World Health Organization Reference Research Articles

Paving the way for establishing a reference measurement system for standardization of plasma prothrombin time: Harmonizing the manual tilt tube method

BackgroundInternational normalized ratio (INR) is traceable to World Health Organization (WHO) International Standards for thromboplastins. International Standards must be used with a manual tilt tube technique (MTT) for prothrombin time (PT) determination. An important part of the total variability of INR is due to poor harmonization of MTT across WHO reference laboratories. ObjectivesTo determine the origins of PT differences between operators performing MTT and to develop a harmonized MTT. MethodsTwo workshops were held where WHO reference laboratory operators could compare their PTs using MTT and the same equipment. A harmonized MTT was used by seven operators in the second workshop. ResultsDifferences have been observed in tilting frequency and in the height of pipetting plasma in the test tube. At the beginning of the first workshop, the tilting cycle time varied between 1.1 and 2.7 seconds. The mean PT of normal plasma obtained by pipetting plasma at the top of the tube was 14.3 seconds but was 12.9 seconds when plasma was pipetted at the bottom of the tube. When using the harmonized MTT for WHO International Standard rTF/16, the differences between operators were not greater than 1.1 seconds in normal plasma, and not greater than 1.3 seconds in patient plasma with average INR of 3.0. INR between‐operator coefficient of variation was 2.3%. ConclusionApplication of a harmonized MTT in three reference laboratories resulted in substantial reduction of between‐operator variation of PT and INR. The harmonized MTT is proposed as Candidate Reference Measurement Procedure.

Validation of the analytical performance of the NOVEOS™ System, a system which improves upon the third-generation in vitro allergy testing technology.

Objectives Detection of allergen-specific immunoglobulin E (sIgE) is important for the diagnosis of allergy. IgE sensitization is commonly demonstrated in vivo by skin prick testing (SPT), or in vitro utilizing automated systems. Recently, HYCOR® Biomedical launched its new system for allergen sIgE testing called the NOVEOS™ Immunoanalyzer. This study aims to evaluate the analytical performance of the NOVEOS system in a bi-center study at Philipps-University Marburg (Site-1) and Charité Medical University Berlin (Site-2), respectively. Methods The analytical performance was evaluated based on the guidelines I/LA20-A3, EP5-A3, EP17-A2, EP6-A, EP7-A3, and EP9-A3 of the Clinical and Laboratory Standards Institute (CLSI). Results The conducted repeatability and within-laboratory precision tests provided acceptable performance with 3.0%-11.9% coefficient of variation across both sites. The limit of blank (LoB) and limit of detection (LoD) were <0.1 kU/L at both centers. A within-parameter linearity for all tested allergens was reported at both sites. Of note, no significant interference was observed for high levels of biotin, methylprednisolone, diphenhydramine, omalizumab, or ranitidine. Method comparison between the NOVEOS calibration and the latest World Health Organization (WHO) reference standard showed good agreement at both sites. Conclusions The results from the analytical performance of the NOVEOS allergen sIgE assay and instrument testing at both sites were comparable. Overall, a good precision and linearity as well as a detection limit <0.1 kU/L were observed, with minimal impact of common interfering substances on patient recoveries. The NOVEOS is calibrated to the latest WHO reference standard and adds benefits like a small sample size and para-magnetic microparticles that improve upon third-generation allergen sIgE assays' design and performance.

Socio-demographic and Household-Level Risk Factors for Severe Acute Malnutrition in Pre-school Children in North-Western Nigeria.

