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Resumen: Introducción: El instrumento utilizado habitualmente para valorar la autoeficacia de la lactancia materna (LM) es la breastfeeding self-efficacy scale-short form (BSES-SF). Este estudio valora la relación entre la puntuación de la BSES-SF y el riesgo de abandono de la lactancia. También se determina el punto de corte en la puntuación de la escala que optimiza la detección de este riesgo desde la atención primaria. Métodos: Análisis secundario de datos del estudio Lactancia y Desarrollo Infantil (LAyDI). Ensayo de cohorte única realizado a través de la red de investigación de pediatras de atención primaria (PAPenRed). Cada especialista reclutó un recién nacido cada mes durante un año. Se siguió la cohorte durante 24 meses. Las madres respondieron la BSES-SF en la primera visita. Se recogieron datos generales de el embarazo y el parto y se valoró la LM (suplementada o exclusiva) hasta los seis meses. Resultados: n = 1.845. El área bajo la curva ROC para la LM exclusiva fue al primer mes de 0,79 (0,77 a 0,82) y al segundo mes de 0,760 (0,734 a 0,786). Para los cuatro y seis meses, así como para cualquier edad en las madres que dan LM suplementada, el área bajo la curva fue menor de 0,75 y su capacidad predictiva no se consideró adecuada. Para una sensibilidad del 80% en la detección de las mujeres en riesgo de abandono de la lactancia, la puntuación de corte fue 58. Conclusiones: Las madres que en atención primaria presenten una puntuación en la BSES-SF por debajo de 58 tienen riesgo de abandono de la LM exclusiva antes de los dos meses. Abstract: Introduction: The most widely used tool for assessing breastfeeding self-efficacy is the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF). This study asses the relationship between the BSES-SF score and the risk of breastfeeding (BF) cessation and determine the cut-off point in the scale score that optimizes detection of this risk in primary health care pediatric consultations. Methods: Secondary data analysis of the LAyDI study. It is a cohort study. It was carried out through a research network of primary care pediatricians (PAPenRed). A newborn was recruited every month for one year by 210 pediatricians. The cohort was followed for 24 months. Mothers responded to the BSES-SF at the first visit. General pregnancy and delivery data were collected and assessed to determine whether breastfeeding was exclusive or supplemented during the first six months. Results: n = 1,845. The area under the ROC curve for the exclusive BF was 0.790 (0.765-0.815) the first month and 0.760 (0.734-0.786) the second month. For four and six months, as well as for any age in mothers who give supplemented BF, the Area Under the Curve was less than 0.75 and its predictive capacity was not considered to be good. For a sensitivity of 80% in detecting mothers at risk of BF cessation with the BSES-SF, the cut-off score was 58. Conclusions: Mothers with a BSES-SF score below 58 points in primary health care, are at risk of early withdrawal of exclusive BF within two months.

BACKGROUND: The Gaze Stabilization Test (GST) identifies vestibulo-ocular reflex (VOR) dysfunction using a decline in target recognition with increasing head velocity, but there is no consensus on target (optotype) size above static visual acuity. OBJECTIVE: To determine the optimal optotype size above static visual acuity to be used during the GST in subjects with unilateral vestibular dysfunction and healthy individuals. METHODS: Eight subjects with unilateral vestibular dysfunction (UVD) and 19 age-matched, healthy control subjects were studied with the standard GST protocol using two optotype sizes, 0.2 and 0.3 logMAR above static visual acuity (ΔlogMAR). Maximal head velocity achieved while maintaining fixation on both optotypes was measured. Sensitivity, specificity and receiver-operator characteristic area under the curve (ROC AUC) analyses were performed to determine the optimal head velocity cut off point for each optotype, based on ability to identify the lesioned side of the UVD group from the control group. RESULTS: There was a significant difference in maximal head velocity between the UVD group and control group using 0.2 ΔlogMAR (p = 0.032) but not 0.3 ΔlogMAR (p = 0.061). While both targets produced similar specificities (90%) for distinguishing normal from subjects with UVD, 0.2 ΔlogMAR targets yielded higher sensitivity (75%) than 0.3 logMAR (63%) and accuracy (86% vs 80%, respectively) in detecting the lesioned side in subjects with UVD versus controls with maximal head velocities≤105 deg/s (p = 0.017). Furthermore, positive likelihood ratios were nearly twice as high when using 0.2 ΔlogMAR targets (+ LR 10) compared to 0.3 ΔlogMAR (+ LR 6.3). CONCLUSION: The 0.2 ΔlogMAR optotype demonstrated significantly superior identification of subjects with UVD, better sensitivity and positive likelihood ratios than 0.3 ΔlogMAR for detection of VOR dysfunction. Using a target size 0.2logMAR above static visual acuity (ΔlogMAR) during GST may yield better detection of VOR dysfunction to serve as a baseline for gaze stabilization rehabilitation therapy.

