Utilidad del índice kappa en el diagnóstico de esclerosis múltiple y validación de valores de referencia en la Comunidad de Aragón / Usefulness of the kappa index in the diagnosis of multiple sclerosis and validation of reference values in the Community of Aragon

Introducción: La determinación de bandas oligoclonales (BOC) en el líquido cefalorraquídeo es esencial para el diagnóstico de esclerosis múltiple (EM). El índice kappa es un biomarcador con una sensibilidad y una especificidad comparables a las de las BOC. El objetivo de este trabajo fue estudiar su utilidad y calcular el punto de corte óptimo. Material y métodos. Estudio observacional de muestras recibidas en el servicio de inmunología de referencia para Aragón entre enero de 2019 y junio de 2020. Se determinó el valor del índice kappa y el índice IgG. Se trazaron y compararon curvas ROC frente a la detección de BOC y el diagnóstico de EM. Se calcularon valores de sensibilidad y especificidad y el punto de corte óptimo. Resultados: Se analizaron 181 pacientes (59,7%, mujeres; edad media, 47,62 ± 17,8 años). El grupo de EM demostró valores estadísticamente superiores de índice kappa (66,62 frente a 0,02; p < 0,001). En el análisis de curvas ROC, el índice kappa demostró un área bajo la curva superior al índice IgG en la detección de BOC+ (0,93 frente a 0,83; p < 0,002) y el diagnóstico de EM (0,91 frente a 0,83; p < 0,021). El punto de corte óptimo del índice kappa para la detección de BOC fue 5,02 (sensibilidad y especificidad, 0,92) y 7,58 para el diagnóstico de EM (sensibilidad, 0,85; especificidad, 0,94). Conclusiones: El índice kappa es un biomarcador útil en el diagnóstico de la EM. Su determinación es un proceso automático y rápido, con valores de sensibilidad y especificidad superiores al índice IgG. Todavía se debe llegar a un consenso sobre el punto de corte óptimo para su positividad, si bien, en nuestro medio, un punto de corte de 5,02 parece razonable.(AU)

INTRODUCTION: Detection of oligoclonal bands (OCB) in CSF is essential in the diagnosis of multiple sclerosis (MS). Kappa-index is a promising biomarker, with sensitivity and sensibility values comparable to those of OCB. Our objective was to investigate kappa-index utility in the diagnosis work-up for MS and to determine the optimal cut-off point for our population. Material and methods. Observational study of consecutive samples received in the Immunology lab department in a third level hospital between January 2019 to June 2020. Kappa-index and IgG index were measured. ROC analysis for screening of OCB and for diagnosis of MS was conducted. Sensibility, specificity and the optimal cut-off points were determined. RESULTS: 181 samples were included (59.7% females; age, 47.62 ± 17.8 years). Patients in the EM group presented significantly higher kappa-index level than patients without an EM diagnosis (66.62 versus 0.02; p < 0.001). ROC analysis reported a better area under the curve for the kappa-index than the IgG index for the detection of BOC (0.93 versus 0.83; p < 0.002) and the diagnosis of EM (0.91 versus 0.83; p < 0.021). An optimal cut-off point of 5.02 was determined for the detection of BOC (sensibility and specificity, 0.92) and of 7.58 for the diagnosis of EM (sensibility, 0.85; specificity, 0.94). CONCLUSIONS: Kappa-index is an useful biomarker in the diagnosis of MS. Its specificity and sensibility are superior to the IgG index. The optimal cut-off point has yet to be determined, but for our population a cut-off of 5.02 seems reasonable.(AU)

Reflux finding score: análisis de la concordancia inter-observador / Reflux finding score: analysis of the interobserver concordance / Reflux finding score: análise de concordância interobservador

