Performance of the first-trimester Fetal Medicine Foundation competing risks model for preeclampsia prediction: an external validation study in Brazil.

BACKGROUND: The current version of the Fetal Medicine Foundation competing risks model for preeclampsia prediction has not been previously validated in Brazil. OBJECTIVE: This study aimed (1) to validate the Fetal Medicine Foundation combined algorithm for the prediction of preterm preeclampsia in the Brazilian population and (2) to describe the accuracy and calibration of the Fetal Medicine Foundation algorithm when considering the prophylactic use of aspirin by clinical criteria. STUDY DESIGN: This was a cohort study, including consecutive singleton pregnancies undergoing preeclampsia screening at 11 to 14 weeks of gestation, examining maternal characteristics, medical history, and biophysical markers between October 2010 and December 2018 in a university hospital in Brazil. Risks were calculated using the 2018 version of the algorithm available on the Fetal Medicine Foundation website, and cases were classified as low or high risk using a cutoff of 1/100 to evaluate predictive performance. Expected and observed cases with preeclampsia according to the Fetal Medicine Foundation-estimated risk range (≥1 in 10; 1 in 11 to 1 in 50; 1 in 51 to 1 in 100; 1 in 101 to 1 in 150; and <1 in 150) were compared. After identifying high-risk pregnant women who used aspirin, the treatment effect of 62% reduction in preterm preeclampsia identified in the Combined Multimarker Screening and Randomized Patient Treatment with Aspirin for Evidence-Based Preeclampsia Prevention trial was used to evaluate the predictive performance adjusted for the effect of aspirin. The number of potentially unpreventable cases in the group without aspirin use was estimated. RESULTS: Among 2749 pregnancies, preterm preeclampsia occurred in 84 (3.1%). With a risk cutoff of 1/100, the screen-positive rate was 25.8%. The detection rate was 71.4%, with a false positive rate of 24.4%. The area under the curve was 0.818 (95% confidence interval, 0.773-0.863). In the risk range ≥1/10, there is an agreement between the number of expected cases and the number of observed cases, and in the other ranges, the predicted risk was lower than the observed rates. Accounting for the effect of aspirin resulted in an increase in detection rate and positive predictive values and a slight decrease in the false positive rate. With 27 cases of preterm preeclampsia in the high-risk group without aspirin use, we estimated that 16 of these cases of preterm preeclampsia would have been avoided if this group had received prophylaxis. CONCLUSION: In a high-prevalence setting, the Fetal Medicine Foundation algorithm can identify women who are more likely to develop preterm preeclampsia. Not accounting for the effect of aspirin underestimates the screening performance.

Malnutrition screening tool and nutritional screening tool for classification of nutritional risk in patients with cancer upon hospital admission: Comparison of diagnostic performance using Global Leadership Initiative on malnutrition criteria as reference.

BACKGROUND & AIMS: Tools for screening of nutrition risk in patients with cancer are usually validated against other screening instruments. Here with the performance of Malnutrition Screening Tool (MST) and Nutritional Screening Tool (NUTRISCORE) to identify the risk of malnutrition was assessed. A full nutritional evaluation and diagnosis following criteria from the Global Leadership Initiative of Malnutrition (GLIM) was the reference standard for the classification of malnutrition. METHODS: Diagnostic test prospective analysis of adult patients with a confirmed diagnosis of cancer. MST, NUTRISCORE and nutritional evaluation and diagnosis by GLIM criteria were independently performed within 24 h of admission to a 4th tier hospital in Bogotá, Colombia. RESULTS: From 439 patients the sensitivity and specificity of MST was 75% and 94% and of NUTRISCORE 45% and 97% respectively. The area under receiver operating characteristic (ROC) curves were 0.90 for MST and 0.85 for NUTRISCORE (p = 0.003). CONCLUSION: The MST showed a significantly better diagnostic performance over NUTRISCORE for detection of malnutrition risk at admission to hospital of patients with cancer.

Evaluación de la prueba G8 como tamizaje para valoración geriátrica integral en pacientes adultos mayores con cáncer / Evaluation of the G-8 test as a screening tool for comprehensive geriatric assessment in elderly patients with cancer

RESUMEN Objetivo: evaluar la sensibilidad y especificidad del test G8 en el tamizaje de adultos mayores con cáncer para la realización de la valoración geriátrica integral (VGI). Materiales y métodos: el presente estudio observacional y retrospectivo se realizó en el Servicio de Geriatría del Hospital Almenara de Lima, Perú. Se revisaron los informes de VGI en las historias clínicas electrónicos de adultos mayores (> 60 años) con cáncer, ambulatorios y hospitalizados, durante noviembre de 2022 y julio de 2023. Los pacientes se clasificaron según los criterios SIOG-1 (Sociedad Internacional de Oncología Geriátrica), formando dos grupos: pacientes aptos y pacientes no aptos o unfit (vulnerables + frágiles + muy enfermos). Del test G8 se estimó la sensibilidad, especificidad y valor predictivo positivo, área bajo la curva característica operativa del receptor (AUC). Resultados: ingresaron al estudio 201 pacientes, 91 mujeres (45,3%) y 110 (54,7%) varones, la media de la edad fue de 76,2 ± 7,4 años. Las neoplasias más frecuentes fueron colorrectal, estómago, próstata y vías biliares. La prevalencia de pacientes aptos y no aptos (unfit) fue del 23,4 y 76,6%, respectivamente. Cuando el puntaje de la prueba G8 fue ≤11, la sensibilidad, especificidad, valor predictivo positivo y AUC fueron 73,4% (intervalo de confianza al 95%: 65,7-80,2%), 91,5% (79,6%-97,6%), 96,6% (91,7-98,6%) y 89% (84-93%), respectivamente. Conclusiones: el test G8 con puntaje ≤11 tendría una alta sensibilidad y especificidad, para identificar adultos con cáncer vulnerables o frágiles, que podrían beneficiarse de la VGI.

