maintained. When we repeated the analysis taking only the patients into account, 16-slice MDCT correctly diagnosed 88% of all patients but a moderate negative predictive value (63%) was obtained. Artifacts caused by cardiac motion were the most frequent reason for unevaluable segments. Calcification was the leading cause of degraded image quality and incorrect diagnosis. Our results demonstrated that 16-slice MDCT has a moderate diagnostic value for the correct diagnosis of symptomatic patients with significant coronary artery disease. This result suggests that 16-slice MDCT may not be able to exclude significant coronary artery disease reliably in patients at high risk.     

冠状动脉双源CT与冠状动脉造影成像对急诊胸痛患者诊断冠心病的价值

目的:以常规冠状动脉造影(CAG)为"金标准",探讨急诊胸痛患者双源CT(DSCT)冠状动脉血管成像诊断冠心病的价值,分析DSCT诊断冠心病的准确度、灵敏度、特异度、阳性预测值和阴性预测值。方法:对115例以胸痛为主诉的急诊就诊、临床怀疑冠心病拟行CAG的患者[男60例,女55例,平均年龄(66.37±10.29)岁]进行DSCT冠状动脉成像,统计分析DSCT对诊断冠状动脉不同程度狭窄冠心病的准确度、灵敏度及特异度,并与CAG结果对比。结果:共获得92例有诊断价值的病例,DSCT诊断冠状动脉中重度狭窄的准确度为94.6%,灵敏度、特异度、阳性预测值和阴性预测值分别为96.7%、90.6%、95.1%和93.5%。对于诊断轻度狭窄冠心病的灵敏度为70.6%,特异度为63.9%,阳性预测值为34.3%,阴性预测值为91.2%。结论:DSCT冠状动脉成像可作为临床冠心病可疑患者CAG手术前的预筛手段,当患者的冠状动脉为中重度狭窄时,诊断的准确度、灵敏度、特异度较高,DSCT与CAG有很好的一致性,其对是否需进一步CAG检查有较大的指导意义。DSCT对于冠状动脉轻度狭窄患者的阴性预测值较高,提示如果DSCT判定患者无冠状动脉病变,基本上无进一步行CAG的必要。     

Usefulness of ambulatory blood pressure monitoring in predicting the presence of autonomic neuropathy in type I diabetic patients

This study investigated whether nondipping (defined as a day-night change in blood pressure (BP) 相似文献   

腺苷超声心动图与腺苷负荷心肌灌注显像诊断冠心病的价值

目的探讨腺苷超声心动图负荷试验(ASF)与腺苷负荷~(99m)Tc心肌灌注显像(Ad-SPECT)诊断冠心病的价值。方法选择临床拟诊断为稳定性心绞痛的住院患者86例,同期行ASE和Ad-SPECT单项及联合试验,观察腺苷静脉滴注后心率、血压及其不良反应发生情况。结果 86倒患者接受冠状动脉造影检查,阳性62例,阴性24例。ASF诊断冠心病的敏感性、特异性和准确度分别为74%、79%和76%,Ad-SPECT分别为87%、62%和80%,ASE及Ad-SPECT的联合平行试验敏感性、特异性和准确度分别为97%、63%和87%,联合系列试验分别为65%、88%和80%。联合平行试验的敏感性与各单项试验敏感性之间、联合系列试验的特异性与各单项试验特异性之间差异有统计学意义(P<0.05)。结论腺苷负荷试验安全、可靠,ASE及Ad-SPECT诊断冠心病特异性、敏感性均较高,联合试验可进一步提高诊断冠心病的价值。     

A comparison of the new indicator test for sudomotor function (Neuropad) with the vibration perception threshold and the clinical examination in the diagnosis of peripheral neuropathy in subjects with type 2 diabetes.

