Growth phenotypes of very low birth weight infants for prediction of neonatal outcomes from a Brazilian cohort: comparison with INTERGROWTH

Abstract Objective: To assess the predictive value of selected growth phenotypes for neonatal morbidity and mortality in preterm infants < 30 weeks and to compare them with INTERGROWTH-21st (IG21). Methods: Retrospective analysis of data from the Brazilian Neonatal Research Network (BNRN) database for very low birth weight (VLBW) at 20 public tertiary-care university hospitals. Outcome: the composite neonatal morbidity and mortality (CNMM) consisted of in-hospital death, oxygen use at 36 weeks, intraventricular hemorrhage grade 3 or 4, and Bell stage 2 or 3 necrotizing enterocolitis. Selected growth phenotypes: small-for-gestational-age (SGA) defined as being < 3rd (SGA3) or 10th (SGA10) percentiles of BW, and large-for-gestational-age (LGA) as being > 97th percentile of BW. Stunting as being < 3rd percentile of the length and wasting as being < 3rd percentile of BMI. Single and multiple log-binomial regression models were fitted to estimate the relative risks of CNMM, comparing them to IG21. Results: 4,072 infants were included. The adjusted relative risks of CNMM associated with selected growth phenotypes were (BNRN/IG21): 1.45 (0.92-2.31)/1.60 (1.27-2.02) for SGA; 0.90 (0.55-1.47)/1.05 (0.55-1.99) for LGA; 1.65 (1.08-2.51)/1.58 (1.28-1.96) for stunting; and 1.48 (1.02-2.17) for wasting. Agreement between the two references was variable. The growth phenotypes had good specificity (>95%) and positive predictive value (70-90%), with poor sensitivity and low negative predictive value. Conclusion: The BNRN phenotypes at birth differed markedly from the IG21 standard and showed poor accuracy in predicting adverse neonatal outcomes.

Upper airway angle and glottic height: a prospective cohort to evaluate two new features for airway prediction

Abstract Background: Predicting difficult direct laryngoscopies remains challenging and improvements are needed in preoperative airway assessment. We conceived two new tests (the upper airway angle and the glottic height) and assessed their association with difficult direct laryngoscopies as well as their predictive performance. Methods: A prospective cohort was conducted with 211 patients undergoing general anesthesia for surgical procedures. We assessed the association between difficult laryngoscopies and modified Mallampati Test (MMT), Upper Lip Bite Test (ULBT), Mandibular Length (ML), Neck Circumference (NC), Mouth Opening (MO), Sternomental Distance (SMD), Thyromental Distance (TMD), Upper Airway Angle (UAA), and Glottic Height (GH). We also estimated their predictive values. Results: Difficult laryngoscopy was presented by 12 patients (5.7%). Six tests were significantly associated with difficult laryngoscopies and their area under the ROC curve, and 95% CIs were as follows: UAA = 88.82 (81.86-95.78); GH = 86.43 (72.67-100); ML = 83.75 (72.77-94.74); NC = 79.17 (64.98-93.36); MO = 65.58 (45.13-86.02); and MMT = 77.89 (68.37-87.41). Conclusion: We have found two new features (the UAA and the GH) to be significantly associated with the occurrence of difficult direct laryngoscopies. They also presented the best predictive performance amongst the nine evaluated tests in our cohort of patients. We cannot ensure, however, these tests to be superior to other regularly used bedside tests based on our estimated 95% CIs.

Establish deferral criterion for HIV serological testing in blood donors / 中国输血杂志