ABSTRACT Objective: To evaluate sensitivity and specificity of the G8 test in screening older adults with cancer who may benefit from a Comprehensive Geriatric Assessment (CGA). Material and methods: This observational retrospective study was carried out in the Geriatrics Service of the Guillermo Almenara Hospital in Lima, Peru. CGA reports were reviewed in the electronic medical records of older adults (> 60 years) with cancer, both outpatients and inpatients, between November 2022 and July 2023. Patients were classified according to the SIOG-1 (International Society of Geriatric Oncology) criteria into two groups: fit and non-fit patients (vulnerable + frail + too sick). Sensitivity, specificity, and positive predictive value, area under the receiver operating characteristic curve (AUC), were estimated for the G8 test. Results: 201 patients entered the study, 91 women (45.3%) and 110 (54.7%) men; their mean age was 76.2 ± 7.4 years. The most frequent neoplasms were colorectal, stomach, prostate, and bile ducts. The prevalence of eligible and unfit patients was 23.4% and 76.6%, respectively. When the G8 test score was ≤11, sensitivity, specificity, positive predictive value, and AUC were 73.4% (95% Confidence Interval: 65.7- 80.2%), 91.5% (79.6%-97.6%), 96.6% (91.7-98.6%), and 89% (84-93%), respectively. Conclusions: The G8 test with a score ≤11 would have high sensitivity and specificity for identifying vulnerable or frail patients with cancer who could benefit from the CGA.

Proposal of a screening instrument for autism spectrum disorder in children (Mini-TEA Scale) / Proposta de um instrumento de triagem para transtorno do espectro autista em crianças (Escala Mini-TEA)

Abstract Background Autism spectrum disorder (ASD) requires trained professionals for its adequate diagnosis. There is a shortage of such professionals in Brazil. Screening tools could identify priority cases. The only instrument for that in Brazilian Portuguese is employed for toddlers up to 2.5 years old. Objective The Mini-TEA scale was conceived and tested as a screening for children from 2.5 to 12 years old. Methods After local ethics committee's approval, this study was conducted from December 2022 to April 2023 in the Associação de Pais e Amigos dos Excepcionais, Passo Fundo/RS, of invitations to children's parents/relatives who were under evaluation for ASD and by local advertisement. Inclusion criteria were age from 2.5 to 12 years old; consent from the child's legal guardians. 75 children's parents/relatives were interviewed using the 15-item Mini-TEA scale. After that, children were evaluated for the diagnosis of ASD by a pediatric neurologist. Sensibility and specificity for ASD diagnosis along the Mini-TEA scores were measured. Experts and target population evaluated the validity/reliability of the Mini-TEA scale. The reproducibility of the scores was assessed about 40 days later. Results From the 75 participants, 28 received a diagnosis of ASD. Scores ≥ 10 on the Mini-TEA scale require further evaluation of the children (sensitivity 100%; specificity 68%). Content validity coefficient (CVC) rendered values > 0.80 (acceptable). Test-retest analyzes with the intraclass correlation coefficient (ICC) indicated excellent reliability (> 0.90). The time spent for applying the screening was about 10 minutes. Conclusion The Mini-TEA scale presents as an easy tool for screening ASD among children.

Resumo Antecedentes O transtorno do espectro autista (TEA) requer profissionais treinados para o diagnóstico, escassos no Brasil. Instrumentos de triagem poderiam identificar casos prioritários para avaliação. O único em português brasileiro é empregado para crianças até 30 meses de idade. Objetivo A escala Mini-TEA foi concebida e testada como triagem para crianças entre 2,5 e 12 anos. Métodos Estudo foi conduzido de dezembro de 2022 a abril de 2023 na Associação de Pais e Amigos dos Excepcionais (APAE) de Passo Fundo/RS, após a aprovação bioética local. O recrutamento consistiu em convite aos familiares de crianças que estavam sendo avaliadas para TEA e por divulgação local. Os critérios de inclusão foram idade entre 2,5 e 12 anos e consentimento do guardião legal. Familiares de 75 crianças foram entrevistados com a escala Mini-TEA (15 itens). Depois, as crianças foram avaliadas para o diagnóstico de TEA por neuropediatra. A sensibilidade e a especificidade do diagnóstico de TEA com os escores da Mini-TEA foram mensuradas. A validade e a confiabilidade da escala Mini-TEA foram avaliadas por experts e pela população alvo. A reprodutibilidade dos escores foi medida após ± 40 dias. Resultados Dos 75 participantes, 28 receberam diagnóstico de TEA. Escores ≥ 10 na escala Mini-TEA requerem avaliação das crianças (sensibilidade 100%; especificidade 68%). O coeficiente de validação de conteúdo (CVC) rendeu valores > 0,80 (aceitável). Análises de teste-reteste com coeficiente de correlação intraclasse (ICC) indicou excelente confiabilidade (> 0,90). O tempo gasto para a triagem foi cerca de 10 minutos. Conclusão A escala Mini-TEA constitui ferramenta breve e fácil para triagem de TEA em crianças.

