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BACKGROUND: Currently, there is a lack of affordable and accessible indicators that can accurately predict immune-related adverse events (irAEs) resulting from the use of immune checkpoint inhibitors (ICIs). In order to address this knowledge gap, our study explore the potential predictive value of two ratios, namely the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR), for irAEs in cancer patients. METHODS: A systematic search was performed in PubMed, Embase, and the Cochrane library. Studies involving NLR or PLR with irAEs were included. Quality and risk of bias of the selected studies were assessed. Forest plots were created based on Cox model analysis. Random effects meta-analyses were conducted to estimate odds ratio (OR) and its 95% confidence interval (CI). RESULTS: After screening 594 studies, a total of 7 eligible studies with 1068 cancer patients were included. Analysis based on Cox regression showed that low neutrophil-lymphocyte ratio (L-NLR) (OR = 3.02, 95% CI 1.51 to 6.05, P = 0.002) and low platelet-lymphocyte ratio (L-PLR) (OR = 1.83, 95% CI 1.21 to 2.76, P = 0.004) were associated with irAEs. In the subgroup analysis of cut-off value, when the NLR cut-off value was 3, irAEs was significantly correlated with NLR (OR = 2.63, 95% CI 1.63 to 4.26, P < 0.001). CONCLUSIONS: Both L-NLR and L-PLR have been found to be significantly associated with irAEs. Consequently, patients identified as being at a higher risk for irAEs should be subjected to more diligent monitoring and close observation.
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Abstract Objective: To investigate the predictive validity and cut-off point of the Turkish version of the Infant Colic Scale (ICS) in the diagnosis of colic. Methods: This methodological study was carried out in a pediatric outpatient clinic of a university hospital in Turkey with infants aged 6-16 weeks (n = 133). The data were collected using the Mother-Infant Description Form, the ICS, and the Rome IV criteria form. The scale is a 6-point Likert-type scale consisting of 19 items in total. A low total mean score obtained from it indicates that the probability of colic increases, while a high mean score indicates that the probability of colic decreases. The Rome IV criteria were used as the gold standard. Results: The mean score obtained from the ICS was 59.4 ± 13.7. According to the Rome IV criteria, 26.3% of the infants had colic. The area under the ROC curve was 87.4% (95% CI = 0.815-0.934, SE = 0.30, p = 0.001), and the cut-off point for the best sensitivity value (88.6%) and the best specificity value (70.5%) of the ICS was determined to be 60.5. According to the cut-off point, the positive predictive value was 51%, and the negative predictive value was 94%. Conclusion: The predictive validity of the Turkish version of the ICS was found to be at a good level with high sensitivity and acceptable specificity for a cut-off point of 60.5. Healthcare professionals working in the child field can use the ICS to exclude colic in infants.
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OBJECTIVE: To investigate the predictive validity and cut-off point of the Turkish version of the Infant Colic Scale (ICS) in the diagnosis of colic. METHODS: This methodological study was carried out in a pediatric outpatient clinic of a university hospital in Turkey with infants aged 6-16 weeks (n = 133). The data were collected using the Mother-Infant Description Form, the ICS, and the Rome IV criteria form. The scale is a 6-point Likert-type scale consisting of 19 items in total. A low total mean score obtained from it indicates that the probability of colic increases, while a high mean score indicates that the probability of colic decreases. The Rome IV criteria were used as the gold standard. RESULTS: The mean score obtained from the ICS was 59.4 ± 13.7. According to the Rome IV criteria, 26.3% of the infants had colic. The area under the ROC curve was 87.4% (95% CI = 0.815-0.934, SE = 0.30, p = 0.001), and the cut-off point for the best sensitivity value (88.6%) and the best specificity value (70.5%) of the ICS was determined to be 60.5. According to the cut-off point, the positive predictive value was 51%, and the negative predictive value was 94%. CONCLUSION: The predictive validity of the Turkish version of the ICS was found to be at a good level with high sensitivity and acceptable specificity for a cut-off point of 60.5. Healthcare professionals working in the child field can use the ICS to exclude colic in infants.
