1. A study compared the diagnostic accuracy of prostate specific antigen (PSA) testing, acid phosphatase (AP) testing, and microscopic sperm examination in 2450 vaginal swab samples from women reporting rape.
2. PSA testing showed higher sensitivity (80.4%) and specificity (92.3%) than AP testing (sensitivity 65.5%, specificity 96.4%) when compared to microscopic examination as the reference standard.
3. The combination of PSA and AP testing had the highest diagnostic accuracy, with a sensitivity of 84.5% and specificity of 91.9%, and the largest area under the receiver operating characteristic curve, indicating it performed better than either test alone.
Crimson Publishers: Practical Issues of Inhibition in Forensic Body Fluid Ide...Crimson-ForensicScience
The main objectives of forensic biological examinations are body fluid analysis and identification of persons involved in a criminal act. Recent molecular biological techniques have enabled the analysis of trace and impure forensic samples. In particular, polymerase chain reaction (PCR)-based DNA typing is the standard test used in human identification worldwide [1]. PCR technology is suitable for analysis of trace particles of evidence; however, the problem with PCR inhibition is known for making proper amplification difficult
Testicular Failure in Humans: Current management and future perspectivesSandro Esteves
This document summarizes a presentation on testicular failure in humans. It discusses the current management and future perspectives on this condition. Some key points include:
- Spermatogenic failure is a challenging condition affecting 1% of men and is usually irreversible. About 40-50% of men with this condition still have residual spermatogenesis that can be retrieved.
- Diagnostic tests are not always accurate in predicting if sperm can be found, but a genetic assessment of the Y chromosome can provide helpful information.
- Different management approaches are used at Androfert clinic, including counseling, identifying candidates that may benefit from interventions before sperm retrieval, selecting the best sperm retrieval method, and using advanced lab techniques.
This document provides an overview of the clinical management of nonobstructive azoospermia (NOA). It begins by defining NOA and explaining its challenges. It then discusses the diagnostic evaluation and differentiates between obstructive and nonobstructive causes. For NOA due to spermatogenic failure, the document outlines that the condition is irreversible and reviews sperm retrieval techniques and their success rates depending on the underlying etiology. It also notes that while biomarkers can reflect testicular function, they cannot definitively predict whether sperm will be found for retrieval.
Management of Nonobstructive Azoospermia Before Surgical Sperm RetrievalSandro Esteves
This document summarizes the management of non-obstructive azoospermia before attempting sperm retrieval. It discusses evaluating patients for obstructive vs. non-obstructive causes, predicting success of sperm retrieval based on medical history and examination findings, and potential interventions such as varicocele repair and hormone therapy to improve sperm production and increase likelihood of finding sperm.
1. The study examined whether women were more likely to wear red clothing during their fertile window compared to other times in their menstrual cycle.
2. Using frequent hormone sampling to determine ovulation timing within a within-subjects design, they found women had higher odds of wearing red during their estimated fertile window.
3. Further analysis found that within-subject fluctuations in the ratio of estradiol to progesterone statistically mediated the within-subject shifts in red clothing choices, providing support that specific hormone levels predict changes in women's courtship behaviors.
The document summarizes various techniques for retrieving sperm from men with azoospermia for use in IVF-ICSI procedures. It discusses the differences between obstructive and non-obstructive azoospermia and various sperm retrieval methods such as MESA, TESE, and microdissection TESE. It also covers evidence for techniques like FNA mapping followed by directed TESE to potentially improve sperm retrieval rates in men with non-obstructive azoospermia.
Dr. Sujoy Dasgupta is a reproductive medicine specialist who has extensive training and experience in managing male factor infertility. He discusses various cases involving different causes of male infertility such as mild abnormalities, varicocele, genetic issues, ejaculatory disorders, and physical abnormalities. He analyzes the diagnostic workup and treatment strategies for each case, including lifestyle modifications, medical therapy, surgical correction, assisted reproduction techniques, and counseling regarding prognosis.
Crimson Publishers: Practical Issues of Inhibition in Forensic Body Fluid Ide...Crimson-ForensicScience
The main objectives of forensic biological examinations are body fluid analysis and identification of persons involved in a criminal act. Recent molecular biological techniques have enabled the analysis of trace and impure forensic samples. In particular, polymerase chain reaction (PCR)-based DNA typing is the standard test used in human identification worldwide [1]. PCR technology is suitable for analysis of trace particles of evidence; however, the problem with PCR inhibition is known for making proper amplification difficult
Testicular Failure in Humans: Current management and future perspectivesSandro Esteves
This document summarizes a presentation on testicular failure in humans. It discusses the current management and future perspectives on this condition. Some key points include:
- Spermatogenic failure is a challenging condition affecting 1% of men and is usually irreversible. About 40-50% of men with this condition still have residual spermatogenesis that can be retrieved.
- Diagnostic tests are not always accurate in predicting if sperm can be found, but a genetic assessment of the Y chromosome can provide helpful information.
- Different management approaches are used at Androfert clinic, including counseling, identifying candidates that may benefit from interventions before sperm retrieval, selecting the best sperm retrieval method, and using advanced lab techniques.
This document provides an overview of the clinical management of nonobstructive azoospermia (NOA). It begins by defining NOA and explaining its challenges. It then discusses the diagnostic evaluation and differentiates between obstructive and nonobstructive causes. For NOA due to spermatogenic failure, the document outlines that the condition is irreversible and reviews sperm retrieval techniques and their success rates depending on the underlying etiology. It also notes that while biomarkers can reflect testicular function, they cannot definitively predict whether sperm will be found for retrieval.
Management of Nonobstructive Azoospermia Before Surgical Sperm RetrievalSandro Esteves
This document summarizes the management of non-obstructive azoospermia before attempting sperm retrieval. It discusses evaluating patients for obstructive vs. non-obstructive causes, predicting success of sperm retrieval based on medical history and examination findings, and potential interventions such as varicocele repair and hormone therapy to improve sperm production and increase likelihood of finding sperm.
1. The study examined whether women were more likely to wear red clothing during their fertile window compared to other times in their menstrual cycle.
2. Using frequent hormone sampling to determine ovulation timing within a within-subjects design, they found women had higher odds of wearing red during their estimated fertile window.
3. Further analysis found that within-subject fluctuations in the ratio of estradiol to progesterone statistically mediated the within-subject shifts in red clothing choices, providing support that specific hormone levels predict changes in women's courtship behaviors.
The document summarizes various techniques for retrieving sperm from men with azoospermia for use in IVF-ICSI procedures. It discusses the differences between obstructive and non-obstructive azoospermia and various sperm retrieval methods such as MESA, TESE, and microdissection TESE. It also covers evidence for techniques like FNA mapping followed by directed TESE to potentially improve sperm retrieval rates in men with non-obstructive azoospermia.
Dr. Sujoy Dasgupta is a reproductive medicine specialist who has extensive training and experience in managing male factor infertility. He discusses various cases involving different causes of male infertility such as mild abnormalities, varicocele, genetic issues, ejaculatory disorders, and physical abnormalities. He analyzes the diagnostic workup and treatment strategies for each case, including lifestyle modifications, medical therapy, surgical correction, assisted reproduction techniques, and counseling regarding prognosis.
Panel Discussion Problems of MALE INFERTILITY & Management of Oligo Astheno T...Lifecare Centre
This document summarizes a panel discussion on male infertility and the management of oligo astheno teratospermia (OAT). The panel included urologists, IVF experts, and gynaecologists who discussed topics such as the causes of male infertility, recent WHO criteria for semen analysis, what constitutes OAT, specific and idiopathic causes of OAT, how smoking affects fertility, and the steps in evaluating a male for infertility including history, examination, semen analysis, hormone assays, ultrasound, and additional tests or procedures when indicated.
Chromosomal Abnormalities in a Male Partner Who was a Candidate for Assisted ...Apollo Hospitals
A 30-year-old man presented with 5 years of infertility. Cytogenetic analysis revealed a chromosomal translocation between chromosomes 1 and 21 in the male [46, XY t (1; 21) (q32; q22)], which was likely the cause of his infertility. The female partner showed a normal karyotype. Chromosomal abnormalities are a known cause of male infertility and genetic testing is recommended for infertile men prior to assisted reproduction techniques to identify abnormalities. The couple was counseled on their options which included assisted reproduction followed by preimplantation genetic diagnosis.
This document describes a study that developed a cost-effective screening test for detecting microdeletions on the Y chromosome associated with male infertility.
The researchers established a preliminary diagnostic screening test using a set of six primer pairs ("set-of-six") that could detect up to 95% of published Y microdeletion cases. They tested this set-of-six on 114 infertile men and found 10 microdeletions (8.8%), demonstrating the set-of-six could reliably identify microdeletions. Testing another 34 patients with just the set-of-six again found 3 microdeletions (8.8%). Their results were similar to literature frequencies, showing the set-of-six provides
NURSING ASSESSMENT – HISTORY AND PHYSICAL ASSESSMENT OF MALE REPRODUCTIVE SYS...ANILKUMAR BR
The document provides information on assessing the male reproductive system. It discusses obtaining a medical history including sexual health and symptoms. A physical exam includes a digital rectal exam to assess the prostate and testicular exam. Diagnostic tests may include a prostate-specific antigen blood test, ultrasound of the prostate, and analysis of prostate fluid or tissue if infection is suspected. Assessment of sexual function is important, and psychological evaluation may be included if sexual dysfunction is an issue.
