Different Methods Of Screening Research Articles

Detection of Cervical Precancer Using Visual Inspection Method with Acetic Acid.

Cervical cancer screening is the priority activity of the government. Visual inspection with Acetic acid (VIA), Pap smear Liquid-based cytology, and HPV DNA testing are different methods of screening. VIA-based screening is the cost-effective method of screening in a resource-constrained setting like in our country as this doesn't require cyto-histological testing, can be performed by trained paramedics too, and is as accurate as a cytological test. The aim is to explore pre-cancer cervical lesions by screening women in the community by visual inspection using acetic-acid. Community-based cross-sectional study done at a health camp setting for three months from March to June 2023. The married non-pregnant women of 30-60 years were screened. Descriptive tests as well as sub-group analysis performed by Chi-Square tests. From ten community health camps, 1255 cases were screened and screen positivity was 14.3%. Positive results were proportionately distributed to all parity by 13-19%. Half of the positive results (47.2%) were in the 34-40 age group. There were no significant differences in screen positivity by parity or vaginal discharge. Menopausal women had 7.7% screen positivity. The prevalence of VIA positivity in the community was found double the previous facility-based prevalence; and there was no significant difference by parity, menopausal status, and vaginal discharge. The positivity was more in 30-45 years of age.

Screening for pre-eclampsia by maternal serum glycosylated fibronectin and angiogenic markers at 36 weeks' gestation.

First, to examine the predictive performance of maternal serum glycosylated fibronectin (GlyFn) at 35 + 0 to 36 + 6 weeks' gestation in screening for delivery with pre-eclampsia (PE) and delivery with gestational hypertension (GH) at ≥ 37 weeks' gestation, both within 3 weeks and at any time after the examination. Second, to compare the predictive performance for delivery with PE and delivery with GH of various combinations of biomarkers, including GlyFn, mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), serum placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1). Third, to compare the predictive performance for delivery with PE and delivery with GH by serum PlGF concentration, sFlt-1/PlGF concentration ratio and the competing-risks model with different combinations of biomarkers as above. Fourth, to compare the predictive performance of screening at 11 + 0 to 13 + 6 weeks vs 35 + 0 to 36 + 6 weeks for delivery with PE and delivery with GH at ≥ 37 weeks' gestation. This was a case-control study in which maternal serum GlyFn was measured in stored samples from a non-intervention screening study in singleton pregnancies at 35 + 0 to 36 + 6 weeks' gestation using a point-of-care device. We used samples from women who delivered at ≥ 37 weeks' gestation, including 100 who developed PE, 100 who developed GH and 600 controls who did not develop PE or GH. In all cases, MAP, UtA-PI, PlGF and sFlt-1 were measured during the routine visit at 35 + 0 to 36 + 6 weeks. We used samples from patients that had been examined previously at 11 + 0 to 13 + 6 weeks' gestation. Levels of GlyFn were transformed to multiples of the expected median (MoM) values after adjusting for maternal demographic characteristics and elements from the medical history. Similarly, the measured values of MAP, UtA-PI, PlGF and sFlt-1 were converted to MoM. The competing-risks model was used to combine the prior distribution of the gestational age at delivery with PE, obtained from maternal risk factors, with various combinations of biomarker MoM values to derive the patient-specific risks of delivery with PE. The performance of screening of different strategies was estimated by examining the detection rate (DR) at a 10% fixed false-positive rate (FPR) and McNemar's test was used to compare the DRs between the different methods of screening. The DR, at 10% FPR, of screening by the triple test (maternal risk factors plus MAP, PlGF and sFlt-1) was 83.7% (95% CI, 70.3-92.7%) for delivery with PE within 3 weeks of screening and 80.0% (95% CI, 70.8-87.3%) for delivery with PE at any time after screening, and this performance was not improved by the addition of GlyFn. The performance of screening by a combination of maternal risk factors, MAP, PlGF and GlyFn was similar to that of the triple test, both for delivery with PE within 3 weeks and at any time after screening. The performance of screening by a combination of maternal risk factors, MAP, UtA-PI and GlyFn was similar to that of the triple test, and they were both superior to screening by low PlGF concentration (PE within 3 weeks: DR, 65.3% (95% CI, 50.4-78.3%); PE at any time: DR, 56.0% (95% CI, 45.7-65.9%)) or high sFlt-1/PlGF concentration ratio (PE within 3 weeks: DR, 73.5% (95% CI, 58.9-85.1%); PE at any time: DR, 63.0% (95% CI, 52.8-72.4%)). The predictive performance of screening at 35 + 0 to 36 + 6 weeks' gestation for delivery with PE and delivery with GH at ≥ 37 weeks' gestation was by far superior to screening at 11 + 0 to 13 + 6 weeks. GlyFn is a potentially useful biomarker in third-trimester screening for term PE and term GH, but the findings of this case-control study need to be validated by prospective screening studies. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

