Re‐evaluation of normative electronystagmography data in healthy ageing

Previous work by our group questions the validity of existing electronystagmography ( eng ) reference ranges in the elderly. We aim to establish valid reference ranges for eng in people over 65 on the Nicolet Nystar Plus system. Ninety‐six healthy asymptomatic subjects over 65 underwent eng , including spontaneous and positional nystagmus, saccades, smooth pursuit, optokinetic nystagmus and bithermal calorics; 95% reference ranges with confidence intervals were calculated. The newly determined reference ranges were far wider than those provided by the eng equipment manufacturer for eight out of 11 parameters (all P < 0.001). Vestibular function is known to deteriorate and become more variable with age. The failure to reflect this change in currently used reference ranges may have contributed to the high rates of vestibular disease reported in some series of dizzy elderly patients. Clinical interpretation of eng depends on valid reference ranges.     

Mortality outcomes based on ED qSOFA score and HIV status in a developing low income country

Objective

To evaluate the utility of the quick Sepsis-related Organ Failure Assessment (qSOFA) score to predict risks for emergency department (ED) and hospital mortality among patients in a sub-Saharan Africa (SSA) setting.

Hot topics in coagulation testing: Important considerations for testing children for bleeding/thrombotic disorders

The accurate use and interpretation of diagnostic investigations are essential for safe and effective patient care. Appropriate application and interpretation of coagulation testing can be challenging, and many controversies exist relating to the standardization of testing procedures, the application of relevant tests to different patient populations and the interpretation of test results. We present a list of the most prominent controversies in coagulation testing and have selected three specific examples (age‐appropriate reference ranges, therapeutic anticoagulation monitoring and tests of thrombin generation) for closer discussion, highlighting examples with a paediatric framework. We discuss the limitations of discrete age‐partitioned reference intervals, given the established principle of developmental haemostasis; the difficulties in establishing normative data across different laboratories; important pre‐analytical variables affecting coagulation testing; the challenges in interpreting APTT and anti‐Xa assays for monitoring unfractionated heparin therapy in different clinical situations; and the limitations in interpreting tests of thrombin generation due to current available thrombin‐specific substrates and the complicating factor of variable alpha2‐macroglobulin levels. These controversies are demonstrated using paediatric examples, but raise important implications for coagulation testing in patients of all ages and highlight the pressing need for further research in these areas.     

The identification of severity ranges for the Edinburgh Postnatal Depression Scale

Objective: The present study established severity cut-off scores for the Edinburgh Postnatal Depression Scale (EPDS) based on a widely used depression symptom severity measure, the Beck Depression Inventory (BDI).

Background: The EPDS is a widely used screening tool to identify clinically significant levels of depression in postpartum women. Traditionally, an EPDS cut-off score is used to identify probable depression. This dichotomisation of postpartum women into depressed vs. non-depressed groups fails to account for valuable information regarding the variability in symptom severity among those in the depressed group. The identification of depression severity ranges (e.g. mild, moderate or severe) for the EPDS would provide incremental information regarding level of depression, which in turn, could inform treatment referrals.

Methods: A sample of 1516 postpartum women completed the EPDS and the BDI. Equipercentile linking was used to develop concordance between EPDS and BDI scores, and severity ranges were established by identifying EPDS scores that corresponded to established severity ranges on the BDI.

Results: The following severity ranges were established for the EPDS: none or minimal depression (0–6), mild depression (7–13), moderate depression (14–19), and severe depression (19–30).

Conclusion: Postpartum women experience a wide range of depression severity. The establishment of severity ranges for EPDS scores may guide treatment referrals. Although the study sample size was large, only a limited number of women scored in the severe range of depression symptoms. Replication in a larger sample of depressed women is an important direction for future research.     

Reference ranges of Doppler parameters of foetal pulmonary artery segments between 19 and 39 weeks of gestation

Objective: To determine reference ranges of Doppler parameters of foetal pulmonary artery segments.

Methods: A prospective cross-sectional study was conducted to evaluate 150 healthy singleton pregnancies between 19 and 39 weeks of gestation. The proximal, middle and distal segments of the foetal pulmonary artery were assessed. The following Doppler parameters were evaluated: pulsatility index (PI) and peak systolic velocity (PSV). The mean, standard deviation (SD) and maximum and minimum values were determined for each Doppler parameter. Pearson’s correlation coefficient (r) was used to assess the correlation between the foetal pulmonary artery segments. Polynomial regression was performed, and adjustments were made using the coefficient of determination (R²).

Results: The mean PI values (mean?±?SD) in the proximal, middle and distal arterial segments were 2.99?±?0.61, 2.25?±?0.96 and 1.31?±?0.58, respectively. The mean PSVs in the proximal, middle and distal segments were 50.68?±?16.63, 24.396?±?11.86 and 12.08?±?3.66?cm/s, respectively. Significant differences were observed between the PI and PSV values from the different segments (p?<?0.0001). A correlation between each Doppler parameter and gestational age was observed, and it was better represented using linear equations.

Conclusion: We successfully determined the reference ranges for Doppler parameters of foetal pulmonary artery segments between 19 and 39 weeks of gestation.     

106例胎儿血生化指标分析研究

目的了解胎儿血液生化指标特点及在各孕周变化规律,为胎儿宫内代谢异常的诊断与治疗提供参考依据.方法应用日立7170全自动生化分析仪对106例孕19～38w胎儿脐血进行血液尿素氮(BUN)、二氧化碳结合力(CO2)、肌酸磷酸激酶同工酶-1(CK-MB)等18项生化指标检测,胎儿脐血取自B超引导下母腹脐静脉穿刺产前诊断其结果正常胎儿,并经胎血鉴定,各指标按孕周分组计算均值,经统计学分析.结果发现胎儿各孕周组血液生化指标中BUN、CO2、Cr、UA、ALP、AST、ALT、TB、HBDH、LDH、CK、CK-MB等代表心、肾功能指标均无显著差异(P＞0.05),代表肝功能的DB、IB、TP、ALB、GLB、r-GT均值在胎儿各孕期随孕周增加升高,有统计学意义(P＜0.05).结论胎儿生化指标有独特的参考范围心、肾功能指标在整个孕期变化不大,肝功能各项指标随孕周曾加.     

未分组资料百分位数新计算方法

目的 探索未分组资料百分位数计算方法适宜公式。方法 提出适宜的新公式，用医学资料实施计算机模拟实验，将新方法与旧方法比较。结果 新方法所确定的百分位数与理论值均完全相同；而旧方法有系统性的偏差，且与样本例数、百分数大小有关。结论 在当前微机、软件普及情况下，为确定医学参考值范围(单指标与多指标)，建议使用适宜的未分组资料百分位数计算方法的新公式。