Severe acute malnutrition (SAM) is associated with significant morbidity and mortality and is disproportionately distributed mainly in developing countries. In Nigeria, the prevalence of SAM in the North-Western region of the country is significantly higher than the national average. In this study, we identified risk factors for SAM in North-Western Nigeria. Identifying such risk factors would be helpful in developing local preventive strategies and providing insights for broader SAM control programs in other high-burden country settings. We performed post hoc data analysis, comparing baseline socio-demographic and household-level risk factors in a cohort of 1011 children aged between 6 and 59 months who either had SAM or were well-nourished children. We defined nutritional status using the World Health Organization (WHO) reference standards and investigated the association between SAM and our identified risk factors using multivariable logistic regression model. Children aged between 12 and 23 months [adjusted odds ratio (AOR) 2.95, 95% confidence interval (CI) 1.99-4.38], household who reared domestic animals (AOR 1.94, 95% CI 1.40-2.69) and those from polygamous households (AOR 1.91, 95% CI 1.33-2.74) had significantly increased odds of developing SAM. Parental education and being on the household diet reduced the odds of having SAM. Our findings suggest the need to develop optimal complementary feeding nutrition programs and promote adult and general education in our community. Cultural and feeding practices in local polygamous households also need further investigation to understand the association between polygamy with SAM.

Anthropometric measurements of school-going-girls of the Punjab, Pakistan

BackgroundChild’s growth has been considered an important indicator to evaluate health trends in a population and to devise strategies accordingly. The purpose of the present study was to determine most commonly occurring weight abnormalities among school-going girls from Punjab and to compare with international growth references devised by World Health Organization (WHO) and Centre for Disease Control and Prevention (CDC).MethodsIn this cross-sectional study a sample of 10,050 child and adolescent girls from 12 districts, 35 public/private sector schools, located in rural, semi-urban and urban areas of northern, central and southern Punjab were included. Parameters were measured according to standardised techniques and centile curves obtained by Lambda, Mu, Sigma (LMS) method.ResultsThe results showed an increase in weight, height and BMI of the Punjabi girls until 15 years. When compared with international growth references, weight and BMI in our population were significantly lowered; however, height was lower during 12–16 years of age and the differences observed were more pronounced with CDC as compared to WHO. When 3rd, 50th and 90th percentiles of weight, height and BMI in our population were compared with international standards, the values were lower in our paediatric population.ConclusionThe Punjabi schoolgirls significantly differed from CDC and WHO references, and this difference should be taken into consideration for evaluation of growth abnormalities in our paediatric population. However, in the absence of national reference data, WHO standards have been considered more appropriate for comparison.

Survey of Methylmercury Exposures and Risk Factors Among Indigenous Communities in Guyana, South America.

Background.Gold mining activities in forested areas across Guyana have been a common practice for more than a century. The intensification of artisanal and small-scale gold mining (ASGM) in recent decades caused by global market demand is contributing to the mobilization of mercury into aquatic systems. Indigenous populations who consume high levels of locally sourced fish are greater at risk for methylmercury poisoning from ingestion of contaminated fish.Objectives.The aim of the present study was to investigate the levels of mercury contamination and identify the risk factors associated with hair mercury levels in four indigenous communities in Guyana.Methods.Concentrations of total mercury were measured in hair samples from 99 participants from four indigenous communities in the south Rupununi region in Guyana. The findings of this study were compared with those of previous studies to assess the prevalence of mercury contamination in indigenous communities across Guyana.Results.Hair mercury levels were found to be above the World Health Organization (WHO) reference value for residents who live close to ASGM activities and who consume high quantities of locally sourced fish. Our results are not only consistent with those obtained in previous studies, but also evidence that mercury poisoning has become a generalized problem for indigenous communities in Guyana.Conclusions.Fish is the main source of protein for many riverine communities and consumption of mercury-contaminated fish poses a serious health hazard for these vulnerable populations. The situation is especially dire for community members of Parabara with 100% of participants showing elevated (>15 μg*g−1) hair mercury levels. It is therefore crucial that Parabara residents be evaluated by relevant health agencies for clinical symptoms related to mercury toxicity.Participant Consent.ObtainedEthics Approval.The study protocol was approved by the Institutional Review Board of the Ministry of Public Health, Guyana.Competing Interests.The authors declare no competing financial interests.

Child Growth Curves in High-Altitude Ladakh: Results from a Cohort Study.

