Papel de la ecografía en la sala de emergencia en el diagnóstico del trauma de tórax / The Role of Sonography in the Emergency Room for the Diagnosis of Thoracic Trauma

Introducción: Dentro de la atención al lesionado con trauma torácico se cuenta con varios medios diagnósticos, entre ellos la evaluación por ecografía focalizada en trauma extendido a tórax, el cual ha mostrado una alta sensibilidad, aun realizado por médicos no radiólogos como cirujanos generales, emergencistas e intensivistas. Objetivo: Determinar la utilidad de la ecografía torácica extendida realizada por cirujanos en lesionados con traumatismo torácico. Métodos: Se realizó un estudio observacional, descriptivo de evaluación de pruebas diagnósticas con un diseño transversal, en 1052 pacientes ingresados en la sala de emergencia. Se les realizó la evaluación por ecografía torácica extendida en el Hospital Universitario "General Calixto García", durante el período comprendido entre enero de 2020 y febrero de 2021. Resultados: Fueron realizados en un periodo de 1 año un total de 1052 ultrasonidos torácicos, 221 casos fueron positivos, de ellos 81 neumotórax (7,7 por ciento) y 62 hemoneumotórax (5,9 por ciento) todos confirmados por tomografía de tórax. La edad promedio fue de 45,27 (18-97), el sexo masculino prevaleció con 772 casos (73,4 por ciento). Los mecanismos productores de trauma más frecuentes fueron: caída de altura 273 casos (26 por ciento) y trauma contuso 181 casos (17,2 por ciento). La ecografía torácica extendida obtuvo una sensibilidad de un 95,24 por ciento y una especificidad de 99,88 por ciento en el diagnóstico lesiones torácicas. Conclusiones: La ecografía torácica extendida demostró que en manos de los cirujanos generales es una herramienta confiable, segura, no invasiva, poco costosa, repetible, que permite diagnosticar rápidamente lesiones torácicas y tratarlas(AU)

Introduction: Within care for the injured patient with thoracic trauma there are several diagnostic means. For example, extended focused assessment with sonography for thoracic trauma has shown high sensitivity, even when performed by non-radiologists such as general surgeons, emergency specialists and intensivists. Objective: To determine the usefulness of extended thoracic sonography performed by surgeons on injured patients with thoracic trauma. Methods: An observational, descriptive and cross-sectional study of diagnostic tests assessment was carried out in 1052 patients admitted to the emergency room. They were assessed by extended thoracic sonography at General Calixto García University Hospital, during the period between January 2020 and February 2021. Results: A total of 1052 thoracic ultrasounds were performed in a period of one year, of which 221 cases were positive. Of them, 81 were pneumothorax (7.7 percent) and 62 were hemopneumothorax (5.9 percent), all confirmed by chest tomography. The average age was 45.27 (18-97). The male sex prevailed, with 772 cases (73.4 percent). The most frequent trauma-producing mechanisms were altitude fall, accounting for 273 cases (26 percent), and blunt trauma, accounting for 181 cases (17.2 percent). Extended thoracic ultrasound showed a sensitivity of 95.24 percent and a specificity of 99.88 percent in the diagnosis of thoracic injuries. Conclusions: Extended thoracic ultrasound showed that, in the hands of general surgeons, it is a reliable, safe, noninvasive, inexpensive and repeatable tool that allows rapid diagnosis and treatment of thoracic injuries(AU)

Herramientas digitales como un aliado informativo en el Perú para el autocuidado en tiempos de COVID-19 / Digital tools as information aids for self-care in the time of COVID-19 in Peru

Este estudio tuvo como objetivo analizar las métricas disponibles de las herramientas digitales que fomentan el autocuidado para comprender sus efectos en la población en tiempos de COVID-19. Se realizó una búsqueda sobre sitios web, aplicaciones móviles y redes sociales que ofrecían información a la población sobre la COVID-19, los cuales debían pertenecer al gobierno peruano o a instituciones oficiales relacionadas con la salud. Se revisaron las métricas disponibles de cada herramienta digital para una posterior evaluación de uso. Los sitios web identificados brindaban información referente a la COVID-19, así como datos actualizados sobre los casos existentes, la autoevaluación para descartar la enfermedad y el reporte de resultados de la prueba para su diagnóstico. El sitio web más visitado fue el del Gobierno del Perú, el cual contenía la página web del Ministerio de Salud. Asimismo, la aplicación móvil del Gobierno del Perú PerúEnTusManos fue la más descargada por parte de la población peruana. Las redes sociales, en colaboración con estas herramientas digitales en el Perú, vienen siendo utilizadas activamente para informar e interactuar con la población en estos tiempos de COVID-19. Por lo tanto, por la rápida adaptabilidad que tienen los sitios web y las aplicaciones móviles, estas se han convertido en el Perú en una herramienta informativa ideal para hacer frente a la pandemia de la COVID-19(AU)

