Diagnostic accuracy of hysteroscopy in relation to histopathology in patients with abnormal uterine bleeding at a tertiary care centre

Background: : Judicious use of hysteroscopy to manage abnormal uterine bleeding (AUB) adds a new dimension in handling this perplexing problem. Hysteroscopy combined with histological examination is the new “Gold Standard” for evaluating a case of abnormal uterine bleeding Objectives: To study Diagnostic accuracy of hysteroscopy in relation to histopathology in patients with abnormal uterine bleeding Methods: A hospital based diagnostic accuracy study was carried out among 100 women with abnormal uterine bleeding. All patients underwent the procedure of hysteroscopy. Samples were collected in all patients for histopathology confirmation of the hysteroscopy findings. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were calculated for hysteroscopy in comparison to gold standard histopathology. Results: Majority of the women belonged to 40-49 years (41%). Majority (37%) reported after one year of occurrence of the symptoms. Majority (54%) had menorrhagia. Hysteroscopy was found to be having good sensitivity and specificity in comparison to gold standard histopathology. Sensitivity=97.7%; specificity=78.5%, positive predictive value=78.1%; negative predictive value=97.7%; diagnostic accuracy=87% for hysteroscopy in comparison to histopathology. Conclusion: Hysteroscopy is simple to perform and provides direct visualization of the uterus cavity and the endo-cervical canal. In abnormal uterine bleeding, quick and safe diagnosis is possible by hysteroscopy. In cases of endometrial polyp and sub mucous myoma which are pedunculated structures, diagnostic accuracy is greater with hysteroscopy and can be treated during the procedure itself. Thus, Hysteroscopic guided biopsy and histopathology is considered as new “Gold Standard” in diagnosis and often treatment of abnormal uterine bleeding.

Validez de la evaluación del consumo de alcohol establecido en la norma técnica de atención integral del adulto con infección por el VIH

Objetivos: Determinar la validez de la evaluación de consumo de alcohol realizado en la Estrategia Nacional de Salud para la Prevención y Control de ITS-VIH / SIDA (ESNITSS) a pacientes con VIH que iniciaron tratamiento antirretroviral (TARV). Material y métodos: El tipo de estudio fue de evaluación de prueba diagnóstica en pacientes en TARV de un hospital del Ministerio de Salud (MINSA), entre septiembre de 2017 y enero de 2018; en base al análisis de datos de la Fase I del estudio "Efectividad de la Consejería en Enfermería en la Mejora de la Adherencia al TARV en pacientes con VIH y Conducta de Consumo de Alcohol". 4000 pacientes conformaron la población de estudio y 350 pacientes fueron seleccionados aleatoriamente. Se procedió a la validación de la evaluación del consumo de alcohol realizado por la ESNITSS con dos Gold estándar: i. la evaluación del consumo de alcohol en el último mes y ii. el consumo de riesgo identificado con el Alcohol Use Disorders Identification Test (AUDIT). Se calculó sensibilidad, especificidad, seguridad de la evaluación y razones de probabilidad. Resultados: La sensibilidad y especificidad fue regular para la evaluación de consumo de alcohol en el último mes (S=0,64, E=0,57), la especificidad fue mala para la evaluación de consumo de riesgo (E=0,48). Las razones de verosimilitud positivas demuestraron que la evaluación no tiene utilidad diagnóstica para ninguno de los casos (<2). Conclusiones: La evaluación de "consumo actual de alcohol" realizada por la ESNITSS no mostró utilidad diagnóstica.

SUMMARY Objectives: To determine the validity of the evaluation of alcohol consumption established by the national strategy to prevent and control STI-HIV-AIDS (ESNITSS) of HIV-infected adults that started anti-retroviral treatment (ART). Methods: Diagnostic study of HIV patients in a single hospital in Lima from September 2017 to January 2018 using data from a phase one study "Effectiveness of nursing counseling in improving adherence to ART among patient with alcohol consumption". Three hundred and fifty patients were randomly selected among 4000 participants. Two gold standards evaluated alcohol consumption: 1. Last month alcohol consumption and ii; alcohol consumption identified by the Alcohol Use Disorders Identification Test (AUDIT). Sensitivity, specificity, safety of the evaluation and probability rates. Results: sensitivity and specificity were moderate for last month alcohol consumption (s=0.64; e=0.57); specificity was low for evaluation of consumption risk (e=0.48). Positive validity rates demonstrated that the evaluation is not useful (<2). Conclusions: The evaluation of alcohol consumption followed by the ESNITSS has no diagnostic utility.