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Cólico , Niño , Femenino , Humanos , Lactante , Sensibilidad y Especificidad , Turquía , Valor Predictivo de las Pruebas , Curva ROC , Reproducibilidad de los ResultadosRESUMEN
PURPOSE: To determine the Duke Activity Status Index (DASI) cut-off scores and verify if they would be able to discriminate between chronic stroke individuals, who had poor, from those who had good functional capacity (FC). MATERIALS AND METHODS: Cross-sectional study, where 92 individuals with chronic stroke had their FC measured by DASI scores and were classified into community and non-community walkers. Both the receiver operating characteristic and the area under the curve were used to determine the best DASI cut-off values that could discriminate between individuals, who had poor, from those who had good FC. Binary logistic regression analysis is used to investigate the ability of DASI scores in predicting community walkers. RESULTS: DASI cut-off value of 31.95 showed to be sensitive and specific to differentiate between individuals, who had poor from good FC. The regression analysis revealed that the chance of individuals, who had better FC (≥ 31.95) be community walkers was 10.69 (95%CI:4-32.75) times higher than that of those who had poor FC (< 31.95). The model demonstrated good predictive ability. CONCLUSIONS: The DASI cut-off value of 31.95 showed to be sensitive and specific to distinguish between chronic stroke individuals, who had poor, from those who had good FC.IMPLICATIONS FOR REHABILITATIONThe identification of individuals, who have good and poor functional capacity, is important for clinical reasoning and decision-making in stroke rehabilitation.The Duke Activity Status Index (DASI) is a clinically useful tool for the assessment of functional capacity, based upon the performance of common daily living activities.The DASI cut-off of 31.95 points was able to discriminate between individuals with stroke, who had poor, from those who had good functional capacity.The chance of individuals, who had good functional capacity (DASI ≥ 31.95) be community walkers was 10.69 times higher than that of those who had poor functional capacity (DASI < 31.95).The findings support the use of the DASI as a simple tool for the assessment of functional capacity, especially in low-resource settings.
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Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Actividades Cotidianas , Estudios Transversales , Humanos , Accidente Cerebrovascular/diagnóstico , Encuestas y CuestionariosRESUMEN
Resumen En las investigaciones psicológicas resulta de amplia relevancia conocer si los cuestionarios utilizados miden los constructos latentes de interés. A tal efecto, el Análisis Factorial Confirmatorio se emplea frecuentemente en la literatura especializada para aportar evidencias de validez a las escalas empleadas. Sin embargo, en la actualidad existe cierta disparidad de criterios respecto de los puntos de corte que deben tenerse en consideración. Por este motivo, el presente trabajo se propone revisar la literatura en torno a los diferentes puntos de corte tradicionales de los índices de ajuste más utilizados. Se concluye que para seleccionar los indices e interpretar los resultados se debe tener en cuenta que estos puntos de corte pueden cambiar por diferentes motivos, tales como el tamaño de la muestra.
Abstract In psychological research, it is of great relevance to know whether the questionnaires used measure the latent constructs of interest. For this purpose, Confirmatory Factor Analysis is frequently used in the specialized literature to provide evidence of validity to the scales used. However, there is currently a certain disparity in the criteria regarding the cut-off points to be taken into consideration. For this reason, this paper aims to review the literature on the different cut-off points for the most commonly used fit indexes. It is concluded that to select the indexes and interpret the results, it should be should take into account that these cut-off points may change for different reasons, such as sample size.
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BACKGROUND: Suriname has accomplished a steep decline in malaria burden, even reaching elimination levels. Plasmodium serology data are not available for Suriname and even extremely scarce within the region, therefore malaria serology testing was introduced, country customized cut-off values were determined and a study was performed to explore the antibody status for Plasmodium falciparum, Plasmodium vivax and Plasmodium malariae. METHODS: A cross-sectional survey was conducted between July 2017 and March 2018 in two areas of the interior with different malaria settings: Stoelmanseiland, representing Maroon villages and Benzdorp, a gold mining area, with mostly Brazilian miners. Dried blood spots (DBS) were collected (n = 197) and antibody presence against seven Plasmodium antigens was detected using a multiplex bead-based, IgG antibody assay. Demographic information was gathered through a questionnaire. Country customized cut-off values were generated from a Surinamese malaria-naïve reference population (n = 50). RESULTS: Serological analysis for the reference population revealed cut-off values ranging from 14 MFI for LSA-1 to 177 MFI for PmMSP-119. Seroprevalence against any of the three MSP-119 antibodies was similar in both regions and surpassed 75%. Single seropositivity against PfMSP-119 antibodies was higher in Stoelmanseiland (27.0%) than Benzdorp (9.3%), in line with the historical malaria burden of Stoelmanseiland, while the reverse was observed for PvMSP-119 antibodies. Despite sporadic reports of P. malariae infections, PmMSP-119 antibody presence was 39.6%. A more detailed examination of P. falciparum serology data displayed a higher seroprevalence in villagers (90.7%) than in Brazilians (64.6%) and a highly diverse antigenic response with 22 distinct antibody combinations. CONCLUSIONS: The results on the malaria antibody signature of Maroon villagers and Brazilian miners living in Suriname displayed a high Plasmodium seroprevalence, especially for P. falciparum in villagers, still reflecting the historical malaria burden. The seroprevalence data for both regions and the observed combinations of P. falciparum antibodies provided a valuable dataset from a historically important region to the international malaria serology knowledge. First insight in malaria serology data for Suriname indicated that the use of other target groups and assessment of age-dependent seroprevalence are required to successfully use malaria serology as tool in the national elimination strategy.
