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PubMed1995

[High mean pallor value--a risk factor for deterioration of the visual field in glaucoma and ocular hypertension. A pilot study using the optic nerve head analyzer].

UNLABELLED: Does the disc parameter "mean pallor value" suggest a risk for further deterioration of visual field defects? PATIENTS: In 10 patients with ocular hypertension and 23 patients with primary open-angle glaucoma (Octopus 201, Humphrey perimeter) disc pallor was calculated by double examinations with the ONHA in 1987-1988, and a long-term follow-up of the visual field was performed. In all patients we also acquired information about the IOP level and visual field during the observation time from the ophthalmologists. Only one eye per patient was evaluated after randomized selection. RESULTS: In ocular hypertensive patients only 1 of 10 eyes showed deterioration of the visual field. In the glaucoma group 4 eyes out of 23 showed an increase in visual field loss. The eyes with a tendency to deteriorate had a higher mean pallor value compared with the mean value of the corresponding group [ocular hypertensives: 0.40 compared to 0.31 +/- 0.07 (0.02); POAG: 0.50 +/- 0.06 (0.03) compared to 0.33 +/- 0.08 (0.02); mean value +/- SE (SEM)]. The difference was statistically significant in the glaucoma group; Wilcoxon, Mann and Whitney U-test; P < 0.005. CONCLUSIONS: Taking into consideration all risk factors, the mean pallor value might help additionally to prognosticate the risk of deterioration of the visual field as far as 5-year follow-up allows this preliminary conclusion. The pallor value alone is not suitable for the follow-up of glaucoma patients because of the influence of increasing lens opacities and changes in the video system of the ONHA over years.

Follow-Up Studies↗
PubMedDate not supplied

Screening for severe anaemia in pregnancy in Kenya, using pallor examination and self-reported morbidity.

Severe anaemia in pregnancy is an important preventable cause of maternal and perinatal morbidity and mortality. Different methods of screening for severe anaemia in pregnancy were evaluated in a 2-phased study conducted in Kilifi, Kenya. In phase 1 (in 1994/95), pallor testing was evaluated alone and in addition to raised respiratory/pulse rates: 1787 pregnant women were examined by one of 2 midwives. Sensitivities for detecting severe anaemia (haemoglobin < 7 g/dL) were 62% and 69% and specificities 87% and 77%, respectively for each of the midwives. Addition of high pulse rate increased sensitivity to 77% and 81%, but specificity reduced to 60% and 51%, respectively. In phase 2, following qualitative in-depth work, a screening questionnaire was developed. An algorithm based on screening questions had 80% sensitivity and 40% specificity. Midwife pallor-assessment was conducted following the screening questionnaire. In this phase (conducted in 1997), the midwife performed very highly in detecting severe anaemia, achieving sensitivity of 84% and specificity of 92%. Spending a few minutes asking women questions may have improved the ability to interpret pallor findings. This study demonstrates the value of pallor testing and raises alternative approaches to improving it.

Anemia↗
PubMed2005

[Validation of the palmar pallor sign in the diagnosis of anemia in children in Bucaramanga (Colombia)].

BACKGROUND: The prevalence of anemia in children from Santander (Colombia), is nearly 28 %. Economic conditions make it difficult to perform the hemoglobin test in all children with suspected anemia. The palmar pallor sign has been recommended by the World Health Organization (WHO) and the Pan-American Health Organization for the diagnosis of anemia in children aged less than 5 years old; however, the yield of the test has not been established in Colombian communities. The aims of the present study were to establish the efficiency of the test and to determine its reproducibility. METHODS: The palmar pallor sign was evaluated in a sample of 167 children attending a low complexity hospital located in a deprived area of Bucaramanga city. Two pediatricians determined the presence of the sign, according to criteria from the "Integrated Management of Childhood Illness" strategy of the WHO and the Pan-American Health Organization. A hospital laboratory determined the concentration of hemoglobin in each of the children. Based on these data, the sensitivity, specificity, positive predictive value and negative predictive value were determined and the agreement between observers was established. RESULTS: The prevalence of anemia in the sample evaluated was 28.74 %. Sensitivity was 33.33 %, specificity was 79.83 %, the positive predictive value was 40 % and the negative predictive value was 74.8 %. The reproducibility of the test was low. The yield of the test substantially improved when the hemoglobin cut-off point was reduced from 11 g/dl, which is the value proposed by the WHO, to 10.5 g/dl. CONCLUSIONS: Anemia is frequent in children aged less than 5 years old in Bucaramanga city. The Palmar pallor sign is a valuable tool for the diagnosis of severe anemia, but is much less useful in mild or moderate anemia. If the hemoglobin level proposed by the WHO were lower, the palmar pallor sign would be more useful.

Anemia↗
PubMed2003

[Reliability and validity of palmar and conjunctival pallor for anemia detection purposes].

