Accuracy of clinical pallor in the diagnosis of anaemia in children: a meta-analysis

BACKGROUND: Anaemia is highly prevalent in children of developing countries. It is associated with impaired physical growth and mental development. Palmar pallor is recommended at primary level for diagnosing it, on the basis of few studies. The objective of the study was to systematically assess the accuracy of clinical signs in the diagnosis of anaemia in children. METHODS: A systematic review on the accuracy of clinical signs of anaemia in children. We performed an Internet search in various databases and an additional reference tracking. Studies had to be on performance of clinical signs in the diagnosis of anaemia, using haemoglobin as the gold standard. We calculated pooled diagnostic likelihood ratios (LR's) and odds ratios (DOR's) for each clinical sign at different haemoglobin thresholds. RESULTS: Eleven articles met the inclusion criteria. Most studies were performed in Africa, in children underfive. Chi-square test for proportions and Cochran Q for DOR's and for LR's showed heterogeneity. Type of observer and haemoglobin technique influenced the results. Pooling was done using the random effects model. Pooled DOR at haemoglobin <11 g/dL was 4.3 (95% CI 2.6–7.2) for palmar pallor, 3.7 (2.3–5.9) for conjunctival pallor, and 3.4 (1.8–6.3) for nailbed pallor. DOR's and LR's were slightly better for nailbed pallor at all other haemoglobin thresholds. The accuracy did not vary substantially after excluding outliers. CONCLUSION: This meta-analysis did not document a highly accurate clinical sign of anaemia. In view of poor performance of clinical signs, universal iron supplementation may be an adequate control strategy in high prevalence areas. Further well-designed studies are needed in settings other than Africa. They should assess inter-observer variation, performance of combined clinical signs, phenotypic differences, and different degrees of anaemia

Prostate cancer disparities in Hispanics by country of origin: a nationwide population-based analysis

BACKGROUND: We sought to evaluate prostate cancer (PCa) characteristics and outcomes of Hispanics living in the United States by country of origin in the Surveillance, Epidemiology and End Results (SEER) program. METHODS: Retrospective analysis of 72,134 adult Hispanics with PCa between 1995-2014. Origin was Mexican (N=16,995; 24%), South/Central American (N=6,949; 10%), Puerto Rican (N=3,582; 5%), Cuban (N=2,587; 4%), Dominican (N=725; 1%), Hispanic not specified (NOS, N=41,296; 57%), as coded by SEER. Patient and PCa characteristics were analyzed with chi-square and Kruskal-Wallis tests. Overall and PCa survival were analyzed with Kaplan-Meier and Cox models adjusting for baseline variables. RESULTS: At diagnosis, Mexicans had more advanced stage, higher prostate-specific antigen and higher Gleason score while Cubans and Dominicans had more favorable PCa at diagnosis (all P<0.05). After a median follow up of 69 months, 20,317 men died, including 6,223 PCa deaths. Compared to Mexicans, Cubans (HR=1.22, 95%CI=[1.14-1.30]) and Puerto Ricans (HR=1.15 [1.08-1.22]) had worse overall survival while Dominicans (HR=0.76 [0.64-0.91]), South/Central Americans (HR=0.68, [0.65-0.72]) and NOS (HR=0.81 [0.78-0.84]) had better overall survival. Compared to Mexicans, Cubans (HR=1.08, [0.96-1.22]) and Puerto Ricans (HR=1.03, [0.92-1.15]) had similar PCa survival while Dominicans (HR=0.72, [0.53-0.98]), South/Central Americans (HR=0.67 [0.60-0.74]) and NOS (HR=0.68 [0.64-0.73]) had significantly better PCa survival. CONCLUSIONS: Among Hispanics in the United States, disparities in PCa characteristics and survival by country of origin exist, with Dominicans, South/Central Americans and Hispanic NOS having better PCa survival compared to Mexicans, Cubans and Puerto Ricans