A COMPARATIVE STUDY ON CERVICAL CANCER SCREENING METHOD: IS IMMUNO-MARKER A BETTER OPTION?

Cervical cytology by Papanicolaou (PAP) staining has been the backbone of primary screening of cervical cancer. For low resource countries, the major constraints in running a successful screening program are paucity of experienced personnel, requirement for multiple visits, economic considerations and inherent attributes of the test including a low sensitivity and specificity. The present study was designed to compare the efficacy of commonly available screening tests and feasibility of immuno-markers (p16 & Ki-67) as a primary screening tool. This was a cross-sectional analytical study. 100 patients were approached and agreed to participate in this study. They underwent cervical screening by multiple modalities including PAP smear, Liquid based cytology (LBC), HPV- DNA testing, cytology + HPV- DNA/p16/ Ki-67 and dual markers. Screening test results were compared with histopathology and statistical analysis done. The sensitivity and specificity of conventional cytology was 61.11% and 70%; LBC: 88.88% and 50%; Cytology + HPV DNA: 94.44% and 50%; Cytology + p16: 88.88% and 60%; Cytology + Ki-67: 88.88% and 100%; P16+Ki67: 88.88% and 60%. Combining Ki- 67 with Conventional cytology improved specificity and positive predictive value of cervical cancer screening.

Early warning of low maternal unconjugated estriol level by prenatal screening for fetus with X-linked ichthyosis / 中华妇产科杂志

Objective:To analyze the characteristic of prenatal serological screening in fetus with X-linked ichthyosis (XLI), and to explore the relationship between unconjugated estriol (uE 3) levels and XLI. Methods:A total of 56 fetuses with Xp22.31 microdeletion indicated by prenatal diagnosis and 70 fetuses diagnosed with trisomy 21 and 26 fetuses with trisomy 18 in Henan Provincial People's Hospital and Affiliated Hospital of Weifang Medical College from September 2016 to June 2021 were collected. The multiples of median (MoM) values of uE 3, alpha-fetoprotein (AFP), and human chorionic gonadotropin (hCG) during the second trimester of pregnancy were retrospectively analyzed. Prenatal diagnosis was made by amniotic fluid karyotype analysis and genome copy number variant analysis, parent genetic verification and pathogenicity analysis were performed, and maternal and infant outcomes were followed up. Results:Of 56 pregnant women with fetal Xp22.31 microdeletion, 43 underwent serological screening during the second trimester of pregnancy, of which 42 were abnormal (39 male fetuses and 3 female fetuses). The median uE 3 MoM value of 39 male fetuses [0.06 (0.00-0.21)] was lower than the normal value and significantly lower than that of fetuses with trisomy 21 [0.71 (0.26-1.27)] and fetuses with trisomy 18 [0.36 (0.15-0.84)], the difference was statistically significant ( Z=99.96, P<0.001). While the MoM values of AFP and hCG were all within the normal range. Among the 56 fetuses carrying Xp22.31 microdeletion, 45 were male fetuses and 11 were female fetuses, and the deletion fragments all involved STS gene. Eighty-nine percent (50/56) were inherited from mother (49 cases) or father (1 case), and 11% (6/56) were de novo mutations. Follow-up showed 48 live births (38 males and 10 females) and 8 chose to terminate pregnancy (7 males and 1 female). Among the 38 male newborns, 37 presented with scaly skin changes from 1 to 3 months of age, and one had no clinical manifestations until 4 months after birth. Ten female newborns had no obvious clinical manifestations. Conclusions:The decrease levels of uE 3 MoM on maternal serological screening is closely related to the higher risk of XLI in male fetuses. For pregnant women with low uE 3 in serological screening or with family history of ichthyosis, in addition to chromosomal karyotype analysis, joint detection of genomic copy number variant analysis should be recommended.

