Choroid plexus enlargement correlates with periventricular pathology but not with disease activity in radiologically isolated syndrome.

BACKGROUND: Choroid plexus (ChP) enlargement is an emerging radiological biomarker in multiple sclerosis (MS). OBJECTIVES: This study aims to assess ChP volume in a large cohort of patients with radiologically isolated syndrome (RIS) versus healthy controls (HC) and explore its relationship with other brain volumes, disease activity, and biological markers. METHODS: RIS individuals were included retrospectively and compared with HC. ChPs were automatically segmented using an in-house automated algorithm and manually corrected. RESULTS: A total of 124 patients fulfilled the 2023 RIS criteria, and 55 HCs were included. We confirmed that ChPs are enlarged in RIS versus HC (mean (±SD) normalized ChP volume: 17.24 (±4.95) and 11.61 (±3.58), respectively, p < 0.001). Larger ChPs were associated with more periventricular lesions (ρ = 0.26; r2 = 0.27; p = 0.005 for the correlation with lesion volume, and ρ = 0.2; r2 = 0.21; p = 0.002 for the correlation with lesion number) and lower thalamic volume (ρ = -0.38; r2 = 0.44; p < 0.001), but not with lesions in other brain regions. Conversely, ChP volume did not correlate with biological markers. No significant difference in ChP volume was observed between subjects who presented or did not have a clinical event or between those with or without imaging disease activity. CONCLUSIONS: This study provides evidence that ChP volume is higher in RIS and is associated with measures reflecting periventricular pathology but does not correlate with biological, radiological, or clinical markers of disease activity.

Kappa index in the diagnostic work-up of autoimmune encephalitis.

BACKGROUND: The presence of inflammatory changes in the cerebrospinal fluid (CSF), including immunoglobulin intrathecal synthesis (IS), can support the diagnosis of autoimmune encephalitis (AE) and allow prompt treatment. The main aim of our study was to calculate the Kappa index as a marker of IS, in patients with AE. METHODS: Charts of patients undergoing a diagnostic work-up for suspected AE between 2009 and 2023 were reviewed and the Graus criteria applied. CSF and serum kappa free light chains were determined using the Freelite assay (The Binding Site Group) and the turbidimetric Optilite analyzer. RESULTS: We identified 34 patients with "definite" AE (9 anti-NMDAR AE and 25 limbic AE) and nine patients with "possible" AE. Five patients (15%) with definite AE had pleocytosis and twelve (34%) showed CSF-restricted oligoclonal bands (OCB) at isoelectric focusing. The Kappa index was >6 in 29.4% and > 3 in 50% of the definite AE patients. It was elevated (>3) in 36.4% of patients with definite AE who resulted negative to OCB testing and was the only altered parameter suggestive of an ongoing inflammatory process in the CNS in three definite AE patients with otherwise normal CSF findings (i.e. normal cell count and protein levels, no OCBs). In the possible AE group, one patient had a Kappa index >3 in the absence of OCB. CONCLUSIONS: The Kappa index could be useful, as a more sensitive marker of IS and as a supportive marker of neuroinflammation, in the diagnostic work-up of suspected AE.

Intrathecal B cell activation and memory impairment in multiple sclerosis.

BACKGROUND: Cognitive impairment (CI) is a common and disabling feature of people with multiple sclerosis (pwMS), but its underlying mechanisms are heterogenous and not fully understood. A role of infiltrating immune cells in the meninges and brain parenchyma has been hypothesized. This study aimed to explore the hypothesis that intrathecal B cells might influence cognitive performance in pwMS. METHODS: A retrospective study was performed on 39 newly diagnosed pwMS who underwent cerebrospinal fluid (CSF) analysis. Kappa (κ)-index was measured as a biomarker of intrathecal B cell activation. Cognitive performance was assessed using the Brief Repeatable Battery of Neuropsychological Tests (BRBN). Brain T2 lesions number (T2LN) and volume (T2LV) together with brain, cortical grey matter, thalamic and hippocampal volumes were calculated to account for MRI-visible damage. RESULTS: κ-index was higher in pwMS with verbal memory impairment (median 99.6, range 58.5-195.2 vs. median 37.2, range 2.3-396.9, p < 0.001), and it was negatively associated with BRBN tests exploring verbal memory and information processing speed. In multivariate models, higher κ-index was confirmed to be independently associated with worse scores of BRBN tests exploring verbal memory and with a higher probability of verbal memory impairment. CONCLUSION: Intrathecal B cells might drive memory impairment in pwMS independently of brain damage visible on MRI scans.