The purpose of the study was to analyze the metrics available for digital tools fostering self-care to understand their effects on the population in the time of COVID-19. A search was conducted about websites, mobile applications and social networks offering information to the population about COVID-19 and belonging to the Peruvian government or health-related official institutions. A review was performed of the metrics available for each digital tool with a view to an eventual evaluation of their use. The websites identified provided information about COVID-19 as well as updated data about existing cases, self-evaluation to rule out the disease and the report of results of diagnostic tests. The most visited website was that of the Government of Peru, which contained the website of the Ministry of Health. The mobile application of the Government of Peru PerúEnTusManos was the most commonly downloaded by the Peruvian population. Social networks, in joint cooperation with these digital tools, are actively used in Peru to inform and interact with the population in the time of COVID-19. Due to the rapid adaptability of websites and mobile applications, these have become an ideal information tool in Peru to face the COVID-19 pandemic(AU)

Exploration of an Efficient Simultaneous Molecular Detection Method of HIV, HCV, and Syphilis from a Single Dried Blood Spot / 生物医学与环境科学（英文）

Objective@#The aim of the present study was to evaluate the performance of the simultaneous detection of HIV-1 RNA, HIV-1 DNA, and HCV RNA using one dried blood spot (DBS) as an alternative sample to plasma.@*Method@#A total of 571 paired DBS/plasma samples were collected from men who have sex with men (MSM) and injection drug users (IDUs), and serological and molecular assays were performed. Using plasma results as the reference standard, the performance of DBS tests for HIV-1 RNA, HIV-1 DNA, and HCV RNA was evaluated. Pearson's correlation coefficients and Bland-Altman analysis were performed to assess the correlation and concordance between DBS and plasma.@*Results@#Among paired plasma/DBS samples with detectable HIV-1 RNA and HCV RNA, five samples (5/32) were not detectable in DBS, while measurable HIV-1 RNA levels were present in plasma (1.44 to 3.99 log @*Conclusion@#The performance of the simultaneous detection of HIV-1 RNA, HIV-1 DNA, and HCV RNA using one DBS was acceptable. DBS, as an alternative sample to plasma, may be a viable option for the simultaneous detection of HIV-1 RNA, HIV-1 DNA, and HCV RNA in resource-limited settings or for individuals living in areas that are difficult to access.

Rapid diagnosis of respiratory distress syndrome by oral aspirate in premature newborns / Diagnóstico rápido da síndrome do desconforto respiratório por aspirado bucal em recém-nascidos prematuros

Abstract Objective: The stable microbubble test on gastric aspirate and on amniotic fluid has been used for the diagnosis of respiratory distress syndrome in the newborn. However, no study has performed this test on oral aspirates from premature infants. The objective of this study was to evaluate the performance of the stable microbubble test on oral aspirates from preterm newborns to predict respiratory distress syndrome. Method: This study included infants with gestational age <34 weeks. Oral fluids were obtained immediately after birth and gastric fluids were collected within the first 30 minutes of life. The samples were frozen and tested within 72 hours. Results: The sample was composed of paired aspirates from 64 newborns, who were divided into two groups: respiratory distress syndrome group (n = 21) and control group (n = 43). The median (interquartile range) of the stable microbubble count in the oral samples of infants with respiratory distress syndrome was significantly lower than that of infants who did not develop respiratory symptoms: respiratory distress syndrome group = 12 (8 -22) stable microbubbles/mm2; control group = 100 (48 -230) microbubbles/mm2 (p < 0.001). The correlation between microbubble count in gastric and oral aspirates was 0.90 (95% confidence interval = 0.85 -0.95; p < 0.001). Considering a cut-off point of 25 microbubbles/mm2, the sensitivity and the specificity of the stable microbubble test were 81.4% and 85.7%, respectively. Conclusion: The study suggests that the stable microbubble test performed on oral aspirate is a reliable alternative to that performed on gastric fluid for the prediction of respiratory distress syndrome in the newborn.