OBJECTIVE: To evaluate the reliability and the validity of the use of simple clinical signs as a method of anemia detection. METHODS: The study was carried out in a S o Paulo, Brazil, day-care center, and included 135 children from ages 3 months-6 years. Hemoglobin level results and palmar and conjunctival pallor assessment were used. Children with Hb under 11g/dl were considered as anemic; subjective criteria were used for the assessment of palmar and conjunctival pallor. Kappa statistics were used in order to verify agreement, and, in order to evaluate the technique's validity, sensitivity and specificity levels were calculated. RESULTS: The results show low levels of agreement. There was a greater level of sensitivity to conjunctival pallor than to palmar pallor. Specificity results may be considered as good. CONCLUSIONS: It is still early to recommend the routine use of this technique. However, it could promote substantial savings if perfected.

Anemia↗
PubMed1977

Scanning microdensitometry of optic disc pallor in glaucoma.

A scanning microdensitometric technique has been developed for measuring the optical density of black and white photographs of the optic disc. From the frequency distribution curve of all the densities of the whole area of the optic disc, a separate peak was identified as corresponding to the area of pallor of the optic disc. Areas of pallor were measured as percentage of areas of the total disc for normal, ocular hypertensive, open-angle glaucoma patients, and those with suspect discs. Median values of percent area of pallor showed correspondence with the clinical diagnosis, the glaucoma patients having significantly larger areas than the normal subjects. The microdensitometric technique provides an objective means of measuring the amount of optic dis pallor. It has potential usefulness for screening and for following up suspect and confirmed glaucomas to determine progression of the disease.

Densitometry↗
PubMed1989

Reproducibility of pallor measurements with the optic nerve head analyzer.

One eye each of ten healthy volunteers was tested with the Rodenstock Optic Nerve Head Analyzer on ten separate occasions. A color-coded pallor map was developed for each examination. A color transparency of each pallor map was then obtained from the television monitor of the Optic Nerve Head Analyzer, using a camera mounted on a tripod at a fixed distance from the screen. A color-coded zone within the center of the disc was chosen for each set of ten studies, and the area of this zone was measured by boundary analysis with another computerized image analyzer, the Oasys Image Processor. There was wide intrasubject variation in all ten volunteers, suggesting that the pallor map generated by the Optic Nerve Head Analyzer, when used in the manner described in this paper, is not adequate for following subtle changes in optic nerve head pallor.

Humans↗
PubMed1985

Measurements of reversibility of optic disc cupping and pallor in ocular hypertension and glaucoma.

Four cases are presented of young and elderly glaucoma patients who had both surgical and medical therapy and showed reversal of cupping and pallor of the optic disc. The cupping was measured by photogrammetry and the pallor by computerized image analysis from photographs of the optic disc. Two patients showed regression of visual field loss. The optic disc and visual field changes corresponded to the changes in ocular pressures, generally showing worsening with an increase in ocular pressure. With a decrease in ocular pressure there was regression of visual field loss and a decrease in cupping; pallor did not decrease consistently. The changes in cupping and pallor in some patients followed similar courses but in others behaved in an independent manner. It is proposed that these new sensitive and reproducible techniques for measuring changes in the optic disc may allow the detection of disc changes early in the disease, prior to visual field loss. If treatment is begun at this time, reversal of optic disc changes may occur.

Aged↗
PubMed1985

Detection of increased pallor over time. Computerized image analysis in untreated ocular hypertension.

Computerized image analysis was used to measure changes in percent area of pallor of the optic disc in a retrospective study of a group of 16 normals and 39 untreated ocular hypertensives. The optic discs of the subjects were photographed on at least two visits at least one year apart (mean, 2 years). No significant changes in area of pallor for the normal group were observed between visits, except in the inferior quadrant of the left eye. The ocular hypertensive group showed a significant increase in area of pallor between visits for the total disc and for most quadrants of both eyes. Multiple regression analysis revealed that, in addition to ocular hypertension, the significant factors associated with a change in optic disc pallor were change of ocular pressure, standard deviation of the ocular pressures, presence of vascular hypertension, and standard deviation of vascular pulse pressures. Clinical implications of early detection of disc changes for follow-up and treatment of ocular hypertensives are discussed.

Adult↗
PubMed1986

Evaluation of conjunctival pallor in the diagnosis of anaemia.

The diagnosis of anaemia using conjunctival pallor was evaluated using the concept of predictive values. The presence or absence of pallor in 951 individuals and their haemoglobin levels were matched, defining haemoglobin of 10 g dl-1 or less as representing anaemia. The sensitivity and specificity of the test of pallor were 18.6% and 95.8%, respectively. At 16.3% prevalence of anaemia the positive and negative predictive values were 46.3% and 85.8%, respectively. The findings suggest that conjunctival pallor as a screening test for anaemia may not be very reliable.

