Predictors of high-flow nasal cannula failure in COVID-19 patients in a northern Peruvian hospital.

OBJECTIVES: To determine predictors of high-flow nasal cannula (HFNC) failure in COVID-19 patients in a hospital in northern Peru. METHODOLOGY: A retrospective cohort study was conducted during the months of March and May 2021. Data collection was based on a follow-up of 156 hospitalized patients with a diagnosis of COVID-19 who were users of HFNC. Epidemiological factors and clinical outcomes of treatment were analyzed from medical records. Epidemiological, analytical, and HFNC use-related characteristics were described using measures of absolute and relative frequencies, measures of central tendency, and dispersion. A multivariate Poisson regression analysis with robust variance and a 95% confidence interval was performed. RESULTS: We found that age, SpO2/FiO2, work of breathing (WOB scale) at admission, degree of involvement, type of infiltrate on CT scan, lymphocytes, c-reactive protein, and D-dimer were significantly associated with failure of HFNC (p < 0.05). In addition, the WOB scale, PaO2/FiO2, SaO2/FiO2, and ROX index were variables that presented statistical significance (p < 0.0001). In the multivariate analysis model, a risk of failure of HFNC was determined with age > = 60 years [RRa 1.39 (1.05-1.85)] and PaO2/FiO2 score less than 100 [Rra 1.65 (0.99-2.76)]. CONCLUSIONS: Predictors to failure of HFNC are age older than 60 years and minimally significantly lower PaO2/FiO2 than 100.

Deep-learning based detection of vessel occlusions on CT-angiography in patients with suspected acute ischemic stroke.

Swift diagnosis and treatment play a decisive role in the clinical outcome of patients with acute ischemic stroke (AIS), and computer-aided diagnosis (CAD) systems can accelerate the underlying diagnostic processes. Here, we developed an artificial neural network (ANN) which allows automated detection of abnormal vessel findings without any a-priori restrictions and in <2 minutes. Pseudo-prospective external validation was performed in consecutive patients with suspected AIS from 4 different hospitals during a 6-month timeframe and demonstrated high sensitivity (≥87%) and negative predictive value (≥93%). Benchmarking against two CE- and FDA-approved software solutions showed significantly higher performance for our ANN with improvements of 25-45% for sensitivity and 4-11% for NPV (p ≤ 0.003 each). We provide an imaging platform ( https://stroke.neuroAI-HD.org ) for online processing of medical imaging data with the developed ANN, including provisions for data crowdsourcing, which will allow continuous refinements and serve as a blueprint to build robust and generalizable AI algorithms.

Landed property as collateral to access credit for housing development in Ghana: The case of Northern Region of Ghana.

Property in the commons, or the Washington Consensus, as it is known in other circles, posits that landed property and access to formal credit are directly related. Whether landed property improves access to formal credit or not has been at the centre of the debate, with varying practical evidence, especially for the Global South. Another related dimension of the debate concerns the implications of family-help-mortgage arrangements using intra-family transfer of land as collateral to support a member's mortgage by placing a charge on the collective property. This paper investigates the use of landed property as collateral to access formal credit from financial institutions for housing development in the Tamale Metropolitan Area (TMA) in the Northern Region of Ghana. The primary research question is: does formal documentation of landed property as collateral help in accessing formal credit for housing development in TMA? The study involves the use of in-depth interviews to investigate the opinions of estate developers, credit officers of universal banks, and land title holders on the relative importance of landed property and access to credit for housing development. The data are analysed by means of thematic content analysis. The findings indicate that even though landed property may contribute to the decision to grant formal credit, it is not a turn-key solution easily accepted in the final lending decision. This study adds to the body of knowledge primarily by evaluating the effects of reforms to increase credit access with landed property as collateral in Ghana, investigating the implications of family-help mortgage arrangements, including the use of intra-family assets as collateral in obtaining loans for investment at the micro-level in Ghana. The paper concludes that while formal documentation of land rights matters in the broad scheme of estate financing, it is not sufficient to bring about more immediate access to credit, especially for those who lack regular or reliable systems of income that could be critical in ensuring the payback of loans contracted using landed property as collateral for housing development.

