[Interobserver agreement in the diagnosis of bladder outlet obstruction in women]. / Variabilidad interobservador en el diagnóstico de obstrucción del tracto de salida vesical en mujeres.

Background: The diagnosis of bladder outlet obstruction (BOO) in women is a challenge for functional urology. In Mexico there are few data that report the prevalence of OTSV in women, being up to 24% in a group of patients. Objective: The aim of this study is to compare six different definitions of bladder outlet obstruction and evaluate the interobserver agreement in an educational setting. Material and Methods: Urodynamic studies (UDS) of women with and without diagnosis of BOO were retrospectively assesed. Farrar, Chassagne, Lemack, Defreitas, Blavais and Groutz, Solomon-Greenwell definitions were evaluated. All UDS were independently reviewed by 5 observers. The easiest, the hardest and the fastest were chosen. Interobserver agreement to classify the patients as obstructed was assessed by kappa reliability statistical analysis. We classified the type of mistakes the participants made; error of interpretation and miscalculation. Results: A total of 28 urodynamic studies were reviewed. All observers had a substantial agreement (0.64-0.78) to classify BOO using all but Lemack and Solomon-Greenwell definitions. A total 120 errors from 840 responses were found; 45.8% errors of interpretation of UDS and 54.1% miscalculation of the equation. Finally, all the participants chose the Solomon-Greenwell was the most difficult definition. Conclusion: Chassagne, Defreitas and Farrar definitions proved substantial interobserver agreement. Solomon-Greenwell and Lemack´s definitions had the highest number of pitfalls and the lowest level of agreement.

Introducción: el diagnóstico de obstrucción de tracto de salida vesical (OTSV) en mujeres supone un reto para la urología funcional. En México existen pocos datos que reporten la prevalencia de OTSV en mujeres, siendo de hasta el 24% en un grupo de pacientes. Objetivo: comparar seis definiciones diferentes de obstrucción de tracto de salida vesical (OTSV) en mujeres y evaluar la concordancia entre observadores en un entorno educativo. Material y métodos: evaluación retrospectiva de estudios urodinámicos de mujeres con y sin diagnóstico de OTSV. Se evaluaron las definiciones de Farrar, Chassagne, Lemack, Defreitas, Blavais y Groutz y Solomon-Greenwell. A todos los participantes se les brindó un taller teórico-práctico para analizar los estudios urodinámicos en su fase de flujo-presión y diagnosticar la OTSV. Los estudios urodinámicos fueron revisados de forma independiente por cinco observadores. La concordancia interobservador para clasificar a los pacientes como obstruidos se evaluó mediante análisis estadístico de confiabilidad kappa. Se clasificó el tipo de errores que cometieron los participantes, error de interpretación de estudios urodinámicos y error de cálculo en los criterios. Resultados: se revisaron en total 28 estudios urodinámicos. Todos los observadores tuvieron una concordancia buena de (0.64-0.78) para clasificar OTSV usando todas las definiciones excepto las de Lemack y Solomon-Greenwell. Se encontraron un total de 120 errores de 840 respuestas, 45.8% errores de interpretación y 54.1% error de cálculo de la ecuación. Los participantes eligieron la definición de Solomon-Greenwell, la más difícil. Conclusión: las definiciones de Chassagne, Defreitas y Farrar demostraron una concordancia sustancial entre observadores. Las definiciones de Solomon-Greenwell y Lemack tuvieron el mayor grado de dificultad y el menor nivel de acuerdo.

Concordancia entre el resultado de la biopsia hepática y el índice APRI (Ast to Platelet Ratio Index) en el diagnóstico de cirrosis en pacientes con enfermedad hepática autoinmune / Concordance between hepatic biopsy and the APRI index (Ast to Platelet Ratio Index) for the diagnosis of cirrhosis in patients with autoimmune liver disease