High prevalence of child underweight and stunting in high-altitude areas has often been reported. However, most previous studies on this topic were cross-sectional. Another critical concern is that using the World Health Organization (WHO) Child Growth Standards to evaluate child growth in high-altitude areas may lead to overestimations of underweight and stunting. Our study aimed to evaluate the long-term growth pattern of children (3 to 18 years) above the altitude of 3500 m in Ladakh, India. The participants’ body weight (BW), body height (BH), and body mass index (BMI) were measured annually according to the WHO Child Growth Standards for children under 5 years old and the WHO reference data for children aged 5 to 19 years. The generalized estimating equation (GEE) was used to estimate the means and z-scores of BW, BH, and BMI at different ages. A total of 401 children were enrolled from 2012 to 2018. Their mean z-scores of BW, BH, and BMI were −1.47, −1.44, and −0.85 in 2012 and increased to −0.74, −0.92, and −0.63 in 2018. This population’s specific growth curve was also depicted, which generally fell below the 85th percentile of the WHO standards. This is the first cohort study about long-term child growth patterns in a high-altitude area. The detailed underlying mechanisms of our findings need future research on more representative data of high-altitude populations.

Elevated Hair Mercury Levels Are Associated With Neurodevelopmental Deficits in Children Living Near Artisanal and Small-Scale Gold Mining in Peru.

Children living near artisanal and small‐scale gold mining (ASGM) are at risk of exposure to mercury, a neurotoxicant. It is not certain whether such exposures are harming development, as they occur in underresourced contexts entwined with other stressors, such as malnutrition and enteric infection. This study sought to investigate the association between hair‐mercury levels and visual‐motor, cognitive, and physical development among children living near ASGM in the Peruvian Amazon. Total hair‐mercury levels were measured in 164 children ages 5–12 living in Madre de Dios, Peru. Primary outcomes included Visual‐Motor Integration assessed via the Beery‐VMI Developmental Test, General Cognitive Ability assessed via the Batería‐III Woodcock‐Munoz (Spanish‐language Woodcock‐Johnson Tests of Cognitive Abilities), and Physical Health assessed via anthropometry/hemoglobin counts. Mean (SD) hair‐mercury level was 2.06 (2.43) μg/g. Fifty‐four children (32.9%) had hair‐mercury levels above the World Health Organization reference level of 2.0 μg/g. After controlling for sex, child age, maternal education, and family socioeconomic status, each one unit increase in log hair‐mercury level was associated with a 1.01 unit decrease in Visual‐Motor Integration (95%CI: −2.06, 0.05, p = 0.061), a 2.59 unit decrease in General Cognitive Ability (95%CI: −4.52, −0.66, p = 0.012), and a 2.43 unit decrease in Physical Health (95%CI: −5.34, 0.49, p = 0.096). After adjustment for covariates, children with hair‐mercury levels exceeding the World Health Organization reference level scored 4.68 IQ points lower in Cognitive Ability than their peers. Mercury exposures related to ASGM may be harming child development in the Peruvian Amazon. Children in this region may benefit from intervention to reach their full developmental potential.

Semen infections in men with primary infertility in the real-life setting

To study the impact of asymptomatic semen infections on seminal parameters in men presenting for primary couple's infertility. Cross-sectional study. Academic center. Socio-demographic, clinical, and laboratory data from 1689 infertile men were analyzed. Semen analysis was based on 2010 World Health Organization reference criteria. Each patient underwent semen culture test to identify common urogenital pathogens. Infections by Mycoplasma, Ureaplasma, and Chlamydia spp. were evaluated through a real time polymerase chain reaction platform. Descriptive statistics and linear and logistic regression models were used to test the association between semen infections and clinical, seminal, and hormonal parameters. Prevalence of asymptomatic semen infection and impact of semen infection on sperm parameters. Of 1689 men, 354 (21.0%) had an asymptomatic positive semen culture. Ureaplasma urealyticum (37.6%) was the most frequent single pathogen, followed by Enterobacteriaceae (any type; 24.8%), other pathogens (20.3%), Chlamydia trachomatis (3.4%) and Mycoplasma spp (3.4%). Positive semen cultures were associated with lower sperm concentrations (P<0.001) and progressive motility (P<.001). These latter findings were mostly particular to men with infections caused by Ureaplasma urealyticum compared with negative semen cultures. A positive semen culture was both univariably (P<.001) and multivariably (P=.04) associated with a lower sperm concentration. One out of five men presenting for a couple's primary infertility had asymptomatic semen infections, which were significantly associated with impaired sperm concentration. These observations point out the importance of an accurate investigation of semen infection in the everyday clinical practice diagnostic workup of infertile men.

