Intra- and interobserver reproducibility of grading of helicobacter pylori gastritis according to the updated sydney system

Aims. To study the intra- and interobserver reproducibility of Sydney System amongst pathologists in Cameroon as Sydney System gradation has not gained enough confidence in African pathologists. Methods. We performed a descriptive study including 100 patients who benefited from gastric biopsy by endoscopy. These biopsy specimens were stained with hematein and eosin and modified Giemsa; and read independently using the same microscope by two pathologists with four years experience and no experience with the updated Sydney System. Gastritis was graded according to the updated Sydney System. Levels of intra- and interobserver reproducibility were assessed using the unweighted kappa coefficient. Results. The intraobserver reproducibility of gradation of Helicobacter pylori density; activity; chronic inflammation; atrophy; and intestinal metaplasia showed respective values of kappa: 0.63; 0.34; 0.61; 0.48; and 0.82 for one observer against 0.42; 0.005; 0.41; 0.31; and 0.72 for the other. Interobserver reproducibility kappa values were; respectively; 0.41; 0.18; 0.57; 0.58; and 0.82. Conclusion. Results are encouraging but experience in the updated Sydney System should be improved. The later should be introduced as a means to grade and classify gastritis in Cameroon and African countries

Interobserver variation in respiratory signs of severe malaria

Respiratory abnormalities are common presentations of malaria and acute respiratory tract infection; both of which are major causes of childhood mortality and morbidity in sub-Saharan Africa. Appropriate management depends on accurate assessment of disease severity which for the majority of children must be based on clinical signs alone. Choosing which signs best serve this purpose remains a considerable problem particularly in malaria endemic areas. As part of a prospective study to define clinical signs indicative of life threatening malaria video recordings were used to examine the level of agreement between clinicians for potentially important respiratory signs in 51 children. Overall agreement was good for recession; severe recession; and nasal flaring (kappa = 0.57; 0.50; and 0.60 respectively) and substantial for deep breathing and the summary impression of respiratory distress (kappa = 0.70 and 0.69 respectively). However; within this substantial variation in interpretation was apparent between individual observers from slight to almost perfect agreement (kappa values 0.10-0.92). Video is a useful tool to demonstrate interobserver variation and it may also allow training in recognition of signs and a means of standardising clinical signs between centres. Source: Arch-Dis-Child. 1995 apr; 72(4):334-6