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OBJECTIVE: This study evaluates the ROX index's accuracy in predicting the success or failure of high-flow nasal cannula (HFNC) therapy in children under 2 years with acute respiratory failure (ARF) from lower respiratory tract infections. METHODS: From January 2018 to 2021 we conducted this multicenter retrospective cohort study, which included patients aged 2-24 months. We aimed to assess HFNC therapy outcomes as either success or failure. The analysis covered patient demographics, diagnoses, vital signs, and ROX index values at intervals from 0 to 48 h after initiating HFNC. We used bivariate analysis, repeated measures ANOVA, multivariate logistic regression, and the area under the receiver operating characteristic (AUC-ROC) curve for statistical analysis. RESULTS: The study involved 529 patients from six centers, with 198 females (37%) and a median age of 9 months (IQR: 3-15 months). HFNC therapy failed in 38% of cases. We observed significant variability in failure rates across different centers and physicians (p < .001). The ROX index was significantly associated with HFNC outcomes at all time points, showing an increasing trend in success cases over time (p < .001), but not in HFNC failure cases. Its predictive ability is limited, with AUC-ROC values ranging from 0.56 at the start to 0.67 at 48 h. CONCLUSION: While the ROX index is associated with HFNC outcomes in children under 2 years, its predictive ability is modest, impacted by significant variability among patients, physicians, and centers. These findings emphasize the need for more reliable predictive tools for HFNC therapy in this patient population.
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Cánula , Terapia por Inhalación de Oxígeno , Insuficiencia Respiratoria , Infecciones del Sistema Respiratorio , Insuficiencia del Tratamiento , Humanos , Femenino , Masculino , Lactante , Estudios Retrospectivos , Infecciones del Sistema Respiratorio/terapia , Terapia por Inhalación de Oxígeno/métodos , Terapia por Inhalación de Oxígeno/instrumentación , Insuficiencia Respiratoria/terapia , Saturación de Oxígeno , PreescolarRESUMEN
OBJECTIVE(S): In this study, the laryngopharynx microbiome alterations were characterized after proton pump inhibitor treatment in patients with Laryngopharyngeal Reflux Disease (LPRD) and healthy people. The potential outcome-predictive biomarker was explored. METHODS: Patients with LPRD and healthy controls were enrolled. The composition of their laryngopharynx microbiota was analyzed both by traditional plate count of the main bacterial groups and PCR amplification followed by denaturing gradient gel electrophoresis. Shannon-Wiener index and evenness index based on Dice index were used to assess the bacterial diversity. Droplet digital PCR was used to determine the total bacterial RNA and relative abundance of Klebsiella oxytoca. Receiver operating characteristic curve was plotted to explore the potential of Klebsiella oxytoca as an outcome-predictive biomarker. RESULTS: A total of 29 LPRD cases and 28 healthy subjects were enrolled. The composition of the laryngopharynx microbiota was almost similar, except Klebsiella oxytoca. The cluster analysis showed that the similarity between healthy and treatment-effective groups, as well as pretreatment and treatment-invalid groups, was close. Statistical analysis showed that there were differences in the diversity index and richness among the healthy, treatment-effective, pretreatment and treatment-invalid groups. The abundance of Klebsiella oxytoca in the treatment-effective LPRD group was lower than that of the treatment-invalid LPRD group. The abundance of Klebsiella oxytoca can distinguish treatment-effective and -invalid groups (AUC=0.859) with a sensitivity of 77.78% and specificity of 90.91%. CONCLUSION: There were differences in the diversity of cecal contents microbial community between treatment-invalid and treatment-effective LPRD groups. Klebsiella oxytoca has potential to distinguish treatment outcomes. LEVEL OF EVIDENCE: How common is the problem? Level 1. Is this diagnostic or monitoring test accurate? (Diagnosis) Level 4. What will happen if we do not add a therapy? (Prognosis) Level 5. Does this intervention help? (Treatment Benefits) Level 4. What are the COMMON harms? (Treatment Harms) Level 4. What are the RARE harms? (Treatment Harms) Level 4. Is this (early detection) test worthwhile?(Screening) Level 4.