Oxidative stress, DNA damage and apoptosis levels in those who use borderline high level fluoride content drinking water

Aim: Fluoride is necessary for tooth and bone development, but when exposed to excessive levels can cause oxidative stress, DNA damage, apoptosis, fluorosis and cancer. The aim of this study is to reveal the underlying mechanism of fluoride toxicity and to clarify, in part, the uncertainty of the fluoride level in the reference value ranges of drinking water. Material and Methods: Two groups were included in the study as exposure and control groups. Serum Total Oxidant Status and Total Antioxidant Status were measured with colorimetric; Urine 8-OHdG (8-hydroxy-2-deoxyguanosine) (CUSABIO) levels as DNA damage biomarkers and serum M30 and M65 levels (PEVIVA) as apoptosis biomarkers were studied by ELISA method. In addition, all participants underwent a dental examination by the dentist. Results: Serum total antioxidant status (TAS) were lower in the exposure group compared to the control group (p &amp;lt;0.001); serum total oxidant status (TOS) (p &amp;lt;0.001), OSI (p &amp;lt;0.001), M30 (p &amp;lt;0.001) and M65 (p &amp;lt;0.001) levels and urine 8-OHdG (p = 0.011) levels were high. However, the M30 / M60 ratio was not statistically different between the two groups (p = 0.371). Dental fluorosis was detected in all participants in the exposure group. Conclusion: This study showed increased levels of oxidative stress, DNA damage and apoptosis biomarkers in drinking water users with borderline high level fluoride. Therefore, instead of the World Health Organization's reference value range (0.5-1.5 mg/L) for fluoride levels in drinking water, the US Public Health Service’s (0.7 mg/L) reference value range seems to be more appropriate to the precaution.

Leukocytospermia is not an informative predictor of positive semen culture in infertile men: results from a validation study of available guidelines.

STUDY QUESTIONAre the European Association of Urology (EAU) guidelines for performing semen culture accurate enough for detecting a positive semen culture in Caucasian-European infertile men?SUMMARY ANSWERThe majority (80%) of asymptomatic infertile men with a positive sperm culture may miss a proper diagnostic assessment when relying on EAU guidelines; no single parameter can assist in medical decision-making.WHAT IS KNOWN ALREADYThe EAU guidelines suggest performing semen culture in case of increased leukocytes in semen (>106 peroxidase positive white blood cells/ml, i.e. leukocytospermia).STUDY DESIGN, SIZE, DURATIONA cross-sectional validation study including 523 infertile men was carried out during 2010–2018.PARTICIPANTS/MATERIALS, SETTING, METHODSInfertile men who were asymptomatic for genital infections were enrolled at a single academic center, and a semen culture was obtained in every case. A concentration of >103 cfu/ml urinary tract pathogens in the ejaculate was considered indicative of significant bacteriospermia. Semen analysis values were assessed on the basis of 2010 World Health Organization reference criteria. EAU guidelines for semen culture were used to predict positive semen culture in our cohort and thus validated. Moreover, we tested the predictive performance and accuracy of several clinical parameters and compared them to EAU guidelines.MAIN RESULTS AND THE ROLE OF CHANCEA positive semen culture was found in 54 men (10%). The application of EAU guidelines would have missed 43 out of 54 (80%) positive semen cultures with 120/131 (92%) useless examinations. EAU guidelines specificity, sensitivity and discrimination were 74%, 20% and 47%, respectively. When trying to improve positive semen culture prediction, we were unable to find any informative baseline parameter except for serum neutrophil-to-lymphocyte ratio (odds ratio 1.70 (95% CI 1.04–2.77)), although without any improvement in terms of discrimination (P = 0.10).LIMITATIONS, REASONS FOR CAUTIONThe study was limited by the lack of a control group of fertile men its retrospective nature. Moreover, monoclonal antibodies were not used for leukocyte assessment.WIDER IMPLICATIONS OF THE FINDINGSSince it is not possible to identify infertile men at risk of semen infection, further studies are needed to tailor the execution of semen culture.STUDY FUNDING/COMPETING INTEREST(S)No funding was received for this study. There are no competing interests.