Introducción y objetivos: Se ha propuesto que métodos no invasivos pueden remplazar la biopsia hepática en el diagnóstico del daño tisular en pacientes con hepatopatía autoinmune (EHA). Este estudio evalúa el rendimiento diagnóstico y grado de concordancia entre el índice Ast to Platelet Ratio Index (APRI) y la biopsia hepática en el diagnóstico de cirrosis en estos pacientes. Material y métodos: En una cohorte de pacientes con EHA se determinó el valor del índice APRI y los resultados de la biopsia hepática según la escala METAVIR. Se evaluó el área bajo la curva (AUC) y la concordancia entre un valor de APRI > 2 y un puntaje METAVIR F4 como marcadores de la presencia de cirrosis hepática mediante un estadístico de kappa. Resultados: Se incluyeron 70 pacientes (51 ± 13 años). Las hepatopatías autoinmunes más frecuentes fueron la cirrosis biliar primaria (CBP) (40%), Hepatitis autoinmune (HAI) (24,3%) y el síndrome de sobreposición HAI–CBP (32,9%). Se confirmó cirrosis por biopsia en 16 pacientes (22,9%); 15 pacientes (21,4%) presentaron índice APRI > 2 (cirrosis) y solo seis cumplieron ambos criterios. El AUC del APRI fue de 0,77 (IC 95% 0,65-0,88). La concordancia entre las pruebas fue baja para un punto de corte APRI > 2 (kappa 0,213; IC 95% 0,094 - 0,332), o para puntos de corte > 1,5, > 1 o > 0,5 (kappa 0,213, 0,255, 0,257, respectivamente). Conclusiones: Nuestros resultados sugieren que existe un pobre acuerdo entre el resultado del APRI y la biopsia hepática en el diagnóstico de cirrosis en pacientes con EHA, por lo tanto, no se debe utilizar como método diagnóstico único para determinar la presencia de cirrosis.(AU)

Introduction and objectives: It has been proposed that non-invasive methods may replace liver biopsy for the diagnosis of tissue damage in patients with autoimmune liver disease (ALD). The aim of this study was to determine diagnostic performance and degree of concordance between the APRI index and liver biopsy for diagnosing cirrhosis in these patients. Material and methods: In a cohort of patients with ALD, the value of the APRI index and liver biopsy results were determined according to the METAVIR score. The AUC and the degree of concordance between an APRI value >2 and a METAVIR score of F4 were evaluated as markers of liver cirrhosis, through a kappa statistic. Results: In total, 70 patients (age 51 ± 13 years) were included. The most common autoimmune liver diseases were primary biliary cirrhosis (PBC) (40%), autoimmune hepatitis (AIH) (24.3%) and AIH-PBC overlap syndrome (32.9%). Cirrhosis was confirmed by biopsy in 16 patients (22.9%). 15 patients (21.4%) had an APRI index >2 (Cirrhosis) and only six met both criteria. The AUC of the APRI was 0.77 (95% CI 0.65-0.88). The degree of concordance between the tests was low for an APRI cut-off point >2 (kappa 0.213; 95% CI 0.094-0.332), as well as for cut-off points >1.5, >1 and >0.5 (kappa 0.213, 0.255, 0.257, respectively). Conclusion: Our results suggest that there is little concordance between APRI and liver biopsy for the diagnosis of cirrhosis in patients with ALD. It should therefore not be used as a single diagnostic method to determine cirrhosis.(AU)

Concordance between hepatic biopsy and the APRI index (Ast to Platelet Ratio Index) for the diagnosis of cirrhosis in patients with autoimmune liver disease. / Concordancia entre el resultado de la biopsia hepática y el índice APRI (Ast to Platelet Ratio Index) en el diagnóstico de cirrosis en pacientes con enfermedad hepática autoinmune.

