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PubMed2004

Neonatal TSH levels as an index of iodine sufficiency: differences related to time of screening sampling and methodology.

INTRODUCTION: Current WHO guidelines consider that under adequate iodine intake <3% of newborns should have neonatal TSH levels of >5 mU/l blood when screening is performed in cord blood or at 3 days to 3 weeks of age. OBJECTIVE: To estimate whether this absolute criterion when applied to newborns older than 48 h of age and native to Buenos Aires coincides with the traditional ones (goiter and urinary iodine in school-age children (SAC)), and if the evaluation varies with either the methodology used for TSH measurements and/or the time of specimen sampling. POPULATION AND METHODS: TSH was measured by an immunofluorometric assay (IFMA) on filter paper blood spots of 186 cord blood samples, 112 babies <48 h of age and 1,500 newborns >48 h of age, and by immunoradiometric assay (IRMA) in 238 newborns. The WHO ICCIDD absolute criteria were applied to each population. Thyroid volume was assessed by direct palpation in 500 SAC, and in 100 of them urinary iodine levels were measured. RESULTS: TSH levels were >5 mU/l blood in 11.3% of the cord blood samples and in 3.6% of the samples from babies <48 h of age, suggesting mild iodine deficiency. TSH was >5 mU/l in 2.7% of newborns >48 h of age tested by IFMA (iodine sufficient) and in 30% measured by IRMA (moderate iodine insufficiency). Median urinary iodine and goiter prevalence in SAC were 143 mug/l and 4.5%, respectively, as expected in an iodine-sufficient area. conclusion: The TSH levels in Buenos Aires conform with the WHO criterion that defines iodine sufficiency. Application of this criterion, however, to cord blood samples or samples from babies <48 h old and the use of different methodologies may lead to erroneous conclusions.

Aging↗
PubMed2005

Real-time PCR screening for 16S rRNA mutations associated with resistance to tetracycline in Helicobacter pylori.

The effectiveness of recommended first-line therapies for Helicobacter pylori infections is decreasing due to the occurrence of resistance to metronidazole and/or clarithromycin. Quadruple therapies, which include tetracycline and a bismuth salt, are useful alternative regimens. However, resistance to tetracycline, mainly caused by mutations in the 16S rRNA genes (rrnA and rrnB) affecting nucleotides 926 to 928, are already emerging and can impair the efficacies of such second-line regimens. Here, we describe a novel real-time PCR for the detection of 16S rRNA gene mutations associated with tetracycline resistance. Our PCR method was able to distinguish between wild-type strains and resistant strains exhibiting single-, double, or triple-base-pair mutations. The method was applicable both to DNA extracted from pure cultures and to DNA extracted from fresh or frozen H. pylori-infected gastric biopsy samples. We therefore conclude that this real-time PCR is an excellent method for determination of H. pylori tetracycline resistance even when live bacteria are no longer available.

DNA, Bacterial↗
PubMedDate not supplied

Screening parameters for ThinPrep and conventional gynecologic cytology via automated monitoring.

OBJECTIVE: To compare diagnostic discrepancies and screening parameters between conventional (CP) and ThinPrep (TP) (Cytyc Corporation, Boxborough, Massachusetts, U.S.A.) cervicovaginal samples using Pathfinder (Neopath, Redmond, Washington, U.S.A.). STUDY DESIGN: Pathfinder tracked average screening time, percent slide coverage and percent overlap of viewing fields for CP and TP. False negative rate (FNR) was determined by rescreening 10% of random and high-risk negative cases. CP and TP FNR with Pathfinder were compared to control groups without Pathfinder. RESULTS: A total of 46,393 Pathfinder cases were evaluated (43,354 CP, 3,039 TP) as compared to 62,981 without Pathfinder (60,307 CP, 2,674 TP). FNR was calculated for 12,983 negatives. Using Pathfinder resulted in a significant reduction in FNR for CP atypical squamous cells of undetermined significance and atypical glandular cells of undetermined significance cases. No decrease in FNR was observed for CP squamous intraepithelial lesions or for TP cases. TP slides were screened 66 seconds faster on average than CP. With electronic feedback, mean percent slide coverage and percent overlap were similar between CP and TP cases. Without feedback, coverage dropped and overlap increased slightly for both CP and TP. Technologists screened faster with feedback, saving an average of 50 seconds on CP and 41 seconds on TP. CONCLUSION: Pathfinder significantly reduced FNR for CP but not TP. Technologists screened TP significantly faster than CP while maintaining similar coverage and overlap. Pathfinder feedback itself may decrease screening time.