Objetivo: Establecer la prevalencia de eosinofilia en sangre en adultos con enfermedad pulmonar obstructiva crónica (EPOC) según varios puntos de corte. Métodos: Se realizó un estudio transversal en pacientes con EPOC. La frecuencia de eosinofilia en sangre se determinó a partir de la concentración absoluta (células/µL) y relativa (%) de eosinófilos. Fueron realizados modelos multivariados para identificar factores asociados. Resultados: En 81 pacientes incluidos, la edad promedio fue de 71.9 ± 9.8 años; de los cuales, 46 (57 %) fueron hombres. La prevalencia de eosinofilia para los puntos de corte ≥ 100, ≥ 150, ≥ 200, ≥ 300 y ≥ 400 células/µL fue de 64.2, 43.2, 37.0, 16.1 y 9.9 %, respectivamente. De 81 pacientes, 34 (42 %) tuvieron una concentración ≥ 2 %; 21 (25.9 %) ≥ 3 %; 14 (17.3 %) ≥ 4 %; y 10 (12.3 %) ≥ 5 %. La eosinofilia ≥ 100 células/µL se asoció con la edad ≥ 80 años (RM = 6.04, p = 0.026) y con la exacerbación de la EPOC (RM = 9.40, p = 0.038); en cambio, la eosinofilia ≥ 2 %, lo hizo con solamente la edad ≥ 80 años (RM = 3.73, p = 0.020). Complementariamente, la concentración de eosinófilos ≥ 100 y < 300 células/µL se asoció con la exacerbación de la EPOC (RM = 11.00, p = 0.026). Conclusiones: Nuestros resultados sugieren que la frecuencia de eosinofilia en EPOC muestra variaciones sustanciales según la definición adoptada.

Chile, and several Latin American countries, use the Atalah standard to assess nutritional status during pregnancy. However, this standard (underweight: pre-pregnancy body mass index (BMI)

Background Considering that pulmonary embolism (PE) is one of the leading causes of mortality among pregnant women and that the D-dimer level in pregnancy can be highly fluctuating, a new and reliable D-dimer reference value is essential to identifying PE in this group of patients. Hence, the present study aimed to evaluate the diagnostic effect of D-dimer testing in pregnant women with suspected PE. Methods This study recruited 100 women with confirmed pregnancy or six weeks after delivery or abortion with suspected PE symptoms. Wells criteria, D-dimer values, and pregnancy trimesters were recorded. Definitive PE results were obtained using multidetector computed tomography (MDCT) or pulmonary ventilation/perfusion scans. Results D-dimer cut-off point in PE diagnosis was higher than 1,447 µg/L [sensitivity, 87.5%; specificity, 63.04%; area under the curve (AUC)=0.735; P =0.003]. In addition, the combination of Wells criteria with the D-dimer test indicated that the cut-off points of D-dimer in PE likely and unlikely women were 1,962 and 1,447 µg/L, respectively, and had acceptable and significant diagnostic value in PE detection. In addition, the diagnostic value of D-dimer in pregnancy trimesters was not found to be significant (P ＞0.05). Conclusion The new cut-off points of 1,447 and 1,962 µg/L were determined for D-dimer in pregnant women with likely and unlikely PE, respectively. Moreover, the new cut-off points in the first and second trimesters of pregnancy were 1,701 µg/L and 1,451 µg/L, respectively, which indicated no statistically acceptable diagnostic value.