COMPARISON OF DOUBLE-DISC SYNERGY, COMBINED DISC DIFFUSION, AND E TEST FOR METALLO-BETA-LACTAMASE DETECTION IN PSEUDOMONAS AERUGINOSA IN A TERTIARY CARE HOSPITAL

Objective: Pseudomonas aeruginosa is an important opportunistic pathogen associated with nosocomial infections. The metallo-beta-lactamases (MBLs) are an important class of carbapenemases which are predominantly produced by P. aeruginosa. This study is aimed to study the prevalence of MBLs among imipenem (IMP)-resistant P. aeruginosa and to evaluate three different methods of screening and detecting MBLs produced by P. aeruginosa. Methods: 100 isolates of P. aeruginosa were obtained from various clinical specimens, including pus, wound, sputum, urine, body fluids, and ET tips received at the laboratory from July 2021 to December 2021. Screening for MBL production among IMP-resistant P. aeruginosa was done by double-disc synergy test and combined disc test. Confirmation of MBL production was done by E-test. Results: Of the 100 P. aeruginosa isolates, 16 were IMP resistant, of which 16 are MBL producers. Most of the samples were obtained from 50 to 60 years followed by 40–50 and 60–70 were pus (50%) followed by sputum (20%), urine (15%), and body fluids (5%). Of the 100 isolates, 66 were isolated from females and 34 from males. Pus samples showed most MBL-producing isolates, accounting for 60.5%. MBL producers accounted for 90% of IMP-resistant cases using combined disc method and 100% using MBL E-strip test. By comparison, double-disc synergy test (DDST) retrieved 45% of Pseudomonas MBL producers. Conclusion: This study found moderate prevalence of Pseudomonas MBL producers (16/100). The study supports the use of combined disc-diffusion test and DDST for screening and confirming MBL producers of P. aeruginosa by E test where polymerase chain reaction is not available.

Comparison of ophthalmic artery Doppler with PlGF and sFlt-1/PlGF ratio at 35-37 weeks' gestation in prediction of imminent pre-eclampsia.

To compare the predictive performance for delivery with pre-eclampsia (PE) at < 3 weeks and at any stage after assessment at 35 + 0 to 36 + 6 weeks' gestation of serum placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1)/PlGF ratio with that of a competing-risks model utilizing maternal risk factors, mean arterial pressure (MAP) and ophthalmic artery peak systolic velocity (PSV) ratio. This was a prospective observational study of women attending for a routine hospital visit at 35 + 0 to 36 + 6 weeks' gestation. This visit included recording of maternal demographic characteristics and medical history, ultrasound examination of fetal anatomy and growth, assessment of flow velocity waveforms from the maternal ophthalmic arteries and measurement of MAP, serum PlGF and serum sFlt-1. The performance of screening for delivery with PE at < 3 weeks and at any time after the examination was assessed using areas under the receiver-operating-characteristics curves and detection rates (DRs), at a 10% false-positive rate (FPR). McNemar's test was used to compare DRs, at a 10% FPR, between screening by PlGF concentration, the sFlt-1/PlGF concentration ratio and the competing-risks model utilizing maternal risk factors, MAP and ophthalmic artery PSV ratio. Model-based estimates of screening performance for different methods of screening were also produced. The study population of 2338 pregnancies contained 75 (3.2%) cases that developed PE, including 30 (1.3%) that delivered with PE at < 3 weeks from assessment, and 2263 cases unaffected by PE. The DR of PE at < 3 weeks from assessment, at a 10% FPR, of sFlt-1/PlGF ratio (70.0% (95% CI, 50.6-85.3%)) was superior to that of PlGF (50.0% (95% CI, 31.3-68.7%)) or PSV ratio (56.7% (95% CI, 37.4-74.5%)) but inferior to that of the combination of maternal risk factors, MAP multiples of the median (MoM) and PSV ratio delta (96.7% (95% CI, 82.8-99.9%)). Similarly, the DR of PE at any stage after assessment of sFlt-1/PlGF ratio (62.7% (95% CI, 50.7-73.6%)) was superior to that of PlGF (52.0% (95% CI, 40.2-63.7%)) or PSV ratio (41.3% (95% CI, 30.1-53.3%)) but inferior to that of the combination of maternal risk factors, MAP MoM and PSV ratio delta (78.7% (95% CI, 67.7-87.3%)). The empirical results for DR at a 10% FPR were consistent with the modeled results, both for delivery with PE at < 3 weeks and at any time after assessment. Ophthalmic artery Doppler in combination with maternal risk factors and blood pressure could potentially replace measurement of PlGF and sFlt-1/PlGF ratio in the prediction of imminent PE. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Development of a Computer-Tailored Intervention/Decision Aid To Increase Colorectal Cancer Screening in Health Systems.