Avaliação do estado nutricional de pacientes atendidos em ambulatório de neuropsiquiatria infantil

Objective: This study set out to identify the prevalence of nutritional disorders in patients treated at a children’s neuropsychiatric day clinic, based on data from medical records in April 2013 - July 2015. Methods: A cross-sectional descriptive study of prevalence. Research project approved by the Research Ethics Committee. Data obtained for age, gender, weight and height, diagnosis and current medication. Body mass index (BMI = weight/height²) calculated by World Health Organization references. Results: The study analysed medical records of 381 patients, aged between 3 and 19 years (mean =11), X males and Y females. The prevailing nutritional status was thinness, especially among patients with attention deficit hyperactivity disorder (ADH). Overweight and obesity were more prevalent in mentally retarded patients. The most prevalent diagnoses were ADHD (n = 180; 47.49%). ADHD was the most prevalent in males (n= 147; 54,8 %) and in females (n= 34; 30,6%). 0,5% of patients were preschoolers, 26,3% were students and 73,2% adolescents. In terms of medication, 21.2% (n = 81) were taking Methylphenidate while 11.8% (n = 45) were taking Risperidone. Conclusion: In this population, thinness is most prevalent, while overweight and obesity prevail in the healthy population of this same age group. It suggested that further studies on the nutritional status of children and adolescents with psychiatric disorders be carried out with a view to drafting multidisciplinary care strategies encompassing nutritional aspects to provide effective and comprehensive care to these patients.

World Health Organization's Growth Reference Overestimates the Prevalence of Severe Malnutrition in Children with Sickle Cell Anemia in Africa.

Anthropometric indices are widely used to assess the health and nutritional status of children. We tested the hypothesis that the 2007 World Health Organization (WHO) reference for assessment of malnutrition in children with sickle cell anemia (SCA) overestimates the prevalence of severe malnutrition when compared to a previously constructed SCA-specific reference. We applied the WHO and SCA-specific references to children with SCA aged 5–12 years living in northern Nigeria (Primary Prevention of Stroke in Children with SCA in sub-Saharan Africa (SPRING) trial) to determine the difference in prevalence of severe malnutrition defined as body mass index (BMI) Z-score <−3 and whether severe malnutrition was associated with lower mean hemoglobin levels or abnormal transcranial Doppler measurements (>200 cm/s). A total of 799 children were included in the final analysis (median age 8.2 years (interquartile range (IQR) 6.4–10.4)). The application of the WHO reference resulted in lower mean BMI than the SCA-specific reference (−2.3 versus −1.2; p < 0.001, respectively). The use of the WHO reference when compared to the SCA-specific reference population also resulted in a higher prevalence of severe malnutrition (28.6% vs. 6.4%; p < 0.001). The WHO reference significantly overestimates the prevalence of severe malnutrition in children with SCA when compared to an SCA-specific reference. Regardless of the reference population, severe malnutrition was not associated with lower mean hemoglobin levels or abnormal transcranial Doppler (TCD) measurements.