Protecting adults at risk of pneumococcal infection and influenza from exposure to SARS-CoV-2.

There is a paucity of evidence linking pneumococcal infection and influenza with SARS-CoV-2 and COVID-19. There is circumstantial evidence of the possibility of an association between S. pneumoniae and SARS-CoV-2 such as the increased binding of S. pneumoniae to coronavirus-infected human airway epithelium, the frequent use of broad-spectrum antibiotics in the management of COVID-19 which could mask secondary bacterial infection, and the observation that pneumococcal vaccination is associated with decreased SARS-CoV-2 nasopharyngeal swab positivity. We performed a targeted literature review for the year 2020, using search terms S. pneumoniae, influenza, SARS-CoV-2, and found 25 relevant articles of a total of 291. Pneumococcal and influenza vaccinations have the potential to contribute toward efforts aimed at reducing the health burden of SARS-CoV-2, especially by reducing preventable admissions to hospital for pneumonia and the consequent risk of nosocomial SARS-CoV-2 transmission.

Mitochondrial heat shock protein mortalin as potential target for therapies based on oxidative stress.

BACKGROUND: Treatments based on production of reactive oxygen species for bladder cancer such as photodynamic therapy (PDT) have been marginalized due to low specificity and the existence of resistance mainly associated with the up-regulation of Heat Shock Proteins (HSPs). To overcome these barriers, the establishment of strategies combining PDTs with HSP inhibitors may be promising and the identification of HSPs involved with oxidative stress from bladder tumors in animal models represents a key step in this direction. MATERIALS: Thus, the present study aims to identify cytosolic and mitochondrial HSPs up expressed in murine bladder tumors and in the urothelial carcinoma cell line MB49 by qRT-PCR screening, and to analyze the importance of the activity of the HSPs associated with oxidative stress protection in the survival of the MB49 using strategy of inhibition in vitro. RESULTS: Results showed that both tumor tissues and MB49 cells in culture had significant overexpression of the mitochondrial HSPA9 (mortalin) and HSP60 mRNAs, while the cytosolic HSP90 was overexpressed only in the tumor. The effect of mortalin in the MB49 cells survival under oxidative stress was evaluated in vitro in presence of the specific inhibitor MKT-077 and H2O2. The findings showed that MB49 viability was permanently reduced by the MKT-077 in a dose-dependent manner by inducing apoptosis or necrosis, mainly under oxidative stress conditions. CONCLUSION: Results suggest that mortalin is preferentially expressed in the MB49 cancer model and plays a key role in tumoral survival, especially under oxidative stress, making this HSP a potential target for an alternative treatment combining PDT with HSP inhibitors.

Development of vaccines against the sexually transmitted infections gonorrhoea, syphilis, Chlamydia, herpes simplex virus, human immunodeficiency virus and Zika virus.

The success in preventing hepatitis B virus and human papillomavirus infections by means of vaccination paves the way for the development of other vaccines to prevent sexually transmitted infections (STIs) such as gonorrhoea, syphilis, chlamydia, herpes simplex virus, human immunodeficiency virus and Zika virus. The current status of vaccine development for these infections will be explored in this review. The general principles for success include the need for prevention of latency, persistence and repeat infections. A reduction in transmission of STIs would reduce the global burden of disease. Therapeutic activity of vaccines against STIs would be advantageous over preventative activity alone, and prevention of congenital and neonatal infections would be an added benefit. There would be an added value in the prevention of long-term consequences of STIs. It may be possible to re-purpose 'old' vaccines for new indications. One of the major challenges is the determination of the target populations for STI vaccination.

Altered cortical brain activity in end stage liver disease assessed by multi-channel near-infrared spectroscopy: Associations with delirium.

