Estudio de la variabilidad inter - e intraobservador en la determinación de la densidad mamaria según la 5ª edición del Atlas BI-RADS(R) / Interobserver and intraobserver variability in determining breast density according to the fifth edition of the BI-RADS(R) Atlas

OBJETIVO: Determinar el acuerdo intra- e interobservador en la categorización de la densidad mamográfica entre un grupo de profesionales según la 5.a edición del Atlas BI-RADS® - ACR y analizar la concordancia entre la categorización de los expertos y un software comercial de un mamógrafo digital para categorización automática. MÉTODOS: 6 médicos categorizaron la densidad mamográfica de 451 mamografías en dos oportunidades con un intervalo de 1 mes. Calculamos los coeficientes kappa ponderados lineales de acuerdo inter- e intraobservador para el grupo médico y la concordancia entre el software comercial y el reporte de la mayoría. Analizamos los resultados para las cuatro categorías de densidad mamaria y para el resultado dicotómico de mama densa/no densa. RESULTADOS: El acuerdo interobservador entre especialistas y el reporte de la mayoría fue moderado y casi perfecto para el análisis por categoría (kappa = 0,64 a 0,84) y de manera dicotómica (kappa = 0,63 a 0,84). El acuerdo intraobservador fue sustancial y casi perfecto (kappa = 0,68 a 0,85 para 4 categorías y k=0,70 a 0,87 para el análisis dicotómico). El acuerdo entre el reporte de la mayoría y el software comercial fue moderado tanto por categoría (kappa = 0,43) como en el análisis dicotómico (kappa = 0,51). CONCLUSIÓN: Hemos observado un acuerdo entre moderado y casi perfecto inter- e intraobservador entre los radiólogos, según los criterios establecidos en la 5.ª edición del Atlas BI-RADS®. El nivel de acuerdo entre el reporte de los especialistas y un software disponible comercialmente fue moderado

OBJECTIVE: To determine the level of agreement within and between observers in the categorization of breast density on mammograms in a group of professionals using the fifth edition of the American College of Radiology's BI-RADS® Atlas and to analyze the concordance between experts' categorization and automatic categorization by commercial software on digital mammograms. METHODS: Six radiologists categorized breast density on 451 mammograms on two occasions one month apart. We calculated the linear weighted kappa coefficients for inter- and intra-observer agreement for the group of radiologists and between the commercial software and the majority report. We analyzed the results for the four categories of breast density and for dichotomous classification as dense versus not dense. RESULTS: The interobserver agreement among radiologists and the majority report was between moderate and nearly perfect for the analysis by category (Kappa = 0.64 to 0.84) and for the dichotomous classification (Kappa = 0.63 to 0.84). The intraobserver agreement was between substantial and nearly perfect (Kappa = 0.68 to 0.85 for 4 categories and k=0.70 to 0.87 for the dichotomous classification). The agreement between the majority report and the commercial software was moderate both for the four categories (Kappa = 0.43) and for the dichotomous classification (Kappa = 0.51). CONCLUSION: Agreement on breast density within and between radiologists using the criteria established in the fifth edition of the BI-RADS® Atlas was between moderate and nearly perfect. The level of agreement between the specialists and the commercial software was moderate

[Effect of nutritional status on mortality and functional recovery in older adults with hip fracture]. / Efecto del estado nutricional en la mortalidad y recuperación funcional en adultos mayores con fractura de cadera.

INTRODUCTION: Malnutrition is a common problem in the elderly population but has not been fully studied in elderly people with hip fractures. The goal is to estimate annual mortality based on nutrition in the elderly with hip fracture and compare motor functionality. MATERIAL AND METHODS: Retrospective cohort of patients over 65 years of age with hip fracture included in the Institutional Register of The Elderly with Hip Fracture of a University Hospital, between July 2014 and July 2018. Nutritional status with Mini Nutritional Assessment Short-Form (MNA-SF) was assessed at hospital admission. Motor functional capacity was evaluated with Parker Scale (PS) basal, at three and 12 months. RESULTS: 1,253 patients were included. 49.92% (CI95% 47.12-52.72) were malnourished. The annual mortality of the well-nourished (WN) was 9.45% (CI95% 7.23-12.30) against 21.52% (CI95% 18.12-25.45; p 0.001) of the malnourished (MN). The risk of death was associated with malnutrition HR 2.45 (CI95% 1.75-3.43; p 0.001). After adjusting it by age, sex, fragility, AVD, Charlson comorbility index and dementia, the risk remained HR 1.71 (CI95% 17-2.49; p = 0.005). With respect to functionality, the basal Parker Scale median (EP) for the WN group was 9 (RIC6-9) and for MN was 5 (RIC3-9) p 0.001, 6 months (RIC3-6) and 4 (RIC2-6) p 0.001 and 12 months 6 (RIC4-7) and 3 (RIC2-6) p 0.001. CONCLUSIONS: There is an association between the malnutrition of the elderly with hip fracture and its mortality with a year of evaluation; we also find a difference in motor functionality.

