Classification of heart failure in population based research: An assessment of six heart failure scores

Several scores based on symptoms and signs have been developed to assess the presence of heart failure. The goal of this study was to compare six heart failure scores in non-hospitalised subjects and to determine their usefulness in population based research. The scores were applied to 54 participants of a population based study. All underwent a complete medical examination, including chest X-ray, electrocardiography and Doppler echocardiography. Using all information available, a cardiologist, unaware of the results of the scores, clinically classified participants as having no, possible or definite heart failure. Sensitivity, specificity, predictive values and receiver operating characteristics were calculated, using the cardiologist's assessment as a gold standard. The cardiologist judged definite or possible heart failure to be present in 17 persons. All scores had a high sensitivity for the detection of definite heart failure, whereas the study of men born in 1913 and Walma's score had the highest sensitivity for the combination of possible and definite heart failure. Gheorgiade's and the Boston score had the highest positive predictive values. In conclusion, five of the six scores we studied are broadly similar in the detection of heart failure. The men born in 1913 score relies heavily on the assessment of dyspnea, resulting in a relatively large number of false positives. Although the scores are useful in detecting manifest heart failure, objective measurements of cardiac function appear necessary to reduce the false positive rate and accurately detect early stages of heart failure.     

Influence of age and human papillomavirus-infection on reliability of cervical cytopathology

The aim of the present study was to evaluate the effect of age and human papillomavirus (HPV) infection associated cellular changes on the predictive value of cervical cytology. In a group of 671 women with Papanicolaou smears suggesting low grade squamous intraepithelial lesion (LSIL), high grade squamous intraepithelial lesion (HSIL) or invasive cervical cancer, cervical cytology was correlated with the histological finding. Predictive values were calculated and related to severity of the lesion, age and HPV associated changes. The predictive values of Papanicolaou (cervical) smears suggesting LSIL, HSIL and invasive carcinoma were 40%, 86%, and 78%, respectively. A poor predictive value of smears suggesting LSIL was found among older women. HPV associated changes were diagnosed in 80% of women 25 years of age, 66% in the age group 26 to 35 years, 51% in the age group 36 to 45 years and 38% in women aged 46 years (P = 0.03). The presence of HPV associated cellular changes led to a significantly higher number of overdiagnoses (9% with HPV infection compared to 4% without HPV infection) and HPV negative cases were more frequently associated with underdiagnosis (15% without HPV infection compared to 8% with HPV infection,P = 0.0011). This result remained significant after adjustment for age (P = 0.004). Cellular changes associated with HPV infection most frequently occurred in young women. HPV infection should therefore be acknowledged as source of overdiagnosis in the cytological evaluation of SIL especially in woung women.Supported by the Research Grant of the Mayor of Vienna (no. 1045 [to Dr. Kainz])     

血瘀证目征与血瘀证诊断标准的比较研究

通过６种标准对７８１例患者的诊断研究,提示在诊断阳性率,敏感度,特异度,假阳性率假阴性率和总和积分值等方面,中国血瘀症诊断标准和国际血瘀证诊断标准最优,血瘀证目片和日本瘀血证诊断标准次之,国际瘀血诊断标准试行方案和中山氏瘀血压痛点更次之。各种标准各有其独特优点,应相互取长补短,同时,探讨了导致各种标准不足之处的原因,并提出合理建议。     

Evaluation of delta-aminolaevulinic acid excretion in random urine samples of children

Urinary delta-aminolaevulinic acid (-ALA) excretion was evaluated in random urine samples of 191 healthy children, aged 2–14 years, with blood lead levels <0.8 mol/l (mean ± SD: 0.34±0.13), erythrocyte zinc-protoporphyrin <70 mol/mol haem (mean ± SD: 50.4±8.0) and blood haemoglobin >6.8 mmol/l (mean ± SD: 8.2±0.5). It was found that uncorrected -ALA concentration and -ALA/creatinine ratio are age-dependent, whereas the ratio of -ALA/logarithm of creatinine concentration (mean ± SD: 55.3±13.5 mol/log mmol) is independent of age and sex. The authors recommend the use of this parameter for the assessment of -ALA excretion in random urine samples in children     

中国健康中青年女性全血比粘度参考值与海拔高度的关系

目的：为制定中国健康中青年女性全血比粘度参考值的统一标准提供科学依据。方法：收集了中国各地用毛细管法测定的健康中青年女性全血比粘度参考值,并对其与海拔高度的关系进行了研究。结果：发现随着海拔高度的逐渐增大,健康中青年女性全血比粘度参考值也在逐渐增大,相关性很显著。用一元回归分析的方法推导出一个回归方程。结论：如果知道了中国某地的海拔高度,就可以用回归方程估算这个地区的健康中青年女性全血比粘度参考值。     