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Abstract Objective(s): In this study, the laryngopharynx microbiome alterations were characterized after proton pump inhibitor treatment in patients with Laryngopharyngeal Reflux Disease (LPRD) and healthy people. The potential outcome-predictive biomarker was explored. Methods: Patients with LPRD and healthy controls were enrolled. The composition of their laryngopharynx microbiota was analyzed both by traditional plate count of the main bacterial groups and PCR amplification followed by denaturing gradient gel electrophoresis. Shannon-Wiener index and evenness index based on Dice index were used to assess the bacterial diversity. Droplet digital PCR was used to determine the total bacterial RNA and relative abundance of Klebsiella oxytoca. Receiver operating characteristic curve was plotted to explore the potential of Klebsiella oxytoca as an outcome-predictive biomarker. Results: A total of 29 LPRD cases and 28 healthy subjects were enrolled. The composition of the laryngopharynx microbiota was almost similar, except Klebsiella oxytoca. The cluster analysis showed that the similarity between healthy and treatment-effective groups, as well as pretreatment and treatment-invalid groups, was close. Statistical analysis showed that there were differences in the diversity index and richness among the healthy, treatment-effective, pretreatment and treatment-invalid groups. The abundance of Klebsiella oxytoca in the treatment-effective LPRD group was lower than that of the treatment-invalid LPRD group. The abundance of Klebsiella oxytoca can distinguish treatment-effective and -invalid groups (AUC = 0.859) with a sensitivity of 77.78% and specificity of 90.91%. Conclusion: There were differences in the diversity of cecal contents microbial community between treatment-invalid and treatment-effective LPRD groups. Klebsiella oxytoca has potential to distinguish treatment outcomes. Level of evidence: How common is the problem? Level 1. Is this diagnostic or monitoring test accurate? (Diagnosis) Level 4. What will happen if we do not add a therapy? (Prognosis) Level 5. Does this intervention help? (Treatment Benefits) Level 4. What are the COMMON harms? (Treatment Harms) Level 4. What are the RARE harms? (Treatment Harms) Level 4. Is this (early detection) test worthwhile?(Screening) Level 4.
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The large amount of data generated during the COVID-19 pandemic requires advanced tools for the long-term prediction of risk factors associated with COVID-19 mortality with higher accuracy. Machine learning (ML) methods directly address this topic and are essential tools to guide public health interventions. Here, we used ML to investigate the importance of demographic and clinical variables on COVID-19 mortality. We also analyzed how comorbidity networks are structured according to age groups. We conducted a retrospective study of COVID-19 mortality with hospitalized patients from Londrina, Parana, Brazil, registered in the database for severe acute respiratory infections (SIVEP-Gripe), from January 2021 to February 2022. We tested four ML models to predict the COVID-19 outcome: Logistic Regression, Support Vector Machine, Random Forest, and XGBoost. We also constructed a comorbidity network to investigate the impact of co-occurring comorbidities on COVID-19 mortality. Our study comprised 8358 hospitalized patients, of whom 2792 (33.40%) died. The XGBoost model achieved excellent performance (ROC-AUC = 0.90). Both permutation method and SHAP values highlighted the importance of age, ventilatory support status, and intensive care unit admission as key features in predicting COVID-19 outcomes. The comorbidity networks for old deceased patients are denser than those for young patients. In addition, the co-occurrence of heart disease and diabetes may be the most important combination to predict COVID-19 mortality, regardless of age and sex. This work presents a valuable combination of machine learning and comorbidity network analysis to predict COVID-19 outcomes. Reliable evidence on this topic is crucial for guiding the post-pandemic response and assisting in COVID-19 care planning and provision.
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Objective: To determine if the triglycerides and glucose index (TyG) can be used as a marker for insulin resistance (IR) in Argentinean schoolchildren according to age and sex. Methods: Anthropometric data, blood glucose levels, lipid profiles, and insulin levels were measured. The TyG index was defined by Ln [fasting triglyceride (mg/dL)* fasting glucose (mg/dL)/2]. A comparison of the ability of TyG to identify children with IR was performed using receiver operating characteristic (ROC) curves and the area under the ROC (AUROC) curve. IR was defined as HOMA-IR > III quartile. Results: A total of 915 (528, 57.7% males) apparently healthy schoolchildren, aged 9.3 ± 2.2, were evaluated. The AUROC using the HOMA-IR > III quartile as the dichotomous variable showed that TyG was a fair marker to identify IR (0.65, 95% CI, 0.61-0.69; p < 0.01). There was a significantly higher TyG AUROC in males (0.69, 95% CI, 0.63-0.75; p < 001) than in females (0.60, 95% CI, 0.54-0.66; p < 0.01). When children were divided according to age into two groups (5.0-9.9 and 10.0-14.9-year-olds); younger children (0.64, 95% CI, 0.58-0.69; p < 0.011) and older children (0.62, 95% CI, 0.55-0.68; p = 0.01) had a similar and fair AUROC. However, when children were divided by age and sex, females older than ten had a non-significant AUROC (0.53, 95% CI, 0.42-0.63; p = 0.61). The TyG index compared with HOMA-IR had low sensitivity and specificity, ranging from 0.62 to 0.56. Conclusion: The TyG index had a fair AUROC with low sensitivity and specificity, indicating poor discrimination in identifying IR in apparently healthy Argentinean children. The ability to use TyG for screening purposes seems limited in Argentinean schoolchildren.
