Cut-off Sensitivity Research Articles

Comparative analysis of the accuracy of urinary hCG tests in vitro

To identify whether cutoff for sensitivity advertised by three pregnancy tests in urine are compatible to those reported by the manufacturer and to describe their diagnostic performance. The urine of a male volunteer was used to dilute recombinant β-hCG at defined concentrations of 0, 6.25, 12.5, 25, 50, and 100 mIU/mL. The tubes containing each of the concentrations were coded and blindly assessed for positivity in three different lots of hCG tests: Strip Test Plus ® , BioEasy ® , and Visitect Pregnancy ® . The sample size was calculated for an alpha error of 5%, with a power of 99%. All three brands, in their three lots analyzed, had 100% of sensitivity for detecting β-hCG, with 100% negative predictive value, using only negative controls and samples with concentrations equal or higher than the test cutoff (n = 180/brand). The accuracy of the tests was 83% (BioEasy ® ), 84%(Visitect ® ) and 91% (Strip Test Plus ® ). Strip Test Plus ® had the best positive likelihood ratio (52.5), while Visitect ® had the best negative likelihood ratio (zero). The three brands have adequate sensitivity for the advertised cutoffs. The Strip Test Plus ® test had the best performance to identify urinary concentrations of β-hCG ≥ 12.5 mIU/mL, and consequently, to confirm pregnancy, while Visitect ® had the best performance to exclude β-hCG in urine (negative post-test probability: zero).

Psychophysical and Electrophysiological Testing in Ocular Hypertension

The purpose of this study was to compare psychophysical and electrophysiological testings in early optic nerve dysfunction in a group of clinically asymptomatic subjects with suspect ocular hypertension (OHT). Forty eyes of 40 patients with suspect OHT and asymmetrical horizontal cup/disc ratio (0.2/0.4), 22 eyes of 22 patients with open-angle glaucoma (OAG), and 40 eyes of 40 healthy controls were evaluated by using frequency-doubling technology perimetry (FDT), contrast sensitivity (CS), pattern electroretinography (PERG), and pattern visual-evoked potentials (VEP). The VEP were elicited by checkerboard stimuli with large (VEP 120), medium (VEP 45), and small (VEP 15) checks; then the values of the amplitude (A) and latency (L) of P100 peaks were studied. Receiver operator characteristic (ROC) curves were calculated to determine the sensitivity, specificity, and optimal cutoff points of abnormal values. A logistic regression analysis was performed to determine which tests were providing the most useful information. In addition, Kruskal-Wallis test was performed to test the differences between the control group and the OHT group. VEP P100 peak latency (VEP L15 and VEP L45) and amplitude (VEP A120), PERG N95 peak amplitude, CS at medium spatial frequencies (CS 4SF), and FDT pattern standard deviation (PSD) yielded the greatest sensitivity (85.0 to 60.0%) and specificity (80.0 to 60.0%) ratio, displaying the largest ROC curve areas; whereas PERG N95 peak latency ROC curve had the smallest areas. Kruskal-Wallis test showed that most diagnostic tests were able to differentiate the OHT group from the control group. Stepwise logistic regression analysis identified VEP L15 (p < 0.001), CS 4SF (p = 0.023), FDT PSD (p = 0.032), and VEP A120 (p = 0.072) as tests that could be useful to distinguish controls from OHT. Our data confirm that psychophysical and electrophysiological tests are useful for early detection of patients at risk of developing OAG.

Uso de cultivo cuantitativo de aspirado endotraqueal para el diagnóstico de neumonía asociada a ventilación mecánica en pediatría: estudio prospectivo, analítico

Ventilator-associated pneumonia (VAP) is dificult to diagnose because of the absence of a gold standard.To evaluate the use of quantitative cultures of endotracheal aspirates for diagnosis of pediatric VAP and to obtain acceptable sensitivity and specificity cutoff points.Prospective, analytic study which included patients under 15 years, who were connected to mechanical ventilation at Hospital Luis Calvo Mackenna's intensive care units. They were classified as cases or controls according to NNIS criteria.During a period of 21 months we recruited a total of 43 patients with a mean age of 16 months. We obtained endotracheal aspirated samples to perform quantitative cultures. Most frequently isolated pathogens were Staphylococcus aureus (34.5%) and non-fermentative Gram-negative bacilli (24.1%). We obtained a sensitivity of 88%, specificity of 70%, PPV of 82%, and NPV of 79% for samples greater than 10(6) CFU.Quantitative culture of endotracheal aspirates is a reliable method for diagnosing pediatric VAP when the value is greater than 10 CFU.