High-risk human papillomavirus testing as a primary screening for cervical cancer: position statement by the Korean Society of Obstetrics and Gynecology and the Korean Society of Gynecologic Oncology

Based on emerging data and current knowledge regarding high-risk human papillomavirus (hrHPV) testing as a primary screening for cervical cancer, the Korean Society of Obstetrics and Gynecology and the Korean Society of Gynecologic Oncology support the following scientific facts: • Compared to cytology, hrHPV screening has higher sensitivity and detects more cases of high-grade cervical intraepithelial neoplasia. • Qualified hrHPV testing can be considered as an alternative primary screening for cervical cancer to the current cytology method. • The starting age of primary hrHPV screening should not be before 25 years because of possible overtreatment in this age, which has a high human papillomavirus (HPV) prevalence but rarely progresses to cancer. The screening interval should be no sooner than every 3 years and no longer than every 5 years. • Before the introduction of hrHPV screening in Korea, research into comparative effectiveness of primary hrHPV screening for cervical cancer should be conducted to determine the appropriate HPV assay, starting age, and screening interval.

High-risk human papillomavirus testing as a primary screening for cervical cancer: position statement by the Korean Society of Obstetrics and Gynecology and the Korean Society of Gynecologic Oncology / 부인종양

Assessment of knowledge on non-communicable diseases and their screening tests among elderly population in an urban area of Bengaluru

Background: Non-communicable diseases (NCDs) are the leading cause of morbidity and premature mortality in most low and middle income countries (LMIC) around the world. Recent estimates shown that about 80% of NCDs deaths occur in LMIC and nearly three fourth of global NCDs related deaths take place after the age of 60. The knowledge of NCDs and their related screening tests among elderly is essential for early detection which reduces further development of the disease and its complications, thereby reducing the burden of health care cost. Hence, the present study was undertaken.Methods: A descriptive study was conducted among 245 study subject after obtaining informed consent. Using pre-tested structured questionnaire, information was collected regarding knowledge on NCDs and their screening tests. Results were entered in Microsoft excel and analyzed using descriptive statistics.Results: 81.6% of study subjects were aware of common NCDs. Off which only 02% were aware of 6 NCDs (out of 12 NCDs considered in this study). Regarding individual diseases, about 61.6% subjects were aware of Hypertension and 52.7% about DM. About knowledge of screening test, 69% were aware about any screening test and 58.8% were aware of screening test for hypertension and 41.6% for diabetes mellitus.Conclusions: The overall knowledge regarding NCDs and their screening tests is poor among elderly population.

A study of prevalence of asymptomatic bacteriuria in pregnant women from rural areas attending to Obstetric Department in Akash Hospital, Karnataka, India

Background: Asymptomatic bacteriuria (ASB) in pregnancy is a significant risk factor for developing upper urinary tract infection and pyelonephritis which is associated with significant maternal and fetal risks. The aim of this study was to know the prevalence of asymptomatic bacteriuria in pregnancy, to identify the organisms and their antibiotic susceptibility patterns and to formulate a single or combined rapid screening method as an acceptable alternative to urine culture.Methods: A total of 375 pregnant women aged between 18 to 45 years were included in this study. Clean catch mid-stream urine samples were collected. Screening tests done were gram staining of uncentrifuged urine, pus cell count, nitrite test and leukocyte esterase test. Identification of pathogens and antibiotic sensitivity tests were performed as per standard urine culture and sensitivity methods.Results: Out of the 375 pregnant women, 31 (8.4%) had significant bacteriuria. High percentage of women with ASB were primigravidas (51.38%) and in 2nd trimester (43.86%). The most common organism isolated was E.coli (56.14%). In screening tests, gram staining of uncentrifuged urine had a sensitivity of 85.71%. Sensitivity of 71.42% was found in Nitrite and leucocyte esterase tests. However, the combination of these two tests, with either test positive, showed sensitivity and negative predictive value of 90.47% and 99.09% respectively.Conclusions: Early detection and treatment of ASB in pregnancy can prevent complications. ASB can be identified by simple and combined rapid screening methods and urine culture along with antibiogram. Therefore, screening and treatment of ASB may be incorporated as routine antenatal care for safe motherhood and healthy newborn.