【Objective】 To establish deferral criterion of HIV ELISA (enzyme-linked immunosorbent assay) and electrochemiluminescence immunoassay(ECLIA) by using receiver operating characteristic curve(ROC) method to screen HIV reactive blood donors suitable for entering the re-entry process and improve the management efficiency of reactive blood donors. 【Methods】 The test results of 92 001 blood donors from February to September 2019 were analyzed, and 177 reactive samples were screened by conventional screening mode (twice ELISA and once nucleic acid), supplemented with electrochemiluminescence immunoassay assay (ECLIA), and confirmed by Western blotting (WB). Screening reactive samples were divided into three groups: group A was both serological and nucleic acid reactivity, group B was only serological reactive, and group C was only nucleic acid reactivity. Its efficacy in blood donor classification was assessed by drawing ROC curves with 99% specific corresponding S/CO low values as the deferral criterion of the corresponding serological method. 【Results】 1) A total of 177 HIV reactive samples were detected in conventional mode, including 34 in group A, 142 in Group B and 1 in Group C. The positive predictive value (PPV) was 100%, 0.75% and 100%, respectively. ECLIA detection mode (once ECLIA and once NAT), a total of 67 HIV reactive samples including 34 in group A, 32 in group B and 1 in group C, with positive predictive values of 100%, 3.7% and 100%, respectively.2) The HIV test results showed diversity, with 36 true positive samples including 1 HIV elite controller and 3 early HIV infections (1 HIV ELISA antigen/antibody window and 2 ELISA HIV antibody window), and 32 serological and NAT cases were reactive infections.3) The deferral limit of ELISA 1 and ELISA 2 in conventional screening mode were 20.25 and 9.85, respectively, can screen 97.14% (34/35) of all true positive samples in group A and B, except for one ELISA HIV antibody window (ELISA 2 reactivity). The positive predictive values were 93.94% and 92.85%, respectively. The ECLIA deferral limit of 7.83 can screens all true positive samples in Groups A and B (35/35)in ECLIA mode. The positive predictive value was 94.59%. 【Conclusion】 The establishment of deferral limits in this study can effectively screen HIV-positive blood donors, and the number of screened blood donors is greatly reduced, which is helpful to fine and scientific management of HIV-reactive blood donors. The deferral limit values of different testing reagents are quite different, so each laboratory should choose appropriate testing methods to establish the deferral limit values suitable for the laboratory according to its own testing ability, so as to provide technical support for optimizing the process of returning blood donors to the team.

Integrating physician’s and patient’s interest before judging the efficiency of a diagnostic test

Background: Customarily, physicians utilize an efficient diagnostic test before confirming the illness to start a treatment procedure. In this process, physician’s seeks maximum possible sensitivity  and specificity. On the contrary, patient wants maximum attainable positive and negative predictive values. A duality exists between both vital patient’s and physician’s interest and it helps to judge whether a diagnostic is superior.Methods: This article integrates physician’s and patient’s interest in a novel manner to judge a diagnostic test is efficient. This approach is seen to be optimal, according to illustrations.Results: The results based on expressions of this article in data on rotavirus, mammogram, post-surgery infection, opinion of two independent nurses about ear infection, whether a surgery contained cancer cells, whether a second surgery rectifies ruptures in breast gels, and whether the elder’s fall due to medications they consumed are all convincing that the integration works well.Conclusions: The new integrated metric, , susceptibility index, excessive risk, calibration index, and phi-coefficients of this article are supportive to that both the physician’s and patient’s interest together identify a superior diagnostic test.

Diagnostic Performance Characteristics of Serum Chemistry in the Detection of Cysticercus fasciolaris in Brown Rats (Rattus norvegicus)

Aim: Brown rats (R. norvegicus), a natural intermediate host for Cysticercus fasciolaris, are widely distributed in Grenada. C. fasciolaris causes cysts in a number of organs, but with greater frequency in the liver. The purpose of this study was to investigate the alterations of serum chemistry particularly serum proteins and activity of liver enzymes associated with liver cysts in brown rats infected with C. fasciolaris, as well as to assess their performance in the diagnosis of Cysticercus fasciolaris. Study Design: In this cross sectional study, 170 brown rats were anesthetized and blood was obtained directly from the heart and collected in red-top tubes. The rats were then euthanized, and dichotomously classified as positive or negative for Cysticercus fasciolaris based on the presence or absence of Cysticercus fasciolaris-associated cysts, grossly and/or histopathologically. Methodology: For both groups of rats (positive or negative), the concentrations of each specific protein (g/dL), selected liver and pancreatic enzymes (U/L), metabolic waste products (mg/dL) and electrolytes (mg/dL) were measured using Vet Test (IDEXX, USA). Cut-off points for test values of liver enzymes were set at 2-fold or greater than upper reference limit. For all other analytes, test values that were outside the reference interval were considered to be diagnostically relevant. In order to determine the diagnostic performance and agreement between liver enzymes and Cysticercus fasciolaris-associated liver cysts, predictive values and Cohen’s kappa statistics, respectively were calculated. Results: The activity of AST significant increased among the infected brown rat population. The sensitivity and specificity of AST in detecting Cysticercus fasciolaris in brown rats was 76% and 59%, respectively. The positive and negative predictive values of AST were (80%) and (35%) respectively. Based on Cohen’s kappa, AST showed good agreement to gross/histopathology [0.4, 95% CI 0.16 – 0.53, SEkappa 0.42] in the detection of Cysticercus fasciolaris-associated liver cysts. Conclusion: AST is the most reliable enzyme in detecting Cysticercus fasciolaris in brown rats, and thus C. fasciolaris should be included among the differential diagnoses whenever increased serum activity of AST are observed in brown rats.

