Validation of the Kriol and Belizean English Adaptation of the Revised Children's Anxiety and Depression Scale for Use With Adolescents in Belize.

PURPOSE: To validate a culturally-adapted Kriol and Belizean English version of the Revised Children's Anxiety and Depression Scale (RCADS) through comparison with clinical diagnoses made using the Kiddie Schedule of Affective Disorders and Schizophrenia. METHODS: Participants comprised of 256 adolescents aged 10-14 years and 15-19 years, who completed the adapted RCADS (10 depression items, 12 anxiety items) in one-on-one interviews, followed by a diagnostic assessment using Kiddie Schedule of Affective Disorders and Schizophrenia administered by trained clinicians. Sensitivity, specificity, positive predictive value, negative predictive value, diagnostic odds ratios, area under the curve (AUC), and Youden's Index were calculated for RCADS cutoffs and scores on the total scale and anxiety and depression subscales. RESULTS: For adolescents aged 10-14 years (n = 161), the AUC was 0.72 for the full scale, 0.67 for anxiety subscale, and 0.76 for depression subscale. For adolescents aged 15-19 years (n = 95), the AUCs were 0.82, 0.77, and 0.83. Most depression items performed well in discriminating those with and without diagnoses. Separation anxiety items performed poorly. "Thoughts of death" were common even among adolescents not meeting diagnostic criteria. The RCADS depression subscale presented the strongest psychometric properties with adolescents aged 15-19 years (at cutoff of 13, sensitivity = 0.83, specificity = 0.77, positive predictive value = 0.47, negative predictive value = 0.95, odds ratio = 15.96). CONCLUSION: The adapted RCADS-22 had acceptable categorization for adolescents aged 10-14 years and excellent categorization for adolescents aged 15-19 years; therefore, the tool is recommended for use among the latter age group. Based on sensitivity and specificity values at different cutoffs, guidance is provided to select different thresholds to suit clinical, public health, or other uses to detect and quantify adolescent depression and anxiety in Belize.

Validez de la evaluación del consumo de alcohol establecido en la norma técnica de atención integral del adulto con infección por el VIH

Objetivos: Determinar la validez de la evaluación de consumo de alcohol realizado en la Estrategia Nacional de Salud para la Prevención y Control de ITS-VIH / SIDA (ESNITSS) a pacientes con VIH que iniciaron tratamiento antirretroviral (TARV). Material y métodos: El tipo de estudio fue de evaluación de prueba diagnóstica en pacientes en TARV de un hospital del Ministerio de Salud (MINSA), entre septiembre de 2017 y enero de 2018; en base al análisis de datos de la Fase I del estudio "Efectividad de la Consejería en Enfermería en la Mejora de la Adherencia al TARV en pacientes con VIH y Conducta de Consumo de Alcohol". 4000 pacientes conformaron la población de estudio y 350 pacientes fueron seleccionados aleatoriamente. Se procedió a la validación de la evaluación del consumo de alcohol realizado por la ESNITSS con dos Gold estándar: i. la evaluación del consumo de alcohol en el último mes y ii. el consumo de riesgo identificado con el Alcohol Use Disorders Identification Test (AUDIT). Se calculó sensibilidad, especificidad, seguridad de la evaluación y razones de probabilidad. Resultados: La sensibilidad y especificidad fue regular para la evaluación de consumo de alcohol en el último mes (S=0,64, E=0,57), la especificidad fue mala para la evaluación de consumo de riesgo (E=0,48). Las razones de verosimilitud positivas demuestraron que la evaluación no tiene utilidad diagnóstica para ninguno de los casos (<2). Conclusiones: La evaluación de "consumo actual de alcohol" realizada por la ESNITSS no mostró utilidad diagnóstica.

SUMMARY Objectives: To determine the validity of the evaluation of alcohol consumption established by the national strategy to prevent and control STI-HIV-AIDS (ESNITSS) of HIV-infected adults that started anti-retroviral treatment (ART). Methods: Diagnostic study of HIV patients in a single hospital in Lima from September 2017 to January 2018 using data from a phase one study "Effectiveness of nursing counseling in improving adherence to ART among patient with alcohol consumption". Three hundred and fifty patients were randomly selected among 4000 participants. Two gold standards evaluated alcohol consumption: 1. Last month alcohol consumption and ii; alcohol consumption identified by the Alcohol Use Disorders Identification Test (AUDIT). Sensitivity, specificity, safety of the evaluation and probability rates. Results: sensitivity and specificity were moderate for last month alcohol consumption (s=0.64; e=0.57); specificity was low for evaluation of consumption risk (e=0.48). Positive validity rates demonstrated that the evaluation is not useful (<2). Conclusions: The evaluation of alcohol consumption followed by the ESNITSS has no diagnostic utility.