Introducción: el reflujo laringofaríngeo (RLF) es una manifestación extradigestiva del Reflujo Gastroesofágico (RGE). Actualmente, el algoritmo diagnóstico usado en la mayoría de los Servicios de Otorrinolaringologìa (ORL) consiste en identificar los síntomas sugestivos de reflujo laringofaríngeo y realizar una fibronasolaringoscopia flexible para determinar si existen cambios estructurales identificables en la laringe o en los tejidos vecinos. Se ha desarrollado una escala subjetiva para cuantificar la severidad de los cambios inflamatorios de la laringe, identificando los hallazgos laringoscópicos asociados con reflujo laringofaríngeo. Los mismos son clasificados por el índice de hallazgos de reflujo “Reflux Finding Score” (RFS), desarrollado por Belafky y cols. El puntaje máximo es de 26 y un puntaje de 7 o mayor a 7 es considerado altamente sospechoso de RLF. Objetivos: Determinar el índice Kappa de Resultados Interobservador usando el RFS en pacientes con RLF en el Servicio de Otorrinolaringología del Sanatorio Allende. Determinar las características de los pacientes con diagnóstico de RLF según: Sexo, edad, síntomas presentes y tratamiento indicado en pacientes que consultaron ambulatoriamente en el Servicio de ORL del Sanatorio Allende sucursal Nueva Córdoba. Material y método: Se determinó el índice Kappa de Resultados entre observadores usando el RFS en paciente con RLF entre 2 médicos del staff de Servicio de ORL del Sanatorio Allende, se analizó frecuencia de sexo, edad, síntomas, conducta médica. Conclusión: El índice Kappa del RFS para cada uno de los 8 ìtems del RFS es leve, medido como < 0,2.

Introduction: the Laryngopharyngeal Reflux (LPR) is recognized as an extra-digestive manifestation of gastroesophageal reflux (GERD). At present, the diagnostic algorithm used in most of the otorhinolaryngology (ORL) services involves identifying suggestive symptoms of laryngopharyngeal reflux and carrying out a flexible fibronasolaryngoscopy to determine if there are identifiable structural changes in the larynx or neighboring tissues. A subjective scale has been developed to quantify the severity of inflammatory changes in the larynx by identifying endoscopic findings related to laryngopharyngeal reflux. These subjective findings for patients with LPR are classified using the “Reflux Finding Score” (RFS) developed by Belafsky et al.The maximum score is 26 and a score of 7 or greater is considered to indicate that LPR is highly likely. Objetive: To determine the Kappa Coefficient of the interobserver agreement using the RFS in patients with LPR in the Otorhinolaryngology Service of the Allende Hospital. To determine the characteristics of patients with LPR diagnosis according to: Gender, age, manifested symptoms and treatment indicated in patients that were treated as an outpatient in the ORL Service of the Allende Hospital, Nueva Córdoba’s branch. Material and method: The Kappa Coefficient was determined by the interobserver agreement using the RFS in patients with LPR between two Staff doctors of the ORL Service of the Allende Hospital; it was investigated the sex frequency, age, symptoms and medical behavior. Conclusions: The Kappa Coefficient of LPR for each of the eight items of LPR is poor, valued as < 0.2.

Introdução: o refluxo laringofaríngeo (RFL) é uma manifestação extra-digestiva do refluxo gastroesofágico (RGE). Atualmente o algoritmo diagnóstico usado pela maioria dos Serviços de Otorrinolaringología (ORL) consistem em identificar os sintomas sugestivos do RFL e realizar uma fibronasolaringoscopia flexível para determinar se existem mudanças estruturais identificáveis na laringe ou nos tecidos vizinhos. Existe uma escala subjetiva para quantificar a severidade das alterações inflamatórias na laringe, identificando os achados laringoscópicos que têm relação com o RFL. Eles são classificados pelo índice de achados de refluxo “Reflux Finding Score” (RFS), desenvolvido por Belafky e cols. A pontuação maxima é de 26 e uma pontuação de 7 ou maior é considerado quase sugestivo de RFL. Objetivos: Determinar o índice Kappa dos resultados interobservador usando o RFS em pacientes com RFL no Serviço de Otorrinolaringologia do Sanatorio Allende. Determinar as características dos pacientes com diagnóstico de RFL Segundo: Sexo, idade, sintomas presentes e tratamento indicado em pacientes que fizeram consultas externas no Serviço de ORL do Sanatorio Allende em Nueva Córdoba. Material e método: Determinou-se o índice Kappa dos resultados entre observadores usando o RFS em pacientes com RFL entre 2 médicos do staff do Serviço de ORL do Sanatorio Allende. Analizou-se a frequência entre o sexo, a idade, os sintomas, as doenças associadas e a terapeútica médica. Conclusões: O índice Kappa do RFS para cada item do RFS é insuficiente, medida como < 0,2.

Modification in the properties of paper by using cellulase-free xylanase produced from alkalophilic Cellulosimicrobium cellulans CKMX1 in biobleaching of wheat straw pulp.

