Radiographers supporting radiologists in the interpretation of screening mammography: a viable strategy to meet the shortage in the number of radiologists.

BackgroundAn alternative approach to the traditional model of radiologists interpreting screening mammography is necessary due to the shortage of radiologists to interpret screening mammograms in many countries.MethodsWe evaluated the performance of 15 Mexican radiographers, also known as radiologic technologists, in the interpretation of screening mammography after a 6 months training period in a screening setting. Fifteen radiographers received 6 months standardized training with radiologists in the interpretation of screening mammography using the Breast Imaging Reporting and Data System (BI-RADS) system. A challenging test set of 110 cases developed by the Breast Cancer Surveillance Consortium was used to evaluate their performance. We estimated sensitivity, specificity, false positive rates, likelihood ratio of a positive test (LR+) and the area under the subject-specific Receiver Operating Characteristic (ROC) curve (AUC) for diagnostic accuracy. A mathematical model simulating the consequences in costs and performance of two hypothetical scenarios compared to the status quo in which a radiologist reads all screening mammograms was also performed.ResultsRadiographer's sensitivity was comparable to the sensitivity scores achieved by U.S. radiologists who took the test but their false-positive rate was higher. Median sensitivity was 73.3 % (Interquartile range, IQR: 46.7-86.7 %) and the median false positive rate was 49.5 % (IQR: 34.7-57.9 %). The median LR+ was 1.4 (IQR: 1.3-1.7 %) and the median AUC was 0.6 (IQR: 0.6-0.7). A scenario in which a radiographer reads all mammograms first, and a radiologist reads only those that were difficult for the radiographer, was more cost-effective than a scenario in which either the radiographer or radiologist reads all mammograms.ConclusionsGiven the comparable sensitivity achieved by Mexican radiographers and U.S. radiologists on a test set, screening mammography interpretation by radiographers appears to be a possible adjunct to radiologists in countries with shortages of radiologists. Further studies are required to assess the effectiveness of different training programs in order to obtain acceptable screening accuracy, as well as the best approaches for the use of non-physician readers to interpret screening mammography

Is diet partly responsible for differences in COVID-19 death rates between and within countries?

Correction: Volume: 10 Issue: 1 Article Number: 44 DOI: 10.1186/s13601-020-00351-w Published: OCT 26 2020Reported COVID-19 deaths in Germany are relatively low as compared to many European countries. Among the several explanations proposed, an early and large testing of the population was put forward. Most current debates on COVID-19 focus on the differences among countries, but little attention has been given to regional differences and diet. The low-death rate European countries (e.g. Austria, Baltic States, Czech Republic, Finland, Norway, Poland, Slovakia) have used different quarantine and/or confinement times and methods and none have performed as many early tests as Germany. Among other factors that may be significant are the dietary habits. It seems that some foods largely used in these countries may reduce angiotensin-converting enzyme activity or are anti-oxidants. Among the many possible areas of research, it might be important to understand diet and angiotensin-converting enzyme-2 (ACE2) levels in populations with different COVID-19 death rates since dietary interventions may be of great benefit.Peer reviewe

Instrumentation for a plasma needle applied to E. coli bacteria elimination

Microplasmas are nowadays a powerful tool with multiple practical applications. The performance of a specific instrumentation for a plasma needle capable of producing non-thermal plasmas and a DBD reactor able to produce atmospheric pressure plasmas, both of them designed and already constructed, is reported. These devices operate at 13.56 MHz and are driven by a specifically built radio frequency (RF) resonant converter. The reactors, which operate at atmospheric pressure in a He-air gas mixture at a 1.5 SLPM flow, have been successfully applied to eliminate E. coli bacteria. In the needle case, bacterial samples were submitted typically to a 500 V peak voltage plasma discharge for 120 s. In the DBD treatment, the samples were processed with typical 750 V peak voltage plasma discharges for 80 s. The sample pH was used as a criterion to measure the effectiveness of the plasma treatment, in such a way that the return to the basal pH value after the treatment can be assumed as the validation of the complete bacterial elimination

Radiographers supporting radiologists in the interpretation of screening mammography: a viable strategy to meet the shortage in the number of radiologists.

BackgroundAn alternative approach to the traditional model of radiologists interpreting screening mammography is necessary due to the shortage of radiologists to interpret screening mammograms in many countries.MethodsWe evaluated the performance of 15 Mexican radiographers, also known as radiologic technologists, in the interpretation of screening mammography after a 6 months training period in a screening setting. Fifteen radiographers received 6 months standardized training with radiologists in the interpretation of screening mammography using the Breast Imaging Reporting and Data System (BI-RADS) system. A challenging test set of 110 cases developed by the Breast Cancer Surveillance Consortium was used to evaluate their performance. We estimated sensitivity, specificity, false positive rates, likelihood ratio of a positive test (LR+) and the area under the subject-specific Receiver Operating Characteristic (ROC) curve (AUC) for diagnostic accuracy. A mathematical model simulating the consequences in costs and performance of two hypothetical scenarios compared to the status quo in which a radiologist reads all screening mammograms was also performed.ResultsRadiographer's sensitivity was comparable to the sensitivity scores achieved by U.S. radiologists who took the test but their false-positive rate was higher. Median sensitivity was 73.3 % (Interquartile range, IQR: 46.7-86.7 %) and the median false positive rate was 49.5 % (IQR: 34.7-57.9 %). The median LR+ was 1.4 (IQR: 1.3-1.7 %) and the median AUC was 0.6 (IQR: 0.6-0.7). A scenario in which a radiographer reads all mammograms first, and a radiologist reads only those that were difficult for the radiographer, was more cost-effective than a scenario in which either the radiographer or radiologist reads all mammograms.ConclusionsGiven the comparable sensitivity achieved by Mexican radiographers and U.S. radiologists on a test set, screening mammography interpretation by radiographers appears to be a possible adjunct to radiologists in countries with shortages of radiologists. Further studies are required to assess the effectiveness of different training programs in order to obtain acceptable screening accuracy, as well as the best approaches for the use of non-physician readers to interpret screening mammography