Clinical management of infertile men with nonobstructive azoospermia: current...Sandro Esteves
This document summarizes a presentation on the clinical management of men with nonobstructive azoospermia (NOA). It discusses how NOA is one of the most challenging conditions in infertility care. For men diagnosed with NOA, tests are conducted to determine if the cause is hypogonadotropic hypogonadism or spermatogenic failure. For spermatogenic failure, sperm retrieval techniques may be used but success rates vary depending on the underlying cause. Interventions like varicocele repair before sperm retrieval may improve chances of finding sperm. The document emphasizes that biomarkers cannot definitively predict sperm retrieval outcomes for men with NOA due to spermatogenic failure.
Male infertility can be caused by many factors and requires investigation. A semen analysis examines sperm concentration, morphology, and motility according to WHO guidelines. Other tests include a physical exam, genetic testing, and potentially a testicular biopsy to diagnose causes of male infertility such as abnormalities in sperm number, shape, movement or genetic issues. Treatment depends on the underlying cause.
This study examined the role of genetic and autoimmune factors in premature ovarian failure (POF) in 78 women. The women were divided into 3 groups based on the number of CGG repeats in the FMR1 gene: less than 28 repeats, 28-36 repeats, and more than 36 repeats. The study found that women with 28-36 repeats were most strongly associated with the presence of anti-ovarian antibodies, suggesting an autoimmune cause of POF. Women with autoimmune-driven POF had significantly higher anti-Mullerian hormone levels than those without an autoimmune cause. The presence of anti-ovarian antibodies above 10 IU/mL was associated with a normal CGG repeat number and better preservation
This document provides information about the evaluation of male infertility, including two case presentations. It discusses the workup for a 25-year-old male with primary infertility for 1 year who has a small left testes and grade 1 left varicocele. It also discusses the workup for a 38-year-old male with primary infertility for 10 years who has bilateral undescended testes. The document outlines the definition, terms, epidemiology, classification, etiology, history, examination, basic and special investigations in the evaluation of male infertility.
Journal of the Formosan Medical Association (2011) 110, 695e70.docxcroysierkathey
Journal of the Formosan Medical Association (2011) 110, 695e700
Available online at www.sciencedirect.com
journal homepage: www.jfma-online.com
ORIGINAL ARTICLE
A multivariable logistic regression equation to
evaluate prostate cancer
Jhih-Cheng Wang a, Steven K. Huan a, Jinn-Rung Kuo b, Chin-Li Lu c,
Hung Lin a, Kun-Hung Shen a,*
a Division of Urology, Departments of Surgery, Chi-Mei Medical Center, Tainan, Taiwan
b Division of Neurosurgery, Department of Surgery, Chi-Mei Medical Center, Tainan, Taiwan
c Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
Received 29 January 2010; received in revised form 14 May 2010; accepted 9 August 2010
KEYWORDS
Logistic regression;
men’s health;
probability;
prostate cancer;
risk factor;
score
* Corresponding author. Division of U
Taiwan 710.
E-mail address: [email protected]
0929-6646/$ - see front matter Copyr
doi:10.1016/j.jfma.2011.09.005
Background/Purpose: A possible means of decreasing prostate cancer mortality is through
improved early detection. We attempted to create an equation to predict the likelihood of
having prostate cancer.
Methods: Between January 2005 and May 2008, patients who received prostate biopsies were
retrospective evaluated. The relationship between the possibility of prostate cancer and the
following variables were evaluated: age; serum prostate specific antigen (PSA) level, prostate
volume, numbers of prostatic biopsies, digital rectal examination (DRE) findings, and the pres-
ence of hypoechoic nodule under transrectal ultrasonography.
Results: A multivariate regression model was created to predict the possibility of having pros-
tate cancer, and a receiver-operating characteristic (ROC) curve was drawn based on the
predictive scoring equation. Using a predictive equation, P Z 1/(1 � e�x), where X Z
�4.88, þ 1.11 (if DRE positive), þ 0.75 (if hypoechoic nodule of prostate present), þ 1.27
(when 7 < PSA � 10), þ 2.02 (when 10 < PSA � 24), þ 2.28 (when 24 < PSA � 50), þ 3.93 (when
50 < PSA), þ 1.23 (when 65 < age � 75), þ 1.66 (when 75 < age), followed by ROC curve
analysis, we showed that the sensitivity was 88.5% and specificity was 79.1% in predicting
the possibility of prostate cancer.
Conclusion: Clinicians can tailor each patient’s follow-up according to the nomogram based on
this equation to increase the efficacy of evaluating for prostate cancer.
Copyright ª 2011, Elsevier Taiwan LLC & Formosan Medical Association. All rights reserved.
rology, Department of Surgery, Chi-Mei Medical Center, 901 Chung Hwa Road, Yung Kang City, Tainan,
il.com (K.-H. Shen).
ight ª 2011, Elsevier Taiwan LLC & Formosan Medical Association. All rights reserved.
mailto:[email protected]
http://dx.doi.org/10.1016/j.jfma.2011.09.005
www.sciencedirect.com/science/journal/09296646
http://www.jfma-online.com
http://dx.doi.org/10.1016/j.jfma.2011.09.005
http://dx.doi.org/10.1016/j.jfma.2011.09.005
696 J.-C. Wang et al.
Prostate cancer is the most common solid malignancy ...
Anti-Thyroid Peroxidase And Risk Of Recurrent Spontaneous AbortionCourtney Esco
This document summarizes a study that examined the relationship between anti-thyroid peroxidase (anti-TPO) antibodies and recurrent spontaneous abortion (RSA). The study tested sera from 58 women with a history of RSA and 58 healthy control subjects for anti-TPO antibodies. The study found no significant association between the presence of anti-TPO antibodies and a history of RSA, as 12 of the RSA patients (20.7%) tested positive compared to 8 of the controls (13.8%). Based on these results, the study concluded that testing for anti-TPO does not appear to be useful in evaluating patients with a history of RSA.
Poster on clinical significance of sperm morphology assessment a lekshmiAiswarya Lekshmi
Clinical Significance of Sperm Morphology Assessment
The document discusses the clinical significance of sperm morphology assessment. It notes that sperm morphology is closely correlated with sperm function and fertility outcomes like IVF success. The configuration of the acrosome, which is involved in fertilization, is a good indicator of a sperm's fertilizing ability. Abnormalities in sperm morphology like small acrosomes make sperm more susceptible to cell death. The document also discusses methods for assessing sperm morphology and various abnormalities seen in abnormal sperm.
This document summarizes several studies on prostate cancer screening and treatment that will be discussed at an American Urological Association panel. One study found that a single blood test before age 50 could predict long-term risk of prostate cancer death, with 44% of deaths occurring in men with above-average PSA levels. Another study found that while prostate cancer was rare in men with low PSA at age 60-70, continued screening could identify most high-risk cases. A third study found limitations to using PSA velocity but that closely following patients despite initial negative biopsies may be important. The panel will discuss refining PSA use and interpretation to better determine which cancers require treatment.
This document summarizes several studies on prostate cancer screening and treatment that will be discussed at an American Urological Association panel. One study found that a single blood test before age 50 could predict long-term risk of prostate cancer death, with 44% of deaths occurring in men with above-average PSA levels. Another study found that while prostate cancer was rare in men with low PSA at age 60-70, continued screening could identify most high-risk cases. A third study found limitations to using PSA velocity but that closely following patients despite initial negative biopsies may be important. The panel will discuss refining PSA use and interpretation to better determine which cancers require treatment.
IOSR Journal of Pharmacy and Biological Sciences(IOSR-JPBS) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of Pharmacy and Biological Science. The journal welcomes publications of high quality papers on theoretical developments and practical applications in Pharmacy and Biological Science. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Purpose: To review the Testicular Sperm Extraction (TESE) with and without microscopy on patients with Klinefelter Syndrome (KS).
Method: A literature search was conducted for studies comparing TESE and mTESE efficacy for men with KS. The efficacy was measured by using the SRR and PR following Intracytoplasmic Sperm Injection (ICSI). The studies used were divided into two groups: large studies with 40 or more patients, and small studies with fewer than 40 patients.
Inheritance of some genetic diseases is linked to a sex chromosome. These disorders are also called sex-linked diseases. Approximately 800 various genes were identified on the X chromosome. The Y chromosome contains only 45 genes, which are predominantly connected with the determination of male sex and with spermatogenesis. For this reason, sex-linked diseases are primarily determined by the presence of abnormal variations of genes located on the X chromosome. Tt has become customary to refer to sex-linked diseases as X-linked diseases.
Clinical management of men with nonobstructive azoospermia - Azoospermia Diff...Sandro Esteves
Reproductive Andrology Workshop III
17-21 January 2016 - Kuwait City - KUWAIT
Organized by: Al Jahra Reproductive Medicine Unit - Ministry of Health
Lecture 1: Azoospermia Differential Diagnosis
Clinical management of men with nonobstructive azoospermia - Chances of Harve...Sandro Esteves
Reproductive Andrology Workshop III
17-21 January 2016 - Kuwait City - KUWAIT
Organized by: Al Jahra Reproductive Medicine Unit - Ministry of Health
Lecture 2: Chances of Harvesting Sperm in Nonobstructive Azoospermia
Panel Discussion Problems of MALE INFERTILITY & Management of Oligo Astheno T...Lifecare Centre
This document summarizes a panel discussion on male infertility and the management of oligo astheno teratospermia (OAT). The panel included urologists, IVF experts, and gynaecologists who discussed topics such as the causes of male infertility, recent WHO criteria for semen analysis, what constitutes OAT, specific and idiopathic causes of OAT, how smoking affects fertility, and the steps in evaluating a male for infertility including history, examination, semen analysis, hormone assays, ultrasound, and additional tests or procedures when indicated.