Awareness and practices of cervical cancer screening among women in Rajnandgaon district, central India: health education is the need of the hour

Background: Cervical cancer is a leading cause of morbidity and mortality among rural women in India. Early screening has been shown to be the most effective measure to prevent the disease. However, lack of awareness, lack of infrastructure, social stigma and fear are barriers to cervical cancer screening. The study was undertaken to assess the knowledge and practice among rural women regarding cervical cancer and screening tests with the aim of helping health professionals to revise policies and practices.Methods: It was a cross-sectional questionnaire-based study, conducted from January 2018 to September 2018 in the Department of Obstetrics and Gynecology at Government Medical College Rajnandgaon. A tertiary care hospital located in the southwest Chhattisgarh. A total of 506 women aged 21-65 years were included and assessed. Qualitative data were presented as frequencies and percentages by using SPSS version 21.Results: Of the total 506 respondents, 15.41 % had heard of cervical cancer, while 8.1% about cervical cancer screening. Unfortunately, only 1.2% women were ever been screened by Pap test. Although importance of screening had been thoroughly explained to the respondents, despite the fact only 57.1% showed willingness to undergo cervical cancer screening in the future. However, 63.9%women having gynecological complains were significantly associated with better attitude towards future cervical cancer screening than women without having gynaecological complains.Conclusions: Awareness and practice of the screening for cervical cancer was very poor in the rural population as well as in health care providers. Hence intensive health education is the need of the hour to change the scenario.

Serological response to Neospora caninum infection in goats and agreement between three diagnostic techniques to detect caprine neosporosis / Resposta sorológica à infecção por Neospora caninum em cabras e concordância entre três técnicas diagnósticas para detecção de neosporose caprina

The present study aimed to measure the serological response of goats infected with Neospora caninum by assessing the diagnostic performance and agreement between three techniques (indirect immunofluorescent antibody test, IFAT; Neospora agglutitation test, NAT; enzyme-linked immunosorbent assay, ELISA). The panel of sera were comprised of 500 samples of goats, and 60 reference serum samples. These reference and field serum samples were tested by ELISA, NAT, and IFAT. In the field serum samples tested, the seroprevalences of anti-N. caninum antibodies were 3.2%, 4.6%, and 6.4% in the NAT, IFAT and ELISA, respectively. Using the IFAT as the gold standard, the NAT and the ELISA agreement was considered weak (k=0.28) and strong (k=0.75), respectively. When the IFAT performance was used for comparison purposes, the ELISA showed 91.3% sensitivity and 97.7%, specificity with a PPV of 65.2% and a NPV of 99.6%; The NAT presented sensitivity of 26.1% and specificity of 97.9% with a PPV of 37.5% and a NPV of 96.5%. Accordingly, the IFAT should remain the assay of choice for studies about N. caninum infection in goats in individual serum samples. A combination of serological assays with high sensitivity and specificity is recommended in serosurveys of caprine neosporosis.(AU)

Objetivou-se avaliar a resposta sorológica de caprinos infectados com Neospora caninum mediante o estudo da performance e concordância de três técnicas sorológicas (RIFI, NAT e ELISA). O painel de soros testes foi composto por 500 amostras de caprinos e ainda 60 soros classificados como de referência. Todos os soros de referência e de campo foram testados por ELISA, NAT e RIFI. Nos soros de campo, as soroprevalências de anticorpos anti-N. caninum foram de 3,2% no NAT, 4,6% na RIFI e 6,4% no ELISA. Utilizando a RIFI como técnica de referência, a concordância de NAT e ELISA foi considerada fraca (k=0,28) e substancial (k=0,75), respectivamente. Ainda utilizando a RIFI como comparação, foram obtidos valores de sensibilidade de 91,3% e 97,7% de especificidade no ELISA, e valores preditivos positivo de 65,2% e negativo de 99,6%; NAT apresentou resultados de sensibilidade de 26,1% e de especificidade de 97,9% com valores preditivos positivo de 37,5% e negativo de 96,5%. Com base nos resultados deste trabalho, sugerimos que a RIFI permaneça como técnica de escolha no estudo da neosporose caprina em amostras individuais, resguardando as recomendações e pontos de corte adotados neste estudo. Indicamos a associação de técnicas sorológicas de alta sensibilidade e especificidade.(AU)

Update on the current modalities used to screen high risk youth for prediabetes and/or type 2 diabetes mellitus