Procjena saglasnosti tri različita klasifikaciona sistema za određivanje uhranjenosti učenika

The aim of this paper is to determine the agreement in assessing the nutritional status of adolescents using the classification systems of the US Centers for Disease Control and Prevention (CDC), the International Obesity Task Force (IOTF) and the World Health Organization (WHO). Non-experimental observation was performed on a sample of 213 first grade high school students from Banja Luka, Republika Srpska, Bosnia and Herzegovina, with an average age of 15.67 years, of which 89 (41.8%) were male and 124 female (58.2%). Each of the subjects was categorized according to a unique scale, as underweight, normal weight, overweight or obese, using IOTF, CDC and WHO reference values. The Cohen kappa coefficient (k) was used to estimate the agreement of the three classification systems in determining nutritional status. The prevalence of underweight was found to be highest according to IOTF standards in both sexes, while the prevalence of overweight was highest according to WHO references. The differences between analyzed three systems are not large for the obese category, especially in girls. In boys, CDC references show a slightly higher percentage of obese compared to the other two systems. The agreement between the classification systems ranges from 0.83 to 0.86 on the total sample of respondents based on all nutritional status categories, which can be considered a reliable parameter for further monitoring, comparison and prescribing of measures.

Clinical and Metabolic Complications in patients with thalassemia undergoing transfusion therapy.

Background:The transfusions in patients with thalassemia are a double-edged sword as the patients develop complications due to inadequate transfusions and due to multiple transfusions. These complications vary from metabolic complications such as diabetes mellitus and clinical complications such as growth retardation, transfusion-transmitted infections (TTI), and iron overload. We selected Balasore district in Odisha which is a satellite center of AIIMS Bhubaneshwar and has a huge population of hemoglobinopathy patients especially thalassemia and this district in Odisha lags in terms of healthcare and health awareness.Materials and Method:In all, 123 patients with thalassemia major were included in this study for the evaluation of metabolic and clinical complications. Anthropometric measurements such as height and weight with age and gender were used for evaluation of growth parameters as per World Health Organization (WHO) reference data. Children were termed wasted and stunted if the values were below 2 standard deviation of the reference WHO median. Blood samples were collected for TTI status and fasting blood sugar levels.Result:A total of 118 (95.9%) were detected to have under nutrition, 73 (59.3%) of the patients were HCV-positive, and 54 (48.6%) had high fasting blood sugar levels. Based on the HCV status, they were classified as HCV-positive and HCV-negative to compare the anthropometric and growth status in these patients. About 98.6% of the HCV-positive cases were undernutrition and 83.6% were stunted.Conclusion:There is an increasing trend of associated metabolic derangements in patients with thalassemia. The district-level health services have an urgent need for improvement in chelation regimes and screening technologies.

Prevalence of obesity and overweight within the school environment in Tafilalet oasis, south-east of Morocco

IntroductionL’obésité représente un sérieux problème de santé publique qui a un impact direct sur la santé physique et mentale des individus. L’objectif du présent travail est de déterminer la prévalence de l’obésité et du surpoids en milieu scolaire urbain et rural, chez une population infantile oasienne.MéthodesNous avons entrepris une étude transversale descriptive au sein des établissements scolaires publics urbains et ruraux de l’oasis de Tafilalet. Nous avons recruté un échantillon représentatif de 3684 enfants scolarisés appartenant à 39 écoles publiques primaires.RésultatsLa moyenne d’âge était de 9,81 ± 2,13 ans. L’échantillon total s’est réparti en 1794 garçons (48,70%) et 1890 filles (51,30%). Deux mille trois cent neuf appartenant à l’urbain (62,70%) et 1375 au rural (37,30%). Selon les références de l’organisation mondiale de la santé, notre étude a révélé un taux d’obésité de 1,9% et 10,8% pour le surpoids. L’obésité et le surpoids n’étaient pas significativement associés avec le sexe des enfants.ConclusionLa prévalence de l’obésité dans l’oasis de Tafilalet est inférieure aux données nationales et internationales, le mode de vie et les habitudes alimentaires de cette population semblent être un facteur protecteur contre l’obésité et le surpoids.