Evaluation of quantitative cultures of endotracheal aspirates for pediatric ventilator-associated pneumonia diagnosis: analytic, prospective study

Ventilator-associated pneumonia (VAP) is dificult to diagnose because of the absence of a gold standard. To evaluate the use of quantitative cultures of endotracheal aspirates for diagnosis of pediatric VAP and to obtain acceptable sensitivity and specificity cutoff points. Prospective, analytic study which included patients under 15 years, who were connected to mechanical ventilation at Hospital Luis Calvo Mackenna's intensive care units. They were classified as cases or controls according to NNIS criteria. During a period of 21 months we recruited a total of 43 patients with a mean age of 16 months. We obtained endotracheal aspirated samples to perform quantitative cultures. Most frequently isolated pathogens were Staphylococcus aureus (34.5%) and non-fermentative Gram-negative bacilli (24.1%). We obtained a sensitivity of 88%, specificity of 70%, PPV of 82%, and NPV of 79% for samples greater than 10(6) CFU. Quantitative culture of endotracheal aspirates is a reliable method for diagnosing pediatric VAP when the value is greater than 10 CFU.

Automated determination of the ankle-brachial index using an oscillometric blood pressure monitor: validation vs. Doppler measurement and cardiovascular risk factor profile

The ankle-brachial index (ABI) is a method used widely for peripheral arterial disease (PAD) diagnosis and cardiovascular risk prediction. This study validated automated ABI measurements taken using an oscillometric blood pressure (BP) monitor allowing simultaneous arm-leg BP measurements. A total of 93 patients (hypertension 83%; dyslipidemia 72%; diabetes 45%; cardiovascular disease 23%; smoking 15%) were submitted to Doppler and automated ABI measurements, performed using a professional oscillometric BP monitor (Microlife WatchBP Office; triplicate simultaneous arm-leg BP measurements), in a randomized order. The mean difference between the Doppler reading (1.08 ± 0.17) and (1) the first oscillometric ABI reading was 0.03 ± 0.11, (2) the average of two oscillometric readings was 0.02 ± 0.10 and (3) the average of three oscillometric readings was 0.02 ± 0.09 (P < 0.01 for all). Strong correlations were found between oscillometric and Doppler ABI (r 0.80, 0.85 and 0.86 for single and average of two and three oscillometric readings, respectively; P < 0.001 for all). Agreement between oscillometric and Doppler ABI in diagnosing PAD (Doppler ABI < 0.9) was found in 95% of cases (κ 0.79; agreement in diabetics: 94%, κ 0.79). A receiver operating characteristic (ROC) curve revealed area under the curve at 0.98, with a 0.97 oscillometric ABI cutoff for optimal sensitivity (92%) and specificity (92%) in diagnosing PAD. Average time for automated ABI measurement was 5.8 vs. 9.3 min for Doppler (P < 0.001). Doppler and oscillometric ABI were associated and predicted (multivariate regression analysis) by the same cardiovascular risk factors (pulse pressure, smoking and cardiovascular disease history). Automated ABI measurement using a professional BP monitor allowing simultaneous arm-leg BP measurements appears to be a reliable and faster alternative to Doppler measurement.

Sub-Micron Area Heterojunction Backward Diode Millimeter-Wave Detectors With 0.18 ${\rm pW/Hz}^{1/2}$ Noise Equivalent Power

InAs/AlSb/AlGaSb heterojunction backward diodes are promising detectors for millimeter-wave imaging applications due to their high sensitivity, low noise, and high cutoff frequency. By using a device heterostructure with a thin (11 Å) barrier layer, δ-doped cathode, and optimized AlxGa1-xSb anode composition (x=12%), in conjunction with submicron (0.4×0.4 μm2) active area, fabricated detectors have demonstrated DC curvatures of -47 V-1 and record unmatched sensitivities of 4600 V/W at 94 GHz. Impedance-matched sensitivities of 49,700 V/W at 94 GHz are projected from on-wafer S-parameter and sensitivity measurements. These detectors have measured junction resistances of 814 Ω·μm2 and capacitances of 15 fF/μm2. A record low NEPmin of 0.18 pW/Hz1/2 has been projected under conjugate matching conditions. This study demonstrates the potential of Sb-heterostructure backward diodes as ultra-low-noise millimeter-wave direct detectors.