BackgroundNon-compliance with scheduled colonoscopy is common among patients, especially in underserved populations. High no-show and late cancelation rates result in wasted resources, increased costs, and missed opportunities for colorectal cancer (CRC) screening. Among the barriers to colonoscopy is a lack of knowledge about the benefits, fears, and limited time for patient counseling.MethodologyWe produced a digital video disc and a website program to enhance awareness about CRC screening and address patient barriers in a population with low screening adherence.ResultsPatients can be educated via an interactive computer-tailored intervention with both DVD and web versions. It details the benefits and need for CRC screening, different methods of screening, and addresses patient-related barriers.ConclusionsPatient education is crucial to increase CRC screening among eligible individuals. Because online engagement is affected by attention, interest, and affect, content should be concise but comprehensive.

Public awareness of women toward breast cancer and its screening methods in Tabuk city, Saudi Arabia

Background: Breast cancer is the second leading cause of death in women in the world. It can emerge at any age, but women above the age of 40 are more commonly affected. Objective: To assess the public awareness of women toward breast cancer and the methods of screening, and to determine the relationship between the level of awareness with different sociodemographic factors. Methods: This cross-sectional study was conducted among the women of Tabuk, Saudi Arabia, via a nonprobability sampling technique. Data collection was carried out through an online self-administered questionnaire. Results: A total of 431 women were included in this study. Almost 40% were aged 18-30 years. The mean awareness score of the participants was 17.3 ± 3.5 (SD) out of a total of 24 points. More than half of the females revealed good awareness (52.7%). In addition, about 72.6% of the women knew that breast cancer is very common and most of them admitted that different methods of screening are not harmful but useful. Breast lumps was most frequently recognized symptom of breast cancer. Furthermore, significant associations were found between the level of awareness and age, marital status, occupational status, and age of menarche. Conclusion: The results showed an intermediate level of breast cancer awareness and screening methods. However, this level is still insufficient. Therefore, educational interventions are recommended to provide awareness of breast cancer. The above-listed associated factors should be considered while applying these interventions.

Experiences with screening for atrial fibrillation: a qualitative study in general practice

BackgroundGuidelines recommend screening for atrial fibrillation (AF). Currently, screening is not considered standard care among GPs.AimTo explore the experiences of primary care workers with different methods of screening for AF and with implementation in daily practice.Design & settingA qualitative study using semi-structured interviews with GPs, nurses, and healthcare assistants (HCAs) who were experienced with implementing different methods of screening.MethodTwo independent researchers audio-recorded and analysed interviews using a thematic approach. They asked participants about their experiences with the different methods used for screening AF and which obstacles they faced when implementing screening in daily practice.ResultsIn total 15 GPs, nurse practitioners, and HCAs from seven different practices were interviewed. The GP’s office is suited for screening for AF, which ideally should be integrated with standard care. Participants considered pulse palpation, automated sphygmomanometer with AF detection, and single-lead electrocardiography (ECG) as practical tests. Participants trusted pulse palpation over the algorithm of the devices. The follow-up of a positive test with a time-consuming 12-lead ECG hindered integration of screening. The single-lead ECG device reduced the need for immediate follow-up because it can record a rhythm strip. The extra workload of screening and lack of financial coverage form obstacles for implementation.ConclusionPulse palpation, automated blood pressure measure monitors with AF detection, and single-lead ECGs might facilitate screening in a general practice setting. When implementing screening, focus should be on how to avoid disruption of consultation hours by unplanned 12-lead ECGs.