Delirium is a common and serious psychiatric syndrome caused by an underlying medical condition. It is associated with significant mortality and increased healthcare resource utilization. There are few biological markers of delirium, perhaps related to the etiologic heterogeneity of the syndrome. Functional near-infrared spectroscopy (fNIRS) is an optical topography system to measure changes in the concentration of oxygenated hemoglobin ([oxy-Hb]) in the cerebral cortex. We examined whether altered cortical brain activity in delirious patients with end stage liver disease (ESLD) is detected by fNIRS. We found that the [oxy-Hb] change during the verbal fluency task (VFT) was reduced in patients with ESLD compared with healthy controls (HC) in the prefrontal and bi-temporal regions. The [oxy-Hb] change during the sustained attention task (SAT) was elevated in patients with ESLD compared to HC in the prefrontal and left temporal regions. Notably, [oxy-Hb] change in the left dorsolateral prefrontal cortex during SAT showed a positive correlation with the severity of delirium. Our results suggest that [oxy-Hb] change in the prefrontal cortex during the sustained attention task measured with fNIRS might serve as a biological marker associated with delirium in ESLD patients.

Tissue microarray: physical and chemical parameters involved in the construction of recipient blocks / Microarranjo de tecidos: parâmetros físicos e químicos envolvidos na construção dos blocos receptores

ABSTRACT Introduction: Tissue microarray (TMA) is considered an innovative method in several fields, with a great diversity of applications and advantages over traditional histomorphometric techniques. The most important advantage that TMA offers is the simultaneous evaluation of a large number of specimens from a limited source of material. However, TMA exhibits a high rate of non-viable samples in the final stages of the process, which compromise their use in analyzes that can not be repeated. Objective: Considering this disadvantage, the objective of this study was to optimize the methodology to maximize the viability of the samples, as well as to increase the efficiency of the technique. Material and methods: For this purpose, several variables involved in the construction of the recipient blocks, including paraffin composition, diameter, spacing distance, localization and type of the tissue samples in the block were tested in order to establish correlations between the quality of the values and the parameters studied. Results: The results showed that the blocks built with polymer-enriched paraffin, subjected to the fusion protocol at 37ºC, associated to a tempering, and constructed with one millimeter diameter samples and 1000 µm spacing between tissues, produced slides whith superior features. Conclusion: The data obtained from the physical and chemical adjustments of the TMA recipient blocks provided vital information that, when applied in TMA research projects, may reduce the losses associated with the method.

RESUMO Introdução: O microarranjo tecidual (MAT) é considerado um método inovador em vários campos, com uma vasta diversidade de aplicações e vantagens em relação às técnicas histomorfométricas clássicas. A vantagem mais importante que o MAT oferece é a avaliação simultânea de um grande número de espécimes de uma fonte limitada de material. Contudo, ele apresenta uma taxa elevada de amostras não viáveis nos estádios finais do processo, o que compromete sua utilização em análises que não podem ser repetidas. Objetivos: Considerando essa desvantagem, o objetivo deste estudo foi otimizar a metodologia para maximizar a viabilidade das amostras, bem como aumentar a eficiência da técnica. Material e métodos: Para tanto, foram testadas várias variáveis envolvidas na construção dos blocos receptores, como composição da parafina, diâmetro, distância de espaçamento, localização e tipo das amostras de tecido no bloco, a fim de estabelecer correlações entre a qualidade dos valores e os parâmetros estudados. Resultados: Os resultados mostraram que os blocos construídos com parafina enriquecida em polímero, submetidos ao protocolo de fusão a 37ºC, acoplados a ciclos de aquecimento e resfriamento e construídos com amostras de um milímetro de diâmetro e espaçamento entre os tecidos de 1000 µm, produziram lâminas com características superiores. Conclusão: Os dados obtidos dos ajustes físicos e químicos dos blocos de receptores de MAT forneceram informações vitais que, quando aplicadas em projetos de pesquisa de MAT, podem reduzir as perdas associadas ao método.

