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The peripheral anterior chamber depth was less than one-fourth the peripheral corneal thickness in both eyes. Let us examine the rationale behind this statement. That in itself is not enough for a SpPIN, or 'rule in,' and doesn't help too much. However, the two tests can be combined to increase the specificity and perhaps apply SpPIN and 'rule in' diagnosis.
The 'open angle' described earlier is shown in [Figure - 3]. The angles on repeat gonioscopy indentation are shown in [Figure - 4]. While 35 is a low sensitivity as far as tests in general are concerned, it doesn't really matter here as we are utilizing the 'rule in' specifically to make the diagnosis in an individual patient.
Let's take another example: a patient has repeatable IOP measurements of 24 mmHg with normal pachymetry, and the angles this time are really open.
And, while not too useful a measure, the cup disc ratio is 0. This specificity is high enough to "rule in" the diagnosis of POAG, without further testing. Any further testing is probably required for monitoring.
Of course, whether we treat or not is a different matter. Some of us want even more evidence than this. The approach we describe allows incorporation of further testing including optimal and effective use of modern imaging techniques too.
If we combine this with just the IOP, can you calculate the combined specificity? Did you get As a 'rule in,' this is almost as good as it gets. Regrettably, there is no absolute certainty. According to our clinical Bible, absolute certainty is limited to theologians and like-minded clinicians.
If the tests were not independent, there would be some 'convergence,' as it is technically called. When we use three tests, such convergence would have minimal clinical significance. Case 2 A year-old male is suspected to have sarcoidosis. It is an idiopathic multi-system granulomatous disease, where the diagnosis is made by a combination of clinical, radiological and laboratory findings. The gold standard is a tissue biopsy showing noncaseating granuloma. Ocular sarcoidosis could present as anterior, intermediate, posterior or panuveitis; but none of these are pathognomonic.
Therefore, one has to rely on ancillary testing to confirm the diagnosis. Sensitivities can be used in the same manner to rule out diagnoses. But you feel the disc is suspicious or the patient has a family history or has been referred or whatever. Based on the above information, could the patient still have glaucoma? Did you try to calculate that? That's certainly not good enough to rule out a disease like glaucoma. The combined specificity now becomes 1 - 0.
You should be able to rule out 'functional' glaucoma now. So you can use the GDX to combine information about the nerve fiber layer. What is the combined sensitivity now? Can we send the patient home now?
More importantly, we have discussed the advantage and limitations of these measures and provided how we should use these measures in our day-to-day clinical practice. Variant metabolic risk factor profile leading to premature coronary disease: time to define the syndrome of accelerated atherocoronary metabolic syndrome in Asian Indians.
Singapore Med J ; Considerable disagreement among definitions of metabolic syndrome for Japanese. Circ J ; Cardiovasc Diabetol ; Diagnosis of insulin resistance in hypertensive patients by the metabolic syndrome: AHA vs.
IDF definitions. Int J Clin Pract ; Diabetes Metab Res Rev ; Harmonizing the Metabolic Syndrome.
A proposal for the cutoff point of waist circumference for the diagnosis of metabolic syndrome in the Japanese population. Optimal waist circumference for prediction of metabolic syndrome in young Korean women with polycystic ovary syndrome. Obesity Silver Spring ; Optimal waist circumference cutoff values for metabolic syndrome diagnostic criteria in a Korean rural population.
J Korean Med Sci ; Appropriate definition of metabolic syndrome among Iranian adults: Report of the Iranian National Committee of Obesity.
Arch Iran Med ; Cut-off values for waist circumference in rural Iraqi adults for the diagnosis of metabolic syndrome. Rural Remote Health ; Index of central obesity - A novel parameter, Med Hypotheses ; J Gen Med ; 21 Index of central obesity is better than waist circumference in defining metabolic syndrome. Metab Syndr Relat Disord ; Br J Nutr ; Insulin sensitivity in chronic pancreatitis and features of insulin resistance syndrome.
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For Classrooms and Courtrooms 2. New and latest material has been added at appropriate places, several old photographs replaced by better visuals, and many new photographs also added in the text.. Recent topics like the Protection of Children from Sexual Offences Act, , and recent changes in the criminal law in relation to rape, sexual deviations, penetrating sexual assauH and acid attacks have been incorporated.
Other topics of current importance like body farming, virtual autopsy, narcoanalysis, hair dye poisoning, newer plant poisons like brasinolide, and khat abuse have been added. Most old photographs have been replaced with new and recent photographs with crisp captions in relation to decomposition, autopsy 4.