Alkalophilic Cellulosimicrobium cellulans CKMX1 isolated from mushroom compost is an actinomycete that produces industrially important and environmentally safer thermostable cellulase-free xylanase, which is used in the pulp and paper industry as an alternative to the use of toxic chlorinated compounds. Strain CKMX1 was previously characterized by metabolic fingerprinting, whole-cell fatty acids methyl ester analysis, and 16S rDNA and was found to be C. cellulans CKMX1. Crude enzyme (1027.65 U/g DBP) produced by C. cellulans CKMX1, having pH and temperature optima of 8.0 and 60 °C, respectively, in solid state fermentation of apple pomace, was used in the production of bleached wheat straw pulp. Pretreatment with xylanase at a dose of 5 U/g after pulping decreased pulp kappa points by 1.4 as compared with the control. Prebleaching with a xylanase dose of 5 U/g pulp reduced the chlorine charge by 12.5%, increased the final brightness points by approximately 1.42% ISO, and improved the pulp strength properties. Xylanase could be substituted for alkali extraction in C-Ep-D sequence and used for treating chemically bleached pulp, resulting in bleached pulp with higher strength properties. Modification of bleached pulp with 5 U of enzyme/g increased pulp whiteness and breaking length by 1.03% and 60 m, respectively; decreased tear factor of pulp by 7.29%; increased bulk weight by 3.99%, as compared with the original pulp. Reducing sugars and UV-absorbing lignin-derived compound values were considerably higher in xylanase-treated samples. Cellulosimicrobium cellulans CKMX1 has a potential application in the pulp and paper industries.

Diagnóstico dermatológico: correlación entre médicos de atención primaria de salud y médicos dermatólogos / Diagnostic concordance between of primary care physicians and dermatologist

En Chile los médicos de Atención Primaria (AP) diagnostican y tratan gran cantidad de enfermedades de la piel. Sin embargo, muchos pacientes requieren ser referidos al Nivel Secundario para ser evaluados por especialistas. Objetivo: El presente estudio tiene como propósito analizar la concordancia del diagnóstico dermatológico realizado por los médicos de AP. Método: Se realizó un estudio retrospectivo en el que se incluyeron 1.478 pacientes referidos desde la AP a la Unidad de Dermatología en el Centro de Referencia de Salud (CRS) Cordillera entre enero de 2005 y enero de 2006. Se registraron sexo, edad, patología cutánea, época del año de la consulta y tiempo de espera para ser evaluados por dermatólogos. Para analizar la concordancia diagnóstico entre el médico general y el dermatólogo se utilizó el índice Kappa (IK), que se clasifica en seis categorías: sin acuerdo (KI < O), insignificante (O < KI > 0,2), discreto (0,21 < KI > 0,40), moderado (0,41 < KI > 0,60), sustancial (0,61 < KI > 0,80) y casi perfecto (0,81 < KI > 1,00). Resultados: La edad promedio de la muestra fue de 34.7 años. 63,8% de las consultas correspondieron a mujeres y 36,2% a varones. Los diagnósticos más frecuentes en la AP fueron: nevi (21,04%), verrugas virales (10,96%), dermatitis inespecífica (6,63%), acné (6,02%), dermatitis atópica (5,4%) y psoriasis (4,67%). Los diagnósticos más frecuentes en Dermatología fueron: nevi (13,80%), verrugas virales (8,19%), acné (6,09%), queratosis seborreico (5,63%) y psoriasis (3,92%). La concordancia diagnóstico (CD) global fue moderada (IK = 0,563), obteniéndose el más alto para acné (IK = 0,899) y alopecia (IK = 0,835), y el más bajo en queratosis seborreico (IK = 0,081) y melanoma (IK = 0,186). Conclusiones: La CD entre médicos de AP y dermatólogos es moderada. Es fundamentar elaborar estrategías...