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Anticuerpos Antiprotozoarios/sangre , Antígenos de Protozoos/sangre , Inmunoglobulina G/sangre , Malaria Falciparum/epidemiología , Malaria Vivax/epidemiología , Malaria/epidemiología , Adulto , Anciano , Brasil/etnología , Estudios Transversales , Femenino , Humanos , Masculino , Proteína 1 de Superficie de Merozoito/inmunología , Persona de Mediana Edad , Minería , Plasmodium falciparum/fisiología , Plasmodium malariae/fisiología , Plasmodium vivax/fisiología , Prevalencia , Estudios Seroepidemiológicos , Suriname/epidemiología , Adulto JovenRESUMEN
BACKGROUND: Cryptococcus neoformans/ Cryptococcus gattii species complex is composed of encapsulated yeast species that are causative agents of cryptococcosis. The characterisation of pathogenic Cryptococcus species provides useful data for epidemiological studies as well as the clinical diagnosis and treatment of patients. OBJECTIVES: This study aimed to characterise the epidemiology, antifungal susceptibility and virulence of 72 clinical strains isolated from cryptococcosis cases between 2012 and 2017 in a tertiary reference hospital in south-eastern Brazil. METHODS: Species and molecular types were molecularly assessed by PCR and PCR-restriction fragment length polymorphism (RFLP) of the URA5 gene. Antifungal susceptibility testing was performed according to the CLSI protocols. The virulence was studied in a Galleria mellonella infection model. RESULTS: The most frequently isolated strain was C. neoformans molecular type VNI (61/72; 84.7%), although C. neoformans molecular type VNII (3/72; 4.2%) was also isolated. Additionally, C. deuterogattii molecular type VGII (8/72; 11.1%) was present, but most frequently from non-HIV-infected patients. Non-wild-type phenotype to the antifungals was observed in 26.4% (19/72) of the C. neoformans and C. deuterogattii clinical isolates, and the latter demonstrated higher MIC to fluconazole and itraconazole than C. neoformans clinical isolates. Finally, the virulence of C. neoformans and C. deuterogattii clinical isolates was diverse in G mellonella larvae and uncorrelated with the virulence factors of melanin and capsule. CONCLUSIONS: The assessment of the spread of cryptococcal species and molecular types as well as the pattern of corresponding antifungal susceptibility and virulence aids in surveil the emergence of resistant strains, ensuring more accurate management of the cryptococcal infection.