短小芽胞杆菌E601抗电离辐射性的研究

目的　短小芽胞杆菌Ｅ６０１ 已在中国确定为辐射灭菌指示菌。为使指示菌在灭菌过程中的应用标准化、规范化,保证灭菌质量,需要对其固有抗辐射性和影响因素,以及如何制备抗辐射稳定的生物指示剂作详尽研究。方法　应用钴６０γ射线和高能电子束对短小芽胞杆菌Ｅ６０１ 进行辐照,测定不同条件下的Ｄ１０ 值。结果　①因载体、介质不同,Ｄ１０ 值变化在１ ．６０ ～２．５３ｋＧｙ 之间。②不同温度下保存一年,指示菌片芽胞抗辐射性无明显变化。但随着保存时间延长,菌片上存活菌数逐渐减少。③载体、介质影响存活率,电子束与钴６０ 结果一致。结论　短小芽胞杆菌Ｄ１０ 值在１ ．６０～２．５３ｋＧｙ 之间,且抗性稳定。本试验条件下制备的可溶性菌片抗力高,Ｄ１０ 值为２ ．５３ｋＧｙ,可长期保存,适宜作指示剂应用     

Adverse drug events in hospitalized patients A comparison of doctors, nurses and patients as sources of reports

Objective: This study investigated the relative value of adverse drug events reported by doctors, nurses and patients. Methods: The study was conducted on a total of four wards: the paediatric and internal medicine wards (including geriatric patients) of two peripheral hospitals in the Netherlands. Adverse drug events were collected by spontaneous reporting (doctor and nurse reports) and by daily ward visits, during which the patients were interviewed by a hospital pharmacist (patient reports). Criteria for relative value of the reported adverse drug events were the number of potentially serious reactions, the number of reactions not mentioned in the patient information leaflet and the number of reactions reported to new drugs (5 years or less on the Dutch market). No formal causality assessment was applied. Results: Over a period of 2 months in 1996 (Hospital I) and 2 months in 1997 (Hospital II) a total of 620 patients were included in the study and adverse drug events were reported in 179 (29%) of these cases. Doctors reported a statistically significant larger number of serious (26% of all doctor reports; odds ratio (OR) 3.2; confidence interval (CI) 1.2–8.7) and unknown (39%; OR 2.5; CI 1.0–6.0) adverse drug events than patients themselves during the daily ward visit. Doctors also reported more serious and unknown adverse drug events than nurses. Adverse reactions to new drugs were reported during the daily ward visit only (8% of all daily ward visit reports). Conclusion: This study reconfirms that doctors are the main source for reports of serious and unknown adverse drug events in hospitalized patients. However, patients themselves seem to report more adverse reactions to new drugs (during the daily ward visit). By focusing on patients using new drugs, the daily ward visit might become cost-effective. This needs to be explored in future studies. Received: 10 September 1998 / Accepted in revised form: 30 November 1998     

Retrospective prediction of birth weight by growth velocity curves during neonatal period

In this prospective study, birth weight of 304 babies born at Kamla Nehru Hospital Pune during study period was recorded. From these 304 babies, babies with birth weight above 2000 grams were selected (260 babies) to prepare growth velocity curves. Daily weight of these 260 babies was recorded for 30 days. The mean birth weight of study population was 2742.5 grams. Among the daily weight recorded babies, all the babies lost weight ranging from 92 to 218 grams (mean 121 grams) after birth. The weight loss continued upto 5 days. Days required to gain weight equal to birth weight ranged from 5 to 13 days. Total weight gain observed in 30 days was 734.7 grams. Predictive value of these curves was tested in 49 infants. Deviation upto 50 grams of predicted birth weight from actual birth weight was observed in 90% of babies on day-2, 79% on day-4, 65% on day-8 and 39% on day-30.     

Incidence of analgesic nephropathy among patients undergoing renal replacement therapy in Czech republic and Slovak republic

BACKGROUND.: The occurrence of analgesic nephropathy (AN) among renal replacementtherapy patients in former Czechoslovakia is not known. Previoussurveys were not based on representative samples and lackeduniform criteria for diagnosing the disease. METHODS.: Incidence of AN in former Czechoslovakia was investigated inpatients commencing renal replacement therapy in 24 (1/3 ofall) dialysis centres from 1 January to 31 December 1992. Patientsshowing an unclear renal diagnosis (n=149) were investigatedwith an interview and renal imaging techniques. The diagnosisof AN was withheld or rejected on the base of recently publisheddiagnostic criteria demonstrating that a decreased renal massof both kidneys combined with bumpy contours and/or papillarycalcifications had a high performance for diagnosing AN (NephrolDial Transplant 1992; 7: 479–486). RESULTS.: Based on the renal imaging criteria, AN was diagnosed in 30of 328 registered patients, resulting in an AN incidence of9.1% while the EDTA data only mentioned an incidence of 4.8%(period 1986–1989). The products most commonly abusedwere analgesic mixtures containing two analgesic substancescombined with caffeine and/or codeine. CONCLUSIONS.: AN was found to be a common disease in the Czech and SlovakRepublics. The disease was diagnosed using reliable renal imagingcriteria.