MO767CENTRAL VEIN STENOSIS: FROM DIAGNOSTICS TO TREATMENT STRATEGY

Abstract Background and Aims To analyze the screening and prognostic value of various diagnostic signs of central vein stenosis (CVS). Method The retrospective study included 549 patients with AVF/AVG dysfunction. 211 patients were diagnosed with CVS, other patients had lesions of peripheral venous segments. In case of vascular access dysfunction, patients were examined according to the local protocol: ultrasound examination of peripheral (to exclude damage of the peripheral AVF segments) and central veins (at an accessible length) was performed, followed by CT angiography or percutaneous angiography, if necessary. Results Among various clinical signs only limb edema and dilated veins on the chest demonstrated high sensitivity. Aneurysmal dilatation of an AVF was more common in peripheral lesions (CVS RR&amp;lt;1). It should be considered that the clinical signs itself are more likely to be associated with the peripheral lesion than CVS (high NPV value) – table 1. “Indirect dialysis signs” also have very low screening efficacy (Se and Sp) and prognostic values – table 2. Ultrasound signs have low screening accuracy, but high prognostic values. In other words, in the presence of ultrasound signs, patient is likely to have CVS with high probability – table 3. When comparing the frequency of correct and incorrect classifications for different types of lesion, ultrasound accuracy exceeds the clinical picture for types of lesion 1C and 1D (according to the types of lesion in Society of Interventional Radiology Reporting Standards for Thoracic Central Vein Obstruction, doi: 10.1016/j.jvir.2017.12.013): RR= 3,433 [95% CI 2,074; 6,132], p&amp;lt;0.0001 and RR= 2,538 [95% CI 1,592; 4,265], p&amp;lt;0.0001, respectively, but not for lesion types 2B and 3: RR=1.583 [95% CI 0.935; 2.779], p=0.0883 and RR=1 [95% CI 0.231; 4.325], p &amp;gt;0.9999, respectively. In total, incorrect CVS type classifications is noted in 30.7% of cases when using ultrasound imaging. CT angiography and percutaneous angiography are almost 100% effective in the diagnosis of CVS. However, CT angiography is not always informative when AVF is functioning and the volume blood flow is high. In turn, percutaneous angiography does not always allow to assess the condition of the veins of the contralateral side. At the same time, correct detection of lesion type is pivotal to determine the future strategy of providing the patient with permanent vascular access. For example, the patient has very little chance to get functional AVF in case of with two-sided subclavian vein stenosis. Conclusion The CVS diagnostics should be comprehensive, using different methods for screening, confirming CVS and determining of it type.

Pre-therapeutic dihydropyridimidine dehydrogenase (DPD) deficiency screening: Impact on fluoropyrimidine dose reduction at the second chemotherapy cycle and on early severe toxicity.

