Utilidad diagnóstica de la audiometría de alta frecuencia en sujetos expuestos a ruido recreacional / Diagnostic utility of high frequency audiometry in subjects exposed to recreational noise

INTRODUCCIÓN: Recientes investigaciones mencionan que, debido a los altos niveles de ruidos, el 75% de los habitantes en las ciudades industrializadas padecen algún tipo de deficiencia auditiva. La audiometría de alta frecuencia es un examen complementario importante para detectar tempranamente la pérdida de audición. OBJETIVO: Determinar la utilidad diagnóstica de la audiometría de alta frecuencia en la detección temprana de la hipoacusia en sujetos expuestos a ruido recreacional. MATERIAL Y MÉTODO: Estudio analítico de corte transversal. Se evaluaron 87 estudiantes de fonoaudiología. Se aplicó una audiometría convencional y de alta frecuencia mediante audiómetro clínico. RESULTADOS: La audiometría de alta frecuencia presenta una sensibilidad del 100%, especificidad del 64,60%. El valor predictivo (+) es de 14,70%, mientras que el valor predictivo (-) es del 100%. La razón de verosimilitud (+) es de 2,28, y para la razón de verosimilitud (-) es de 0,0. CONCLUSIÓN: La audiometría de alta frecuencia puede ser utilizada para monitorizar la audición de los sujetos, comprobando que efectivamente los umbrales auditivos de alta frecuencia se encuentren dentro de rangos normales. Lo anterior, dado por sus valores de sensibilidad, valor predictivo negativo, razón de verosimilitud negativa y por el aumento entre la probabilidad preprueba y posprueba.

INTRODUCTION: Recent research mentions that, due to the high noise levels, 75% of the habitants in industrialized cities suffer from some type of hearing impairment. High frequency audiometry is an important complementary test to detect early hearing loss. AIM: To determine the diagnostic utility of high frequency audiometry in the early detection of hearing loss in subjects exposed to recreational noise. MATERIAL AND METHODS: Study analytical type and cross section. 87 speech therapy students were evaluated. A conventional and high frequency audiometry was applied, using a clinical audiometer. RESULTS: High frequency audiometry has a sensitivity of 100%, specificity of 64,60%. The predictive value (+) is 14,70%, while the predictive value (-) is 100%. The likelihood ratio (+) is 2,28, and for the likelihood ratio (-) it is 0,0. CONCLUSION: High frequency audiometry can be used to monitor the hearing of the subjects, checking that effectively the high frequency hearing thresholds are within normal ranges. The above, given by their values of sensitivity, negative predictive value, negative likelihood ratio and the increase between the pre-test probability and the posttest probability.

Discriminative validity of an abbreviated Semantic Verbal Fluency Test / Validade discriminativa de um teste abreviado de Fluência Verbal Semântica

ABSTRACT. Semantic verbal fluency (SVF) is one of the most widely used tests for cognitive assessment due to its diagnostic utility (DU). Objective: our objective is to evaluate the DU to detect cognitive impairment (CI) of a short version of the SVF applied in 30 seconds (SVF1-30). Methods: a prospective sample of consecutive patients evaluated in a Neurology Unit between December 2016 and December 2017 were assessed with the Global Deterioration Scale (GDS), 30-second and 60-second SVF tests (animals), and the Fototest, which includes a fluency task of people's names. The DU for CI was evaluated by the area under the ROC curve and effect size ("d" Cohen). Results: the study included 1012 patients (256 with CI, 395 with dementia). SVF1-30 shows a good correlation with GDS stage. The DU of SVF1-30 is identical to that of the classical version, applied in 60 seconds, (SVFtotal) for CI (0.89 ± 0.01; p > 0.50), and shows no significant difference for dementia (0.85 ± 0.01 vs. 0.86 ± 0.01, p > 0.15). Discussion: the DU of SVF1-30 is similar to that of the SVFtotal, allowing a reduction in examination time with no loss of discriminative capacity.