Determination of Shock Index and Age Shock Index Cut-Off Points in Patients with ST-Segment Elevation Myocardial Infarction: SEMI-CI Study

Abstract Background Shock index (SI) and age shock index (ASI) are less frequently used for assessment of major adverse cardiovascular events (MACE) among patients with ST-segment elevation myocardial infarction (STEMI), and their reported cut-off points are controversial. Objectives We aimed to define proper cut-off value of these indices for MACE prediction among Iranian patients with STEMI. Methods This study was in the context of the ST-Elevation Myocardial Infarction Cohort in Isfahan (SEMI-CI) study. SI and ASI were calculated by division of heart rate (HR) over systolic blood pressure (SBP) and age multiplied by SI, respectively, in 818 subjects with STEMI. Receiver operating characteristic (ROC) curve analysis was used to determine optimal SI and ASI cut-off values. Chi-square test, independent t test, and analysis of variance were employed for nominal and numerical variables, as appropriate, with consideration of p values < 0.05. MACE was defined as a composite of non-fatal reinfarction, heart failure (HF), recurrent percutaneous intervention (PCI), rehospitalization for cardiovascular diseases, and all-cause mortality. Results Mean age was 60.70 ± 12.79 years (males: 81.7%). Area under curve (AUC) values from ROC curve analysis for SI and ASI were 0.613 (95% confidence interval [CI]: 0.569 to 0.657, p < 0.001) and 0.672 (95% CI: 0.629 to 0.715, p < 0.001), respectively. Optimal SI and ASI cut-offs were 0.61 (sensitivity: 61%, specificity: 56%) and 39.5 (sensitivity: 65%, specificity: 66%), respectively. Individuals with SI ≥ 0.61 or within the highest quartile (SI ≥ 0.75) had significantly higher frequency of one-year MACE compared to the reference group (34.7% versus 22.2%, p < 0.001 and 42.4% versus 20.6%, p < 0.05, respectively). Similar relations were observed in terms of ASI values (ASI ≥ 39.5 versus ASI < 39.5: 43.6% versus 17.3%, p < 0.001, ASI Q4 ≥ 47.5 versus ASI Q1 ≤ 28.8: 49% versus 16.6%, p < 0.05). Conclusions SI and ASI cut-off values of 0.61 and 39.5 could reliably predict MACE occurrence among Iranian patients with STEMI.

Avaliação das propriedades psicométricas da versão brasileira do Short Portable Mental Status Questionnaire (SPMSQ) de Pfeiffer / Evaluation of the psychometric properties of the Brazilian version of the Short Portable Mental Status Questionnaire (SPMSQ) by Pfeiffer

Resumo Objetivo Avaliar as propriedades psicométricas, contemplando validade, confiabilidade, sensibilidade e especificidade do SPMSQ-BR. Método A análise foi realizada em 93 idosos, avaliados com a versão brasileira do SPMSQ, Mini-Exame do Estado Mental (MEEM), Teste do Desenho do Relógio (TDR) e Teste de Fluência Verbal (TFV). A consistência interna foi estimada pelo coeficiente alfa de Cronbach. Para avaliar a estabilidade intra-avaliador e a reprodutibilidade inter-avaliador, utilizou-se o coeficiente de correlação intraclasse (CCI) com intervalo de confiança de 95%. Para a validade concorrente e convergente, utilizou-se o coeficiente de correlação de Spearman. A acurácia para estabelecer o ponto de corte do SPMSQ-BR para rastreamento da sensibilidade e especificidade realizou-se através da curva ROC. Resultado: O SPMSQ-BR demonstrou excelente consistência interna (α=0,803), alta confiabilidade intra e inter-avaliador (CCI-0,977) e (CCI-0,973) respectivamente. Na validade concorrente apresentou forte correlação linear com o MEEM (-0,799 p<0,001), já com TDR (-0,584 p<0,01) e TFV (-0,569 p<0,01) foram encontradas correlações moderadas. O SPMSQ-BR mostrou-se capaz de discriminar o comprometimento cognitivo com ponto de corte a partir de 3 erros, conforme a escala original. A área sob a curva considerando a escolaridade foi de AUC=0,905 (S=81,3% e E=76,9%) e sem considerar a escolaridade AUC=0,927 (S=87,5% e E=80,8%) apresentando uma boa sensibilidade e especificidade em ambos os casos. Conclusão O estudo demonstrou que a versão brasileira do SPMSQ estabelecida como Breve Escala de Capacidade Cognitiva apresentou-se estável, reprodutível, válida e confiável para avaliar a capacidade cognitiva de idosos, além de ser sensível na identificação de comprometimento cognitivo.