Identification of the Most Appropriate Site for the Cold Test in Molar Teeth / Identificación del sitio más apropiado para la prueba de frío en dientes molares

Abstract A test frequently used to complement endodontic diagnoses is the cold test; however, in the last 20 years, authors have reported incorrect results within pulp sensitivity tests. Specifically, a high frequency of false results in posterior teeth, were found. The aim of this study was to identify the most appropriate site for the cold test in molar teeth with a need for endodontic treatment, calculating predictive values, accuracy and reproducibility. A cross-sectional study was performed, evaluating 390 subjects. A total of 152 subjects of both genders from the ages of 15-65 years old participated. The ideal standard was established by direct pulp inspection, and the cold test agent used was 1,1,1,2-tetrafluoroethane. The patients were divided into four groups in relation to the molar tooth: (1) mandibular first molar, (2) mandibular second molar, (3) maxillary first molar, and (4) maxillary second molar. 169 teeth and 676 sites were studied. (a) The most appropriate sites for cold test were the middle third of the buccal surface and cervical third of the buccal surface in the mandibular molars with the following results: Middle third of the first molar: Accuracy 0.93, positive predictive value 0.90 and negative predictive value 0.96. Middle third of the second molar: Accuracy 0.93, positive predictive value 1.00 and negative predictive value 0.90. In relation to third cervical the results were: First molar: Accuracy 0.93, positive predictive value 0.89 and negative predictive value 0.97 y second molar: Accuracy 0.93, positive predictive value 1.00 and negative predictive value 0.90. (b) The highest reproducibility was observed in the middle third of the buccal surface with cervical third of the buccal surface in the mandibular second molar (1.00). The most appropriate site and reproducibility of the sites are auxiliary to complement endodontic diagnose with the cold test.

Resumen Una prueba frecuentemente utilizada para complementar los diagnósticos endodónticos es la prueba de frío. Sin embargo, en los últimos 20 años, los autores han reportado resultados incorrectos con las pruebas de sensibilidad pulpar. Específicamente, se ha observado una alta frecuencia de resultados falsos en dientes posteriores. El objetivo del estudio fue identificar el sitio más adecuado para la prueba de frío en dientes molares con necesidad de tratamiento endodóntico, calculando valores predictivos, exactitud y reproducibilidad. Se realizó un estudio transversal donde se evaluaron a 390 sujetos. 152 sujetos de ambos sexos de 15 a 65 años cumplieron con los criterios de inclusión. El estándar ideal que se utilizó en el estudio fue la inspección directa de pulpa en la cámara pulpar y la prueba de frío utilizada fue el 1,1,1,2-tetrafluoroetano. Los pacientes fueron divididos en cuatro grupos en relación al diente molar: (1) primer molar mandibular, (2) segundo molar mandibular, (3) primer molar maxilar, y (4) segundo molar maxilar. En el estudio se evaluaron 169 dientes con 676 sitios. (a) Los sitios más adecuados para la prueba de frío fueron el tercio medio y el tercio cervical de la superficie bucal en los molares mandibulares con los siguientes resultados: Tercio medio del primer molar: Exactitud 0.93, valor predictivo positivo 0.90 y valor predictivo negativo 0.96. Tercio medio del segundo molar: Exactitud 0.93, valor predictivo positivo 1.00 y valor predictivo negativo 0.90. En relación al tercio cervical los resultados fueron: Primer molar: Exactitud 0.93, valor predictivo positivo 0.89 y valor predictivo negativo 0,97 y segundo molar: Exactitud 0.93, valor predictivo positivo 1.00 y valor predictivo negativo 0.90. (b) La más alta reproducibilidad (1.00) se observó entre el tercio medio con el tercio cervical de la superficie bucal en el segundo molar inferior. El sitio más apropiado y la reproducibilidad de los sitios son auxiliares para complementar el diagnóstico endodóntico con la prueba de frío.

