ABSTRACT
AIM: The aim of our study was to compare the potential usefulness of procalcitonin with the CRP as a diagnostic marker of pediatric diseases and to define the diagnostic accuracy and relation with the inflammation etiology and severity of procalcitonin. METHODS: The analysis focused on a sample of 141 children, hospitalized for fever with bacterial, viral or inflammatory etiology, studied at the time of admission in the Hospital, and after defervescence. The sensitivity, the specificity, the positive and negative predictive value have been calculated for the both tests, explained above. RESULTS: The diagnostic accuracy of procalcitonin is the same as the one of PCR in all cases. The result of the test has been positive in 85.7% of the serious infections and has been useful to identify the etiology of infections in almost 2/3 of patients. CONCLUSION: Procalcitonin seems to be a promising marker of infections because of its following features: a larger contribution in the monitoring phase (fast positivization and normalization); the diagnostic accuracy and a good correlation with the etiology and the severity of infections. Nonetheless, the routine use of procalcitonin is not recommended in the light of the uncertainty on the optimal cut-off and the still high costs.
Subject(s)
C-Reactive Protein/analysis , Calcitonin/blood , Inflammation/blood , Inflammation/diagnosis , Protein Precursors/blood , Adolescent , Biomarkers/blood , Calcitonin Gene-Related Peptide , Child , Child, Preschool , Female , Humans , Infant , Inflammation/microbiology , MaleABSTRACT
Many cases of coeliac disease are currently undiagnosed. We carried out a pilot study on screening for coeliac disease in a school population. The screening protocol consisted of three parts: (1) IgG and IgA antigliadin antibody (AGA) assay; (2) antiendomysium antibody and total serum IgA determinations; (3) jejunal biopsy. A total of 5280 students aged 11-15 years (71.7% of the eligible population) underwent the first evaluation; 113 subjects performed the second tests and 35 of these needed the third investigation. Coeliac disease was diagnosed in 23 cases, most of which were atypical or silent forms. The prevalence of undiagnosed coeliac disease was 4.36 per 1000 screened subjects (95% CI 2.58-6.14) and 5.03 per 1000 (95% CI 3.41-6.65) in the general population. The ratio of known to undiagnosed cases was 1 to 6.4. This high prevalence of undiagnosed coeliac disease raises a number of problems that require further evaluation.
Subject(s)
Antibodies/analysis , Celiac Disease/diagnosis , Celiac Disease/epidemiology , Gliadin/immunology , Adolescent , Celiac Disease/immunology , Child , Female , Humans , Immunoglobulin A/analysis , Immunoglobulin G/analysis , Italy/epidemiology , Male , Mass Screening , Pilot Projects , Prevalence , StudentsABSTRACT
It is now generally believed that subclinical coeliac disease is common in the general population. We have undertaken screening for this disorder in a school district in central Italy. Screening was divided into three levels: first, IgG and IgA antigliadin antibody (AGA) assay on capillary blood obtained by finger prick; second, AGA plus IgA anti-endomysium antibody (AEA) test and measurement of serum immunoglobulins in venous blood; and third, intestinal biopsy. 3351 students (66% of the eligible population) aged 11-15 years attended first-level screening. 71 (2%) were recalled because of AGA positivity; 18 of these satisfied second-level criteria and underwent intestinal biopsy. Coeliac disease was diagnosed in 11 subjects, most of whom had no serious symptoms. Selective IgA deficiency was found in 4 subjects, 1 of whom also had coeliac disease. The prevalence of subclinical coeliac disease in the study group was 3.28 per 1000. Coeliac disease screening is feasible and involves only slight discomfort to the general population. Such screening can detect large numbers of cases of coeliac disease, which can be treated with a gluten-free diet. Many subclinical cases of coeliac disease would not be detected by screening only a selected group of at-risk patients.
Subject(s)
Autoantibodies/blood , Celiac Disease/epidemiology , Celiac Disease/prevention & control , Gliadin/immunology , Immunoglobulin A/blood , Immunoglobulin G/blood , Mass Screening/methods , Muscles/immunology , Population Surveillance , Adolescent , Biopsy , Celiac Disease/blood , Celiac Disease/complications , Celiac Disease/pathology , Child , Decision Trees , Enzyme-Linked Immunosorbent Assay , Feasibility Studies , Female , Histocompatibility Testing , Humans , Italy/epidemiology , Male , Pilot Projects , Prevalence , Risk Factors , Sensitivity and SpecificityABSTRACT
Tetanus antitoxin levels were measured in a non-random group of 281 subjects of pediatric age, using a passive haemagglutination technique. 94.7% of sera had protective antitoxin levels (titer greater than or equal to 1: 1024), while the other ones had levels usually considered as partly protective (titer of 1:256 or 1:512). Subjects who completed vaccination schedule had protective levels also 6 or more years after last dose. Subjects with partly protective antitoxin levels can be identified reviewing vaccination registers and recalling people who did not complete vaccination schedule. This procedure, if used as screening test, has sensitivity of 20%, specificity of 98% and a predictive value of positive tests of 37.5%. The quality of vaccination service of the study area, assessed using three indicators, resulted fairly good.
