OBJECTIVES: To prospectively validate the diagnostic performance of a non-invasive point-of-care tool (Rapid IAI System), including vaginal alpha-fetoprotein and interleukin-6, to predict the occurrence of intra-amniotic inflammation in a Spanish cohort of patients admitted with a diagnosis of preterm labor and intact membranes. METHODS: From 2017 to 2022, we prospectively evaluated a cohort of pregnant women diagnosed with preterm labor and intact membranes admitted below 34+0 weeks who underwent amniocentesis to rule-in/out intra-amniotic infection and/or inflammation. Vaginal sampling was performed at the time of amniocentesis or within 24-48 h. Amniotic fluid IL-6, vaginal alpha-fetoprotein and vaginal IL-6 concentrations were measured using a point-of-care tool provided by Hologic Inc., "Rapid IAI System". We defined intra-amniotic inflammation when amniotic fluid IL-6 values were greater than 11.3 ng/mL. During recruitment, clinicians were blinded to the results of the point-of-care tool. The original prediction model proposed by Hologic Inc. to predict intra-amniotic inflammation was validated in this cohort of patients. RESULTS: We included 151 patients diagnosed with preterm labor and intact membranes. Among these, 29 (19.2 %) had intra-amniotic inflammation. The algorithm including vaginal IL-6 and alpha-fetoprotein showed an area under curve to predict intra-amniotic inflammation of 80.3 % (±5.3 %) with a sensitivity of 72.4 %, specificity of 84.6 %, positive predictive valuve (PPV) of 52.5 %, negative predictive value (NPV) of 92.9 %, and a positive likelihood ratio (LR+) of 4.6 and negative likelihood ratio (LR-) of 0.33. CONCLUSIONS: External validation of a non-invasive rapid point-of-care tool, including vaginal alpha-fetoprotein and IL-6, showed very good diagnostic performance for predicting the absence of intra-amniotic inflammation in women with preterm labor and intact membranes.
- MeSH
- alpha-Fetoproteins * analysis metabolism MeSH
- Amniocentesis methods MeSH
- Chorioamnionitis * diagnosis MeSH
- Adult MeSH
- Risk Assessment methods MeSH
- Interleukin-6 * analysis blood metabolism MeSH
- Humans MeSH
- Amniotic Fluid * metabolism chemistry MeSH
- Point-of-Care Testing MeSH
- Obstetric Labor, Premature * diagnosis MeSH
- Predictive Value of Tests MeSH
- Prospective Studies MeSH
- Pregnancy MeSH
- Vagina metabolism MeSH
- Point-of-Care Systems MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Validation Study MeSH
OBJECTIVE: Preeclampsia is a major pregnancy complication that results in significant maternal and infant mortality and morbidity, yet difficulties remain in the diagnosis of preeclampsia based on clinical parameters alone. The objective was to assess the performance of a hand-held point-of-care (POC) immunoassay in a clinical environment for glycosylated fibronectin (GlyFn) for the prediction of preeclampsia within 4 weeks of sampling. METHODS: Multinational European prospective observational pilot study of predominantly high-risk patients in the second half of pregnancy to assess a point-of-care immunoassay for GlyFn in predicting preeclampsia within 4 weeks of sampling. GlyFn was measured using a second generation hand held POC immunoassay. Results were considered normal for GlyFn concentrations of < 350 μg/mL, positive for GlyFn concentrations of 351-600 μg/mL, and high-positive for GlyFn concentrations > 600 μg/mL. RESULTS: Preeclampsia developed in 16 (19%) of 84 subjects and was associated with a shorter gestational age at delivery 35.3 weeks vs. 37.3 weeks for non-preeclamptics, n = 82; p = 0.001), a higher risk of fetal growth restriction (FGR; 31.2% vs. 10.3% for non-preeclamptics, p = 0.046), and an increased risk of preterm birth < 37 weeks gestation (83.3% vs. 33.3% for non-preeclamptics, (n = 78; p = 0.003). GlyFn positive or high positive was seen in 13/16 (81%) and in 35/68 (51.5%), yielding a sensitivity of 81%, a specificity of 49%, a positive predictive value of 27%, and a negative predictive value of 92%. GlyFn positive or high positive was also associated with preterm birth < 37 weeks in singleton pregnancy non-preeclamptic patients. Preterm birth occurred in 4.8% of those with normal GlyFn, in 26.7% with positive GlyFn, and in 50% of those with high GlyFn in singleton gestations without preeclampsia (p = 0.008). CONCLUSION: The ability to use this test in a POC format provides a method for practitioners to quickly determine risk for preeclampsia in their pregnant patients and offers an affordable alternative, as a single analyte to other diagnostic or screening tests that require laboratory-based testing or ultrasound equipment. Independent of preeclampsia, an elevated GlyFn was also correlated with preterm delivery and requires further study.
