Should we consider performing oral glucose tolerance tests more frequently in postmenopausal women for optimal screening of impaired glucose tolerance?

OBJECTIVE: To investigate an optimal screening protocol for impaired glucose tolerance (IGT) and type II or non-insulin-dependent diabetes mellitus (DM) by using fasting plasma glucose (FPG) and oral glucose tolerance test (OGTT) in postmenopausal women. DESIGN: One hundred consecutive postmenopausal women were screened with FPG determination, and then all underwent an OGTT. Basal serum lipid and insulin levels of these women were also determined. Insulin sensitivity was determined by using the homeostasis model assessment. Receiver operating characteristic analysis was performed to determine the efficacy of these variables in detecting women with IGT and DM, and optimal cutoff values were determined. RESULTS: FPG with a cutoff value of 98 mg/dL had the best combination of sensitivity (71%) and specificity (76%) for the detection of IGT and DM. Combined FPG and body mass index screening (with the optimal cutoff value of 26.5 kg/m2) improved the sensitivity to 96% but decreased the specificity to 47%. This combined screening protocol detected 94% of the women with IGT and all diabetic women. CONCLUSIONS: Given that IGT and DM are common among postmenopausal women and DM can be prevented by nonpharmacologic interventions in women with IGT, OGTT may be used more frequently among these women. Our data indicate that for optimal screening of non-insulin-dependent DM and IGT, OGTT should be considered in postmenopausal women, especially when risk factors in addition to age are present. This model may detect most of the women with IGT and almost all diabetic women.     

Galactosemia: when is it a newborn screening emergency?

Classic galactosemia is an autosomal recessive disorder of carbohydrate metabolism, due to a severe deficiency of the enzyme, galactose-1-phosphate uridyltransferase (GALT), that catalyzes the conversion of galactose-1-phosphate and uridine diphosphate glucose (UDPglucose) to uridine diphosphate galactose (UDPgalactose) and glucose-1-phosphate. Upon consumption of lactose in the neonatal period, the affected infants develop a potentially lethal disease process with multiorgan involvement. Since the advent of newborn screening (NBS) for galactosemia, we rarely encounter such overwhelmingly ill newborns. After ascertainment that the positive NBS indicates the possibility of galactosemia due to GALT deficiency, the critical question for the physician is whether the infant has the classic or a variant form of GALT deficiency, as classic galactosemia is a medical emergency. However, there are over 230 GALT gene mutations that have been detected around the world. Yet, most positive NBS tests are due to the Duarte biochemical variant condition or a simple false positive. In order to make the correct decision as well as provide informative counseling to parents of infants with a positive NBS, I utilize a relatively simple classification scheme for GALT deficiency. There are three basic forms of GALT deficiency: 1) classic galactosemia; 2) clinical variant galactosemia; and 3) biochemical variant galactosemia. The classic genotype is typified by Q188R/Q188R, the clinical variant by S135L/S135L and the biochemical variant by N314D/Q188R. In classic galactosemia, the erythrocyte GALT enzyme activity is absent or markedly reduced, the blood galactose and erythrocyte galactose-1-phosphate levels are markedly elevated, and the patient is at risk to develop potentially lethal E. coli sepsis, as well as the long-term diet-independent complications of galactosemia. Patients with the clinical variant form require treatment but do not die from E. coli sepsis in the neonatal period. If the clinician suspects galactosemia, even if based on clinical findings alone, then the infant should be immediately placed on a lactose-restricted diet. The purpose of this review is to help the clinician make the correct therapeutic decision after an NBS test has returned positive for galactosemia.     

Genetic screening for reproductive purposes at school: is it a good strategy?

Thalassemia and Tay-Sachs disease were the first diseases in which the criteria for heterozygote genetic screening were met and successful programs for reproductive purposes were initiated in populations at risk. However, many of the couples first discover the possibility of genetic screening during pregnancy and efforts are made to bring couples to consider screening tests before the first pregnancy. In this context, high school offers a convenient setting and several pilot programs have been very successful. All evaluations of these programs found that education plays a critical role in allowing informed decisions and minimizing the possible harms. While it has been suggested that high school may be the best setting for reproductive screening programs, guidelines of several societies of human genetics recommend the use of carrier screening only in individuals older than 18 years. There are several other problems related to genetic screening programs at school and some are discussed in the review. Our opinion is that school should be a place to provide the tools for decisions by education only; while the option to have the genetic tests later in life or in another setting should be offered to the students as part of the education session. This may allow the students to decide when and where to have a genetic test.     

Genetic screening for Alzheimer's disease: what factors predict intentions to take a test?

The authors investigated factors that predict intention to take a genetic test for Alzheimer's disease (AD). The 449 men and women were surveyed in two groups: (a) those told that a positive result meant a 90% chance of developing AD (increased certainty) and (b) those told that a positive result meant a 50% chance of developing AD (decreased certainty). Participants completed measures of the Theory of Planned Behavior (TPB), anticipated regret, risk perception, likelihood of taking a genetic test for cancer, and AD risk factors. Just over 50% of the variance in intentions was related to TPB variables, likelihood of taking a genetic test for cancer, number of people the participants knew who had AD, experimental condition, and anticipated regret. The subjective norm was the strongest predictor of intention in the increased certainty group, whereas positive belief was the strongest predictor in the decreased certainty group.     