Chromosomal Abnormalities in a Male Partner Who was a Candidate for Assisted ...Apollo Hospitals
A 30-year-old man presented with 5 years of infertility. Cytogenetic analysis revealed a chromosomal translocation between chromosomes 1 and 21 in the male [46, XY t (1; 21) (q32; q22)], which was likely the cause of his infertility. The female partner showed a normal karyotype. Chromosomal abnormalities are a known cause of male infertility and genetic testing is recommended for infertile men prior to assisted reproduction techniques to identify abnormalities. The couple was counseled on their options which included assisted reproduction followed by preimplantation genetic diagnosis.
This document describes a study that developed a cost-effective screening test for detecting microdeletions on the Y chromosome associated with male infertility.
The researchers established a preliminary diagnostic screening test using a set of six primer pairs ("set-of-six") that could detect up to 95% of published Y microdeletion cases. They tested this set-of-six on 114 infertile men and found 10 microdeletions (8.8%), demonstrating the set-of-six could reliably identify microdeletions. Testing another 34 patients with just the set-of-six again found 3 microdeletions (8.8%). Their results were similar to literature frequencies, showing the set-of-six provides
NURSING ASSESSMENT – HISTORY AND PHYSICAL ASSESSMENT OF MALE REPRODUCTIVE SYS...ANILKUMAR BR
The document provides information on assessing the male reproductive system. It discusses obtaining a medical history including sexual health and symptoms. A physical exam includes a digital rectal exam to assess the prostate and testicular exam. Diagnostic tests may include a prostate-specific antigen blood test, ultrasound of the prostate, and analysis of prostate fluid or tissue if infection is suspected. Assessment of sexual function is important, and psychological evaluation may be included if sexual dysfunction is an issue.
Clinical management of infertile men with nonobstructive azoospermia: current...Sandro Esteves
This document summarizes a presentation on the clinical management of men with nonobstructive azoospermia (NOA). It discusses how NOA is one of the most challenging conditions in infertility care. For men diagnosed with NOA, tests are conducted to determine if the cause is hypogonadotropic hypogonadism or spermatogenic failure. For spermatogenic failure, sperm retrieval techniques may be used but success rates vary depending on the underlying cause. Interventions like varicocele repair before sperm retrieval may improve chances of finding sperm. The document emphasizes that biomarkers cannot definitively predict sperm retrieval outcomes for men with NOA due to spermatogenic failure.
Male infertility can be caused by many factors and requires investigation. A semen analysis examines sperm concentration, morphology, and motility according to WHO guidelines. Other tests include a physical exam, genetic testing, and potentially a testicular biopsy to diagnose causes of male infertility such as abnormalities in sperm number, shape, movement or genetic issues. Treatment depends on the underlying cause.
This study examined the role of genetic and autoimmune factors in premature ovarian failure (POF) in 78 women. The women were divided into 3 groups based on the number of CGG repeats in the FMR1 gene: less than 28 repeats, 28-36 repeats, and more than 36 repeats. The study found that women with 28-36 repeats were most strongly associated with the presence of anti-ovarian antibodies, suggesting an autoimmune cause of POF. Women with autoimmune-driven POF had significantly higher anti-Mullerian hormone levels than those without an autoimmune cause. The presence of anti-ovarian antibodies above 10 IU/mL was associated with a normal CGG repeat number and better preservation
This document provides information about the evaluation of male infertility, including two case presentations. It discusses the workup for a 25-year-old male with primary infertility for 1 year who has a small left testes and grade 1 left varicocele. It also discusses the workup for a 38-year-old male with primary infertility for 10 years who has bilateral undescended testes. The document outlines the definition, terms, epidemiology, classification, etiology, history, examination, basic and special investigations in the evaluation of male infertility.
Journal of the Formosan Medical Association (2011) 110, 695e70.docxcroysierkathey
Journal of the Formosan Medical Association (2011) 110, 695e700
Available online at www.sciencedirect.com
journal homepage: www.jfma-online.com
ORIGINAL ARTICLE
A multivariable logistic regression equation to
evaluate prostate cancer
Jhih-Cheng Wang a, Steven K. Huan a, Jinn-Rung Kuo b, Chin-Li Lu c,
Hung Lin a, Kun-Hung Shen a,*
a Division of Urology, Departments of Surgery, Chi-Mei Medical Center, Tainan, Taiwan
b Division of Neurosurgery, Department of Surgery, Chi-Mei Medical Center, Tainan, Taiwan
c Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
Received 29 January 2010; received in revised form 14 May 2010; accepted 9 August 2010
KEYWORDS
Logistic regression;
men’s health;
probability;
prostate cancer;
risk factor;
score
* Corresponding author. Division of U
Taiwan 710.
E-mail address: [email protected]
0929-6646/$ - see front matter Copyr
doi:10.1016/j.jfma.2011.09.005
Background/Purpose: A possible means of decreasing prostate cancer mortality is through
improved early detection. We attempted to create an equation to predict the likelihood of
having prostate cancer.
Methods: Between January 2005 and May 2008, patients who received prostate biopsies were
retrospective evaluated. The relationship between the possibility of prostate cancer and the
following variables were evaluated: age; serum prostate specific antigen (PSA) level, prostate
volume, numbers of prostatic biopsies, digital rectal examination (DRE) findings, and the pres-
ence of hypoechoic nodule under transrectal ultrasonography.
Results: A multivariate regression model was created to predict the possibility of having pros-
tate cancer, and a receiver-operating characteristic (ROC) curve was drawn based on the
predictive scoring equation. Using a predictive equation, P Z 1/(1 � e�x), where X Z
�4.88, þ 1.11 (if DRE positive), þ 0.75 (if hypoechoic nodule of prostate present), þ 1.27
(when 7 < PSA � 10), þ 2.02 (when 10 < PSA � 24), þ 2.28 (when 24 < PSA � 50), þ 3.93 (when
50 < PSA), þ 1.23 (when 65 < age � 75), þ 1.66 (when 75 < age), followed by ROC curve
analysis, we showed that the sensitivity was 88.5% and specificity was 79.1% in predicting
the possibility of prostate cancer.
Conclusion: Clinicians can tailor each patient’s follow-up according to the nomogram based on
this equation to increase the efficacy of evaluating for prostate cancer.
Copyright ª 2011, Elsevier Taiwan LLC & Formosan Medical Association. All rights reserved.
rology, Department of Surgery, Chi-Mei Medical Center, 901 Chung Hwa Road, Yung Kang City, Tainan,
il.com (K.-H. Shen).
ight ª 2011, Elsevier Taiwan LLC & Formosan Medical Association. All rights reserved.
mailto:[email protected]
http://dx.doi.org/10.1016/j.jfma.2011.09.005
www.sciencedirect.com/science/journal/09296646
http://www.jfma-online.com
http://dx.doi.org/10.1016/j.jfma.2011.09.005
http://dx.doi.org/10.1016/j.jfma.2011.09.005
696 J.-C. Wang et al.
Prostate cancer is the most common solid malignancy ...
Anti-Thyroid Peroxidase And Risk Of Recurrent Spontaneous AbortionCourtney Esco
This document summarizes a study that examined the relationship between anti-thyroid peroxidase (anti-TPO) antibodies and recurrent spontaneous abortion (RSA). The study tested sera from 58 women with a history of RSA and 58 healthy control subjects for anti-TPO antibodies. The study found no significant association between the presence of anti-TPO antibodies and a history of RSA, as 12 of the RSA patients (20.7%) tested positive compared to 8 of the controls (13.8%). Based on these results, the study concluded that testing for anti-TPO does not appear to be useful in evaluating patients with a history of RSA.
Poster on clinical significance of sperm morphology assessment a lekshmiAiswarya Lekshmi
Clinical Significance of Sperm Morphology Assessment
The document discusses the clinical significance of sperm morphology assessment. It notes that sperm morphology is closely correlated with sperm function and fertility outcomes like IVF success. The configuration of the acrosome, which is involved in fertilization, is a good indicator of a sperm's fertilizing ability. Abnormalities in sperm morphology like small acrosomes make sperm more susceptible to cell death. The document also discusses methods for assessing sperm morphology and various abnormalities seen in abnormal sperm.
This document summarizes several studies on prostate cancer screening and treatment that will be discussed at an American Urological Association panel. One study found that a single blood test before age 50 could predict long-term risk of prostate cancer death, with 44% of deaths occurring in men with above-average PSA levels. Another study found that while prostate cancer was rare in men with low PSA at age 60-70, continued screening could identify most high-risk cases. A third study found limitations to using PSA velocity but that closely following patients despite initial negative biopsies may be important. The panel will discuss refining PSA use and interpretation to better determine which cancers require treatment.
This document summarizes several studies on prostate cancer screening and treatment that will be discussed at an American Urological Association panel. One study found that a single blood test before age 50 could predict long-term risk of prostate cancer death, with 44% of deaths occurring in men with above-average PSA levels. Another study found that while prostate cancer was rare in men with low PSA at age 60-70, continued screening could identify most high-risk cases. A third study found limitations to using PSA velocity but that closely following patients despite initial negative biopsies may be important. The panel will discuss refining PSA use and interpretation to better determine which cancers require treatment.
IOSR Journal of Pharmacy and Biological Sciences(IOSR-JPBS) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of Pharmacy and Biological Science. The journal welcomes publications of high quality papers on theoretical developments and practical applications in Pharmacy and Biological Science. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Purpose: To review the Testicular Sperm Extraction (TESE) with and without microscopy on patients with Klinefelter Syndrome (KS).
