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Background: The study compared the peak reflux velocity and reflux time in cases of varicose veins and non-varicose veins with a focus on quantifying the reflux parameters. Methods: This is a hospital based observational comparative study. The limbs with CEAP Clinical classification of C2 or more were taken as diseased limbs and contra-lateral limbs with no symptoms or disease were taken as control limbs. Results: Altogether 792 limbs (452 diseased limbs and 340 control limbs) were evaluated with color duplex. Mean Great Saphenous Vein diameter was 5.68 ± 2.07 mm and 4.00 ± 1.34mmin diseased limbs and control limbs respectively (p=0.0001). Mean sapheno-femoral junction diameter was 8.23 ± 2.64 mm and 6.16 ± 1.93 mm in diseased limbs and control limbs respectively (p=0.0001). Mean peak reflux velocity in diseased limbs was significantly higher than control limbs (77.38 cm/sec vs 7.95 cm/sec; p=0.0001). Similarly mean reflux time was significantly longer in diseased limbs than non-diseased limb (406.58ms and 67.28 ms respectively; p=0.0001). An optimal cut-off point of 27.4 cm/s for peak reflux velocity and 250 ms for the reflux time at Sapheno-Femoral junction had a discriminatory power between the two groups. Conclusion: The quantification of peak reflux velocity seems to be more consistent than reflux time in determining the superficial venous reflux. An optimal peak reflux velocity cut off point of 27.4 cm/sec has the discriminatory power between diseased and non-diseased limb. Keywords: Peak reflux velocity; reflux time; superficial venous insufficiency; ultrasound color duplex; varicose veins

Aim: The aim of this study was to develop quantiative criteria for defining visceral obesity and to establish dual-energy X-ray absorptiometric (DXA) diagnostic cut-off points (CP) for normal and abnormal values of the central obesity indexes (COI) that best differentiate extreme visceral obesity in Cushing’s syndrome (CS) from non CS obese and non obese women. Material and Methods: COI1–4 values calculated as a ratio of android to gynoid tissue mass, fat mass and their % were determined in 4 groups, each consisting of 18 women: 1st group of CS, 2nd group of obese women (O1) not different according to their age and BMI from CS, 3rd group of obese women (O2) with BMI of 35 ± 1.2 kg and 4th group of non obese healthy women (C) with normal BMI. Diagnostic accuracy (DG) of CP values of COI1m-4m indexes of abdominal obesity and CP values of COI1n-4n indexes of normal body fat distribution (BFD) was determined. Results: COI1-4 indexes values were highly significantly different among the 4 examined groups and were significantly highest in CS patients and lowest in group C (p < 0.0001). COI1m-4m CP values differentiated extreme visceral, abdominal obesity in CS with highest DG as well as COI1n-4n CP values differentiated normal BFD in group C. COI1m CP of 0.55 best differentiated CS from O1 for DG of 100%. COI2n of 0.38 best differentiated C from CS and O2 for highest DG of 100% compared to O1 because of the significantly higher BMI and COI1n-4n values in O2 that were associated with more pronounced abdominal obesity and highly significantly positive correlation with BMI. Conclusions: DXA cut-off point values of indexes COI1m-4m and COI1n-4n were established as diagnostic indexes and criteria useful in discovering extreme abdominal and normal BFD. COI1m CP value of 0.55 was discovered as a diagnostic criterion of extreme abdominal obesity and COI2n of 0.38 as a diagnostic criterion of normal BFD that excluded abdominal obesity. The other indexes COI1m-4m and COI1n-4n CP values had also high DG in discovering abdominal and normal body fat distribution.

Background/aim: In this study, our objective was to evaluate the mortality in geriatric hip fracture patients who were operated within 48 h after admission or after the 48thh. Materials and methods: A total of 194 patients who had undergone surgery for hip fracture between 2016 and 2018 were retrospectively evaluated. Patient information was obtained from the hospital’s database using the ICD codes 81.52, 82.00–82.09, and 82.10. Radiological examination reports were collected from the patient files. Information on mortality was obtained from the Death Notification System of the Turkish Ministry of Health. First-year mortality rates of patients operated within 48 h (Group 1) and those operated at 48–96 h (Group 2) were compared.Results: The mean duration between admission to the hospital and surgical intervention was 33.90 ± 1.95 h (3–96 h). The mean total hospitalization time was 7.29 ± 1.53 days (2–36 days). Of the patients, 62 (32%) died within one year after the operation. The mean survival times for patients operated ≤48 h or >48 h were 8.47 ± 1.90 and 6.57 ± 2.59 months, respectively (Z = 1.074, P = 0.283). There was no significant correlation between survival time and the time delay before the operation (r = –0.103, P = 0.153). Additionally, the Cox regression analysis, including age (years), ASA (grade 3 vs. 2), time to operation (h), and days spent in the ICU, demonstrated no significant independent effect of the time to operation on survival (P = 0.200).Conclusion: Although shortening the time to surgery may have some rationale, we did not find any difference in patients operated before 48 h compared to 48–96 h concerning mortality.

Background: Various molecular biomarkers, including epidermal growth factor receptor (EGFR), have gained importance as predictors of head and neck cancer disease progression.Aims: This study aimed ...

Background This longitudinal cohort study aimed to examine the impact of the first wave of the COVID‐19 pandemic in Ireland on parents of children with externalising difficulties, in comparison to parents of children without such difficulties. Method Parents of 159 children completed online self‐report measures at three time points during the first wave of the COVID‐19 pandemic; (a) Delay and Mitigation Phase (March 2020 to May 2020), (b) Reopening of Society Phase (June 2020 to July 2020) and (c) Wave 2 Case Acceleration Phase (September 2020 to October 2020). Participants were allocated to the clinical group if they met the clinical cut off point on the Conduct or Hyperactivity/Inattention subscales of the Strengths and Difficulties Questionnaire at Time 1. Results Parents of children with externalising difficulties experienced significantly higher levels of stress, lower levels of wellbeing and engaged in higher levels of avoidant‐focused coping strategies longitudinally. There was a significant difference between outcomes at the different phases of the COVID‐19 pandemic, for stress related to parenting, personal/family stress related to the impact of the COVID‐19 and type of coping strategies employed. Children with externalising difficulties, in comparison to children without externalising difficulties, showed significantly greater adjustment over time for behavioural and emotional difficulties, as reported by their parents. Conclusions Results provide important information regarding the trajectory of psychological outcomes in parents of children with externalising difficulties over the first wave of the COVID‐19 pandemic, highlighting the need for increased parental supports during, and after, the COVID‐19 pandemic.