SemClinBr - a multi-institutional and multi-specialty semantically annotated corpus for Portuguese clinical NLP tasks.

BACKGROUND: The high volume of research focusing on extracting patient information from electronic health records (EHRs) has led to an increase in the demand for annotated corpora, which are a precious resource for both the development and evaluation of natural language processing (NLP) algorithms. The absence of a multipurpose clinical corpus outside the scope of the English language, especially in Brazilian Portuguese, is glaring and severely impacts scientific progress in the biomedical NLP field. METHODS: In this study, a semantically annotated corpus was developed using clinical text from multiple medical specialties, document types, and institutions. In addition, we present, (1) a survey listing common aspects, differences, and lessons learned from previous research, (2) a fine-grained annotation schema that can be replicated to guide other annotation initiatives, (3) a web-based annotation tool focusing on an annotation suggestion feature, and (4) both intrinsic and extrinsic evaluation of the annotations. RESULTS: This study resulted in SemClinBr, a corpus that has 1000 clinical notes, labeled with 65,117 entities and 11,263 relations. In addition, both negation cues and medical abbreviation dictionaries were generated from the annotations. The average annotator agreement score varied from 0.71 (applying strict match) to 0.92 (considering a relaxed match) while accepting partial overlaps and hierarchically related semantic types. The extrinsic evaluation, when applying the corpus to two downstream NLP tasks, demonstrated the reliability and usefulness of annotations, with the systems achieving results that were consistent with the agreement scores. CONCLUSION: The SemClinBr corpus and other resources produced in this work can support clinical NLP studies, providing a common development and evaluation resource for the research community, boosting the utilization of EHRs in both clinical practice and biomedical research. To the best of our knowledge, SemClinBr is the first available Portuguese clinical corpus.

Animal Models to Test SARS-CoV-2 Vaccines: Which Ones Are in Use and Future Expectations.

Since late 2019 and early 2020, with the emergence of the COVID-19 pandemic, scientists are rushing to develop treatment and prevention methods to combat SARS-CoV-2. Among these are vaccines. In view of this, the use of animals as experimental models, both to investigate the immunopathology of the disease and to evaluate the efficacy and safety of vaccines, is mandatory. This work aims to describe, through recent scientific articles found in reliable databases, the animal models used for the in vivo testing of COVID-19 vaccines, demonstrating some possibilities of more advantageous/gold-standard models for SARS-CoV-2 vaccines. The majority of the studies use rodents and primates. Meanwhile, the most adequate model to be used as the gold standard for in vivo tests of COVID-19 vaccines is not yet conclusive. Promising options are being discussed as new tests are being carried out and new SARS-CoV-2 variants are emerging.

Current Diagnostic Methods for Assessing Transfer of Passive Immunity in Calves and Possible Improvements: A Literature Review.

Several direct or indirect methods can be used to assess immunoglobulin G (IgG) concentrations in calves, which evaluates the transfer of passive immunity (TPI). Radial immunodiffusion (RID) is the gold standard method to measure serum IgG in bovines. Previous studies have shown that colostrum provides several molecules in addition to immunoglobulins, which play an important role in the passive immunity of the calf. However, no studies have yet determined the level of interference of these components in the immunity, health and survival of calves. In this sense, the objective of this study is to review the methods of evaluation available for the laboratory and field diagnosis of TPI in calves and discuss the main aspects of each technique. Several methods available for TPI evaluation in calves may provide insights into the various components of colostrum involved in passive immunity.

¿Son válidos los métodos manuales modificados para determinar la Velocidad de Eritrosedimentación Globular (VSG) en laboratorios clínicos? / Are modified manual methods valid to establish Erythrocyte Sedimentation Rate (ESR) in clinical laboratories? / Os métodos manuais modificados são válidos para determinar a velocidade de hemossedimentação(VHS) nos laboratórios clínicos?

