¿Cómo establecer la hipótesis y los objetivos de un proyecto de investigación en Radiología? / How are the hypothesis and the objectives established in a Radiology research project?

La investigación es un proceso sistemático destinado a responder a una pregunta. Ésta constituye el punto de partida de todo proyecto, y formula de manera concreta un problema observado en el análisis dela realidad. La respuesta pretende aclarar una incertidumbre de nuestro conocimiento. La hipótesis conceptual es la respuesta teórica a la pregunta planteada. La forma concreta por la que se pretende demostrar lahipótesis conceptual es lahipótesis operativa. Los objetivos son la razón de ser y hacer enlainvestigación. Ayudan a definir qué es lo que se pretende obtener, qué respuestas va a dar a las preguntas formuladas. Deben mostrar una relación clara y consistente con la descripción del problema y, específicamente, con las preguntas y/o hipótesis que se quieren resolver (AU)

Research is a systematic process designed to answer a question. This is the starting point of the whole project and specifically formulates a problem observed in the analysis of the reality. The answer to this attempts to clarify an uncertainty in our knowledge. The conceptual hypothesis is the theoretical answer to the question set out. The operational hypothesis is the particular form that which sets out to demonstrate the conceptual hypothesis. The objectives are the justification for conducting the research. They help to define what it attempts to obtain, and what answers it will give to the formulated questions. It must show a clear and consistent relationship with the description of the problem and, specifically, with the questions and/or hypothesis that are to be resolved (AU)

[How are the hypothesis and the objectives established in a Radiology research project?]. / ¿Cómo establecer la hipótesis y los objetivos de un proyecto de investigación en Radiología?

Research is a systematic process designed to answer a question. This is the starting point of the whole project and specifically formulates a problem observed in the analysis of the reality. The answer to this attempts to clarify an uncertainty in our knowledge. The conceptual hypothesis is the theoretical answer to the question set out. The operational hypothesis is the particular form that which sets out to demonstrate the conceptual hypothesis. The objectives are the justification for conducting the research. They help to define what it attempts to obtain, and what answers it will give to the formulated questions. It must show a clear and consistent relationship with the description of the problem and, specifically, with the questions and/or hypothesis that are to be resolved.

[eOphthalmology: current state and future tendencies]. / eOftalmología: estado actual y tendencias futuras.

eOphthalmology can be defined as the use of information and telecommunications technologies to provide or support a group of activities related to ophthalmic care. The same concept applied to ophthalmic care would be eOphthalmology. This paper describes the current state of eOphthalmology-based models in diabetic retinopathy screening and in the diagnosis and follow-up of chronic glaucoma and age-related macular degeneration. Furthermore, the main advantages of these models and the technological requirements needed for their implementation are described. Finally, a prediction of the impact of eOphthalmology on the future of health care is offered.

eOftalmología: estado actual y tendencias futuras / eOphthalmology: current state and future tendencies

La eSalud se puede definir como el uso de las tecnologíasde la información y las comunicaciones paraproporcionar o apoyar un diverso grupo de actividadesrelacionadas con la atención en salud. Si este conceptose traslada a la atención oftalmológica sería lo quedenominamos como eOftalmología. En este artículose describe el estado actual de los modelos de eOftalmologíaen el cribado de la retinopatía diabética y eldiagnóstico y el seguimiento del glaucoma crónico yla degeneración macular asociada a la edad. Tambiénse definen los requerimientos tecnológicos necesariospara implantar este tipo de modelos de asistencia, sediscuten las ventajas derivadas de los mismos y se haceuna previsión del impacto que la eOftalmología puedetener en el futuro de la asistencia sanitaria(AU)

eOphthalmology can be defined as the use of informationand telecommunications technologies to provideor support a group of activities related to ophthalmiccare. The same concept applied to ophthalmiccare would be eOphthalmology. This paper describesthe current state of eOphthalmology-based models indiabetic retinopathy screening and in the diagnosis andfollow-up of chronic glaucoma and age-related maculardegeneration. Furthermore, the main advantages of thesemodels and the technological requirements neededfor their implementation are described. Finally, a predictionof the impact of eOphthalmology on the futureof health care is offered(AU)

[Quantification of liver iron concentration using 1-Tesla MRI]. / Cuantificación de la concentración de hierro en hígado mediante RM de 1 Tesla.