Background: The COVID pandemic has forced the closure of many colorectal cancer (CRC) screening programs. Resuming these programs is a priority, but fewer colonoscopies may be available. We developed an evidence-based tool for decision-making in CRC screening programs, based on a fecal hemoglobin immunological test (FIT), to optimize the strategy for screening a population for CRC.Methods: We retrospectively analyzed data collected at a regional CRC screening program between February/2014 and November/2018. We investigated two different scenarios: not modifying vs. modifying the FIT cut-off value. We estimated program outcomes in the two scenarios by evaluating the numbers of cancers and adenomas missed or not diagnosed in due time (delayed).Results: The current FIT cut-off (20-μg hemoglobin/g feces) led to 6,606 colonoscopies per 100,000 people invited annually. Without modifying this FIT cut-off value, when the optimal number of individuals invited for colonoscopies was reduced by 10–40%, a high number of CRCs and high-risk adenomas (34–135 and 73–288/100.000-people invited, respectively) will be undetected every year. When the FIT cut-off value was increased to where the colonoscopy demand matched the colonoscopy availability, the number of missed lesions per year was remarkably reduced (9–36 and 29–145/100.000 people, respectively). Moreover, the unmodified FIT scenario outcome was improved by prioritizing the selection process based on sex (males) and age, rather than randomly reducing the number invited.Conclusions: Assuming a mismatch between the availability and demand for annual colonoscopies, increasing the FIT cut-off point was more effective than randomly reducing the number of people invited. Using specific risk factors to prioritize access to colonoscopies should be also considered.

Reproductive-aged women are prone to type 2 diabetes mellitus. This study aims to evaluate the optimal cut off point of Triglyceride/Glucose Index for predicting glucose status conversion among women of reproductive age.This study involved normoglycemic and prediabetes women aged 20-49 years from the Bogor Non-Communicable Diseases Cohort Study (West Java, Indonesia) conducted from 2011 to 2016. Statistical analysis was performed using Receiver Operating Characteristics curve analysis with STATA version 15.Among prediabetes subjects (n = 371), the cut-off point of TyG index for regression from prediabetes to normoglycemic subjects was4.51 [sensitivity, specificity, AUC (95%CI) 83.9%, 80.1%, 0.913 (0.875-0.943), respectively] and the cut-off point for progression from prediabetes to diabetes was4.54 [80.0%, 73.1%, 0.858 (0.807-0.900)]. Among normoglycemic subjects (n = 1300), the cut-off point of TyG index for progression to prediabetes and diabetes were4.44 [80.1%, 71.1%, 0.834 (0.812-0.854)] and4.47 [80.6%, 80.8%, 0.909 (0.890-0.926)] respectively.Based on sample of subjects evaluated between 2011 and 2016, TyG index appears to be a promising marker for glucose status conversion among reproductive-aged women in Jakarta, Indonesia.

Objective Social media disorder (SMD) is an increasing problem, especially in adolescents. The lack of a consensual classification for SMD hinders the further development of the research field. The six components of Griffiths’ biopsychosocial model of addiction have been the most widely used criteria to assess and diagnosis SMD. The Bergen social media addiction scale (BSMAS) based on Griffiths’ six criteria is a widely used instrument to assess the symptoms and prevalence of SMD in populations. This study aims to: (1) determine the optimal cut-off point for the BSMAS to identify SMD among Chinese adolescents, and (2) evaluate the contribution of specific criteria to the diagnosis of SMD. Method Structured diagnostic interviews in a clinical sample ( n = 252) were performed to determine the optimal clinical cut-off point for the BSMAS. The BSMAS was further used to investigate SMD in a community sample of 21,375 adolescents. Results The BSMAS score of 24 was determined as the best cut-off score based on the gold standards of clinical diagnosis. The estimated 12-month prevalence of SMD among Chinese adolescents was 3.5%. According to conditional inference trees analysis, the criteria “mood modification”, “conflict”, “withdrawal”, and “relapse” showed the higher predictive power for SMD diagnosis. Conclusions Results suggest that a BSMAS score of 24 is the optimal clinical cut-off score for future research that measure SMD and its impact on health among adolescents. Furthermore, criteria of “mood modification”, “conflict”, “withdrawal”, and “relapse” are the most relevant to the diagnosis of SMA in Chinese adolescents.

OBJECTIVES: The objective of the study was to establish a cut-off point for high dysphonia risk in children using the Child Dysphonia Risk Screening Protocol (DRSP-C). METHODS: Through a preliminary study, voice recordings of 59 children (4-12 years of age) were collected during an auditory-perceptual analysis using the Consensus Auditory-Perceptual Evaluation of Voice protocol. Thirty of the patients had voice disorders (patient group), and 29 did not (control group). A risk score for dysphonia was then calculated, and data were compared between groups. The relationship between overall degrees of deviation and questionnaire scores was analysed. The questionnaire’s validity was verified from the area under the Receiver Operating Characteristic (ROC) curve, and cut-off points were obtained based on diagnostic criteria for screening procedures. RESULTS: The DRSP-C score was found to be higher for the patient group, as was the partial score for vocal behaviour. No correlation was found between overall degrees of dysphonia and questionnaire scores. The area under the ROC curve was measured as 0.678, denoting limited diagnostic capacity. The cut-off point was set at 16.50. Thus, above this value, dysphonia risk is higher. CONCLUSION: A cut-off point for high dysphonia risk was calculated. The DRSP-C proved to be a promising tool for children’s clinical vocal and health promotion and should be used in conjunction with General Dysphonia Risk Screening.

Objective Cytoreduction has an important role in improving the survival rate of epithelial ovarian cancer (EOC) patients. This study aimed to assess the ability of preoperative serum CA125, FASN and GLS as predictors of cytoreductive surgery for epithelial ovarian cancer (EOC). Results The average values of serum CA-125, FASN, and GLS in the suboptimal cytoreduction group were higher than those in optimal cytoreduction group. The cut off point (COP) was 248.55 (p = 0.0001) with 73.2% sensitivity and 73.6% specificity for CA-125, 0.445 (p = 0.017) with 62.5% sensitivity and 60.4% specificity for FASN, and 22.895 (p = 0.0001) with 73.2% sensitivity and 75.5% specificity for GLS. The COP of CA-125 and GLS combined was 29.16 (p = 0.0001) with sensitivity 82.1% and specificity 73.6%, while the COP of CA-125, GLS, and FASN combined was 0.83 (p = 0.0001) with 87.5% sensitivity and 73.6% specificity.

ObjectivesThe International Classification of Diseases (ICD-10) distinguishes a large number of causes of death (CODs) that could each be studied individually when monitoring time-trends. We aimed to develop recommendations for using the size of CODs as a criterion for their inclusion in long-term trend analysis.DesignRetrospective trend analysis.Setting21 European countries of the WHO Mortality Database.ParticipantsDeaths from CODs (3-position ICD-10 codes) with ≥5 average annual deaths in a 15-year period between 2000 and 2016.Primary and secondary outcome measuresFitting polynomial regression models, we examined for each COD in each country whether or not changes over time were statistically significant (with α=0.05) and we assessed correlates of this outcome. Applying receiver operating characteristicROC curve diagnostics, we derived COD size thresholds for selecting CODs for trends analysis.ResultsAcross all countries, 64.0% of CODs had significant long-term trends. The odds of having a significant trend increased by 18% for every 10% increase of COD size. The independent effect of country was negligible. As compared to circulatory system diseases, the probability of a significant trend was lower for neoplasms and digestive system diseases, and higher for infectious diseases, mental diseases and signs-and-symptoms. We derived a general threshold of around 30 (range: 28–33) annual deaths for inclusion of a COD in trend analysis. The relevant threshold for neoplasms was around 65 (range: 61–70) and for infectious diseases was 20 (range: 19–20).ConclusionsThe likelihood that long-term trends are detected with statistical significance is strongly related to COD size and varies between ICD-10 chapters, but has no independent relation to country. We recommend a general size criterion of 30 annual deaths to select CODs for long-term mortality-trends analysis in European countries.