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Antifúngicos/farmacología , Criptococosis/microbiología , Cryptococcus gattii/efectos de los fármacos , Cryptococcus gattii/genética , Cryptococcus neoformans/efectos de los fármacos , Cryptococcus neoformans/genética , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Animales , Brasil , Niño , Cryptococcus gattii/patogenicidad , Cryptococcus neoformans/patogenicidad , Farmacorresistencia Fúngica , Femenino , Humanos , Larva , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Tipificación Molecular , Mariposas Nocturnas , Técnicas de Tipificación Micológica , Polimorfismo de Longitud del Fragmento de Restricción , Estudios Retrospectivos , Virulencia , Adulto JovenRESUMEN
OBJECTIVES: Imported Chagas disease (CD) is an emerging health problem in Europe due to immigration from endemic countries. Although WHO currently recommends two different serological methods to establish diagnosis, new tools like the ARCHITECT Chagas assay have potential for use as a single diagnostic test. Our objective was to determine an optimal signal-to-cut-off (S/CO) value for the ARCHITECT Chagas assay to diagnose CD with a single test. METHODS: A retrospective study conducted at the 12 de Octubre University Hospital (Madrid, Spain). All patients with requests for Chagas screening between January 2014 and August 2017 were consecutively included. All samples were routinely tested with the ARCHITECT assay. Negative samples (S/CO < 0.8) required no further testing. Immunochromatographic testing (ICT) and/or indirect immunofluorescence (IFI) was used to confirm samples with S/CO ≥ 0.8. Receiver operator characteristic (ROC) curve analysis determined the ARCHITECT S/CO value that yielded 100% specificity and positive predictive value. SPSS software, version 22.0 was used for data analysis. RESULTS: A total of 4153 samples were analysed; 361 (8.69%) gave a reactive ARCHITECT Chagas result. 261/361 (72.3%) were women; median age was 38 years old (2-79). 92.8% were Bolivian. A total of 307 (85.0%) were confirmed as cases of Chagas; 52 (14.4%) were not infected; two (0.6%) were not evaluable. Seroprevalence was 7.39%. An S/CO ≥ 3.80 yielded 100% specificity (95% confidence interval [CI], 0.93-1.00) and 100% positive predictive value (95% CI, 0.99-1.00). CONCLUSIONS: Using S/CO ≥ 3.80, the ARCHITECT Chagas could be used as a single test for diagnosis of chronic CD in Bolivian immigrants. Patients with S/CO between 0.80 and 3.80 would require additional testing.
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Enfermedad de Chagas/diagnóstico , Pruebas Diagnósticas de Rutina/métodos , Emigrantes e Inmigrantes/estadística & datos numéricos , Tamizaje Masivo , Adolescente , Adulto , Anciano , Bolivia/epidemiología , Bolivia/etnología , Enfermedad de Chagas/epidemiología , Niño , Preescolar , Enfermedad Crónica , Enfermedades Endémicas , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Sensibilidad y Especificidad , Adulto JovenRESUMEN
This paper presents a validated protocol, using a novel, specifically formulated medium, to perform broth microdilution antimicrobial susceptibility assays of the salmonid bacterial pathogen Piscirickettsia salmonis. The minimum inhibitory concentrations (MIC) for florfenicol and oxytetracycline against 58 P. salmonis isolates recovered from various outbreaks occurred in Chilean salmonid farms were determined using this protocol. Normalized resistance interpretation (NRI) analysis was applied to these data to calculate appropriate protocol-specific epidemiological cut-off values. These cut-off values allow the isolates to be categorized as either fully susceptible wild type (WT) members of this species, or as manifesting reduced susceptibility non-wild type (NWT). The distribution of MIC values of florfenicol was bimodal and the distribution of the normalized values for the putative WT observation had a standard deviation of 0.896 log2 µg mL-1. This analysis calculated a cut-off value of ≤0.25 µg mL-1 and categorized 33 (56%) of the isolates as manifesting reduced susceptibility to florfenicol. For the oxytetracycline MIC data the NRI analysis also treated the distribution as bimodal. The distribution of the normalized values for the putative WT observation had a standard deviation of 0.951 log2 µg mL-1. This analysis gave a cut-off value of ≤0.5 µg mL-1 and categorized five isolates (9%) as manifesting reduced susceptibility to oxytetracycline. The susceptibility testing protocol developed in this study was capable of generating MIC data from all the isolates tested. On the basis of the precision of the data it generated, and the degree of separation of values for WT and NWT it achieved, it is argued that this protocol has the performance characteristics necessary for it to be considered as a standard protocol.