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BACKGROUND: PCM is a neglected systemic mycosis endemic in Brazil. The middle-west region of Brazil has shown the highest number of PCM by Paracoccidioides lutzii (P lutzii) cases. Differentiating cases of severe PCM from non-severe ones should be a concern at the bedside. Diagnosis of severe PCM by P lutzii is based on the subjectivity of clinical manifestations, which can result in a delay in starting its treatment and, consequently evolution to severe sequelae. There is not laboratory biomarker available to support the early diagnosis of severe PCM that is feasible for all the realities that coexist in Brazil. OBJECTIVES: The aim of this study was to investigate the usefulness of laboratory biomarkers as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and neutrophil/lymphocyte ratio (NLR) in the diagnosis of severe PCM. PATIENTS/METHODS: ESR, CRP and NLR were analysed for 44 patients with PCM by P lutzii and a Receiver Operation Characteristic (ROC) curve were generated to identify the NLR cut-off point and point out the presence of severe PCM. RESULTS: Sixteen (36.4%) had severe PCM and 28 (63.6%) had non-severe PCM. The mean NLR was higher and statistically significant among patients with severe PCM than among those with non-severe PCM. The area under the ROC curve was 0.859 for the diagnosis of severe PCM. The cut-off point for NLR for the diagnosis of severe PCM was 3.318 (sensitivity of 100%, specificity of 77%). CONCLUSIONS: According to results, it is plausible to conclude that NLR represents a potential biomarker for the diagnosis of severe PCM.
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Linfocitos/inmunología , Neutrófilos/inmunología , Paracoccidioides/inmunología , Paracoccidioidomicosis/diagnóstico , Paracoccidioidomicosis/inmunología , Adulto , Anciano , Infecciones Asintomáticas , Biomarcadores/análisis , Brasil , Técnicas de Laboratorio Clínico , Femenino , Humanos , Recuento de Linfocitos/métodos , Recuento de Linfocitos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
Overweight is increasing in the adolescent population and became a public health problem in the world. This study aimed to identify the body adiposity indices (BAI) with the best capacity to predict excess fat tissue and propose cut-off points for them, according to sex and adolescence period. This is a cross-sectional study. We calculated BMI, conicity index (CI), BAI, body roundness index (BRI), waist:height ratio (WtHR) and waist:hip ratio. Predictive capacity and cut-off points of adiposity indices were established by ROC (receiver operating characteristic) curves. We determined AUC-ROC and CI, stratified by sex and adolescence period. The best index to identify excess body fat in 10-13-year-old female adolescents was the WtHR (AUC = 0·92), like the BAI in girls aged from 14 to 16 years old (AUC = 0·87) and 17 to 19 years old (AUC = 0·80). In male adolescents aged from 10 to 13 years old and 14 to 16 years old, the best index was the WtHR (AUC = 0·93 and AUC = 0·8, respectively), like the BAI in boys aged from 17 to 19 years old (AUC = 0·95). The use of indices with specific cut-off points for each period of adolescence and according to sex is important for the reliable diagnosis of excess body fat. It is advisable to use indices together to obtain a more accurate assessment. Thus, the WtHR and BAI are reproducible and reliable, with high sensitivity and specificity values, and can be used together with the BMI.
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Adiposidad , Relación Cintura-Estatura , Tejido Adiposo , Adolescente , Adulto , Antropometría , Índice de Masa Corporal , Niño , Estudios Transversales , Femenino , Humanos , Masculino , Curva ROC , Circunferencia de la Cintura , Adulto JovenRESUMEN
OBJECTIVE: To propose cut-off points for the TAG-glucose (TyG) index in Brazilian children and evaluate the link to cardiometabolic risk. DESIGN: A cross-sectional study with children from a municipality in Minas Gerais, Brazil. Anthropometric (weight, height, waist circumference and waist:height ratio), biochemical (lipid and glucose profile) and blood pressure (BP) tests were performed. Using the receiver operating characteristic curve, cut-off points for the TyG index were proposed according to sex using homoeostasis model of assessment - insulin resistance (IR) as the reference method. SETTING: Viçosa, MG, Brazil. PARTICIPANTS: Children aged 4-9 years (n 515). RESULTS: The TyG index cut-off points to identify the risk of IR were 7·9 and 8·1 for boys and girls, respectively. We observed that 48·7 % of the children had an increased TyG index. The increased TyG index was associated with overweight, total body and central fat, increased BP and altered lipid profile. Children with an increased TyG index had a higher accumulation of cardiometabolic risk factors. CONCLUSIONS: According to the cut-off points proposed by the current study, children at risk of IR estimated by the TyG index presented a higher cardiometabolic risk, including isolated risk factors, as to the higher accumulation of these.