Background : Polytrauma patients have a risk of progressive organ dysfunction due to uncontrolled immunological process. Sepsis and multiple organ failure are the most common causes of morbidity and mortality in late death of polytrauma patients. Clinical diagnosis and routine laboratory test are not specific until the patient entered a critical state. Delayed diagnosis of sepsis is caused by difficulties in diagnosing. Procalcitonin is a biomarker that is useful in predicting the onset of sepsis. The aim of this research is to determine the level of procalcitonin as early biomarker sepsis in polytrauma patients in RSHS Bandung. Methods : A diagnostic study using secondary data from the Academic Leadership Grant (ALG) study on polytrauma patients in Emergency Room of RSHS Bandung from January-June 2017. This study determined the cut of point, sensitivity, spesificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), and accuracy to diagnosis sepsis. Result : A total of 70 subjects were enrolled in this study, 92.9% were male gender with average age 33.21±13.395 years old. Twenty-one patients (30%) were diagnosed with sepsis. Based on receiver operating characteristic (ROC) curve showed the level of procalcitonin was given in the area under curve (AUC) 0.96 with Confidence Interval 0.923-1.00 (p < 0.05). The Procalcitonin cut of point was 1.46 ng/mL with a sensitivity of 90.5%, specificity of 89.8%, PPV of 79.2%, NPV of 95.7%, and accuracy of 90.0%. Conclusion: Plasma Procalcitonin 1.46 ng/mL is a good predictor for early diagnosis sepsis toward polytrauma patients.

ObjectiveThis study was performed to determine the cut-off point of the Functional Independence Measure (FIM) to discriminate patients with acute stroke who develop adverse events during their stay in a stroke care unit (SCU).MethodsAll consecutive patients with stroke admitted to a single institute from January to March 2015 were enrolled. They were divided into two groups according to their average daily energy intake in the SCU: ≥66% or ResultsThe length of stay in the SCU was significantly longer and the serum C-reactive protein level (CRP) was significantly higher in the low- than high-energy group (7 vs. 4 days and 2.15 vs. 0.20 mg/dL, respectively). The total FIM score cut-off value was 63 points.ConclusionsAn energy intake of

The MetS (metabolic syndrome) is one of the main risk factors for cardiovascular disease and obesity is one of the major markers of its progression. The aim of this study was to know the comparative differences of waist circumference while predicting the relevant optimal cut-off in Turkman and non-Turkman people in the north of Iran. In our study 248 subjects aged 25-70 years have been chosen from 25 clusters with 10 cases. ATP-III method was used for diagnosis of MetS. The optimal cut-off and the corresponding sensitivity and specificity for age have estimated in the threshold that maximizes the sum of sensitivity and specificity or equivalently maximizes in ROC (receiver operating characteristic) curve operating points. The statistical differences were significant between Turkman and non-Turkman groups in almost all the parameters such as HDLc, LDLc, cholesterol, TG, and FBS. In non-Turkman group, the association between WC and TG, LDLc and FBS showed a positive relationship but it was negative with HDLc. The association between WC and cholesterol level was not significant. The cut-off values of WC for hyper TG, HDLc low and diabetes was respectively higher 6.0, 7.25 and 8.25 cm in non-Turkman group than in Turkman group, however; based on hypercholesterolemia and LDLc it was lower in non-Turkman than in Turkman group. The differences in the above parameters while comparing separately between male and females is also found interesting. Conclusively, the gene has a protective role based on the cholesterol in Turkman people.

The Metabolic syndrome (MetS ) is one of the main risk factor for cardiovascular disease and the aim of this study was to compare the discriminative capacity of age in a prediction of non-adipose components and to determine its relevant optimal cut-off in Turkman and non-Turkman residents of the northern part of Iran. This study has been conducted on the 248 subjects of 25-70 years age. ATP-III method was used for diagnosis of MetS. The optimal cut-off, the corresponding sensitivity and specificity for age have estimated in the threshold that maximizes the sum of sensitivity and specificity or equivalently maximizes in ROC curve operating points. Finally, the prevalence of MetS was evidenced in 37.6% of subjects and significantly was 14.7% more in non-Turkman than in Turkman group. Compared with Turkman group, the means of fasting plasma glucose, Triglycerides, WC and diastolic blood pressure (DBP) were statistical significantly more in non-Turkman group, respectively. Age cut-off values for predicting of MetS was 33.5 years in Turkman, 50.5 years in non-Turkman and 42.5 years in total of subjects. The AUCs (Area Under Curve) ranged from 0.546 in Turkman group to 0.726 for the non-Turkman group.

Background: Using morphologic features of the bones is the basis of gender determination in anthropology and forensic medicine. In this study, we evaluated the calcaneus diameters for gender determination in the Iranian population. Methods: This cross-sectional study was conducted on Iranians referring to Hazrat-e Rasool Hospital's radiology ward for plain lateral X-ray of the foot. Lateral foot X-rays from 100 men and 100 women were gathered and evaluated for calcaneal indexes. These patients aged between 18 and 80 years old who did not suffer major trauma to the calcaneus bone were recruited. Using a picture archiving and communication system (PACS), four variables were calculated for each X-ray graph: Maximum anterior-posterior length of the calcaneus (MAXL), Maximum height of the bone (MAXH), Height of the cuboid facet (CFH) and Height the calcaneal body (BH). Cut off points for each index were calculated using the area under curve (AUC) in ROC curves. Results: Lateral foot X-rays from 100 men and 100 women were gathered and evaluated for calcaneal indexes. The means of the four indexes were compared between the sexes which showed all four means are significantly different p value

Background: Pulmonary vascular resistance (PVR) plays an important role in the natural history, prognosis, and outcome after valve intervention in patients with mitral stenosis (MS). The existing formula to estimate PVR by means of echocardiography is not readily applicable in the MS patient subset because it does not specifically calculate the risk of PVR in MS. The aim of this study was to find a new echocardiography formula to estimate PVR in MS.Methods: This diagnostic study was conducted in 2 stages. In the first stage, 58 consecutive subjects with MS were studied to find some model formulas for estimating PVR by multiple regression. Eight echo parameters were analyzed to seek their correlation with the invasive PVR value as a gold standard. The formula that had the best correlation and was easiest to use would be selected. In the second stage, those model formulas were validated by applying them to a further 34 consecutive MS subjects.Results: Four formulas which gave a discriminator coefficient of r2 0.62–0.68 were derived. The best model formula was proposed for further application. The new selected formula PVR=-7.465+3.566 TRvmax –(0.23 TVs’)+6.799 (RV-MPI) showed good correlation (r=0.71, p