Resumen Se evaluó estadísticamente la validez de cuatro métodos para determinar la Velocidad de Eritrosedimentación Globular (VSG) alternos al de Westergren, el que se tomó como "gold standard". Los métodos evaluados fueron Wintrobe (WB), Wintrobe inclinado (WI) a 45° y dos micrométodos capilares, uno vertical (MM) y otro inclinado a 45° (MMI). Se procesaron 419 muestras por los cinco métodos. Se evaluó la concordancia (C), la sensibilidad (S), especificidad (E), valor predictivo positivo (VPP) y valor predictivo negativo (VPN). Los resultados de S, E, VPP, VPN y C fueron: 93,8%, 93,6, 98,8%, 72,8% y 71% en el de WB; 86,3%, 85,7%, 97,2%, 52,4% y 54% en el de WI; 94,6%, 66,6%, 94,1%, 71,4% y 54% para MM y 91,9%, 72,4%, 94,8%, 60,8% y 55% para MMI. El índice kappa mostró una concordancia "buena" entre el método de Westergren y el método de Wintrobe y "moderada" con los métodos de WBI, MM y MMI. Los resultados del presente estudio muestran que el método de Wintrobe es confiable para su uso en el laboratorio clínico comparado con el de Westergreen.

Abstract Four methods were statistically evaluated for their validity to determine the alternative Erythrocyte sedimentation rate to that of Westergren, which was taken as the "gold standard". The methods evaluated were Wintrobe (WB), Wintrobe inclined (WI) at 45° and two capillary micromethods, one vertical (MM) and one inclined at 45° (MMI). A total of 419 samples were processed by the five methods. Concordance (C), sensitivity (S), specificity (E), positive predictive value (PPV) and negative predictive value (NPV) were evaluated. The results for S, E, PPV, NPV and C were: 93.8%, 93.6, 98.8%, 72.8% and 71% for WB; 86.3%, 85.7%, 97.2%, 52.4% and 54% for WI; 94.6%, 66.6%, 94.1%, 71.4% and 54% for MM and 91.9%, 72.4%, 94.8%, 60.8% and 55% for MMI. The kappa index showed "good" agreement between the Westergren method and the Wintrobe method and "moderate" agreement with the WBI, MM and MMI methods. The results of the present study show that the Wintrobe method is reliable for use in the clinical laboratory compared to the Westergren method.

Resumo Neste trabalho, foi avaliada estatisticamente a validez de quatro métodos para determinar a Velocidade de Eritrosedimentação Globular (VSG) alternos ao Westergren, que foi considerado como o "Método Padrão". Os métodos avaliados foram Wintrobe (WB), Wintrobe inclinado a 45° (WI) e dois micro-métodos capilares, um vertical (MM) e outro inclinado a 45° (MMI). 419 amostras foram processadas pelos cinco métodos. Envalou-se a concordância (C), sensibilidade (S), especificidade (E), assim como os valores preditivos positivos (VPP) e negativos (VPN). Os resultados de S, E, VPN e VPP foram: 93.8%, 93.6%, 98.8%, 72.8% e 71% com o WB; 86.3%, 85.7%, 97.2%, 52.4% e 54% com o WI; 94.6%, 66.6%, 94.1%, 71.4% e 54% para MM e 91.9%, 72.4%, 94.8%, 60.8% e 55% para o MMI. O índice kappa apresentou "boa" concordância entre os métodos de Westergren e Wintrobe, enquanto teve concordância "moderada" com os métodos WBI, MMe MMI. Os resultados deste estudo revelaram que o método de Wintrobe é confiável para seu uso no laboratório clínico comparado com o método de Westergren.

Evaluation of the performance of three serological tests for diagnosis of Leishmania infantum infection in dogs using latent class analysis / Avaliação da realização de três testes sorológicos para diagnóstico de infecção por Leishmania infantum em cães utilizando análise de classe latente