The modalities currently employed to screen for type 2 diabetes mellitus (T2DM)/prediabetes are HbA1(c), fasting plasma glucose (FPG), and 2-hour plasma glucose (PG) during an oral glucose tolerance test (OGTT). The purpose of this review is to highlight the positive qualities and pitfalls of these diagnostic modalities and reflect on the most reasonable and effective approach to screen high risk youth. Given its inherent preanalytical advantages, glycated hemoglobin (HbA1(c)) continues to be the preferred diagnostic modality used by pediatricians to screen high risk youth. However, when the three aforementioned tests are performed in youths of different races/ethnicities, discrepant results for T2DM/prediabetes are observed. The prevalence rates for T2DM vary from 0.53% in Chinese youth (including youth of all body mass indexes) to 18.3% in high-risk, overweight, obese Korean youth. Moreover, the FPG is abnormal (>100 less than <126 mg/dL) in 15% of Korean youth versus 8.7% of Chinese youth. The prevalence rates for prediabetes are 1.49% in Chinese youth versus 21% in Emirati youth (HbA1(c), 5.7%–6.4%). The coefficient of agreement, k, between these screening tests for T2DM are fair, 0.45–0.5 across all youth. However, using HbA1(c) as a comparator, the agreement is weak with FPG (k=0.18 in German youth versus k=0.396 in Korean youth). The American Diabetes Association (ADA) Standards of Medical Care Guidelines define “high risk youth” who need to be tested for T2DM and/or prediabetes. OGTT and HbA1(c) do not always detect T2DM in similar individuals. HbA1(c) may not be an ideal test for screening Hispanic and African American youth. FPG and OGTT are suitable screening tests for youth of ethnic minorities and those with cystic fibrosis or hemoglobinopathies. Performing all three tests either together or sequentially may be the only way to encompass all youth who have aberrations in different aspects of glucose homeostasis.

Factors Related to Noncompliance in Screening and Tracking Mild Cognitive Impairment Patients in a Single Community

OBJECTIVE: We assessed the cumulative conversion rates (CCR) from minor cognitive impairment (MCI) to dementia among individuals who failed to participate in annual screening for dementia. Additionally, we analyzed the reasons for failing to receive follow-up screening in order to develop better strategies for improving follow-up screening rates. METHODS: We contacted MCI patients who had not visited the Dongdaemun-gu Center for Dementia for annual screening during the year following their registration. We compared the CCR from MCI to dementia in the following two groups: subjects registered as having MCI in the Dongdaemun-gu Center for Dementia database and subjects who failed to revisit the center, but who participated in a screening test for dementia after being contacted. The latter participants completed a questionnaire asking reasons for not previously visiting for follow-up screening. RESULTS: The final diagnoses of the 188 subjects who revisited the center only after contact were 19.1% normal, 64.9% MCI and 16.0% dementia. The final diagnoses of the 449 subjects in the Dongdaemun-gu Center for Dementia database were 25.6% normal, 46.1% MCI and 28.3% dementia. The CCR of the revisit-after-contact group was much lower than anticipated. The leading cause for noncompliance was “no need for tests” at 28.2%, followed by “other reasons” at 23.9%, and “I forgot the appointment date” at 19.7%. CONCLUSION: Considering the low dementia detection rate of the group who revisited only after contact and the reasons they gave for noncompliance, there appears to be a need for ongoing outreach and education regarding the course and prognosis of MCI.

La medicina de óptima calidad (MOC) en Colombia. Los internistas debemos abrir el camino / High value care (HVC) in Colombia. Internists must set the path