3096 Background: DPD deficiency screening before fluoropyrimidine is a matter of debate. To avoid lethal toxicity, French authorities impose DPD screening before fluoropyrimidine-based chemotherapy by dosing uracilemia since April 2019. Methods: We have included all consecutive adult patients receiving 5-fluorouracil (5-FU) or capecitabin from April 2019 to January 2020 in 6 cancer centers. During the study period, different methods for screening had been applied: DPYD complete sequencing, phenotype (uracilemia and/or dihydrouracilemia/uracilemia ratio - UH2/U -) or both. All sceening tests were conducted in the same laboratory. Association between the method of DPD screening and fluoropyrimidine dose reduction at second chemotherapy cycle or on severe ≥grade 3 early toxicity (between first and second cycle) was evaluated using multivariate logistic regression. Concordance between genotype and phenotype for DPD deficiency was explored using Cohen Kappa test. Results: We included 597 patients, the median age was 63 (range, 55-77). The most prevalent cancers were digestive (68.3%), head and neck (19.4%) and breast (9.2%). 12.3% of patients received capecitabine and 87.3% received polychemotherapy. DPD deficiency screening was done for most of patients (n=519, 86.9%). DPD screening method consisted in full sequencing of DPYP (n=41; 7.9%), phenotype analysis (n=44, 8.5%) or both (n=424, 83.6%). We did not identify any complete DPD deficiency. Uracilemia was dosed for 467 patients, the median was 6.5 ng/mL and for 21 patients (4.5%) uracilemia was &gt; 16 ng/mL and/or UH2/U &lt;6, suggesting DPD deficiency. Severe early toxicities were observed for 82 patients (14%), with two patients presenting grade 5 toxicity. Overall DPD screening and method of DPD screening were not associated with fluoropyrimidine dose reduction at second cycle or early severe toxicity. In multivariate analysis, the only predictor for fluoropyrimidine reduction at second cycle (n = 125 patients) was polychemotherapy (OR=2.8; p=0.012). Kappa between uracilemia and UH2/U was 0.23 (poor concordance). Kappa between DPYP sequencing and uracilemia or UH2/U was 0.09 (very poor concordance). Conclusions: No DPD deficiency screening method was associated with dose adaptation at second cycle or early severe toxicity. The optimal strategy for DPD screening requires further clinical evaluation.

A systematic review of screening and diagnostic tests outcome for melioidosis in children and adolescents

Melioidosis is a disease caused by infection of the Gram-negative environmental bacterium Burkholderia pseudomallei. Despite of the high fatality rate from this infection, melioidosis is often a neglected disease. It has been estimated that this disease was regularly under-reported in many countries in Southeast Asia and elsewhere in the tropics. Infection occurs following percutaneous inoculation, inhalation, or ingestion of the organism. The spectrum of the infection is broad, ranging from minor skin or soft tissue infection to pneumonia and bacteraemia with a high mortality rate. The objective of this study is to review the available literatures on the different methods of screening and diagnostic developed for melioidosis among children. Methods. Article search was conducted using two electronic databases including Science Direct and PubMed. Articles published within the year from 2013 until 2018 that fulfills the inclusion and exclusion criteria were selected and included in the list for further review. Keywords such as melioidosis, children, screening and diagnosis were used during the article search process. Children and adolescent aged less than 19 years were chosen as the target group for this review. Results. Six full text article were selected and included in the final data extraction and analysis process. Overall, six different screening methods that were used in melioidosis detection were discussed in this review. Among these methods, blood culture technique was consistently reported in all the six selected literatures and have reported a 100% detection rate for melioidosis. Conclusion. The blood culture method showed the most promising result in detecting melioidosis compared to the other available methods of screening. This method has been consistently reported throughout the various studies with a reasonably high detection rate. Keywords: melioidosis, children, screening and diagnosis

Cost effectiveness of different screening strategies for gestational diabetes mellitus screening: study protocol of a randomized community non-inferiority trial

BackgroundThere is lack of ideal and comprehensive economic evaluations of various GDM strategies. The aim of this study is to the compare efficacy and cost-effectiveness of five different methods of screening for gestational diabetes mellitus (GDM).MethodsThis study is a randomized community non-inferiority trial among 30,000 pregnant women in five different geographic regions of Iran, who were randomly assigned to one of the five GDM screening methods. All first trimester pregnant women, seeking prenatal care in governmental health care systems, who met our eligibility criteria were enrolled. The criteria suggested by the International-Association-of-Diabetes-in-Pregnancy-Study-Group, the most intensive approach, were used as reference. We used the non-inferiority approach to compare less intensive strategies to the reference one. Along with routine prenatal standard care, all participants were scheduled to have two phases of GDM screening in first and second-trimester of pregnancy, based on five different pre-specified protocols. The screening protocol included fasting plasma glucose in the first trimester and either a one step or a two-step screening method in the second trimester of pregnancy. Pregnant women were classified in three groups based on the results: diagnosed with preexisting pre-gestational overt diabetes; gestational diabetes and non-GDM women. Each group received packages for standard-care and all participants were followed till delivery; pregnancy outcomes, quality of life and cost of health care were recorded in detail using specific standardized questionnaires. Primary outcomes were defined as % birth-weight > 90th percentile and primary cesarean section. In addition, we assessed the direct health care direct and indirect costs.ResultsThis study will enable us to compare the cost effectiveness of different GDM screening protocols and intervention intensity (low versus high).ConclusionResults which if needed, will also enable policy makers to optimize the national GMD strategy as a resource for enhancing GDM guidelines.Trial registration Name of the registry: Iranian Registry of Clinical Trials. Trial registration number: IRCT138707081281N1. Date of registration: 2017-02-15. URL of trial registry record: https://www.irct.ir/trial/518

