ABSTRACT
The presence of antiphospholipid antibodies (aPLs) is associated with antiphospholipid syndrome (APS), characterized by thrombosis and obstetric morbidity. aPLs included in APS classification criteria are lupus anticoagulant, anti-cardiolipin and anti-beta-2-glycoprotein-I of IgG or IgM isotypes. Enzyme-linked immunosorbent assay is the most used diagnostic technique to determine aPLs. Recently, new automated technologies mainly based in antigen-coated beads have been developed. The aim is to compare a fluorescence enzyme immunoassay (M1) and an antigen-coated bead assay (M2) in obstetric and thrombotic APS patients. All samples from the first 1020 patients received in the Immune Service Laboratory (Hospital 12 de Octubre) during the recruitment period, without exclusions, were analysed for aPLs. The weighted kappa for both methods in all the patients was 0.39 (0.30-0.47). Agreement increased to 0.56 (0.38-0.73) in patients with autoimmune disease. Sensitivity and specificity obtained for M1 were 17.1% and 89.3%, respectively, and 12.7% and 91.4% for M2. The sensibility and specificity of IgG isotypes were higher than the IgM ones. Regarding obstetric patients, M1 obtained significant diagnostic performance and had more sensitivity 23.75 (14.95-34.58) compared to M2 12.50 (6.16-21.79). In conclusion, clinical suspicion-based method selection for aPLs should be considered. To identify obstetric APS patients, solid phase methods remain more preferable.
Subject(s)
Antiphospholipid Syndrome , Thrombosis , Female , Pregnancy , Humans , Antibodies, Antiphospholipid , Lupus Coagulation Inhibitor , Immunoglobulin G , Immunoglobulin MABSTRACT
Introducción. Analizar el presente y el futuro de la especialidad de Medicina del Trabajo mediante la técnica de los seis sombreros para pensar. Material y métodos. Técnica de los seis sombreros para pensar, técnica utilizada para poder analizar decisiones desde diferentes puntos de vista. Seis sombreros de diferente color, seis maneras diferentes de pensar. Resultados. Se encontraron múltiples opiniones y variedad de pensamientos en relación al presente y al futuro de la Medicina del Trabajo..Conclusiones. De la diversidad de los pensamientos obtenidos según el color de cada sombrero depende la postura a adoptar, por tal motivo se sugiere encontrar las alternativas que ofrece cada uno (AU)
Objetive. To analyze the present and future of occupational medicine as a specialty using the Six Thinking Hats technique. Material and methods. Six Thinking Hats, technique that allows us to analyze decisions from different points of view. Six Hats with different colors represent each a different perspective. Results. Multiple options and a variety of thoughts regarding the present and future of Occupational Medicine aroused. Conclusions. The position to adopt depends on the variety of thoughts coming from the color of each hat. Therefore, finding the alternatives for each approach is what is best suggested (AU)