The diagnostic value of determination of positive and negative acute phase proteins in milk from dairy cows with subclinical mastitis

Currently, somatic cell count (SCC) and bacterial culture are considered as the gold standard methods for the diagnosis of bovine subclinical mastitis. However, SCC has a low diagnostic accuracy. Therefore, for identification of infected animals, new biomarkers with high diagnostic accuracy are needed. Acute phase proteins (APPs) are proteins that are increased (positive APPs) or decreased (negative APPs) in response to inflammation. The objective of this study was to determine the diagnostic value of milk APPs for the diagnosis of subclinical mastitis in dairy cows. A total of 90 clinically healthy cows were randomly selected. Of these, 52 cows were considered subclinical mastitic based on a SCC higher than 130 × 1,000 cells/mL of milk and positive bacterial culture results of milk samples obtained from at least one of the quarters. Milk amyloid A (MAA) concentration was measured using a commercial ELISA kit and albumin, α-lactalbumin, β-lactoglobulin, and immunoglobulin (Ig) were measured in the whey samples by the use of cellulose acetate electrophoresis. Diagnostic sensitivity and specificity and cutoff points for each test were determined via receiver-operating characteristics analysis. Significant (P 1.6 mg/L. The results of this study showed that determination of MAA can be used as a reliable method for the diagnosis of bovine subclinical mastitis.

Electrophysiological sensory demyelination in typical chronic inflammatory demyelinating polyneuropathy

The presence of electrophysiological demyelination of sensory nerves is not routinely assessed in the evaluation of suspected chronic inflammatory demyelinating polyneuropathy (CIDP). Whether this can be useful is unknown. We compared, using surface recording techniques, in 19 patients with typical CIDP and 26 controls with distal large fibre sensory axonal neuropathy, the forearm median sensory conductions, sensory nerve action potential (SNAP) amplitudes and durations and sensory nerve conduction velocities (SNCVs) of median, radial and sural nerves. Median nerve sensory conduction block (SCB) across the forearm was greater in CIDP patients than in controls (P = 0.005). SNAP durations were longer in CIDP patients for median (P = 0.001) and sural nerves (P = 0.004). Receiver operating characteristic (ROC) curves provided sensitive (>40%) and specific (>95%) cut-offs for median nerve SCB as well as median and sural SNAP durations. SNCVs were significantly slower for median and sural nerves in CIDP patients, but ROC curves did not demonstrate cut-offs with useful sensitivities/specificities. Median SCB or prolonged median SNAP duration or prolonged sural SNAP duration offered a sensitivity of 73.7% for CIDP and specificity of 96.2%. Used as additional parameters, they improved diagnostic sensitivity of the American Academy of Neurology (AAN) criteria for CIDP of 1991, from 42.1% to 78.9% in this population, with preserved specificity of 100%. Sensory electrophysiological demyelination is present and may be diagnostically useful in typical CIDP. SCB detection and SNAP duration prolongation appear to represent more useful markers of demyelination than SNCV reduction.

Seromic profiling of ovarian and pancreatic cancer

Autoantibodies, a hallmark of both autoimmunity and cancer, represent an easily accessible surrogate for measuring adaptive immune responses to cancer. Sera can now be assayed for reactivity against thousands of proteins using microarrays, but there is no agreed-upon standard to analyze results. We developed a set of tailored quality control and normalization procedures based on ELISA validation to allow patient comparisons and determination of individual cutoffs for specificity and sensitivity. Sera from 60 patients with pancreatic cancer, 51 patients with ovarian cancer, and 53 age-matched healthy donors were used to assess the binding of IgG antibodies against a panel of >8000 human antigens using protein microarrays and fluorescence detection. The resulting data interpretation led to the definition and ranking of proteins with preferred recognition by the sera from cancer patients in comparison with healthy donors, both by frequency and strength of signal. We found that 202 proteins were preferentially immunogenic in ovarian cancer sera compared to 29 in pancreatic cancer, with few overlaps. Correlates of autoantibody signatures with known tumor expression of corresponding antigens, functional pathways, clinical stage, and outcome were examined. Serological analysis of arrays displaying the complete human proteome (seromics) represents a new era in cancer immunology, opening the way to defining the repertoire of the humoral immune response to cancer.