Resumen En muchos países existe evidencia de un creciente aumento del gasto en salud. Se estima que hasta 30% del mismo es innecesario y representa por lo tanto despilfarro de recursos. Una gran parte de ese despilfarro corresponde a la sobreutilización de pruebas de laboratorio e imágenes diagnósticas que no agregan calidad a la atención de los pacientes. Se considera que para que una intervención en salud sea de calidad para el paciente, su beneficio neto debe ser superior a la suma de sus costos (directos y los denominados "cascada abajo") y los daños que pueda ocasionar. En un intento por reducir el desperdicio en salud, buena parte del cual depende de los profesionales de la salud, varias organizaciones internacionales han desarrollado estrategias para identificar aquellas pruebas diagnósticas que no agregan valor a la atención de los pacientes, independientemente de su costo. Campañas como "Choosing Wisely" del American Board of Internal Medicine (ABIM) y "High-value, cost-conscious care" del American College of Physicians y la Alianza para la Medicina Interna Académica (AAIM por sus siglas en inglés) promueven la identificación, en el interior de las diferentes especialidades médicas y quirúrgicas, de las cinco pruebas diagnósticas que son más frecuentemente ordenadas por sus médicos, pero que se consideran no agregan calidad a la atención del paciente y que por lo tanto deben ser desaconsejadas. Estas pruebas así identificadas se conocen como las "top 5". También los pacientes deben estar involucrados y ser informados acerca del poco o ningún valor que estas pruebas representan para su atención. En Colombia el Capítulo Colombia del American College of Physicians (ACP) ha conformado un grupo de trabajo de medicina de óptima calidad (MOC), como se ha denominado la iniciativa en nuestro país, encargado de su difusión entre las diferentes sociedades científicas e instituciones académicas a nivel de pre y posgrado. Bajo la consideración que los médicos internistas deben liderar esta iniciativa en Colombia, se trabaja ya en la metodología más apropiada que permitirá identificar un primer grupo de pruebas diagnósticas propias de la medicina interna que se consideran de poco valor (calidad) en nuestro medio. (Acta Med Colomb 2016; 41: 191-197).

Abstract In many countries there is evidence of increasing health spending. It is estimated that up to 30% of it is unnecessary and therefore represents waste of resources. A great part of this waste corresponds to over-use of laboratory tests and diagnostic images that do not add quality to patient care. It is considered that in order that a health intervention may be of quality for the patient, its net benefit must be greater than the sum of its costs (direct and so-called "down stream") and the damage it net benefit may cause. In an attempt to reduce waste in health, large part of which depends on the health professionals, several international organizations have developed strategies to identify those diagnostic tests that do not add value to patient care, regardless of cost. Campaigns like "Choosing Wisely" from the American Board of Internal Medicine (ABIM) and "High-value, cost-conscious care" of the American College of Physicians and the Alliance for the Academic Internal Medicine (AAIM for its acronym in English) promote identification of the 5 diagnostic tests that are more frequently ordered by their doctors within the different medical and surgical specialties, but that are considered not to add value to patient care and therefore should be discouraged. These tests thus identified are known as the "top 5". Patients should also be involved and informed of the little or no value that these tests represent for their health care. In our country, the Colombia Chapter of the American College of Physicians (ACP) has formed a working group of medical optimal quality (MOC), as the initiative has been named in our country, responsible for its dissemination among different scientific societies and academic institutions at pre-and postgraduate level. Under the consideration that internal medicine physicians must lead this initiative in Colombia, work is being done on the most appropriate methodology that will allow identify a first group of diagnostic tests characteristic of Internal Medicine that are considered of little value (quality) in our environment. (Acta Med Colomb 2016; 41: 191-197).

Evaluation of child development: beyond the neuromotor aspect / Avaliação do desenvolvimento infantil: além do neuromotor

Abstract Objective: To review the epidemiology and update the scientific knowledge on the problems of development and behavior in childhood, and the recommendations for the role of the pediatrician in identifying and managing delays and disturbances in child development and mental health. Sources: A search for relevant literature was performed in the PubMed and Scopus databases and publications of the National Scientific Council on the Developing Child. Summary of the findings: With the decline in the incidence of communicable diseases in children, problems with development, behavior, and emotional regulation are increasingly becoming a part of the work of pediatricians, yet many are not trained and feel uncomfortable about this extension of their role. The available screening tools for child development and behavior are reviewed, and a ‘school readiness’ checklist is presented, together with recommendations on how the pediatrician can incorporate developmental surveillance into routine practice, aware of the need for children to acquire social, emotional, and cognitive skills so that they can develop their full potential. Conclusions: The pediatrician's role in the future will include both physical and mental health, recognizing that social development, resilience, and emotional maturity are as important as physical growth and neuromotor skills in a child's life course.