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Enfermedades Cardiovasculares , Resistencia a la Insulina , Glucemia , Índice de Masa Corporal , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Niño , Preescolar , Estudios Transversales , Femenino , Glucosa , Humanos , Masculino , Triglicéridos , Circunferencia de la CinturaRESUMEN
BACKGROUND: Evidence shows an association between grip strength and health; however, grip strength cut-offs for the detection of metabolic syndrome (MetS) in Latin American populations are scarce. The purpose of this study was to determine cut-offs of normalized grip strength (NGS) for the detection of MetS in a large nonrepresentative sample of a collegiate student population from Colombia. METHODS: A total of 1795 volunteers (61.4% female; ageâ¯=â¯20.68 ± 3.10 years, mean ± SD), ranging between 18 and 30 years of age participated in the study. Strength was estimated using a handheld dynamometer and normalized to body mass (handgrip strength (kg)/body mass (kg)). Anthropometrics, serum lipids indices, blood pressure, and fasting plasma glucose were measured. Body composition was measured by bioelectrical impedance analysis. MetS was defined as including ≥3 of the 5 metabolic abnormalities according to the International Diabetes Federation definition. A metabolic risk score was computed from the following components: waist circumference, triglycerides, high-density lipoprotein cholesterol, glucose, and systolic and diastolic blood pressure. RESULTS: Receiver operating curve analysis showed significant discriminatory accuracy of NGS in identifying the thresholds and risk categories. Lower strength was associated with increased prevalence of MetS. In males, weak, intermediate, and strong NGS values at these points were <0.466, 0.466-0.615, >0.615, respectively. In females, these cut-off points were <0.332, 0.332-0.437, >0.437, respectively. CONCLUSION: Our sex-specific cut-offs of NGS could be incorporated into a clinical setting for identifying college students at cardiometabolic disease risk.
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Fuerza de la Mano , Síndrome Metabólico/diagnóstico , Adolescente , Adulto , Antropometría , Biomarcadores/sangre , Glucemia/metabolismo , Presión Sanguínea , Composición Corporal , Colombia , Estudios Transversales , Femenino , Humanos , Lípidos/sangre , Masculino , Síndrome Metabólico/sangre , Debilidad Muscular/fisiopatología , Prueba de Estudio Conceptual , Factores de Riesgo , Adulto JovenRESUMEN
BACKGROUND AND AIM: Intrahepatic metastasis (IM) of hepatocellular carcinoma (HCC) occurs via vascular invasion; the tumor diameter that affects the risk of micro intra-hepatic metastasis (MIM) should be larger than that which affects the risk of micro vessel invasion (MVI). The aim of the present study was to determine the optimum tumor diameter cut-off value for predicting the presence of MIM in HCC patients without treatment history and HCC patients with a treatment history and to compare these diameters between cases of MVI and MIM. METHODS: This retrospective study included 621 patients without macroscopic vessel invasion or intrahepatic metastasis on preoperative imaging who underwent hepatectomy. The cut-off tumor diameter for predicting the presence of MIM was determined by a receiver operating characteristic curves analysis. RESULTS: The optimum cut-off value for predicting the presence of MIM in HCC patients without treatment history was 43 mm. In contrast, the optimum cut-off value for predicting the presence of MIM in HCC patients with a treatment history was 20 mm. Among 46 HCC patients with MIM without treatment history, there were 20 patients with MIM without MVI who were considered to have potential multi-centric (MC) tumors rather than IM. The cumulative overall survival rates in patients with MIM without MVI (potential MC) was significantly better than that in patients with both MIM and MVI (P = 0.022). CONCLUSIONS: The tumor diameter cut-off value for predicting MIM differed between HCC patients without treatment history and with a treatment history and slightly smaller than those for predicting MVI beyond our expectation.