Throughout the brief history of proprietary estoppel, it has been rare to find a case where it was argued that the promisor passed away before the promisee suffers sufficient detriment. Rarer still, to find this promise made jointly by co-owners as tenants-in-common of a property. In Cheung Lai Mui v Cheung Wai Shing [2021], the Hong Kong Court of Final Appeal found the “cut-off” point for assessing detriment in such a case to be the death of the last surviving co-owner—but why should it be? This article explores the theoretical interactions between proprietary estoppel, unconscionability and co-ownership in seeking to answer this question.

OBJECTIVE This study identified when musculoskeletal pain (MSP) in the upper extremities indicates lowered work performance to gauge when secondary prevention of musculoskeletal disorders is needed. METHODS Seven hundred thirty-three subjects from 12 manufacturing or healthcare facilities in Washington state participated. Work performance was measured by the Disabilities of the Arm, Shoulder and Hand work module (DASH-Work). Each DASH-Work score was compared to the mean among U.S. workers to determine if workers had lowered work performance. ROC curve analysis was conducted to find the cut-off in a composite MSP index (summing MSP intensities in shoulders, elbows/forearms, and hands/wrists; range 0 to 24) to detect lowered work performance. RESULTS The MSP index score of 2 achieved the best balance between sensitivity (0.79) and specificity (0.69) in detecting lowered work performance. CONCLUSIONS To prevent reduced work performance, moderate or multisite pain may require proper management.

Background: Nephrolithiasis is a major worldwide source of morbidity, constituting a common urological disease affect-ing 10-15% of the world population. Aim of Study: To compare the S.T.O.N.E versus sResc scoring system in prediction of the surgical outcome as regards stone free rate and complication after PCNL. Patients and Methods: A prospective randomized clinical study conducted in Department of Urology, Faculty of Med-icine, Ain Shams University Hospitals. Study period was 6 months from 3-2020 till 9-2020. Results: STONE total score involved size, tract length, degree of obstruction, number of involved calyces and stone density. STONE score was 6.8±1.7. S-ReSC total score was 3.1±1.6. A significant statistical association between both scores was found (c2: 119.681, p 2 with sensitivity 100%, specificity 76.19% and Area Under Curve (AUC) 95% while the best cut off point for STONE score to detect residual free rate was found >6 with sensitivity 70.3%, specificity 68.3% and Area Under Curve (AUC) 76.4%. Conclusion: Both S-ReSC and S.T.O.N.E Nephrolithom-etry Scores can be used to stratify the complexity of renal stone before PCNL to predict the stone clearance and compli-cation.

In this study, we analyzed sarcopenia prevalence and the cut-off points for skeletal muscle mass index (SMI), gait speed, and handgrip strength in young (18-39 years), middle-aged (40-59 years), and elderly (>60 years) individuals (n=1685) from Zhejiang Province in China. The prevalence of sarcopenia among individuals above 65 years was 2.21%, 4.87%, 5.31%, 14.16%, and 16.37% according to five diagnostic criteria (AWGS2019, AWGS2014, EWGSOP1, EWGSOP2, and local standard). The mean SMI (Kg/m2) was 7.961±0.7966, 7.801±0.7276, and 7.544±0.7493, respectively, in young, middle-aged, and elderly males. The mean SMI in young, middle-aged, and elderly females was 6.1570±0.5658, 6.604±0.5658, and 6.248±0.7483, respectively. SMI correlated negatively with age (r=-0.2344, P