Peripheral neuropathy remains a major cause of morbidity and is a cardinal factor in the pathogenesis of diabetic foot ulceration. The aim of the present study was to compare the new indicator test for sudomotor function (Neuropad) with the vibration perception threshold (VPT) and the clinical examination in the diagnosis of peripheral neuropathy in subjects with type 2 diabetes. This study included 154 type 2 diabetic patients (76 men) with a mean age of 64.3+/-7.3 years and a mean diabetes duration of 12.8+/-4.3 years. Neuropathy was diagnosed clinically using the Neuropathy Disability Score (NDS). The VPT was measured with a neurothesiometer, values > 25Volts being classified as abnormal. Sudomotor function was evaluated by the indicator test. Sensitivity of the indicator test for neuropathy was 97.8% and specificity was 67.2%. Sensitivity and specificity of VPT for neuropathy were 78.9% and 85.9% respectively. A significant correlation was shown between time to colour change of the indicator test and VPT (rs=0.889, p<0.001). CONCLUSIONS: Both the indicator test and the VPT have a high sensitivity for neuropathy. Sensitivity is higher with the indicator test, but specificity is higher with VPT. Time until complete colour change of the indicator test shows a positive correlation with VPT. Thus, the indicator test appears to be a useful additional diagnostic tool of neuropathy, particularly suitable for screening and self-examination, in type 2 diabetes. The correlation between time to colour change of the indicator test and VPT is interesting and merits investigation in a prospective study.     

Predictive diagnostic value of the tourniquet test for the diagnosis of dengue infection in adults

Objective To examine the accuracy of the admission tourniquet test in the diagnosis of dengue infection among Lao adults. Methods Prospective assessment of the predictive diagnostic value of the tourniquet test for the diagnosis of dengue infection, as defined by IgM, IgG and NS1 ELISAs (Panbio Ltd, Australia), among Lao adult inpatients with clinically suspected dengue infection. Results Of 234 patients with clinically suspected dengue infection on admission, 73% were serologically confirmed to have dengue, while 64 patients with negative dengue serology were diagnosed as having scrub typhus (39%), murine typhus (11%), undetermined typhus (12%), Japanese encephalitis virus (5%), undetermined flavivirus (5%) and typhoid fever (3%); 25% had no identifiable aetiology. The tourniquet test was positive in 29.1% (95% CI = 23.2–34.9%) of all patients and in 34.1% (95% CI = 27.0–41.2%) of dengue‐seropositive patients, in 32.7% (95% CI = 23.5–41.8) of those with dengue fever and in 36.4% (95% CI = 24.7–48.0) of those with dengue haemorrhagic fever. Interobserver agreement for the tourniquet test was 90.2% (95% CI = 86.4–94.0) (Kappa = 0.76). Using ELISAs as the diagnostic gold standard, the sensitivity of the tourniquet test was 33.5–34%; its specificity was 84–91%. The positive and negative predictive values were 85–90% and 32.5–34%, respectively. Conclusions The admission tourniquet test has low sensitivity and adds relatively little value to the diagnosis of dengue among Lao adult inpatients with suspected dengue. Although a positive tourniquet test suggests dengue and that treatment of alternative diagnoses may not be needed, a negative test result does not exclude dengue.     

Tc-99m tetrofosmin myocardial SPECT perfusion imaging: comparison of rest-stress and stress-rest protocols

Aim. The purpose of this study was to evaluate the diagnostic value of Tc-99m tetrofosmin SPECT myocardial perfusion scintigraphy rest/stress and stress/rest protocols for the assessment of coronary artery disease (CAD). Methods. 65 patients underwent both rest and stress SPECT imaging in a one-day protocol and coronary angiography within 2 months before or after scintigraphy. Scintigraphic data was obtained according to two different protocols; 1) rest-stress (n=18) and 2) stress-rest (n=47). Results. Scintigraphic evidence for myocardial ischaemia was found in 36 patients (55%). The overall sensitivity to detect CAD (>50% luminal stenosis) was 94% (34/36), specificity 66% (19/24), positive predictive value 77%, negative predictive value 90%. The sensitivity to detect CAD for protocols 1 and 2 were 100% and 93%, specificity 56% and 70%, positive predictive value 69% and 81% and negative predictive value 100% and 88%, respectively. The left anterior descending coronary artery showed a sensitivity (overall, protocol 1 & 2) of 78%, 75% (3/4) and 79% (15/19) and a specificity of 71%, 64% (9/14) and 75% (21/28). The right coronary artery showed a sensitivity (overall, protocol 1 & 2) of 91%, 100% (6/6) and 88% (14/16) and a specificity of 70%, 92% (11/12) and 61% (19/31). The left circumflex coronary artery showed a sensitivity (overall, protocol 1 & 2) of 50%, 67% (2/3) and 46% (6/13) and a specificity of 94%, 100% (15/15) and 91% (31/34). Conclusion. Tc-99m tetrofosmin appears to be a valuable tool in predicting significant CAD. The sensitivity and the positive predictive value are high, making this test highly appropriate for the diagnosis of CAD. The diagnostic value of the individual coronary arteries is high to moderate. No significant differences were found between both protocols.     