Cervix Uteri↗
PubMed2001

Primary antegrade ureteric stenting: prospective experience and cost-effectiveness analysis in 50 ureters.

AIM: To evaluate the success rate and cost efficiency of primary antegrade ureteric stenting (antegrade ureteric stent insertion as a single procedure without preliminary drainage). MATERIALS AND METHODS: A policy of primary stenting was tested in 38 patients (50 ureters) with obstructive hydronephrosis, of acute or chronic onset and of benign or malignant origin. Patients with suspected pyonephrosis were excluded. Patients successfully primarily stented (group 1) were compared to a group stented as a traditional two-stage procedure (group 2). End point assessments were screening time, equipment used, procedure-related costs, bed occupancy and technical and clinical success rate. Using these cost and outcome measures, a cost-efficiency analysis was performed comparing the two strategies. RESULTS: 40/50 (80%) ureters were considered primary stent successes. The average procedure-related bed occupancy was 2 days (range 1-2 days). Simple equipment alone was successful in 16 cases. Van ( pound46/case). The mean screening time was similar for the two groups (13.5 min vs Andel dilatation catheters and peel-away sheaths were frequently used (23 ureters). Expensive equipment was rarely necessary (four cases) and average extra equipment cost was small 15.3 min; P > or = 0.05). There was a minimum saving of pound800 per successful primary stent. The cost-effectiveness of a primary antegrade stenting strategy was pound1229 vs pound2093 for secondary stenting. CONCLUSION: In carefully selected patients, the majority of obstructed ureters can be primarily stented using simple equipment. The reduced hospital stay and overall success rate significantly improves the cost competitiveness of antegrade ureteric stenting.

Acute Disease↗
PubMed2001

Time costs associated with cervical cancer screening.

OBJECTIVES: Time costs borne by women when undergoing cervical cancer screening have rarely been elucidated, although such costs may pose substantial barriers to care. The purpose of this project was to quantify the opportunity costs associated with cervical cancer screening in young women attending Planned Parenthood Clinics. METHODS: We conducted a self-report survey of 105 women from six clinics to measure travel, waiting, and exam times associated with cervical cancer screening. Respondents recorded their time of arrival and departure, length of time in the waiting room, age, income level, and hours per week they worked outside of the home. Time costs were valued three ways: through self-reported hourly wage, age- and gender-adjusted minimum earnings, and national age- and gender-adjusted hourly wages. RESULTS: Respondents were on average 24 years old, worked 29 hours per week outside the home, and earned less than $20,000 per year. Mean time for one-way travel was 18.7 minutes; waiting room time was 16.9 minutes; and exam time was 50.8 minutes. Time costs were estimated to be $14.08 per visit based upon the self-reported hourly wage; $16.46 per visit based upon age- and gender-adjusted minimum earnings; and $19.63 per visit based upon age- and gender-adjusted national wage rates. CONCLUSIONS: Time costs associated with cervical cancer screening represent an important opportunity cost and should be considered in studies attempting to identify barriers to screening adherence. Our results indicate that time costs accounted for up to 25% of cervical cancer screening costs. Time costs should be identified, measured, valued, and included in cost-effectiveness analyses of cervical cancer screening.

Adult↗
PubMed1996

ThinPrep processing of endoscopic brushing specimens.