Introduction: In India alone in year 2000 there were 30 million people to suffered with Coronary Heart Diseases (CHD). CHD has 3% prevalence and incidence of Heart failure with CHD is about 0.4% to 2.3% per year. There are many traditional and nontraditional risk factors that are associated with cardiovascular diseases (CVD). Atherosclerosis is not only a lipid disorder but it is the process of active communication between endothelial dysfunction, sub-endothelial inflammation and wound healing process of vascular smooth muscle cells. Inflammation leading to atherosclerosis results in a CAD where innate and adaptive immune systems play a major role. Interleukin-1 (IL-1) also has a major role in the development of atherosclerotic CAD by promoting atherogenesis. Aim: To determine serum IL-1β levels for detecting CVD patients from Western Maharashtra population. Materials and Methods: We recruited 229 cases of CVDs (16 cases of complete heart block, one case of congenital heart disease, 22 cases of heart failure, 169 cases of myocardial infarction, one case of myocarditis and 20 cases of rheumatic heart disease) who were enrolled at Cardiology and Medicine Department of Lokamanya Tilak Municipal General Hospital, Sion, Mumbai along with 229 age and sex matched healthy controls were included in this case control study. Serum IL-1β was measured with commercially available ELISA kit. Cut-off level for estimation of IL-1β was done with Receiver Operative Curve (ROC) analysis. Statistical analysis was carried out using SPSS version 16.0 and Microsoft Excel 2007. Results: The median and Inter Quartile Range (IQR) level of IL-1β in CVD group was significantly higher than control group (p-value

The purpose of this study was to provide the estimated percentile curves of occlusal pairs (OPs) in adults for use in oral health instruction. Data on number of present teeth (PT) were obtained from the National Report on the Survey of Dental Disease in 2005. Data from 1,535 males and 2,248 females, ranging in age from 18 to 82, were analysed. The mean number of OPs were used from our previous report. In that report we can be estimated OPs from the number of PT. In this study, PT data were replaced by the mean number of OPs. Estimated percentile curves in males, the 10th percentile of OPs was 13.7 at 60 years of age and 12.5 at 70. The 50th percentile of OPs was 12.2 at 50 years of age, 11.2 at 60 and 5.4 at 70. The 90th percentile of OPs was 7.6 at 50 years of age, 2.1 at 60 and 0 at 70. There appeared to be a cut off point after 10 OPs where the 50th to 97th percentile curves of OPs dropped off rapidly. In females, the 10th percentile of OPs was 13.4 at 60 years of age and 12.7 at 70. The 50th percentile of OPs was 11.5 at 50 years of age, 10.2 at 60 and 6.2 at 70. The 90th percentile of OPs was 7.1 at 50 years of age, 2.4 at 60 and 0 at 70. In females again the percentile curves dropped off after 10 OPs. Our results suggest that the loss of OPs may be accelerated when the number of OPs drops below 10. This means that patients need at least 10 OPs in order to maintain a stable oral status. The estimated percentile curves given in this study should be made available for use in adult oral health education.

Background Rapid increasing of high body mass index (BMI) is a global health concern. Population with high BMI predicts an increased risk of diabetes and hypertension. The objective of the present study is to estimate the trend and prediction of diabetes and hypertension in Bangladesh, to examine the association of BMI with risk of diabetes and hypertension, and to ascertain an appropriate BMI cut-off point for screening diabetes. Methods We searched PubMed from inception to August 2016 and identified studies reporting diabetes and hypertension prevalence in Bangladesh. Bangladesh Demographic and Health Survey 2011 data was also included in this study. Bayesian model was used to estimate trend and projection in diabetes and hypertension prevalence by sex and residence. Receiver operating characteristic curves was used to determine the optimal BMI cut-off point for screening diabetes. Findings Of 535 articles reviewed, 35 studies reported prevalence of diabetes and hypertension. Prevalence of diabetes (95% credible interval) increased between 1992 and 2015 from 3.2% (2.2–4.3) to 12.1% (9.1–15.4) in men, and from 2.5% (1.8–3.5) to 13.4% (9.7–17.6) in women. Diabetes prevalence in 2030 is expected to reach 23.6% (13.6–36.3) for men and 33.5% (19.9–50.9) for women. Hypertension prevalence increased between 1992 and 2015 from 11.0% (8.6–13.7) to 20.4% (18.4–22.4%) in 2015 in men, and from 14.0% (10.3–19.0) to 21.3% (19.0–23.6) in women. Annual average rate of change for diabetes prevalence was higher among women and in rural areas, while for hypertension prevalence it was higher in men and urban areas. Adults with BMI of 22.5 kg/m2 or above had a higher risk of diabetes and hypertension in this study. The optimal BMI cut-off point for screening diabetes was 23 kg/m2 for overall population, 22 kg/m2 for men, and 23 kg/m2 for women. Interpretation Diabetes is more prevalent among women and rural population groups, while hypertension is more prevalent among men and urban population groups in Bangladesh. A BMI of 22.5 kg/m2 or more is risk factors for developing diabetes and hypertension. Screening for diabetes may be considered for all Bangladeshi adults with a BMI of ⩾23 kg/m2.

We have recently established a ‘health-associated’ reference interval of homeostasis model assessment of insulin resistance (HOMA-IR) between 0.4 and 2.4. In the present study, the aim was to establish a ‘decision-based’ limit of HOMA-IR for the discrimination of metabolic syndrome (MetS) in non-diabetic Japanese subjects. The receiver–operating characteristic curve of HOMA-IR for detecting MetS was developed using data from 6868 non-diabetic subjects (3727 men, 3141 women). The optimal cut-off point was determined based on the point that yielded the minimum value of the square root of [(1 – sensitivity)2 + (1 – specificity)2]. HOMA-IR = 1.7 was determined as the optimal cut-off value, with a sensitivity and specificity of 73.4% and 70.5% for men, and 81.5% and 77.0% for women, respectively. In conclusion, the optimal cut-off value for HOMA-IR to discriminate MetS in non-diabetic Japanese subjects appears to be 1.7. (J Diabetes Invest, doi: 10.1111/j.2040-1124.2012.00194.x, 2012)

Acute mountain sickness (AMS) is common on ascent to high altitude, with self assessment being the current method used to assess symptoms. The Lake Louise Self-Report Score (LLSRS) and the Environmental Symptoms Questionnaire (ESQ) are widely used and validated. A Visual Analogue Scale (VAS) may be used as a simpler alternative for AMS assessment. Our aims were to compare a VAS using lines of length 100 mm, for both individual symptoms of AMS and self-assessed overall AMS with both LLSRS and a shortened Environmental Symptoms Questionnaire (ESQc) on ascent to 4392 m. We set out to suggest a specific score as a cut off point for diagnosis of AMS when using the VAS. There were significant positive correlations (p