RESUMO. A fluência verbal semântica (SVF) é um dos testes mais utilizados na avaliação cognitiva devido à sua utilidade diagnóstica (UD). Objetivo: Nosso objetivo foi o de avaliar o DU de uma versão abreviada do SVF aplicado em 30 segundos (SVF1-30) para a detecção do comprometimento cognitivo (CC). Métodos: Amostra prospectiva de pacientes avaliados em uma Unidade de Neurologia entre dezembro de 2016 e dezembro de 2017. Global Deterioration Scale (GDS), um teste de SVF (animais), registrando os resultados em 30 e 60 segundos e Fototest, que inclui uma tarefa de fluência de nomes de pessoas foram aplicadas. A UD para CC foi avaliada pela área sob a curva ROC e o tamanho do efeito ("d" Cohen). Resultados: foram incluídos 1012 sujeitos (256 CC e 395 demência). O SVF1-30 mostrou uma boa correlação com o estágio GDS. A UD de SVF1-30 é idêntico ao da versão clássica (SVFtotal) para CC (0,89 ± 0,01; p > 0,50) e sem diferença significativa para demência (0,85 ± 0,01 vs. 0,86 ± 0,01; p > 0,15). Discussão: a UD do SVF1-30 é similar ao SVFtotal, o que permite diminuir o tempo de exploração sem perder a capacidade discriminativa.

Chromosomal Microarray With Clinical Diagnostic Utility in Children With Developmental Delay or Intellectual Disability

BACKGROUND: Chromosomal microarray (CMA) testing is a first-tier test for patients with developmental delay, autism, or congenital anomalies. It increases diagnostic yield for patients with developmental delay or intellectual disability. In some countries, including Korea, CMA testing is not yet implemented in clinical practice. We assessed the diagnostic utility of CMA testing in a large cohort of patients with developmental delay or intellectual disability in Korea. METHODS: We conducted a genome-wide microarray analysis of 649 consecutive patients with developmental delay or intellectual disability at the Seoul National University Children's Hospital. Medical records were reviewed retrospectively. Pathogenicity of detected copy number variations (CNVs) was evaluated by referencing previous reports or parental testing using FISH or quantitative PCR. RESULTS: We found 110 patients to have pathogenic CNVs, which included 100 deletions and 31 duplications of 270 kb to 30 Mb. The diagnostic yield was 16.9%, demonstrating the diagnostic utility of CMA testing in clinic. Parental testing was performed in 66 patients, 86.4% of which carried de novo CNVs. In eight patients, pathogenic CNVs were inherited from healthy parents with a balanced translocation, and genetic counseling was provided to these families. We verified five rarely reported deletions on 2p21p16.3, 3p21.31, 10p11.22, 14q24.2, and 21q22.13. CONCLUSIONS: This study demonstrated the clinical utility of CMA testing in the genetic diagnosis of patients with developmental delay or intellectual disability. CMA testing should be included as a clinical diagnostic test for all children with developmental delay or intellectual disability.

Diagnostic utility of an immunochromatography test for the detection of Leptospira IgM antibodies in domestic dogs

A cross-sectional study using 99 serum samples of dogs from southern Chile was conducted to determine the diagnostic utility of a rapid immunochromatography assay for the detection of Leptospira specific IgM antibodies as screening test and as a potential aid in the diagnosis of leptospirosis in animals with and without clinical suspicion of the disease. The Microscopic Agglutination Test (MAT) was used as reference assay. Anti-Leptospira antibodies were detected in 37.3% of the dogs with MAT. Using the immunochromatography test, specific IgM antibodies were found in 13.1% of sampled dogs. The sensitivity of the rapid test as screening assay was 29.7% (95% Confidence Interval=16.4-47.2) and the specificity was 96.7% (95% Confidence Interval=87.8-99.4). 40.0% of the canines with clinical suspicion of leptospirosis and 37.1% of dogs without clinical signs were serological reactors to MAT, but none of MAT reactive dogs with clinical suspicion tested positive in the rapid test. Rapid and user-friendly diagnostic procedures for canine leptospirosis such as this immunochromatography assay could be important tools to use in clinical practice, however, further studies are needed to obtain more information about their utility, considering that diagnostic tests could not have similar performances in different geographic locations, clinical and epidemiological contexts.(AU)

Prevalencia de infecciones oportunistas en pacientes con VIH-SIDA con base en el estudio microscópico de médula ósea / Prevalence of opportunistic infections in HIV-AIDS patients based on microscopic examination of bone marrow