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Carcinoma Hepatocelular/patología , Carcinoma Hepatocelular/cirugía , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Hepatocelular/irrigación sanguínea , Carcinoma Hepatocelular/mortalidad , Supervivencia sin Enfermedad , Femenino , Hepatectomía , Humanos , Neoplasias Hepáticas/irrigación sanguínea , Neoplasias Hepáticas/mortalidad , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Micrometástasis de Neoplasia , Pronóstico , Estudios Retrospectivos , Tasa de Supervivencia , Carga TumoralRESUMEN
INTRODUCTION AND AIM: Different criteria are applied for the diagnosis of acute-on-chronic liver failure (ACLF). Our aim was to compare the performance of different ACLF diagnostic criteria for predicting mortality. MATERIALS AND METHODS: This was a prospective cohort study of adult cirrhotic patients admitted to a tertiary hospital for acute decompensation (AD) of cirrhosis. The evaluated outcome was mortality at 28 and 90 days, according to the different ACLF diagnostic criteria: Chronic Liver Failure Consortium (CLIF-C), Asian Pacific Association for the Study of the Liver-ACLF Research Consortium (AARC) and North American Consortium for the Study of End-Stage Liver Disease (NACSELD). Prognostic performance was evaluated using receiver operating characteristic (ROC) curves. RESULTS: 146 patients were included. 43 (29.5%) with ACLF according to CLIF-C definition, 14 (9.6%) with ACLF by AARC definition, and 6 (4.1%) by NACSELD definition. According to Kaplan-Meier survival analyses median survival of patients with ACLF by CLIF-C definition was 27.0 days, median survival of patients with ACLF by AARC definition was 27.0 days, and median survival of patients with ACLF by NACSELD definition was 4.0 days. The areas under the ROC curves for performance evaluation in predicting mortality at 28 days for CLIF-C, AARC and NACSELD criteria were, respectively, 0.710, 0.560 and 0.561 (p=0.002). Regarding 90-day mortality, the areas under the ROC curves were 0.760, 0.554 and 0.555 respectively (p<0.001). CONCLUSION: ACLF definition proposed by CLIF-C had better performance in predicting mortality at 28 and 90 days when compared to criteria proposed by AARC and NACSELD.
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Insuficiencia Hepática Crónica Agudizada/diagnóstico , Insuficiencia Hepática Crónica Agudizada/mortalidad , Técnicas de Apoyo para la Decisión , Indicadores de Salud , Cirrosis Hepática/diagnóstico , Cirrosis Hepática/mortalidad , Insuficiencia Hepática Crónica Agudizada/etiología , Insuficiencia Hepática Crónica Agudizada/terapia , Anciano , Femenino , Estado de Salud , Humanos , Cirrosis Hepática/complicaciones , Cirrosis Hepática/terapia , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Reproducibilidad de los Resultados , Medición de Riesgo , Factores de Riesgo , Factores de TiempoRESUMEN
OBJECTIVE: To evaluate agreement of the body adiposity index (BAI) and paediatric body adiposity index (BAIp) in estimating body fat compared with dual-energy X-ray absorptiometry (DXA) and to propose cut-off points for these indices to classify excess adiposity in Brazilian children and adolescents. DESIGN: Cross-sectional study. Measures of weight, height, hip circumference, BMI and body fat percentage (%BF) assessed by DXA were taken, and BAI and BAIp were calculated. The Bland-Altman plot was used to estimate agreement between the methods, and the receiver-operating characteristic curve to determine the cut-off points for BAI and BAIp per age and sex in comparison with DXA. SETTING: Viçosa, Minas Gerais, Brazil. SUBJECTS: Children and adolescents aged 8-19 years (n 1049). RESULTS: Of the children and adolescents, 52·4 % were girls. BAI and BAIp had satisfactory performance by the receiver-operating characteristic curve, except for the 18-19 years age group, whose BAIp had better predictive capacity than BAI. The agreement analysis showed that BAI overestimated %BF by 2·64 %, on average, using DXA; while BAIp underestimated %BF by 3·37 %. CONCLUSIONS: BAI and BAIp showed low agreement with the body fat obtained by DXA, requiring caution when interpreting body composition data in children and adolescents.