Simultaneous dobutamine stress echocardiography and dobutamine scintigraphy (99mTc-MIBI-SPET) for assessment of coronary artery disease

Background: Simultaneous dobutamine stress echocardiography (DSE) and^99mTc-MIBI-SPET (DMS) for the evaluation of the presence and the extent of coronary artery disease (CAD) were assessed for a head to head comparison regarding the diagnostic accuracy of the two tests. Methods and Results: Forty-five consecutive patients (33 males and 12 females: 53±6.8 yr.) underwent exercise electrocardiography and simultaneous dobutamine stress echocardiography and MIBI-SPET imaging. Coronary angiography was performed in all patients (significant coronary stenosis > 50%). On the basis of the results of exercise electrocardiogram the pre-test probability for coronary artery disease (Diamond's algorithm) was low (45.6±12.7 %). The overall specificity, sensitivity and predictive accuracy of Echo-dobutamine stress test for diagnosis of the presence or absence of CAD were: specificity 82%, sensitivity 76%, diagnostic accuracy 80%, positive predictive value 90%, negative predictive value 40%. The overall specificity, sensitivity and predictive accuracy of MIBI-SPET-dobutamine test for diagnosis of the presence or absence of CAD were: specificity 86%, sensitivity 87%, diagnostic accuracy 84%, positive predictive value 97%, negative predictive value 54%. MIBI-SPET-dobutamine test showed a significantly higher sensitivity in comparison with ECHO-dobutamine test (P<0.05). Conclusion: Both noninvasive methods for the detection of CAD showed a good diagnostic accuracy. Nevertheless the SPET model showed an higher sensitivity in comparison with DSE model, essentially in the presence of a lower extent of CAD and during submaximal test.     

The role of Sudoscan feet asymmetry in the diabetic foot

The aim of this study was to investigate the role of Sudoscan asymmetry parameters in the diabetic foot.Patients and methodsIn this study we included 165 participants: 84 type 2 diabetes patients divided into three HbA1c matched groups – group 1: newly diagnosed diabetics (n = 31), group 2: people with longer diabetes duration and established neuropathy (n = 33), group 3: patients with diabetic foot ulcer (n = 20), and a control group of 81 people with prediabetes. All subjects underwent peripheral sudomotor evaluation using Sudoscan device (Impeto Medical, Paris).ResultsPatients with diabetic foot had significantly higher Sudoscan feet asymmetry (19.6%) compared to those with only diabetic neuropathy (7.9%), compared to the group with newly diagnosed diabetes (7.44%), and compared to controls (2.5%). This test has shown a good discriminative value (with a threshold of 9.5%) for diabetic foot with area under the ROC curve of 0.955 (p = 0.001). Additionally, in a regression model feet asymmetry proved its predictive value for participants with diabetic foot.ConclusionIn this study Sudoscan feet asymmetry proved to be a novel discriminator and predictor for diabetic foot patients. It might be considered as a marker for early damage in the neuropathy evaluation protocol.     

Usefulness of immunostaining for plakoglobin as a diagnostic marker of arrhythmogenic right ventricular cardiomyopathy

The clinical diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC) is often challenging due to phenotypic variation, reduced/age-related penetrance, and lack of a diagnostic test. A single report has suggested quantitative myocardial immunoanalysis for the desmosomal protein plakoglobin as a diagnostic test with high sensitivity and specificity. We performed immunohistochemistry for plakoglobin and a control protein on myocardial biopsies with fibrofatty replacements from 50 consecutive, unrelated patients. The clinical, genetic, and immunohistochemical data were evaluated by independent observers in a blinded manner. The immunohistochemical and clinical diagnoses were compared and the sensitivity, specificity, and predictive values calculated. Our analysis showed 37 samples (74%) with a reduced immunosignal for plakoglobin. Of the 34 patients with a clinical diagnosis of ARVC, 29 displayed a reduced plakoglobin signal. Of the 14 patients with a clinical diagnosis other than ARVC, 6 displayed a reduced signal. Two patients were excluded from further analysis. A sensitivity of 85%, a specificity of 57%, a positive predictive value of 83%, and a negative predictive value of 62% were found. In conclusion, immunohistochemical analysis for plakoglobin, applied as a diagnostic test for ARVC, seems associated with a relatively high sensitivity, but limited specificity, and although additional validation is required, we advocate caution in basing clinical decision-making on the proposed diagnostic test.     