espanolEl presente articulo trata sobre las posibilidades de propagacion de ondas superficiales torsionales en un medio viscoelastico bajo campo de gravedad. Durante el estudio,se pudoobservar que el aumento del parametro de gravedad aumenta, a su vez,la velocidad de la onda,mientras que el incrementodel parametro viscoelastico disminuyela velocidad de la onda,hasta que el producto de la frecuencia angular y el parametro viscoelastico sea menor ala unidad. Tambien,se observoque a medida que aumenta la velocidad la curva se vuelve asintotica por naturaleza cuando se incrementael periodo de tiempo de oscilacion. De hecho, la maxima amortiguacion de la velocidad tambien se ha identificado en este punto de corte, que puede considerarse como el punto en el que un material viscoelastico se convierte en un medio viscoso. Se calcularon los coeficientes de absorcion para diferentes valores de parametro viscoelastico y campo de gravedad. El estudio reveloque el medio espacio viscoelastico en ausencia de campo de gravedad no permite ondas superficiales de torsion, mientras que en presencia de campo de gravedad las ondas se propagan y amortiguan. EnglishThe present paper deals with the possibilities of propagation of torsional surface waves in a viscoelastic medium under gravity field. During the study it may observe that the increase in gravity parameter will increase the velocity of the wave whereas theincrease in viscoelastic parameter, decrease the velocity of the wave till the product of angular frequency and viscoelastic parameter is less than unity. It may also observe that as the velocity increases, the curve becomes asymptotic in nature when the time period of oscillation increases. In fact the maximum damping in velocity has also been identified at this cut off point which may be considered as the point where a viscoelastic material becomes a viscous medium. The absorption coefficients have also been calculated for different values of viscoelastic parameter and gravity field. The study may reveals that viscoelastic half space in the absence of gravity field does not allow torsional surface waves whereas in presence of gravity field the waves are propagates and is damped.

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.

Outpatient services hosted by the hospital have never been absent from public visits. In fact, every year an outpatient visitor is always increasing. This research intends to identify potential failure mode that can inhibit of every flow of service in the outpatient care unit using the Failure Mode Effect Analysis (FMEA) method. Qualitative research plan using an observation survey approach and in-depth interviews with the outpatient service head Coordinator conducted in February 2020 on the hospital outpatient unit service process. The results of this study Indicate the potential failure mode that has the value of the RPN above the value of cut off point 180 as many as six out of ten failure modes. Firstly, the check is not on schedule (360), secondly, the patient lags a turn call order Check (270), third, Specific drug failure is not available (245), fourth, general patient protests with the price of the drug (224), fifth, the patient is void to poly (196), the sixth patient registrant online missed sequence number queue (180). Based on the results of the research, hospitals are expected to follow up with the results of this research by conducting a redesign of the process that occurs today using the FMEA to maintain service quality.

Objective To evaluate the outcomes of retrograde intrarenal surgery (RIRS) treatment of calyceal diverticular calculi and identify the associated factors affecting post-operative stone-free rate. Materials and methods From August 2015 to May 2019, data of 32 patients with calyceal diverticular calculi who were treated by RIRS in a Siriraj Hospital were retrospectively studied. All operations were performed by the same surgeon using flexible ureterorenoscopy (f-URS) and holmium YAG laser lithotripsy. Calyceal diverticula were identified by our refluxing technique and from the collected demographic, diverticular and stone data. Operative outcomes were retrospectively evaluated. Data were analysed to identify the factors associated with stone-free outcomes. Stone-free was defined as no residual stones remaining after surgery. Results Mean age of the patients was 55.7 years. Stone locations were non-lower pole in 81.2% of cases and lower pole for the remaining 18.8% of cases. Median stone size was 1.2 cm with three as the median number of stones per patient. Calcium oxalate was the most common stone composition (56.3%). Positions of the diverticulum were anterior calyx (34.4%) and posterior calyx (50%), while the remainder were undetermined (incomplete data). Average length of the diverticular neck was 0.4 cm. Mean operative time was 46 minutes and mean hospital stay was 2.9 days. Complications included fever in three patients (9.3%) and sepsis in two patients (6.3%), with overall post-operative stone-free rate at 75%. Factors significantly affecting stone-free status were stone size (P=0.003) and length of diverticular neck (P=0.038). Multivariate analysis determined that only stone size had a statistically significant effect on post-operative stone-free status (P=0.015). Cut off point for stone size that increased the chances of a post-operative stone-free outcome was less than 1.5 cm, as determined by the ROC curve. Conclusion RIRS was found to be an effective and safe treatment option for the removal of calyceal diverticular calculi. Stone size of less than 1.5 cm offered a better chance of post-operative stone-free condition.