The Cross-Cultural Validity of Post-Traumatic Stress Disorder and Post-Traumatic Stress Symptoms in the Indian Context: A Systematic Search and Review.

Background: The cross-cultural validity of the construct of post-traumatic stress disorder (PTSD) has been a life-long debate in the field of trauma. Its validation in a setting such as India—a nation prone to considerably traumatic events such as conflict, natural disasters, and sexual violence against women—warrants exploration. Objective: To describe how PTSD and post-traumatic stress symptoms (PTSS) are conceptualized in the Indian context by systematically examining the evidence of studies that investigate PTSD and PTSS in India. Methods: A systematic search in PubMed, Web of Science, and Science Direct yielded a total of 56 studies that discussed one or multiple aspects of PTSD and PTSS in India. Data relating to types of events, populations, diagnostic tools, manifestations, and interventions were extracted and analyzed. Results: Eleven of 29 Indian states and 2/7 union territories were represented in the 56 included studies, with most studies (n = 21) originating from Tamil Nadu. Natural Disasters (n = 28), War/Conflict (n = 10), and Medical conditions (n = 7) were the top three most commonly investigated traumatic events. The majority of studies focused on entire communities (n = 16), while children and adolescents made up the second largest group (n = 14). Less attention was paid explicitly to male (n = 3) or female (n = 4) victims. Twenty-five different methods for screening for PTSD were identified, with the most common being the impact of events scale (n = 14). The majority of studies reported the screening and clinical diagnosis of PTSD by professional health care providers (n = 24). Abuse scored the highest average prevalence of PTSD at 52.3%, while the lowest was 16.4% due to man-made accidents. Overall, there was a lack of assessment on trauma-specific interventions, though psychosocial support was the most commonly mentioned intervention. Conclusions: Results indicate diversity in approaches for identifying, measuring, and treating PTSD and PTSS in the Indian population and how sociocultural norms influence its manifestation in this population. Future research calls for the development of culturally sensitive approaches to identifying and addressing PTSD and PTSS in India.

Evolution in screening for Down syndrome

Key content This article describes how screening for fetal trisomy 21 has evolved from advanced maternal age, with a detection rate of 30% at a false positive rate (FPR) of 5%, to second trimester serum biochemistry, with a detection rate of 60–75% at an FPR of 5%, and then to the first trimester combination of fetal nuchal translucency and serum biochemistry, with a detection rate of 90% at an FPR of 5%. The introduction of cell‐free DNA analysis of maternal blood is outlined. This method has improved detection rate to 99% with a reduction in FPR to 0.1%. As this test is currently expensive, it may be difficult to offer it to all patients as a first‐line method of screening. A feasible approach to the introduction of the cell‐free DNA test is discussed, which is to offer it contingent on the results of first‐line screening with the combined test. Learning objectives To understand the different methods available for screening for fetal trisomy 21. To learn about the performance of different methods of screening. To be able to describe the new method of screening by cell‐free DNA testing. To understand the issues related to clinical implementation of cell‐free DNA testing. Ethical issues Should the cell‐free DNA test be offered solely based on health economic considerations or on individual patient interests? Should screening be carried out for conditions other than trisomy 21?