Evaluation of a new indicator test for sudomotor function (Neuropad) in the diagnosis of peripheral neuropathy in type 2 diabetic patients.

Sudomotor neuropathy is associated with reduction of plantar sweating and contributes to the pathogenesis of diabetic foot ulcers. The aim of the present study was to evaluate the new indicator test for sudomotor function (Neuropad) in the diagnosis of peripheral neuropathy among type 2 diabetic patients. This study included 104 type 2 diabetic patients (51 men) with a mean age of 64.2+/-5.6 years and a mean diabetes duration of 12.8+/-3.7 years. Peripheral neuropathy was diagnosed by means of the Diabetic Neuropathy Index (DNI). Sudomotor neuropathy was assessed by means of colour change in the indicator test. Peripheral neuropathy was diagnosed in 71 patients (68.3 %). Sudomotor neuropathy was diagnosed in 67 patients (94.4 %) with peripheral neuropathy and in 10 patients (30.3 %) without peripheral neuropathy (p=0.0001). Compared with DNI, sensitivity of the indicator test for diagnosing peripheral neuropathy was 94.4 % and specificity was 69.7 %. Overall prevalence of neuropathy was higher using the indicator test (77 patients, 74.0 %) than using the DNI (71 patients, 68.3 %). Time until complete colour change of the indicator test was 23.8+/-6.7 min in patients with peripheral neuropathy and 7.7+/-1.2 min in patients without peripheral neuropathy (p=0.001). Among patients with peripheral neuropathy, time until complete colour change of the indicator test was 14.2+/-1.9 min in those with a DNI value between 2.5 and 4.5, while it was 32.8+/-2.6 min in those with a DNI value between 5 and 8 (p=0.003). CONCLUSIONS: Use of the new indicator test has a very high sensitivity in detection of diabetic peripheral neuropathy. Sudomotor dysfunction can be demonstrated in a considerable part of patients with normal clinical examination. Time until complete colour change of the indicator test is associated with severity of peripheral neuropathy.     

The immunoserological diagnosis of tuberculosis: a comparison of two tests

A comparative study of the diagnostic value of the ICT-TB test and the TB-Dot test, based on laboratory examination, was carried out in 39 patients suffering from sputum positive pulmonary tuberculosis (25 males and 14 females, aged 16-50 years) and in 48 patients (27 males and 21 females, aged 17-55 years) suffering from non-tuberculosis pulmonary diseases, that had attended the Tembagapura Hospital and the TB Control Health Center Timika-Mimika, Papua. The diagnostic sensitivity of the ICT-TB test was 87.18%, the diagnostic specificity was 81.25%, the diagnostic positive predictive value was 79.07%, the negative predictive value was 88.64%, and the diagnostic efficiency was 83.91%. The diagnostic sensitivity of the TB-Dot test was 93.31%, the diagnostic specificity was 95.83%, the diagnostic positive predictive value was 94.74%, the negative predictive value was 93.85%, and the diagnostic efficiency was 94.25%. The results of the statistical analysis of the data obtained in this study revealed that the diagnostic specificity, the diagnostic positive predictive value and the diagnostic efficiency of the TB-Dot test were significantly higher (p < 0.05) than those of the ICT-TB test. However, the diagnostic sensitivity and the negative predictive value of both tests did not differ significantly (p > 0.05). Viewed from the point of their practicability, it can be justified that the ICT-TB test is a very practicable test, which needs only 15 minutes and does not require special instruments to perform the test, but is more expensive than the TB-Dot test. On the other hand, though the TB-Dot test is not very practicable and relatively time consuming, it has a significantly higher degree of diagnostic value and is much cheaper when compared to the ICT-TB test.     

Usefulness of anti‐p155 autoantibody for diagnosing cancer‐associated dermatomyositis: A systematic review and meta‐analysis

Objective

Anti‐p155 autoantibody, which was recently described in adult patients with dermatomyositis (DM), seems to be associated with cancer in this population. We performed a systematic review and meta‐analysis to ascertain the accuracy of anti‐p155 testing for the diagnosis of cancer‐associated myositis.

Methods

We searched relevant databases, with no restrictions on study design or language, for original studies that included adult patients with probable/definite DM or amyopathic DM who were evaluated for neoplasm and anti‐p155 status. Pooled sensitivity and specificity were calculated using a bivariate model. We computed the diagnostic odds ratio (OR), likelihood ratios (LRs) for positive and negative test results, positive and negative predictive values, and the summary receiver operating characteristic (SROC) curve. Statistical heterogeneity between studies was assessed using the I² statistic, and 95% confidence intervals (95% CIs) were computed for the parameters studied.