Introducción: la utilidad diagnóstica del estudio de médula ósea en pacientes con VIH ha sido evaluada en pocos estudios en Latinoamérica. Se desconoce la frecuencia con la que este estudio aporta a la identificación de infecciones oportunistas en nuestro medio. Diseño: estudio analítico de corte transversal. Métodos: revisión retrospectiva de historias clínicas de pacientes VIH-SIDA, hospitalizados en el Hospital Universitario de Santander entre 2009 y 2012, quienes fueron sometidos a estudio de médula ósea para evaluar citopenias. Se excluyeron casos con historia de neoplasia y quimioterapia tres meses antes del aspirado. Se calculó tamaño de muestra para evaluación de asociaciones. Resultados: se evaluaron 92 muestras de médula ósea de 83 pacientes, encontrando una prevalencia de infección oportunista de 23% con examen directo y 34.5% cuando se realizaron cultivos. La histoplasmosis fue la infección más frecuente 20.6%, seguida de Mycobacterias 10.8%e infección por Criptococcus spp 3.2%. La clínica hematológica que predominó en casos positivos para oportunista fue pancitopenia febril en 41% y monocitopenia en 32%. La deshidrogenasa láctica ≥ 600 UI/dL, se asoció con un diagnóstico positivo para infección oportunista en el estudio microscópico de médula ósea, con OR 5.42 (IC95% 1.09-26.9 p =0.03). Conclusión: el estudio de médula ósea en los pacientes con VIH-SIDA permitió un diagnóstico de infección oportunista en una cuarta parte de los casos, siendo especialmente útil para la identificación temprana de histoplasmosis. Se requieren estudios para evaluar el impacto en estancia hospitalaria, desenlaces clínicos y costos del uso de este examen de forma temprana en el abordaje de pacientes VIH hospitalizados en medicina interna. (Acta Med Colomb 2015; 40: 93-100).

Introduction: the diagnostic utility of the study of bone marrow in patients with HIV has been evaluated in a few studies in Latin America. The frequency with which this study contributes to the identification of opportunists in our country is unknown. Design: Analytical cross-sectional study. Methods: a retrospective review of medical records of HIV-AIDS patients hospitalized at the University Hospital of Santander between 2009 and 2012 who underwent bone marrow study to evaluate cytopenia. Cases with a history of malignancy and chemotherapy three months before vacuuming were excluded. Sample size for evaluation of partnerships was calculated. Results: 92 samples of bone marrow of 83 patients were evaluated, finding a prevalence of opportunistic infection in 23% with direct examination and 34.5% when cultures were performed. Histoplasmosis was the most common infection with 20.6%, followed by 10.8% Mycobacteria and Cryptococcus spp infection 3.2%. The hematologic clinic that prevailed in the positive cases for opportunist was pancitopenia febril (in 41% of the cases) and monocitopenia (in 32% of the cases). The LDH ≥ 600 IU / dL was associated with a positive diagnosis for opportunistic infection in the microscopic study of bone marrow, with OR 5.42 (95% CI 1.09-26.9 p = 0.03). Conclusion: the study of bone marrow in patients with HIV-AIDS allowed a diagnosis of opportunistic infection in a quarter of cases, and is especially useful for early identification of histoplasmosis. Studies to assess the impact on hospital stay, clinical outcomes and costs of using this test early in the approach to HIV patients hospitalized in Internal Medicine are required. (Acta Med Colomb 2015; 40: 93-100).

Utilidad clínica del Memory Impairment Screen (MIS): análisis del instrumento como prueba de tamizaje de memoria / Clinical utility of Memory Impairment Screen (MIS): analysis of the instrument as a screening test memory