BMI Specific Waist Circumference for Detecting Clusters of Cardiovascular Risk Factors in a Japanese Population

The purpose of the study was to determine the sensitive cutoff values of waist circumference (WC) in relation to the body mass index (BMI) for detecting the clustering of cardiovascular risk factors (CCRF) in Japanese men and women. The study population included 2,476 male and female residents who participated in a ward health examination in Tokyo, Japan. The CCRF were defined according to the Japanese Committee of the Criteria for Metabolic Syndrome. Receiver Operating Characteristics (ROC) analysis was conducted within each BMI category. The percentage of study participants in the normal BMI category was around 70% for both men and women. The sensitive cutoff values for the largest WC with at least 80% sensitivity were 81 cm for normal and 89 cm for overweight men. The corresponding values for women were 79 cm and 86 cm, respectively. The WC with maximized sensitivity plus specificity was 80 cm for normal and 89 cm for overweight men, and the sensitivity was 88.7% and 83.0%, respectively. The corresponding values for women were 78 and 94 cm, respectively, and the sensitivity was 91.5% and 57.6%, respectively. For the early detection and management of clusters of cardiovascular risk factors, we concluded that a BMI-specific WC cutoff value of 80 cm for normal weight in both men and women and 89 cm for overweight men and 86 cm for overweight women should be discriminate cutoff values.

Image analysis for retinopathy of prematurity diagnosis

To review findings from the authors' published studies involving telemedicine and image analysis for retinopathy of prematurity (ROP) diagnosis. Twenty-two ROP experts interpreted a set of 34 wide-angle retinal images for presence of plus disease. For each image, a reference standard diagnosis was defined from expert consensus. A computer-based system was used to measure individual and linear combinations of image parameters for arteries and veins: integrated curvature (IC), diameter, and tortuosity index (TI). Sensitivity, specificity, and receiver operating characteristic areas under the curve (AUC) for plus disease diagnosis were determined for each expert. Sensitivity and specificity curves were calculated for the computer-based system by varying the diagnostic cutoffs for arterial IC and venous diameter. Individual vessels from the original 34 images were identified with particular diagnostic cutoffs, and combined into composite wide-angle images using graphics editing software. For plus disease diagnosis, expert sensitivity ranged from 0.308-1.000, specificity from 0.571-1.000, and AUC from 0.784 to 1.000. Among computer system parameters, one linear combination had AUC 0.967, which was greater than that of 18 of 22 (81.8%) experts. Composite computer-generated images were produced using the arterial IC and venous diameter values associated with 75% under-diagnosis of plus disease (ie, 25% sensitivity cutoff), 50% under-diagnosis of plus disease (ie, 50% sensitivity cutoff), and 25% under-diagnosis of plus disease (ie, 75% sensitivity cutoff). Computer-based image analysis has the potential to diagnose severe ROP with comparable or better accuracy than experts, and could provide added value to telemedicine systems. Future quantitative definitions of plus disease might improve diagnostic objectivity.

Prevalência e fatores associados à obesidade em idosos residentes em Pelotas, Rio Grande do Sul, Brasil: classificação da obesidade segundo dois pontos de corte do índice de massa corporal

The aim of this study was to estimate obesity prevalence and associated factors in the elderly, according to two cutoff points for body mass index (BMI). This was a cross-sectional, population-based study of a sample of 596 elderly residents in Pelotas, southern Brazil. Nutritional status was evaluated through BMI based on self-reported weight and stature. Poisson multiple regression with hierarchical analysis was applied, with two dependent variables for definition of obesity: BMI > 27 kg/m(2) and BMI > or =30 kg/m(2), the cutoff points proposed by Lipschitz and the World Health Organization, respectively. Prevalence of obesity was 48.7% (95%CI: 44.6-52.7) for BMI > 27 kg/m2 and 25.3% (95%CI: 21.9-29.0) for BMI > or =30 kg/m(2). Two multiple regression models showed an association between obesity and female gender and age. BMI > 27 kg/m(2) showed an association with age and smoking and BMI > or =30 kg/m(2) with sedentary lifestyle. Obesity prevalence was high in this group of elderly. For the Brazilian elderly population and from a public health perspective, the study suggests the use of a more sensitive cutoff point, namely BMI > 27 kg/m(2).