Discussion on Technical Evaluation Requirements of Allergen Detection Reagent Pre-marketing / 中国医疗器械杂志

In the perspective of technical evaluation, the pre-marketing regulatory requirements of allergen detection reagents in China, America, European Union were compared, and the regulatory risks and performance requirements of this product were analyzed based on the monitoring of post-marketing adverse events, reference standards and domestic and foreign regulatory documents. In view of the "neck-stuck" problems such as the difficulty of clinical trials, the difficulty of finding comparable contrast reagents and the lack of clinical diagnostic gold standards, this paper discusses and gives regulatory suggestions, with a view to providing technical reference for product R&D, production, evaluation, approval and supervision in this field.

How to use χ2 test correctly——χ2 test for the data of four-fold table collected from the matched pairs design / 四川精神卫生

The purpose of this paper was to introduce the McNemar΄s χ2 test and SAS and R software implementation of four-fold table data collected from the matched pairs design. Firstly， it was proposed that there were three situations for the data of four-fold table of the paired design， namely ①the data of paired design four-fold table with the special "gold standard" was worthy of statistical analysis； ②the data of four-fold table of the paired design without the special "gold standard" was not worthy of statistical analysis； ③the data of four-fold table collected from the matched pairs design with implicit "gold standard" was worthy of statistical analysis. Secondly， taking the "problems and data" in the first case as the object of statistical analysis， SAS and R software were used to analyze the differences， the calculation results were given and explained， and the statistical and professional conclusions were also made.

¿Son válidos los métodos manuales modificados para determinar la Velocidad de Eritrosedimentación Globular (VSG) en laboratorios clínicos? / Are modified manual methods valid to establish Erythrocyte Sedimentation Rate (ESR) in clinical laboratories? / Os métodos manuais modificados são válidos para determinar a velocidade de hemossedimentação(VHS) nos laboratórios clínicos?

Resumen Se evaluó estadísticamente la validez de cuatro métodos para determinar la Velocidad de Eritrosedimentación Globular (VSG) alternos al de Westergren, el que se tomó como "gold standard". Los métodos evaluados fueron Wintrobe (WB), Wintrobe inclinado (WI) a 45° y dos micrométodos capilares, uno vertical (MM) y otro inclinado a 45° (MMI). Se procesaron 419 muestras por los cinco métodos. Se evaluó la concordancia (C), la sensibilidad (S), especificidad (E), valor predictivo positivo (VPP) y valor predictivo negativo (VPN). Los resultados de S, E, VPP, VPN y C fueron: 93,8%, 93,6, 98,8%, 72,8% y 71% en el de WB; 86,3%, 85,7%, 97,2%, 52,4% y 54% en el de WI; 94,6%, 66,6%, 94,1%, 71,4% y 54% para MM y 91,9%, 72,4%, 94,8%, 60,8% y 55% para MMI. El índice kappa mostró una concordancia "buena" entre el método de Westergren y el método de Wintrobe y "moderada" con los métodos de WBI, MM y MMI. Los resultados del presente estudio muestran que el método de Wintrobe es confiable para su uso en el laboratorio clínico comparado con el de Westergreen.

Abstract Four methods were statistically evaluated for their validity to determine the alternative Erythrocyte sedimentation rate to that of Westergren, which was taken as the "gold standard". The methods evaluated were Wintrobe (WB), Wintrobe inclined (WI) at 45° and two capillary micromethods, one vertical (MM) and one inclined at 45° (MMI). A total of 419 samples were processed by the five methods. Concordance (C), sensitivity (S), specificity (E), positive predictive value (PPV) and negative predictive value (NPV) were evaluated. The results for S, E, PPV, NPV and C were: 93.8%, 93.6, 98.8%, 72.8% and 71% for WB; 86.3%, 85.7%, 97.2%, 52.4% and 54% for WI; 94.6%, 66.6%, 94.1%, 71.4% and 54% for MM and 91.9%, 72.4%, 94.8%, 60.8% and 55% for MMI. The kappa index showed "good" agreement between the Westergren method and the Wintrobe method and "moderate" agreement with the WBI, MM and MMI methods. The results of the present study show that the Wintrobe method is reliable for use in the clinical laboratory compared to the Westergren method.

