Reliability of radiologic evaluation of abdominal aortic calcification using the 24-point scale.

OBJECTIVE: Calcification of the abdominal aorta is associated with increased cardiovascular morbidity, so a reliable method to quantify it is clinically transcendent. The 24-point scale (AAC-24) is the standard method for assessing abdominal aortic calcification on lateral plain films of the lumbar spine. The aim of this study was to determine the intraobserver and interobserver agreements for the AAC-24, taking into account the heterogeneity of the distribution of the calcifications in the design of the statistical analysis. MATERIAL AND METHODS: We analyzed the intraobserver agreement (in plain films from 81 patients, with a four-year separation between observations) and the interobserver agreement (in plain films from 100 patients, with three observers), using both intraclass correlation and Bland-Altman plots. RESULTS: The intraobserver intraclass correlation coefficient was 0.93 (95% confidence interval [CI95%]: 0.6-0.9), and the interobserver intraclass correlation coefficient was 0.91 (CI95%: 0.8-0.9) with an increase in the coefficient in the tercile with the greatest discrepancy. The difference in means ranged from 0.3 to 1.2 points, and the distance between the limits of agreement ranged from 4.7 to 9.4 points. These differences increased significantly as the calcification progressed. CONCLUSIONS: Using the AAC-24 on lateral plain films of the lumbar spine is a reliable and reproducible method of assessing calcification of the abdominal aorta; both intraobserver and interobserver agreement are higher during the initial phases of calcification.

[Particulate matter PM10, NO2 and exacerbations of chronic respiratory diseases]. / Partículas en suspensión PM10, NO2 y agudizaciones de enfermedad respiratoria crónica.

OBJECTIVES: The new World Health Organization guidelines recommend studies with simultaneous exposure to multiple air pollutants. The main objective has been to analyze the strength of the association between different concentrations of PM10 and NO2 and the exacerbation of chronic respiratory diseases (ECRD), specifically asthma and chronic obstructive pulmonary disease. MATERIAL AND METHODS: Retrospective cross-sectional study. The population analyzed were adults treated in an urgent and primary health care center on certain lag+1 days in 2019. Three indices have been developed (1: high levels of PM10 and NO2; 2: high level of PM10 and low level of NO2, and 3: low levels of PM10 and NO2) and a logistic regression model for each of them, with ECRD as the outcome variable, and the progressive addition of adjustment variables (sex, age, tobacco, Charlson index, season, precipitation, wind and temperature). RESULTS: Four hundred and sixty-one people were analyzed, 17 with ECRD. Models 1 and 2 presented very similar values in the adjusted OR (4.28 [95% CI 1.05-17]), R2 (0.88) and the area under the ROC curve (>0.72). In both of them the significance was maintained after including the adjustment variables, while model 3 only allowed the addition of precipitation. The inclusion of the Charlson index and the tobacco consumption in the 3 models implied the loss of statistical significance of the PM10/NO2 combination regarding ECRD. CONCLUSIONS: High levels of PM10 are related to ECRD and have a greater impact than NO2, with tobacco use and comorbidities being the main precipitants of ECRD.

Radiologic assessment of abdominal aortic calcifications, atherosclerotic burden levels and statistical bias affecting the reliability.

INTRODUCTION: AAC-8 and AAC-24 are two widely used scales to evaluate abdominal aortic calcification (AAC) on X-ray images. Levels of ≥3 (AAC-8) and ≥5 points (AAC-24) are of high relevance since they are associated with greater risk of cardiovascular events. Given that it is unknown, our aim was to determine the reliability of both scales at those levels of atherosclerotic burden. METHODS: The sample (93 subjects, 67.3 ± 9.7 years, BMI 28.8 ± 3.8, 57.6% smokers, 64.1% with hypertension) was classified according to quartiles of calcification. Six clinicians evaluated AAC independently with both scales on lateral lumbar spine X-ray images. We analyzed inter-rater agreement with the intraclass correlation coefficient (ICC) and the Bland-Altman scatterplots. RESULTS: We assessed 15 pairs of raters. Scores in both scales were significantly correlated with cardiovascular risk (r = 0.31 and r = 0.32; p < 0.005). Agreement was very high in the first quartile and moderate in the rest (p < 0.05). At cut-off points, ICC = 0.70 (95%CI, 0.54-0.86) and ICC = 0.68 (95%CI, 0.60-0.85) with AAC-8 and AAC-24. With the Bland-Altman method, mean of the differences ranged between 0 and 0.4 (AAC-8), and between 0.2 and 1 (AAC-24), while 95% limits of agreement showed values between 2.9 and 4.4 (AAC-8), and between 6 and 11.2 (AAC-24). Analyzing entire scales, ICC = 0.97 (95%CI, 0.97-0.98) and ICC = 0.98 (95%CI, 0.97-0.98) for AAC-8 and AAC-24, respectively. CONCLUSION: Both scales presented only moderate reliability at levels of atherosclerotic burden. Analyzing quartiles with ICC and the Bland-Altman plot showed concordant results. High global ICC values traditionally reported with both scales are likely biased. IMPLICATIONS FOR PRACTICE: AAC predicts subsequent vascular morbidity and mortality and should implicate evaluation of cardiovascular risk. Optimal visualisation of AAC and its correct assessment are mandatory in order to maximize patient care.

[Accuracy and reliability between glucose meters: A study under normal clinical practice conditions]. / Exactitud y concordancia entre glucómetros: un estudio en condiciones habituales de práctica clínica.

INTRODUCTION: The glucose meters usually show a high accuracy, and in clinical practice, capillary and plasma glucose (PG) are used interchangeably. However, many variables can affect the validity of these devices. The aim of this study was to determine the accuracy and reliability of 3 glucose meters that are currently used in a primary care centre. MATERIAL AND METHODS: A sample of venous blood and a drop of capillary blood were obtained from 59 participants. The drop was analysed in 3 glucose meters: 2 FreeStyle® Optium (OP1 and OP2), and one Accu-Chek® Aviva. The PG acted as the reference value, and the haematocrit and plasma levels of urea, bilirubin, uric acid and triglycerides were also analysed. We used the Passing-Bablok regression for accuracy and the intraclass correlation coefficient and the Bland-Altman method for reliability. The current American Diabetes Association standard of a total error of±5% was applied. RESULTS: Differences in mean±standard deviation (mg/dL) and the systematic error were 5.8±7 and 5.8% (OP1); 6.2±8 and 5.9% (OP2); 8.3±8 and 6.3% (Accu-Chek®). The OP1/OP2 pair showed the highest level of reliability, with an intraclass correlation coefficient=0.97, bias=-0.4mg/dL, and a width of the 95% limits of agreement of 28.6mg/dL. The highest levels of accuracy and reliability were observed in high glucose ranges (PG≥126mg/dL). CONCLUSIONS: Despite their clinically acceptable mean difference compared to the PG, the 3 glucose meters did not fulfill the current American Diabetes Association standard. The regular performance of quality control tests of these devices is recommended.