A comparison of measles-rubella-zoster reaction, oligoclonal IgG bands, oligoclonal kappa free light chains and kappa index in multiple sclerosis.

BACKGROUND AND OBJECTIVES: To evaluate the diagnostic performance of the measles-rubella-zoster reaction (MRZR) in a large real-world multiple sclerosis (MS) cohort. Second, to compare MRZR with the determination of oligoclonal IgG bands (OCB), oligoclonal kappa free light chain bands (oKFLC), and the KFLC index. METHODS: A single-center retrospective study was conducted at the University Hospital Ostrava (Czech Republic). Patients were eligible if aged ≥18 years with a determined clinical diagnosis. IgG antibodies against measles (M), rubella (R), and varicella zoster (Z) viruses were determined in paired CSF and serum using ELISA and MRZR indicated as positive if at least two components had an antibody index >1.4. OCB and oKFLC were detected by means of isoelectric focusing, and KFLC CSF and serum concentrations for calculation of the KFLC index were determined immunochemically. RESULTS: A total of 1,751 patients were included in the analyzed data set, which comprised 379 MS patients and 1,372 non-MS controls. The frequency of positive MRZR was higher in MS than in non-MS cases (MS 32.2 % vs non-MS 2.8 %; p < 0.001). This corresponded to a specificity of 97.2 % (95 % CI 96.1-98.0) and sensitivity of 32.2 % (95 % CI 27.5-37.2) and overall accuracy of 83.1 % (95 % CI 81.3-84.8). In comparison, the highest sensitivity of 95.6% (95 % CI 93.0-97.5) was for OCB with specificity of 86.9 % (95 % CI 84.9-88.7), followed by oKFLC with sensitivity and specificity of 94.7 % (95 % CI 91.5-96.9) and 78.4% (95 % CI 75.7-80.8), respectively, and the KFLC index with sensitivity of 92.5 % (95 % CI 86.6-96.3) and specificity of 93.5 % (95 % CI 90.5-95.9). DISCUSSION: MRZR remains a very specific test for the diagnosis of MS but has low sensitivity, which disallows its independent use. In contrast, OCB showed the highest sensitivity and thus remains the gold standard for the diagnosis of MS.

Relevance of kappa free light chains index in patients with aquaporin-4 or myelin-oligodendrocyte-glycoprotein antibodies.

BACKGROUND: The kappa free light chains index (κ-index) is increasing in importance as a fast, easy, cost-effective, and quantitative biomarker in multiple sclerosis (MS), which can replace cerebrospinal fluid (CSF)-restricted oligoclonal bands (OCB) detection. In previous studies, controls often included mixed patients with several inflammatory central nervous system disorders. The aim of the present study was to assess the κ-index in patients with serum aquaporin-4 (AQP4)-IgG or myelin-oligodendrocyte-glycoprotein (MOG)-IgG. METHODS: We analyzed CSF/serum samples of patients with AQP4-IgG or MOG-Ig and evaluated distinct κ-index cut-offs. We described clinical and magnetic resonance imaging (MRI) features of patients with the highest κ-index values. RESULTS: In 11 patients with AQP4-IgG, median κ-index was 16.8 (range 0.2; 63) and 6/11 (54.5%) had κ-index >12. Among 42 patients with MOG-IgG, 2 had low positive MOG-IgG titers, were ultimately diagnosed with MS, and had a markedly increased κ-index (54.1 and 102.5 respectively). For the remaining 40 MOG-IgG-positive patients the median κ-index was 0.3 (range 0.1; 15.5). Some 6/40 (15%) and 1/40 (2.5%) patients had a κ-index >6 and >12, respectively. None fulfilled MRI dissemination in space and dissemination in time (DIS/DIT) criteria and the final diagnosis was MOG-IgG-associated disease (MOGAD) for these 40 patients. Four of the 40 (10%) MOG-IgG-positive patients had OCB. CONCLUSION: While a marked increase in κ-index could discriminate MS from MOGAD, a low κ-index threshold could lead to confusion between MS and MOGAD or AQP4 antibody-positive neuromyelitis optica spectrum disorder.

Comparative analysis between STANDARD-E Covi-FERON ELISA with pre-existing IFN-γ release assays and determination of the optimum cutoff value for assessment of T-Cell response to SARS-CoV-2.