Adolescent↗
PubMed1980

Quantitative measurement of red blood cell central pallor and hypochromasia.

A quantitataive definition and techniques of measurement for central pallor of red blood cells are proposed. These are based on high-resolution measurements of absorbance across the center of the cell. Thus, the measurements reflect both variations in cell thickness and hemoglobin concentration. Although contributions of thickness and concentration may differ in individual cells, to a first approximation, a specific cell may be considered as having a similar concentration of hemoglobin throughout, and thus the major contribution to the central pallor is that due to the difference in thickness between the edges of the cell and the center. The definition proposed expresses central pallor as the percentage volume of indentation, comparing the red cell to a disc of uniform absorbance equal to the maximum found at the cell edges. Population distributions of central pallor then provide a basis for quantitation of hypochromasia. The mean and standard deviation of such distributions are proposed as quantitative descriptors. Sample distributions from 27 normal persons, 8 patients with spherocytic anemia and 26 patients with iron deficiency anemia were studied.

Anemia, Hypochromic↗
PubMed2002

Taking a medical history and using a colour scale during clinical examination of pallor improves detection of anaemia.

We developed a colour tint scale to use as an aid in the clinical assessment of anaemia by measuring conjunctival pallor. The objectives of this study were to evaluate the accuracy and agreement among observers in detecting anaemia in three sequential phases with incremental information using clinical pallor of different anatomical sites, subsequently adding subjects' medical history for physical symptoms and the colour scale. After training in the application of these three sequential assessments, 12 primary health workers were assigned to independently examine 198 anaemic and 254 non-anaemic pregnant women while blind to the true anaemic status. Their assessments in each phase were then compared with the anaemic status based on haemoglobin level, measured using HemoCue, taken as the gold standard, to determine sensitivity and specificity, and agreements among observers in detecting anaemia were calculated. In the three sequential phases of assessment the sensitivities were 73.8, 78.3, 82.9% and specificities 76.0, 84.7 and 90.9%, respectively. In each subsequent step, the improvements in both the sensitivity and specificity were statistically significant [P(chi2(McNemar)) < 0.01]. Kappa statistics for agreement among 12 observers for assessing anaemia in the sequential phases were 0.50, 0.71 and 0.82, respectively. The Spearman rank correlation coefficient between haemoglobin level and the colour scale reading was 0.68 (P < 0.001). Taking medical history and incorporating a simple colour tint scale with examination of pallor improved the sensitivity, specificity and agreement for detection of anaemia by health workers.

Anemia↗
PubMed2004

[Diagnostic value of tegument pallor in anemia in pregnant women in Benin].

Anemia in pregnant women is a common and severe public health problem encountered in developing countries. Its detection is most often based upon clinical examination and observation of conjunctive pallor; however, little is known or documented on the performance indicators of this clinical method in Africa. This work aims assess the value of performance indicators in detecting moderate and severe anemia by means of tegument pallor examination in a maternity ward in rural Benin. To this end, 480 pregnant women were recruited at random during their prenatal visits to a rural maternity clinic. Two independent observers had noted conjunctive or other forms of teguments in all of the women selected, and a concentration of hemoglobin was confirmed by a blood test. An analysis of the results indicated that 67.4% of pregnant women were biologically anemic (Hb < 11.0 g/dl) while only 49% among them were clinically anemic. The sensitivity of the clinical observation method for conjunctive pallor is 87.5% for severe anemia and 74% for moderate anemia. Its positive predictive value is 62.5% for moderate anemia and very weak for light cases of anemia, at only 3%. The accuracy of this clinical method varies from 51-71%, when the likelihood is determined as 1.8 to 2.3. Its reproducibility appears equally weak and clinical observer variability seems to be poor to fair agreement at k = 0.34 (p = 0.00). For practical reasons, the authors suggest the strengthening of the teaching of this method to obstetrics' care providers and medical students in training in order to improve its more effective use and practice in rural maternity units without laboratories.

Adult↗
PubMed2000

Palmar pallor as an indicator for anthelminthic treatment among ill children aged 2-4 years--Western Kenya, 1998.

Infections with the soil-transmitted intestinal helminths (i.e., Ascaris lumbricoides, Trichuris trichiura, and hookworm), estimated to affect approximately 1 billion persons, are among the most common and widespread human infections. Among children aged <5 years, intestinal helminth infections cause malnutrition and anemia, two important causes of mortality. Anthelminthic treatment (deworming) improves nutritional status of school-aged children. The World Health Organization and the United Nations Children's Fund (UNICEF) have developed guidelines that include interventions for anemia and malnutrition in the integrated management of childhood illness (IMCI) for children aged <5 years seen at first-level health-care facilities in developing countries. Under the IMCI guidelines, in geographic areas where hookworm or Trichuris infections are endemic, children aged 2-4 years with palmar pallor are treated with an anthelminthic drug. This report summarizes an investigation of the use of palmar pallor as an indication for anthelminthic treatment among ill children aged 2-4 years seen at first-level health-care facilities in rural western Kenya; the investigation found that palmar pallor was associated with anemia but not with intestinal helminth infection.