Validation of Depression Screening Scales in Patients With CKD

Depressive symptoms, assessed by using self-report scales, are present at a striking rate of 45% in patients with chronic kidney disease (CKD) at dialysis therapy initiation. These scales may emphasize somatic symptoms of anorexia, sleep disturbance, and fatigue, which may coexist with chronic disease symptoms and lead to overestimation of depression diagnosis. No study has validated these scales in patients with CKD before dialysis therapy initiation. We conducted a diagnostic test study in participants with CKD to investigate the screening characteristics of 2 depression self-report scales against a gold-standard structured psychiatric interview. 272 consecutively recruited outpatients with stages 2 to 5 CKD not treated by dialysis were studied. The Beck Depression Inventory (BDI) and the 16-item Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR(16)) depression screening scales were administered to all participants. A structured Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition)-based interview, the Mini International Neuropsychiatric Interview, was administered by trained persons blinded to self-report scale scores. 57 of 272 (21%) patients had major depression according to the reference test. The best cutoff scores by means of receiver/responder operating characteristic curves to identify a major depressive episode were 11 for the BDI and 10 for the QIDS-SR(16). Sensitivities were 89% (95% confidence interval [CI], 78 to 96; BDI) and 91% (95% CI, 80 to 97; QIDS-SR(16)), whereas specificities were 88% (95% CI, 83 to 92; BDI) and 88% (95% CI, 83 to 92; QIDS-SR(16)). The positive and negative likelihood ratios for these cutoff scores were 7.6 and 0.1 (BDI) and 7.5 and 0.1 (QIDS-SR(16)). Single-center study and a sample not representative of US demographics. We found that a BDI score of 11 or higher was a sensitive and specific cutoff value for identifying a major depressive episode in patients with CKD not on dialysis therapy. Both the BDI and QIDS-SR(16) are effective screening tools.

Lowering body mass index cutoffs better identifies obese persons with spinal cord injury

Cross-sectional, non-experimental design. (1) Determine the sensitivity and specificity of the general population body mass index (BMI) cutoff for obesity (30 kg m(-2)) in a representative sample of persons with spinal cord injury (SCI); (2) develop a more sensitive BMI cutoff for obesity based on percentage of fat mass (%FM) and C-reactive protein (CRP). Ontario, Canada. A total of 77 community-dwelling adults with chronic SCI underwent anthropometric measures (%FM by bioelectrical impedance analysis, length, weight, BMI (kg m(-2))) and provided blood samples to determine CRP. Sensitivity and specificity analyses, piecewise regression, non-linear regression, and receiver-operator characteristic curves were used to determine new BMI cutoffs. A BMI cutoff of 30 kg m(-2) failed to identify 73.9% of obese participants vs 26.1% at a lowered cutoff of 25 kg m(-2). BMI cutoffs based on risk levels of the %FM and CRP considered together ranged from 22.1 kg m(-2)-26.5 kg m(-2). People with chronic SCI and BMI values >22 kg m(-2) should be considered as being at high risk for obesity and obesity-related chronic diseases. Canadian Institutes of Health Research.