BACKGROUND: Interferon-gamma (IFN-γ) release assays (IGRAs) are useful for the assessment of the T-cell response to severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). We aimed to assess the performance of the newly developed IGRA ELISA test compared to the pre-existing assays and to validate the cutoff value in real-world conditions. METHODS: We enrolled 219 participants and assessed agreement between STANDARD-E Covi-FERON ELISA with Quanti-FERON SARS-CoV-2 (QFN SARS-CoV-2), as well as with T SPOT Discovery SARS-CoV-2 based on Cohen's kappa-index. We further determined the optimal cutoff value for the Covi-FERON ELISA according to the immune response to vaccinations or infections. RESULTS: We found a moderate agreement between Covi-FERON ELISA and QFN SARS-CoV-2 before vaccination (kappa-index = 0.71), whereas a weak agreement after the first (kappa-index = 0.40) and second vaccinations (kappa-index = 0.46). However, the analysis between Covi-FERON ELISA and T SPOT assay demonstrated a strong agreement (kappa-index >0.7). The cut-off value of the OS (original spike) marker was 0.759 IU/mL with a sensitivity of 96.3% and specificity of 78.7%, and that of the variant spike (VS) marker was 0.663 IU/mL with a sensitivity and specificity of 77.8% and 80.6%, respectively. CONCLUSION: The newly determined cut-off value may provide an optimum value to minimize and prevent the occurrence of false-negative or false-positive during the assessment of T-cell immune response using Covi-FERON ELISA under real-world conditions.

Inter-Laboratory Concordance of Cerebrospinal Fluid and Serum Kappa Free Light Chain Measurements.

The kappa index (K-Index), calculated by dividing the cerebrospinal fluid (CSF)/serum kappa free light chain (KFLC) ratio by the CSF/serum albumin ratio, is gaining increasing interest as a marker of intrathecal immunoglobulin synthesis. However, data on inter-laboratory agreement of these measures is lacking. The aim was to assess the concordance of CSF and serum KFLC measurements, and of K-index values, across different laboratories. KFLC and albumin of 15 paired CSF and serum samples were analyzed by eight participating laboratories. Four centers used Binding Site instruments and assays (B), three used Siemens instruments and assays (S), and one center used a Siemens instrument with a Binding Site assay (mixed). Absolute individual agreement was calculated using a two-way mixed effects intraclass correlation coefficient (ICC). Cohen's kappa coefficient (k) was used to measure agreement on positive (≥5.8) K-index values. There was an excellent agreement in CSF KFLC measurements across all laboratories (ICC (95% confidence interval): 0.93 (0.87-0.97)) and of serum KFLC across B and S laboratories (ICC: 0.91 (0.73-0.97)), while ICC decreased (to 0.81 (0.53-0.93)) when including the mixed laboratory in the analysis. Concordance for a positive K-Index was substantial across all laboratories (k = 0.77) and within S laboratories (k = 0.71), and very good (k = 0.89) within B laboratories, meaning that patients rarely get discordant results on K-index positivity notwithstanding the testing in different laboratories and the use of different platforms/assays.

Kappa free light chains: Diagnostic performance in multiple sclerosis and utility in a clinical laboratory.

BACKGROUND: Automated, technically simple analytical methods offering objective results are highly valued in clinical laboratories. Kappa free light chains (KFLC) in cerebrospinal fluid (CSF) are promising multiple sclerosis (MS) biomarkers, particularly kappa (K) index. METHODS: KFLC were determined in CSF and serum samples of patients diagnosed with MS, clinically/radiologically isolated syndrome (N, 39), and controls (N, 152; inflammatory and non-inflammatory neurological disorders). Diagnostic performance of several KFLC parameters, previously determined oligoclonal band (OCB) testing, and IgG index, was assessed. A K index decision threshold for sample screening was identified and reduction in performed OCB analyses estimated accordingly. RESULTS: Higher KFLC parameters were detected in the MS group and K index performed best among them (AUC 0.92). At a 7.25 cut-off it showed better sensitivity (85% vs. 77%) though less specificity (88% vs. 91%) than OCBs. Comparatively, IgG index's performance was inferior (AUC 0.83). A decision K index threshold of 2.55 (97% sensitivity) would reduce OCB testing by 52% in the studied population. CONCLUSIONS: The proposed 7.25 cut-off could assist MS diagnostics and identify some false negative cases from OCB studies. Sequential algorithms using K index for the decision to perform OCB detection would improve laboratory efficiency and substantially reduce costs.