Abstract Objective To evaluate the psychometric properties, including validity, reliability, sensitivity, and specificity of the SPMSQ-BR. Method The analysis was conducted on 93 older adults, assessed with the Brazilian version of the SPMSQ, Mini-Mental State Examination (MMSE), Clock Drawing Test (CDT), and Verbal Fluency Test (VFT). Internal consistency was estimated using Cronbach's alpha coefficient. In order to assess intra-rater stability and inter-rater reproducibility, the intraclass correlation coefficient (ICC) with a 95% confidence interval was employed. For concurrent and convergent validity, Spearman's correlation coefficient was utilized. Accuracy in establishing the cutoff point for the SPMSQ-BR to screen sensitivity and specificity was assessed through ROC curve analysis. Result The SPMSQ-BR demonstrated excellent internal consistency (α=0.803), high intra-rater and inter-rater reliability (ICC=0.977 and ICC=0.973), respectively. In terms of concurrent validity, it showed a strong negative linear correlation with the MMSE (-0.799, p<0.001), while moderate correlations were found with the CDT (-0.584, p<0.01) and VFT (-0.569, p<0.01). The SPMSQ-BR proved capable of discriminating cognitive impairment with a cutoff point of 3 errors, following the original scale. The area under the curve (AUC) considering education level was 0.905 (sensitivity=81.3%, specificity=76.9%), and without considering education level, the AUC was 0.927 (sensitivity=87.5%, specificity=80.8%), indicating good sensitivity and specificity in both cases. Conclusion The study demonstrated that the Brazilian version of the SPMSQ, established as a Brief Cognitive Capacity Scale, proved to be stable, reproducible, valid, and reliable for assessing the cognitive capacity of older adults. Furthermore, it showed sensitivity in identifying cognitive impairment.

Rendimiento diagnóstico de un sistema molecular de uso en el punto de atención para la detección de SARS-CoV-2 en Perú / Diagnostic performance of a point-of-care molecular system for the detection of SARS-CoV-2 in Peru

RESUMEN En el presente estudio se estimó el rendimiento diagnóstico de la prueba Xpert®Xpress SARS-CoV-2 en comparación con la RT PCR en tiempo real-protocolo Charité, para la detección de SARS-CoV-2 en pacientes peruanos. Se trató de un diseño de prueba diagnóstica que incluyó 100 muestras de hisopado nasal y faríngeo. Se obtuvo una concordancia global de 98,70% (IC95%: 92,98-99,97), con un coeficiente kappa de 0,97 (IC95%: 0,86-1.00); se estimó una sensibilidad y especificad relativa de 100% y 96,15%, respectivamente. Adicionalmente, el porcentaje del área bajo la curva ROC fue 98,08% en ambos casos y se obtuvo una especificidad analítica del 100% para los diferentes virus respiratorios evaluados. En conclusión, la prueba Xpert®Xpress SARS-CoV-2 a partir de muestras de hisopado nasal y faríngeo fue altamente sensible y específica, así mismo el coeficiente kappa mostró una excelente correlación, al compararla con la prueba de referencia.

ABSTRACT The present study assessed the diagnostic performance of the Xpert®Xpress SARS-CoV-2 test in comparison with the Charité protocol real-time RT PCR for the detection of SARS-CoV-2 in Peruvian patients. This was a diagnostic test study that included 100 nasal and pharyngeal swab samples. We obtained an overall concordance of 98.70% (95%CI: 92.98-99.97), with a kappa coefficient of 0.97 (95%CI: 0.86-1.00) and sensitivity and relative specificity rates of 100% and 96.15%, respectively. Additionally, the percentage of the area under the ROC curve was 98.08% in both cases, and an analytical specificity rate of 100% was obtained for the different respiratory viruses evaluated. In conclusion, the Xpert®Xpress SARS-CoV-2 test, by using nasal and pharyngeal swab samples, was highly sensitive and specific, and the kappa coefficient showed an excellent correlation when compared to the reference test.

Sensitivity and specificity of a syphilis rapid diagnostic test in blood donors' samples.

Rapid Diagnostic Tests (RDT) are useful to identify syphilis cases, particularly for hard-to-reach populations and if laboratory services are scarce. However, RDT performance may be suboptimal. We aimed to assess the sensitivity and specificity of a syphilis RDT using well-characterized blood donors' samples. We categorized samples from 811 blood donors into five groups: 1 - Samples with reactive Chemiluminescence (QML), FTA-Abs, and VDRL; 2 - Samples with reactive QML and FTA-Abs, and nonreactive VDRL; 3 - Samples with reactive QML, and nonreactive for other markers (false-positives); 4 - Controls with nonreactive QML; and 5 - Samples reactive for HIV, with nonreactive QML. Sensitivity was tested in groups 1 (overall and according to VDRL titers) and 2; specificity was tested in groups 3‒5. The RDT had high specificity, even in samples reactive for HIV. The sensitivity was high (91.9%) in samples with reactive VDRL but varied between 75.0%‒100% according to VDRL titers. The overall sensitivity was lower (81.3%) in samples with reactive FTA-Abs and nonreactive VDRL. The RDT is a useful tool to detect active syphilis but may be more limited for cases with very early or remote infection, or those with prior treatment. When higher sensitivity is needed, additional strategies including recurrent testing or laboratory-based tests may be required.

Sensitivity and specificity of the Patient Health Questionnaire (PHQ-9, PHQ-8, PHQ-2) and General Anxiety Disorder scale (GAD-7, GAD-2) for depression and anxiety diagnosis: a cross-sectional study in a Peruvian hospital population.