Method: A literature search was conducted for studies comparing TESE and mTESE efficacy for men with KS. The efficacy was measured by using the SRR and PR following Intracytoplasmic Sperm Injection (ICSI). The studies used were divided into two groups: large studies with 40 or more patients, and small studies with fewer than 40 patients.
Inheritance of some genetic diseases is linked to a sex chromosome. These disorders are also called sex-linked diseases. Approximately 800 various genes were identified on the X chromosome. The Y chromosome contains only 45 genes, which are predominantly connected with the determination of male sex and with spermatogenesis. For this reason, sex-linked diseases are primarily determined by the presence of abnormal variations of genes located on the X chromosome. Tt has become customary to refer to sex-linked diseases as X-linked diseases.
Clinical management of men with nonobstructive azoospermia - Azoospermia Diff...Sandro Esteves
Reproductive Andrology Workshop III
17-21 January 2016 - Kuwait City - KUWAIT
Organized by: Al Jahra Reproductive Medicine Unit - Ministry of Health
Lecture 1: Azoospermia Differential Diagnosis
Clinical management of men with nonobstructive azoospermia - Chances of Harve...Sandro Esteves
Reproductive Andrology Workshop III
17-21 January 2016 - Kuwait City - KUWAIT
Organized by: Al Jahra Reproductive Medicine Unit - Ministry of Health
Lecture 2: Chances of Harvesting Sperm in Nonobstructive Azoospermia
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
Chapter wise All Notes of First year Basic Civil Engineering.pptxDenish Jangid
Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
This presentation was provided by Steph Pollock of The American Psychological Association’s Journals Program, and Damita Snow, of The American Society of Civil Engineers (ASCE), for the initial session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session One: 'Setting Expectations: a DEIA Primer,' was held June 6, 2024.
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Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
This document provides an overview of wound healing, its functions, stages, mechanisms, factors affecting it, and complications.
A wound is a break in the integrity of the skin or tissues, which may be associated with disruption of the structure and function.
Healing is the body’s response to injury in an attempt to restore normal structure and functions.
Healing can occur in two ways: Regeneration and Repair
There are 4 phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. This document also describes the mechanism of wound healing. Factors that affect healing include infection, uncontrolled diabetes, poor nutrition, age, anemia, the presence of foreign bodies, etc.
Complications of wound healing like infection, hyperpigmentation of scar, contractures, and keloid formation.
1. Semen PSA & AP Testing
for Sexual Assault
EBM 8A
Alya Faizah (2006567503)
Cokorda Istri Agung Dewinta Adnyani
(2006468213)
Diski Saisa (2006567693)
Josh Nathaniel J
Khaura Tsabitha ( 2006533396)
Tutor - dr. Oktavinda Safitry, Sp.F MPdKed
2. Clinical Scenario
The incidence of rape cases has increased in Brazil. These increases in numbers are more evident in metropolitan
areas such as São Paulo. According to studies conducted in Brazil, the majority of cases like this are done by relatives
and people close to the victim. This has made the crime more difficult to denounce, as only 10% of the cases are
reported to competent police authorities. Usually crimes like this uses cytological exams to confirm suspicion of
rape. But, one difficulty found in using cytological exams is that spermatozoa is not always detected. The absence of
spermatozoa in specimens collected from rape victims could happen due to several factors such as the agressor is
suffering azoospermia or has undergo a successful vasectomy. Because of these phenomena, confirming rape cases
with absence of spermatozoa has been difficult.
The same goes with this particular case of subject X. A 25 year old female, Subject X, was found dead in the streets
of São with bruses, blood stains and naked bottom. After conducting investigation and autopsy of the subject,
findings suggested that there were multiple sharp force injuries and indications of sexual assault. To confirm the
suspicions, vaginal swabs were taken from the subject to be examined with cytological exams. Results show an
absence of spermatozoa from the specimen. The report suggests the use of PSA test kit and AP test kit in addition
to conventional sperm smear for investigation as confirmatory tests to better provide specific and sensitive
information about the case.
3. According to Indonesia National Commission on Violence Against Women, In 2020, Sexual assault is the
second most common violence case to woman in Indonesia. It took 21% of all cases or about 1.731 cases.
In sexual assault crimes, the exchange of biological material, such as hair and bodily fluids, can occur if
physical contact is involved. Thus, indicating the presence of biological material in the victim's body is
essential to define the crime committed.
Currently, the gold standard of forensic analysis of sexual assault s is spermatozoa examination.
Spermatozoa examination is based on light microscopy. Finding spermatozoa in sexual assault is a difficult
task because the sperm cell could lose its characteristics of “tadpole” morphology. Spermatozoa examination
is also time-consuming which requires 5-7 hours to analyze.
Other than spermatozoa examination, Acid phosphatase (AP) and Prostate-specific antigen (PSA) test also
can be used in rape cases as been proven before. AP activity uses for screening or presumptive tests because
of its sensitivity and specificity that can be detected up to 72 hours post-coitus in the vagina. PSA test use as
confirmatory test because for up to 48 hours post-coitus it still persists at detectable levels.
In Indonesia, PSA test kits and AP test kits are still rarely used in such cases. This study aims to provide
evidence of the sensitivity, specificity, and diagnostic evidence to confirm its applicability to diagnose sexual
intercourse in sexual assault cases
Introduction
4. Clinical Question & PICO
Women Patient in
suspicion of sexual
assault
Patient
01
PSA and AP testing
Intervention
02
Sperm detection
microscopy
Comparison
03
Sensitivity, AUC,
Specificity
Outcome
04
Clinical Question
Can PSA and AP testing be used to confirm
sexual assault offenses in comparison to
sperm detection?
5. Keyword Analysis
Patient/Problem Intervention Control Outcome
Keyword Sexual assault PSA testing
AP testing
Sperm detection
microscopy
Sensitivity,
Specificity, and
AUC
Synonyms ● Sex offences,
● Rape,
● Sexual Abuse,
● Sexual violence
● Prostate
Specific
Antigen
(PSA)
● Acid
Phosphatase
(AP)
● Spermatozo
a
● Diagnosis
6. Methods - Search strategy
Pubmed | Cochrane
Medline | Scopus I EMBASE
Search Databases
Inclusion
● Studies included are systematic review of observational
epidemiological study design (Case Series, Cohort, Cross Sectional)
OR diagnostic tests
● Studies must include rape/sexual assault cases
● Studies are controlled with sperm/spermatozoa microscopic test
● Measurement outcome should be positive and negative outcome
with confirmatory test results
Exclusion
● Incomplete Data Report
● Unretrievable full text
● Non-english studies
Study selection
Type : Diagnosis
Study Design:
1. Systematic Review of
Cross Sectional Study
2. Cross Sectional Study
Level of Evidence and
Type of Study
7. Results - searching
Database name Search strategy Hits Selected
articles
MEDLINE ((sensitivity OR specificity OR detection OR diagnosis OR ROC OR AUC) AND
(acid phosphatase OR ap) OR (prostate specific antigen OR psa OR psa
test)) AND (sexual harassment OR sexual violence OR rape OR sex violence
OR sexual trauma OR sex abuse OR domestic violence )
189 8
Scopus ( ( sexual ) AND ( assault OR violent OR abuse ) ) AND ( psa OR "prostate
specific antigen" OR "prostate-specific antigen" OR "PSA test" ) OR ( "Acid
Phosphatase" OR "AP test" ) AND ( ( diagnosis OR diagnostic OR "diagnostic
value" OR specificity OR sensitivity OR "area under curve" OR auc OR
"receiver operating characteristic" OR roc ) )
186 6
8. Database
name
Search strategy Hits Selected
articles
Cochrane (Sexual assault OR Sex offences OR Rape OR Sexual Abuse OR Sexual violence)
AND (Prostate Specific Antigen OR PSA OR Acid Phosphatase OR AP) AND
(Sensitivity OR Specificity OR ROC OR AUC)
10 0
EMBASE ('sexual assault'/exp OR 'sexual assault' OR (sexual AND ('assault'/exp OR
assault)) OR 'sex offences' OR (('sex'/exp OR sex) AND offences) OR 'rape'/exp
OR rape OR 'sexual abuse'/exp OR 'sexual abuse' OR (sexual AND ('abuse'/exp OR
abuse)) OR 'sexual violence'/exp OR 'sexual violence' OR (sexual AND
('violence'/exp OR violence))) AND ('prostate specific antigen'/exp OR 'prostate
specific antigen' OR (('prostate'/exp OR prostate) AND specific AND
('antigen'/exp OR antigen)) OR psa OR 'acid phosphatase'/exp OR 'acid
phosphatase' OR (('acid'/exp OR acid) AND ('phosphatase'/exp OR phosphatase))
OR ap) AND ('sensitivity'/exp OR sensitivity OR 'specificity'/exp OR specificity OR
roc OR 'auc'/exp OR auc)
58 6
PubMed ('sexual assault'/exp OR 'sexual assault' OR (sexual AND ('assault'/exp OR
assault)) OR 'sex offences' OR (('sex'/exp OR sex) AND offences) OR 'rape'/exp
OR rape OR 'sexual abuse'/exp OR 'sexual abuse' OR (sexual AND ('abuse'/exp OR
abuse)) OR 'sexual violence'/exp OR 'sexual violence' OR (sexual AND
('violence'/exp OR violence))) AND ('prostate specific antigen'/exp OR 'prostate
specific antigen' OR (('prostate'/exp OR prostate) AND specific AND
('antigen'/exp OR antigen)) OR psa OR 'acid phosphatase'/exp OR 'acid
phosphatase' OR (('acid'/exp OR acid) AND ('phosphatase'/exp OR phosphatase))
OR ap) AND ('sensitivity'/exp OR sensitivity OR 'specificity'/exp OR specificity OR
138 4
11. Author Patient Group Outcome Key results
Peonim et al,. (2013), J Forensic Leg Med,
Thailand [1]
Cross Sectional Study
2450 vaginal swabs from raped women
was examined using 3 methods acid
phosphatase (AP) activity, prostate
specific antigen (PSA) detection, and
spermatozoa examination.