A Study on Knowledge, Attitude and Practices towards Breast Cancer among Reproductive Age Group Women in an Urban Area of Coimbatore

Background: Breast cancer is the most common cancer representing 25% of all cancers. For every 2 cases diagnosed breast cancer one women dies. Early detection and treatment of breast cancer increases the chance of survival. Breast self -examination (BSE), Clinical breast examination, Mammography are different methods for screening of breast cancer. Only with early detection we can achieve longer survival. Aims and Objective: To assess the knowledge, attitude and practice towards breast cancer among women of reproductive age group and to suggest necessary recommendations based on the observation to improve awareness of breast cancer in the study population. Methodology: Using Purposive sampling technique 125 women aged 18-49 years were interviewed to assess their Knowledge, attitude and practice in an Urban area of Coimbatore. Results: Among the participants 27.2% had family history of gynaecological cancer, 70.4% know about breast cancer, 40% know the methods of Breast Self-Examination (BSE), 36.8% practice BSE.

IARC Handbook of Cancer Prevention Vol. 17 - Colorectal Cancer Screening

The IARC Handbook of Cancer Prevention conduct evidence-based expert evaluations on the cancer preventive effects of interventions and strategies for primary and secondary prevention. In November 2017, 23 experts from 15 countries met at the International Agency for Research on Cancer in Lyon, France to evaluate different methods of screening for CRC. Evaluations were conducted for the stool-based tests of occult blood (guaiac fecal occult blood test, and immunochemical fecal test), endoscopic techniques (colonoscopy and sigmoidoscopy) and computed tomographic (CT) colonography. The Working Group critically reviewed all available evidence from randomized controlled trials, observational studies and modeling studies, and assessed the benefits in reducing mortality and incidence, and the benefit-harm ratio taking into account potential adverse effects. The Working Group also reviewed the literature on related topics, including availability of CRC screening worldwide, determinants of participation to screening, emerging CRC screening techniques and screening in high-risk groups. Overall, there is sufficient evidence that screening for colorectal cancer with stool-based tests of occult blood or with endoscopic techniques decreases the risk of colorectal cancer mortality; there is also sufficient evidence for a positive benefit-harm ratio with these methods, although colonoscopy may induce more substantial harms. With CT colonography, evidence for a reduction in colorectal cancer incidence and/or mortality is limited, and a minority of the Working Group rated the evidence as inadequate.

The choice of the optimal secondary adrenal insufficiency screening method

Background. The insulin tolerance test (ITT) is the “gold standard” of the secondary adrenal insufficiency (SAI) diagnosis but it is rather difficult to carry out, has some contraindications and requires patient’s hospitalization. The availability of a reliable screening method could reduce the necessity of using ITT.Aim: to compare different methods of screening with ITT and to work out an optimal diagnostic algorithm of SAI.Methods. 40 patients (20 women) after craniospinal (CSI) irradiation in a doze 35 Gy were examined. The average age at the time of the observation was 19,5±3 years, at the time of treatment 12,5±3,5 years. Patient’s blood samples were collected for basal cortisol (BC), DHEA-S. ITT was performed for all patients, glucagon stimulation test (GST) was for 27 persons. Patients were divided into groups: SAI and without SAI (W-SAI) after ITT. ROC- analysis was conducted to identify the thresholds for BC, DHEA-S and GST. Cut-off points for BC and DHEA-S levels corresponding to 100% sensitivity (Se) for SAI group and 100% specificity (Sp) for W-SAI patients were estimated to select a group of patients which do not require stimulative tests. Linear regression was used to construct a predictive model (PM) of SAI occurrence after CSI.Results. 22/40 subjects failed ITT, 13/27 passed GST. 3 patients failed ITT but passed GST. Their level of neutrophils and monocytes was higher than the other patients'. SAI-patients had BC and DHEA-S lower than W-SAI (321±102 vs 516± 183; p=0,003 and 2,6±1,4 vs 5,1±2,1, p=0,003). ROC-analysis showed area under curve (AUC) for GST=0,91 with optimal cut-off for cortisol=489 which corresponds to 100% Sp and 62% Se. AUC was 0,83 for BC and 0,84 for DHEA-S.In 70% patients' BC was in a “grey zone” (32% of them passed ITT), 8% had BC lower than 200 (which corresponds to 100% Se) and 22% more than 499 (100% Sp). 50% of patients were in a “grey zone” for DHEA-S (50% of them had SAI), 18% had DHEA-S level below 2,0 and 32% above 4,7. A combination of BC and DHEA-S in the PM of SAI (0,592+0,001*BC+0,11*DHEA-S) had AUC 94%. This PM didn’t give the prognosis of SAI for 32% (CI: 18-49%) of patients. The addition of maximal cortisol (MC) level during GST (0,53+0,01*BC+0,066*DHEA-S+0,001*MC) increased AUC to 99% and didn’t allow to predict SAI in 8% (3,2% - 24,9%) of patients only.Conclusions. When the screening methods were used separately, they showed comparable accuracy and it was not high. The PM may be used as optimal screening method for SAI and may allow to use ITT more rarely. But further studies are required to validate the PM proposed in this study.