Resumo Neste trabalho, foi avaliada estatisticamente a validez de quatro métodos para determinar a Velocidade de Eritrosedimentação Globular (VSG) alternos ao Westergren, que foi considerado como o "Método Padrão". Os métodos avaliados foram Wintrobe (WB), Wintrobe inclinado a 45° (WI) e dois micro-métodos capilares, um vertical (MM) e outro inclinado a 45° (MMI). 419 amostras foram processadas pelos cinco métodos. Envalou-se a concordância (C), sensibilidade (S), especificidade (E), assim como os valores preditivos positivos (VPP) e negativos (VPN). Os resultados de S, E, VPN e VPP foram: 93.8%, 93.6%, 98.8%, 72.8% e 71% com o WB; 86.3%, 85.7%, 97.2%, 52.4% e 54% com o WI; 94.6%, 66.6%, 94.1%, 71.4% e 54% para MM e 91.9%, 72.4%, 94.8%, 60.8% e 55% para o MMI. O índice kappa apresentou "boa" concordância entre os métodos de Westergren e Wintrobe, enquanto teve concordância "moderada" com os métodos WBI, MMe MMI. Os resultados deste estudo revelaram que o método de Wintrobe é confiável para seu uso no laboratório clínico comparado com o método de Westergren.

Evaluation of the performance of three serological tests for diagnosis of Leishmania infantum infection in dogs using latent class analysis / Avaliação da realização de três testes sorológicos para diagnóstico de infecção por Leishmania infantum em cães utilizando análise de classe latente

Abstract Canine leishmaniasis (CanL) is a disease caused by Leishmania infantum. Serological methods are the most common diagnostic techniques used for the diagnosis of the CanL. The objective of our study was to estimate the sensitivity and specificity of one in-house ELISA kit (ELISA UNIZAR) and three commercially available serological tests (MEGACOR Diagnostik GmbH) including an immunochromatographic rapid test (FASTest LEISH®), an immunofluorescent antibody test (MegaFLUO LEISH®) and an enzyme-linked immunosorbent assay (MegaELISA LEISH®), using latent class models in a Bayesian analysis. Two hundred fifteen serum samples were included. The highest sensitivity was achieved for FASTest LEISH® (99.38%), ELISA UNIZAR (99.37%), MegaFLUO LEISH® (99.36%) followed by MegaELISA LEISH® (98.49%). The best specificity was obtained by FASTest LEISH® (98.43%), followed by ELISA UNIZAR (97.50%), whilst MegaFLUO LEISH® and MegaELISA LEISH® obtained the lower specificity (91.94% and 91.93%, respectively). The results of present study indicate that the immunochromatographic rapid test evaluated FASTest LEISH® show similar levels of sensitivity and specificity to the quantitative commercial tests. Among quantitative serological tests, sensitivity and specificity were similar considering ELISA or IFAT techniques.

Resumo A leishmaniose canina (Lcan) é uma causada pela Leishmania infantum. Os métodos sorológicos são as técnicas diagnósticas mais utilizadas para o diagnóstico da leishmaniose canina. O objetivo do nosso estudo foi estimar a sensibilidade e a especificidade de um kit ELISA interno (ELISA UNIZAR) e de três testes sorológicos disponíveis comercialmente, feitos pelo mesmo fabricante (MEGACOR Diagnostik GmbH), incluindo um teste rápido imunocromatográfico (FASTest LEISH®), um teste de anticorpos imunofluorescentes (Megafluo LEISH®) e um ensaio de imunoabsorção enzimática (Megaelisa LEISH®), utilizando-se modelos de classe latentes numa análise bayesiana. Foram incluídas duzentas e quinze amostras de soro. A maior sensibilidade foi alcançada para Fastest LEISH® (99,38%), ELISA UNIZAR (99,37%), Megafluo LEISH® (99,36%) seguida por Megaelisa LEISH® (98,49%). A melhor especificidade foi obtida por FASTest LEISH® (98,43%), seguida por ELISA UNIZAR (97,50%), enquanto Megafluo LEISH® e Megaelisa LEISH® obtiveram a menor especificidade (91,94% e 91,93%, respectivamente). Os resultados do presente estudo indicam que o teste rápido imunocromatográfico, avaliado por FASTest LEISH® mostra níveis similares de sensibilidade e especificidade aos testes comerciais quantitativos incluídos. Entre os testes sorológicos quantitativos, a sensibilidade e a especificidade foram semelhantes, considerando-se as técnicas de ELISA ou IFI.