Computational analysis and low-scale constitutive expression of laccases synthetic genes GlLCC1 from Ganoderma lucidum and POXA 1B from Pleurotus ostreatus in Pichia pastoris.

Lacasses are multicopper oxidases that can catalyze aromatic and non-aromatic compounds concomitantly with reduction of molecular oxygen to water. Fungal laccases have generated a growing interest due to their biotechnological potential applications, such as lignocellulosic material delignification, biopulping and biobleaching, wastewater treatment, and transformation of toxic organic pollutants. In this work we selected fungal genes encoding for laccase enzymes GlLCC1 in Ganoderma lucidum and POXA 1B in Pleurotus ostreatus. These genes were optimized for codon use, GC content, and regions generating secondary structures. Laccase proposed computational models, and their interaction with ABTS [2, 2'-azino-bis(3-ethylbenzothiazoline-6-sulphonic acid)] substrate was evaluated by molecular docking. Synthetic genes were cloned under the control of Pichia pastoris glyceraldehyde-3-phosphate dehydrogenase (GAP) constitutive promoter. P. pastoris X-33 was transformed with pGAPZαA-LaccGluc-Stop and pGAPZαA-LaccPost-Stop constructs. Optimization reduced GC content by 47 and 49% for LaccGluc-Stop and LaccPost-Stop genes, respectively. A codon adaptation index of 0.84 was obtained for both genes. 3D structure analysis using SuperPose revealed LaccGluc-Stop is similar to the laccase crystallographic structure 1GYC of Trametes versicolor. Interaction analysis of the 3D models validated through ABTS, demonstrated higher substrate affinity for LaccPost-Stop, in agreement with our experimental results with enzymatic activities of 451.08 ± 6.46 UL-1 compared to activities of 0.13 ± 0.028 UL-1 for LaccGluc-Stop. This study demonstrated that G. lucidum GlLCC1 and P. ostreatus POXA 1B gene optimization resulted in constitutive gene expression under GAP promoter and α-factor leader in P. pastoris. These are important findings in light of recombinant enzyme expression system utility for environmentally friendly designed expression systems, because of the wide range of substrates that laccases can transform. This contributes to a great gamut of products in diverse settings: industry, clinical and chemical use, and environmental applications.

Complicaciones de la segunda molar inferior ocasionadas por la mal posición anatómica de la tercera molar inferior en jóvenes de 17 a 24 años de edad / Complications of the lower second molar caused by the poor anatomical position of the lower third molar in young people between 17 and 24 years of age

Objetivo: Determinar la prevalencia de complicaciones más frecuentes de la segunda molar inferior, ocasionadas por la posición anatómica de la tercera molar inferior, en estudiantes entre 17 y 24 años de edad de la Facultad de Odontología de la Universidad de El Salvador, de Marzo a Junio del 2014. Materiales y métodos: Estudio descriptivo y correlacional, a 202 estudiantes se les evaluaron las segundas y terceras molares inferiores utilizando dos guías de observación, una para examen clínico y otra para interpretación de radiografía panorámica. El análisis de datos se realizó mediante estadísticos descriptivos y prueba X². Resultados: El 61.39% de la población de estudio, es del sexo femenino y el 38.61% del sexo masculino. Según la clasificación de Winter la posición anatómica de la tercera molar de mayor prevalencia fue mesioangulación con el 59.9%. Según la clasificación de Pell y Gregory el espacio disponible, que prevaleció fue la clase IIA con un 29%. Entre las complicaciones de la segunda molar esta la caries en superficie distal con 48.78%, prevaleciendo con un 23.3% la R1, según clasificación de Pitts. En cuanto a la reabsorción de la cresta ósea alveolar, un 20.1% en tercio medio; la profundidad de bolsa periodontal de 4 a 6 mm fue de 35.0%. Y la reabsorción radicular externa de la raíz distal del segundo molar fue de 10 %. La falta de espacio disponible de la tercera molar inferior, genera al menos una complicación en la segunda molar inferior adyacente con una significancia estadística de P=0.002 y un X²= 12.916; y la posición anatómica mesioangulada de la tercera molar inferior, ocasiona complicaciones en la segunda molar adyacente con una significancia estadística de P=0.000 y un X²=18.603. Conclusión: La mal posición anatómica mesioangular de la tercera molar inferior y la falta de espacio para su erupción, provocan afecciones estadísticamente significativas en la segunda molar adyacente como: caries en superficie distal, reabsorción de cresta ósea, enfermedad periodontal y reabsorción radicular.