Diabetic retinopathy screening: global and local perspective.

Diabetes mellitus has become a global epidemic. It causes significant macrovascular complications such as coronary artery disease, peripheral artery disease, and stroke; as well as microvascular complications such as retinopathy, nephropathy, and neuropathy. Diabetic retinopathy is known to be the leading cause of blindness in the working-age population and may be asymptomatic until vision loss occurs. Screening for diabetic retinopathy has been shown to reduce blindness by timely detection and effective laser treatment. Diabetic retinopathy screening is being done worldwide either as a national screening programme or hospital-based project or as a community-based screening programme. In this article, we review different methods of screening including grading used to detect the severity of sight-threatening retinopathy and the newer screening methods. This review also includes the method of systematic screening being carried out in Hong Kong, a system that has helped to identify diabetic retinopathy among all attendees in public primary care clinics using a Hong Kong-wide public patients' database.

Breast-Cancer Screening — Viewpoint of the IARC Working Group

In November 2014, experts from 16 countries met at the International Agency for Research on Cancer (IARC) to assess the cancer-preventive and adverse effects of different methods of screening for breast cancer. (The members of the working group for volume 15 of the IARC Handbook are listed at the end of the article; affiliations are provided in the Supplementary Appendix, available with the full text of this article at NEJM.org.) This update of the 2002 IARC handbook on breast-cancer screening1 is timely for several reasons. Recent improvements in treatment outcomes for late-stage breast cancer and concerns regarding overdiagnosis call for reconsideration. . . .

Comparison of different screening methods for blood pressure disorders in children and adolescents

ObjectiveTo compare different methods of screening for blood pressure disorders in children and adolescents. MethodA database with 17,083 medical records of patients from a pediatric cardiology clinic was used. After analyzing the inclusion and exclusion criteria, 5,650 were selected. These were divided into two age groups: between 5 and 13 years and between 13 and 18 years. The blood pressure measurement was classified as normal, pre‐hypertensive, or hypertensive, consistent with recent guidelines and the selected screening methods. Sensitivity, specificity, and accuracy were then calculated according to gender and age range. ResultsThe formulas proposed by Somu and Ardissino's table showed low sensitivity in identifying pre‐hypertension in all age groups, whereas the table proposed by Kaelber showed the best results. The ratio between blood pressure and height showed low specificity in the younger age group, but showed good performance in adolescents. ConclusionScreening tools used for the assessment of blood pressure disorders in children and adolescents may be useful to decrease the current rate of underdiagnosis of this condition. The table proposed by Kaelber showed the best results; however, the ratio between BP and height demonstrated specific advantages, as it does not require tables.

Two different methods for screening of bile salt hydrolase activity in Lactobacillus strains

Bile salt hydrolase (BSH) activity of intestinal bacteria (including lactobacilli) is one of the indirect ways of decreasing a cholesterol level in human body. Tested Lactobacillus strains were isolated from various sources (faeces of fully breast-fed infants, cow's colostrum, cow's raw milk cheeses, and cow's raw milk) and identified by genotypic and phenotypic methods. All strains, including three commercial probiotic strains and six culture collection strains, were subsequently tested for their BSH activity via two methods - thin layer chromatography (TLC) and plate assay. Among all the 59 Lactobacillus strains, 15 strains were shown to be BSH positive by TLC method and only 8 of them by plate assay. Most of the BSH positive strains (9 strains) were isolated from faeces. Differences between BSH activities for sodium salts of cholyltaurine and cholylglycine were demonstrated. The TLC method was shown to be more sensitive compared to the plate assay for BSH activity determination.