1. Sensitivity
2. Specificity
3. ROC
1. Sensitivity of AP test is 65.5%, PSA test is
80.4% and AP-PSA is 84.5%
2. Specificity of AP test is 96.4%, PSA test
is 92.3% and AP-PSA test is 91.9%
3. ROC area of AP test is 0.8091, PSA test
is 0.8639, and AP-PSA test is 0.8823. ROC
area of the AP-PSA was significantly
greater than both the tests individually.
Suttipasit., et al (2018), J Forensic Leg
Med, Thailand
Cross Sectional Study
114 female victims raped by men.
Samples from subjects are then tested
using sperm test, PSA test and Sg test.
1) determine the persistence of each
marker
2) determine their detection rates,
comparing all three over specific time
intervals
3) compare the PSA test and the Sg test
performance when the sperm test is
positive or negative over time
4) determine the order of priority for
running these screening tests
1) sperm had the longest persistence
2) sperm had the highest detection rate
3) detection rate of the Sg test was
significantly better than that of the PSA
test overall
4) the order of priority of the tests are
sperm detection, Sg test, and PSA test
Khaldi et al, (2004), J Forensic Sci
Cohort Selection
Cross Sectional Study
227 anonymous sample were divided
into four groups (normospermia,
oligospermia, azoospermia, and
controls).
the samples were then analyse and
were subjected to three fast detection
semen tests: Diff-Quick fast coloration,
AP detection, and PSA detection
Discover whether spermatozoa
concentration and the delay between
ejaculation and test influence the results
of seminal fluid fast detection tests
1. AP and PSA were not influenced by
spermatozoa concentration
2. PSA detection results remained
constant up to 72 h and were more
reliable after 48 h than those obtained
by AP detection
12. Author Patient Group Outcome Key results
Sato et al, (2006), Int J Legal Med, Japan
Cross Sectional Study
174 sexual assault case from 3 forensic
lab are tested for semenogelin and PSA
from samples of clothing, body surface,
tissue paper, bed sheet vaginal swab,
anal swab, and liquid saliva.
1. Sensitivity
2. Specificity
3. DNA profiling with detection limit and
condition effect
1. Semen dilution for 200.000 folds are
the lowest detection limit available for
plasma
2. Various condition may interfere with
PSA and Sg indication. This apply on
prostate cancer, Lung SCC, and other
adenoma.
3. Male DNA profile are also detected in
conjuction for postiive Sg signal
Stubbings et al, (1985), JFSCA, Canada
Comparative Study
Postcoital from lab were tested for GGT
and p30. In addition, 144 postcoital swab
from case material were test for p30
(PSA), spermatozoa, and acid
phosphatase .
1. Stability
2. Specificity
3. Sensitivity
1. GGT in semen for crime scene proof
have high absorbance value will provide
a low specificity of analysis
2. p30 and AP provide high sensitivity
and specificity in test >8 hours.
3. ELISA test for both p30 and AP has
better sensitivity than electrophoresis.
The results also indicate a more stable
product.
Ricci et al, (1982), Ann Emerg Med,
Lousiana
Cohort Selection Cross Sectional Study
70 gynecology patients and 11 alleged
sexual assault victims are tested for
routine vaginal and papanicolau smear
for sperm identification and acid
phosphatase analysis.
1. Sensitivity
2. Specificity
3. ACP diagnostic level (Sigma units) for
sexual assault case
1. The PPV for AP test is 91.7% while PPV for
Sperm is 58.4%
2. Sperm analysis is less sensitive and
correlated poorly with time of
intercourse
3. ACP value for intercourse within 24h is
>50 (>138 sigma units/cc), while values
>20 but <50 are correlated for
intercourse wihtin 48h
13. Author Patient Group Outcome Key results
Peonim et al, (2007), J Med Assoc Thai,
Thailand
Comparative study
100 vaginal specimens were examined
for prostate specific antigen by rapid
one step immunochromatographic
assay and compared with ELISA
1. Sensitivity
2. specificity
3. PPV
4. NPV
1. sensitivity is 85% for rapid one test kit
and 83% for ELISA
2. specificity is 85% for rapid one test kit
and 85% for ELISA
3. accuracy is 85% for rapid one test kit
and 85% for ELISA
4. positive predictive value is 89% for
rapid one test kit and 89% for ELISA
5. negative predictive value 79% for
rapid one test kit and 77% for ELISA
Kamenev et al, (1990), J For Sci, Belgium
Cohort Selection Cross Sectional Study
104 specimens (vagina samples (n=28),
anal (n=5), buccal (n=2), various
substances (n=69)) were examined for
p30 (PSA), ACP, and spermatozoa
examination
1. P30=absorbancy value
Spermatozoa=++++/+++/++/+/-
ACP=+++/++/+/-
2. Specificity
3. Sensitivity
1. Specificity and sensitivity for p30
detection is 95.6% and 94.8% (compare
to spermatozoa exam)
2. Specificity and sensitivity of ACP
detection is 90.0% and 84.4%
3. p30 EI test is more specific and more
sensitive than the ACP activity test
14. Comparison between prostate specific antigen and acid phosphatase for
detection of semen in vaginal swabs from raped women (Peonim et al, 2013)
1. Was there an independent, blind comparison with a
reference (“gold”) standard of diagnosis?
YES
• The laboratory didn’t know the situation except the
history of vaginal penetration
• Every swab was tested by 3 methods: AP activity, PSA
detection, and spermatozoa examination (GS)
2. Was the diagnostic test evaluated in an appropriate
spectrum of patients (like those in whom it would be
used in practice)?
YES
● The Patient Component (Patient in suspect of rape) are
all assessed in this case with no exclusion for severe or
mild sexual assault case.
3. Was the reference standard applied regardless of the
diagnostic test result?
YES
● Every swab was tested by 3 methods: AP activity, PSA
detection, and spermatozoa examination (GS)
1
15. Diagnostic Test for PSA and AP Rapid in comparison to Microscopy
AP
• Sensitivity = a/(a+c) = 65.5%
• Specificity = d/(b+d) = 96,4%
• Positive Predictive Value = a/(a+b) = 85.6%
• Negative Predictive Value = d/(c+d) = 89.4%
• Likelihood Ratio for a positive test result =
LR+= sens/(1-spec)= 18,19
• Likelihood Ratio for a negative test result= LR-
= (1-sens)/spec = 0,357
• Pre-test Probability (prevalence) =
(a+c)/(a+b+c+d) = 0,25=25%
• Pre-test-odds = prevalence/(1-prevalence) =
0,33
• Post-test odds = Pre-test odds x Likelihood
Ratio =
• Post Test Odds + = 6
• Post Test Odds - = 0,12
• Post-test Probability = Post-test
odds/(Post-test odds+1) =
• Post Test Probs + = 0,86
• Post Test Probs - = 0,1
16. Diagnostic Test for PSA and AP Rapid in comparison to Microscopy
PSA
• Sensitivity = a/(a+c) = 80,4%
• Specificity = d/(b+d) = 92,3%
• Positive Predictive Value = a/(a+b) = 77,6%
• Negative Predictive Value = d/(c+d) = 93,5%
• Likelihood Ratio for a positive test result =
LR+= sens/(1-spec)= 10,44
• Likelihood Ratio for a negative test result= LR-
= (1-sens)/spec = 0,21
• Pre-test Probability (prevalence) =
(a+c)/(a+b+c+d) = 0,25=25%
• Pre-test-odds = prevalence/(1-prevalence) =
0,33
• Post-test odds = Pre-test odds x Likelihood
Ratio =
• Post Test Odds + = 3,44
• Post Test Odds - = 0,07
• Post-test Probability = Post-test
odds/(Post-test odds+1) =
• Post Test Probs + = 0,77
• Post Test Probs - = 0,07
17. Diagnostic Test for PSA and AP Rapid in comparison to Microscopy
Combined
• Sensitivity = a/(a+c) = 84,5%
• Specificity = d/(b+d) = 91,9%
• Positive Predictive Value = a/(a+b) = 77,5%
• Negative Predictive Value = d/(c+d) = 94,7%
• Likelihood Ratio for a positive test result =
LR+= sens/(1-spec)= 10,43
• Likelihood Ratio for a negative test result= LR-
= (1-sens)/spec = 0,17
• Pre-test Probability (prevalence) =
(a+c)/(a+b+c+d) = 0,25=25%
• Pre-test-odds = prevalence/(1-prevalence) =
0,33
• Post-test odds = Pre-test odds x Likelihood
Ratio =
• Post Test Odds + = 3,44
• Post Test Odds - = 0,06
• Post-test Probability = Post-test
odds/(Post-test odds+1) =
• Post Test Probs + = 0,77
• Post Test Probs - = 0,06
18. Applicability
1. Is the diagnostic test available, affordable, accurate, and precise in your setting?
a. PSA Immunochromatography are widely available in Indonesia and widely use in other
clinical procedure
b. AP test is available in indonesia, however the affordable access is quite debatable.
c. The accuracy and precision of the test kit available in Indonesia must be assessed further
with studies in Indonesia or/and the same kit that is available
2. Can you generate a clinically sensible estimate of your patient’s pre-test probability (from
practice data, from personal experience, from the report itself, or from clinical speculation)
a. Clinical sensible estimate from the pre-test probability are generated from the incidence rate
in Indonesia (4.2 case per 100.000 population) while cases in the study has a relatively small
population of test in comparison to the prevalence.