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Absorciometría de Fotón/estadística & datos numéricos , Tejido Adiposo , Antropometría/métodos , Distribución de la Grasa Corporal/estadística & datos numéricos , Índice de Masa Corporal , Adiposidad , Adolescente , Composición Corporal , Distribución de la Grasa Corporal/métodos , Estatura , Peso Corporal , Brasil , Niño , Estudios Transversales , Femenino , Humanos , Masculino , Valores de Referencia , Reproducibilidad de los Resultados , Adulto JovenRESUMEN
OBJECTIVE: To evaluate the ability of anthropometric measurements to identify excess android fat and to propose cut-off points for excess central adiposity in children, according to age and sex. DESIGN: A cross-sectional study with children from a municipality of Minas Gerais, Brazil. Receiver-operating characteristic curve analyses were performed to evaluate waist circumference (WC), waist-to-height ratio (WHtR) and conicity index (C-index) in estimating excess android fat by dual energy X-ray absorptiometry (DXA). SETTING: Viçosa, Minas Gerais, Brazil. SUBJECTS: Children aged 4-9 years (n 788). RESULTS: Overweight prevalence was 29·1 % and android fat percentage was higher among girls. All central fat measurements were able to discriminate excess android fat in the age groups evaluated, especially WC and WHtR, with cut-off points showing good sensitivity and specificity overall. CONCLUSIONS: Because these methods are easy to obtain and inexpensive, it is possible to use WC, WHtR and C-index in population surveys to evaluate central obesity. The proposed cut-off points showed satisfactory values of sensitivity and specificity and can be used in epidemiological studies.
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Absorciometría de Fotón/estadística & datos numéricos , Distribución de la Grasa Corporal/estadística & datos numéricos , Obesidad Abdominal/diagnóstico , Circunferencia de la Cintura , Relación Cintura-Estatura , Distribución de la Grasa Corporal/métodos , Brasil , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Masculino , Obesidad Abdominal/epidemiología , Prevalencia , Curva ROC , Valores de Referencia , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: The present study aimed to investigate whether the visceral adiposity index (VAI) is an effective predictor to identify unhealthy metabolic phenotype by comparing normal-weight and overweight individuals. DESIGN: A population-based cross-sectional study. Data were collected by interviews, anthropometric evaluation, dietetic, clinical and laboratory tests. The area under the receiver-operating characteristic curve (AUC) and prevalence ratio (PR), obtained from Poisson regression, were used to compare the predictive capacity of the obesity indicators evaluated (VAI, BMI, waist and neck circumference, waist-to-height and waist-to-hip ratios) and their association with the unhealthy metabolic phenotype. All analyses were stratified by sex and by nutritional status. SETTING: Viçosa, Minas Gerais, Brazil.ParticipantsA total of 854 Brazilian adults (20-59 years old) of both sexes. RESULTS: VAI was the best predictor for unhealthy metabolic phenotype among men (AUC = 0·865) and women (AUC = 0·843) at normal weight. VAI also had the best predictive capacity among overweight women (AUC = 0·903). Among overweight men, its accuracy (AUC = 0·830) was higher than that of waist-to-hip ratio. In the adjusted regression models, VAI was the indicator most strongly associated with the unhealthy metabolic phenotype, especially among those with normal weight (PR = 6·74; 95 % CI 3·15, 14·42 for men; PR = 7·14; 95 % CI 3·79, 13·44 for women). CONCLUSIONS: VAI has better predictive capacity in detecting unhealthy metabolic phenotype than conventional anthropometric indicators, regardless of nutritional status and sex.
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Adiposidad , Grasa Intraabdominal/metabolismo , Fenotipo , Adulto , Índice de Masa Corporal , Pesos y Medidas Corporales , Brasil , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sobrepeso/metabolismo , Adulto JovenRESUMEN
BACKGROUND: Different definitions are nowadays adopted to estimate the threshold of exposure of households to catastrophic health expenditures and different thresholds are used in various studies. This study was conducted to compare these thresholds and select the most appropriate threshold for defining catastrophic health expenditure in Iran and Brazil. METHODS: In this cross-sectional study, data were collected from 592 households from District 17 of Tehran, Iran, and 869 households from Porto Alegre, Brazil in 2013. Firstly, catastrophic health expenditures were calculated using two common proportions, i.e. out-of-pocket health payments, as a proportion of total cost and as a proportion of ability to pay. These proportions were analysed using the ROC curve and Kappa coefficient. RESULTS: The appropriate cut off point for the thresholds of 5%, 10%, 15%, and 20% of the total expenditure was 0.52, 0.34, 0.28, and 0.46 in Iran, and 0.44, 0.36, 0.28, and 0.23 in Brazil, respectively. The appropriate cut off point for the thresholds of 20%, 25%, 30%, 35%, and 40% of ability to pay was 0.31, 0.28, 0.25, 0.34, and 0.40 in Iran and 0.36, 0.34, 0.30, 0.38, and 0.46 in Brazil, respectively. CONCLUSION: The appropriate cut off point for the proportion of out-of-pocket health payments to total expenditure and proportion of health expenditure to ability to pay was the threshold of 20% of total expenditure and 35% of ability to pay, respectively.