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 The aim of this study is to prospectively determine whether the computed tomography perfusion (CTP) can predict the tumor grade in colorectal cancer (CRC), and investigation of the best position of the tumor region of interest (ROI) could improve the tumor grade differentiation. Results The mean blood flow (mBF) at the tumor edge was significantly different among different tumor grades with the highest value noted in moderately differentiated and the lowest value in poorly differentiated CRC (111.67 ± 38.91 vs. 52.25 ± 21.97 ml/min/100 g, respectively, P = 0.03). At the tumor center, the BF and blood volume (BV) showed highest value in moderately differentiated and the lowest value in poorly differentiated CRC (P < 0.001, 0.02 respectively). The ROC curve revealed that the BF at the tumor edge showed its best results as regard its sensitivity 73.9% and specificity 82.1% in the characterization of moderately differentiated CRC from the other subtypes at > 92.2 ml/100 g/min cut off point and their AUC and P value were (0.82 and P value was 0.03. In the characterization of poorly differentiated CRC from the other subtypes, BF cut off value at P value was . BF was higher at the edge than at the center of the tumor (88.53 ± 22.45 vs. 78.79 ± 28.98 ml/min/100 g; P < 0.001 respectively). Conclusions PCT could help in prediction of the poorly and the moderately differentiated CRC and the mBF was the most reliable parameter in prediction of the grade. The variation in ROI position has no substantial difference in the prediction of the tumor grade; however, this variation has a significant impact on the measurements of the PCT parameters especially the BF.

BACKGROUND: The subject of discussion is the issue of the separation point, which determines sufficient levels of vitamin D for bone health. When determining the adequate reference range of vitamin D, researchers are mainly guided by the results of research, where the level of 25(OH)D is determined, at which the PTH level decreases and reaches a plateau. AIM: To establish the «cut-off point» of vitamin D by suppressing excessive secretion of PTH. MATERIALS AND METHODS: Observational, single-site, single-stage, selective, uncontrolled study of the search for vitamin D levels by the effect on PTH secretion in residents of Tyumen region was conducted (n = 176). All selected study participants determined the level of 25(OH)D and PTH in serum. The calculation of the «cut-off point» was carried out using the method of searching for changes in the correlation dependence of PTH on the level of vitamin D, followed by verification of the data obtained using ROC analysis. RESULTS: A mathematical analysis of the dependence of 25(OH)D and PTH showed the “cut-off point” of vitamin D, equal to – 23.6 ng/ml. CONCLUSION: The “cut-off point” of 23.6 ng/ml is optimal for suppressing excessive PTH secretion. The data obtained may be an incentive for further working out the “cut-off point” of vitamin D for the Russian population and can be used to clarify the classification of deficiency, insufficiency and optimal levels of vitamin D for the population of the Russian Federation.

Introduction: The health-related physical fitness (HRPF) show an inverse association with several cardiovascular risk factors in young people, however, a few studies have investigate the changes of HRF indicators throughout a determined period. Objective: To check the secular trend of HRPF indicators in children of seven to 10 years old. Methods: were analyzed 1.136 subjects with seven to 10 years in three-time period (2002, 2005, 2010-2011). The HRPF tests were: sit-and-reach (SR), abdominal resistance (AB), 9 min walk/run test (9min) and the body adiposity by skinfold sum (?SF). The classification of the HRPF indicators were made by the Physical Best cut off point. The ANCOVA test (controlled by BMI, height, ?SF) compared the difference of the HRPF indicators amongst the three-time period. Results: The boys presented 6% of decrease in the flexibility between 2010 and 2002 period; no significance was found in the AB test; children of both sexes presented higher values in the 9min test on 2005 period. Conclusion: It was concluded that there was a negative secular trend for an HRPF, and gifts were the results in 2010 were compared as their peers (2002-2005) to an HRPF group, in both sexes, except for abdominal strength and endurance.