Kappa Index Versus CSF Oligoclonal Bands in Predicting Multiple Sclerosis and Infectious/Inflammatory CNS Disorders.

BACKGROUND: Cerebrospinal fluid (CSF) kappa free light chains (KFLC) are gaining increasing interest as markers of intrathecal immunoglobulin synthesis. The main aim of this study was to assess the diagnostic accuracy (AUC) of the kappa index (CSF/serum KFLC divided by the CSF/serum albumin ratio) compared to CSF oligoclonal IgG bands (OCB) in predicting Multiple Sclerosis (MS) or a central nervous system infectious/inflammatory disorder (CNSID). METHODS: We enrolled patients who underwent a diagnostic spinal tap throughout two years. KFLC levels were determined using a Freelite assay (Binding Site) and the turbidimetric Optilite analyzer. RESULTS: Of 540 included patients, 223 had a CNSID, and 84 had MS. The kappa index was more sensitive (0.89 versus 0.85) and less specific (0.84 versus 0.89), with the same AUC (0.87) as OCB for MS diagnosis (optimal cut-off: 6.2). Adding patients with a single CSF IgG band to the OCB-positive group slightly increased the AUC (0.88). Likewise, the kappa index (cut-off: 3.9) was more sensitive (0.67 versus 0.50) and less specific (0.81 versus 0.97), with the same AUC (0.74) as OCB, for a CNSID diagnosis. CONCLUSION: The kappa index and CSF OCB have comparable diagnostic accuracies for a MS or CNSID diagnosis and supply the clinician with useful, complementary information.

Cerebrospinal fluid free light chains compared to oligoclonal bands as biomarkers in multiple sclerosis.

Cerebrospinal fluid (CSF) free light chains (FLC) may be an alternative biomarker to oligoclonal bands (OCB) in multiple sclerosis (MS). Herein, we compared the diagnostic accuracy of CSF OCB and FLC and we tested the prognostic value of FLC in a cohort of 64 MS patients and 106 controls. A κ-index >7.83 was more sensitive but less specific than OCB in discriminating MS patients from controls. Additionally, a κ-index >10.61 performed better than OCB in the discrimination between MS and controls with inflammatory neurological diseases (p < .001). In clinically isolated syndrome (CIS) patients, a κ-index >10.61 significantly predicted time to conversion to MS (p = .020). κ-index might be a valid alternative to OCB as a diagnostic biomarker for MS and might also be a prognostic marker in CIS.

Cerebrospinal fluid kappa and lambda free light chains in oligoclonal band-negative patients with suspected multiple sclerosis.

BACKGROUND AND PURPOSE: Cerebrospinal fluid (CSF) kappa free light chains (FLCs) may be a more sensitive marker of intrathecal immunoglobulin (Ig)G synthesis compared with oligoclonal bands (OCBs). Our aim was to retrospectively determine the additional value of the kappa and lambda index (CSF FLC/serum FLC)/(CSF albumin/serum albumin) in predicting a multiple sclerosis (MS) diagnosis in a group of OCB-negative patients with suspected MS. METHODS: The CSF and serum kappa and lambda FLCs were tested using the Freelite kit (serum) and Freelite Mx (CSF) assay (The Binding Site Group, Bimingham, UK) in 391 OCB-negative patients with suspected/possible MS and in 54 OCB-positive patients with MS. RESULTS: The CSF kappa FLC levels were below the detection limit (0.27 mg/L) in 61% of patients. Using quantitative data, we found the best kappa index cut-off value for the prediction of MS to be 5.8. A kappa index ≥5.8 was present in 25% of OCB-negative MS (23/92) and in 98% of OCB-positive patients with MS. Using a qualitative approach and a kappa index cut-off of 5.9, based on literature data, we likewise found that 24% of OCB-negative patients with MS had a kappa index ≥5.9, compared with 5.4% of OCB-negative patients without MS (P < 0.001). No reliable data could be obtained for the lambda index; lambda FLCs were below the detection limit (0.68 mg/L) in 90% of CSF samples. CONCLUSIONS: The kappa index could contribute to the identification of OCB-negative patients with a high probability of an MS diagnosis. Using more sensitive techniques might even improve the diagnostic performance of the kappa index and better define the role of the lambda index.