INTRODUCTION AND OBJECTIVES: It has been proposed that non-invasive methods may replace liver biopsy for the diagnosis of tissue damage in patients with autoimmune liver disease (ALD). The aim of this study was to determine diagnostic performance and degree of concordance between the APRI index and liver biopsy for diagnosing cirrhosis in these patients. MATERIAL AND METHODS: In a cohort of patients with ALD, the value of the APRI index and liver biopsy results were determined according to the METAVIR score. The AUC and the degree of concordance between an APRI value >2 and a METAVIR score of F4 were evaluated as markers of liver cirrhosis, through a kappa statistic. RESULTS: In total, 70 patients (age 51 ± 13 years) were included. The most common autoimmune liver diseases were primary biliary cirrhosis (PBC) (40%), autoimmune hepatitis (AIH) (24.3%) and AIH-PBC overlap syndrome (32.9%). Cirrhosis was confirmed by biopsy in 16 patients (22.9%). 15 patients (21.4%) had an APRI index >2 (Cirrhosis) and only six met both criteria. The AUC of the APRI was 0.77 (95% CI 0.65-0.88). The degree of concordance between the tests was low for an APRI cut-off point >2 (kappa 0.213; 95% CI 0.094-0.332), as well as for cut-off points >1.5, >1 and >0.5 (kappa 0.213, 0.255, 0.257, respectively) CONCLUSION: Our results suggest that there is little concordance between APRI and liver biopsy for the diagnosis of cirrhosis in patients with ALD. It should therefore not be used as a single diagnostic method to determine cirrhosis.

STUDY OF AGREEMENT BETWEEN THE ROSSO-MARDONES AND ATALAH SCALES FOR NUTRITIONAL ASSESSMENT IN PREGNANCY. LA ERMITA CLINIC, CARTAGENA, 2017.

OBJECTIVE: To assess the degree of agreement between the model for maternal nutritional assessment proposed by Rosso-Mardones and the one proposed by Atalah. METHODS: Diagnostic agreement study. Pregnant women between the ages of 19 and 37 years with a gestational age of 10 or more weeks were incuded; patients with diabetes, thyroid disease, pregnancy-associated hypertension, twin pregnancy, severe fetal malformation, fetal death and hydrops fetalis were excluded. Non-probabilistic sampling. Sociodemographic, obstetrical and nutritional status variables were measured. RESULTS: Overall, 98 pregnant women were included. With the use of the Rosso-Mardones scale, 33% of the patients were classified as having a normal nutritional status, 22% as low weight, and 44% as overweight or obese. With the Atalah scale, 41% of the women were classified as having a normal nutritional status, 10% as low weight and 48% as overweight or obese. The weighted kappa value was 0.74 with a standard error of 0.04, a 95% CI of 0.66-0.82 and a p value < 0.05. CONCLUSIONS: There is substantial agreement between nutritional assessment scales used in pregnancy, namely the Rosso-Mardones nomogram and the Atalah scale. Further studies to assess the agreement of these scales in the pregnant population are required.

TITULO: ESTUDIO DE CONCORDANCIA ENTRE LAS ESCALAS DE ROSSO-MARDONES Y ATALAH PARA LA EVALUACIÓN NUTRICIONAL EN EMBARAZADAS. CLÍNICA LA ERMITA DE CARTAGENA, 2017. OBJETIVO: evaluar el grado de concordancia entre el modelo de evaluación del estado nutricional materna propuesto por Rosso-Mardones con el propuesto por Atalah. METODOS: estudio de concordancia diagnóstica. Se incluyeron gestantes entre los 19 y 37 años, con una edad gestacional de 10 o más semanas; se excluyeron gestantes con: diabetes, enfermedad tiroidea, hipertensión asociada al embarazo, embarazos gemelares, malformaciones fetales graves, muerte fetal e hidrops fetalis. Muestreo no probabilístico. Se midieron las variables sociodemográficas, obstétricas y el estado nutricional. Se calculó el valor de kappa de concordancia entre las dos escalas de evaluación nutricional. RESULTADOS: se incluyeron 98 gestantes. La escala de Roso-Mardones clasificó al 33 % de las pacientes en estado nutricional normal, al 22 % con bajo peso y al 44 % con sobrepeso u obesidad. La escala de Atalah clasificó al 41 % de las gestantes en estado nutricional normal, al 10 % con bajo peso y al 48 % con sobrepeso u obesidad. El valor kappa ponderado obtenido fue 0,74 con un error estándar de 0,04 y un IC 95 %: 0,66-0,82 con valor p < 0,05. CONCLUSIONES: las escalas de evaluación nutricional en gestantes, nomograma de Rosso-Mardones y de Atalah, tienen un acuerdo considerable. Se requieren más estudios que evalúen la concordancia entre estas escalas en población gestante.