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INTRODUCTION: Obesity is defined by the World Health Organization (WHO) as a disease characterized by the excessive accumulation of body fat. Obesity is considered a public health problem, leading to serious social, psychological and physical problems. However, the appropriate cut-off point of body mass index (BMI) based on body fat percentage (BF%) for classifying an individual as obese in middle-aged adults living in Rio de Janeiro remains unclear. MATERIALS AND METHODS: This was a prospective cross-sectional study comprising of 856 adults (413 men and 443 women) living in Rio de Janeiro, Brazil ranging from 30-59 years of age. The data were collected over a two year period (2010-2011), and all participants were underwent anthropometric evaluation. The gold standard was the percentage of body fat estimated by bioelectrical impedance analysis. The optimal sensitivity and specificity were attained by adjusting BMI cut-off values to predict obesity based on the WHO criteria: BF% >25% in men and >35% in women, according to the receiver operating characteristic curve (ROC) analysis adjusted for age and for the whole group. RESULTS: The BMI cut-offs for predicting BF% were 29.9 kg/m2 in men and 24.9 kg/m2 in women. CONCLUSIONS: The BMI that corresponded to a BF% previously defining obesity was similar to that of other Western populations for men but not for women. Furthermore, gender and age specific cut-off values are recommended in this population.
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BACKGROUND: The increase in obesity, especially the increase of visceral fat, has been directly associated with health risk. Additionally, a waist-to-height ratio (WHtR) (0.5) has been proposed as an indicator of early health risk. AIMS: To test the association between anthropometric measurements and inflammatory mRNA expression and to evaluate the effectiveness of WHtR to predict inflammatory risk in children. SUBJECTS AND METHODS: Anthropometric measurements and fasting blood samples were collected in 94 Brazilian children (46 boys) aged 9-11 years. Children were identified as being at inflammatory risk based on cytokine mRNA expression levels at and above the 75th percentile. Inflammatory cytokine mRNA expression levels were determined through buff-coat using real-time polymerase chain reaction. RESULTS: Body mass index (BMI), waist circumference (WC) and WHtR showed moderate-to-strong association with inflammatory cytokine mRNA gene expression. WHtR = 0.51 was the most accurate cut-off point in distinguishing children at inflammatory risk. Compared with children with WHtR <0.51, children with a WHtR ≥0.51 presented an odds ratio of 2.643 (95% CI = 1.749-3.994) for both diagnosed IL-6 and MCP-1 above the 75th percentile and 2.796 (95% CI = 1.802-4.338) for TNF-α above the 75th percentile. WHtR = 0.50 presented the same values of sensitivity and odds ratio and â¼7% lower specificity compared to WHtR = 0.51. CONCLUSION: Anthropometric measurements have shown a moderate-to-strong association with the mRNA expression of inflammatory genes and a WHtR of 0.5 could serve as a cut-off point, suggesting increased risk of inflammatory responses.
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Citocinas/metabolismo , Inflamación/metabolismo , Relación Cintura-Estatura , Brasil , Niño , Humanos , Masculino , ARN Mensajero/metabolismo , Reacción en Cadena en Tiempo Real de la PolimerasaRESUMEN
Paper-based assays are an attractive low-cost option for clinical chemistry testing, due to characteristics such as short time of analysis, low consumption of samples and reagents, and high portability of assays. However, little attention has been given to the evaluation of the performance of these simple tests, which should include the use of a statistical approach to define the choice of best cut-off value for the test. The choice of the cut-off value impacts on the sensitivity and specificity of the bioassay. Here, we developed a paper-based immunoassay for the detection of the carcinoembryonic antigen (CEA) and performed a statistical assessment to establish the assay's cut-off value using the Youden's J index (68.28 A.U.), what allowed for a gain in sensibility (0.86) and specificity (1.0). We also discuss about the importance of defining a gray zone as a safety margin for test (±12% over the cut-off value), eliminating all false positives and false negatives outcomes and avoiding misleading results. The test accuracy was calculated as the area under the curve (AUC) of the receiver operating characteristic (ROC) curve, presenting a value of 0.97, what classifies this test as highly accurate. We propose here a low-cost method capable of detecting carcinoembryonic antigen (CEA) in human serum samples, highlighting the importance of statistical tools to evaluate a new low-cost diagnostic method.