Plus Disease in Retinopathy of Prematurity: Development of Composite Images by Quantification of Expert Opinion

To demonstrate a methodology for generating composite wide-angle images of plus disease in retinopathy of prematurity (ROP), using quantitative analysis of expert opinions. Thirty-four wide-angle retinal images were independently interpreted by 22 ROP experts as "plus" or "not plus." All images were processed by the computer-based Retinal Image multiScale Analysis (RISA) system to calculate two parameters: arterial integrated curvature (AIC) and venous diameter (VD). Using a reference standard defined by expert consensus, sensitivity and specificity curves were calculated by varying the diagnostic cutoffs for AIC and VD. From these curves, individual vessels from multiple images were identified with particular diagnostic cutoffs, and were combined into composite wide-angle images using graphics-editing software. The values associated with 75% underdiagnosis of true plus disease (i.e., 25% sensitivity cutoff) were AIC 0.061 and VD 4.272, the values associated with 50% underdiagnosis of true plus disease (i.e., a 50% sensitivity cutoff) were AIC 0.049 and VD 4.088, and the values associated with 25% underdiagnosis of true plus disease (i.e., 75% sensitivity cutoff) were AIC 0.042 and VD 3.795. Composite wide-angle images were generated by identifying and combining individual vessels with these characteristics. Computer-based image analysis permits quantification of retinal vascular features, and a spectrum of abnormalities is seen in ROP. Selection of appropriate vessels from multiple images can produce composite plus disease images corresponding to expert opinions. This method may be useful for educational purposes, and for development of future disease definitions based on objective, quantitative principles.

DIAGNOSTIC ACCURACY AND CUTOFF POINTS OF HER-2/NEU, CYFRA 21-1, AND CEA IN LUNG ADENOCARCINOMA-ASSOCIATED MALIGNANT PLEURAL EFFUSIONS

PURPOSE: Cytology fails to detect neoplastic cells in approximately 40–50% of malignant pleural effusions, which commonly accompany lung adenocarcinomas. Published reports of the diagnostic sensitivity of various tumor markers are inconsistent. Reports on Her-2/neu in lung adenocarcinoma-associated malignant pleural effusion, for example, differ markedly (72% vs. 10%). In addition, optimal cutoff points have not been determined. To clarify contrasting reports and maximize diagnostic efforts, we evaluated the diagnostic sensitivity, specificity and optimal cutoff points for Her-2/neu, Cyfra 21-1 and carcinoembryonic antigen (CEA) in distinguishing lung adenocarcinoma-associated malignant from benign pleural effusions.

Hemangiomas and Angiosarcomas of the Breast: Diagnostic Utility of Cell Cycle Markers With Emphasis on Ki-67

Vascular tumors comprise a minor subgroup of tumors arising in the breast and represent variants of hemangiomas and angiosarcomas. Diagnostic challenges may arise when differentiating hemangiomas from types I and II angiosarcomas. Ki-67 expression has been used as an adjunct to distinguish between benign and malignant lesions exhibiting histologic overlap at various anatomic sites. To investigate the utility of Ki-67 and other cell cycle regulatory proteins (S-phase kinase-associated protein 2 [Skp2], p27, and cyclin D1) in the differential diagnosis of mammary vascular lesions. Thirty-four vascular tumors (21 hemangiomas and 13 angiosarcomas) of the breast were studied. The Ki-67 index and immunoreactivity for Skp2, p27, and cyclin D1 were determined in each case. Appropriate statistical methods were used. The mean value of Ki-67 index was statistically different when comparing hemangiomas and angiosarcomas (P < .001). Angiosarcomas were typically positive for Skp2, whereas hemangiomas were negative (P < .001). Sensitivity and specificity cutoffs for Ki-67 index to distinguish hemangiomas from angiosarcomas showed a candidate cutoff point of 175. The mean values of Ki-67 of low-grade angiosarcomas were significantly different from all hemangiomas (P < .001) and also different from the subset of atypical hemangiomas (P = .02). Sensitivity and specificity cutoffs for Ki-67 index to distinguish all hemangiomas from low-grade angiosarcomas showed a candidate cutoff point between 150 and 175. Among angiosarcomas, positivity for Ki-67 was inversely related to that of p27 but not to Skp2 or cyclin D1. This was also true among hemangiomas. Ki-67 index can be used as a diagnostic tool to distinguish between benign and malignant vascular lesions of the breast. This can be particularly helpful in cases of histologic overlap such as low-grade angiosarcoma and hemangioma.

