[Intra and inter-observer reliability of electroencephalogram interpretation in pediatric patients with neurological alterations]. / Confiabilidad intra e interobservador de la lectura del EEG en pacientes pediátricos con alteraciones neurológicas.

BACKGROUND: Interpreting an electroencephalogram (EEG) is a subjective process which involves various obstacles to reach an agreement. If the interobserver agreement of a diagnostic process is poor, that process cannot be considered accurate. The aim of this study was to evaluate the intra and interobserver agreement of the EEG reading in pediatric patients. METHODS: 108 EEGs of children under 16 years of age were included. EEGs were interpreted by two pediatric neurologists. Observer number one performed three readings on three different moments to assess intraobserver agreement, while the third reading was blind for the diagnosis. Interobserver agreement was assessed with a single blind reading for the diagnosis of the two observers. Agreement was measured with the kappa index. RESULTS: Intraobserver agreement to differentiate if the EEG was normal or abnormal was substantial when the three readings were compared (kappa index: 0.66-0.78). The highest agreement rate corresponded to the readings of those who had knowledge of the diagnosis. The interobserver agreement assessing between abnormal or normal EEG was slight (k = 0.12). CONCLUSIONS: Since the EEG is a subjective interpreter dependent study, it is necessary to establish a consensus to standardize the criteria for its interpretation in order to increase the interobserver agreement.

Introducción: interpretar un electroencefalograma (EEG) es un proceso subjetivo que involucra diversos obstáculos para llegar a un acuerdo. Si la concordancia interobservador de un proceso diagnóstico es pobre, ese proceso no puede considerarse certero. El objetivo de este estudio fue valorar la concordancia intra e interobservador de la lectura del EEG en pacientes pediátricos. Métodos: se incluyeron 108 EEG de niños menores de 16 años, los cuales fueron interpretados por dos neurólogos pediatras. Para evaluar la concordancia intraobservador, el observador número uno realizó tres lecturas en tres tiempos distintos; la tercera lectura fue ciega para el diagnóstico. La concordancia interobservador fue evaluada por medio de una lectura ciega para el diagnóstico de los dos observadores. Se midió el índice kappa. Resultados: la concordancia intraobservador para diferenciar si el EEG era normal o anormal fue substancial en las tres lecturas (kappa 0.66-0.78). La concordancia más alta correspondió a las lecturas con conocimiento del diagnóstico. La concordancia interobservador para evaluar si el EEG era anormal o normal fue leve (k = 0.12). Conclusiones: el EEG es un estudio subjetivo que depende del interpretador. Es necesario establecer un consenso para uniformar los criterios para su interpretación y así aumentar la concordancia.

[Risk factors for allergy to honey-bee venom in Mexican beekeepers]. / Factores de riesgo de alergia al veneno de abeja en apicultores mexicanos.

BACKGROUND: Allergy to Hymenoptera venom has a low prevalence in the general population, but in beekeepers could be as high as 42%. The exposure to bee sting confers an occupational allergic risk to beekeepers, causing them sensitization during the first years, which if continues for a long time may induce immune tolerance. OBJECTIVE: To know some risk factors of allergic reactions to honey-bee stings in a sample of beekeepers through a self-applied questionnaire. METHODS: A self-applied questionnaire was performed by beekeepers from the whole country, with questions about age, sex, time of beekeeping activities, average number of stings per month and types of post-sting reactions. The relative risk and the odds ratio were calculated for some risk factors. RESULTS: A total of 1541 questionnaires were completed. The average age was 37 years. There were 1289 (84%) men and 252 women. The average time of exposure to honey-bee sting was 7.2 years, and the number of stings per month averaged 33. There was atopic family history in 14.5% of the beekeepers, and 20% of them had personal atopy. In 125 (8%) beekeepers there were local allergic reactions and in 32 (2%) there were systemic allergic reactions. The relative risk for allergy to honey-bee venom in whom had atopic family history was 3.9 (CI 1.7-9.2), in those with less than 4 stings per month was 3.2 (CI 1.12-9.33), in those with more than 20 years exposure was 0.97 (CI 0.95-0.98) and for those over 50 years of age was 0.32 (CI 0.1-0.8). Beekeepers with less than 10 years of exposure had OR of 4.33 (CI 0.5-33.9). CONCLUSIONS: The risk factors observed for hypersentivity to honey-bee venom in beekeepers were: atopic family history, less than 10 years of exposure and less than 4 stings per month. As probable protective factors we found the exposure for over 20 years and persons older than 50 years of age.

[Mortality related to honey-bee stings in Mexico from 1988 to 2009]. / Mortalidad en México relacionada con picaduras de abeja de 1988 a 2009.