Background: End stage renal disease patients on regular hemodialysis patients have higher rate of mortality and morbidity compared to the general population. Objective: This study aimed to study the association between neutrophil-to-lymphocytic ratio and other inflammatory markers (IL-6, high sensitive CRP, PLR, etc) in hemodialysis patients. Patients and methods: This study was designed to assess inflammation in hemodialysis patients and study the association between high sensitive CRP (hs-CRP) and the other inflammatory markers in those patients. Initially, forty two patients with end stage renal disease (ESRD), on regular hemodialysis in dialysis unit, Internal Medicine Department, AL-Hussien Hospital, Faculty of Medicine, Al-Azhar University-Egypt. Results: We calculated the cut off point for IL-6 that best indicates the presence of inflammation in hemodialysis patients, we found that it was value more than 30 ng/l with sensitivity 96.6, specificity 69.2%, with AUC: 00.77 and P < 0.004. Moreover, we calculated the cutoff point for PLR that is consistent with presence of inflammation in hemodialysis patients, we found that it was more than 180.2 with sensitivity 82.2%, specificity 92.3% with AUC .087 and p value equals 0.0001. In addition to calculating the cut off point for NLR that best indicates the presence of inflammation, we found that it was ≥1.6 with sensitivity 93.1%, specificity 92.3%, with AUC: 0.92 and P < 0.001. Conclusion: We can assess cardiovascular condition of our hemodialysis patients along with their morbidity and mortality with measuring these inflammatory markers which are nonexpensive and has high sensitivity and specificity.

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.

Background: Delayed intracerebral hemorrhage (DICH) secondary to ventriculoperitoneal (VP) shunt is considered to be a potentially severe event, however, little is known about the risk factors and underlying mechanisms. This study aimed to investigate the association between NLRR (a ratio of postoperative neutrophil-to-lymphocyte ratio to preoperative neutrophil-to-lymphocyte ratio) and DICH secondary to VP shunt.Methods: We performed a retrospective review of patients who underwent VP shunt between January 2016 and June 2020. Multivariable logistic regression analysis was used to assess the association of DICH and NLRR. Then patients were divided into two groups according to the optimal cut-off point of NLRR, propensity score matching (PSM) method was performed to reconfirm the result.Results: A total of 130 patients were enrolled and DICH occurred in 29 patients. Elevated NLRR (odds ratio [OR], 2.774; 95% confidence interval [CI], 1.372-5.609; P2.05 had much higher incidence of DICH (OR, 11.25; 95%CI, 1.35-93.50; p=0.025; PSM cohort, n=82). Conclusions: Our finding suggested that DICH following VP shunt was not a rare complication and elevated NLRR could independently predict DICH. Inflammatory responses might play an important role in the development of DICH following VP shunt.

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.

Introduction: Six-minute walk test has been a recommended valid and reliable tool used for functional capacity assessment. American Thoracic Society (ATS) had stated that there are no global standards in interpreting 6-minute walking distance (6MWD) as a one-time measurement of functional assessment, which may be caused by population differences and various 6MWT technique utilized in previous studies. Single time cut off is required to evaluate functional status at the start of a program as a baseline for further follow-up evaluations. It is then a necessity to determine these cut off points in every country/race. Methods: The study was performed on healthy subjects, sedentary lifestyle, age 18-50, Indonesian ethnicity (Mongoloid race). Recorded data were 6 minute walking distance,also body height and weight. Predicted walking distance based on gender is obtained by calculating walk distance, body weight, body height, gender and subject age in Nury’s predicted walk distance formula. Data is analysed with SPSS 20, utilizing independent T-test. Results: As much as 123 subjects (58 males, 65 females) were included in this study. Mean walking distance for males is 581,98 meters, while females are 516,80 meters, and these differences were statistically significant. Walking distance cut off point between gender were compared. In male subjects, actual walking distance were taken as normalif >483 meters, poor if 434-483 meters, and very poor 442 meters, poor when 405-442 meters, and very poor in distance 85%, poor when distance is 77-85%, and

Purpose: One of the main factor of cervical foraminal stenosis (CFS) is the hypertrophic change of the cervical facet joint. In order to analyze the connection between CFS and the facet joint hypertrophy, we devised a new morphological parameter, called the cervical facet joint cross-sectional area (CFJA). The CFJA has not yet been investigated for its association with CFS. We hypothesized that the CFJA is an important morphologic parameter in the diagnosis of CFS. Patients and methods: All patients over 50 years of age were included. Data regarding the CFJA were collected from 160 subjects with CFS. A total of 162 control individuals underwent cervical spine magnetic resonance imaging (CMRI) as part of a routine medical examination. Axial T2-weighted CMRI images were acquired from all subjects. We used a picture archiving system to analyze the cross-sectional area of the bone margin of the cervical facet joint at the level of the most stenotic cervical spine in the axial plane. Results: The average CFJA was 109.07±20.91 mm2 in the control group, and 126.75±22.59 mm2 in the CFS group. The CFS group was found to have significantly higher levels of the CFJA (p