To evaluate ThinPrep (Cytyc, Marlborough, MA) processing of endoscopic brushing specimens for cytologic examination, ThinPrep slides and direct smears of 29 gastrointestinal (GI) and 22 bronchial brushings were compared. Clinicians prepared the direct smears. The brush was then immersed in CytoLyt (Cytyc) and one ThinPrep slide made. All cases had corresponding biopsies. Smears and ThinPrep slides were screened and reviewed independently. Screening time per case was recorded. All slides were evaluated for cellularity, quality, cellular preservation, and quantity of diagnostic cells. A diagnosis was rendered for each case. Cytologic and histologic diagnoses were correlated. Follow up was obtained for cases with discrepant histologic and cytologic diagnosis. Twenty-three brushings were from esophagus, 5 stomach, 1 duodenum, and 22 lung. An average of 3.6 direct smears (range 2-6) was made for each case. Average screening time per case was 12 minutes for GI direct smear, 15 minutes bronchial direct smear, 4 minutes GI ThinPrep slide, and 9 minutes bronchial ThinPrep slide. ThinPrep slides were superior to direct smears in cellularity, quantity of diagnostic cells, and quality of slides. ThinPrep slides and direct smears showed comparable cellular preservation. The sensitivity of detecting malignancy by biopsy, direct smears, and ThinPrep slides was 81%, 75%, and 75%, respectively. One false-positive diagnosis was made on cytology with both direct smear and ThinPrep slide, a case with radiation atypia. In conclusion, ThinPrep slides are at least comparable to direct smears in cytologic examination of brushings. However, false-positive diagnosis is a possible potential pitfall.

Biopsy↗
PubMed2003

Do radiologists' radiation-related opinions predict their fluoroscopy doses?

The influence of radiologists' radiation-related opinions to fluoroscopy doses was studied. Dose-area products (DAP), screening times and the number of exposures per patient were recorded in 528 barium enema examinations performed by 23 residents (14 female, 9 male). The residents' scored opinions (on the general radiation risk in radiology, the importance of radiation protection in radiology and their estimate of their own dose level on which they operate when compared with their colleagues) were correlated with these radiation variables. Residents' opinion on the importance of radiation protection correlated positively with screening time (r=0.402, p=0.008) and with DAP (r=0.333, p=0.028). The female residents (score 8.3) considered radiation protection more important than the males (score 7.4, p=0.029). The stability of these opinions was suggested by finding them not to correlate with residents' age or radiological experience. Residents could not reliably estimate their true dose levels, which were compared with the estimated dose levels. Fluoroscopy behaviour and doses seem to be affected by psychological factors. Further psychologically oriented studies might assist in revealing such factors and in developing proper teaching methods for radiologists to control their doses.

Attitude of Health Personnel↗
PubMed2004

Radiation peak skin dose to risk stratify electrophysiological procedures for deterministic skin damage.

UNLABELLED: Ionising radiation is has the potential to cause harm both by increasing the probability future malignancy (stochastic mechanisms) and by direct physical injury (deterministic mechanisms). Several measures have been developed to quantify radiation exposure during a procedure and cardiologists usually refer to fluoroscopic screening time (FST). FST, however, has limitations for predicting deterministic injury which is directly dependant on peak skin dose (PSD). We compared FST to PSD for a range of interventional cardiac electrophysiology procedures. METHODS: All patients undergoing electrophysiology procedures during a 2-month period in our institution were studied. Demographic details, nature of procedure, FST and PSD were measured. The FST to PSD ratio was calculated and compared between patient and procedural factors. RESULTS: 67 procedures on patients (23 female) with body mass index (BMI) of 28 (SD 5) Kg/m2 were studied. Screening times ranged from 0.2 to 96.6 min (median 11.2). PSD ranged from <0.1 to 1108 mGy (median 141). There was a positive correlation between PSD to FST ratio and BMI (r = 0.59, p < 0.001). The PSD to FST ratio was higher in cardiac resynchronization therapy (CRT) devices than single or dual chamber ICDs (p = 0.002). CONCLUSION: FST is not a reliable predictor of deterministic skin injury and in high-risk procedures such as CRT devices and those on individuals of high BMI PSD should be measured.

Body Mass Index↗
PubMed1997

Assessment of lifetime gained as a result of mammographic breast cancer screening using a computer model.