INTRODUCCIÓN: La malnutrición es una problemática frecuente en la población anciana, pero no ha sido completamente estudiado en ancianos con fractura de cadera. El objetivo es estimar mortalidad anual según nutrición en ancianos con fractura de cadera y comparar la funcionalidad motora. MATERIAL Y MÉTODOS: Cohorte retrospectiva de pacientes mayores de 65 años con fractura de cadera incluidos en el Registro Institucional de Ancianos con Fractura de Cadera de un Hospital Universitario, entre Julio de 2014 y Julio de 2018. Se evaluó el estado nutricional con Mini Nutritional Assessment Short-Form (MNA-SF) al ingreso hospitalario. La capacidad funcional motora fue evaluada con escala de Parker (EP) basal, a los tres y 12 meses. RESULTADOS: Se incluyeron 1,253 pacientes. 49.92% (IC95% 47.12-52.72) estaba malnutrido. La mortalidad anual de los bien nutridos (BN) fue de 9.45% (IC95% 7.23-12.30) contra 21.52% (IC95% 18.12-25.45; p 0.001) de los malnutridos (MN). El riesgo de muerte se asoció a la malnutrición HR 2.45 (IC95% 1.75-3.43; p 0.001). Luego de ajustarlo por edad, sexo, fragilidad, AVD, índice de comorbilidades de Charlson y demencia, el riesgo se mantuvo HR 1.71 (IC95% 17-2.49; p = 0.005). Con respecto a la funcionalidad, la mediana de la escala de Parker (EP) basal para el grupo BN fue 9 (RIC6-9) y para MN fue 5 (RIC3-9) p 0.001, a los tres meses 6 (RIC3-6) y 4 (RIC2-6) p 0.001 y a los 12 meses 6 (RIC4-7) y 3 (RIC2-6) p 0.001. CONCLUSIONES: Existe asociación entre la malnutrición del anciano con fractura de cadera y su mortalidad al año, asimismo una diferencia en la funcionalidad motora.

Interobserver and intraobserver variability in determining breast density according to the fifth edition of the BI-RADS® Atlas. / Estudio de la variabilidad inter- e intraobservador en la determinación de la densidad mamaria según la 5.a edición del Atlas BI-RADS®.

OBJECTIVE: To determine the level of agreement within and between observers in the categorization of breast density on mammograms in a group of professionals using the fifth edition of the American College of Radiology's BI-RADS® Atlas and to analyze the concordance between experts' categorization and automatic categorization by commercial software on digital mammograms. METHODS: Six radiologists categorized breast density on 451 mammograms on two occasions one month apart. We calculated the linear weighted kappa coefficients for inter- and intra-observer agreement for the group of radiologists and between the commercial software and the majority report. We analyzed the results for the four categories of breast density and for dichotomous classification as dense versus not dense. RESULTS: The interobserver agreement among radiologists and the majority report was between moderate and nearly perfect for the analysis by category (κ=0.64 to 0.84) and for the dichotomous classification (κ=0.63 to 0.84). The intraobserver agreement was between substantial and nearly perfect (κ=0.68 to 0.85 for 4 categories and k=0.70 to 0.87 for the dichotomous classification). The agreement between the majority report and the commercial software was moderate both for the four categories (κ=0.43) and for the dichotomous classification (κ=0.51). CONCLUSION: Agreement on breast density within and between radiologists using the criteria established in the fifth edition of the BI-RADS® Atlas was between moderate and nearly perfect. The level of agreement between the specialists and the commercial software was moderate.

Survival and functionality in the elderly over 85 years of age with hip fracture. / Supervivencia y funcionalidad en ancianos mayores de 85 años con fractura de cadera.