Patient falls have long been a difficult problem and topic of research in the inpatient hospital environment. Hospitals experience heavy financial burden due to patient falls. Preventing falls can improve patient outcomes as well as reduce financial burden on both the patient as well as the healthcare organization. In this study, we determine the optimal cut-off value for patients at risk for falls using a Falls Screening Tool, the Morse Falls Scale. This study was conducted at a community-owned hospital with 256 acute care private rooms and 36 critical care rooms. This study used only the admission Morse Falls Scale (MFS) score in its analysis.

Determination of a Cut-Off Point of a Scale for Achievement Motive in Geriatrics That Predicts the Frequency of Undertaking Instrumental Activities of Daily Living in Community-Dwelling Elderly People

Postoperative fatigue (POF) is an often underestimated problem after surgery. Studies on POF often report fatigue scores without relating this to the clinical relevance for the patients. The aim of this study was to define the cut-off point for clinically significant POF in three commonly applied fatigue scales; the Postoperative Fatigue Scale, Christensen’s Fatigue Scale, and the Chalder Fatigue Questionnaire. The identification of cut-off points will make it possible to indicate whether statistically significant findings of increased fatigue are of clinical relevance. We combined data from day 0 (pre-operatively) and day 1, 3, 6, and 30 after surgery in two fatigue-related studies with 442 patients. In order to define clinically significant fatigue, a key question was added in each questionnaire; “Given your current description of fatigue, would you say it has been of considerable significance to you?”; “Yes/No”. We analysed each scale’s ability to identify clinically significant fatigue, by performing receiver-operating characteristics (ROC) analyses, and calculated the optimal cut-off point between Sensitivity and Specificity. The average weighted cut-off point for clinically significant POF when measured with the Postoperative Fatigue Scale was ≥ 50 (scale range 0–100), with Christensen’s Fatigue Scale ≥ 6 (scale range 1–10) and with the Chalder Fatigue Questionnaire ≥ 16 (scale range 0–33). In three commonly used fatigue scales, we have identified cut-off points for clinically significant fatigue among patients recovering from surgery. This can be particularly valuable for diagnostic purposes and in treatment evaluation. Further, it may be possible to analyse and review data from earlier studies in light of clinical relevance.

Background: Anxiety is one of the most common psychological disorders in school-aged children and adolescents worldwide. Anxiety is associated with substantial negative effects on children’s social, emotional and academic success. Objectives: To find out the prevalence of anxiety among adolescent students and its association with sociodemographic factors in rural block Beri. Methods: It was a cross sectional study taking the sample size of 600 (300 males and 300 females) studying in class 8th to 12th. A pre-designed, pre-tested tool SCL 90 R containing 90 items was used to screen anxiety in these students. Anxiety is one of the psychiatric morbidities screened by this tool. Cut off point of estimated raw score of 1 was used to label as anxiety. Results: It was observed that nearly 18.5% adolescents suffered from anxiety. Anxiety was highest in 17-19 years age group (30.4%) followed by mid adolescence phase (13-16 years). Anxiety was maximum in 10th and 12th standard students which were 19.3% and 24% respectively. It was significantly high among females (23.7%) than males (13.7%). Anxiety was maximum in upper and lower socio-economic class of students with 24.1% and 22.3% respectively. It was more among students whose mothers were unemployed (19.5%) than those whose mothers were employed (14.6%). Conclusion: More than one – third (35%) of study subjects who were apparently healthy suffered from unnoticed anxiety. Appropriate counseling through school-based screening programme is the urgent need of the hour.