Software para la categorización semiautomática de asociaciones libres sobre el bienestar de trabajadores habaneros / Software for semi-automatic categorization of free associations to promote the welfare of workers of Havana

RESUMEN Introducción: Especialistas de la Facultad de Psicología de la Universidad de La Habana propusieron el cuestionario sobre Bienestar Humano Personal, Laboral y Social (BHPLS), que se aplicó a 135 trabajadores cubanos de tres grupos sociolaborales. Dada la variedad de respuestas, se impuso un análisis de contenido (AC) para la Pregunta 1 del cuestionario. Objetivo: Proponer e implementar un software que permita la categorización semiautomática en un AC para dicha pregunta. Material y Métodos: Se utilizó el índice de concordancia Kappa para evaluar el acuerdo entre expertos respecto al esquema de categorías. Se implementó un software en el lenguaje de programación Python para cumplir el objetivo, considerando las funcionalidades de softwares similares. Resultados: Se implementó, validó y registró un software "BHPLS data processing-UH®" que permite establecer las categorías, cargar los datos, categorizarlos semiautomáticamente y guardar el resultado, entre otras funcionalidades. La categorización manual con estudiantes de Psicología obtuvo un índice de concordancia Kappa negativo (bajo acuerdo entre expertos), mientras que usando el software propuesto, se alcanzó un Kappa global 0.7871 con p=0.00 (alta concordancia y alta significación estadística). Además, se propuso un algoritmo para la unificación de las categorizaciones de expertos y se ejecutó un Análisis de Correspondencias (ANACOR) sobre la combinación de categorizaciones obtenidas. Conclusiones: Dada la alta concordancia alcanzada, se recomienda el uso del software por su adaptabilidad, facilidad de uso y la "humanización" del AC. El ANACOR permitió observar similitudes entre los grupos sociolaborales. Las funcionalidades del software pueden aplicarse para el procesamiento de asociaciones libres en otros escenarios.

ABSTRACT Introduction: Experts of the Faculty of Psychology of the University of Havana proposed the Personal, Labor and Social Human Well-being questionnaire (BHPLS, in Spanish), that was applied to 135 Cuban workers of three social and occupational groups. Given the variety of responses, a content analysis (CA) was used for Question 1 of the mentioned questionnaire. Objective: To present and implement a software that allows a semi-automatic categorization in a CA used for this question. Material and Methods: The Kappa index test was used to evaluate experts´ agreement with respect to category schemes. We implemented a software with the Python programming language to achieve our objective, considering other similar software functionalities. Results: We implemented, validated and registered the software BHPLS data processing-UH® that allows to set up a categories system, load the collected data, categorize associations in a semi-automatic way, and save the results, among other functionalities. This software was validated by Psychology students and, when they performed the manual categorization, a negative Kappa agreement index (low categorization agreement between experts) was obtained whereas using the proposed software, a global Kappa index of 0.7871 with p=0.00 (high and statistically significant categorization agreement between experts) was obtained. Besides, we proposed a unified algorithm for expert's categorizations, and carried out a Correspondence Analysis (ANACOR) on the basis of the categorizations achieved. Conclusions: According to the high concordance attained, we recommend the software due to its adaptability, ease of use, and "humanization'' of the process. The CA allowed us to observe similarities in social and occupational groups. The software functionalities can be applied for processing free associations in other scenarios.

Wildfires in the wildland-urban interface in Catalonia: Vulnerability analysis based on land use and land cover change.

The crisis in traditional forest and farming activities that began in the second half of the 20th century has given way to a new territorial structure, characterised by greater forest density and an acceleration of urban sprawl, which has affected the impact of fires on the territory and especially on the inhabitants. The increased vulnerability of homes located at the wildland-urban interface (WUI) and the differences in the intensity of fire impact makes it necessary to identify different typologies of WUI zones. Characterization of WUI typologies was based on four forest fires with distinct characteristics, selected from fires that occurred in Catalonia in 2003 and 2012. Based on the different landscape units that have been studied and the dynamics of the changes that have occurred in the study area over the past 15 years, together with the occurrence of fires during this period, identified three major WUI zone typologies: a) metropolitan, b) agroforest and c) mountain agrosilvopastoral. The results, based on Kappa index and Rate of Change, show significant changes in Land Use and Land Cover between 2003 and 2009 in each study area, but the economic and social context in each region generated different territorial dynamics for each typology. This diagnosis contributes to knowledge that expands the available planning and management tools to mitigate the effects of wildfires.

The Influence of Different Knowledge-Driven Methods on Landslide Susceptibility Mapping: A Case Study in the Changbai Mountain Area, Northeast China.