Introducción. Se ha insistido en la necesidad de seleccionar apropiadamente las pruebas neuropsicológicas más sencillas y precisas en el diagnóstico precoz de deterioro cognitivo y demencia. Objetivo. Comparar la utilidad clínica del MIS (Memory Impairment Screen) con otras pruebas breves de cribado cognitivo en una población mayor de 60 años que consultó específicamente por quejas de memoria. Pacientes y Método. Estudio prospectivo, muestra de 142 pacientes mayores de 60 años, derivados a evaluación neuropsicológica por quejas de memoria al policlínico de Neuropsicología de la Sección de Geriatría del Hospital Clínico de la Universidad Chile. Se aplicaron MIS, Mini-Cog, Test del Reloj (CDT) y Recuerdo libre y selectivamente facilitado (FCSRT). La validez de MIS,Mini-Cog y CDT fue evaluada contra FCSRT como gold standard. Resultados. El 70.4 por ciento eran mujeres, con promedios de edad 75.9+/-7 años, escolaridad 9.5+/-4.7 años y MMSE (Mini Mental State Examination) 25+/-3.7 puntos. MIS presentó los valores más altos de sensibilidad (82 por ciento), especificidad (75 por ciento), Valor Predictivo Positivo (61 por ciento) y Valor Predictivo Negativo (90 por ciento). En un 31.7 por ciento de los pacientes se detectó deterioro según FCSRT, mientras que con MIS fue de 43 por ciento, Mini-Cog 47.2 por ciento y CDT 45.2 por ciento. Por otra parte, el 35.6 por ciento de los pacientes con déficit de memoria según MIS serían falsos positivos, es decir, fueron incorrectamente diagnosticados como sanos. Conclusiones: La detección precoz del déficit de memoria mediante el MIS sería superior a otras pruebas simples de tamizaje, sin embargo FCSRT permite optimizar la evaluación de la memoria constituyendo un instrumento clínico que no podría ser sustituido por MIS.

Introduction. It has emphasized the need for appropriately selected neuropsychological testing simple and accurate early diagnosis of cognitive impairment and dementia. Objective. To compare the clinical utility of MIS (Memory Impairment Screen) with other brief cognitive screening test in a population older than 60 years who consulted specifically for memory complaints. Patients and Method. Prospective study sample of 142 patients over 60 years, referred for neuropsychological assessment of memory complaints to the polyclinic of Neuropsychology, Section of Geriatric Hospital of the University of Chile. MIS were applied, Mini-Cog, Clock Test (CDT) and selectively facilitated free recall (FCSRT). The validity of MIS, Mini-Cog and CDT was evaluated against FCSRT as gold standard. Results. 70.4 percent were women, with mean age 75.9 +/- 7 years, education 9.5 +/- 4.7 years and MMSE (Mini Mental State Examination) 25 +/- 3.7 points. MY presented the highest values of sensitivity (82 percent, specificity (75 percent), positive predictive value (61 percent) and negative predictive value (90 percent). In 31.7 percent of patients according FCSRT deterioration detected while MIS was 43 percent, Mini-Cog CDT 47.2 percent and 45.2 percent. On the other hand, 35.6 percent of patients with memory deficits as MIS would be false positives, ie, were incorrectly diagnosed as healthy. Conclusions. The early detection of memory deficits by MIS would be simpler than other screening tests, however FCSRT optimizes memory assessment forming a clinical instrument that could not be replaced by MIS.

Development and Validation of a Screening Scale for Depression in Korea: The Lee and Rhee Depression Scale

OBJECTIVE: The aim of this study was to develop a culturally sensitive instrument that addressed how individuals express and experience depression to detect this disorder in Koreans. We also assessed the validity, reliability, and diagnostic utility of this scale (Lee and Rhee Depression Scale; LRDS). METHODS: The sample consisted of 3,697 normal adults selected from 12 administrative districts (Do) and 448 Korean patients diagnosed with depression using the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). Reliability was calculated using Cronbach's alpha. Construct validity, discriminant validity, and concurrent validity were also measured. Receiver-operator-characteristic (ROC) analysis was employed to evaluate diagnostic efficiency. RESULTS: The LRDS was found to be a reliable instrument (Cronbach's alpha=0.95) consisting of six factors: negative thinking about the future, negative thinking about the self, worry and agitation, depressed mood, somatization, and loss of volition. Comparison of LRDS scores discriminated the group of patients with depression from the normal individuals in the control group. The measure showed good concurrent validity in that scores were significantly and strongly correlated with scores on established scales such as the Beck Depression Inventory (BDI), the Hamilton Depression Rating Scale (HAM-D), and the D scale of the Minnesota Multiphasic Personality Inventory-second edition (MMPI-2). Diagnostic efficiency was 77.7%, and the cut-off scores were 65 for males and 70 for females. CONCLUSION: To our knowledge, this is the first study to develop a depression-screening scale on the basis of Korean patients' complaints about the disorder. As a culturally sensitive tool, the LRDS will be useful in clinical and research settings in Korea.