Anemia↗
PubMed1980

Digital measurement of pallor-disc ratio.

In an effort to quantitate optic nerve head pallor, a method has been devised to measure pallor-disc ratio using optic nerve head photographs. After electronically scanning photographs through various Wratten filters, it was observed that a red filter produces good contrast between the disc and the retinal surface, while a green filter produces good contrast between the pale area of the disc and the remaining normal-appearing nerve head. A computer program fitted an elliptical form to both the disc region of red image and the pale area of green image. Pallor-disc ratios were calculated on both area and radial bases. Reproducibility of 3.5% for the area ratios and 7% for the radial ratios were obtained.

Computers↗
PubMed1982

Measurement of the optical density of the optic nerve head I: the pallor of the papilla in artificial ocular hypertension.

The pallor of the optic disc during acute raise of intraocular pressure can be shown on the negatives of orthochromatic film and is measured by a photoscanner. When raising intraocular pressure from normal values to ablut 40 mm Hg, ten young persons showed an increase in optical density from 0.28 log units +/- 0.04 SEM to 0.38 log units +/- 0.04 SEM. When raising IOP to 65 mm Hg, the optical density was 0.43 log units +/- 0.04; with 110 mm Hg the optical density was 0.44 log units +/- 0.04 SEM. Above values of 40 mm Hg IOP, the pallor does not remain constant but may also decrease in some cases. The higher the intraocular pressure, the more contradictory the response. The phenomenon may be shown on various parts of the rim simultaneously. The amount of maximum pallor is directly related to the value of optical density with normal intraocular pressure. After restoring IOP to normal values, optical density decreases again, the amount of decrease being related to initial value. The contradictory response with higher IOP may be due to autoregulation of the capillaries of the optic nerve head.

Humans↗
PubMed1988

Reproducibility of computerized pallor measurements obtained with the Rodenstock Disk Analyzer.

Computerized pallor measurements of the optic nervehead were performed by global analysis with the Rodenstock Disk Analyzer. Total intervideographic and intravideographic variability was calculated. The coefficients of variation ranged from 8.3% to 20.08% for intervideographic variability of different pallor histogram values. The intravideographic variability for pallor histogram values ranged from 0.82% to 2.94%.

Analysis of Variance↗
PubMed1985

The reproducibility of computerized boundary analysis for measuring optic disc pallor in the normal optic disc.

The optic discs of eight normal subjects were photographed on three separate visits under widely varying conditions. Each photograph was scanned by a television camera, converted to digital form, and then analyzed using computer image analysis techniques. The computer was programmed to delineate the boundary around the optic disc and the area of pallor. The percentage of disc pallor was then computed across the entire disc and for each disc quadrant. The reproducibility of the procedure was determined by evaluating several photographic parameters: camera flash intensity, film type, magnification, and centering of the disc in the photograph. The focus adjustment on the television scanner was also varied. Under carefully controlled conditions, results showed that the reproducibility of measuring the total percent of disc pallor was 2%. Results for reproducibility are also given for less than optimal conditions and for manual planimetry on the same set of photographs.

Computers↗
PubMedDate not supplied

Predictive value of conjunctival pallor in the diagnosis of anaemia.

Because of the need to develop a simple yet reliable method of diagnosing anaemia, a compelling health problem, several studies had examined the possibility of utilizing physical examination of mucous membranes as a test of anaemia, but have produced conflicting results. This study was undertaken to determine if physical examination of a patient's mucous membranes will give predictive values of his haemoglobin concentration. A representative sample was drawn from the population of the Local Government Area selected for the study. Data collected on each study subject included age, sex, body weight, diagnosis, if any and conjunctival tint. At the same time, a venous blood sample was also obtained and its haemoglobin concentration determined with the oxyhaemoglobin concentration method. This was matched with the survey data on each subject for analysis. Results showed that 2697 subjects were s surveyed and that the prevalence of anaemia in the study population, defined in this report as Hb < 100g/l, was 29.9%; 14.9% was found to have conjunctival pallor. Statistical analysis gave sensitivity and specificity scores of 25% and 89% respectively and positive and negative predictive values of 46.9% and 75.4% respectively. The study observed that these results indicate that while conjunctival pallor is not a reliable measure of the presence of anaemia, the probability that it correctly excludes those that are not anaemic is high. Conjunctival pallor is recommended as a screening rather than a diagnostic tool.

Adolescent↗