OBJECTIVE: To evaluate the quantification of liver iron concentration using 1-Tesla magnetic resonance imaging (MRI) and its ability to diagnose or rule out hemochromatosis. To evaluate the role of 1.5-Tesla MRI in inconclusive cases. MATERIAL AND METHOD: Between 2002 and 2006, we used 1-Tesla MRI (Gandon method) and liver biopsy to quantify the liver iron concentration in 31 patients. Moreover, we used 1.5-Tesla MRI (according to Alústiza's model) and liver biopsy to determine the liver iron concentration in 10 additional patients and to check the results of 10 patients in whom 1-Tesla MRI detected iron overload. RESULTS: In the first group of 31 patients, liver biopsy classified the liver iron concentration as normal (<36 micromol.Fe/g) in 11 patients, as hemosiderosis (36-80 micromol.Fe/g) in 15, and as hemochromatosis (>80 micromol.Fe/g) in 5. The correlation with the values calculated at MRI was 100% in the 5 cases with hemochromatosis; in the 15 patients with hemosiderosis, 5 were correctly classified and the liver iron concentration was overestimated in 10; of the 11 patients with normal liver iron concentration, 6 were correctly classified and 5 were overestimated. Quantification >80 at MRI has a sensitivity and negative predictive value of 100% and specificity of 50% for the diagnosis of hemochromatosis. Quantification <36 at MRI has a positive predictive value and specificity of 100% to identify the absence of iron overload. In the 10 patients with liver biopsy that underwent 1.5-Tesla MRI, there was a high correlation between the two techniques. CONCLUSION: The reliability of the evaluation of liver iron concentration using 1-Tesla MRI is useful for ruling out hemochromatosis and identifying patients without iron overload. We observed a tendency to overestimate liver iron concentration in both patients with overload and in those without, and this limits the reliability of the technique. 1.5-Tesla MRI is a good alternative for quantifying liver iron concentration more precisely.

[Agreement among ophthalmologists and primary care physicians in the evaluation of retinographies of diabetic patients]. / Concordancia en el estudio de retinografías en diabéticos: oftalmólogos vs médicos de familia.

PURPOSE: To assess the extent of agreement in the evaluation of non-mydriatic retinographies of diabetic patients among ophthalmologists and a group of primary care physicians with previous training. METHODS: The study was divided in two phases. In the first phase, the four participants were instructed in the interpretation of retinographies. The second phase involved the evaluation of 1000 images of 200 patients, 100 without retinopathy and 100 with signs of diabetic retinopathy. The four participants had to decide if the images did or did not show evidence of diabetic retinopathy. Kappa index was used to assess the extent of agreement. A percentage disagreement of 15% with a precision of 5% (+/-5%) with a confidence level of 95% was considered adequate. RESULTS: The percentage of coincident diagnoses among ophthalmologists and primary care physicians was between 89 and 97.5%. With respect to the assessment of the agreement, the kappa index was between 80 and 95%. In all cases the confidence interval was at least 85%. CONCLUSIONS: After an adequate training process, the reliability of evaluation of non-mydriatic retinographies of diabetic patients by primary care physicians was very high. This could allow the establishment of screening for diabetic retinopathy at the primary care level. Advantages of this system include a greater involvement of primary care physicians in the global management of diabetic patients and a lower demand for ophthalmic attention.

Concordancia en el estudio de retinografías en diabéticos: oftalmólogos vs médicos de famlia / Agreement among ophthalmologists and primary care physicians in the evaluation of retinographies of diabetic patients

Objetivo: Determinar la concordancia en la interpretación de retinografías no midriáticas de pacientes diabéticos entre oftalmólogos y un grupo de médicos de atención primaria previamente sometidos a un proceso de adiestramiento. Métodos: El estudio fue dividido en dos fases. En la primera se adiestró a los participantes en la interpretación de imágenes retinográficas. La segunda fase se realizó sobre 1000 imágenes correspondientes a 200 pacientes, 100 sin retinopatía diabética y 100 con retinopatía. Los participantes debían decidir si las imágenes presentaban o no signos de retinopatía diabética. Para la valoración de la concordancia se utilizó el índice kappa. Se estimó como adecuado un porcentaje de desacuerdo del 15% con una precisión del 5% (±5%) con un nivel de confianza del 95%. Resultados: El porcentaje de diagnósticos coincidentes entre oftalmólogos y médicos de atención primaria está entre 89 y 97,5%. Por lo que respecta a la evaluación de la concordancia, el índice kappa se sitúa entre 80 y 95%. En todos los casos el intervalo de confianza incluye el 85%. Conclusiones: Después de un adecuado adiestramiento, la fiabilidad de facultativos de atención primaria en interpretar retinografías no midriáticas de diabéticos es muy alta. Esto permitiría establecer en atención primaria el filtro para el cribado de la retinopatía diabética. Las ventajas de esta medida serían una mayor implicación de atención primaria en el manejo global de los diabéticos y una disminución de la demanda de atención oftalmológica