Resumo Objetivo: Revisar a epidemiologia e atualizar os conhecimentos científicos sobre os problemas do desenvolvimento e do comportamento na infância e das recomendações do papel do pediatra na identificação e conduta frente aos transtornos da saúde mental infantil. Fontes de dados: Pesquisamos a literatura relevante nas bases de dados PubMed e Scopus e em publicações do National Scientific Council on the Developing Child. Síntese dos dados: Com o declínio na incidência de doenças transmissíveis em crianças, problemas do desenvolvimento, comportamento e regulação emocional fazem cada vez mais parte do trabalho do pediatra, mas muitos ainda não estão treinados e se sentem desconfortáveis com essa extensão do seu papel. Os instrumentos de triagem do desenvolvimento e comportamento foram revisados e uma lista de verificação da “prontidão escolar” foi apresentada, juntamente com orientações sobre como o pediatra pode incorporar a vigilância da saúde mental em sua de rotina de atendimento, consciente da necessidade da aquisição das habilidades sociais, emocionais e cognitivas para que a criança possa desenvolver toda sua potencialidade. Conclusões: O papel do pediatra no futuro irá abranger tanto a saúde física quanto a mental e reconhecer que o desenvolvimento social, a resiliência e o amadurecimento emocional são tão importantes quanto o crescimento físico e as habilidades neuromotoras no curso da vida de uma criança.

Single-center experience of the Korean-Developmental Screening Test for infants and children / 소아과

PURPOSE: We investigated the number of test takers of the Korean-Developmental Screening Test (K-DST) in a single children's hospital within a year, according to age, referral rate, and follow-up percentage. METHODS: For this study, 4,062 children who visited and received K-DST at Woorisoa Children's Hospital between January and December 2015 were enrolled. Seven test sets were used according to the Korean National Health Screening Program for infants and children in the following age groups: 4 to 6, 9 to 12, 18 to 24, 30 to 36, 42 to 48, 54 to 60, and 66 to 71 months. The results of the K-DST were categorized into 4 groups as follows: further evaluation (1SD). RESULTS: The test participants' population and follow-up population were concentrated before the age of 24 months (2,532, 62.3%). The children most commonly referred for further evaluation were those in the 30- to 41-month age group. A mismatch was found between the results of the K-DST and the additional questions. Most of the infants and children with suspicious developmental delays showed catch-up development in their follow-up tests (43 of 55, 78.2%). CONCLUSION: The use of K-DST should be encouraged, especially among children aged over 24 months. Multiple-choice question format for the additional questions is recommended to avoid confusion. We suggest a nationwide study to evaluate and revise the K-DST.

Office-Based Olfaction Assessment.

A simple assessment of olfactory acuity is essential and can play a vital role in patient care and quality-of-life parameters. Any process that interferes with the physiologic environment of the nasal mucosa can be associated with restricted olfaction. Studies have examined how the human sense of smell likely integrates information from complex arrays of odorant chemicals that, individually, would seem to produce conflicting odorous sensations. “Scratch and sniff” format screening tests are readily available and have been standardized for age, gender, and ethnicity. It is important to identify a scent that can be used as in an initial olfactory test If a patient cannot identify this scent, they should take further diagnostic testing. In this review, we give some essential information on office-based olfaction assessment and attempt to cover important aspects of the evaluation, especially from a clinical perspective.

Association Between Overactive Bladder and Polyneuropathy in Diabetic Patients / 대한배뇨장애요실금학회지

PURPOSE: Diabetes mellitus (DM) is a chronic metabolic disorder that often leads to complications. We aimed to correlate two complications of DM, polyneuropathy and hyperactive bladder syndrome, using noninvasive measures, such as screening tests. METHODS: We included 80 female and 40 male type 2 diabetic patients in this prospective study. Diabetic polyneuropathy evaluations were conducted using the Douleur Neuropathique 4 Questions (DN4), and overactive bladder (OAB) evaluations were performed using the Overactive Bladder Questionnaire (OAB-V8). The patients were also evaluated for retinopathy and nephropathy. The diabetic male and female patients with or without OAB were chosen and compared for microvascular complications (polyneuropathy, retinopathy, and nephropathy). RESULTS: There were no significant correlations between OAB and retinopathy as well as between OAB and nephropathy among diabetic patients (female patients, P>0.05; male patients, P>0.05). However, the patients with OAB were significantly more likely to develop polyneuropathy (female patients, P<0.05; male patients, P<0.05). CONCLUSIONS: In diabetic patients, OAB and diabetic peripheral neuropathy are significantly correlated. These correlations were demonstrated using short, understandable, valid, and reliable disease-specific tests without invasive measures. Using these screening tests, both neurologists and urologists can easily diagnose these complications.

