Cervical degenerative index: a new quantitative radiographic scoring system for cervical spondylosis with interobserver and intraobserver reliability testing

Background  The lack of a widely available scoring system for cervical degenerative spondylosis encouraged the authors to establish and validate a systematic quantitative radiographic index. Materials and methods  This study included intraobserver and interobserver reliability testing among three reviewers with different years of experience. Each observer independently scored four cervical radiographs of 48 patients at separate intervals, and statistical analysis of the grading was performed. Results  There was high intraobserver and interobserver reliability between the two experienced observers. There was fair reliability between the less experienced observer and the more experienced observers. Conclusions  The cervical degenerative index appears to be a reliable and reproducible radiographic assessment of cervical spondylosis. The index will have direct applicability for longitudinal study of cervical spondylosis and may be clinically relevant as well.     

Imagerie osseuse du patient insuffisant rénal chronique : un nouvel outil ?

Bone damage in patients with chronic kidney disease (CKD), in the spectrum of chronic kidney disease-mineral and bone disorders (CKD-MBD), represents a daily challenge for nephrologists. The impact of CKD on bone health may be immediate (biological equilibrium) or delayed (fractures and vascular calcifications). Histomorphometry remains the gold standard to evaluate bone but it is rarely perfomed in clinical practice. A real measurement of bone mineral density (BMD) by dual X-ray absorptiometry (DXA) is currently performed to evaluate bone mass. However, this technique presents some limitations. In 2000, the National Institute of Health (NIH) defined new "quality" criteria for the diagnosis of osteoporosis in addition to a decreased bone mass. Bone strength actually integrates two concepts: bone density and bone quality (i.e., microarchitectural organization, bone turnover, mineralization and microfractures). These quality criteria cannot be evaluated by DXA. New bone imaging techniques have thus been developed, leading to an improvement in bone evaluation.     

Assessment of reliability and validity of IBD phenotyping within the National Institutes of Diabetes and Digestive and Kidney Diseases (NIDDK) IBD Genetics Consortium (IBDGC)

BACKGROUND: The NIDDK IBD Genetics Consortium (IBDGC) collects DNA and phenotypic data from inflammatory bowel disease (IBD) subjects to provide a resource for genetic studies. No previous studies have been performed on the reliability and validity of phenotypic determinations in either Crohn's disease (CD) or ulcerative colitis (UC) using primary records. Our aim was to determine the reliability and validity of these phenotypic assessments. METHODS: The de-identified records of 30 IBD patients were reviewed by 2 phenotypers per center using a standard protocol for phenotypic assessment. Each phenotyper evaluated 10 charts on 2 occasions 5 months apart. Reliability was expressed as the kappa (kappa) statistic. Performance characteristics were determined by comparison to a consensus-derived "gold standard" and by generation of receiver operating characteristic (ROC) curves. RESULTS: Agreement for diagnosis was excellent (kappa = 0.82; 95% confidence interval [CI]: 0.71-0.92). Agreement for CD location was good for jejunal, ileal, colorectal, and perianal disease with kappa between 0.60 and 0.74 but was fair for esophagogastroduodenal (kappa = 0.36). Agreement for UC extent (kappa = 0.67; 95% CI: 0.48-0.85), and CD behavior (kappa = 0.67; 95% CI: 0.49-0.83) were very good. Area under the ROC curves was greater than 0.84 for diagnosis, CD behavior, UC extent, and ileal and colonic CD location. CONCLUSIONS: IBD phenotype classification using a standard protocol exhibited very good to excellent inter- and intrarater agreement and validity. This study highlights the importance of standard protocols in generating reliable and valid phenotypic assessments. The data will facilitate estimates of phenotyping misclassification rates that should be considered when making inferences from IBD genotype-phenotype studies.     

Awakenings change results of nighttime ambulatory blood pressure monitoring

OBJECTIVE: Investigate the effect of distinguishing nighttime and sleep on nocturnal blood pressure results in ambulatory blood pressure monitoring. METHODS: We recruited 36 patients, 29 men, with suspected obstructive sleep apnea/hypopnea syndrome attending a sleep clinic for diagnostic polysomnography and who agreed to wear a Spacelabs 90207 ambulatory blood pressure monitor during polysomnography. Their mean age was 45+/-11 years; body mass index (BMI), 30.8+/-5.4 kg/m; apnea-hypopnea index, 35+/-29 AH/h; 13 had a history of hypertension. A microphone attached to the ambulatory blood pressure monitor recorded its sounds in the polygraph and allowed us to classify each ambulatory blood pressure monitoring measurement as being made in electrographically-determined wake (e-wake) or sleep state (e-sleep). RESULTS: Patients were asleep during (mean+/-SD) 61+/-24% (range 0-100%) of the 14+/-1 nighttime blood pressure measurements. Systolic and diastolic ambulatory blood pressure monitoring readings were significantly higher during e-wake (121+/-12/73+/-9 mmHg) than during total nighttime (119+/-11/70+/-8 mmHg) and e-sleep (116+/-13/68+/-9 mmHg). On the basis of nighttime measurements, 22 patients (61%) had nocturnal hypertension. On the basis of measurements made during e-sleep, nocturnal hypertension was diagnosed in 12 patients (33%; chi2=5.54; P=0.018). A multiple linear regression model showed that the percentage of measurements made in e-sleep was the only variable that significantly explained the difference between nighttime and e-sleep blood pressure figures, when controlling for sex, age, BMI, apnea-hypopnea index, and lowest SaO2. CONCLUSION: During ambulatory blood pressure monitoring, nighttime blood pressure readings are higher than during e-sleep and this changes dipping and nocturnal hypertension classification.     

HIV risk in Karachi and Lahore, Pakistan: an emerging epidemic in injecting and commercial sex networks

The objective of this study was to measure HIV prevalence and risk behaviour in injecting drug users (IDUs), male sex workers (MSWs), Hijras (transgenders), female sex workers (FSWs) and male truckers in Karachi and Lahore, Pakistan. The design was a linked-anonymous cross-sectional study of individuals identified at key venues or through peer referral. Approximately 400 respondents in each group (200 for Hijras) responded to a standardized questionnaire and were tested for HIV antibodies at each site. In Karachi, 23% of IDUs and 4% of MSWs were HIV positive, and HIV-positive individuals were identified in all risk groups in at least one city. Two-thirds of all IDUs used a shared needle in the previous week, and unprotected commercial sex activity with men and women was high. The HIV epidemic has entered IDU and male and female commercial sex networks in Karachi and Lahore. Targeted intervention services must be scaled up and risk group surveillance intensified.     

Haemoglobinuria in a 38-year-old French expatriate man living in Cameroon following artemisinin-based antimalarial treatment

Massive haemoglobinuria is encountered rarely during the course of malaria. It is usually considered a diagnostic criterion for severe malaria, together with anaemia, acute renal failure and jaundice. Haemoglobinuria can also present among expatriates travelling to endemic areas following repeated exposure to quinoline or arylaminoalcohol drugs. A case is described of haemoglobinuria developing in a 38-year-old French expatriate diagnosed concurrently with numerous tropical infections, and treated on presumptive basis with an antimalarial regimen containing artemisinin derivatives. Haemoglobinuria resolved spontaneously within a few days. Although this case does not definitely indicate a causal link between haemoglobinuria and artemisinin derivatives, the risk of such infrequent side-effects should be taken into account in pharmacovigilance monitoring. Moreover, the patient illustrates the multifaceted pathology that can be encountered with tropical infections.