Task Force Report on the Validation of Diagnosis Codes and Other Outcome Definitions in the Japanese Receipt Data / 薬剤疫学

Although the recent revision of the ministerial ordinance on Good Post-marketing Study Practice (GPSP) included the utilization of medical information databases for post-marketing surveillance, there has been limited research on the validity of diagnosis codes and other outcome definitions in Japanese databases such as administrative claims (“receipt”) database. This task force proposed how to conduct good validations studies, based on the narrative review on around 100 published papers around the world. The established check list consists of ： (ⅰ) understanding the type of the database (e.g. administrative claims data, electronic health records, disease registry) ； (ii) understanding the setting of the validation study (e.g. “population-based” or not) ； (iii) defining the study outcome ； (iv) determining the way of linkage between databases ； (v) defining the gold standard ； (vi) selecting the sampling method (e.g. using the information of all patients in the database or a hospital, random sampling from all patients, random sampling from patients satisfying the outcome definition, random sampling from patients satisfying and not satisfying the outcome definition, “all possible cases” method) and sample size ； (vii) calculating the measures of validity (e.g. sensitivity, specificity, positive predictive value, negative predictive value) ； and (viii) discussing how to use the result for future studies. In current Japan, where the linkage between databases is logistically and legally difficult, most validation studies would to be conducted on a hospital basis. In such a situation, detailed description of hospital and patient characteristics is important to discuss the generalizability of the validation study result to the entire database. This report is expected to encourage and help to conduct appropriate validation studies.

Development of Decision Support Formulas for the Prediction of Bladder Outlet Obstruction and Prostatic Surgery in Patients With Lower Urinary Tract Symptom/Benign Prostatic Hyperplasia: Part II, External Validation and Usability Testing of a Smartphone A / 대한배뇨장애요실금학회지

PURPOSE: We aimed to externally validate the prediction model we developed for having bladder outlet obstruction (BOO) and requiring prostatic surgery using 2 independent data sets from tertiary referral centers, and also aimed to validate a mobile app for using this model through usability testing. METHODS: Formulas and nomograms predicting whether a subject has BOO and needs prostatic surgery were validated with an external validation cohort from Seoul National University Bundang Hospital and Seoul Metropolitan Government-Seoul National University Boramae Medical Center between January 2004 and April 2015. A smartphone-based app was developed, and 8 young urologists were enrolled for usability testing to identify any human factor issues of the app. RESULTS: A total of 642 patients were included in the external validation cohort. No significant differences were found in the baseline characteristics of major parameters between the original (n=1,179) and the external validation cohort, except for the maximal flow rate. Predictions of requiring prostatic surgery in the validation cohort showed a sensitivity of 80.6%, a specificity of 73.2%, a positive predictive value of 49.7%, and a negative predictive value of 92.0%, and area under receiver operating curve of 0.84. The calibration plot indicated that the predictions have good correspondence. The decision curve showed also a high net benefit. Similar evaluation results using the external validation cohort were seen in the predictions of having BOO. Overall results of the usability test demonstrated that the app was user-friendly with no major human factor issues. CONCLUSIONS: External validation of these newly developed a prediction model demonstrated a moderate level of discrimination, adequate calibration, and high net benefit gains for predicting both having BOO and requiring prostatic surgery. Also a smartphone app implementing the prediction model was user-friendly with no major human factor issue.