Canine leishmaniasis (CanL) is a disease caused by Leishmania infantum. Serological methods are the most common diagnostic techniques used for the diagnosis of the CanL. The objective of our study was to estimate the sensitivity and specificity of one in-house ELISA kit (ELISA UNIZAR) and three commercially available serological tests (MEGACOR Diagnostik GmbH) including an immunochromatographic rapid test (FASTest LEISH®), an immunofluorescent antibody test (MegaFLUO LEISH®) and an enzyme-linked immunosorbent assay (MegaELISA LEISH®), using latent class models in a Bayesian analysis. Two hundred fifteen serum samples were included. The highest sensitivity was achieved for FASTest LEISH® (99.38%), ELISA UNIZAR (99.37%), MegaFLUO LEISH® (99.36%) followed by MegaELISA LEISH® (98.49%). The best specificity was obtained by FASTest LEISH® (98.43%), followed by ELISA UNIZAR (97.50%), whilst MegaFLUO LEISH® and MegaELISA LEISH® obtained the lower specificity (91.94% and 91.93%, respectively). The results of present study indicate that the immunochromatographic rapid test evaluated FASTest LEISH® show similar levels of sensitivity and specificity to the quantitative commercial tests. Among quantitative serological tests, sensitivity and specificity were similar considering ELISA or IFAT techniques.(AU)

A leishmaniose canina (Lcan) é uma causada pela Leishmania infantum. Os métodos sorológicos são as técnicas diagnósticas mais utilizadas para o diagnóstico da leishmaniose canina. O objetivo do nosso estudo foi estimar a sensibilidade e a especificidade de um kit ELISA interno (ELISA UNIZAR) e de três testes sorológicos disponíveis comercialmente, feitos pelo mesmo fabricante (MEGACOR Diagnostik GmbH), incluindo um teste rápido imunocromatográfico (FASTest LEISH®), um teste de anticorpos imunofluorescentes (Megafluo LEISH®) e um ensaio de imunoabsorção enzimática (Megaelisa LEISH®), utilizando-se modelos de classe latentes numa análise bayesiana. Foram incluídas duzentas e quinze amostras de soro. A maior sensibilidade foi alcançada para Fastest LEISH® (99,38%), ELISA UNIZAR (99,37%), Megafluo LEISH® (99,36%) seguida por Megaelisa LEISH® (98,49%). A melhor especificidade foi obtida por FASTest LEISH® (98,43%), seguida por ELISA UNIZAR (97,50%), enquanto Megafluo LEISH® e Megaelisa LEISH® obtiveram a menor especificidade (91,94% e 91,93%, respectivamente). Os resultados do presente estudo indicam que o teste rápido imunocromatográfico, avaliado por FASTest LEISH® mostra níveis similares de sensibilidade e especificidade aos testes comerciais quantitativos incluídos. Entre os testes sorológicos quantitativos, a sensibilidade e a especificidade foram semelhantes, considerando-se as técnicas de ELISA ou IFI.(AU)

Evaluation of the performance of three serological tests for diagnosis of Leishmania infantum infection in dogs using latent class analysis / Avaliação da realização de três testes sorológicos para diagnóstico de infecção por Leishmania infantum em cães utilizando análise de classe latente

Abstract Canine leishmaniasis (CanL) is a disease caused by Leishmania infantum. Serological methods are the most common diagnostic techniques used for the diagnosis of the CanL. The objective of our study was to estimate the sensitivity and specificity of one in-house ELISA kit (ELISA UNIZAR) and three commercially available serological tests (MEGACOR Diagnostik GmbH) including an immunochromatographic rapid test (FASTest LEISH®), an immunofluorescent antibody test (MegaFLUO LEISH®) and an enzyme-linked immunosorbent assay (MegaELISA LEISH®), using latent class models in a Bayesian analysis. Two hundred fifteen serum samples were included. The highest sensitivity was achieved for FASTest LEISH® (99.38%), ELISA UNIZAR (99.37%), MegaFLUO LEISH® (99.36%) followed by MegaELISA LEISH® (98.49%). The best specificity was obtained by FASTest LEISH® (98.43%), followed by ELISA UNIZAR (97.50%), whilst MegaFLUO LEISH® and MegaELISA LEISH® obtained the lower specificity (91.94% and 91.93%, respectively). The results of present study indicate that the immunochromatographic rapid test evaluated FASTest LEISH® show similar levels of sensitivity and specificity to the quantitative commercial tests. Among quantitative serological tests, sensitivity and specificity were similar considering ELISA or IFAT techniques.