Aim and objective. To assess the accuracy of a reduced Breastfeeding Assessment Score in a group of Italian women; the reducedBreastfeeding Assessment Score considers only five of the eight original Breastfeeding Assessment Score items studied, those notindicating a pathology.Background. The World Health Organization recommends exclusive breastfeeding for the first 6 months of life because of itsmany benefits. A prognostic approach that identifies mothers at increased risk of early breastfeeding cessation is needed toprovide preventive support. The Breastfeeding Assessment Score is useful to this approach.Design. This is a descriptive, prospective study. This study involves two Italian hospitals.Method. We included healthy Italian mothers who gave birth from 7 July 2008–15 January 2009. The exclusion criteria on theconvenience sample were: non-Italian nationality, birth under 36 weeks and twin birth. The authors calculated a reducedBreastfeeding Assessment Score (‘reduced’ because the original eight items studied by Hall, were reduced to five) 48 hours afterbirth. After 4 weeks a structured follow-up telephone interview was carried out: the primary outcome was breastfeedingcessation.Results. We recruited 386 women, with six lost during follow-up. Out of 380 women, 127 (33AE4%) stopped breastfeeding.With a cut off point of 8, the reduced Breastfeeding Assessment Score sensitivity was 52AE0%, which increased to 77AE9% by usinga cut-off point of 9. We also calculated a modified Breastfeeding Assessment Score with different age categories, which isadequate based on the Italian situation: in this case sensitivity was 70AE1%. This study suggests that a reduced BreastfeedingAssessment Score with a different cut-off point or modified with a different age classification is useful in identifying Italianmothers who will discontinue breastfeeding, as in both cases sensitivity does increase.Relevance to clinical practice. Italian midwives could use this modified Breastfeeding Assessment Score to identify mothers atincreased risk of early breastfeeding cessation.Key words: Breastfeeding Assessment Score, breastfeeding cessation, breastfeeding support, midwifery, nurses, nursing

Aim In this study we evaluated the concordance between vFXM and aFXM using SAB and a predetermined cut off point that has been established in our laboratory. Methods AXM: 773 crossmatches performed by FCXM were retrospectively analyzed. The cut off for T &B are 64, 100 respectively. This includes 573 crossmatches performed using PB/ or spleen deceased donor cells with potential recipients & 200 consecutive final crossmatches performed for living transplantation. VXM: Donor HLA- antigens were compared against the potential recipient’s antibody specificities. Prediction of vFXM was based on antibody identification using SAB. Normalized MFI values of 3000 were used to identify antibodies predicted to cause a positive FCXM for A, B, DR &5000 for HLA-C and DQ specificities when present as single antibody. A sum of multiple weak antibodies (MFI ⩽ 2000) that yield MFI of ⩾3000 was used to predict positivity. Results Only positive FCXM positive for B or B & T simultaneously are considered. The vast majority of aFXM were in concordance with vFXM with an overall concordance of 97%. Twenty-three predicted to be negative showed positive aFXM, 12 of them had 0% cPRA and 11 were found in patients with multiple non DSA- HLA- antibodies, dilution of these sera revealed weak DSA. Three predicted positive vFXM yield negative aFXM, two of them had allele specific antibodies. (Table 1). Because sera of highly sensitized patients are diluted we rarely deceived by prozone phenomenon. Therefore the only cause of false negative VXM is auto or non HLA- antibodies. Due to the extreme sensitivity of SAB, reporting false positive VXM remains a possibility and will continue to be a limitation for VXM. Conclusions vFXM based on precise characterization of antibody specificities detected by SAB using our cutoff point accurately predicted FXM in the majority of patients and can be used safely to allocate kidney offers without performing physical crossmatches in selected patients. Download : Download high-res image (61KB) Download : Download full-size image

The aim of this study was to establish the cut-off point of ultrasound (US) B-lines number for detecting the presence of significant interstitial lung disease (ILD) in patients with systemic sclerosis (SSc) (SSc-ILD) in relation to high-resolution computed tomography (HRCT) findings.Consecut

Metabolic syndrome (MetS) has been redefined by a new criterion in Japan, in which waist circumference cut-off points, that is 85 cm for men and 90 cm for women, are used; however, objections are rising against this criterion. The present study examined the criterion for waist circumference to predict the accumulation of the components of MetS. In the present study, we used data for 5972 Japanese people who received annual health examinations, and 621 men (16.3%) and 51 women (2.4%) were diagnosed as having MetS. A cut-off point as a predictor for two or more components of MetS was evaluated by the sensitivity/specificity and a receiver operating characteristic analysis. The optimal point of waist circumference was estimated as being approximately 84 cm for men and 80 cm for women. We therefore recommend revising the cut-off value for the criterion of MetS in women according to our results and studies from other investigators. (J Diabetes Invest, doi: 10.1111/j.2040-1124.2010.00020.x, 2010)

In order to elucidate possible differences of reference intervals in various populations, serum basal thyrotropin (TSH) was measured in euthyroid healthy volunteers (N = 170), in thyroid out-patients (N = 215), in geriatric (N = 354) and in seriously ill (N = 32) patients. The results, except in the healthy control subjects, were compared to the TSH responses (delta TSH) in the Thyrotropin Releasing Hormone test. Normal ranges calculated from the basal TSH of the euthyroid groups of different age were similar. There was a significant positive correlation of basal to delta TSH in all groups but the regression equations expressing the qualitative connection of basal and delta TSH were rather different. The basal TSH cut off point predicting a positive TRH-test (i.e. euthyroidism) with more than 95% probability was higher in the geriatric groups (greater than 0.7 mU/l versus greater than 0.4 mU/l in the other groups). In thyroid out-patients and geriatric patients a measurable (greater than 0.1 mU/l) basal TSH indicated measurable delta TSH (thus excluding clinical hyperthyroidism), while in seriously ill patients only a basal TSH greater than 0.2 mU/l was reliably predictive in this respect. Thus, various populations have different reference intervals for TSH. This fact must be considered when the sensitive TSH is used in different populations as the primary screening parameter for thyroid dysfunctions.

Objectives To review the literature on the experimental, physiological and clinical effects of blood purification with high cut-off (HCO) point membranes in septic acute renal failure (ARF). Study Design MEDLINE and PubMed database search combining relevant terms and integrating data from studies on the use of HCO membranes. Setting and Population Ex vivo studies of endotoxemia, animal studies of bacteremia and clinical studies using HCO membranes in patients with septic ARF. Selection Criteria for Studies: Original data from primary publications. Interventions: HCO membrane-based hemodialysis, hemodiafiltration or hemofiltration. Outcomes: Plasma cytokine clearance, immunological and physiological effects and safety parameters of HCO membranes. Results HCO membranes effectively remove cytokines from blood. Treatment using HCO membranes has beneficial effects on immune cell function and increases survival in animal models of sepsis. Preliminary clinical studies show that HCO membranes decrease plasma cytokine levels and the need for vasopressor therapy. HCO membrane-based blood purification has now been applied in four pilot randomized controlled studies of 70 patients with septic ARF with no reports of serious adverse effects. Limitations Because of substantial heterogeneity, no formal quantitative analysis could be performed. Conclusions The available evidence on HCO blood purification justifies larger randomized controlled trials in patients with septic ARF.