Assessment of nutritional status of children aged 34-92 months using various nutritional status indices and validity of age independent indices

Background: Even though there are many programs run by Government to tackle the problem of malnutrition in India, problem of malnutrition is still there. Malnutrition leads to infections and even can lead to death of child in severe cases. The mortality rate is very high compared to other countries. The objective of the study to study validity of age independent various nutritional status indices in comparison to gold standard of weight for ageMethods: Present study was institution based cross sectional study carried out at SDA high school, from January 2019 to July 2019 among 58 school children aged 34-92 months of age. Anthropometric measurements like weight, height, head circumference, chest circumference, mid arm circumference were recorded as per the standard guidelines. Weight for height, weight of age, Kanawati Index, Jeliffe's ratio, Rao index, and Dugdales index was calculated. Gold standard used was weight for age. Sensitivity, specificity, positive predictive value and negative predictive value were calculated for these indices.Results: Majority of the children belonged to 48-60 months and 61-72 months i.e. 29.3% each. Males were more than females. Prevalence of malnutrition was 60.3%, 48.3%, 51.7%, 91.4%, and 56.8% based on weight for age, Kanawati index, Rao index, Jeliffe's ratio and Dugdale's index respectively. Dugdale's index was found to have high sensitivity (85.7%) and specificity (86.9%) compared to all other indices.Conclusions: Among age independent indices of nutritional status available, Dugdales index can be used as it has been found that it has remarkably higher sensitivity and specificity compared to other age independent indices of nutritional status.

Evaluation of the WHO/UNICEF algorithm for integrated management of childhood illness

Background: The present study was designed to evaluate the feasibility and utility of the integrated management of the childhood illness (IMCI) algorithm to diagnose the illnesses in children under the age of 2 months to 5 years.Methods: The study was conducted on 300 children, aged 2 months to 5 years, who presented with a fresh episode of any illness to the out-patient Department of the SMGS Hospital over a period of 9 months. Within these initial selection criteria, the WHO/UNICEF algorithm for management of the sick child was referred to, children were assessed and classified as per "IMCI" algorithm and treatments required were identified. The final diagnosis was made and appropriate therapy instituted served as the "Gold standard". The diagnostic and therapeutic agreements between the 'gold standard' and the IMCI and vertical (on the basis of primary presenting complaint) algorithms were computed.Results: Among all 300 subjects, more than one illness was present in 207 (69%) of subjects as per Gold standard diagnosis. The corresponding, figures for IMCI module were 141 (47%) and 222 (74%) for low and high malaria algorithms respectively. The mean illnesses per child were 2.12, 182 and 2.21, respectively. The subjects who would have been referred as per IMCI module had a greater co-existence of illnesses than those who would not have been referred (mean 2.5 versus 1.5 illnesses per child respectively). The specificity for general danger signs was 66% while the sensitivity was 71%.Conclusions: In conclusion, the performance of the IMCI algorithm is significantly better than the vertical disease specific algorithm. In addition, the IMCI algorithm incorporates an element of preventive care in the form of immunization and feeding advice.

Multiple Calcified Scrotal Sebaceous Cysts: A Rare Case Presentation

A sebaceous cyst is a retention cyst. The classical management of scrotal sebaceous cysts is complete surgical excision and in the current era and as expected from the patient from the doctor and as the duty of the doctor, excellent outcome, minimal morbidity with good cosmetic results.

Multiple Calcified Scrotal Sebaceous Cysts: A Rare Case Presentation

A sebaceous cyst is a retention cyst. The classical management of scrotal sebaceous cysts is complete surgical excision and in the current era and as expected from the patient from the doctor and as the duty of the doctor, excellent outcome, minimal morbidity with good cosmetic results.

'Outbreak Gold Standard'Selection to Provide Optimized Threshold for Infectious Diseases Early-alert Based on China Infectious Disease Automated-alert and Response System / 华中科技大学学报（医学）（英德文版）