Uso de tests diagnósticos en la práctica clínica (Parte 1): análisis de las propiedades de un test diagnóstico / Clinical use of diagnostic tests (Part 1): analysis of the properties of a diagnostic test

Diagnostic tests are widely used in clinical practice. Qualitative analysis of diagnostic test properties (validity, reproducibility and safety) has been systematized using clinical epidemiology tools that have introduced a series of concepts such as sensitivity, specificity and predictive values. Based on data reported by a clinical investigation, the present article illustrates the theoretical background underlying these concepts, explains the methodology for their calculation, and analyzes their main strengths and limitations. A second article (Part 2: Clinical application and usefulness of a diagnostic test), describes the manner in which information provided by a test should be applied in order to correctly resolve a clinical dilemma.

Los tests diagnósticos constituyen herramientas complementarias ampliamente utilizadas en la práctica clínica. La Epidemiología Clínica ha sistematizado el análisis cualitativo de sus propiedades (validez, repro-ducibilidady seguridad) mediante la introducción de una serie de conceptos tales como sensibilidad, especificidad y valores predictores. En base a los datos aportados por una investigación clínica, el presente artículo ilustra el sustrato teórico subyacente a los conceptos anteriormente mencionados, detalla su forma de cálculo y analiza sus principales fortalezas y limitaciones. En un segundo artículo (Parte 2: Aplicación clínica y utilidad de un test diagnóstico) se describe la forma en que la información aportada por una prueba debe ser aplicada correctamente en la resolución de un dilema clínico.

Evaluación del ultrasonido renal para predecir reflujo vesicoureteral en recién nacidos con infección del tracto urinario / Assessment of renal ultrasound (US) to predict vesicoureteral reflux in newborns presenting with infection of urinary tract

El presente estudio buscó determinar si la ausencia de hidronefrosis confirmada mediante ultrasonido renal rutinario constituye un indicador confiable de la inexistencia de reflujo vesicoureteral, sobre todo, grave. MÉTODOS. Se realizó un estudio observacional, prospectivo desde 1992 hasta 2006, de una cohorte de recién nacidos que ingresaron con infección del tracto urinario de localización alta, según criterios clínicos, y a los que se realizaron ultrasonido renal y uretrocistografía miccional. Se analizaron las características clínicas e imagenológicas de la hidronefrosis, y la relación y predicción del resultado del ultrasonido renal respecto de la presencia de reflujo vesicoureteral. RESULTADOS. Se estudiaron 348 pacientes. El ultrasonido renal realizado al diagnóstico de la infección del tracto urinario resultó positivo para hidronefrosis en 110 de los recién nacidos (31,6 por ciento). El grado de hidronefrosis se asoció a la presencia de anomalías del tracto urinario representadas predominantemente por reflujo vesicoureteral. En la predicción del ultrasonido para reflujo vesicoureteral tuvimos que los estadígrafos de sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo fueron respectivamente: 0,48; 0,73; 0,32 y 0,84 y fue similar para la predicción diagnóstica de los grados III o mayores. Hubo pacientes con reflujo vesicoureteral de grado III o mayor que tuvieron un ultrasonido normal. CONCLUSIONES. La tercera parte de los recién nacidos estudiados tuvieron hidronefrosis de grado variable en el ultrasonido renal, predominantemente ligera, algunas asociadas a anomalías, y otras sin causa subyacente. La hidronefrosis en el examen de ultrasonido renal no predice suficientemente la presencia de reflujo vesicoureteral, si bien el resultado negativo tampoco la excluye, aun en casos con reflujo vesicoureteral grave.

Present study tried to determine if lack of hydronephrosis confirmed by routine renal US is a reliable indicator of non-existence of vesicoureteral reflux, mainly the severe one. METHODS: We carried out a prospective observational study from 1992 to 2006 in a cohort of newborns admitted presenting urinary tract infection of a high location, according clinical criteria, and also a renal US and micturition ureterocystography. Clinical and imaging features of hydronephrosis were analyzed as well as relation and prediction of result. RESULTS: A total of 348 patients were studied. Renal US performed to diagnosis of urinary tract infection was positive mainly to hydronephrosis in 110 of newborns (31, 6 percent) by vesicoureteral reflux. Hydronephrosis degree was associated with presence of tract urinary anomalies represented by vesicoureteral reflux. In prediction of US for above mentioned reflux, we note that sensitivity, specificity, and positive predictive value were: 0, 48, 0, 73, 0, 32, and 0,84 respectively and was similar for diagnostic prediction of III grades or greater. There were patients presenting Grade III vesicoureteral reflux or greater with a normal US. CONCLUSIONS: Third part of study newborns had hydronephrosis of variable degree in renal US, mainly the light type one, some associated with anomalies, and other without underlying cause. Hydronephrosis in renal US examination don't predict enough presence of vesicoureteral reflux, even though negative results don't exclude it, even in a severe vesicoureteral reflux.