OBJECTIVES: The Patient Health Questionnaire (PHQ) and Generalised Anxiety Disorder Scale (GAD) are widely used screening tools, but their sensitivity and specificity in low-income and middle-income countries are lower than in high-income countries. We conducted a study to determine the sensitivity and specificity of different versions of these scales in a Peruvian hospital population. DESIGN: Our study has a cross-sectional design. SETTING: Our participants are hospitalised patients in a Peruvian hospital. The gold standard was a clinical psychiatric interview following ICD-10 criteria for depression (F32.0, F32.1, F32.2 and F32.3) and anxiety (F41.0 and F41.1). PARTICIPANTS: The sample included 1347 participants. A total of 334 participants (24.8%) were diagnosed with depression, and 28 participants (2.1%) were diagnosed with anxiety. RESULTS: The PHQ-9's≥7 cut-off point showed the highest simultaneous sensitivity and specificity when contrasted against a psychiatric diagnosis of depression. For a similar contrast against the gold standard, the other optimal cut-off points were: ≥7 for the PHQ-8 and ≥2 for the PHQ-2. In particular, the cut-off point ≥8 had good performance for GAD-7 with sensitivity and specificity, and cut-off point ≥10 had lower levels of sensitivity, but higher levels of specificity, compared with the cut-off point of ≥8. Also, we present the sensitivity and specificity values of each cut-off point in PHQ-9, PHQ-8, PHQ-2, GAD-7 and GAD-2. We confirmed the adequacy of a one-dimensional model for the PHQ-9, PHQ-8 and GAD-7, while all PHQ and GAD scales showed good reliability. CONCLUSIONS: The PHQ and GAD have adequate measurement properties in their different versions. We present specific cut-offs for each version.

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.

Waist-to-Height Ratio: A Sensitive Tool for Assessing the Need for Nutritional Risk Management in Elderly Populations from Brazil.

INTRODUCTION: Nutritional status assessment commonly relies on body mass index (BMI), which overlooks lean mass and adipose tissue distribution. However, waist circumference (WC) and waist-to-height ratio (WHtR) provide additional insights into fat accumulation. By combining these indices, it may be possible to identify older adults needing weight management interventions. OBJECTIVES: To assess the WC and WHtR as strategies for identifying individuals requiring weight management. METHODS: A cross-sectional study was conducted with 509 elderly individuals in Northeast Brazil. Weight, height, hip circumference, and waist circumference were measured, and combined with indices such as BMI WC, WHR, and WHtR to identify those who require weight management. The DeLong test compared areas under the curves using receiver operating characteristic curves and statistical significance. Sensitivity, specificity, and positive and negative predictive values were calculated to verify usefulness for clinical application. A validation sample of 599 elderly individuals from the country's Southern region was used to confirm the results. RESULTS: Both WC and WHtR showed adequate diagnostic accuracy with no statistically significant difference in AUCs. WHtR ≥ 0.50 had 92% sensitivity in identifying men and women requiring nutritional management. WC presented lower sensitivity but 93% specificity, useful for excluding elderly individuals from the nutritional risk category. These results were consistent in the validation sample. CONCLUSION: WHtR is a valuable index for screening nutritional risk management in the elderly population, applicable to men and women. Conversely, WC performs better in excluding individuals who do not need nutritional risk management.

Escala predictiva de los resultados adversos en la hemorragia digestiva alta no varicosa / It not climbs predictiva of the adverse results in the high digestive hemorrhage varicose

Introducción: Existen varios sistemas de puntuación para predecir los resultados adversos en los pacientes con hemorragia digestiva alta no varicosa, pero no se han validado lo suficiente y cada uno pertenece a distintas poblaciones fuentes. Objetivo: Demostrar la utilidad de una escala propuesta para predecir las probabilidades de resangrado, de mortalidad y de necesidad de cirugía en los pacientes con hemorragia digestiva alta no varicosa. Métodos: Se realizó un estudio retrospectivo de una prueba diagnóstica en el hospital de Prenda, Luanda, Angola desde enero del 2021 hasta mayo del 2022. El universo estuvo formado por 93 pacientes atendidos durante ese período con el criterio de inclusión de tener el diagnóstico de hemorragia digestiva alta de origen no varicoso. Resultados: De un total de 93 pacientes se obtuvo como desenlace primario una recurrencia del sangrado de 18 pacientes para un 19,35 por ciento del total, seguido con 12 fallecidos para un 12,90 por ciento del total y cuatro fallecidos para un 4,40 por ciento del total. Los valores predictivos de la escala de forma general fueron, al ser aplicada una sensibilidad de 0,91, la especificidad de un 0,92, el valor predictivo negativo de un 0,95 y el valor predictivo negativo de un 0,86. Conclusiones: La escala propuesta tiene una sensibilidad y especificidad adecuada para predecir, en los pacientes con hemorragia digestiva alta no varicosa, la probabilidad de resangrado, de mortalidad y la necesidad de cirugía(AU)