The China Infectious Disease Automated-alert and Response System (CIDARS) was successfully implemented and became operational nationwide in 2008.The CIDARS plays an important role in and has been integrated into the routine outbreak monitoring efforts of the Center for Disease Control (CDC) at all levels in China.In the CIDARS,thresholds are determined using the'Mean+2SD'in the early stage which have limitations.This study compared the performance of optimized thresholds defined using the'Mean +2SD'method to the performance of 5 novel algorithms to select optimal 'Outbreak Gold Standard (OGS)'and corresponding thresholds for outbreak detection.Data for infectious disease were organized by calendar week and year.The'Mean+2SD',C1,C2,moving average (MA),seasonal model (SM),and cumulative sum (CUSUM) algorithms were applied.Outbreak signals for the predicted value (Px) were calculated using a percentile-based moving window.When the outbreak signals generated by an algorithm were in line with a Px generated outbreak signal for each week,this Px was then defined as the optimized threshold for that algorithm.In this study,six infectious diseases were selected and classified into TYPE A (chickenpox and mumps),TYPE B (influenza and rubella) and TYPE C [hand foot and mouth disease (HFMD) and scarlet fever].Optimized thresholds for chickenpox (P55),mumps (P50),influenza (P40,P55,and P75),rubella (P45 and P75),HFMD (P65 and P70),and scarlet fever (P75 and Ps0) were identified.The C1,C2,CUSUM,SM,and MA algorithms were appropriate for TYPE A.All 6 algorithms were appropriate for TYPE B.C1 and CUSUM algorithms were appropriate for TYPE C.It is critical to incorporate more flexible algorithms as OGS into the CIDRAS and to identify the proper OGS and corresponding recommended optimized threshold by different infectious disease types.

A study of phacoemulsification cataract surgery preference over Small Incision Cataract Surgery in rural eye center of Bodhan, Nizamabad District

Cataract is a major cause of decreased vision in elderly aged population. In rural areas till last decade small incision cataract surgery with IOL implantation is the only surgical option for treating cataracts. In recent past after introduction of the phacoemulsification with foldable IOL implantation is becoming popular surgical technique in urban areas. In our study conducted at rural eye center, phacoemulsification with IOL is gaining popularity over SICS with IOL. This shows increased awareness among the rural population towards minimal invasive surgery and latest surgical techniques regarding better recovery procedures.

MRI is the gold standard investigation for early detection, extent of involvement and management of patient in Potts spine

Introduction: Tuberculosis is increasing in the developing countries and re-emerging in the developed ones because of overcrowding and increase in of population. Spinal TB is the most clinically important form of extra-pulmonary tuberculosis, as it may produce serious neurological sequel due to compression of spinal cord by its excessive spread and involvement of spinal canal as a result of the disease itself, as well as the resultant deformity. Early recognition and prompt treatment are therefore necessary to minimize residual spinal deformity and or permanent neurological deficit. This retrospective study lightens and correlates the image morphology of spinal TB on MRI. Materials and methods: The study was done from January 2015 to June 2015 on 70 patients diagnosed with Tuberculosis of spine. MRI of spine was carried out in all the patients. MRI was done using a 1.5 tesla Philips system. MRI features were observed on T1W, T2W, Short tau inversion recovery (STIR) and post contrast (gadolinium) T1W sequences with sections in sagittal, coronal and axial planes. Results: This study showed that the most common clinical feature was back pain followed by deformity with most patients being afebrile. Most common vertebrae involved were dorsal followed by lumbar and the cervical with sacral being the least involved. Central type of vertebral lesion was common than paradiscal and rarely it involves posterior elements and inter vertebral disc. As compared to the other modalities soft tissue involvement, extent of lesion, type of lesion and Inter vertebral disc involvement are better visualised on MRI. Conclusion: MRI offers excellent visualization of the bone and soft tissue components of spinal tuberculosis and helps to identify disease at distant asymptomatic sites (skip lesions) before and accurately as compare to other modalities. MR imaging clearly demonstrated the extent of soft tissue Rathva A, Zala S. MRI is the gold standard investigation for early detection, extent of involvement and management of patient in Pott’s spine. IAIM, 2017; 4(1): 7-15. Page 8 involvement and its effect on the thecal sac/cord and neural foramen. It helps in early diagnosis and therefore management.

Laparoscopic varicocelectomy now the gold standard procedure for varicocele – A comparative study with open technique based on our experience