3. Will the resulting post-test probabilities affect your management and help your patient? (Could
it move you across a test-treatment threshold?; Would your patient be a willing partner in
carrying it out?)
a. Yes, because AP increase the diagnostic strength from 25% to 86%, PSA 25% to 77%,
combined 25 to 77%
b.
4. Would the consequences of the test help your patient?
a. Yes, the test would help patients with oligospermia and azoospermia causes.
Conclusion: Yes, this study is applicable to the patient.
19. Detection of prostate specific antigen and semenogelin in specimens from
female rape victims (Suttipasit P,)
1. Was there an independent, blind comparison with a
reference (“gold”) standard of diagnosis?
Not mention/unclear
3. Was the reference standard applied regardless of the
diagnostic test result?
YES
● Every specimen was tested by sperm detection and PSA
test kit
2. Was the diagnostic test evaluated in an appropriate spectrum of patients (like those in whom it would be used in practice)?
YES
● The Patient Component (Patient in suspect of rape) are all assessed; with 6 criteria
○ Women examined at Siriraj Hospital
○ Case circumstances indicating that sexual assault may have occurred (i.e. non-consensual sexual contact
○ Women having physical wounds on the body or genitalia, or substantial evidence that these women were under duress, or under
the influence conscious-altering drugs (i.e alcohol, ketamine, etc.). Under Thai law, the definition of duress for non-consensual
sexual contact may occur under what is considered “reasonable cause/s” and includes use of weapons to coerce, use of physical
force (bodily), other forms of coercion such as blackmail (threats) and other reasonable causes as defined by the court/law
enforcement, even if there is not clear evidence of physical injuries to the genitalia or other parts of the body. Detection of
physical injury by police or doctors is just one criteria of many under this definition
○ The interval between assault and evidence collection was less than 3 weeks
○ Women had no other sexual intercourse in the intervening 3 weeks, either consensual or not, and no sexual intercourse in the 2
weeks before the alleged rape occurred
○ No evidence of condom use during the assault.
2
20. Diagnostic Test for PSA and AP Rapid in comparison to Microscopy
PSA
• Sensitivity = a/(a+c) = 32/76 = 42%
• Specificity = d/(b+d) = 92%
• Positive Predictive Value = a/(a+b) = 32/33 = 97%
• Negative Predictive Value = d/(c+d) =12/56=
21,4%
• Likelihood Ratio for a positive test result = LR+=
sens/(1-spec)= 5,25
• Likelihood Ratio for a negative test result= LR- =
(1-sens)/spec = 0,6
• Pre-test Probability (prevalence) = (a+c)/(a+b+c+d)
= 76/89 = 85%
• Pre-test-odds = prevalence/(1-prevalence) = 5,67
• Post-test odds = Pre-test odds x Likelihood Ratio =
• Post Test Odds + = 29,77
• Post Test Odds - = 3,4
• Post-test Probability = Post-test odds/(Post-test
odds+1) =
• Post Test Probs + = 0,97
• Post Test Probs - = 0,77
Positive
Sperm
Negative
sperm
Positive PSA 32 1 33
Negative
PSA
44 12 56
76 13 89
21. Applicability
1. Is the diagnostic test available, affordable, accurate, and precise in your setting?
a. PSA Immunochromatography are widely available in Indonesia and widely use in other
clinical procedure
b. AP test is available in indonesia, however the affordable access is quite debatable.
c. The accuracy and precision of the test kit available in Indonesia must be assessed further
with studies in Indonesia or/and the same kit that is available
2. Can you generate a clinically sensible estimate of your patient’s pre-test probability (from
practice data, from personal experience, from the report itself, or from clinical speculation)
a. Clinical sensible estimate from the pre-test probability are generated from the incidence rate
in Indonesia (4.2 case per 100.000 population) while cases in the study has a relatively small
population of test in comparison to the prevalence.
3. Will the resulting post-test probabilities affect your management and help your patient? (Could
it move you across a test-treatment threshold?; Would your patient be a willing partner in
carrying it out?)
a. Yes, because it increase the diagnostic strength from 85% to 97%.
4. Would the consequences of the test help your patient?
a. Yes, the test would help patients with oligospermia and azoospermia causes.
Conclusion: Yes, this study is applicable to the patient.
22. Comparable between Rapid One Step Immunochromatographic Assay and
ELISA in the Detection of Prostate Specific Antigen in Vaginal Specimens of
Raped Women (Peonim et al, 2007)
1. Was there an independent, blind comparison with a
reference (“gold”) standard of diagnosis?
YES
● All test are run by the laboratory (blinded and
independent to the clinician and patient)
● Gold Standard are used (Sperm Microscopic Exam)
2. Was the diagnostic test evaluated in an appropriate
spectrum of patients (like those in whom it would be
used in practice)?
YES
● The Patient Component (Patient in suspect of rape) are
all assessed in this case with no exclusion for severe or
mild sexual assault case.
● The patient that is tested are from a spectrum of cases
3. Was the reference standard applied regardless of the
diagnostic test result?
YES
● All specimen are being tested for the
Immunochromatographic Assay, ELISA, and the
Microscopic Sperm Examination
● All 100 specimen are being picked randomly to be used
as sample in this study
3
23. Diagnostic Test for PSA Rapid in comparison to Microscopy
Sensitivity = a/(a+c) = 85%
Specificity = d/(b+d) = 85%
Likelihood Ratio for a positive test result =
LR+= sens/(1-spec) = 5.67
Likelihood Ratio for a negative test
result=LR-=(1-sens)/spec = 0.18
Positive Predictive Value = a/(a+b) =
89.47%
Negative Predictive Value = d/(c+d) =
79.10%
Pre-test Probability (prevalence) = (a+c)/(a+b+c+d) = 0.60
Pre-test-odds = prevalence/(1-prevalence) = 1.5
Post-test odds = Pre-test odds x Likelihood Ratio =
● Post Test Odds + = 8.51
● Post Test Odds - = 0.27
Post-test Probability = Post-test odds/(Post-test odds+1) =
● Post Test Probs + = 0.891
● Post Test Probs - = 0.212
24. Diagnostic Test for PSA ELISA in comparison to Microscopy
Sensitivity = a/(a+c) = 83.33%
Specificity = d/(b+d) = 85.00%
Likelihood Ratio for a positive test result =
LR+ = sens/(1-spec) = 5.55
Likelihood Ratio for a negative test result=
LR- = (1-sens)/spec = 0.196
Positive Predictive Value = a/(a+b) =
89.29%
Negative Predictive Value = d/(c+d) =
77.27%
Pre-test Probability (prevalence) = (a+c)/(a+b+c+d) =
0.60
Pre-test-odds = prevalence/(1-prevalence) = 1.5
Post-test odds = Pre-test odds x Likelihood Ratio =
● Post Test Odds + = 8.325
● Post Test Odds - = 0.294
Post-test Probability = Post-test odds/(Post-test odds +
1) =
● Post Test Probs + = 0.893
● Post Test Probs - = 0.227
25. Applicability
1. Is the diagnostic test available, affordable, accurate, and precise in your setting?
a. PSA Immunochromatography and ELISA are widely available in Indonesia and widely use in
other clinical procedure. Its affordability however must be assessed further on in
comparison to microscopic examination that is already being used in many case.
b. The accuracy and precision of the test kit available in Indonesia must be assessed further
with studies in Indonesia or/and the same kit that is available
2. Can you generate a clinically sensible estimate of your patient’s pre-test probability (from
practice data, from personal experience, from the report itself, or from clinical speculation)
a. Clinical sensible estimate from the pre-test probability are generated from the incidence rate
in Indonesia (4.2 case per 100.000 population) while cases in the study has a relatively small
population of test in comparison to the prevalence.
b. Indonesia’s prevalence of sexual assault is comparable to cases in the studies country.
3. Will the resulting post-test probabilities affect your management and help your patient? (Could
it move you across a test-treatment threshold?; Would your patient be a willing partner in
carrying it out?)
a. Yes, because it increase the diagnostic strength from 60% to 80% and its LR indicate a
moderate improvement of diagnosis. Its use in the procedure also does not differ making its
use more easily adopted.
4. Would the consequences of the test help your patient?
a. Yes, the test would help patients with oligospermia and azoospermia causes. Thus, the PSA
test help its diagnosis without physical proof of sperm in swabs.
Conclusion: Yes, this study is applicable to the patient.
26. Detection of p30 antigen in sexual assault case material
(Kamenev et al., 1990)
1. Was there an independent, blind comparison with a
reference (“gold”) standard of diagnosis?
UNCLEAR
● All test are tested with Spermatozoa Staining
Microscopy and p30 (AP) immunoassay
● No description of blinding in each test are presented.
Thus, there is unclear evidence of blind independent
comparison
2. Was the diagnostic test evaluated in an appropriate
spectrum of patients (like those in whom it would be
used in practice)?