Introduction: Several scoring systems exist to predict adverse outcomes in patients with nonvariceal upper gastrointestinal bleeding, but they have not been sufficiently validated and each pertains to different source populations. Objective: To demonstrate the usefulness of a proposed scoring scale to predict the probability of rebleeding, mortality, and need for surgery in patients with nonvariceal upper gastrointestinal bleeding. Methods: A retrospective study of a diagnostic test was performed at the hospital of Prenda, Luanda, Angola, from January 2021 to May 2022. The study universe consisted of 93 patients attended during that period, with the inclusion criterion of having a diagnosis of upper gastrointestinal bleeding of nonvariceal origin. Results: From a total of 93 patients, the primary outcome was a recurrence of bleeding in 18 patients, accounting for 19.35 percent of the total; followed by 12 deaths, representing 12.90 percent of the total, and four deaths, accounting for 4.40 percent of the total. After the scale was applied, the following general predictive values were obtained: sensitivity of 0.91, specificity of 0.92, negative predictive value of 0.95 and negative predictive value of 0.86. Conclusions: The proposed scale presents adequate sensitivity and specificity for predicting the probability of fatal rebleeding and the need for surgery in patients with nonvariceal upper gastrointestinal bleeding(AU)

Rendimiento diagnóstico de tres índices antropométricos de peso y talla para síndrome metabólico en trabajadores

Introducción: La presencia del síndrome metabólico está asociada con enfermedades crónicas a largo plazo, por lo que se buscan diferentes formas de obtener un diagnóstico temprano. Objetivo: Determinar el rendimiento diagnóstico de 3 índices antropométricos de peso y talla para síndrome metabólico en una muestra de trabajadores peruanos. Métodos: La población son trabajadores de 18 a 65 años, de ambos sexos, ocupación operarios y administrativos. Las variables estudiadas son: edad, sexo, ocupación, peso, talla, perímetro de cintura, antecedentes de diabetes mellitus tipo 2, presión arterial sistólica, diastólica, glucosa en ayunas, triglicéridos y lipoproteína de alta densidad. Se incluyeron 370 trabajadores, se crearon curvas características operativa del receptor con su respectiva área bajo la curva (AUC), se obtuvo la sensibilidad y especificidad de cada índice. Resultados: Del total, el 20 % presentó síndrome metabólico; el 46,76 % fueron mujeres, el 60 % tomaron alcohol alguna vez, el 5,14 % señaló haber fumado. El índice de masa corporal tuvo la mayor AUC= 0,73; corte= 26,04; sensibilidad= 78,4 y especifidad= 67,9) seguido del nuevo índice de masa corporal (AUC= 0,70; corte= 27,85; sensibilidad= 68,9 y especificidad= 70,6); el último lugar lo ocupa el índice triponderal (AUC= 0,66; corte= 16,67; sensibilidad= 67,6 y especificidad= 64,5); los parámetros para síndrome metabólico mostraron asociación estadísticamente significativa. Conclusión: El índice de masa corporal es el de mejor rendimiento diagnóstico para síndrome metabólico; podría ser un predictor útil para detectar este síndrome.

Introduction: Metabolic syndrome is associated with long-term chronic diseases, which is why different ways of obtaining an early diagnosis are sought. Objective: To determine the diagnostic yield of 3 anthropometric indices of weight and height for metabolic syndrome in a sample of Peruvian workers. Methods: The population are workers from 18 to 65 years old, both sexes, occupation operators and administrators; the studied variables were: age, sex, occupation, weight, height, waist circumference, history of type 2 diabetes mellitus, pressure systolic and diastolic blood pressure, fasting glucose, triglycerides, and high-density lipoprotein; 370 workers were included, receiver operating characteristic curves (ROC) were created with their respective area under the curve, obtaining the sensitivity and specificity of each of the indices. Results: Of the total number of workers, 20% presented Metabolic Syndrome; 46.76% were women, 60% drank alcohol at some time, and 5.14% reported having smoked. The Body Mass Index the greatest ROC= 0.73; cutoff= 26.04; sensitivity= 78.4 and specificity= 67.9) followed by the New Body Mass Index (ROC= 0.70; cutoff= 27.85; sensitivity= 68.9 and specificity= 70.6), the last place was occupied by the Triponderal Index (ROC= 0.66; cutoff= 16.67; sensitivity= 67.6 and specificity= 64.5); the parameters for metabolic syndrome showed a statistically significant association. Conclusion: Body Mass Index is the best diagnostic yield for Metabolic Syndrome and could be a useful predictor to detect this syndrome.

Performance of fecal S100A12 as a novel non-invasive diagnostic biomarker for pediatric inflammatory bowel disease: a systematic review and meta-analysis.

OBJECTIVE: The incidence and prevalence of inflammatory bowel disease (IBD) in pediatric patients are increasing. Currently, the diagnostic method for IBD is inconvenient, expensive, and difficult. S100A12, a type of calcium-binding protein, detected in the feces of patients with IBD has recently been suggested as a promising diagnostic tool. Hence, the authors aimed to evaluate the accuracy of fecal S100A12 in diagnosing IBD in pediatric patients by performing a meta-analysis. METHODS: The authors performed a systematic literature search in five electronic databases for eligible studies up to July 15, 2021. Pooled diagnostic accuracies of fecal S100A12 were analyzed as the primary outcomes. Secondary outcomes were standardized mean difference (SMD) of fecal S100A12 levels between IBD and non-IBD groups and a comparison of diagnostic accuracies between fecal S100A12 and fecal calprotectin. RESULTS: Seven studies comprising 712 children and adolescents (474 non-IBD controls and 238 IBD cases) were included. Fecal S100A12 levels were higher in the IBD group than in the non-IBD group (SMD = 1.88; 95% confidence interval [CI] = 1.19-2.58; p < 0.0001). Fecal S100A12 could diagnose IBD in pediatric patients with a pooled sensitivity of 95% (95% CI = 88%-98%), specificity of 97% (95% CI = 95%-98%), and area under the receiver operating summary characteristics (AUSROC) curve of 0.99 (95% CI = 0.97-0.99). Fecal S100A12 specificity and AUSROC curve values were higher than those of fecal calprotectin (p < 0.05). CONCLUSION: Fecal S100A12 may serve as an accurate and non-invasive tool for diagnosing pediatric IBD.