Background: The link between varicocele and infertility was first reported by cessius in 1st century AD but it was not widely acknowledged until TULLOCH and colleagues reported the improvement of sperm parameters in 26 of 30 patients undergoing varicocelectomy. Varicocele is defined as excessive dilatation of pampiniform venous plexus of spermatic cord. varicocele is an important cause infertility which can be corrected by surgery. Several methods have been used for its treatment including open surgical ligation of spermatic veins as well as laparoscopic varicocelectomy. Open varicocelectomy has more risk of recurrence and complications whereas laparoscopic varicocelectomy is simple, has less risk of recurrence and complication in expert hands. Objectives: To compare Laparoscopic varicocelectomy with open varicocelectomy, in terms of postoperative pain, recurrence rate, hospital stay, cost, cosmetic and complication. To prove hospital stay was more in open group than laparoscopic group and also patient of laparoscopic group return to normal activities earlier than open group. To standardize the laparoscopic varicocelectomy procedure for varicocele. Materials and methods: It was a randomized clinical trial done in Department of General Surgery, Vinayaka Mission Medical College, Karaikal. Study was carried out from 1 st March, 2015 to 1st R. Bharathidasan, Reny Jayaprakash, Subith P. Bhaskar, G. Ambujam. Laparoscopic varicocelectomy now the gold standard procedure for varicocele - A comparative study with open technique based on our experience. IAIM, 2017; 4(7): 218-221. Page 219 March, 2016. A total 70 patients was taken in our study of its 36 patient undergone open varicocelectomy and 34 patient undergone laparoscopic varicocelectomy. Results: Recurrence rate 0% in Laparoscopic Varicocelectomy and 5.6% in open varicocelectomy. Wound complication was 0% in Laparoscopic varicocelectomy and 2.5% in open varicocelectomy. Post-operative pain was more in open group as compared to laparoscopic varicocelectomy. Laparoscopic varicocelectomy has less post-operative morbidity and early return to normal activity. Also there was improvement in seminal analysis in both groups. Conclusion: We would like to standardize laparoscopic varicocoelectomy and make it as a gold standard for Varicocele by replacing open technique provided there is good experienced surgical team and good instrumentation. Cost of the procedure is comparatively high.

Metodologias e ferramentas para anotação de narrativas clínicas / Methodologies and tools for clinical narratives annotation

A utilização de técnicas de Processamento de Linguagem Natural (PLN) em textos clínicos é amplamente dependente de grandes quantidades de dados textuais anotados, denominados corpus ou padrão ouro. Sendo essenciais para a modelagem da linguagem durante a fase de treinamento de diversos algoritmos de PLN. Porém, para a criação de um padrão ouro é necessário um extenso e custoso trabalho manual de anotação, que demanda um grande esforço de especialistas. OBJETIVO: Realizar uma revisão da literatura, visando o estudo de metodologias e ferramentas utilizadas em procedimentos de anotação de textos. MÉTODO: Levantamento em bases científicas referentes à elaboração de corpus morfológicos, sintáticos e morfossintáticos foi realizado, analisando 32 estudos de anotação e mais 12 ferramentas. RESULTADOS: Foram levantados os principais aspectos nos processos de anotação, bem como realizada uma avaliação dentre critérios pré-definidos de cada das ferramentas de suporte encontradas.

The use of natural language processing techniques (NLP) in clinical texts is dependent on large amounts of annotated text data, called corpus or gold standard. Are essential for the modelling language during the training phase of NLP algorithms. However, for the creation of a gold standard is required extensive and costly manual annotation task, that demands a great deal of experts. OBJECTIVES: To review the literature to identify methodologies and tools applied to text annotation. METHODS: Scientifics databases search regarding the development of morphological, syntactic and morphosyntactic corpus was performed by analyzing 32 annotation studies and 12 tools. RESULTS: Main aspects of the annotation process description, as well as an assessment from pre-defined criteria for each one of the annotation tools identified.

Construção e validação de questionário simplificado para triagem de pacientes com disfunção temporomandibular (QST/DTM) / Construction and validation of a simplified questionnaire for screening of patients with temporomandibular disorders (QST / TMD)