Management of syphilis in pregnant womenand their newborns: is it still a problem? / Manejo de sífilis em gestantes e seus recém-nascidos: ainda um problema?

A sífilis congênita (SC) é um agravo prevenível, mas o Brasil ainda apresenta alta prevalência da doença, com consequente morbimortalidade perinatal. Objetivo: Avaliar a abordagem de sífilis em gestantes e seus recém-nascidos encaminhados para centro de referência. Métodos: Estudo transversal, de março de 2012 a abril de 2013. A coleta de dados foi realizada em prontuários de pacientes referenciados com SC, considerando critérios estabelecidos pelo Ministério da Saúde (MS). Os dados foram analisados pelo Statistical Package for the Social Sciences (SPSS) e o estudo foi aprovado pelo Comitê de Ética. Resultados: Um total de 31 recém-nascidos foi encaminhado devido à triagem materna com Venereal Disease Research Laboratory(VDRL) materno positivo durante a gestação, com 4 mulheres adequadamente tratadas. Treze recém-nascidos apresentaram alteração no hemograma e1 apresentou alteração óssea, 28 deles com tratamento adequado. Discussão: Quando se considera adequação de tratamento de acordo com as diretrizes nacionais, poucos casos de sífilis na gestação são considerados adequadamente tratados. Isso impacta na assistência ao recém-nascido, que, muitas vezes,é submetido a propedêutica invasiva e tratamento extenso, embora na maioria das vezes seja assintomático. Conclusão: O seguimento das recomendações para o tratamento da sífilis na gestante tem sido, frequentemente, considerado inadequado, o que dificulta a eliminação da SC.

Congenital syphilis (CS) is a preventable disease, but its prevalence is still high in Brazil, with consequent perinatal morbidity and mortality.Objective: To evaluate the approach of syphilis in pregnant women and their newborns referred to the referral center of Orestes Diniz, in Belo Horizonte.Methods: A cross-sectional study was carried out from March 2012 to April 2013. Data collection was performed on the medical records of patients referred with CS, considering the criteria established by the Ministry of Health. Data were analyzed using SPSS and the study was approved by the Ethics Committee. Results: A total of 31 newborns were referred due to a positive result in maternal testing with Venereal Disease Research Laboratory during pregnancy. However, only four women have been adequately treated in accordance with the Ministry of Health. Thirteen newborns presented alterations inblood cells count, one had bone rarefactions, and 28 presented proper information of treatment. Discussion: When considering the adequacy of treatmenta ccording to the national guidelines, few cases of syphilis during pregnancy can be considered adequately treated. This affects the assistance to the newborn,who is often subjected to invasive investigation and extensive treatment, although most are asymptomatic. Conclusion: The follow-up of recommendations for the treatment of syphilis in pregnant women has often been considered inadequate, making CS difficult to eliminate

Comparative evaluation of screening tests for maternal and fetal outcome in gestational diabetes.

Background: We aimed to evaluate the predictive value of two screening tests - 50 gm GCT and 75 gm GTT for adverse maternal and fetal outcome in patients with gestational diabetes mellitus. Methods: This was a prospective study of 200 antenatal women booked at tertiary care hospital Delhi during the year 2010-2012. Pregnant females at 24-28 weeks gestation were randomly selected and subjected to 50 gm GCT and 75 gm GTT. The women’s history, clinical examination recorded, 50 gm GCT and 75 gm GTT values recorded and the two tests were compared for maternal and fetal outcome. Results: 75 gm GTT had higher specificity, positive and negative predictive values as compared to 50 gm GCT for both maternal and fetal outcome. However 50 gm GCT was more sensitive for predicting maternal and fetal complications. Conclusions: 75 gm GTT is better than 50 gm GCT for predicting adverse maternal and perinatal outcome in gestational diabetic patients.