AIM: To determine whether a shortened13C urea breath test (13C UBT) (breath collection time of 10 min) is as reliable as the standard assay (30 min).METHODS: Two hundred ninety-seven patients (mean ± SD: 53±16 years, 57% female) completed a13C UBT. Breath samples were obtained at baseline and at 5 min intervals up to 30 min. Sixty-seven patients also underwent endoscopic biopsy. Cluster analysis was performed on the13C UBT data to determine the optimal cut-off point at each time interval. Sensitivity and specificity of the13C UBT at all intervals compared with histology and culture and against the standard 30 min interval were determined.RESULTS: The calculated optimal cut-off points for each time interval (T), expressed as delta over baseline (δ‰), were 3.29 δ‰ at T5, 3.15 δ‰ at T10, 3.42 δ‰ at T15, 3.17 δ‰ at T20, 2.99 δ‰ at T25and 2.82 δ ‰ at T30. Except at T5, the risk of false-positive and false-negative test results at each time interval was lower than 2.3% using these cut-off points. When replacing the cut-off points with 3.0 δ‰, the risk of error was still lower than 2.3%. The test at T10showed 98.6% sensitivity and 98.6% specificity compared with T30. T10and T30showed 100% sensitivity and 96% specificity compared with histology and culture.CONCLUSIONS: The13C UBT is an accurate, noninvasive test, even when the breath sample interval is reduced to 10 min. The present study confirms the validity of a cut-off point of 3.0 δ‰ for the 10 min and 30 min13C UBT.

Background: physical mobility testing is an essential component of the geriatric assessment. The timed up and go test measures basic mobility skills including a sequence of functional manoeuvres used in everyday life. Objectives: to create a practical cut-off value to indicate normal versus below normal timed up and go test performance by comparing test performance of community-dwelling and institutionalised elderly women. Setting and participants: 413 community-dwelling and 78 institutionalised mobile elderly women (age range 65–85 years) were enrolled in a cross-sectional study. Measurements: timed up and go test duration, residential and mobility status, age, height, weight and body mass index were documented. Results: 92% of community-dwelling elderly women performed the timed up and go test in less than 12 seconds and all community-dwelling women had times below 20 seconds. In contrast only 9% of institutionalised elderly women performed the timed up and go test in less than 12 seconds, 42% were below 20 seconds, 32% had results between 20 and 30 seconds and 26% were above 30 seconds. The 10 th –90 th percentiles for timed up and go test performance were 6.0–11.2 seconds for community-dwelling and 12.7–50.1 seconds for institutionalised elderly women. When stratifying participants according to mobility status, the timed up and go test duration increased significantly with decreasing mobility (Kruskall-Wallis-test: p-0.0001). Linear regression modelling identified residential status (p-0.0001) and physical mobility status (p-0.0001) as significant predictors of timed up and go performance. This model predicted 54% of total variation of timed up and go test performance. Conclusion: residential and mobility status were identified as the strongest predictors of timed up and go test performance. We recommend the timed up and go test as a screening tool to determine whether an in-depth mobility assessment and early intervention, such as prescription of a walking aid, home visit or physiotherapy, is necessary. Community-dwelling elderly women between 65 and 85 years of age should be able to perform the timed up and go test in 12 seconds or less.

Complete or partial failure of passive transfer (FPT) of immunoglobulins in the neonatal calf can result in an increased susceptibility to disease, a higher risk of mortality and decreased growth rates (Robison and others 1988, Tyler and others 1998, Tyler and others 1999, Waldner and others 2009, Furman-Fratczat and others 2011). It is therefore critical to the survival and successful rearing of a calf that adequate passive transfer is achieved. Determining the amount of immunoglobulins a neonatal calf has received is a useful measure for veterinary surgeons and farmers to allow monitoring and standard setting for calf health and husbandry. Immunoglobulins may be measured directly by means of a radial immunodiffusion assay (Mancini and others 1965), and although this test is the industry gold standard, it is laboratory based, requiring a minimum of 24 hours to be performed and, thus, is not applicable to routine on-farm monitoring of adequacy of passive transfer. Measuring serum total proteins by hand-held refractometry offers a convenient, simple, rapid and inexpensive on-farm tool by which farmers and veterinary …

Universitat de Barcelona, SpainAbstract. The question of which cut-off point would be more appropriate in the selectionof sub-clinical obsessive-compulsive (OC) samples is an important methodological issue thathas not been formally addressed, hence prompting the current study. Three groups of sub-clinical OC subjects, scoring 1, 1.5, and 2 standard deviations (SD) above the mean on thePadua Inventory, and a matched non-OC control group, were compared on various clinicaland personality measures. As expected, the three sub-clinical groups had higher scores thanthe non-OC group on measures of OC symptoms (including obsessional slowness), depres-sion, anxiety, and on personality measures of neuroticism, psychoticism, and obsessionaltraits. However, no significant differences were observed between the three sub-clinicalgroups on most measures, although the 2 SD group had higher scores on neuroticism andobsessional personality traits. It is concluded that a wide range of selection criteria can yieldsimilar results that are interpretable within the current theoretical models of Obsessive-Compulsive Disorder (OCD). It is suggested that subjects with a diagnosis of OCD shouldbe carefully excluded from sub-clinical studies. [A Spanish abstract follows the references.]Keywords: Obsessive-Compulsive Disorder, sub-clinical, non-clinical, selection criteria.

Objectives. To evaluate the performance of the difference between observed and predicted length of stay (OLOS‐PLOS) as an inefficiency of care indicator for inpatients. Setting. The Internal Medicine and the General Surgery departments of Hermanos Ameijeiras Hospital in Havana. Design and study participants. Two sets of clinical histories were needed for each department: one for deriving the predictive equation and another to validate it. The equation was a linear multiple regression model which included variables recognized as affecting length of stay. The validation group of histories was thoroughly examined and separated into two groups: (i) adequate efficiency or mild problems and (ii) inefficiencies considered to be moderate or severe. This classification was the gold standard to obtain a receiver operating characteristic (ROC) curve for the indicator. Results. The function explained 41% of the total variation for Internal Medicine and 70% for General Surgery. The indicator’s mean difference between the two validation groups of histories was around 10 days for both departments. The areas under the ROC curve were 0.80 for Internal Medicine and 0.88 for General Surgery. Sensitivity and specificity > 0.7 for detecting inefficiencies of care are achieved with a cut off point of 2 days for Internal Medicine and 1 day for General Surgery. Conclusions. The use of predictive equations might be quite useful for detecting efficiency problems in inpatient health care.

The definitive version is available at www.blackwell-synergy.com., Article, PSYCHIATRY AND CLINICAL NEUROSCIENCES. 62(1): 120-122 (2008)

1. The occurrence of the pale, soft exudative (PSE) problem in broiler breast meat was monitored in 700 birds (random samples from 7 flocks). A rapid method of colour measurement was used in the plant to assess the colour of skinless pectoralis muscles at 24 h post mortem. In addition, 10 selected samples from each flock were further evaluated for pH, water holding, cook loss, and texture. 2. The average L* value (lightness) was 47.1 with a variance of 5.38, skewness 0.33 and kurtosis 0.66. Minimum and maximum L* values recorded during the study were 35.3 and 55.5 respectively. 3. Correlations between colour and most of the physical measurements were observed, suggesting that a rapid colour measurement method could be used to recognise PSE meat or identify flocks with a high incidence of PSE. 4. Breast muscle samples with L* > 49 showed poor water holding capacity, which indicated that these samples would be classified as PSE meat. Using this criterion it was shown that the occurrence of PSE ranged from 0% to 28%. However, the precise cut off point for PSE muscle should be determined by each processor depending on final product requirements.