BACKGROUND: Honeybee stings can cause toxic and allergic reactions that may lead to severe symptoms, and sometimes to death. Mexico is the third worldës honey country exporter and sixth producer. Due to the arrival of Africanized bees into Mexico in 1986, the National Program for Control of Africanized Bee (NPCAB) was created, in order to reduce the socioeconomic and sanitary impact from the new bee species. OBJECTIVE: To report deaths related to honey-bee sting in Mexico, from 1988 to 2009. METHODS: Reports gathered from offices of the National Program for the Control of Africanized Honey-Bee throughout the country, were used to show the number of deaths related to honey-bee stings which occurred in Mexico from 1988 to 2009. RESULTS: People suffering from multiple honey-bee stings were reported in all the states of the country. Between 1988 and 1998 there were 360 honey-bee related accidents, involving over 5000 people. From 1988 to 2009 there were 480 demised persons with an annual average of 21.8. Regarding age, people over 50 years were the most affected ones. The largest number of fatal cases, 340, occurred from 1990 to 1999, with an annual average of 34, and between 2000 and 2009, the number of cases decreased to 118. CONCLUSIONS: There was an average of 21 annual death cases related to honey-bee stings from 1988 to 2009. Toxic reactions caused by multiple stings are the most likely cause of death in the majority of cases. Fatal cases occurred mainly in people older than 50 years. There was a decrease in the mortality rate associated to honey-bee stings in the last decade.

[Assessment of hypersensitivity to honey-bee venom in beekeepers by skin tests]. / Valoración mediante pruebas cutáneas de la hipersensibilidad al veneno de abeja en apicultores.

BACKGROUND: Beekeepers are exposed to frequent honey-bee stings, and have the risk to develop hypersensitivity to bee venom, but long-term exposure can induce immune tolerance in them. Up to 30% of beekeepers show positive skin tests with honey-bee venom. The prevalence of systemic reactions to bee stings in beekeepers is from 14% to 42%. OBJECTIVE: To know the prevalence of hypersensitivity to honeybee venom in Mexican beekeepers and non-beekeepers by the use of skin tests. MATERIAL AND METHODS: A group of 139 beekeepers and a group of 60 non-beekeeper volunteers had a history and physical related to age, sex, family and personal atopic history and time of exposure to bee stings. Both groups received intradermal skin tests with honey-bee venom, 0.1 mcg/mL and 1 mcg/mL, and histamine sulphate 0.1 mg/mL and Evans solution as controls. The skin tests results of both groups were compared by chi-squared test. RESULTS: Of the group of beekeepers, 116 were men (83%) and 23 women, average age was 39.3 years, had atopic family history 28% and personal atopy 13%, average time of exposure to bee stings was 10.9 years, skin tests with honey-bee venom were positive in 16.5% and 11% at 1 mcg/mL and 0.1 mcg/mL, respectively. In the non-beekeepers group venom skin tests were positive in 13.3% and 6.7% at 1 mcg/mL and 0.1 mcg/mL. We did not find significant differences between the two venom concentrations tested in both groups, neither in the number of positive skin tests between the two groups. CONCLUSIONS: We found hypersensivity to honey-bee venom slightly higher in the beekeepers than in the group apparently not exposed. Both honey-bee venom concentrations used did not show difference in the results of the skin tests. The similarity of skin tests positivity between both groups could be explained by immune tolerance due to continued exposure of beekeepers.

ANTECEDENTES: los apicultores están expuestos frecuentemente a picaduras de abejas y tienen el riesgo de volverse hipersensibles al veneno de abejas, pero la exposición a largo plazo puede inducir tolerancia inmunológica. Hasta 30% de los apicultores tienen pruebas cutáneas positivas con veneno de abeja. La prevalencia de reacciones sistémicas por picaduras de abejas en los apicultores es de 14 a 42%. OBJETIVO: conocer la prevalencia de hipersensibilidad al veneno de abeja en apicultores mexicanos y no apicultores, mediante la aplicación de pruebas cutáneas. MATERIAL Y MÉTODOS: estudio transversal que se incluyeron 139 apicultores y 60 voluntarios no apicultores se les elaboró su historia clínica con referencia a la edad, sexo, antecedentes familiares y personales atópicos y tiempo de exposición a picaduras de abejas. A los dos grupos se les aplicaron pruebas cutáneas intradérmicas con veneno de abeja con 0.1 y 1 mcg/mL, y como testigos sulfato de histamina 0.1 mg/mL y solución de Evans. Los resultados de las pruebas cutáneas se compararon entre los dos grupos mediante chi cuadrada. RESULTADOS: del grupo de apicultores 116 fueron hombres (83%) y 23 mujeres, la edad promedio fue de 39.3 años; refirieron atopia familiar 28% y atopia personal 13%; el tiempo de exposición promedio a picaduras de abejas fue de 10.9 años; las pruebas cutáneas con veneno de abeja fueron positivas en 16.5 y 11% a concentraciones de 1 y 0.1 mcg/mL, respectivamente. En el grupo de no apicultores las pruebas cutáneas con veneno resultaron positivas en 13.3 y 6.7% a concentraciones de 1 y 0.1 mcg/mL, respectivamente. No se observaron diferencias significativas entre las dos concentraciones de veneno probadas en ambos grupos, ni en el número de pruebas cutáneas positivas entre los dos grupos. CONCLUSIONES: se encontró hipersensibilidad al veneno de abeja ligeramente mayor en los apicultores que en el grupo aparentemente no expuesto. Las dos concentraciones de veneno de abeja probadas no mostraron diferencia en los resultados de las pruebas cutáneas.