Resumo A leishmaniose canina (Lcan) é uma causada pela Leishmania infantum. Os métodos sorológicos são as técnicas diagnósticas mais utilizadas para o diagnóstico da leishmaniose canina. O objetivo do nosso estudo foi estimar a sensibilidade e a especificidade de um kit ELISA interno (ELISA UNIZAR) e de três testes sorológicos disponíveis comercialmente, feitos pelo mesmo fabricante (MEGACOR Diagnostik GmbH), incluindo um teste rápido imunocromatográfico (FASTest LEISH®), um teste de anticorpos imunofluorescentes (Megafluo LEISH®) e um ensaio de imunoabsorção enzimática (Megaelisa LEISH®), utilizando-se modelos de classe latentes numa análise bayesiana. Foram incluídas duzentas e quinze amostras de soro. A maior sensibilidade foi alcançada para Fastest LEISH® (99,38%), ELISA UNIZAR (99,37%), Megafluo LEISH® (99,36%) seguida por Megaelisa LEISH® (98,49%). A melhor especificidade foi obtida por FASTest LEISH® (98,43%), seguida por ELISA UNIZAR (97,50%), enquanto Megafluo LEISH® e Megaelisa LEISH® obtiveram a menor especificidade (91,94% e 91,93%, respectivamente). Os resultados do presente estudo indicam que o teste rápido imunocromatográfico, avaliado por FASTest LEISH® mostra níveis similares de sensibilidade e especificidade aos testes comerciais quantitativos incluídos. Entre os testes sorológicos quantitativos, a sensibilidade e a especificidade foram semelhantes, considerando-se as técnicas de ELISA ou IFI.

Metabolic surgery: gastric bypass for the treatment of type 2 diabetes mellitus.

Type 2 diabetes mellitus (T2DM) is one of the largest health emergencies of the 21st century given the worldwide increase of obesity during the last decades and its close association. T2DM is an inherited, polygenic and chronic disease caused by the interaction between several genetic variants in genes and the environment. The continuous search for new and more effective tools to achieve appropriate glycemic control became imperative in order to reduce long-term complications and mortality rates related to T2DM. Treatment options includes lifestyle modifications and several pharmacotherapies as first step in the therapeutical algorithm, but high corps of evidence have shown that gastrointestinal (GI) operations, especially those that involve food rerouting through the GI tract, are safe interventions and achieve superior outcomes for improvement in glucose metabolism when comparing with optimal medical and lifestyle changes. GI Surgery, specially Roux-en-Y gastric bypass (RYGB), is currently the most accepted surgical procedure to treat T2DM, and has also demonstrated to reduce significantly other cardiovascular risk factors (lipids and blood pressure control) when compared with optimal medical treatment, with good long-term effects on cardiovascular risks and mortality. Although the most effective technique in achieving diabetes remission is biliopancreatic diversion, the effectiveness-adverse effects balance is superior for RYGB. For these reasons, metabolic surgery (which was defined as "the operative manipulation of a normal organ or organ system to achieve a biological result for a potential health gain") has been considered and accepted as a new step in the therapeutic algorithm for T2DM when optimal lifestyle and medical interventions don't achieve optimal glycemic goals.

Metodologias e ferramentas para anotação de narrativas clínicas / Methodologies and tools for clinical narratives annotation

A utilização de técnicas de Processamento de Linguagem Natural (PLN) em textos clínicos é amplamente dependente de grandes quantidades de dados textuais anotados, denominados corpus ou padrão ouro. Sendo essenciais para a modelagem da linguagem durante a fase de treinamento de diversos algoritmos de PLN. Porém, para a criação de um padrão ouro é necessário um extenso e custoso trabalho manual de anotação, que demanda um grande esforço de especialistas. OBJETIVO: Realizar uma revisão da literatura, visando o estudo de metodologias e ferramentas utilizadas em procedimentos de anotação de textos. MÉTODO: Levantamento em bases científicas referentes à elaboração de corpus morfológicos, sintáticos e morfossintáticos foi realizado, analisando 32 estudos de anotação e mais 12 ferramentas. RESULTADOS: Foram levantados os principais aspectos nos processos de anotação, bem como realizada uma avaliação dentre critérios pré-definidos de cada das ferramentas de suporte encontradas.

The use of natural language processing techniques (NLP) in clinical texts is dependent on large amounts of annotated text data, called corpus or gold standard. Are essential for the modelling language during the training phase of NLP algorithms. However, for the creation of a gold standard is required extensive and costly manual annotation task, that demands a great deal of experts. OBJECTIVES: To review the literature to identify methodologies and tools applied to text annotation. METHODS: Scientifics databases search regarding the development of morphological, syntactic and morphosyntactic corpus was performed by analyzing 32 annotation studies and 12 tools. RESULTS: Main aspects of the annotation process description, as well as an assessment from pre-defined criteria for each one of the annotation tools identified.