In Chile, primary care (PC) physicians diagnose and treat large amount of skin diseases; however, a large number of patients are referred to the hospital to be en by dermatologists. Objective: The purpose of the present investigation was to analyse the accuracy of PC physicians in the skin diagnosis diseases. Method: A retrospective analysis of clinical data was performed including 1,478 patients requiring dermatology evaluation at the Dermatology Unit, Centro de Referencia de Salud (CRS) Cordillera, between January 2005 and January 2006. Information about skin disease, sex, age, season consultation and waiting time to see a dermatologist was collected. Kappa index (KI) was used to determine the clinic diagnostic accuracy between the PC physicians and the dermatologists. KI is classified in 6 categories: without agreement (KI < O), insignificant (O < KI > 0.2), discrete (0.21 < KI 0.40), moderate (0.41 < KI > 0.60), substantial (0.61 < KI 0.80) y almost perfect (0.81 < KI > 1.00). Results: The average of age was 34.7 years. 63.8% we females and 36.2% were males. The more frequent skin diagnosis in PC were: nevi (21.04%), warts (10.96%), nonspecific¡ dermatitis (6.63%), acne (6.02%), atopic dermatitis (5.4%) al psoriasis (4.67%). The more frequent skin diagnosis by the dermatologist was: nevi (13.80%), warts (8,19%), acne (6.09%) seborrheic keratosis (5.63%) and psoriasis (3.92%). The general diagnostic concordance (DC) was moderate (KI = 0.56: showing that the highest KI was observed for acne (KI = 0.899) and alopecia (KI = 0.835) and the lowest was for seborrheic keratosis (KI = 0.081) and melanoma (KI = 0.186). Conclusions: The diagnostic correlation between PC physician and dermatologists is moderate. More innovative strategies are needed to improve training in PC physicians to enhance their accurate skin diagnosis.

Concordancia entre ecocardiografía prenatal y posnatal en pacientes con cardiopatías congénitas: Hospital de Niños Dorctor, Roberto Del Río / Concordance between prenatal and posnatal echocardiography in patients with congenital heart defect

Antecedentes: En Chile las malformaciones congénitas son la primera causa de mortalidad neonatal precoz, siendo las cardiopatías congénitas su principal factor. La incorporación de la ecocardiografía prenatal es de gran ayuda en su pesquisa precoz. Objetivos: Evaluar la ecocardiografía prenatal como prueba diagnóstica y su concordancia con la ecocardiografía posnatal. Métodos: Se analizaron embarazadas derivadas al Hospital de Niños Dr. Roberto del Río entre abril 2004 y abril 2008, por sospecha de cardiopatías congénitas con posterior control neonatal. Resultados: Se evaluaron 188 embarazadas tanto con diagnóstico de cardiopatía congénita como con ecocardiografía normal. La edad gestacional promedio de derivación fue de 32 semanas, siendo la principal causa la sospecha de cardiopatía congénita en el examen obstétrico de rutina. Como prueba diagnóstica se obtuvo una sensibilidad de 100 por ciento y especificidad de 40 por ciento con una moderada concordancia entre ésta y el examen postnatal. Como prueba diagnóstica la ecocardiografía prenatal, se obtuvo una sensibilidad de 100 por ciento y especificidad de 89 por ciento del examen, al ser evaluada como cardiopatías en general, con una muy buena concordancia entre ésta y el examen postnatal. Discusión: Existe una tardía derivación y diagnóstico prenatal de las cardiopatías congénitas a nivel nacional, siendo importante capacitar aún más a los obstetras que realizan este tamizaje. La ecocardiografía prenatal realizada en nuestro centro por cardiólogos es una confiable herramienta diagnóstica con una muy buena concordancia con la ecocardiografía posnatal.

Background: In Chile, congenital malformations are the first cause of early neonatal mortality, the congenital heart defects its the main factor. The incorporation of antenatal echocardiography is very helpful in your research early. Objectives: To evalúate prenatal echocardiography as a diagnosis test and their concordance with postnatal echocardiography. Methods: We analyzed pregnancy who were derived to the Hospital de Niños Dr. Roberto del Rio, between April 2004 and April 2008, where studied because suspicion of having congenital heart defects with subsequent neonatal control. Results: 188 pregnancy were evaluated either with a diagnosis of congenital heart defect or with normal echocardiography. The mean gestational age of derivation was 32 weeks, the main causes the suspicion of congenital heart defect on routine obstetric examination. When being studied as diagnosis test it was obtained a sensitivity of 100 percent and a specificity of 40 percent with a modérate concordance between both echocardiographies. When analyzing with the diagnosis test prenatal echocardiography, it was obtained a sensitivity of 100 percent and a specificity of 89 percent of the review, when evaluated as general heart defect, with a very good concordance between it and the postnatal examination. Discussion: There is a late referral and prenatal diagnosis of congenital heart defect at national level, being important to train obstetricians who perform this screening. Prenatal echocardiography performed by cardiologists at our center is a reliable diagnosis tool with a very good concordance with postnatal echocardiography.