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Flavobacterium psychrophilum is the most important bacterial pathogen for freshwater farmed salmonids in Chile. The aims of this study were to determine the susceptibility to antimicrobials used in fish farming of Chilean isolates and to calculate their epidemiological cut-off (COWT) values. A number of 125 Chilean isolates of F. psychrophilum were isolated from reared salmonids presenting clinical symptoms indicative of flavobacteriosis and their identities were confirmed by 16S rRNA polymerase chain reaction. Susceptibility to antibacterials was tested on diluted Mueller-Hinton by using an agar dilution MIC method and a disk diffusion method. The COWT values calculated by Normalized Resistance Interpretation (NRI) analysis allow isolates to be categorized either as wild-type fully susceptible (WT) or as manifesting reduced susceptibility (NWT). When MIC data was used, NRI analysis calculated a COWT of ≤0.125, ≤2, and ≤0.5 µg mL-1 for amoxicillin, florfenicol, and oxytetracycline, respectively. For the quinolones, the COWT were ≤1, ≤0.5, and ≤0.125 µg mL-1 for oxolinic acid, flumequine, and enrofloxacin, respectively. The disk diffusion data sets obtained in this work were extremely diverse and were spread over a wide range. For the quinolones there was a close agreement between the frequencies of NWT isolates calculated using MIC and disk data. For oxolinic acid, flumequine, and enrofloxacin the frequencies were 45, 39, and 38% using MIC data, and 42, 41, and 44%, when disk data were used. There was less agreement with the other antimicrobials, because NWT frequencies obtained using MIC and disk data, respectively, were 24 and 10% for amoxicillin, 8 and 2% for florfenicol, and 70 and 64% for oxytetracycline. Considering that the MIC data was more precise than the disk diffusion data, MIC determination would be the preferred method for susceptibility testing for this species and the NWT frequencies derived from the MIC data sets should be considered as the more authoritative. Despite the high frequency of isolates showing full susceptibility to florfenicol, the significant frequencies of isolates exhibiting reduced susceptibility to oxytetracycline and quinolones may result in treatment failures when these agents are used.
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Epidemiological cut-off values (ECVs) based on minimal inhibitory concentration (MIC) distribution have been recently proposed for some antifungal drug/Cryptococcus neoformans combinations. However, these ECVs vary according to the species studied, being serotypes and the geographical origin of strains, variables to be considered. The aims were to define the wild-type (WT) population of the C. neoformans species complex (C. neoformans) isolated from patients living in Argentina, and to propose ECVs for six antifungal drugs. A total of 707 unique C. neoformans isolates obtained from HIV patients suffering cryptococcal meningitis were studied. The MIC of amphotericin B, flucytosine, fluconazole, itraconazole, voriconazole and posaconazole was determined according to the EDef 7.2 (EUCAST) reference document. The MIC distribution, MIC50 , MIC90 and ECV for each of these drugs were calculated. The highest ECV, which included ≥95% of the WT population modelled, was observed for flucytosine and fluconazole (32 µg ml(-1) each). For amphotericin B, itraconazole, voriconazole and posaconazole, the ECVs were: 0.5, 0.5, 0.5 and 0.06 µg ml(-1) respectively. The ECVs determined in this study may aid in identifying the C. neoformans strains circulating in Argentina with decreased susceptibility to the antifungal drugs tested.
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Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Antifúngicos/farmacología , Criptococosis/epidemiología , Criptococosis/microbiología , Cryptococcus neoformans/efectos de los fármacos , Farmacorresistencia Fúngica , Meningitis Criptocócica/microbiología , Infecciones Oportunistas Relacionadas con el SIDA/mortalidad , Anfotericina B/farmacología , Argentina/epidemiología , Cryptococcus neoformans/aislamiento & purificación , Métodos Epidemiológicos , Fluconazol/farmacología , Flucitosina/farmacología , Infecciones por VIH/microbiología , Humanos , Itraconazol/farmacología , Pruebas de Sensibilidad Microbiana , Triazoles/farmacología , Voriconazol/farmacologíaRESUMEN
The Montenegro skin test (MST) has good clinical applicability and low cost for the diagnosis of American tegumentary leishmaniasis (ATL). However, no studies have validated the reference value (5mm) typically used to discriminate positive and negative results. We investigated MST results and evaluated its performance using different cut-off points.
The results of laboratory tests for 4,256 patients with suspected ATL were analyzed, and 1,182 individuals were found to fulfill the established criteria. Two groups were formed. The positive cutaneous leishmaniasis (PCL) group included patients with skin lesions and positive direct search for parasites (DS) results. The negative cutaneous leishmaniasis (NCL) group included patients with skin lesions with evolution up to 2 months, negative DS results, and negative indirect immunofluorescence assay results who were residents of urban areas that were reported to be probable sites of infection at domiciles and peridomiciles.
The PCL and NCL groups included 769 and 413 individuals, respectively. The mean ± standard deviation MST in the PCL group was 12.62 ± 5.91mm [95% confidence interval (CI): 12.20-13.04], and that in the NCL group was 1.43 ± 2.17mm (95% CI: 1.23-1.63). Receiver-operating characteristic curve analysis indicated 97.4% sensitivity and 93.9% specificity for a cut-off of 5mm and 95.8% sensitivity and 97.1% specificity for a cut-off of 6mm.
Either 5mm or 6mm could be used as the cut-off value for diagnosing ATL, as both values had high sensitivity and specificity.