Objective: To determine the prevalence of the most frequent complications of the lower second molar, caused by the anatomical position of the lower third molar, in students between the ages of 17 and 24 in the School of Dentistry of the University of El Salvador, from March to June 2014. Materials and methods: In the descriptive and correlational study, 202 students were evaluated on their lower second and third molars using guides of observation: one for clinical examination and another for interpretation of panoramic radiograph. The analysis of the data was done by the proof of X². Results: The studied group was comprised of 61.39% females and 38.61% males. According to Winter´s classification, the most prevalent anatomical position of the lower third molar was mesioangulation with 59.9%. The available space according to Pell and Gregory´s classification, class IIA prevalence was 29%. Among the complications of the lower second molar the presence of cavities on the distal face is 48.78%, prevailing of R1 was 23.3%, according to Pitts classification. In regards to the reabsorption of the alveolar bone crest, the 20.1% at the medium third; the depth of the periodontal bag of 4-6mm was 35.0%. And the external radicular reabsorption of the distal root of the lower second molar was 10%. The absence of space available for the lower third molar, generates at least one complication on the lower second molar adjacent with a statistical significance of P=0.002 and a X²= 12.916; and the mesioangular anatomical position of the lower third molar, causes complications in the lower second molar adjacent with a statistical significance of P=0.000 and a X²= 18.603. Conclusions: The mesioangular anatomical position of the lower third molar and the absence of space for the eruption, cause significant complicacy on the lower second molar adjacent, such as: cavities on the distal face, reabsorption of the bone crest, periodontal disease, and radicular reabsorption.

Low-scale expression and purification of an active putative iduronate 2-sulfate sulfatase-Like enzyme from Escherichia coli K12.

The sulfatase family involves a group of enzymes with a large degree of similarity. Until now, sixteen human sulfatases have been identified, most of them found in lysosomes. Human deficiency of sulfatases generates various genetic disorders characterized by abnormal accumulation of sulfated intermediate compounds. Mucopolysaccharidosis type II is characterized by the deficiency of iduronate 2-sulfate sulfatase (IDS), causing the lysosomal accumulation of heparan and dermatan sulfates. Currently, there are several cases of genetic diseases treated with enzyme replacement therapy, which have generated a great interest in the development of systems for recombinant protein expression. In this work we expressed the human recombinant IDS-Like enzyme (hrIDS-Like) in Escherichia coli DH5α. The enzyme concentration revealed by ELISA varied from 78.13 to 94.35 ng/ml and the specific activity varied from 34.20 to 25.97 nmol/h/mg. Western blotting done after affinity chromatography purification showed a single band of approximately 40 kDa, which was recognized by an IgY polyclonal antibody that was developed against the specific peptide of the native protein. Our 100 ml-shake-flask assays allowed us to improve the enzyme activity seven fold, compared to the E. coli JM109/pUC13-hrIDS-Like system. Additionally, the results obtained in the present study were equal to those obtained with the Pichia pastoris GS1115/pPIC-9-hrIDS-Like system (3 L bioreactor scale). The system used in this work (E. coli DH5α/pGEX-3X-hrIDS-Like) emerges as a strategy for improving protein expression and purification, aimed at recombinant protein chemical characterization, future laboratory assays for enzyme replacement therapy, and as new evidence of active putative sulfatase production in E. coli.

Psychological distress associated with severe lower-limb injury.