As disfunções temporomandibulares (DTM) representam a maior causa de dor não dentária da região orofacial. Dada sua alta prevalência na população em geral e a existência de inúmeros instrumentos diagnósticos não padronizados, buscou-se elaborar e validar um questionário simples, de acessibilidade ampla e aplicação prática, com vistas a contribuir para o diagnóstico e o estudo epidemiológico das mesmas. A estratégia utilizada na montagem do instrumento foi estabelecida com base na avaliação criteriosa de questionários já existentes na literatura, validação de expertos na área de DTM, validação fatorial, de face (na primeira fase do estudo) e, frente ao padrão ouro (RDC/TMD), na segunda fase do estudo. Na primeira fase, participaram 160 indivíduos. A consistência interna resultou num Coeficiente Alfa de Cronbach de 0,752 para o questionário com sete itens; enquanto que para o questionário com cinco itens, este resultado foi de 0,694, não sendo o mesmo, considerado baixo por avaliar apenas cinco questões e ainda, em razão do tema central da pesquisa ser bastante subjetivo. A análise fatorial confirmatória apontou para uma variância total dos fatores extraídos do questionário com sete itens, de 58,2 % e do questionário com cinco itens de 70,04%. Portanto, o questionário com cinco questões, apresentou resultados estatísticos superiores ao de sete questões. Na validação frente ao padrão ouro (RDC/TMD), foram avaliados 99 indivíduos tendo sido testados os dois questionários, com sete e com cinco questões. Na estrutura com sete questões, ao se categorizar as mesmas por totais de pontos obtidos, em quatro condições, obteve-se o melhor resultado quando se considerou com DTM a faixa entre 10 e 21 pontos, sendo 85,1% positivos também no RDC/TMD, com acurácia de 90,1% e Kappa 0,817. Nesta condição, a sensibilidade encontrada foi de 95% (IC 95%, 91 a 99), especificidade de 87% (IC 95%, 81 a 93), VPP 85%, VPN 96%, LR+ 7,3 e LR- 17,4. Quando os dados foram avaliados para o questionário com cinco questões (QST/DTM), pode-se observar que o melhor ponto de corte foi quando se considerou como portadores de DTM, os indivíduos na faixa entre 7 e 15 pontos, com acurácia de 85,8% e Kappa 0,817. Nesta condição, a sensibilidade foi 88% (IC 95%, 81,6 a 94,4), especificidade 84% (IC 95%, 76,8 a 91,2), VPP 80%, VPN 90,5%, LR+ 5,5 e LR- 7,0. A simplicidade do presente questionário (QST/DTM) com apenas cinco questões, possibilita seu uso como elemento de triagem inicial na área da dor orofacial em disfunção temporomandibular, com boa compreensibilidade, confiabilidade, reprodutibilidade e possibilidade de aplicação em pesquisas epidemiológicas. Concluiu-se que o questionário aqui validado, permite sua aplicação de forma simples tanto por profissionais e pesquisadores da Odontologia como de outras áreas da saúde. (AU)

Temporomandibular disorders (TMD) represent the biggest cause of non-dental pain in the orofacial region. In reason of its high prevalence in the general population and the existence of numerous non-standardized diagnostic tools, it was sought to develop and validate a simple questionnaire, with wide accessibility and practical application, in order to contribute to the diagnosis and epidemiological study of the same. The strategy used in the assembly of the instrument was based on careful evaluation of existing questionnaires in the literature, validation of experts in the field of TMD, face and factorial validity (at the first moment of the study) and validation against the gold standard (RDC/TMD), at the second moment of the study. At the first stage, participated 160 individuals. The internal consistency resulted in a Cronbach alpha of 0,752 for the questionnaire with seven items, while for the questionnaire with five items, this result was 0,694, not being the same considered a low value since it evaluated only five questions and yet, in reason of the subjectivity of the main theme of the research. Confirmatory factor analysis indicated a total variance of the factors extracted from the questionnaire with seven items of 58,2% and for the questionnaire with five items of 70,04%. Therefore, the questionnaire with five questions presented better statistical results them the one with seven questions. In the validation against the gold standard (RDC/TMD), 99 individuals were evaluated, being tested both questionnaires, with five and seven questions. In the structure with seven issues, when categorizing them by total points earned, on four conditions, we obtained the best result when considering with TMD the range between 10 and 21 points, being 85,1% positive also in the RDC/TMD, with an accuracy of 90,1% and Kappa 0,817. In this condition, the sensitivity was 95% (CI 95%, 91 to 99), specificity of 87% (CI 95%, 81 to 93), PPV 85%, NPV 96%, LR+ 7,3 and LR- 17,4. When the data were evaluated for the questionnaire with five questions (QST/DTM), one can observe that the best cutoff point was when considered as with TMD the individuals aged between 7 and 15 points, with an accuracy of 85,8% and 0,817 Kappa. In this condition, the sensitivity was 88% (CI 95%, 81,6 to 94,4), specificity 84% (CI, 95%, 76,8 to 91,2), PPV 80%, NPV 90,5%, LR+ 5,5 and LR- 7,0. The simplicity of this questionnaire (QST/DTM) with only five issues permits its use as an initial screening in the area of orofacial pain in temporomandibular disorders, with good responsiveness, reliability, reproducibility and possibility of application in epidemiologic researches. It was concluded that the questionnaire here validated, enables its application in a simple manner by both practitioners and researchers of Dentistry as in other areas of health. (AU)