Validation studies on migraine diagnostic tools for use in nonclinical settings: a systematic review / Estudos de validação de ferramentas de diagnóstico de enxaqueca (migrânea) para uso em ambientes não clínicos: uma revisão sistemática

Abstract Background Migraine underdiagnosis and undertreatment are so widespread, that hence is essential to diagnose migraine sufferers in nonclinical settings. A systematic review of validation studies on migraine diagnostic tools applicable to nonclinical settings can help researchers and practitioners in tool selection decisions. Objective To systematically review and critically assess published validation studies on migraine diagnostic tools for use in nonclinical settings, as well as to describe their diagnostic performance. Methods A multidisciplinary workgroup followed transparent and systematic procedures to collaborate on this work. PubMed, Medline, and Web of Science were searched for studies up to January 17, 2022. The QUADAS-2 was employed to assess methodological quality, and the quality thresholds adopted by the Global Burden Disease study were used to tail signaling questions. Results From 7,214 articles identified, a total of 27 studies examining 19 tools were eligible for inclusion. There has been no high-quality evidence to support any tool for use of migraine diagnosis in nonclinical settings. The diagnostic accuracy of the ID-migraine, structured headache and HARDSHIP questionnaires have been supported by moderate-quality evidence, with sensitivity and specificity above 70%. Of them, the HARDSHIP questionnaire has been the most extensively validated. The remaining 16 tools have provided poor-quality evidence for migraine diagnosis in nonclinical populations. Conclusions Up till now, the HARDSHIP questionnaire is the optimal choice for diagnosing migraine in nonclinical settings, with satisfactory diagnostic accuracy supported by moderate methodological quality. This work reveals the crucial next step, which is further high-quality validation studies in diverse nonclinical population groups.

Resumo Antecedentes O sub-diagnóstico e o subtratamento da enxaqueca são tão difundidos que, portanto, é essencial para diagnosticar os portadores de enxaqueca em ambientes não-clínicos. Uma revisão sistemática dos estudos de validação das ferramentas de diagnóstico da enxaqueca aplicáveis a ambientes não-clínicos pode ajudar os pesquisadores e profissionais nas decisões de seleção de ferramentas. Objetivo Revisar sistematicamente e avaliar criticamente estudos de validação publicados sobre ferramentas de diagnóstico da enxaqueca para uso em ambientes não-clínicos, bem como descrever seu desempenho diagnóstico. Métodos Um grupo de trabalho multidisciplinar seguiu procedimentos transparentes e sistemáticos para colaborar neste trabalho. PubMed, Medline e Web of Science foram pesquisados por estudos até 17 de janeiro de 2022. O QUADAS-2 foi empregado para avaliar a qualidade metodológica, e os limites de qualidade adotados pelo estudo da Global Burden Disease foram usados para responder a questões de sinalização. Resultados De 7.214 artigos identificados, um total de 27 estudos examinando 19 ferramentas foram elegíveis para inclusão. Não houve evidência de alta qualidade para apoiar qualquer ferramenta para o uso de diagnóstico de enxaqueca em ambientes não clínicos. A precisão diagnóstica do ID-Migraine, questionário de dor de cabeça estruturada e questionário HARDSHIP foram apoiados por evidências de qualidade moderada, com sensibilidade e especificidade acima de 70%. Deles, o questionário HARDSHIP foi o mais amplamente validado. As 16 ferramentas restantes forneceram provas de má qualidade para o diagnóstico de enxaqueca em populações não-clínicas. Conclusões Até agora, o questionário HARDSHIP é a escolha ideal para o diagnóstico da enxaqueca em ambientes não-clínicos, com precisão diagnóstica satisfatória apoiada por uma qualidade metodológica moderada. Este trabalho revela o próximo passo crucial, que é a realização de mais estudos de validação de alta qualidade em diversos grupos populacionais não-clínicos.

Diagnostic accuracy of a set of clinical and radiological criteria for screening of COVID-19 using RT-PCR as the reference standard.