The postpartum depression screening scale: is it valid to screen for antenatal depression?

The purpose of the study was to analyse for the first time the validity of a slightly modified version of the Portuguese Postpartum Depression Screening Scale (PDSS), to be used as a screening instrument for antenatal depression. Specifically, the aims were to analyse its psychometric properties, to determine PDSS cutoff points and associated conditional probabilities to screen for depression according to DSM-IV and ICD-10 criteria and to compare its screening performance with that of the Beck Depression Inventory-II (BDI-II). Five hundred and three pregnant women in the third trimester of pregnancy completed both questionnaires and were interviewed face-to-face with the Portuguese version of the Diagnostic Interview for Genetic Studies. The Portuguese version of the Operational Criteria Checklist for Psychotic Illness was used to obtain DSM-IV and ICD-10 diagnoses of depression, our gold standards for caseness. PDSS reliability and validity were very good and comparable to those obtained in the postpartum validation studies developed in Portugal and in other countries, showing satisfactory sensitivity and specificity combinations (≅80%). Compared with BDI-II, it has the advantage of being more specific for the motherhood context. Although developed for postpartum depression, PDSS is accurate to screen for antenatal depression, and it could be very useful for clinical and epidemiologic purposes.     

The Othmer and DeSouza test for screening of somatisation disorder: is it useful in general practice?

BACKGROUND: Somatisation disorder is an underdiagnosed and difficult problem for family physicians. Early diagnosis of somatisers is a very important factor in improving health outcomes. AIM: To assess the validity of the Othmer and DeSouza test (a seven-item questionnaire) used by general practitioners as a screening instrument for the diagnosis of somatisation disorder in primary care. DESIGN OF STUDY: A cross-sectional study of patients presenting with unexplained multiple chronic physical symptoms. SETTING: A total of 149 patients were selected for the study by 29 family physicians in the primary health care centres of the Basque Health Service in the metropolitan area of Bilbao, Bizkaia, Spain. METHODS: Participating patients completed the Othmer and DeSouza test, carried out by family physicians. Their answers were compared with the results of the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). This psychiatric interview was administered blind to 144 patients by trained psychiatrists. RESULTS: A total of 19% of patients were diagnosed as having somatisation disorder by the SCAN psychiatric interview. The discriminating capacity of the Othmer and DeSouza test for all possible screening thresholds (> or = 1, > or = 2, ... > or = 6 symptoms) was very low and positive predictive values ranged between 19% and 33%. With respect to negative predictive values, even in the absence of affirmative responses to all seven questions, the pretest probability of being a non-somatiser case remained unchanged. CONCLUSION: Our data indicate that the Othmer and DeSouza test does not present clinically useful predictive values in primary care patients with suggestive symptoms of somatisation disorder.     

Prick tests to aeroallergens: is it possible simply to wipe the device between tests?

BACKGROUND: Improperly performed skin prick tests (SPT) can lead to wrong allergy diagnosis and incorrect treatment. To overcome false-positive results it is recommended to change the puncture device between each test, although very few studies have examined the real drawbacks (false-positives) and advantages (time and cost savings) of using only one device. METHODS: Two groups of 20 patients with rhinitis or asthma, sensitized to either house-dust mites or grass pollens, had successive serial SPT to 9% codeine phosphate and the relevant allergen using the same needle or lancet, wiped between each test. RESULTS: With both the needle and the lancet, there were 12.5-67.5% false-positive results using the house-dust mite or grass pollen allergen extracts, respectively. There were no false-positive results with the 9% codeine phosphate. CONCLUSIONS: Our study shows that this technique is not reliable as it provoked an unacceptable number of false-positive results.     

Frontal sinus: is it a predictor for vertical malocclusions?

Anatomical Science International - The aim of the present study was to evaluate 3D frontal sinus morphology in consideration with different vertical facial developments. The study was conducted...     

Histopathological screening for prostate carcinoma: is a benign biopsy a negative biopsy?

In case of clinical suspicion of a prostate malignancy, a prostate biopsy is the most widely used approach to confirm prostate cancer. Unfortunately, exclusion of prostate cancer is not feasible by means of biopsy and also the negative rate remains consistently high. Here, we review the information the surgical pathologist can still gain from a prostate biopsy in absence of overt carcinoma.     

Is it possible to extract a fingerprint for early breast cancer via EEG analysis?

People with abnormal breast tissue can eventually present breast cancer symptoms. The aim of this paper is to examine new prognostic methods for breast cancer using electroencephalographic techniques (EEG). Since it is known that electrical brain activity can be recorded by EEG, and since proteins and genes affect the electrical activity of the brain via the control of the flow of Na(+) and K(+) ions, and also given the fact that breast cancer and many other types of cancer are associated with 14-3-3 protein and genes, we hypothesize that there is a relationship between breast cancer and EEG. We examine the theoretical linkages between EEG, genes and proteins, and breast cancer, and propose the development of an intelligent technique for associating EEG with the early stages of breast cancer (i.e., atypical hyperplasia) as a fingerprint characteristic. This novel approach may provide the means for a new diagnostic and prognostic approach to early stage breast cancer, and other cancers.     