YES
● Al cases 85 exhibits from 52 forensic cases are used to
separate all case and from all samples (anal, vaginal, and
buccal in specific cases
● All of the spectrum data are present in practical cases
3. Was the reference standard applied regardless of the
diagnostic test result?
YES
● Both diagnostic test are run parallel to ensure the gold
standard treatment is still being used to diagnose the
patient condition
● p30 Immunoassay, EIA, and spermatozoa are used in the
first 24 hours to ensure the standard procedure still
applies.
4
27. Diagnostic Test for ACP in comparison to Microscopy
Sensitivity = a/(a+c) = 92.68%
Specificity = d/(b+d) = 79.41%
Likelihood Ratio for a positive test result =
LR+= sens/(1-spec)= 4.50
Likelihood Ratio for a negative test result=
LR- = (1-sens)/spec = 0.09
Positive Predictive Value = a/(a+b) =
84.44%
Negative Predictive Value = d/(c+d) =
90.00%
Pre-test Probability (prevalence) =
(a+c)/(a+b+c+d) = 0.5467
Pre-test-odds = prevalence/(1-prevalence) = 1.2
Post-test odds = Pre-test odds x Likelihood Ratio
● Post Test Odds + = 5.43
● Post Test Odds - = 0.11
Post-test Probability = Post-test odds/(Post-test
odds + 1)
● Post Test Prob + = 0.844
● Post Test Prob - = 0.097
28. Applicability
1. Is the diagnostic test available, affordable, accurate, and precise in your setting?
a. While ACP is available in Indonesia, its affordability is debatable in many areas
b. Its accuracy and precision in this case provide a better implementation in readily labs around
Indonesia. Its accuracy is also dependable in the laborant skill.
2. Can you generate a clinically sensible estimate of your patient’s pre-test probability (from
practice data, from personal experience, from the report itself, or from clinical speculation)
a. Clinical sensible estimate from the pre-test probability are generated from the incidence rate
in Indonesia (4.2 case per 100.000 population) while cases in the study has a relatively small
population of test in comparison to the prevalence.
b. Indonesia’s prevalence of sexual assault is comparable to cases in the studies country.
3. Will the resulting post-test probabilities affect your management and help your patient? (Could
it move you across a test-treatment threshold?; Would your patient be a willing partner in
carrying it out?)
a. Yes, because it increase the diagnostic strength. Yet, its LR indicate weak improvement with
score <5.
4. Would the consequences of the test help your patient?
a. Yes, the test would help patients with oligospermia and azoospermia causes as a first line
test before PSA or other DNA testing that is more sophisticated.
Conclusion: Yes, this study is applicable to the patient.
29. Evaluation of three rapid detection methods for the
forensic identification of seminal fluid in rape cases.
Journal of forensic sciences [Khalid (2004)]
VALIDITY
1. Was there an independent, blind comparison with a reference (“gold”) standard of diagnosis?
Yes.This was a prospective analytical study performed blind in vitro on anonymous sperm samples
collected at the in vitro fecundation laboratory at Pellegrin Hospital Bordeaux and having already
undergone a spermocytogramme. gold standard are used
2. Was the diagnostic test evaluated in an appropriate spectrum of patients (like those in whom it would
be used in practice)?
yes
3. Was the reference standard applied regardless of the diagnostic test result?
Yes, all samples were tested by cytology, PSA, AP and sperm detection
5
30. IMPORTANCE
1. Sensitivity = 67,5%
2. Specificity = 100%
3. Likelihood Ratio for a positive test
result = 0,68
4. Likelihood Ratio for a negative test
result= 0,325
5. Positive Predictive Value = 100%
6. Negative Predictive Value = 47%
7. Pre-test Probability (prevalence)
=0,775
8. Pre-test-odds = 3,34
9. Post-test odds + = 2,27
10. Post-test odds - = 1,08
11. Post-test Probability + = 0,7
12. Post-test Probability - = 0,51
Diagnostic Test for cytology in
comparison to Microscopy
31. IMPORTANCE
1. Sensitivity = 96%
2. Specificity = 98%
3. Likelihood Ratio for a positive test
result = 0,94
4. Likelihood Ratio for a negative test
result= 0,04
5. Positive Predictive Value = 99,4
6. Negative Predictive Value = 87,7
7. Pre-test Probability (prevalence) =
0,77
8. Pre-test-odds = 3,34
9. post-test odds += 3,14
10. Post-test odds - =0,13
11. Post-test Probability + = 0,75
12. Post-test Probability - = 0,11
Diagnostic Test for AP in comparison
to Microscopy
32. IMPORTANCE
1. Sensitivity = 99,4%
2. Specificity = 98
3. Likelihood Ratio for a positive test
result = 0,97
4. Likelihood Ratio for a negative test
result= 0,006
5. Positive Predictive Value = 99,4
6. Negative Predictive Value = 98
7. Pre-test Probability (prevalence) =
0,77 = 77%
8. Pre-test-odds = 3,34
9. Post-test odds + = 3,24
10. Post-test odds - =0,02
11. Post-test Probability + = 0,76
12. Post-test Probability - = 0,02
Diagnostic Test for PSA in
comparison to Microscopy
33. Applicability
1. Is the diagnostic test available, affordable, accurate, and precise in your setting?
a. PSA Immunochromatography are widely available in Indonesia and widely use in other
clinical procedure. AP test is available in indonesia, however the affordable access is quite
debatable.
b. The accuracy and precision of the test kit available in Indonesia must be assessed further
with studies in Indonesia or/and the same kit that is available
2. Can you generate a clinically sensible estimate of your patient’s pre-test probability (from
practice data, from personal experience, from the report itself, or from clinical speculation)
Clinical sensible estimate from the pre-test probability
3. Will the resulting post-test probabilities affect your management and help your patient? (Could
it move you across a test-treatment threshold?; Would your patient be a willing partner in
carrying it out?)
yes, because AP increase the diagnostic strength from 77% to 99,4 %, PSA 77% to 99,4%,
cytology 77% to 100%
4. Would the consequences of the test help your patient?
yes
Conclusion: yes, this study is applicable for our patient
34. Applicability of Nanotrap Sg as a semen detection kit
before male-specific DNA profiling in sexual assaults
[Sato 2007)]
VALIDITY
1. Was there an independent, blind comparison with a reference (“gold”) standard of diagnosis?
Yes. Spermatozoa microscopically were examined by simple staining with fuchsin acid and methylene blue.
2. Was the diagnostic test evaluated in an appropriate spectrum of patients (like those in whom it would
be used in practice)?
Yes. Forensic casework samples (174 samples) including soiled and stained clothing, victims’ body surfaces,
tissue paper samples, carpet and bed sheet samples, vaginal swabs, anal swabs, and liquid saliva samples
provided from the Scientific Crime Laboratory
3. Was the reference standard applied regardless of the diagnostic test result?
Yes, all samples were tested by PSA kit.
Sg and PSA were detected by Nanotrap Sg (Rohto Pharm, Osaka, Japan) and Seratec PSA Semiquant
(Seratec Diagnostica, Gottingen, Germany) or the PSA-Check 1 (VEDALAB, Alencon, France) kits,
respectively
7
Sato et al., 2007
35. Diagnostic Test for AP Rapid in comparison to Microscopy
• Sensitivity = a/(a+c) = 100%
• Specificity = d/(b+d) = 67.2%
• Likelihood Ratio for a positive test
result = LR+=sens/(1-spec)= 1/32.8 =
0.03
• Likelihood Ratio for a negative test
result=LR-=(1-sens)/spec= 0/0.67 = 0
• Positive Predictive Value = a/(a+b) =
57/133 = 0.43
• Negative Predictive Value = d/(c+d) =
41/41 = 1
● Pre-test Probability (prevalence) =
(a+c)/(a+b+c+d) = 113/174 = 0.65
• Pre-test-odds = prevalence/(1-prevalence) =
0.65/0.35 = 1.85
• Post-test odds = Pre-test odds x Likelihood Ratio
=
• Post Test Odds + = 5.55
• Post Test Odds - = 0
• Post-test Probability = Post-test odds/(Post-test
odds+1) =
• Post Test Probs + = 5.55/6.55 = 0.83
• Post Test Probs - = 0
True Diagnosis False Diagnosis
AP + 57 20 133
AP - 0 41 41
113 61 174
Sato et al., 2007
36. Applicability
1. Is the diagnostic test available, affordable, accurate, and precise in your setting?
a. ACP is available in indonesia, however the affordable access is quite debatable. Moreover
the accuracy and preciseness of this test according to the study cannot be confirmed
because the importance aspect of this study is deemed not so because of low population
usage.
2. Can you generate a clinically sensible estimate of your patient’s pre-test probability (from
practice data, from personal experience, from the report itself, or from clinical speculation)
a. Yes
3. Will the resulting post-test probabilities affect your management and help your patient? (Could
it move you across a test-treatment threshold?; Would your patient be a willing partner in
carrying it out?)
a. Yes
4. Would the consequences of the test help your patient?
a. Yes
Conclusion: Yes
Sato et al., 2007
37. An Evaluation of Gamma-Glutamyl Transpeptidase
(GGT) and p30 Determinations for the Identification
of Semen on Postcoital Vaginal Swabs [Stubbing, 1985]
VALIDITY
1. Was there an independent, blind comparison with a reference (“gold”) standard of diagnosis?
Yes. Ninety-four men contributed liquid semen samples. Of these samples, 54 contained normal numbers
of spermatozoa, 20 were oligospermic, 8 were azoospermic, and 12 were from vaseetomized individuals.