Study of agreement between the Rosso-Mardones and Atalah scales for nutritional assessment in pregnancy. La Ermita clinic, Cartagena, 2017 / Estudio de concordancia entre las escalas de rosso-mardones y atalah para la evaluación nutricional en embarazadas. clínica la ermita de cartagena, 2017

RESUMEN Objetivo: evaluar el grado de concordancia entre el modelo de evaluación del estado nutricional materna propuesto por Rosso-Mardones con el propuesto por Atalah Materiales y métodos: estudio de concordancia diagnóstica. Se incluyeron gestantes entre los 19 y 37 años, con una edad gestacional de 10 o más semanas; se excluyeron gestantes con: diabetes, enfermedad tiroidea, hipertensión asociada al embarazo, embarazos gemelares, malformaciones fetales graves, muerte fetal e hidrops fetalis. Muestreo no probabilístico. Se midieron las variables sociodemográficas, obstétricas y el estado nutricional. Se calculó el valor de kappa de concordancia entre las dos escalas de evaluación nutricional. Conclusiones: las escalas de evaluación nutricional en gestantes, nomograma de Rosso-Mardones y de Atalah, tienen un acuerdo considerable. Se requieren más estudios que evalúen la concordancia entre estas escalas en población gestante.

ABSTRACT Objective: To assess the degree of agreement between the model for maternal nutritional assessment proposed by Rosso-Mardones and the one proposed by Atalah. Materials and methods: Diagnostic agreement study. Pregnant women between the ages of 19 and 37 years with a gestational age of 10 or more weeks were included; patients with diabetes, thyroid disease, pregnancy-associated hypertension, twin pregnancy, severe fetal malformation, fetal death and hydrops fetalis were excluded. Non-probabilistic sampling. Sociodemographic, obstetrical and nutritional status variables were measured. Results: Overall, 98 pregnant women were included. With the use of the Rosso-Mardones scale, 33% of the patients were classified as having a normal nutritional status, 22% as low weight, and 44% as overweight or obese. With the Atalah scale, 41% of the women were classified as having a normal nutritional status, 10% as low weight and 48% as overweight or obese. The weighted kappa value was 0.74 with a standard error of 0.04, a 95% CI of 0.66-0.82 and a p value < 0.05. Conclusions: There is substantial agreement between nutritional assessment scales used in pregnancy, namely the Rosso-Mardones nomogram and the Atalah scale. Further studies to assess the agreement of these scales in the pregnant population are required.

[Comparative study of concordance and costs between tuberculin skin test and QuantiFERON(®)-TB Gold In-Tube in the diagnosis of latent tuberculosis infection among contacts of patients with pulmonary tuberculosis]. / Estudio comparativo de concordancia y costes entre la prueba de la tuberculina y QuantiFERON(®)-TB Gold In-Tube en el diagnóstico de la infección latente tuberculosa en contactos de pacientes con tuberculosis pulmonar.

INTRODUCTION: Recently diagnosis of latent tuberculosis infection (LTBI) can be made using the tuberculin skin test (TST) or by techniques known as interferon-γ release assays (IGRAS), being QuantiFERON(®)-TB Gold In-Tube (QF-G-IT) the most used. The IGRAS avoid some drawbacks of the TST, especially cross-reaction with bacillus Calmette-Guérin (BCG) vaccine, but also present some problems such as those arising from cost and the need of having an adequate infrastructure and experience. There is no clear consensus on which technique should be preferentially used for the diagnosis of LTBI. METHODS: This is a comparative study between the TST and QT-G-IT in a cohort of contacts of patients with pulmonary tuberculosis during the study period. An analysis of global agreement and groups was performed according to whether the contacts were vaccinated with BCG or not. A study of costs of both techniques and diagnostic strategies based on these techniques was performed. RESULTS: The agreement between TST and QF-G-IT was acceptable in the whole sample yet it was very good in the unvaccinated group. Few cases of indeterminate values were recorded. The cost study showed that TST was cheaper than QF-G-IT; however when we analyzed the cost of the strategies according to each technique, the QF-G-IT showed a better cost-benefit. CONCLUSION: We suggest considering QF-G-IT as the only preferred technique for the diagnosis of LTBI in household contacts, based on good overall agreement between the 2 techniques (even if we eliminate the effect of the vaccine) and a cost analysis favorable to QF-G-IT.