Associated Factors with the Child’s Fully Immunized in the Tambacounda Health District (Senegal)

To improve vaccination coverage among children under one year of age in the Tambacounda health district, a household survey was carried out among mothers or babysitters. The objective was to study the factors related to child’s fully immunized in children aged 12 to 23 months. The cross-sectional, descriptive and analytical survey was carried out during the month of April 2019. A multistage cluster survey selected a sample of 657 mothers and babysitters. The data was collected using a questionnaire made from the World Health Organization reference guide. Data entry and analysis were done with Epi Info software and R. Among the women surveyed, biological mothers were the most representative (96.9%). In the series, 74.1% had a good knowledge of the age for initiating vaccination, 78.2% knew the number of contacts. The vaccination record of the children was available in 92.2%, and 71.0% of them had presented an adverse event. The proportion of children fully immunized was 41.0%. Complete childhood vaccination was positively associated with income-generating activity in women (0R = 2.4) and the short distance (<100 m) between home and place of vaccination (OR = 1.5). It was also improved by having a qualified health worker as a vaccinator (OR = 1.4) satisfaction in relation to visit (OR = 2.0), the advice given by the vaccinator (OR = 1.7) and the fixing of the date of the next vaccination appointment (OR = 2.5). The implementation of a good strategy for improving the quality of immunization services is an important element for strengthening immunization coverage in the Tambacounda health district.

Intrauterine growth patterns in rural Ethiopia compared with WHO and INTERGROWTH-21st growth standards: A community-based longitudinal study.

IntroductionChildren’s well-being is highly influenced by their fetal growth. Adequate intrauterine growth (IUG) is a basic feature of a healthy pregnancy. The aim of our study was to assess IUG patterns in a rural and drought-affected population in the Rift Valley area of the Adami Tullu district in Oromia, Ethiopia.MethodsWe conducted a longitudinal, community-based study of IUG patterns utilizing serial ultrasound measurements. Data were collected for 17 months, from July 2016 to November 2017. We included 675 singleton foetuses ≤ 24 weeks old, based on ultrasound-derived estimates of gestational age, and followed them until delivery. We obtained head circumference, biparietal diameter, abdominal circumference, femur length, and estimated fetal weight at 26, 30, and 36 weeks. Fetal weight was estimated using the Hadlock algorithm, and the 5th, 10th, 25th, 50th, 75th, 90th, and 95th centiles were developed from this model. We compared the biometric measurements and fetal weight data from our study to the World Health Organization (WHO) and INTERGROWTH-21st fetal growth reference standards.ResultsDistribution of the biometric measurements and estimated fetal weights in our study were similar to those for the WHO and INTERGROWTH-21st references. Most measurements were between -2 and +2 of the reference z-scores. Based on the smoothed percentiles, the 5th, 50th, and 95th percentiles of our study had similar distribution patterns to the WHO chart, and the 50th percentile had a similar pattern to the INTERGROWTH-21st chart.ConclusionsOur study determined fetal growth patterns in a drought-affected rural community of Ethiopia using common ultrasound biometric measurements. We found similar IUG patterns to those indicated in the WHO and INTERGROWTH-21st fetal growth reference standards.

Clinical effects of calibration of CoaguChek XS PT Test Strips on Anticoagulation Management Services

ObjectiveIn January 2018, Roche Diagnostics calibrated CoaguChek XS PT Test Strips to the latest World Health Organization reference preparation. On September 12, 2018, Roche Diagnostics issued an urgent medical device correction statement warning of inaccurate international normalized ratio (INR) results greater than 4.5 and recommended additional confirmatory testing. Eight weeks later, on November 2, the U.S. Food and Drug Administration issued a class I recall of all affected lot numbers. The objective of this project was to determine the clinical effects of recalibration of CoaguChek on patients managed by the Anticoagulation Management Services (AMS). MethodsTwo retrospective chart reviews were conducted for patients seen by AMS from May 1 to September 11 and from September 12 to November 2, 2018. Data collected included date of INR, confirmatory testing (if applicable), reason for elevated INR, and interventions. Data were analyzed using descriptive statistics. ResultsFrom May 1 to September 11, 2018, 16 of 166 patients were affected by recalibrated strips, resulting in 19 of 1176 INRs being greater than 4.5. Almost half (47%) of elevations were due to unknown causes, and most were corrected by holding at least 1 dose. Of the 152 patients treated from September 12 to November 2, 8 patients were affected by the recalibration, resulting in 11 of 453 INRs being greater than 4.5. Six resulted in confirmatory INR testing with an average difference of 2 points. No bleeding events or hospitalizations were reported in either group. ConclusionBased on the experiences of 1 anticoagulation clinic, the CoaguChek XS PT Test Strip calibration update and class I recall did not result in a meaningful clinical impact.