Background. Obesity is associated with increased morbidity and premature death. Obesity rates have increased worldwide and the WHO recommends monitoring. A steep rise in body mass index (BMI), a measure of adiposity, was detected in Greenland from 1963 to 1998. Interestingly, the BMI starting point was in the overweight range. This is not conceivable in a disease-free, physically active, pre-western hunter population. Objective. This led us to reconsider the cut-off point for overweight among Inuit in Greenland. Design and findings. We found 3 different approaches to defining the cut-off point of high BMI in Inuit. First, the contribution to the height by the torso compared to the legs is relatively high. This causes relatively more kilograms per centimetre of height that increases the BMI by approximately 10% compared to Caucasian whites. Second, defining the cut-off by the upper 90-percentile of BMI from height and weight in healthy young Inuit surveyed in 1963 estimated the cut-off point to be around 10% higher compared to Caucasians. Third, if similar LDL-cholesterol and triglycerides are assumed for a certain BMI in Caucasians, the corresponding BMI in Inuit in both Greenland and Canada is around 10% higher. However, genetic admixture of Greenland Inuit and Caucasian Danes will influence this difference and hamper a clear distinction with time. Conclusion. Defining overweight according to the WHO cut-off of a BMI above 25 kg/m2 in Greenland Inuit may overestimate the number of individuals with elevated BMI. Keywords: BMI; cut-off point; overweight; obesity; Greenland Inuit; ethnicity; review (Published: 5 August 2013) This paper is part of Supplement 1, 2013, ICCH15 Proceedings . More papers from this Supplement can be found here . Citation: Int J Circumpolar Health 2013, 72: 21086 - http://dx.doi.org/10.3402/ijch.v72i0.21086

Aims and objectives To examine the cut-off point of the osteoporosis self-assessment tool, age, weight and body mass index for osteoporosis among young adult Taiwanese women, using a large-scale health examination database containing bone mineral density tests. Background The cut-off points of osteoporosis risk factors identified earlier focus on menopausal or senior Caucasian and Asian women. However, young adult Asian women have seldom been identified. Design A retrospective historical cohort study. Methods Using the 2009–2011 health examination database of a large-scale medical centre in northern Taiwan, this study investigated young adult Asian women (i.e. range in age from 30–49 years) in Taiwan who had received dual-energy X-ray absorptiometry test. This study also explored the cut-off point, sensitivity, specificity and diagnostic accuracy of receiver operating characteristics of osteoporosis among young adult females in Taiwan. Results This study collected 2454 young adult Asian women in Taiwan. Cochran–Armitage analysis results indicated that the prevalence of osteoporosis increased with decreasing weight, body mass index and osteoporosis self-assessment method quartiles. According to the results of receiver operating characteristics, weight, body mass index and osteoporosis self-assessment tool approaches can generally be used as indicators to predict osteoporosis among young adult Asian women. Conclusions Results of this study demonstrate that Taiwanese women contracting osteoporosis tend to be young and underweight, as well as having a low body mass index and osteoporosis self-assessment scores. Those results further suggest that the assessment indicators for cut-off points are appropriately suitable for young adult women in Taiwan. Relevance to clinical practice Early detection is the only available means of preventing osteoporosis. Professional nurses should apply convenient and accurate assessment procedures to help young adult women to adopt preventive strategies against osteoporosis early, thus eliminating the probability of osteoporotic fracture.

Objective To determine whether there is a relation between aortic diameter and morbidity and mortality in men screened for abdominal aortic aneurysm. Design Prospective cohort study. Setting Highland and Western Isles (a large, sparsely populated area of Scotland). Participants 8146 men aged 65-74. Main outcome measures Morbidity and mortality in relation to presence of abdominal aortic aneurysm and three categories of aortic diameter (≤24 mm, 25-29 mm, and ≥30 mm). Results When screened, 414 men (5.1%) had an aneurysm (diameter ≥30 mm), 669 (8.2%) an aortic diameter of 25-29 mm, and 7063 (86.7%) an aortic diameter of ≤24 mm. The cohort was followed up for a median of 7.4 (interquartile range 6.9-8.2) years. Mortality was significantly associated with aortic diameter: 512 (7.2%) men in the ≤24 mm group died compared with 69 (10.3%) in the 25-29 mm group and 73 (17.6%) in the ≥30 mm group. The mortality risk in men with an aneurysm or with an aorta measuring 25-29 mm was significantly higher than in men with an aorta of ≤24 mm. The increased mortality risk in the 25-29 mm group was reduced when taking confounders such as smoking and known heart disease into account. After adjustment, compared with men with an aortic diameter of ≤24 mm, the risk of hospital admission for cardiovascular disease and chronic obstructive pulmonary disease was significantly higher in men with aneurysm and those with aortas measuring 25-29 mm. Men with an aneurysm also had an increased risk of hospital admission for cerebrovascular disease, atherosclerosis, peripheral arterial disease, and respiratory disease. In men with aortas measuring 25-29 mm, the risk of hospital admission with abdominal aortic aneurysm was significantly higher than in men with an aorta of ≤24 mm (adjusted hazard ratio 6.7, 99% confidence interval 3.4 to 13.2) and this increased risk became apparent two years after screening. Conclusions Men with abdominal aortic aneurysm and those with aortic diameters measuring 25-29 mm have an increased risk of mortality and subsequent hospital admissions compared with men with an aorta diameter of ≤24 mm. Consideration should be given to control of risk factors and to rescreening men with aortas measuring 25-29 mm at index scanning.

A 4-year prospective study on the natural history of IGT in South African Indians has allowed for the evaluation of the WHO and NDDG criteria for IGT, using the five groups for non-diabetic glucose tolerance recently recommended and relating these to the risk of diabetes development. Using WHO criteria, 128 subjects were classed IGT in a base-line survey (Year 0). The five recommended categories were applied to the OGTTs done between Year 1 and Year 4 of the study, when mid-test plasma (MPG) samples were also obtained. These categories included N-N (Normal by WHO and NDDG); N-ND1 (Normal by WHO, non-diagnostic level 1 by NDDG); N-ND2 (Normal by WHO, non-diagnostic level 2 by NDDG); I-ND3 (IGT by WHO, non-diagnostic level 3 by NDDG) and I-I (IGT by WHO and NDDG). The risk of diabetes development and the significance of the non-diagnostic category were evaluated by comparing the glucose tolerance status at Year 4 with the status at Year 1. In the cross-sectional evaluation at Year 1, of the 87 non-diabetic OGTTs analysed, 31% (n = 27) were classified I-I, 34.5% (n = 30) were classed N-N and 34.5% (n = 30) were classified non-diagnostic [I-ND3 (23.1%); N-ND2 (8%); N-ND1 (3.4%)]. In the prospective analysis, of the 72 subjects who completed the study, 16 subjects developed NIDDM by Year 4; of these 13 subjects were classed I-I and 3 subjects I-ND3 at Year 1. The rate of diabetes development was highest in the I-I group (61.9%) and was significantly higher when compared with the I-ND3 group (P < 0.01), N-N group (P < 0.0001) and N-ND2 + N-ND1 group (P < 0.01). The risk of diabetes development in the I-ND3 group (15.8%) did not differ significantly from that in the N-N group. The results of this study would suggest that the I-I group, which shows a significant risk of diabetes development, probably represents IGT. It would appear that the non-diagnostic categories (I-ND3, N-ND2 and N-ND1) which possess a lower risk of diabetes development than the I-I group, possibly represent groups whose glucose tolerance behaves more like Normal than IGT. Moreover, the results would support the view that the cut off point for normal fasting plasma glucose (FPG) levels of NDDG might be raised to < 7.8 mM. This study confirms the proposal that further studies relating to the natural history of IGT should include MPG samples in order to evaluate the true status of the NDDG non-diagnostic category.