Landslides are one of the most frequent geomorphic hazards, and they often result in the loss of property and human life in the Changbai Mountain area (CMA), Northeast China. The objective of this study was to produce and compare landslide susceptibility maps for the CMA using an information content model (ICM) with three knowledge-driven methods (the artificial hierarchy process with the ICM (AHP-ICM), the entropy weight method with the ICM (EWM-ICM), and the rough set with the ICM (RS-ICM)) and to explore the influence of different knowledge-driven methods for a series of parameters on the accuracy of landslide susceptibility mapping (LSM). In this research, the landslide inventory data (145 landslides) were randomly divided into a training dataset: 70% (81 landslides) were used for training the models and 30% (35 landslides) were used for validation. In addition, 13 layers of landslide conditioning factors, namely, altitude, slope gradient, slope aspect, lithology, distance to faults, distance to roads, distance to rivers, annual precipitation, land type, normalized difference vegetation index (NDVI), topographic wetness index (TWI), plan curvature, and profile curvature, were taken as independent, causal predictors. Landslide susceptibility maps were developed using the ICM, RS-ICM, AHP-ICM, and EWM-ICM, in which weights were assigned to every conditioning factor. The resultant susceptibility was validated using the area under the ROC curve (AUC) method. The success accuracies of the landslide susceptibility maps produced by the ICM, RS-ICM, AHP-ICM, and EWM-ICM methods were 0.931, 0.939, 0.912, and 0.883, respectively, with prediction accuracy rates of 0.926, 0.927, 0.917, and 0.878 for the ICM, RS-ICM, AHP-ICM, and EWM-ICM, respectively. Hence, it can be concluded that the four models used in this study gave close results, with the RS-ICM exhibiting the best performance in landslide susceptibility mapping.

"Application of the ultra micro analytical system (SUMA) technology for the detection of urinary hCG in antidoping control".

The Ultra Micro Analytical System (SUMA) is an ELISA-based analytical platform, developed andmanufactured by the Cuban Immunoassay Center (IC), which is primarily used in clinical medicine applications. In this article, we describe the validation of the UMELISA HCG kits, which are based on SUMA, as a pre-screening procedure for the detection of human Chorionic Gonadotrophin (hCG) in urine for anti-doping purposes. Validation of assay performance parameters showed satisfactory results, in accordance with the criteria established by the World Anti-Doping Agency (WADA): intra-assay repeatability (6.7-9.7%), inter-assay reproducibility (7.8-10.5%), accuracy (91-98%), limit of detection (2.7 IU/L), and linearity. Relative sensitivity and specificity and Predictive Positive and Negative Values were used to evaluate the Efficacy showing a value of 97.6%. A Kappa Index analysis was applied to check agreement with the commercially available, reference assay COBASe411 (Roche), which is often applied in WADA-accredited anti-doping laboratories for measurement of intact (heterodimeric) hCG in urine. UMELISA HCG kits are considered as fit for anti-doping control purposes.

A prospective study assessing agreement and reliability of a geriatric evaluation.

BACKGROUND: The present study takes place within a geriatric program, aiming at improving the diagnosis and management of geriatric syndromes in primary care. Within this program it was of prime importance to be able to rely on a robust and reproducible geriatric consultation to use as a gold standard for evaluating a primary care brief assessment tool. The specific objective of the present study was thus assessing the agreement and reliability of a comprehensive geriatric consultation. METHOD: The study was conducted at the outpatient clinic of the Service of Geriatric Medicine, University of Lausanne, Switzerland. All community-dwelling older persons aged 70 years and above were eligible. Patients were excluded if they hadn't a primary care physician, they were unable to speak French, or they were already assessed by a geriatrician within the last 12 months. A set of 9 geriatricians evaluated 20 patients. Each patient was assessed twice within a 2-month delay. Geriatric consultations were based on a structured evaluation process, leading to rating the following geriatric conditions: functional, cognitive, visual, and hearing impairment, mood disorders, risk of fall, osteoporosis, malnutrition, and urinary incontinence. Reliability and agreement estimates on each of these items were obtained using a three-way Intraclass Correlation and a three-way Observed Disagreement index. The latter allowed a decomposition of overall disagreement into disagreements due to each source of error variability (visit, rater and random). RESULTS: Agreement ranged between 0.62 and 0.85. For most domains, geriatrician-related error variability explained an important proportion of disagreement. Reliability ranged between 0 and 0.8. It was poor/moderate for visual impairment, malnutrition and risk of fall, and good/excellent for functional/cognitive/hearing impairment, osteoporosis, incontinence and mood disorders. CONCLUSIONS: Six out of nine items of the geriatric consultation described in this study (functional/cognitive/hearing impairment, osteoporosis, incontinence and mood disorders) present a good to excellent reliability and can safely be used as a reference (gold standard) to evaluate the diagnostic performance of a primary care brief assessment tool. More objective/significant measures are needed to improve reliability of malnutrition, visual impairment, and risk of fall assessment before they can serve as a safe gold standard of a primary care tool.