Education, Altitude, and Humidity Can Interactively Explain Spatial Discrepancy and Predict Short Stature in 213,795 Chinese School Children.

Backgrounds and Objectives: The north–south height distinctions in Chinese children suggest that some geographical–climatic factors could determine height variation of short stature. In a national health survey, we aimed to explore the spatial distribution of short stature on city scales, and detect its socio-economic and geographical–climatic factors.Methods: Data on the prevalence of short stature were obtained from a 2014 cross-sectional survey of China (CNSSCH). In total, 213,795 Han Chinese students aged 7–18 years, from 106 cities across 30 provinces, were included. Both China and World Health Organization (WHO) growth references were adopted to define short stature.Results: A spatial clustering was apparent in the distribution of short stature. After multivariable adjustment, altitude and humidity significantly increased the risk of high prevalence in short stature, according to the WHO (odds ratio [OR] = 1.61 and 1.26, 95% confidence interval [CI]: 1.20–2.17 and 1.03–1.54) and China (OR = 1.54 and 1.26; 95% CI: 1.15–2.05 and 1.02–1.55) growth references. Additionally, education significantly decreased the risk of high prevalence in short stature according to the WHO (OR = 0.40; 95% CI: 0.22–0.74) and China (OR = 0.42; 95% CI: 0.22–0.77) growth references. Combining both altitude >400 m and education <9 years, as well as education <9 years and humidity >70%, received the largest effect-size estimate, and significance retained after multivariable adjustment.Conclusions: Our findings indicate that high altitude and humidity increased the risk of high prevalence in short stature, high education was associated with low prevalence. Additionally, we observed possible interactions between education and altitude/humidity. They may interactively explain spatial discrepancy and predict short stature in Chinese school children. Further validations are necessary.

T36UNDERSTANDING PSYCHIATRIC COMORBIDITY IN CHRONIC IMMUNOINFLAMMATORY DISEASES USING GENOMICS

The prevalence of nutritional disorders in Saudi children with inflammatory bowel diseases (IBDs) has been reported using the World Health Organization (WHO) reference. Our aim was to provide more accurate definition of the prevalence of nutritional impairment in Saudi children with IBDs based on the national growth reference and to demonstrate the effect of using a reference from other populations on the prevalence rates.Weight, height, and body mass index data, from the multicenter study of IBDs in Saudi children and adolescents, were plotted on the new Saudi national growth reference. Statistical analyses included frequency calculations and z-test for proportions to investigate the significance of the difference in prevalence. A p-value of < 0.05 was considered significant.Among a total of 374 patients, 119 (32%) had ulcerative colitis (UC) and 255 (68%) had Crohn’s disease (CD). Compared with the WHO reference, the Saudi national reference produced a significantly lower prevalence of thinness in patients with UC (24% vs. 8%, p = 0.001), CD (35% vs. 20%, p = 0.002), and of short stature in patients with CD (28% vs. 11%, p < 0.001). The difference in the prevalence of overweight was not significant.We provide more accurate prevalence estimate of nutritional disorders in Saudi children with IBDs based on national reference. The use of the WHO reference overestimated the prevalence of thinness and short stature in Saudi children. Prevalence estimates based on references from other populations should be interpreted with caution.