Is the Mattis Dementia Rating Scale appropriate to detect mild cognitive impairment? / ¿Es la Escala de Demencia de Mattis adecuada para detectar deterioro cognitivo leve?

Algunos estudios han intentado evaluar la capacidad de la Escala de Demencia de Mattis (MDRS) para detectar demencia incipiente o Deterioro Cognitivo Leve(DCL), pero los resultados no son claros. El objetivo de este estudio fue evaluar la sensibilidad y especificidad de la MDRS para detectar DCL, y localizar el puntaje de corte más adecuado para la población local. Metodología. Una batería neuropsicológica que incluyó la MDRS fue aplicada a 60 adultos mayores de ambos sexos (edad media=68.38, DE=6.80) en Córdoba, Argentina, quienes fueron clasificados según su estado cognitivo en “Normales” (34 casos) o “DCL” (26 casos) según su desempeño en la batería neuropsicológica administrada, excluyendo la puntuación en la MDRS. El criterio empleado fue el de la Sociedad Española de Neurología. Se realizaron comparaciones de medias y un análisis de regresión logística para evaluar la capacidad del MDRS para diferenciar ambos grupos y localizar el puntaje de corte. Resultados. Aunque la MDRS diferenció ambos grupos a partir de la media (p=.004), la precisión diagnóstica fue sólo del 63 por ciento al utilizar un puntaje de corte total de 133. La sensibilidad fue del 42 por ciento y la especificidad fue del 79 por ciento. Conclusiones. El MDRS no parece ser una herramienta útil para detectar DCL, ya que presenta numerosos casos mal clasificados. El desarrollo de herramientas más adecuado para detectar DCL resulta fundamental...

Some studies have tried to assess the Mattis Dementia Rating Scale (MDRS) capability to detect incipient dementia or Mild Cognitive Impairment (MCI), but the results are not clear. The aim of this research was to evaluate the sensitivity and specificity of the MDRS, and to localize the optimal cutoff score for MCI. Methodology. A neuropsychological battery that included the MDRS was administered to 60 older adults of both genders (Mean age=68.38, SD=6.80) in Córdoba, Argentina, who were then classified as “Control” (34 cases) or “MCI” (26 cases) according to performance in the neuropsychological evaluation, excluding the MDRS. The criteria used were those stated by the Sociedad Española de Neurología. We performed mean comparisons in order to evaluate if the MDRS was able to detect the group differences. Then, a logistic regression with the MDRS total score as the predictor variable and the group as the criterion variable was performed to determine the cutoff score. Results. Even though the mean comparisons showed a significant difference in the MDRS (p=.004), the diagnostic accuracy was only 63 percent with a 133 points cutoff score. The sensitivity was 42 percent and the specificity was 79 percent. Conclusions. The MDRS does not seem to be a useful tool to detect MCI since it generates numerous misclassified cases. The development of more accurate tools becomes fundamental in order to detect MCI...

Non-invasive prenatal test using cell free DNA

Although conventional prenatal screening tests for Down syndrome have been developed over the past 20 years, the positive predictive value of these tests is around 5%. Through these tests, many pregnant women have taken invasive tests including chorionic villi sampling and amniocentesis for confirming Down syndrome. Invasive test carries the risk of fetal loss at a low but significant rate. There is a large amount of evidence that non-invasive prenatal test (NIPT) using cell free DNA in maternal serum is more sensitive and specific than conventional maternal serum and/or ultrasound screening. Therefore implementing NIPT will increase aneuploidy detection rate and concurrently decrease fetal loss rate accompanying invasive test. More than 1,000,000 NIPT were performed globally since 2011. The uptake rate of NIPT is expected to increase more rapidly in the future. Moreover, as a molecular genetic technique advances, NIPT can be used for not only common aneuploidy screening but single gene disorder, microdeletion, and whole fetal genome sequencing. In this review, I will focus on the NIPT for common aneuploidies such as trisomy 13, 18, and 21.