Hepatitis C: is there a case for universal screening in pregnancy?

Hepatitis C (HCV) is not routinely screened for antenatally in all maternity hospitals. Most hospitals adopt a policy of targeted screening. The policy in the Coombe Women and Infants University Hospital in Dublin changed from targeted screening in 2006 to universal screening in 2007. We audited the two consecutive years. The prevalence of HCV in our antenatal population was 1.4% for 2006 (67/4666) when targeted screening applied and in 2007--0.71% (66/9222) when universal screening came into affect. One woman in 2007 would not have been detected by targeted screening--1.49% (1/67). Fifty five percent (37/67) of women were HCV-RNA positive in 2006 and 57.5% (38/66) were positive in 2007. We conclude that there were similar detection rates for HCV in 2006 and 2007 and that universal screening is not required if inclusive criteria for selective screening are employed but is of use in research context.     

The 6-min walk test in heart failure: is it a max or sub-maximum exercise test?

The aim of the study is to compare the cardiorespiratory response during the 6-min walk test (6MWT) with a symptom-limited cardiopulmonary exercise test (CPET) in patients with varying degrees of heart failure. Thirty-seven patients with heart failure (New York Heart Association I–III) were asked to complete a 6MWT and a CPET on a cycle ergometer. Respiratory gases were measured during both the tests and patients were grouped into tertiles according to their VO_2peak reached during the CPET prior to performing statistical analysis of all other respiratory parameters. Patients were grouped into the following tertiles: Group 1 (VO_2peak >25.2 ml/kg per min, N = 13), Group 2 (VO_2peak >17.5–25.2 ml/kg per min), and Group 3 (VO_2peak ≤17.5 ml/kg per min). Despite the good overall correlation between 6MWT VO₂ and CPET VO_2peak (r = 0.72, P < 0.001), significant differences were seen within Groups 1 and 3 (P < 0.05). In Group 1, 6MWT VO₂ was significantly lower compared with CPET VO_2peak, whereas Group 3 showed significantly higher 6MWT VO₂ compared with CPET VO_2peak. In conclusion, the use of the 6MWT to evaluate exercise capacity in patients with heart failure is highly dependent on the degree of functional impairment. In patients with advanced heart failure, the 6MWT elicits a maximum exercise response, whereas it only constitutes a sub-maximal exercise test in patients with mild heart failure and no functional limitations. This must be taken into consideration when using the 6MWT in large epidemiological studies to evaluate therapy outcome and clinical prognosis in patients with varying degrees of clinical disabilities.     

From tolerance to autoimmunity: is there a risk in early life vaccination?

The potential for vaccines to act as triggers of autoimmune reactions has received much recent attention. Such an association is very poorly defined mechanistically, but may potentially involve epitope mimicry between vaccinal and self antigen, or the immuno-stimulatory effects of vaccine adjuvant. If such reactions occur, they are more likely to involve adults than infants in early life, as a reflection of the immunological immaturity of the newborn. There has been a recent focus in immunology on the link between innate and adaptive immunity provided by dendritic cells and the range of Toll-like receptors (TLRs) that are the point of first contact of these cells with microbial antigen. These interactions appear to determine the nature of the subsequent adaptive immune response and whether it may be mediated by Th1, Th2, Th17 or T regulatory populations. TLR interactions may also be significant in the induction of vaccinal immunity and agonists of these receptors are being developed as potential vaccine adjuvants. There are differences in cytokine production of adult and newborn dendritic cells, and these differences must be considered in the application of such novel adjuvants to products intended for either age group.     

Simple/rapid test devices for anti-HIV screening: do they come up to the mark?

Thirteen simple/rapid test devices (S/RTDs) for the detection of antibodies to HIV 1 and HIV 2 were assessed. Ninety-two specimens in four categories were used and results with the thirteen S/RTDs were compared with those obtained with six currently available commercial laboratory-based anti-HIV 1/2 EIAs. Seven of the 13 S/RTDs scored all 26 blood donors' specimens as unreactive, and 11 correctly identified all the 25 "straightforward" anti-HIV positive specimens. False negative results arose when testing by Uni-Gold HIV and SeroCard HIV, which gave 72 and 68 correct positive observations, respectively, out of 75. No S/RTD detected seroconversion earlier than the most sensitive EIAs, but four S/RTDs performed similarly to most of the EIAs. On the low-titre panel specimens, six S/RTDs were less sensitive than the least sensitive EIA and, in contrast to four of the six EIAs, only one S/RTD was able correctly to identify all the positive specimens. A manufacturing problem was identified that allowed the HIV antigen-sensitised area on the membrane of two SeroCard HIV devices to be misaligned with the device's reading window so that the reaction was almost entirely obscured. As long as small numbers of specimens were involved, most S/RTDs required considerably less time and less equipment than EIAs, but overall they were slightly less sensitive. Their use in various health settings and for confirmatory procedures is discussed.