Prueba de torniquete como predictiva de sangrado espontáneo en casos de dengue clásico por den-2 / Tourniquet test as predictive of spontaneous bleeding in classic dengue, den-2, cases

Objetivo: Determinar el valor de la prueba de torniquete como predictiva de sangrado espontáneo en pacientes afectados por dengue clásico en un brote por el virus DEN-2. Materiales y métodos: Se realizó un estudio caso-control con una población de 267 pacientes egresados de la Unidad de Atención del Dengue del Hospital Monseñor Sanabria en Puntarenas, con diagnóstico de dengue clásico, en el periodo de julio de 1999 a junio de 2002, durante el brote de virus DEN-2 en la Región Pacífico Central de Costa Rica. Hubo un total de 61 pacientes con sangrado espontáneo, casos, y 181 pacientes sin el evento, controles. Se calculó la capacidad predictiva de la prueba de torniquete mediante una tabla de contingencia con la que se determinaron las características diagnósticas de la prueba así como la razón de posibilidades, Odds ratio y la fracción etiológica, tomando como prueba de oro la condición de sangrado espontáneo. Resultados: La sensibilidad y especificidad de la prueba fueron 41.0 por ciento y 75.1 por ciento, respectivamente; asimismo, el valor predictivo positivo fue de 35.7 por ciento, mientras que el valor predictivo negativo fue de 79.1 por ciento. Los pacientes con diagnóstico de dengue por DEN-2 con la prueba de torniquete positivo tuvieron el doble de posibilidad de sufrir de sangrado espontáneo que aquellos con resultado negativo a la prueba, OR igual 2.1; IC 95 por ciento: 1.1-3.9. Conclusión: La prueba de torniquete no es confiable para indicar fragilidad capilar y no debería utilizarse de manera definitiva para clasificar al paciente que requiere hospitalización por DEN-2.

Objective: To determine the significance of the tourniquet test as predictive of spontaneous bleeding in classic dengue fever patients in an DEN-2 virus outbreak. Materials and methods: A casecontrol study on 267 patients at the Dengue Unit of the Monseñor Sanabria Hospital in Puntarenas, diagnosed as classic dengue fever, between July 1999 and June 2002, during the Central Pacific Area DEN-2 virus outbreak. There were a total of 61 patients with spontaneous bleeding (cases) and 181 controls. The predictive ability of the tourniquet test, the odds ratio and the etiologic fraction were assessed using a 2x2 table, using the spontaneous bleeding condition as golden standard. Results: Sensitivity and specificity of the positive tourniquet were 41.0% and 75.1%, respectively; besides, the predictive positive value was 35.7% while the predictive negative value was 79.1%. Patients diagnosed with dengue by DEN-2 virus, with a tourniquet positive test had two times the chance of spontaneous bleeding than those with a negative test (OR= 2.1, 95% IC: 1.1-3.9). Conclusion: The tourniquet test is not reliable to predict capillary fragility; hence it should not be used to classify patients that require hospitalization in cases of dengue fever caused by DEN-2 virus.

Self-diagnosis of active head lice infestation by individuals from an impoverished community: high sensitivity and specificity

To compare sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of self-diagnosis for head lice infestation with visual inspection, we conducted a study in an urban slum in Brazil. Individuals were asked about active head lice infestation (self-diagnosis); we performed visual inspection and thereafter wet combing (gold standard). Of the 175 individuals included, 77 (44 percent) had an active head lice infestation. For self-diagnosis, sensitivity (80.5 percent), specificity (91.8 percent), PPV (88.6 percent) and NPV (85.7 percent) were high. Sensitivity of visual inspection was 35.1 percent. Public health professionals can use self-diagnosis as a diagnostic tool, to estimate accurately prevalence of pediculosis in a community, and to monitor ongoing intervention strategies.

