RESUMEN
BACKGROUND/AIMS: We evaluated the diagnostic variability and reproducibility of endoscopic signs in two populations with a different pretest likelihood of celiac disease (CD). METHODS: We recruited 289 CD patients (both adults and children) in a multicenter prospective study. Group 1 (high risk) included 111 patients referred for positive serology. Group 2 (low risk) included 178 unselected patients. Mosaic pattern, reduction/loss of Kerckring's folds, scalloping of the valvulae conniventes and a nodular pattern were the endoscopic findings looked for in the duodenum. RESULTS: In group 1, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of endoscopic findings were 100, 84.6, 94.2 and 100% in adults, and 86.8, 9.1, 82.1 and 12.5% in children. In group 2, the sensitivity, specificity, PPV and NPV of endoscopic findings were 33.3, 91.4, 7.7 and 98.5% in adults, and noncalculable, 78.3, 0.0 and 100% in children. Comparing group 1 and group 2, there was a statistically significant difference in sensitivity and PPV in adults, and in specificity, PPV and NPV in children. Concerning the reproducibility of endoscopic findings, a wide variability of κ values was found. CONCLUSION: Endoscopic signs have low reproducibility for CD, and their diagnostic value in selecting patients for multiple intestinal biopsies is unacceptable, especially in populations with low disease prevalence.
Asunto(s)
Enfermedad Celíaca/diagnóstico , Duodenoscopía/normas , Duodeno/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores , Enfermedad Celíaca/epidemiología , Niño , Preescolar , Femenino , Humanos , Lactante , Italia/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Prospectivos , Reproducibilidad de los Resultados , Adulto JovenRESUMEN
The new "low-inoculum" mode of the Phoenix system was evaluated to identify clinical coagulase-negative staphylococci. API ID32 Staph panels were used as comparators, and discrepancies were resolved by 16S rRNA and tuf gene analysis. The system correctly identified 90.5% of isolates, with a mean time of 10.2 h. Accuracy was satisfactory for Staphylococcus epidermidis, S. saprophyticus, and S. haemolyticus.
Asunto(s)
Técnicas de Tipificación Bacteriana/métodos , Coagulasa/biosíntesis , Infecciones Estafilocócicas/diagnóstico , Staphylococcus/clasificación , Staphylococcus/aislamiento & purificación , Proteínas Bacterianas/genética , Humanos , Factor Tu de Elongación Peptídica/genética , ARN Ribosómico 16S/genética , Análisis de Secuencia de ADN , Infecciones Estafilocócicas/microbiología , Staphylococcus/enzimologíaRESUMEN
The inflammatory reaction caused by 2 different suture materials, black silk and polyglycolic acid, was evaluated 8 days after application and permanence in the oral environment. A randomized sample of 55 patients, aged 9 to 76, who had undergone oral urgery was examined. The suture materials (30 black silk and 25 polyglycolic acid), soon after removal, were placed in sterile containers and transferred to the laboratory. A bacterial count was carried out and the sutures were observed under light microscope (x100 magnification) to indirectly evaluate the inflammatory reaction. All patients were recommended to properly disinfect the wound with a 0.2% chlorhexidine solution. The inflammatory reaction of gingival tissues was lower for polyglycolic acid compared to silk sutures. However, the wound conditions, evaluated 8 days after surgery, were acceptable in patients treated with both silk and polyglycolic acid sutures. The use of chlorhexidine solution did not significantly affect the presence and type of microorganisms in either kind of suture.
