Procalcitonin and C-reactive protein: markers in the early diagnosis of anastomotic leak.

OBJECTIVE: To determine the efficacy of serum procalcitonin (PCT) and C-reactive protein (CRP) in the early diagnosis of anastomotic leak (AL) in patients undergoing colorectal surgery. METHOD: Diagnostic test in a tertiary care hospital. Patients who did not have preoperative measurements of PCT and CRP were excluded. Those with postoperative infection not related to AL were eliminated. The diagnostic efficacy measures were sensitivity (Sn), specificity (Sp), positive (PPV) and negative (NPV) predictive values, positive (LR+) and negative (LR-) likelihood ratios, and area under the receiver operating characteristic curve (AUROC). RESULTS: Thirty-nine patients were analyzed; six had AL (15.4%). PCT and CRP increased on the second postoperative day, only in patients with AL. The cut-off points at the second postoperative day were 1.55 ng/mL for PCT and 11.25 mg/L for CRP. The most efficacious test was PCR at second postoperative day (AUROC: 1.00; Sn: 100%; Sp: 96.7%; PPV: 85.7%; NPV: 100%; LR+: 33.0). CONCLUSIONS: CRP at second postoperative day was the most effective test in the early diagnosis of AL in patients undergoing colorectal surgery, with a cut-off point lower than that reported in the international literature.

OBJETIVO: Determinar la eficacia de la procalcitonina (PCT) y la proteína C reactiva (PCR) séricas en el diagnóstico de fuga anastomótica (FA) en los pacientes sometidos a cirugía colorrectal. MÉTODO: Prueba diagnóstica en un hospital de tercer nivel. Se excluyeron los pacientes que no tuvieron mediciones preoperatorias de PCT y PCR. Se eliminaron los que cursaron con infección posoperatoria no relacionada con FA. Las medidas de eficacia diagnóstica fueron sensibilidad (S), especificidad (E), valores predictivos positivo (VPP) y negativo (VPN), razones de verosimilitud positiva (RV+) y negativa (RV−), y área bajo la curva característica operativa del receptor (AUROC). RESULTADOS: Se analizaron 39 pacientes, de los cuales 6 (15.4%) tuvieron FA. La PCT y la PCR aumentaron al segundo día posoperatorio solo en los pacientes con FA. Los puntos de corte al día 2 fueron 1.55 ng/ml para PCT y 11.25 mg/l para PCR. La prueba más eficaz fue la PCR al día 2 (AUROC: 1.00; S: 100%; E: 96.7%; VPP: 85.7%; VPN: 100%; RV+: 33.0). CONCLUSIONES: La PCR en el segundo día posoperatorio fue la prueba más eficaz en el diagnóstico temprano de FA en los pacientes sometidos a cirugía colorrectal, con un punto de corte inferior a lo reportado en la literatura internacional.

Body frame size, body image, self-esteem, and health-related quality of life in schoolchildren.

OBJECTIVE: The aim of this study was to explore the relationship between body frame size (BFS) and body image, self-esteem, and health-related quality of life (HRQL) in Mexican schoolchildren. METHODS: This cross-sectional study included children aged 6 to 11 years. Body image, self-esteem, and HRQL were evaluated through interviews. Two frame-size measures, biacromial and bitrochanteric diameters, were collected and summed for categorizing BFS as small, medium, or large. Height and weight were also measured. Spearman's correlations were determined and adjusted by sex, age, and body mass index (BMI). Multiple logistic regression analyses were performed with the psychological measure as the binary dependent variable, the categories of BFS as the independent variable, and sex, age, and BMI as control variables. RESULTS: The correlation between BFS and body image was 0.15 (P < .01) and after BMI adjustment was 0.07 (P > .05). BFS did not correlate with self-esteem nor HRQL (P > .05). Of the children, 79% were dissatisfied with their body image, 20% had a low self-esteem, and 31.8% had a poorly perceived HRQL; there were no differences by BFS. The multivariate analysis showed that a large BFS was not associated with body image dissatisfaction (OR 1.2, 95% CI 0.6-2.3), low self-esteem (OR 1.3, 95% CI 0.7-2.6), or poor HRQL (OR 1.3, 95% CI 0.8-2.2). CONCLUSIONS: BFS was not correlated with body image, self-esteem, or HRQL. A high self-esteem and a good level of HRQL prevailed, but a high proportion of children were dissatisfied with their body image. School interventions should promote an appropriate body image and a healthy lifestyle.