- MeSH
- Biomarkers analysis MeSH
- Adult MeSH
- Fibronectins * analysis MeSH
- Gestational Age MeSH
- Glycated Proteins MeSH
- Immunoassay methods MeSH
- Humans MeSH
- Pilot Projects MeSH
- Point-of-Care Testing MeSH
- Predictive Value of Tests MeSH
- Pre-Eclampsia * diagnosis MeSH
- Prospective Studies MeSH
- Pregnancy MeSH
- Point-of-Care Systems MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Observational Study MeSH
- MeSH
- Humans MeSH
- Point-of-Care Testing * MeSH
- Primary Health Care MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Biomarkers * blood MeSH
- C-Reactive Protein analysis MeSH
- Communicable Diseases diagnosis MeSH
- Interleukin-6 blood MeSH
- Blood Cell Count MeSH
- Blood Sedimentation MeSH
- Humans MeSH
- Point-of-Care Testing MeSH
- Procalcitonin blood MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
Ultrazvuk plic a hrudních dutin se stal součástí rutinního vyšetření na intenzivních péčích i na příjmových a standardních odděleních. Cílené vyšetření u lůžka nemocného je využíváno především k vyloučení hrudního výpotku, pneumotoraxu, k posouzení hyperemie při plicním edému nebo konsolidace tkáně při pneumonii, a v neposlední řadě jako vodítko k procedurám, především k hrudním punkcím a drenážím.
Lungs and chest cavities ultrasound has become the standard part of the examinations in intensive care as well as in admission and standard wards. The targeted point-of-care examination is mainly used to rule out chest effusion, and pneumothorax, to assess hyperemia in pulmonary edema or tissue consolidation in pneumonia, and last but not least as a guide to procedures, especially chest punctures and drainages.
Echokardiografie je nejdostupnější, a přitom velmi citlivou a spolehlivou metodou pro detekci zvýšeného množství perikardiální tekutiny a zároveň rozeznání stavu s naléhavou potřebou punkce i její bezpečné provedení. Výhodou echokardiografie je kromě dostupnosti u lůžka nemocného prakticky libovolná možnost opakování. Diagnostiku perikardiálního výpotku a zhodnocení jeho hemodynamické významnosti by v rámci screeningového ultrazvukového vyšetření měl v současnosti ovládat každý lékař pracující v intenzivní péči.
Echocardiography is the most accessible, yet very sensitive and reliable method to detect an increased amount of pericardial fluid and to recognize emergent situations requiring pericardial punction and to guide this invasive procedure. The biggest advantages of echocardiography are its' availability bedside and unlimited possibility of repeating the examination. Every doctor working in intensive care should be able to perform a basic ultrasound examination for diagnosing presence of the pericardial effusion and to evaluate its' hemodynamic significance.
Ultrazvukové vyšetření je v dnešní době nezastupitelnou metodou, kterou díky možnosti vyšetření u lůžka pacienta využíváme v akutních situacích stále častěji. Z hlediska vyšetření v akutním stavu jsou nejdůležitějšími diagnózami hluboká žilní trombóza, akutní tepenný uzávěr a postpunkční komplikace po invazivních zákrocích. V článku jsou nastíněny základní indikace a základní metodika těchto vyšetření.
At present, the ultrasound examination is an unreplaceable method, which, thanks to the possibility of examination at the patient's bedside, is used more and more often in acute situations. From the point of view of examination in the acute state, the most important diagnoses are deep vein thrombosis, acute arterial occlusion and post-puncture complications after invasive procedures. The basic indications and basic methodology of these examinations are outlined in this article.
Point-of-care and bedside tests are analytical devices suitable for a growing role in the current healthcare system and provide the opportunity to achieve an exact diagnosis by an untrained person and in various conditions and sites where it is necessary. Using a digital camera integrated into a well-accessible device like a smartphone brings a new way in which a colorimetric point-of-care diagnostic test can provide unbiased data. This review summarizes basic facts about the colorimetric point-of-care tests, principles of how to use a portable device with a camera in the assay, applications of digital cameras for the current tests, and new devices described in the recent papers. An overview of the recent literature and a discussion of recent developments and future trends are provided.
- MeSH
- Smartphone * MeSH
- Colorimetry MeSH
- Humans MeSH
- Point-of-Care Testing * MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