Asunto(s)
Biomarcadores de Tumor/análisis , Antígeno Carcinoembrionario/análisis , Inmunoensayo/métodos , Humanos , Curva ROC , Sensibilidad y EspecificidadRESUMEN
ABSTRACT Introduction: Differential diagnosis of skeletal and dental relationships is crucial for planning orthodontic treatment. Overbite depth indicator (ODI) and anteroposterior dysplasia indicator (APDI) had been introduced in the past for assessment of vertical and sagittal jaw relationships, respectively. Objective: The objectives of this study were to evaluate the reliability of ODI and APDI in overbite and Angle malocclusions, as well as assess their diagnostic reliability among males and females of different age groups. Material and Methods: This study was conducted using pretreatment dental casts and lateral cephalograms of 90 subjects. For ODI, subjects were divided into three groups based on overbite (normal overbite, open bite and deep bite). Likewise, the same subjects were divided for APDI into three groups, based on Angle's malocclusion classification (dental Class I, II and III malocclusions). Mann-Whitney U test was applied for comparison of study parameters regarding sex and different age groups. The mean values of ODI and APDI were compared among study groups by means of Kruskal-Wallis and post-hoc Dunnet T3 tests. The receiver operating characteristic (ROC) curve was applied to test diagnostic reliability. Results: Insignificant differences were found for ODI and APDI angles, particularly in regards to sex and age. Significant intergroup differences were found in different overbite groups and Angle's classification for ODI and APDI, respectively (p < 0.001). ROC showed 91% and 88% constancy with dental pattern in ODI and APDI, respectively. Conclusions: ODI can reliably differentiate deep bite versus normal overbite and deep bite versus open bite. APDI can reliably differentiate dental Class I, II and III malocclusions.
RESUMO Introdução: o diagnóstico diferencial das relações esqueléticas e dentárias é essencial para o plano de tratamento ortodôntico. O indicador de profundidade da sobremordida (ODI)) e o indicador de displasia anteroposterior (APDI) foram desenvolvidos, no passado, para avaliação das relações verticais e sagitais dos maxilares, respectivamente. Objetivo: o objetivo desse estudo foi avaliar a confiabilidade do ODI e do APDI em diferentes sobremordidas e más oclusões de Angle, bem como verificar sua confiabilidade diagnóstica em homens e mulheres de diferentes grupos etários. Métodos: esse estudo foi conduzido utilizando-se modelos de estudo e radiografias cefalométricas laterais pré-tratamento de 90 indivíduos. Para o ODI, os indivíduos foram divididos em três grupos, com base na sobremordida (sobremordida normal, mordida aberta, mordida profunda). Ainda, para avaliação do APDI, esses mesmos indivíduos foram divididos em três grupos baseados na classificação de Angle para as más oclusões (Classes I, II e III dentárias). O teste U de Mann-Whitney foi aplicado para comparar os parâmetros estudados, quanto ao sexo e diferentes grupos etários. Os valores médios do ODI e do APDI foram comparados entre os grupos estudados por meio dos testes de Kruskal-Wallis e post-hoc T3 de Dunnett. A curva ROC (receiver operating characteristic) foi aplicada para testar a confiabilidade do diagnóstico. Resultados: diferenças não significativas foram encontradas para os ângulos ODI e APDI, particularmente em relação ao sexo e à idade. Diferenças significativas foram encontradas entre os grupos com diferentes sobremordidas e diferentes más oclusões de Angle, para o ODI e para o APDI, respectivamente (p < 0,001). A ROC mostrou 91% e 88% de concordância com o padrão dentário, para o ODI e APDI, respectivamente. Conclusões: o ODI mostrou-se confiável para diferenciar entre a mordida profunda e a sobremordida normal, e entre a mordida profunda e a mordida aberta. O APDI é confiável para se diferenciar entre as más oclusões dentárias de Classes I, II e III.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Curva ROC , Sobremordida/diagnóstico , Cefalometría , Reproducibilidad de los Resultados , Estudios Retrospectivos , Diagnóstico Diferencial , Sobremordida/clasificaciónRESUMEN
Management of pediatric chronic liver disease is limited by lack of validated noninvasive biomarkers of histologic severity. We demonstrate that magnetic resonance elastography is feasible and accurate in detecting significant hepatic fibrosis in a case series of 35 children with chronic liver disease, including severely obese children.