Purpose: To assess the extent of agreement in the evaluation of non-mydriatic retinographies of diabetic patients among ophthalmologists and a group of primary care physicians with previous training. Methods: The study was divided in two phases. In the first phase, the four participants were instructed in the interpretation of retinographies. The second phase involved the evaluation of 1000 images of 200 patients, 100 without retinopathy and 100 with signs of diabetic retinopathy. The four participants had to decide if the images did or did not show evidence of diabetic retinopathy. Kappa index was used to assess the extent of agreement. A percentage disagreement of 15% with a precision of 5% (±5%) with a confidence level of 95% was considered adequate. Results: The percentage of coincident diagnoses among ophthalmologists and primary care physicians was between 89 and 97.5%. With respect to the assessment of the agreement, the kappa index was between 80 and 95%. In all cases the confidence interval was at least 85%. Conclusions: After an adequate training process, the reliability of evaluation of non-mydriatic retinographies of diabetic patients by primary care physicians was very high. This could allow the establishment of screening for diabetic retinopathy at the primary care level. Advantages of this system include a greater involvement of primary care physicians in the global management of diabetic patients and a lower demand for ophthalmic attention (Arch Soc Esp Oftalmol 2008; 83: 527-532)

[Diagnosis and quantification of iron overload in the liver using MRI]. / Diagnóstico y cuantificación de la sobrecarga férrica en el hígado mediante resonancia magnética.

Hereditary hemochromatosis is the most common cause of iron overload. The diagnosis of hereditary hemochromatosis has improved since Feder et al. isolated the HFE gene in 1996 and discovered the mutations related with this disease. Nevertheless, in many cases genetic tests for hereditary hemochromatosis are negative. These cases require diagnostic confirmation by quantifying the concentration of iron in the liver (LIC); this has traditionally been accomplished by liver biopsy. Many studies have shown that it is possible to quantify LIC using MRI. However, a consensus has yet to be reached about the most appropriate technique or whether it is possible to reproduce the same methods of calculation on different MRI units. This article reviews the current state of these questions and points to possible lines to standardize this noninvasive method of quantifying LIC in the future.

Diagnóstico y cuantificación de la sobrecarga férrica en el hígado mediante resonancia magnética / Diagnosis and quantification of iron overload in the liver using MRI

La hemocromatosis hereditaria es la modalidad más frecuente de sobrecarga férrica. El diagnóstico de la misma ha mejorado desde que en 1996 Feder et al aislaron el gen HFE descubriendo las mutaciones relacionadas con la enfermedad. Sin embargo, son muchos los pacientes con estudios genéticos negativos, y que por tanto requieren una confirmación diagnóstica mediante la cuantificación de la concentración de hierro en hígado (CHH) que tradicionalmente se ha realizado mediante biopsia hepática. Muchos estudios han demostrado la posibilidad de cuantificar la CHH mediante resonancia magnética. Sin embargo, todavía no existe un consenso en cuanto a la técnica más idónea ni en cuanto a la posibilidad o no de reproducir el mismo método de cálculo en diferentes máquinas. Este artículo revisa la realidad de estas cuestiones y señala posibles líneas de futuro para estandarizar este método no invasivo de cuantificación de la CHH

Hereditary hemochromatosis is the most common cause of iron overload. The diagnosis of hereditary hemochromatosis has improved since Feder et al. isolated the HFE gene in 1996 and discovered the mutations related with this disease. Nevertheless, in many cases genetic tests for hereditary hemochromatosis are negative. These cases require diagnostic confirmation by quantifying the concentration of iron in the liver (LIC); this has traditionally been accomplished by liver biopsy. Many studies have shown that it is possible to quantify LIC using MRI. However, a consensus has yet to be reached about the most appropriate technique or whether it is possible to reproduce the same methods of calculation on different MRI units. This article reviews the current state of these questions and points to possible lines to standardize this noninvasive method of quantifying LIC in the future

Enfermedad celíaca y déficit selectivo de inmunoglobulina A / Celiac disease and selective IgA deficit

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Hepatitis tóxica tras tratamiento con flutamida / Toxic hepatitis after flutamide treatment

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Ageusia e hiposmia reversibles inducidas por tratamiento con interferón en un paciente con hepatitis crónica C / Reversible ageusia and hyposmia induced by interferon in a patient with chronic hepatitis C

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