La tomagrafía computarizada como prueba para diagnosticar enfermedad arterial coronaria con comentarios sobre la aplicación de la teoría de Bayes y la placa vulnerable / Computerized tomography as a coronary artery disease diagnostic test and comments on the Bayes` theory and the vulnerable plaque

Los factores de riesgo en enfermedad arterial coronaria fueron evaluados en historias clínicas y estudios de pruebas de esfuerzos con el protocolo de Duke. Los índices de certeza se definen y utilizan comparándolos con el "el patrón de oro" la arteriografía coronaria. Se establece el valor diagnóstico de la tomagrafía axial computarizada, basándose en los índices de certeza. también se mencionan los estudios intracoronarios para evaluar la placa obstructiva

Risk factors in coronary artery disease were evaluated with the clinical history and the stress test with the Duke protocol. Probability indexes were defined and compared with the gold standard (coronary arteriogram). The diagnostic value of coronary angiotac was established with probability indexes. Intracoronary studies to diagnose vulnerable plaque are also mentioned

An Evaluation of Multiple Query Representations for the Relevance Judgments used to Build a Biomedical Test Collection / 대한의료정보학회지

OBJECTIVES: The purpose of this study is to validate a method that uses multiple queries to create a set of relevance judgments used to indicate which documents are pertinent to each query when forming a biomedical test collection. METHODS: The aspect query is the major concept of this research; it can represent every aspect of the original query with the same informational need. Manually generated aspect queries created by 15 recruited participants where run using the BM25 retrieval model in order to create aspect query based relevance sets (QRELS). In order to demonstrate the feasibility of these QRELSs, The results from a 2004 genomics track run supported by the National Institute of Standards and Technology (NIST) were used to compute the mean average precision (MAP) based on Text Retrieval Conference (TREC) QRELSs and aspect-QRELSs. The rank correlation was calculated using both Kendall's and Spearman's rank correlation methods. RESULTS: We experimentally verified the utility of the aspect query method by combining the top ranked documents retrieved by a number of multiple queries which ranked the order of the information. The retrieval system correlated highly with rankings based on human relevance judgments. CONCLUSIONS: Substantial results were shown with high correlations of up to 0.863 (p < 0.01) between the judgment-free gold standard based on the aspect queries and the human-judged gold standard supported by NIST. The results also demonstrate that the aspect query method can contribute in building test collections used for medical literature retrieval.

Doença do refluxo gastroesofágico em crianças: quão confiável é o padrão-ouro? / Gastroesophageal reflux disease in children: how reliable is the gold standard?

OBJETIVO: O monitoramento do pH esofágico é considerado o método mais confiável para diagnosticar o refluxo gastroesofágico. No entanto, a interpretação do mesmo estudo de pH pode diferir entre observadores. Neste estudo, investigamos as causas e o grau de variabilidade entre observadores. MÉTODOS: Este estudo retrospectivo incluiu todas as crianças (n = 72) que realizaram monitoramento de pH durante 1 ano no Maxima Medical Centre, em Veldhoven, Holanda. RESULTADOS: Foi encontrada uma variabilidade de 18 por cento entre observadores. A variabilidade foi causada por diferenças de opinião sobre a duração do registro, dúvidas sobre a posição da sonda, artefatos e flutuação do pH de base. CONCLUSÕES: A maioria desses problemas pode ser eliminada por avaliação da posição do eletrodo de pH e calibração pós-teste. No entanto, ainda falta uma definição clara dos artefatos de monitoramento. Este estudo mostra que a concordância mútua na interpretação dos estudos de pH foi regular (coeficiente kappa de 0,70).

OBJECTIVE: To investigate the causes and degree of interobserver variability in esophageal pH monitoring for the diagnosis of gastroesophageal reflux. METHODS: This retrospective study included all children (n = 72) who underwent pH monitoring during 1 year at Maxima Medical Centre in Veldhoven, the Netherlands. RESULTS: An interobserver variability of 18 percent was found. Variability was caused by differences in opinion about the duration of registration, doubts about probe position, artifacts and drift of baseline pH. CONCLUSIONS: Most of these problems can be eliminated by posttest calibration and assessment of the pH electrode position. However, a clear definition of monitoring artifacts is lacking. This study shows that mutual agreement in the interpretation of pH studies was fair (kappa coefficient of 0.70).