Evaluation of point-of-care tests for cutaneous leishmaniasis diagnosis in Kabul, Afghanistan.

BACKGROUND: Kabul (Afghanistan) is a major focus of cutaneous leishmaniasis (CL) caused by Leishmania tropica. Microscopy remains the reference test for diagnosis despite its low performance. We evaluated whether Loopamp™ Leishmania Detection Kit (Loopamp) and CL Detect™ Rapid Test (CL Detect), detecting Leishmania DNA and antigen, respectively could improve CL diagnosis. METHODS: A diagnostic accuracy study with prospective inclusion was conducted in a leishmaniasis reference clinic in Kabul. Slit skin samples from CL suspects were analysed by microscopy. Samples taken with a dental broach were tested with CL Detect, Loopamp, and PCR. All samples were transferred to the Academic Medical Center (AMC, the Netherlands) for PCR and Loopamp analyses. The diagnostic performance of the tests was evaluated against a reference combining microscopy and PCR. FINDINGS: 274 CL suspects were included in the study. In Kabul, CL Detect had a 65·4% sensitivity [95% Confidence Interval (CI): 59.2-71.2%] and a 100% specificity [95% CI: 80.5-100%], while these were 87.6% [95%CI: 82.9-91.3%] and 70.6% [95% CI: 44.0-89.7%] for Loopamp. At AMC the Loopamp's sensitivity (92.2% [95% CI: 88.2-95.2%]) and specificity (94.1% [95% CI: 71.3-99.8%]) were higher. An algorithm where CL Detect negative suspects would be tested by Loopamp yielded a 93.4% sensitivity [95% CI: 89.6-96.1%] and a 94.1% specificity [95% CI: 71.3-99.8%] when Loopamp's performance at AMC was used. INTERPRETATION: The high specificity of CL Detect and the performance of Loopamp allow their use in a diagnostic algorithm that would minimize the number of CL patients referred for confirmation. FUND: Federal Ministry of Education and Research, Germany.

Análisis de concordancia entre trazado cefalométrico manual y cefalométrico digital con programa Nemoceph / Analysis of concordance between manual cephalometric and digital cephalometric tracing with Nemoceph program

La importancia del análisis cefalométrico dentro del diagnóstico en ortodoncia ha ido incrementando a través de los años, por ello, el interés de comparar la confiabilidad de los sistemas digitales con el trazado manual convencional. Objetivo: Definir el grado de concordancia entre los resultados de trazado cefalométrico manual y con Nemoceph. Material y métodos: Se utilizaron ocho medidas lineales y angulares del análisis cefalométrico de Steiner. Se realizó un estudio transversal, correlacional, en el cual se analizaron 70 radiografías laterales de cráneo digitales. Los resultados se dividieron en dos grupos, trazado manual y trazado cefalométrico con Nemoceph, los cuales fueron evaluados con un índice de correlación intraclase. Conclusión: Se reportó un grado de correlación intraclase mayor a 0.75, estableciendo que el sistema digital exhibe la misma precisión del manual, con algunas ventajas convenientes a la época (AU)

The importance taken by the cephalometric analysis within the orthodontic diagnosis has been increasing over the years, for that reason the interest of comparing the reliability of the digital systems with the conventional manual tracing. Objective: To define the degree of concordance between the results of manual cephalometric tracing and with Nemoceph. Material and methods: Eight linear and angular measurements of Steiner's cephalometric analysis were used. A crosssectional, correlational study was conducted in which 70 digital skull lateral radiographs were analyzed. The results were divided into two groups; manual tracing and cephalometric tracing with Nemoceph, which were evaluated with an intraclass correlation index. Conclusion: a correlation degree greater than 0.75 was reported. Establishing that the digital system exhibits the same precision of the manual, with some advantages suited to the age (AU)