Results

Six studies including a total of 312 adult patients with DM were selected. The pooled sensitivity of anti‐p155 for diagnosing cancer‐associated DM was 78% (95% CI 45–94%), and specificity was 89% (95% CI 82–93%). The diagnostic OR was 27.26 (95% CI 6.59–112.82), and LRs for positive and negative test results were 6.79 (95% CI 4.11–11.23) and 0.25 (95% CI 0.08–0.76), respectively. Heterogeneity was substantial except with regard to the LR for a positive test result. The area under the SROC curve was 0.91 (95% CI 0.88–0.93). Taking the pooled prevalence of 17% as pretest probability, anti‐p155 had a positive predictive value of 58% and a negative predictive value of 95%.

Conclusion

Our findings indicate that anti‐p155 autoantibody determination is useful for diagnosing cancer‐associated myositis and guiding disease management.

     

The steel ball-bearing test: a new test for evaluating protective sensation in the diabetic foot

Aims/hypothesis The aim of the study was to assess a new steel ball-bearing test as a means of evaluating protective sensation in the diabetic foot. Methods Subjects were enrolled for this study as follows: (1) 39 patients (mean age 61.3±9.7 years) with neuropathy and prior neuropathic ulcer (Group A); (2) 36 patients (mean age 63.7±10.1 years) with neuropathy without neuropathic ulcer (Group B); (3) 34 patients (mean age 52.1±10.4 years) without neuropathy (Group C); and (4) 21 healthy volunteers (mean age 46.7±8.7 years) (Group D). Neuropathy was diagnosed by means of neuropathy disability score (NDS). The plantar area over the second metatarsal head of each foot was examined with steel ball-bearings of varying diameters. The smallest diameter that the patient could feel was used to define the ball-bearing score (range 1–6). Results A high ball-bearing score was significantly more frequent in patients with neuropathic ulceration than in neuropathic patients without ulceration and in diabetic patients without neuropathy (p<0.001). A high score was also more frequent in neuropathic patients without ulceration, than in patients without neuropathy (p<0.001). The ball-bearing score was significantly (p=0.01) correlated with the NDS, the monofilament test, the vibration perception threshold and the thermal perception threshold. The ball-bearing test had a sensitivity of 84% and a specificity of 100% for impaired protective sensation due to neuropathy, and a sensitivity of 84.6% and a specificity of 86.1% for detection of patients with prior neuropathic ulceration. Conclusions/interpretation The steel ball-bearing test has a high sensitivity and specificity both for the evaluation of protective sensation and for detection of patients with prior neuropathic ulceration.     

Neuropad as a diagnostic tool for diabetic autonomic and sensorimotor neuropathy

Aims The aim of the present study was to determine the diagnostic accuracy of the Neuropad sudomotor test for diabetic cardiovascular autonomic neuropathy (CAN) and diabetic polyneuropathy (DPN), the latter assessed using a multi‐level diagnostic approach. Methods In 51 diabetic patients, CAN, symptoms and signs of DPN, vibration perception threshold (VPT), cold (CTT) and warm thermal perception thresholds (WTT) were measured. Neuropad response was determined as normal (complete colour change) or abnormal (absent or incomplete colour change). The time until the complete colour change (CCC time) was recorded. Results CCC time showed significant correlations with all the neurological parameters, the strongest of which were with Valsalva ratio (ρ = ?0.64, P < 0.0001), symptoms of DPN (ρ = 0.66, P < 0.0001), postural hypotension (ρ = 0.54, P = 0.0001) and CTT (ρ = ?0.54, P = 0.0001). CCC time showed moderate diagnostic accuracy for both CAN and DPN: the areas under the receiver operating characteristic (ROC) curves were 0.71 and 0.76, respectively. The diagnostic characteristics of three cut‐off values of CCC time, identified by ROC analysis (i.e. 10, 15 and 18 min), were analysed. Compared with 10 min, the 15‐min cut‐off value provided better specificity (from 27% to 52% and from 31% to 62% for CAN and DPN, respectively) and a better likelihood ratio for negative result (from 0.67 to 0.34 and from 0.58 to 0.33) without lowering sensitivity (from 82% to 82% and from 85% to 80%). Conclusions Neuropad is a reliable diagnostic tool for both CAN and DPN, albeit of only moderate accuracy. Extending the observation period to 15 min provides greater diagnostic usefulness.