A computer model for the simulation of breast cancer screening (MBS) is used to calculate the results of screening in terms of lifetime. To optimize breast cancer screening protocols, risk (lifetime lost due to radiation-induced tumours) versus benefit (lifetime gained due to early detection of breast cancer) analyses are performed for a simulated stable Swedish female population. The present study focuses on the results of different screening strategies employing single view mammography, including starting and finishing ages of screening, time interval between successive screening sessions as well as the influence of high detection screening and differences between different populations, based on lifetime lost or gained. To test the stability of the recommendations with respect to possible changes in the variables used in MBS, calculations are also performed for high risk factors for breast tumour induction using both the additive and multiplicative risk models, fast growing breast tumours, late incidence of breast tumours and age dependent survival. The results of the simulations expressed in terms of lifetime gained suggest that a theoretical benefit can be obtained employing starting and finishing ages of 35 and 75 years, respectively. In terms of number of fatal breast tumours, the favourable screening period is 40-80 years. It is concluded that the recommendations are stable for changes in the input variables of MBS. The benefits of higher detection screening are more marked for younger than for older women. A high screening frequency results in more lifetime gained, especially at relatively young ages, whereas for older ages the effect is only marginal.

Adult↗
PubMed2006

Comparison of ThinPrep and cytospin preparations in the evaluation of exfoliative cytology specimens.

BACKGROUND: There exists limited literature comparing ThinPrep (TP) with conventional cytospins (CS) in nongynecologic specimens. METHODS: The differences between TP and CS were evaluated for a variety of parameters including cellularity, cytologic morphology, specimen preparation, screening time, laboratory cost effectiveness, cytologist preference, and impact on final diagnosis. Eighty-eight cases including 38 urine, 13 respiratory, and 37 body fluids were prepared simultaneously. RESULTS: TP and CS demonstrated similar cellular yield in the majority of cases. Cytologists preferred TP in 63 (71.6%) and CS in 6 (6.8%) cases; whereas they indicated no preference in 19 (21.6%) cases. Of 14 abnormal cytologies, a more definitive diagnosis of malignancy was rendered by TP in 6 (42.9%) and by CS in 2 (14.3%) cases. TP demonstrated better nuclear chromatin morphology and more uniform distribution of cells. CS showed larger-sized clusters with better preservation of their architecture compared with smaller-sized clusters and significant shrinkage of cell size in TP. CONCLUSIONS: TP was preferred over CS in the majority of cases by both cytotechnologists and pathologists. Cellularity, screening time, and specimen preparation were comparable, although the latter was easier to standardize in TP. In abnormal cases, TP was found to be 3 times more helpful than CS in rendering a definitive diagnosis of malignancy. TP, however, was associated with certain artifacts that cytologists must become familiar with when examining such preparations. Although TP was superior to CS in most cases, the application of both methods may be helpful in selected cases in which the TP diagnosis is not conclusive. Finally, TP was found to be more cost effective than CS.

Adenocarcinoma↗
PubMed1986

Timing of screening for osteomalacia in the acutely ill elderly.

Hypocalcaemia and hypophosphataemia either on admission or before discharge from hospital are poor discriminators for the presence of subclinical osteomalacia in the elderly. Reliance has to be placed on the measurement of alkaline phosphatase even though false positive tests are common. Use of paired admission and predischarge data reduces the false positive rate by approximately 50% thereby reducing the requirement for histological confirmation of the diagnosis of osteomalacia. Since the prevalence of osteomalacia is low in this type of hospital population, any measure which reduces the requirement for bone biopsy is of considerable practical value.

Acute Disease↗
PubMed2003

Agrobacterium tumefaciens-mediated transformation of Indian mulberry, Morus indica cv. K2: a time-phased screening strategy.

An efficient and reproducible protocol for the production of transgenic plants was developed for Morus indica cv. K2 by Agrobacterium tumefaciens-mediated transformation. The hypocotyls, cotyledon, leaf and leaf callus explants precultured for 5 days on regeneration medium were co-cultivated with a bacterial suspension at 10(9) cells/ml for 3 days in the dark. Infectivity of A. tumefaciens strain LBA4404 was more than that of strains GV2260 and A281, and among the various plasmids tried, pBI121 and pBI101:Act1 transformed nearly 100% of the explants followed closely by p35SGUSINT. About 90-100% of the explants tested positive in the beta-glucuronidase (GUS) histochemical assay performed after 3 days of co-cultivation. This high level of transient expression, however, decreased to 20-25% after 15 days. Gus activity was most stable in the callus explants, which emerged as the explant of choice for transformation. The transformed explants were selected on 50-75 mg/l kanamycin for 1 month, and 25-50% of the explants developed adventitious buds. On the basis of kanamycin-resistant shoots produced from the total number of explants inoculated, the transformation efficiency was 44%. After 1 month, 40% of these shoots displayed high gus activity as assessed by the GUS fluorometric assay. On a selection-free root induction medium, 80% of the shoots developed roots and 90% of the potted plantlets acclimatized to the growth room conditions. The 3-month-old regenerates showed gus and nptII(neomycin phosphotransferase II) gene activity as assayed by the GUS fluorometric assay and nptII enzyme assay, followed by PCR polymerase chain reaction (54.5%) analysis after 6-months. Transgene integration into the nuclear genome of 1-year-old regenerates was confirmed in 10 of the 18 transformants tested by Southern analysis. The transformation efficiency as defined by the number of transgenic plants produced from the total number of explants co-cultivated was 6%.

