Assessment of inter-and intra-observer variability of the la classification for gerd

Los Angeles classification is widely adopted as a means of unifying endoscopic observation for GERD. We assessed the inter- and intra-observer variability of LA classification. Two-hundred fifty-four still images of the lower esophagus taken by an expert endoscopist [RM] were randomly selected and presented to 9 gastroenterologists [2 females, 6 experts, 3 trainees]. They were asked to report the images according to LA classification. After 2 weeks the images were re-ordered and the same people were asked to report them again. Kappa-statistics was calculated for intra- and inter-observer variability. Mean kappa for intra-observer agreement was 0.54 for experts and 0.55 for trainees [p = NS]. Mean intra-observer kappa was greater among females than males [0.70 vs 0.50 respectively, p=0.05]. Mean inter-observer kappa was 0.20 and 0.31 for experts and trainees respectively [p = NS]. Mean inter-observer weighted kappas were 0.25 and 0.07 [p = 0.007] for males and females respectively. Analyzing data for source of the discrepancy showed that the least reproducible reading was GERD-A both for intra- and inter-observer agreement calculations. According to our data, the LA classification, although a major advance in reporting GERD, has a poor to fair reproducibility. There was no difference between experts and trainees in using the LA classification. Females seem to be more consistent in their readings, but have less agreement with others. Despite the inherent short-comings of kappa statistics and the limitation caused by the possible quality of the still images, revision of the LA system seems to be advisable

[Cancer incidence in Iran in 2002 an international estimation]

During the past century, because of an improvement in the socio-economic conditions in the society and as a consequence a change in the predisposing or risk factors, incidence of diseases has undergone a real change. A decrease in the incidence of infectious diseases and an increase in the incidence of non-infectious diseases and accidents are the major reasons for this changer which has specially affected the developing countries. Presently, cancer is the second most common cause of morbidity and mortality. Control and reduction of the expenses of these types of diseases need planning and execution of a national cancer, but planning such a programme requires valid and authentic information. Such information is only possible through the registration of cancer cases. This paper provides information obtained from five provinces in the country about cancer to evaluate the incidence of it in the country, and comparison of with Globocan as an international reference about the incidence of cancer. By using statistical methods and establishing simple means about the incidence of cancer in Ardabil, Golestan, Mazandaran, Kalanshehr and Tehran according to age and gender, the incidence of cancer in the country was established. At least 50820 new cancers occur in the country yearly out of which 53% are found in males. The five major cancers to ASA in males were stomach [26.1], esophagus [17.6], colorectal [8.2], bladder [8], leukaemia [4.8], and in females were breast [17.1], esophagus [11.4], stomach [11.1], colorectal [6.7] and uterus 4.5 per 10[5]