Background: A reliable early marker is required for diagnosis of cobalamin deficiency. We calculated an appropriate holotranscobalamin (HoloTC) cut-off point for identifying cobalamin deficiency using an immunoenzymatic assay. Methods: Determination of the cut-off threshold and correlation between HoloTC and the other diagnostic parameters routinely used for vitamin B12 deficiency [total vitamin B12 (tB12), folate, homocysteine] were measured in 250 routine blood specimens from 107 men (mean age 59.0±18.8 years) and 143 women (mean age 54.2±23.1 years). The inclusion criterion was serum tB12 concentration ≤221 pmol/L. Results: Analytical performance results agreed with those reported by others. A weak correlation (R=0.42) was found between HoloTC and tB12. A 40 pmol/L cut-off threshold was chosen for HoloTC and the associated sensitivity and specificity was 0.86 and 0.66, respectively. Out of 250 tested samples, 126 showed tB12 concentrations 139–221 pmol/L (gray zone, GZ) and 124 had tB12 concentrations Conclusions: Our results confirmed the analytical reliability of the AxSYM HoloTC assay. The method is adequate for routine use and a cut-off threshold of 40 pmol/L is appropriate for assessing cobalamin deficiency in populations with reduced tB12 values. Clin Chem Lab Med 2010;48:249–53.

OBJETIVO: Analisar, numa ampla amostra, o valor crítico da citrulina que confirma a presença das principais complicações do enxerto: rejeição e infecção. MÉTODOS: Foram coletadas 2135 amostras de citrulina sérica, na forma de gota de sangue seca, de 57 doentes submetidos a transplante de intestino/multivisceral no Jackson Memorial Hospital na Universidade de Miami, de março de 2004 a abril de 2006. Todas as amostras são do pós-operatório três meses em diante, passada a conhecida curva de elevação da citrulina após a recuperação das lesões causadas pela isquemia e reperfusão do pós-transplante. RESULTADOS: Utilizando um valor limite menor que 13 µmoles/L, a sensibilidade da citrulina foi de 96,4% para detectar rejeicão celular aguda (RCA) moderada ou grave. A especificidade para as complicações mais freqüentes, rejeição e infecção foi de 54%-74% nas crianças e 83%-88% nos adultos, e o valor preditivo negativo (VPN) foi > 99%. CONCLUSÃO: A citrulina pode ser utilizada como método não-invasivo para avaliar a evolução do enxerto intestinal após três meses do TI. Os episódios de RCA moderado e grave podem ser afastados quando o valor da citrulina for maior que 13 µmoles/L devido ao alto valor preditivo negativo. OBJECITIVE: A biochemical marker for detection of acute cellular rejection following small intestine transplantation has been sought. Citrulline, a non- protein amino acid synthesized mainly by functioning enterocytes, has been proposed. Trial sensitivity has been reportedly high but with low specificity. Thus, the goal was to determine, in a sufficiently large analysis, the significant value of citrulline level in the post-transplant setting, which would correlate with complications such as rejection and infection. METHODS: Since March, 2004 2,135 dried blood spot (DBS) citrulline samples were obtained from 57 small intestine transplant recipients three months or more after post-transplant, i.e., once the expected period of recovery in the citrulline levels had occurred. RESULTS: Using a 13 µmoles/L cut off point, sensitivity of DBS citrulline for the detection of moderate or severe ACR was extremely high (96.4%). Furthermore, specificity estimates (given the absence of ACR and these particular infections), while controlling for time-to-DBS sample were reasonably high (54%-74% in children and 83%-88% in adults), and the negative predictive value (NPV) was >99%. CONCLUSION: Citrulline is a non-invasive marker to evaluate problems of the intestinal graft after three months post-transplant. Due to the high NPV, a moderate or severe ACR can be ruled out, based exclusively on knowledge of a high value for DBS citrulline.

Objective: To discover the validity indices and establish the most adequate cut off point when using the IPDE questionnaire on a sample of prison inmates. Materials and Methods: A transversal study was carried out on a correlatively selected sample of 100 inmates at two prisons in Madrid. Evaluation instruments, a questionnaire for demographic, prison and toxicological data and a complete interview and IPDE assessment questionnaire (version DSM-IV) were utilised as well as a conditional probability study of the IPDE questionnaire with different cut off points based on the use of the IPDE interview as the “gold standard”. Results: The cut off point of 3 or more non-coincident answers showed low specificity (2.5%) for the presence of one or more personality disorders, and low sensitivity to antisocial (56.7%) and borderline (58.8%) personality disorders. Discusion: The IPDE questionnaire of little use amongst the studied prison population when the habitual reference standards were applied due to the very high number of false positives that were produced. The best validity indices for identifying one or more personality disorders are obtained with a probable cut off point being equal to 4 or more answers that do not coincide with those expected. The IPDE questionnaire was of no great benefit for the inmates in this study because, even when using the habitual cut off point of 3 or more non-coincident questions, sensibility to antisocial and borderline personality disorders, which are the most common PDs amongst the sample group, was found to be low. Key words: Personality Disorders, Personality tests, Validity of Tests, Prisoners

Background : Evaluated serum thyroid-stimulating hormone (TSH), as an early index for diagnosis of neonatal hypothyroidism, indicates insufficient supply of thyroid hormones. Objective : The aim of the study was to estimate the incidence of neonatal hypothyroidism and assessment of iodine deficiency in the eastern part of Iran. Settings and Design : A cross-sectional study was conducted in a pilot screening. Materials and Methods : The measurement of blood TSH spotted on filter paper was performed by ELISA method in 59,436 neonates. TSH value equal to 5 mU/L was considered cut off point. The diagnosis of hypothyroidism in neonates with the blood TSH higher than the cut off point was based on clinical examinations and laboratory tests (serum TSH and T4). Statistical Analysis: The groups were compared using chi-square and ANOVA tests. Results : In our study, the recall rate and incidence of hypothyroidism were 3.6% and 2 per 1000 neonates respectively. Based on the proposal made by WHO/UNICEF/ICCIDD, the results of our study showed a mild iodine deficiency in the area. Conclusions : A comprehensive policy should be developed for control of iodine deficiency and treatment of hypothyroidism in the studied population and neighboring countries.