BACKGROUND: The gold-standard method for establishing a microbiological diagnosis of COVID-19 is reverse-transcriptase polymerase chain reaction (RT-PCR). This study aimed to evaluate the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of a set of clinical-radiological criteria for COVID-19 screening in patients with severe acute respiratory failure (SARF) admitted to intensive care units (ICUs), using reverse-transcriptase polymerase chain reaction (RT-PCR) as the reference standard. METHODS: Diagnostic accuracy study including a historical cohort of 1009 patients consecutively admitted to ICUs across six hospitals in Curitiba (Brazil) from March to September, 2020. The sample was stratified into groups by the strength of suspicion for COVID-19 (strong versus weak) using parameters based on three clinical and radiological (chest computed tomography) criteria. The diagnosis of COVID-19 was confirmed by RT-PCR (referent). RESULTS: With respect to RT-PCR, the proposed criteria had 98.5% (95% confidence interval [95% CI] 97.5-99.5%) sensitivity, 70% (95% CI 65.8-74.2%) specificity, 85.5% (95% CI 83.4-87.7%) accuracy, PPV of 79.7% (95% CI 76.6-82.7%) and NPV of 97.6% (95% CI 95.9-99.2%). Similar performance was observed when evaluated in the subgroups of patients admitted with mild/moderate respiratory disfunction, and severe respiratory disfunction. CONCLUSION: The proposed set of clinical-radiological criteria were accurate in identifying patients with strong versus weak suspicion for COVID-19 and had high sensitivity and considerable specificity with respect to RT-PCR. These criteria may be useful for screening COVID-19 in patients presenting with SARF.

Predictive Values of Systemic Immune-Inflammation Index in New-Onset Atrial Fibrillation Following Coronary Artery Bypass Grafting

ABSTRACT Introduction: We investigated the relationship between the newly-defined systemic immune-inflammation index and the new-onset atrial fibrillation in patients undergoing coronary artery bypass grafting. Method: This study included 392 patients who underwent coronary artery bypass grafting. We divided the participants into two groups as those with and without new-onset atrial fibrillation. Prior to coronary artery bypass grafting, we evaluated blood samples, including systemic immune-inflammation index, and other laboratory parameters of the patients. We formulized the systemic immune-inflammation index score as platelet × neutrophil/lymphocyte counts. Results: The findings revealed that new-onset atrial fibrillation occurred in 80 (20.4%) of 392 patients during follow-ups. Such patients had higher systemic immune-inflammation index, neutrophil/lymphocyte ratio, and C-reactive protein levels than those who did not develop new-onset atrial fibrillation (P<0.001, P<0.001, P=0.010, respectively). In receiver operating characteristic curve analysis, systemic immune-inflammation index levels > 712.8 predicted new-onset atrial fibrillation with a sensitivity of 85% and a specificity of 61.2% (area under the curve: 0.781, 95% confidence interval: 0.727-0.835; P<0.001). Conclusion: Overall, systemic immune-inflammation index, a novel inflammatory marker, may be used as a decisive marker to predict the development of atrial fibrillation following coronary artery bypass grafting.

Diagnosis of fibromyalgia: diagnostic feasibility and accuracy of thermography

INTRODUCTION: Studies have suggested using thermography as a resource to diagnose fibromyalgia, although there has been no evidence confirming this hypothesis so far. OBJECTIVE: To evaluate the sensitivity and specificity of computerized infrared thermography as an auxiliary method for diagnosing fibromyalgia. METHODS: It is a diagnostic accuracy studywith cross-sectional design. One hundred and three individuals were evaluated for global pain using the Visual Analogue Scale. The measurement of pain at tender points was assessed by algometry, and skin temperature was assessed by thermography. To evaluate sensitivity and specificity, the analysis was performed using the Receiver Operating Characteristic Curve, measured by the area under the curve with their respective confidence intervals. RESULTS: Thermography has not been very sensitive or specific for pain (tender points) and diagnosis of fibromyalgia, according to the evaluation of the Receiver Operating Characteristic Curve, with an area under the curve equal to or lower than 0.75. CONCLUSION: In this study the thermography was not sensitive and specific as a tool for diagnosing the fibromyalgia syndrome. This study highlights important clinical implications concerning the current methods for diagnosing it, which, despite all efforts, are still subjective and poorly reproducible.

Bacterial vaginosis and trichomoniasis: prevalence, associated factors, and performance of diagnostic tests

Introduction: Bacterial vaginosis and vaginal trichomoniasis are frequent causes of health care demand. Objective: To estimate the prevalence, identify associated factors, and investigate the performance of diagnostic tests for bacterial vaginosis and trichomoniasis. Methods: Cross-sectional study with participants over 18 years old. All of them were submitted to an interview and gynecological examination with evaluation of vaginal secretion, pH verification, collection of material for Pap smear, wet mount test, Whiff test, bacterioscopy, and polymerase chain reaction for trichomoniasis detection. Logistic regression analysis was applied to identify associated factors with bacterial vaginosis. Diagnostic performance for bacterial vaginosis was evaluated following Amsel criteria, the Ison and Hay score, and the Pap smear, considering the Nugent score as the gold standard. As for trichomoniasis, diagnostic performance was evaluated through the Pap smear and the wet mount test, using the polymerase chain reaction as the gold standard. Results: The prevalence of bacterial vaginosis was 33.7%, and for trichomoniasis, 0.5%. The complaint of abnormal vaginal secretion was associated with the diagnosis of bacterial vaginosis (odds ratio 2.2). The diagnostic accuracy by Amsel criteria, the Ison and Hay score, and the Pap smear was 35.6, 97.0, and 84.2%, respectively. The sensitivity for trichomoniasis through wet mount test was 0.0%, and through the Pap smear, 100%. Conclusion: The prevalence of bacterial vaginosis was high, and trichomoniasis was low. The only associated factor with bacterial vaginosis was the report of abnormal vaginal secretion. The methods with the most accurate diagnostic performance for bacterial vaginosis were the Ison and Hay score and the Pap smear and, for trichomoniasis, the Pap smear