Predictive echo-Doppler indices of left ventricular impairment in B-thalassemic patients

Early detection of cardiac-function impairment by echo-Doppler indices can assist in preventing further cardiac damage by modifying disease progression and treatment. We analyzed our thalassemia major patients database with 10 years cardiac follow-up. Included patients were under constant therapy and should have an initial echo-Doppler study with normal Shortening Fraction (SF > 30%) and reexamination within the last year. We identified patients who developed impaired left ventricular (LV) function in the last Echo and we attempted to find which measured indices could predict LV function impairment. Three hundred fifteen of the 632 database patients were enrolled. Twelve of them developed LV systolic dysfunction. There were no statistically significant differences in mean age, ferritin, and pretransfusion hemoglobin levels of the two groups. LV-systolic-dysfunction group was presenting statistically significantly higher LF end-systolic diameter (LVESD) index, lower SF, higher early transmitral peak flow velocities/late transmitral peak flow velocities (A) ratios, lower A value. All other echocardiographic parameters did not differ significantly. By receiver-operating characteristic analysis, we determined systolic and diastolic indices specificity and sensitivity for LV impairment: LVESD 97% specificity, 11% sensitivity (cutoff value 2.44 cm/m(2) ), SF 92.1 and 33.3% (cutoff value 33%). Regarding diastolic indices, A index was the best criterion (97.7% specificity, 25% sensitivity, cutoff value <or=0.36). Low values of the diastolic index A wave and increased values of the LVESD index were the earliest pathological findings in patients that finally developed LV systolic dysfunction. These parameters could be used as heart-dysfunction predictors with relatively good sensitivity and specificity.

Reliability assessment of glucose measurement by HemoCue analyser in a neonatal intensive care unit

Rapid and reliable bed-side determination of blood glucose concentration is very important in the management of acutely ill infants and especially in premature newborns. HemoCue is an easy-to-use glucose analyser. The aim of the present study was to examine the usefulness of the HemoCue glucose analyser compared to a reference plasma glucose method (SYS, BM/Hitachi 747/737) in a neonatal intensive care unit (NICU). Seventy-eight consecutive neonates admitted to our NICU were enrolled in the study. At the time of the study all patients were grouped according to nutritional management (parenteral or enteral nutrition), haematocrit values and birth weight. The effects of feeding management, haematocrit values, and birth weight on accuracy and precision of the device were evaluated. Overall data linear regression analysis yielded an r-value of 0.905 and the Bland-Altman method demonstrated that HemoCue overestimates plasma glucose by 0.932 mmol/L. Evaluation of our data by receiver operating characteristic curve demonstrated 100% sensitivity cutoff at 4.1 mmol/L. HemoCue cannot be used satisfactorily in the management of glycaemia in the NICU. In the preterm population, birth weight had a dramatic influence on HemoCue accuracy. Low haematocrit and parenteral feeding further contributed to a decrease in the accuracy of this device.

Comparing validity of Edinburgh scale and SRQ20 in screening for post-partum depression

The Edinburgh Postnatal Depression Scale (EPDS) is the instrument most used worldwide for screening of Post-Partum Depression (PPD). The SRQ20 questionnaire has been largely used for screening of minor psychiatric disorders. This study aimed to compare the accuracy of the two instruments in screening for PPD. At the third-month follow-up home visit to infants of the 2004 Pelotas Birth Cohort, Southern Brazil, a sub-sample of 378 mothers was selected. Among other questions, EPDS and SRQ20 were applied by trained fieldworkers. Up to 15 days later, a mental health professional re-interviewed the mother (the gold standard interview). Sensitivity and specificity of each cutoff point were calculated for EPDS and SRQ20 and the results were plotted at a ROC curve. The areas under both curves were compared. Highest sensitivity and specificity cutoff were observed for EPDS ≥ 10 (sensitivity 82.7%, 95%CI 74.0 – 89.4; specificity 65.3%, 95%CI 59.4 – 71.0) and for SRQ20 ≥ 6 (sensitivity 70.5%, 95%CI 60.8 – 79.0%; specificity 75.5%, 95%CI 70.0 – 80.5%). Shape of ROC curves and areas under both curves were virtually identical (respectively, 0.8401 ± 0.02 for EPDS and 0.8402 ± 0.02 for SRQ20; p = 0.9). In conclusion SRQ20 showed to be as valid as EPDS as a screening tool for PPD at third month after delivery.