Foi conduzido um estudo em uma favela urbana no Brasil com o objetivo de comparar a sensibilidade, especificidade, valor preditivo positivo (VPP) e valor preditivo negativo (VPN) do auto-diagnóstico de pediculose com a inspeção visual. Dos 175 indivíduos incluídos, 77 (44 por cento) apresentavam pediculose. Para o auto-diagnóstico, a sensibilidade (80.5 por cento), a especificidade (91.8 por cento), o VPP (88.6 por cento) e o VPN (85.7 por cento) foram altos. A sensibilidade da inspeção visual foi 35.1 por cento. Profissionais de saúde podem utilizar o auto-diagnóstico como uma ferramenta diagnóstica para estimar de forma acurada a prevalência de pediculose em uma comunidade, como também para monitorar estratégias de controle da doença.

Predictive values of 10% potassium hydroxide examination for superficial fungal infection of the skin

Introduction Ten percent potassium hydroxide examination is one of the most frequently performed tests in dermatology. It is usually supplemented by fungal culture for detection of superficial fungal infection of the skin and its appendages. We aim to determine the predictive values of 10% potassium hydroxide examination in Sarawak General Hospital. Materials and Methods A retrospective review of 292 skin scraping results for 10% potassium hydroxide examination and culture was done between October 2003 and December 2004. Data for all the scrapings were analysed for predictive values, specificity, sensitivity and likelihood ratio with fungal culture as the gold standard investigation. Separate data analysis was done for those with onychomycosis. Results Positive cultures were noted in 80.8% of skin scrapping cases and 85.4% of onychomycosis cases. For the skin scrapping cases, the positive predictive value of 10% potassium hydroxide examination was 67.4%, negative predictive value of 16.9%, sensitivity of 12.3% and specificity of 75%. For those with onychomycosis, the positive predictive value was 75%, negative predictive value 13.6%, specificity 85.7% and sensitivity was 7.3%. The positive likelihood ratio for all cases and onychomycosis cases was 0.5 whereas the negative likelihood ratio was 0.9. Conclusion Ten percent potassium hydroxide examination has a very low negative predictive value and sensitivity, making it a poor investigative tool in Sarawak General Hospital. Thus, culture of the skin scraping for suspected superficial fungal infection of the skin and its appendages is of utmost importance. Steps to improve the quality of 10% potassium hydroxide examination are important as it is an easy and inexpensive test.

Normal Predictive Values of Spirometry in Korean Population / 결핵및호흡기질환

BACKGROUND: Spirometry should be compared with the normal predictive values obtained from the same population using the same procedures, because different ethnicity and different procedures are known to influence the spirometry results. This study was performed to obtain the normal predictive values of the Forced Vital Capacity(FVC), Forced Expiratory Volume in 1 Second(FEV1), Forced Expiratory Volume in 6 Seconds(FEV6), and FEV1/FVC for a representative Korean population. METHODS: Based on the 2000 Population Census of the National Statistical Office of Korea, stratified random sampling was carried out to obtain representative samples of the Korean population. This study was performed as a part of the National Health and Nutrition Survey of Korea in 2001. The lung function was measured using the standardized methods and protocols recommended by the American Thoracic Society. Among those 4,816 subjects who had performed spirometry performed, there was a total of 1,212 nonsmokers (206 males and 1,006 females) with no significant history of respiratory diseases and symptoms, with clear chest X?rays, and with no significant exposure to respiratory hazards subjects. Their residence and age distribution was representative of the whole nation. Mixed effect models were examined based on the Akaike's information criteria in statistical analysis, and those variables common to both genders were analyzed by regression analysis to obtain the final equations. RESULTS: The variables affecting the normal predicted values of the FVC and FEV6 for males and females were age2, height, and weight. The variables affecting the normal predicted values of the FEV1 for males and females were age2, and height. The variables affecting the normal predicted values of the FEV1/FVC for male and female were age and height. CONCLUSION: The predicted values of the FVC and FEV1 was higher in this study than in other Korean or foreign studies, even though the difference was < 10%. When compared with those predicted values for Caucasian populations, the study results were actually comparable or higher, which might be due to the stricter criteria of the normal population and the systemic quality controls applied to the whole study procedures together with the rapid physical growth of the younger generations in Korea.