Purpose Although the EDE-Q is derived from the “gold standard” for the assessment of Eating Disorders (ED), its factor structure is controversial, particularly in male samples. The aim of the study was to examine the psychometric properties and factor structure of the EDE-Q, as well to stablish a sensitive and specific cut-off point validated by EDE clinical interview. Methods A series of Confirmatory Factor Analyses were performed among a representative sample of 796 male university students, of whom 139 were interviewed. Sensitivity and specificity were calculated by Receiver Operating Characteristic (ROC) analysis to determinate the most appropriate cut-off value. Results The original factor structure was not confirmed, showing a better fit with a 2-factor solution. For the Spanish male sample, a cut-off ≥ 1.09 for at-risk of ED cases and ≥ 2.41 for clinical cases presents an optimal balance between sensitivity and specificity. Conclusions The establishment of specific cut-off points for males may help to reduce the under-diagnosis of ED in this population.Level of evidence III Evidence obtained from well-designed case-control study.

Objective The objective of this study was to analyze whether some auxological characteristics or a single basal gonadotropin measurement will be sufficient to distinguish the prepubertal from pubertal status. Methods Auxologycal characteristics were recorded and serum LH and FSH were measured by immunochemiluminescence assays before and after GnRH stimulation test in a sample of 241 Caucasian girls with breast budding between 6- and 8-years old. Peak LH levels higher than 5 IU/L were considered a pubertal response. Area under the curve, cut-off points, sensitivity, and specificity for auxologycal variables and basal gonadotropins levels were determined by receiver operating curves. Results There were no significant differences in age at onset, weight, height, BMI and height velocity between both groups. Bone age was significantly higher in pubertal girls (P < 0.05), although with limited discriminatory capacity. The sensitivity and specificity for the basal LH levels were 89 and 82%, respectively, for a cut off point of 0.1 IU/L. All girls in the pubertal group had a basal LH higher than 1.0 IU/L (positive predictive value of 100%). There was a wide overlap of basal FSH and LH/FSH ratio between prepubertal and pubertal girls. Conclusions Auxologycal characteristics should not be used only in the differential diagnosis between prepubertal from pubertal status in 6- to 8-year-old girls. We found a high specificity of a single basal LH sample and it would be useful for establishing the diagnosis of puberty in this age group, reducing the need for GnRH stimulation testing.

In medical diagnostic studies, the Youden index is a summary measure widely used in the evaluation of the diagnostic accuracy of a medical test. When covariates are not considered, the diagnostic accuracy of the test can be biased or misleading. By incorporating information from covariates using linear regression models, we propose generalized confidence intervals for the covariate-adjusted Youden index and its optimal cut-off point. Furthermore, under heteroscedastic regression models, we propose various confidence intervals for the covariate-adjusted Youden index and its optimal cut-off point. Extensive simulation studies are conducted to evaluate the finite sample performance of various confidence intervals for the Youden index and its optimal cut-off point in the presence of covariates. To illustrate the application of our recommended methods, we apply the methods to a dataset on postprandial blood glucose measurements.

We explore the hypothesis of magnetic monopoles and propose a magnetic field configuration that yields a Coulomb-type potential in the electric quadrupole moment system. This field configuration establishes a forbidden region for the neutral particle, hence, it establishes a cut-off point. We thus analyse the influence of this cut-off point on a Coulomb-type potential by searching for bound-state solutions to the Schrödinger equation.

DIAGNOSTIC VALUE OF DAVE UNHAS STROKE SCORE IN CARDIOEMBOLIC ISCHEMIC STROKE PATIENTS WITH ATRIAL FIBRILLATIONABSTRACTIntroduction: It is important to diagnose cardioembolic ischemic stroke quickly especially in the absence of CT scan/MRI, besides having a poor prognosis, cardioembolic ischemic stroke also has high disability and death rates.Aim: To investigate the diagnostic value of Dave Unhas Stroke Score (DUSS) in cardioembolic ischemic stroke patients with atrial fibrillation (AF).Methods: This was a diagnostic test research on cardioembolic ischemic stroke sufferers with AF and without cardioemboli in Wahidin Sudirohusodo Hospital and its networking hospital in Makassar from September 2018 to March 2019. DUSS consists of 5 variables: blood pressure (BP), activity at onset, headache, vomiting, and level of consciousness were assessed in both groups. DUSS cut off point was determined by receiver operating characteristics (ROC). The test results are considered as statistically significant if the p value 10) from noncardioembolic ischemic stroke (score 10) dengan stroke iskemik nonkardioemboli (skor

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.