One donor submitted six successive ejaculates. Liquid semen from one donor was mixed with stains of
saliva, urine, feces, and perspiration from another donor and incubated for 48 h in a moisture chamber at
37~ Seminal stains from five donors were aged for ten weeks at 4, 22, and 37
2. Was the diagnostic test evaluated in an appropriate spectrum of patients (like those in whom it would
be used in practice)?
Yes. Vaginal swabs from 144 cases of alleged sexual assault were examined.
3. Was the reference standard applied regardless of the diagnostic test result?
Yes, all samples were tested by PSA and p30 (AP) kit.
VALIDITY: YES
8
Stubbing et al., 1985
38. Diagnostic Test for PSA Rapid in comparison to Microscopy
• Sensitivity = a/(a+c) = 62.5%
• Specificity = d/(b+d) = 92.8%
• Likelihood Ratio for a positive test
result = LR+=sens/(1-spec)= 8,68
• Likelihood Ratio for a negative test
result=LR-=(1-sens)/spec= 0.4
• Positive Predictive Value = a/(a+b)
= 0.97
• Negative Predictive Value = d/(c+d)
= 0.59
● Pre-test Probability (prevalence) = (a+c)/(a+b+c+d) =
0.67
● Pre-test-odds = prevalence/(1-prevalence) = 0.67/0.33 =
2.03
● Post-test odds = Pre-test odds x Likelihood Ratio =
○ Post Test Odds + = 2.03*8.68 = 17.62
○ Post Test Odds - = 2.03*0.4 =0.81
● Post-test Probability = Post-test odds/(Post-test odds+1)
=
○ Post Test Probs + = 17.62/18.62 = 0.95
○ Post Test Probs - = 0.81/1.81 = 0.45
True Diagnosis False Diagnosis
True PSA 60 2 62
False PSA 36 46 82
96 48 144
Stubbing et al., 1985
39. Diagnostic Test for AP Rapid in comparison to Microscopy
• Sensitivity = a/(a+c) = 69.8%
• Specificity = d/(b+d) = 97.9%
• Likelihood Ratio for a positive test
result = LR+=sens/(1-spec)=
0.698/0.021 = 33.23
• Likelihood Ratio for a negative test
result=LR-=(1-sens)/spec= 0.302/0.979
= 0.308
• Positive Predictive Value = a/(a+b) =
0.85
• Negative Predictive Value = d/(c+d) = 1
● Pre-test Probability (prevalence) =
(a+c)/(a+b+c+d) = 114/144 = 0.79
• Pre-test-odds = prevalence/(1-prevalence) =
0.79/0.21 = 3.77
• Post-test odds = Pre-test odds x Likelihood Ratio
=
• Post Test Odds + = 3.77*33.23 = 125.27
• Post Test Odds - = 3.77*0.308 = 1.16
• Post-test Probability = Post-test odds/(Post-test
odds+1) =
• Post Test Probs + = 125.27/126.27 = 0.99
• Post Test Probs - = 1.16/2.16 = 0.54
True Diagnosis False Diagnosis
True AP 67 1 68
False AP 29 47 76
96 48 144
Stubbing et al., 1985
40. Applicability
1. Is the diagnostic test available, affordable, accurate, and precise in your setting?
a. ACP is available in indonesia, however the affordable access is quite debatable. Moreover
the accuracy and preciseness of this test according to the study cannot be confirmed
because the importance aspect of this study is deemed not so because of low population
usage.
2. Can you generate a clinically sensible estimate of your patient’s pre-test probability (from
practice data, from personal experience, from the report itself, or from clinical speculation)
a. Clinical sensible estimate from the pre-test probability
3. Will the resulting post-test probabilities affect your management and help your patient? (Could
it move you across a test-treatment threshold?; Would your patient be a willing partner in
carrying it out?)
a. Yes
4. Would the consequences of the test help your patient?
a. Yes
APPLICABILITY: YES
Stubbing et al., 1985
41. Prostatic Acid Phosphatase and Sperm in the
Post-Coital Vagina [Ricci L.R. (1982)]
VALIDITY
1. Was there an independent, blind comparison with a reference (“gold”) standard of diagnosis?
Unclear, The study aims to compare the sensitivity of detecting recent coitus in acid phosphatase and sperm
(through pap smear) detection. Because the gold standard of detecting coitus is through microscopic sperm
detection, the answer of this question is yes there is a gold standard comparison. As for the blinding element of
the comparison, the paper did not specify whether or not blinding method has been applied.
2. Was the diagnostic test evaluated in an appropriate spectrum of patients (like those in whom it would
be used in practice)?
Yes, the spectrum of patients in this study range from gynaecology patient and alleged sexual assault patient.
3. Was the reference standard applied regardless of the diagnostic test result?
Yes, Both the AP detection and sperm detection using pap smear is carried out in all patients
Conclusion: yes this study is still valid
9
42. IMPORTANCE
1. Sensitivity = 7/7 = 100%
2. Specificity = 4/5 = 80%
3. Likelihood Ratio for a positive test
result = 1/(1-⅘) = 1/(⅕) = 5
4. Likelihood Ratio for a negative test
result= (1-1)/(⅘) = 0
5. Positive Predictive Value = 7/11 =
63,64%
6. Negative Predictive Value = 0/1 =
0%
7. Pre-test Probability (prevalence) =
7/12 = 58,3%
8. Pre-test-odds = (7/12)/(5/12) = 1,4
9. Post-test odds = 1,4 x 5 = 7
10. Post-test Probability = ⅞ = 0,875
Microscopic
Present Absent Total
ACP Test Positive 7 4 11
Negative 0 1 1
Total 7 5 12
“12 cases ~ 24 hours, 11 were acid phosphatase-positive
(91.7%) while seven were sperm-positive (58.4%)]”
conclusion: this study has no importance because of low
population
43. Applicability
1. Is the diagnostic test available, affordable, accurate, and precise in your setting?
a. ACP is available in indonesia, however the affordable access is quite debatable. Moreover
the accuracy and preciseness of this test according to the study cannot be confirmed
because the importance aspect of this study is deemed not so because of low population
usage.
2. Can you generate a clinically sensible estimate of your patient’s pre-test probability (from
practice data, from personal experience, from the report itself, or from clinical speculation)
a. no because there isn't much data that's provided in the case.
3. Will the resulting post-test probabilities affect your management and help your patient? (Could
it move you across a test-treatment threshold?; Would your patient be a willing partner in
carrying it out?)
a. there isn't much data that's provided in the case.
4. Would the consequences of the test help your patient?
a. Based on the lack of importance aspect of this study, no it will not help our patient.
Conclusion: No, this study is not applicable for our patient
44. Critical Appraisal Summary
No Paper Appraised Validity Importance Applicability Notes
1. Peonim et al, 2013 +
2. Suttipasit et al, 2018 Blinding Unclear
3. Khaldi et al, 2004 +
4. Peonim et al, 2007 +
5.. Kamenev et al, 1990 Blinding Unclear
6.. Sato et al, 2007 +
7.. Stubbings et al, 1985 +
9.. Ricci et al, 1982 Blinding Unclear Low study population may cause
high level of error and data validity
45. Discussion Points
1. Effect Measures
● Its specificity in detecting sexual assault
case is sufficient
● Its sensitivity are varied with its
preparation and time used after the
alleged sexual assault
● The effect of PSA and AP testing is also
dependable on the site from it is
detected (Vaginal, Buccal, Skin, Clothes,
or Other Places)
2. Quality of Studies
● All studies are excellent in quality
● Study by Rucci et al, 1982 must not be
used because of its low population used.
● The standard use of test is already set
using the established procedure
3. Advantages and Disadvantages of
PSA and AP Test
● Advantage: Applicable in many
use case and easily used.
● Disadvantage: Lack of empirical
gold standard detection
4. Applicability in Indonesia
● It is applicable since the two test
is already widely available in
Indonesia
● Its pricing must be considered in
comparison to sperm detection
46. strength and limitations
1. Strength
- This is the first study on PSAAP testing a confirmatory test for
forensic sexual assault case in comparasion to direct sperm
microscopy in Indonesia.
- PSA AP are useful, quick and simple test for forensic sexual assault
case. So, PSA AP can be used clinically
2. Limitations
- The accuracy and precision of the test kit available in Indonesia must be
assessed further with studies in Indonesia or/and the same kit that is
available.
- This paper had excluded papers not english. but it would be better if we
included the as well.
47. Conclusion
In case of oligospermia or aspermia, the vaginal swab screening of PSA
and AP testing is applicable for alleged victims of sexual abuse. Other
use with PSA and AP testing in collaboration with sperm analysis can
help provide proof on sexual abuse case.
48. 1. Perempuan dalam himpitan pandemi: lonjakan kekerasan seksual, kekerasan siber, perkawinan
anak, dan keterbatasan penanganan di tengah Covid-19. Jakarta: Komisi Nasional Anti Kekerasan
Terhadap Perempuan; 2021 Mar 5.
2. Peonim V, Worasuwannarak W, Sujirachato K, Teerakamchai S, Srisont S, Udnoon J, Chudoung U.
Comparison between prostate specific antigen and acid phosphatase for detection of semen in
vaginal swabs from raped women. J Forensic Leg Med. 2013 Aug;20(6):578-81.
3. Talthip J, Chirachariyavej T, Peonim AV, Atamasirikul K, Teerakamchai S. An autopsy report case
of rape victim by the application of PSA test kit as a new innovation for sexual assault
investigation in Thailand. J Med Assoc Thai. 2007 Feb;90(2):348-51.
Referensi