Construção e validação de questionário simplificado para triagem de pacientes com disfunção temporomandibular (QST/DTM) / Construction and validation of a simplified questionnaire for screening of patients with temporomandibular disorders (QST / TMD)

As disfunções temporomandibulares (DTM) representam a maior causa de dor não dentária da região orofacial. Dada sua alta prevalência na população em geral e a existência de inúmeros instrumentos diagnósticos não padronizados, buscou-se elaborar e validar um questionário simples, de acessibilidade ampla e aplicação prática, com vistas a contribuir para o diagnóstico e o estudo epidemiológico das mesmas. A estratégia utilizada na montagem do instrumento foi estabelecida com base na avaliação criteriosa de questionários já existentes na literatura, validação de expertos na área de DTM, validação fatorial, de face (na primeira fase do estudo) e, frente ao padrão ouro (RDC/TMD), na segunda fase do estudo. Na primeira fase, participaram 160 indivíduos. A consistência interna resultou num Coeficiente Alfa de Cronbach de 0,752 para o questionário com sete itens; enquanto que para o questionário com cinco itens, este resultado foi de 0,694, não sendo o mesmo, considerado baixo por avaliar apenas cinco questões e ainda, em razão do tema central da pesquisa ser bastante subjetivo. A análise fatorial confirmatória apontou para uma variância total dos fatores extraídos do questionário com sete itens, de 58,2 % e do questionário com cinco itens de 70,04%. Portanto, o questionário com cinco questões, apresentou resultados estatísticos superiores ao de sete questões. Na validação frente ao padrão ouro (RDC/TMD), foram avaliados 99 indivíduos tendo sido testados os dois questionários, com sete e com cinco questões. Na estrutura com sete questões, ao se categorizar as mesmas por totais de pontos obtidos, em quatro condições, obteve-se o melhor resultado quando se considerou com DTM a faixa entre 10 e 21 pontos, sendo 85,1% positivos também no RDC/TMD, com acurácia de 90,1% e Kappa 0,817. Nesta condição, a sensibilidade encontrada foi de 95% (IC 95%, 91 a 99), especificidade de 87% (IC 95%, 81 a 93), VPP 85%, VPN 96%, LR+ 7,3 e LR- 17,4. Quando os dados foram avaliados para o questionário com cinco questões (QST/DTM), pode-se observar que o melhor ponto de corte foi quando se considerou como portadores de DTM, os indivíduos na faixa entre 7 e 15 pontos, com acurácia de 85,8% e Kappa 0,817. Nesta condição, a sensibilidade foi 88% (IC 95%, 81,6 a 94,4), especificidade 84% (IC 95%, 76,8 a 91,2), VPP 80%, VPN 90,5%, LR+ 5,5 e LR- 7,0. A simplicidade do presente questionário (QST/DTM) com apenas cinco questões, possibilita seu uso como elemento de triagem inicial na área da dor orofacial em disfunção temporomandibular, com boa compreensibilidade, confiabilidade, reprodutibilidade e possibilidade de aplicação em pesquisas epidemiológicas. Concluiu-se que o questionário aqui validado, permite sua aplicação de forma simples tanto por profissionais e pesquisadores da Odontologia como de outras áreas da saúde. (AU)