BACKGROUND: Little is known about the psychological morbidity associated with limb-threatening injuries. It was hypothesized that a substantial proportion of patients who sustain a severe lower-limb injury will report serious psychological distress. METHODS: Adult patients who were admitted to one of eight level-I trauma centers for treatment of an injury threatening the lower limb were enrolled during their initial hospitalization. Patients were recontacted at three, six, twelve, and twenty-four months after the injury and asked to complete the Brief Symptom Inventory (BSI), a fifty-three-item, self-reported measure of psychological distress. Patients who screen positive on the BSI are considered likely to have a psychological disorder and should receive a mental health evaluation. Longitudinal regression techniques were used to model positive case status (i.e., likely to have a psychological disorder) as a function of patient, injury, and treatment characteristics. RESULTS: Of the 569 patients enrolled, 545 (96%) completed at least one BSI and 385 (68%) completed all four. Forty-eight percent of the patients screened positive for a likely psychological disorder at three months after the injury, and this percentage remained high (42%) at twenty-four months. Two years after the injury, almost one-fifth of the patients reported severe phobic anxiety and/or depression. While these two subscales reflected the highest prevalence of severe psychological distress, none of the BSI subscales reflected the prevalence expected from a normal sample (i.e., 2% to 3%). Factors associated with a likely psychological disorder included poorer physical function, younger age, non-white race, poverty, a likely drinking problem, neuroticism, a poor sense of self-efficacy, and limited social support. Relatively few patients reported receiving any mental health services following the injury (12% at three months and 22% at twenty-four months). CONCLUSIONS: Severe lower-limb injury is associated with considerable psychological distress. More attention to the psychological as well as the physical health of patients who sustain a limb-threatening injury may be needed to ensure an optimal recovery following these devastating injuries.

Relationship of the model for end-stage liver disease (MELD) scale to hepatic encephalopathy, as defined by electroencephalography and neuropsychometric testing, and ascites.

OBJECTIVE: It has recently been suggested that the Model for End-Stage Liver Disease (MELD) is a better and a more objective predictor of mortality in patients with end-stage liver disease. The aim of our study was to determine the relationship of the MELD score to hepatic encephalopathy (HE), as determined by electroencephalography (EEG) and clinical and neuropsychometric examination, and ascites. METHODS: A total of 66 patients underwent EEG, a neuropsychometric screening by Mini-Mental State Examination, Trails Making Tests, Rey-Osterreith Complex Figure, and Hopkins Verbal Learning Tests, and a clinical assessment for HE. The MELD score was calculated as previously described by using serum creatinine, bilirubin, and international normalized ratio. Subclinical HE was diagnosed if clinical examination did not detect HE but neuropsychometric tests and EEG were abnormal. RESULTS: Sixteen patients had no HE, 28 had subclinical HE, and 22 had clinical HE. Age, sex, race, and cause of liver disease were similar in all three groups. Child-Turcotte-Pugh score was significantly higher in patients with clinical HE compared with the other two groups. There was only a modest correlation (r = 0.5) between Child-Turcotte-Pugh and the MELD scores. The distribution and mean MELD scores were similar in patients with or without HE as determined by clinical or neuropsychometric examination and EEG. Approximately 90% of patients with clinical HE or abnormal EEG and neuropsychometric tests had a MELD score less than 25. Similarly, the MELD score was not affected by the severity of ascites. CONCLUSION: The MELD score does not correlate well with severity of HE or ascites. Patients with HE and ascites might not receive liver transplantation in a timely manner if MELD scores were to be used exclusively for organ allocation.

Socioeconomic status does not affect the outcome of liver transplantation.