Validity of a shoulder-specific quality of life questionnaire, the Western Ontario Rotator Cuff Index, for patients with scapula alata.

BACKGROUND: No validated shoulder-specific quality of life measurements exist for patients with scapula alata (SA). The objective was to investigate the content validity of the Western Ontario Rotator Cuff (WORC) Index for SA patients. METHODS: Content validity was evaluated by an expert panel of medical doctors and physiotherapists (n = 6) and a sample of SA patients (n = 44). The Content Validity Index (CVI) and a modified kappa index (κ*) assessed the relevance of WORC Index. RESULTS: The experts evaluated ten of 21 items as excellent for content validity (I-CVI > 0.78, κ* > 0.74), five items as fair (I-CVI < 0.78, 0.40 < κ* < 0.60), and six were considered content invalid (I-CVI < 0.78, κ* < 0.40). The average scale (S-CVI/Ave) for the entire WORC Index was 0.72.The SA patients evaluated four of 21 items as excellent for content validity (I-CVI > 0.78, κ* > 0.74), nine items as good (I-CVI < 0.78, 0.60 > κ* < 0.74), six as fair (I-CVI < 0.78, 0.40 < κ* < 0.59) and two were considered content invalid (I-CVI < 0.78, κ* < 0.40). The S-CVI/Ave was 0.56. CONCLUSION: This study is the first step evaluating content validity in the WORC Index for SA patients. The results indicated that half of the 21 items had excellent or good content validity. Several items need to be discussed by an SA team aiming to find consensus for changing or removing, leaving the possibility to develop a new quality of life measure, the first for SA patients.

There is an agreement between constipation referred and that documented by objective criteria? / Existe concordância entre constipação referida e constatada por critérios objetivos?

Abstract Introduction Chronic constipation is the most common digestive complaint at the doctor's office, with high prevalence in the population. However, many patients - and even those physicians not so familiar with pelvic floor disorders-define and consider constipation based on intestinal functionality and stool consistency. But symptoms of incomplete defecation, digital maneuvers, abdominal discomfort, and straining should not be overlooked. Objectives To investigate the correlation between constipation referred and documented through objective criteria in patients admitted on a daytime-nursing ward basis at the Hospital Santa Marcelina, São Paulo. Methodology This is a prospective study of a random sample of patients admitted on a daytime-ward hospitalization basis at Santa Marcelina Hospital to perform minor surgical procedures not related to functional disorders of the gastrointestinal tract in the period from September 2014 to June 2015; the only exclusion criterion was "not agreed to participate in the interview conducted by students of medicine at Santa Marcelina Medical School". Results 102 patients were randomly analyzed in the period considered (51% female) with a mean overall age of 48.6 (19-82) years. Constipation has been reported spontaneously by 17.6% of participants and denied by 82.4%. With the implementation of the Cleveland Clinic's criteria for the diagnosis of constipation, the compliance with the referred symptomatology was 88.9%; the same value was found with the use of the Rome III criteria (Kappa = 0.665). In addition, a higher incidence of constipation was observed in female patients (p = 0.002). Conclusion A higher incidence of constipation was observed in female participants, with no statistical difference with respect to age. Furthermore, a substantial agreement was found between constipation referred and constipation documented through objective criteria.