BACKGROUND: There is a tendency for the aging population to fracture their hips. Our aim was to compare survival and functionality at one year, among elderly and very elderly patients with hip fracture. MATERIAL AND METHODS: A prospective cohort of patients included in the Institutional Registry of Elderly Patients with Hip Fracture between 2014 and 2017. We classified patients as elderly patients (EP) <65 and <85 years and very elderly patients (VEP) ≥85 years. RESULTS: We included 952 patients, 43% were EP and 57% were VEP. The proportion of women was 84% and 86% (P=.33) and with 2 or more points in the Charlson comorbidities index (28 and 31%, P= .36), respectively. The VEP were more dependent according to the Barthel score (34% and 62%, P<.01) and frailer according to the Edmonton score (30% and 61%, P<.01). One-year survival was 91% (95% CI 86-93) in the EP and 76% (95% CI 70-89) in the VEP. In-hospital complications were more frequent in the VEP 12% (7% in the EP, P<.01). Age is an independent risk factor for one-year survival (HR 2.11; 95% CI 1.36-3.29, P<.001). CONCLUSIONS: Age is a risk factor for the VEP group survival despite fragility and comorbidities. Because of their vulnerability, an appropriate care plan should be considered for VEP.

Análogos de prostaglandinas y desarrollo de membrana epirretinal / Topical prostaglandin analogues and development of epiretinal membrane

OBJETIVOS: Evaluar la posible asociación entre el uso de análogos de prostaglandinas (AP) y el desarrollo de membrana epirretinal (MER) en pacientes con glaucoma. MÉTODO: Mediante el método comparativo se realizó un diseño retrospectivo de casos y controles. Se compararon pacientes que presentaban glaucoma y, a su vez, MER y que utilizaban una mayor proporción de AP con un grupo control de pacientes que presentaban glaucoma pero sin MER. El diagnóstico de MER ha sido realizado mediante un examen clínico y un estudio de tomografía de coherencia óptica. RESULTADOS: La edad media de los casos ha sido de 77 años, con DE de 8,68 (IC 95%: 74,3-79,4) y la de los controles de 63 años, con DE de 16,6 (IC 95%: 70,1-78,5). El 50% de los casos (n = 26) estaba compuesto por hombres y el otro 50% eran mujeres (n = 26), mientras que para los controles el 25,4% eran hombres (n = 16) y el 74,6% eran mujeres (n = 47). El 59,6% de los casos (n = 31) y el 60,3% de los controles (n = 38) fueron tratados con AP. No se ha observado ninguna diferencia de colocación de AP entre ambos grupos (p = 0,939). CONCLUSIONES: En este trabajo no hemos podido demostrar si existe asociación entre el uso de AP y el desarrollo de MER

OBJECTIVES: To determine whether patients with glaucoma and epiretinal membrane (ERM) use a greater proportion of prostaglandin analogues (PA) than a control group of patients with glaucoma without ERM. METHOD: A retrospective study of cases and controls was conducted in order to determine whether patients with glaucoma and ERM used a greater proportion of PA than a control group of patients with glaucoma without ERM. The diagnosis of de ERM was made by clinical examination and optical coherence tomography. RESULTS: The mean age of the cases was 77 years (SD: 8.68; 95% CI: 74.3-79.4), compared to the controls with 63 years (SD: 16.6; 95% CI: 70.1-78.5). The cases included 50% (n = 26) men and 50% women (n=26), whereas in the controls 25.4% (n = 16) of the cases were men and 74.6% (n = 47) women. PA treatment was used in 59.6% (n = 31) and 60.3% (n = 38) of the cases and controls, respectively. There was no statistically significant difference in PA use between the 2 groups (P = .939). CONCLUSIONS: In this study, an association between the use of AP and the development of ERM could not be demonstrated

Topical prostaglandin analogues and development of epiretinal membrane. / Análogos de prostaglandinas y desarrollo de membrana epirretinal.

OBJECTIVES: To determine whether patients with glaucoma and epiretinal membrane (ERM) use a greater proportion of prostaglandin analogues (PA) than a control group of patients with glaucoma without ERM. METHOD: A retrospective study of cases and controls was conducted in order to determine whether patients with glaucoma and ERM used a greater proportion of PA than a control group of patients with glaucoma without ERM. The diagnosis of de ERM was made by clinical examination and optical coherence tomography. RESULTS: The mean age of the cases was 77 years (SD: 8.68; 95% CI: 74.3-79.4), compared to the controls with 63 years (SD: 16.6; 95% CI: 70.1-78.5). The cases included 50% (n=26) men and 50% women (n=26), whereas in the controls 25.4% (n=16) of the cases were men and 74.6% (n=47) women. PA treatment was used in 59.6% (n=31) and 60.3% (n=38) of the cases and controls, respectively. There was no statistically significant difference in PA use between the 2groups (P=.939). CONCLUSIONS: In this study, an association between the use of AP and the development of ERM could not be demonstrated.