Clinical guidelines on the diagnosis and treatment of celiac disease in Mexico

Celiac disease, celiac sprue, or gluten-sensitive enteropathy, is a generalized autoimmune disease characterized by chronic inflammation and atrophy of the small bowel mucosa. It is caused by dietary exposure to gluten and affects genetically predisposed individuals. In Mexico, at least 800,000 are estimated to possibly have the disease, prompting the Asociación Mexicana de Gastroenterología to summon a multidisciplinary group of experts to develop the “Clinical guidelines on the diagnosis and treatment of celiac disease in Mexico” and establish recommendations for the medical community, its patients, and the general population. The participating medical professionals were divided into three working groups and were given the selected bibliographic material by the coordinators (ART, LUD, JMRT), who proposed the statements that were discussed and voted upon in three sessions: two voting rounds were carried out electronically and one at a face-to-face meeting. Thirty-nine statements were accepted, and once approved, were developed and revised by the coordinators, and their final version was approved by all the participants. It was emphasized in the document that epidemiology and risk factors associated with celiac disease (first-degree relatives, autoimmune diseases, high-risk populations) in Mexico are similar to those described in other parts of the world. Standards for diagnosing the disease and its appropriate treatment in the Mexican patient were established. The guidelines also highlighted the fact that a strict gluten-free diet is essential only in persons with confirmed celiac disease, and that the role of gluten is still a subject of debate in relation to nonceliac, gluten-sensitive patients. Resumen: La enfermedad celiaca (EC), esprúe celíaco o enteropatía sensible al gluten, es una enfermedad autoinmune generalizada que se caracteriza por inflamación crónica y atrofia de la mucosa del intestino delgado, causada por la exposición al gluten de la dieta que afecta a individuos genéticamente predispuestos. En México se estima que al menos 800,000 personas podrían padecerla, por lo que la Asociación Mexicana de Gastroenterología convocó a un grupo multidisciplinario de expertos para que realizaran la Guía clínica para diagnóstico y tratamiento de enfermedad celíaca en México, y se establecieran recomendaciones para la comunidad médica, sus enfermos y la población general. Los profesionistas participantes, divididos en 3 mesas de trabajo, recibieron material bibliográfico seleccionado por los coordinadores (ART, LUD, JMRT), quienes propusieron los enunciados que fueron discutidos y votados en 3 sesiones: 2 a través de medios electrónicos y una presencial. Al final se aceptaron 39 enunciados que, una vez aprobados, fueron desarrollados y revisados por los coordinadores hasta su versión final, que fue aprobada por todos los participantes. Dentro de estas se destaca que la epidemiología y factores de riesgo asociados (familiares de primer grado, enfermedades autoinmunes, poblaciones de alto riesgo) a EC en México son similares a los descritos en otras partes del mundo. Se establecen pautas para el diagnóstico y el tratamiento apropiado de los pacientes mexicanos que la padecen. Se insiste en que una dieta estricta libre de gluten es indispensable solo en las personas con EC confirmada, y que su papel en pacientes con sensibilidad al gluten sin EC es aún un tema de controversia. Keywords: Celiac disease, Mexico, Diagnosis, Gluten, Allergy, Sensitivity, Palabras clave: Enfermedad celíaca, México, Diagnóstico, Gluten, Alergia, Sensibilida

Consenso mexicano sobre el síndrome de intestino irritable

Antecedentes: Desde la publicación de las guías de diagnóstico y tratamiento del síndrome del intestino irritable (SII) de la Asociación Mexicana de Gastroenterología en el 2009 (Guías 2009) se han producido avances significativos en el conocimiento de la epidemiología, fisiopatogenia, diagnóstico y tratamiento de esta enfermedad. Objetivos: Presentar una revisión consensuada del estado actual de los conocimientos sobre el SII que actualicen las Guías 2009, integrando las nuevas evidencias científicas publicadas a nivel mundial con énfasis en estudios realizados en México. Métodos: Se realizó una revisión de la bibliografía en PubMed de enero del 2009 a marzo del 2015, que se complementó en forma manual. Se incluyeron todas las publicaciones en inglés y español, con preferencia por los consensos, guías, revisiones sistemáticas y metaanálisis. Se generaron enunciados en los diferentes aspectos de la enfermedad que fueron votados por 24 gastroenterólogos con el método Delphi. Una vez consensuado cada enunciado, se calificó el nivel de la evidencia y se otorgó la fuerza de la recomendación utilizando el sistema GRADE. Resultados: Se generaron 48 enunciados que actualizaron la información sobre el SII y complementaron la información que no había sido incluida en las Guías 2009 con referencia al papel del ejercicio y la dieta, las estrategias diagnósticas, así como alternativas de tratamiento existentes que fueron evaluadas con mayor rigor o que surgieron en los 5 últimos años. Conclusiones: Presentamos una revisión consensuada de los progresos más relevantes en el SII, que actualizan y complementan las Guías 2009. Se incluyen diversos estudios realizados en México