Temporomandibular disorders (TMD) represent the biggest cause of non-dental pain in the orofacial region. In reason of its high prevalence in the general population and the existence of numerous non-standardized diagnostic tools, it was sought to develop and validate a simple questionnaire, with wide accessibility and practical application, in order to contribute to the diagnosis and epidemiological study of the same. The strategy used in the assembly of the instrument was based on careful evaluation of existing questionnaires in the literature, validation of experts in the field of TMD, face and factorial validity (at the first moment of the study) and validation against the gold standard (RDC/TMD), at the second moment of the study. At the first stage, participated 160 individuals. The internal consistency resulted in a Cronbach alpha of 0,752 for the questionnaire with seven items, while for the questionnaire with five items, this result was 0,694, not being the same considered a low value since it evaluated only five questions and yet, in reason of the subjectivity of the main theme of the research. Confirmatory factor analysis indicated a total variance of the factors extracted from the questionnaire with seven items of 58,2% and for the questionnaire with five items of 70,04%. Therefore, the questionnaire with five questions presented better statistical results them the one with seven questions. In the validation against the gold standard (RDC/TMD), 99 individuals were evaluated, being tested both questionnaires, with five and seven questions. In the structure with seven issues, when categorizing them by total points earned, on four conditions, we obtained the best result when considering with TMD the range between 10 and 21 points, being 85,1% positive also in the RDC/TMD, with an accuracy of 90,1% and Kappa 0,817. In this condition, the sensitivity was 95% (CI 95%, 91 to 99), specificity of 87% (CI 95%, 81 to 93), PPV 85%, NPV 96%, LR+ 7,3 and LR- 17,4. When the data were evaluated for the questionnaire with five questions (QST/DTM), one can observe that the best cutoff point was when considered as with TMD the individuals aged between 7 and 15 points, with an accuracy of 85,8% and 0,817 Kappa. In this condition, the sensitivity was 88% (CI 95%, 81,6 to 94,4), specificity 84% (CI, 95%, 76,8 to 91,2), PPV 80%, NPV 90,5%, LR+ 5,5 and LR- 7,0. The simplicity of this questionnaire (QST/DTM) with only five issues permits its use as an initial screening in the area of orofacial pain in temporomandibular disorders, with good responsiveness, reliability, reproducibility and possibility of application in epidemiologic researches. It was concluded that the questionnaire here validated, enables its application in a simple manner by both practitioners and researchers of Dentistry as in other areas of health. (AU)

La tomagrafía computarizada como prueba para diagnosticar enfermedad arterial coronaria con comentarios sobre la aplicación de la teoría de Bayes y la placa vulnerable / Computerized tomography as a coronary artery disease diagnostic test and comments on the Bayes` theory and the vulnerable plaque

Los factores de riesgo en enfermedad arterial coronaria fueron evaluados en historias clínicas y estudios de pruebas de esfuerzos con el protocolo de Duke. Los índices de certeza se definen y utilizan comparándolos con el "el patrón de oro" la arteriografía coronaria. Se establece el valor diagnóstico de la tomagrafía axial computarizada, basándose en los índices de certeza. también se mencionan los estudios intracoronarios para evaluar la placa obstructiva

Risk factors in coronary artery disease were evaluated with the clinical history and the stress test with the Duke protocol. Probability indexes were defined and compared with the gold standard (coronary arteriogram). The diagnostic value of coronary angiotac was established with probability indexes. Intracoronary studies to diagnose vulnerable plaque are also mentioned

Doença do refluxo gastroesofágico em crianças: quão confiável é o padrão-ouro? / Gastroesophageal reflux disease in children: how reliable is the gold standard?

OBJETIVO: O monitoramento do pH esofágico é considerado o método mais confiável para diagnosticar o refluxo gastroesofágico. No entanto, a interpretação do mesmo estudo de pH pode diferir entre observadores. Neste estudo, investigamos as causas e o grau de variabilidade entre observadores. MÉTODOS: Este estudo retrospectivo incluiu todas as crianças (n = 72) que realizaram monitoramento de pH durante 1 ano no Maxima Medical Centre, em Veldhoven, Holanda. RESULTADOS: Foi encontrada uma variabilidade de 18 por cento entre observadores. A variabilidade foi causada por diferenças de opinião sobre a duração do registro, dúvidas sobre a posição da sonda, artefatos e flutuação do pH de base. CONCLUSÕES: A maioria desses problemas pode ser eliminada por avaliação da posição do eletrodo de pH e calibração pós-teste. No entanto, ainda falta uma definição clara dos artefatos de monitoramento. Este estudo mostra que a concordância mútua na interpretação dos estudos de pH foi regular (coeficiente kappa de 0,70).

OBJECTIVE: To investigate the causes and degree of interobserver variability in esophageal pH monitoring for the diagnosis of gastroesophageal reflux. METHODS: This retrospective study included all children (n = 72) who underwent pH monitoring during 1 year at Maxima Medical Centre in Veldhoven, the Netherlands. RESULTS: An interobserver variability of 18 percent was found. Variability was caused by differences in opinion about the duration of registration, doubts about probe position, artifacts and drift of baseline pH. CONCLUSIONS: Most of these problems can be eliminated by posttest calibration and assessment of the pH electrode position. However, a clear definition of monitoring artifacts is lacking. This study shows that mutual agreement in the interpretation of pH studies was fair (kappa coefficient of 0.70).