The outcome of liver transplantation is dependent on many factors. It was suggested that racial disparities in outcome may be related to differences in socioeconomic status (SES). In this retrospective study, we analyzed the effect of SES on graft and patient survival. Two hundred seventy-six adult patients who underwent liver transplantation at our institution from July 1988 to June 2001 were included in the analysis. Educational and occupation statuses were coded using established criteria (Hollingshead Index of Social Status [HI]). SES then was calculated using the HI formula: SES = education level x 3 + occupation x 5, and categorized into four groups: group 1, score less than 29 (n = 71); group 2, score of 29 to 42 (n = 82); group 3, score of 42 to 53 (n = 69); and group 4, score greater than 53 (n = 54). Kaplan-Meier analysis was used for graft and patient survival, and Cox regression analysis was used to determine the effect of confounding factors. Demographics of all four groups were similar. One-, 2-, and 5-year graft and patient survival did not differ significantly across groups by Kaplan-Meier and Cox regression survival analysis. In conclusion, SES did not predict graft and patient survival after liver transplantation.

The use of the NEO-five factor inventory to assess personality in trauma patients: a two-year prospective study.

OBJECTIVE: To assess the usefulness and validity of a brief personality assessment for orthopaedic trauma patients. METHODS: The NEO-Five Factor Inventory was evaluated within the context of the Lower Extremity Assessment Project, a prospective study of patients with severe lower extremity trauma admitted to eight level I trauma centers. PATIENTS/PARTICIPANTS: The NEO-FFI was administered to 557 adults and 416 of their significant others. At 2 years postinjury, the NEO-FFI was readministered to 396 patients. MAIN OUTCOME MEASURES: Main outcome measures were as follows: (a) agreement between patient and significant other scores; (b) stability of personality traits over two years; and (c) the relationship of the measured NEO-FFI traits with patient characteristics and health habits. RESULTS: There was fair to moderate agreement between assessments of personality provided by the patients themselves and their significant others, with intraclass correlation coefficients ranging from 0.44 to 0.54 for the different domains of personality. Patient assessments on the NEO-FFI were found to be robust with no significant changes in four of the five personality domains at 2 years postinjury. We also found that personality traits of patients are related to patient characteristics and behaviors in the directions that were expected. CONCLUSIONS: The NEO-FFI is a brief, valid, and stable measure of underlying personality traits that is practical for use in a trauma setting. Its use in both outcomes research and patient evaluation should be encouraged. In cases in which patients cannot complete the test, evaluations by significant others may be useful.

Diagnostic reliability of bipolar II disorder.

BACKGROUND: Although the diagnostic reliability of major depression and mania has been well established, that of hypomania and bipolar II (BPII) disorder has not. This remains an important issue for clinicians, especially for those undertaking genetic studies of BP disorder since bipolar I (BPI) and BPII disorders often cluster in the same families. We have assessed our diagnostic reliability of BP disorders, recurrent unipolar disorder, and their constituent episodes (major depression, mania, and hypomania) using interview and best-estimate diagnostic procedures used in a genetic study of families with BPI disorder. METHODS: Reliability was assessed for (1) co-rated Schedule for Affective Disorders and Schizophrenia-Lifetime version interviews of 37 subjects including 15 with BP disorders; (2) test-retest Schedule for Affective Disorders and Schizophrenia-Lifetime version interviews of 26 subjects including 13 with BP disorders; and (3) best-estimate diagnoses made by 2 noninterviewing psychiatrists on 524 subjects in a genetic linkage study of BPI disorder. Diagnoses were based on Research Diagnostic Criteria for a Selected Group of Functional Disorders, except that recurrent major depression as well as hypomania was required for a diagnosis of BPII disorder. RESULTS: On co-rated interviews, we observed complete agreement between interviewers for diagnosing major depressive, manic, and hypomanic episodes. For test-retest interviews, the Cohen kappa coefficients were 0.83 for manic, 0.72 for hypomanic, and 1.0 for major depressive episodes. At the best-estimate level, the Cohen kappa coefficients were 0.99 for BPI, 0.99 for BPII, and 0.98 for recurrent unipolar disorder. CONCLUSION: Good interrater reliability for BPII can be achieved when the interviews and best-estimate diagnoses are done by experienced psychiatrists.