Agrobacterium tumefaciens↗
PubMed2002

Real-time, universal screening for acute HIV infection in a routine HIV counseling and testing population.

CONTEXT: Acute human immunodeficiency virus (HIV) infection cannot be diagnosed by routine antibody tests and is rarely diagnosed in clinical practice. However, HIV nucleic acid-based testing is widely used to screen for antibody-negative acute infection among low-risk blood donors. OBJECTIVE: To assess the feasibility of screening in high-volume laboratories for acute and long-term HIV infection in a routine HIV testing population, in which HIV infection prevalence is low, using specimen pooling and HIV RNA reverse transcriptase-polymerase chain reaction (RT-PCR) tests. DESIGN AND SETTING: Clinical diagnostic performance evaluation at a state-funded public health virology and serology laboratory. PARTICIPANTS: A total of 8505 consecutive individuals presenting for routine HIV counseling and testing during a total of 20 business days to simulate a month of testing in August and December 2001 at 110 publicly funded testing sites in North Carolina. MAIN OUTCOME MEASURES: Prevalence of acute and long-term HIV infection. Serum specimens negative by HIV enzyme immunoassay (EIA) were screened in pools by an ultrasensitive HIV RNA RT-PCR test. Results for individual HIV RNA-positive specimens were reclassified as true or false according to results of confirmatory testing. RESULTS: Of the 8505 individuals screened, 8194 had not previously tested HIV positive and had sufficient serum to complete the testing protocol. Of those, 39 had long-term HIV infection (prevalence, 47.6 per 10,000 at-risk persons [95% confidence interval, 33.8-65.0 per 10,000]). Of the 8155 at-risk individuals whose antibody tests were negative, 5 were HIV RNA positive. Four of those had true-positive acute infection (prevalence, 4.9 per 10,000 [95% confidence interval, 1.3-12.5 per 10,000]). All 4 were women; 2 developed symptoms consistent with an acute retroviral syndrome in the week after testing. Screening all specimens required 147 HIV RNA tests. Overall specificity of the strategy was 0.9999. CONCLUSIONS: These findings suggest the widespread diagnosis of acute HIV infections in a routine testing population is not only possible but feasible using specimen pooling and nucleic acid testing. These additional procedures may increase diagnostic yield by approximately 10% compared with conventional HIV antibody testing.

AIDS Serodiagnosis↗
PubMed2005

[New developments in 2005 for the management of visual deficit in the infant].

The main progress in ophthalmopediatrics is the knowledge of the importance and efficacy of visual refraction defects screening. This screening has to be the earliest possible, allowing a glass equipment preventing complications: amblyopia, strabismus. This screening allows the same time screening of organic anomalies and early treatment.

Age Factors↗
PubMed2006

[Screening and timing for the delivery of fetuses with intrauterine growth restriction of vascular origin].

The prenatal management of fetuses with intrauterine growth restriction (IUGR) has been a matter of perpetual evolving in obstetrics and has been the topic of numerous studies. The management of IUGR fetuses is currently available in tertiary centres using fetal heart monitoring, short term variability, or doppler investigation of the umbilical artery, ductus venosus and middle cerebral artery. The aim of the prenatal management is to detect anomalies that may predict severe fetal hypoxemia. On the other hand, any efforts should focus on the possibility to delay the time for delivery as gestational age at delivery together with birth weight appear to be essential parameters of the postnatal outcome.

Birth Weight↗