Resumo Introdução A constipação intestinal crônica representa a queixa digestiva mais comum no consultório com elevada prevalência na população. No entanto, frequentemente, os pacientes e mesmo os médicos, não tão afeitos com os distúrbios do assoalho pélvico, definem e consideram constipação baseados na funcionalidade intestinal e consistência das fezes. Entretanto, os sintomas de defecação incompleta, manobras digitais, desconforto abdominal e esforço evacuatório não devem ser negligenciados. Objetivos Verificar a correlação entre constipação intestinal referida e constatada através de critérios objetivos em pacientes internados em regime de enfermaria dia no Hospital Santa Marcelina, São Paulo. Metodologia Estudo prospectivo de amostra aleatória de pacientes internados em enfermaria dia do Hospital Santa Marcelina para realização de cirurgias de pequeno porte e não relacionadas a distúrbios funcionais de trato gastrintestinal no período entre setembro de 2014 e junho de 2015, cujo único critério de exclusão foi o não consentimento em participar da entrevista realizada pelos alunos do curso de medicina da Faculdade Santa Marcelina. Resultados Foram analisados de forma aleatória 102 pacientes no período sendo 51% do sexo feminino e média de idade global de 48,6 anos (19-82 anos). A constipação foi referida de forma espontânea em 17,6% e negada em 82,4%. Ao se utilizar o critério da Cleveland Clinic para constatar constipação houve uma concordância com o sintoma referido fora de 88,9%, com mesmo valor ao se utilizar os critérios de Roma III (Kappa = 0,665). Além disso, verificou-se maior incidência de constipação intestinal nos pacientes do sexo feminino (p = 0,002). Conclusão Verificou-se maior incidência de constipação no sexo feminino sem diferença estatística baseado na idade. Além disso, constatou-se concordância substancial entre a constipação referida e a documentada através de critérios objetivos.

Study on the consistency of doctor-report outcomes and patient-report outcomes in symptoms of traditional Chinese Medicine: a small sample size trial in diabetics.

Patient-Reported Outcomes (PROs) data are increasingly common and widely accepted in clinical investigations of symptoms. Agreements or differences regarding Doctor-Report Outcomes (DROs) VS PROs data are unclear. In this study, we conducted a clinical trial and investigated the agreement levels of DROs VS PROs in symptoms of diabetics. This study had a parallel self-controlled and double blind design. In total, 90 diabetics who presented with the required symptoms were enrolled in this study, and 83 patients completed the study. The severity (none, mild, moderate, and severe) of each symptom was consistently compared with the Visual Analogue Scale (VAS) for the PROs measure and the numerical rating scales (NRS) for the DROs measure. The Kappa index was used to test the agreement in the variables. Our results show that most of the agreements regarding DROs VS PROs were moderate; few were modest and substantial. However, the DROs data failed to agree with the PROs data well in which symptoms effective evaluation criteria overlapped with the inclusion criteria. We believe this results are caused by distortion of information during the doctor's decision process. We suggest that the effective evaluation criteria should not be overlapped with the inclusion criteria in the DROs design. And if it is unavoidable, PROs design should be worth considering.

Evaluation of RT-PCR and hemi-nested RT-PCR in brain samples from dogs with neurologic signs compatible with distemper / Avaliação das técnicas de RT-PCR e heminested RT-PCR em cérebros de cães com sinais neurológicos compatíveis com cinomose

The diagnostic value of RT-PCR and hemi-nested RT-PCR (hnRT-PCR) was compared in brain samples of dogs presenting neurological signs compatible with canine distemper. Samples of central nervous system (CNS) were collected from 68 dogs and tested by direct immunofluorescence test (RFID) and, independent of the results, they were stored at -20°C for at least three years. They were submitted to the RT-PCR and hnRT-PCR techniques aiming to determine the gene responsible for the viral nucleoprotein decoding. Fifty-nine samples were positive for RIFD, 40 for RT-PCR (Kappa = 0.358) and 54 for hnRT-PCR (Kappa = 0.740). All nine RIFD negative samples were also negative for RT-PCR and hnRT-PCR. In spite of the storage duration and proper sample conditions, the estimated accordance between hnRT-PCR and RIFD demonstrated that hnRT-PCR technique can be applied in retrospective studies...

Foi comparado o valor diagnóstico das técnicas de RT-PCR e heminested RT-PCR (hnRT-PCR) em amostras de cérebro de cães com sintomatologia nervosa compatível com cinomose. Fragmentos do sistema nervoso central (SNC) colhidos de 68 animais foram testados pela Imunofluorescência direta (IFD) e, independentemente do resultado, foram armazenados a -20°C por pelo menos três anos. Após esse período, foram submetidos a RT-PCR e a hnRT-PCR com oligonucleotídeos iniciadores direcionados ao gene codificador da nucleoproteína N. As proporções de resultados positivos/examinados foram: 59/68 para a IFD, 40/68 para a RT-PCR (Kappa = 0,358) e 54/68 quando associada à heminested PCR (Kappa = 0,740). Houve nove resultados negativos nas três técnicas empregadas. Os resultados do coeficiente Kappa entre a IFD e hnRT-PCR demonstram que apesar das condições de armazenamento, a hnRT-PCR pode ser utilizada em estudos retrospectivos...