Resumo Objetivo: O teste das microbolhas estáveis no aspirado gástrico e no líquido amniótico foi usado no diagnóstico da síndrome do desconforto respiratório do recém-nascido. Contudo, nenhum estudo fez esse teste nos aspirados bucais de neonatos prematuros. O objetivo deste estudo foi avaliar o desempenho do teste das microbolhas estáveis em aspirados bucais de recém-nascidos prematuros para prever síndrome do desconforto respiratório. Método: Este estudo incluiu neonatos com idade gestacional < 34 semanas. Os fluidos orais foram obtidos imediatamente após o nascimento e os fluidos gástricos foram coletados nos primeiros 30 minutos de vida. As amostras foram congeladas e testadas em 72 horas. Resultados: A amostra foi composta de aspirados pareados de 64 recém-nascidos, divididos em dois grupos: grupo de síndrome do desconforto respiratório (n = 21) e grupo de controle (n = 43). A mediana (intervalo interquartil) da contagem das microbolhas estáveis nas amostras de fluido oral dos neonatos com síndrome do desconforto respiratório foi significativamente menor que a dos neonatos que não desenvolveram sintomas respiratórios: grupo de síndrome do desconforto respiratório = 12 (8-22) microbolhas estáveis/mm2; grupo de controle = 100 (48-230) microbolhas/mm2 (p < 0,001). A correlação entre a contagem das microbolhas nos aspirados gástricos e bucais foi 0,90 (intervalo de confiança de 95% = 0,85-0,95; p < 0,001). Considerando um ponto de corte de 25 microbolhas/mm2, a sensibilidade e a especificidade do teste das microbolhas estáveis foram 81,4% e 85,7%, respectivamente. Conclusão: O estudo sugere que o teste das microbolhas estáveis feito no aspirado bucal é uma opção confiável ao fluido gástrico para a predição da síndrome do desconforto respiratório do recém-nascido.

Performance of an immuno-rapid malaria Pf/Pv rapid diagnostic test for malaria diagnosis in the Western Brazilian Amazon

Abstract INTRODUCTION: Rapid diagnostic tests (RDTs) for detecting Plasmodium antigens have become increasingly common worldwide. We aimed to evaluate the accuracy of the Immuno-Rapid Malaria Pf/Pv RDT in detecting Plasmodium vivax infection compared to standard thick blood smear (TBS) under microscopy. METHODS: Hundred and eighty-one febrile patients from the hospital's regular admissions were assessed using TBS and RDT in a blinded experiment. RESULTS: RDT showed a sensitivity of 98.9%, specificity of 100%, and accuracy of 99.5% for P. vivax infection when compared to TBS. CONCLUSIONS: The RDT is highly accurate, making it a valuable diagnostic tool for P. vivax infection.

Usefulness of rapid urease test samples for molecular analysis of clarithromycin resistance in Helicobacter pylori / Utilidad de las muestras de test rápido de ureasa para el análisis molecular de resistencia a claritromicina en Helicobacter pylori

Helicobacter pylori is a gastric pathogen that is widely recognized as a causative agent of gastric disease. Its eradication is variable, mainly due to increased resistance to clarithromycin. Our objective was: to evaluate (i) if the biopsy specimen used for the rapid urease test is a useful sample to detect resistance to clarithromycin by PCR-RFLP and (ii) the distribution of A2142G and A2143G point mutations in the 23S rRNA gene, in relation to virulence factors in our region. Gastric specimens were collected from adult dyspeptic patients (n = 141) and H. pylori was investigated by the rapid urease test, histopathological analysis and PCR for the hsp60 gene. Clarithromycin resistance was detected by PCR-RFLP in 62 H. pylori (+) paired biopsy specimens submitted to molecular analysis and the rapid urease test. H. pylori virulence factors were analyzed by multiplex PCR using specific primers for the cagA, vacA and babA2 genes. Thirteen out of 62 strains (20.9%) were resistant to clarithromycin: 6/13 (46.2%) harbored the A2143G mutation whereas 7/13 (53.8%) carried the A2142G point mutation. vacA m1s1 was the most frequent genotype among the resistant strains. In conclusion, the biopsy specimens used for the rapid urease test were suitable samples for clarithromycin resistance detection in patients infected with H. pylori, which became especially useful in cases where the number or size of the biopsies is limited. In addition, this is the first report of a molecular analysis for clarithromycin resistance performed directly from gastric biopsies in our region.

Helicobacter pylori es un patógeno ampliamente reconocido como causante de enfermedad gástrica. Su erradicación es variable, principalmente debido al incremento de la resistencia a claritromicina. Nuestros objetivos fueron evaluar la utilidad de la biopsia usada para realizar el test rápido de ureasa en la detección de resistencia a claritromicina por PCR-RFLP y conocer la distribución de las mutaciones puntuales A2142G y A2143G en el gen ARNr 23S, en relación con los factores de virulencia en nuestra región. Se recolectaron muestras gástricas (n=141) provenientes de pacientes adultos dispépticos y se investigó la presencia de H. pylori mediante el test rápido de ureasa, análisis histopatológico y PCR para el gen hsp60. La resistencia a claritromicina se analizó por PCR-RFLP en 62 muestras pareadas de biopsias gástricas H. pylori+ destinadas al análisis molecular y al test rápido de ureasa. Los factores de virulencia de H. pylori fueron analizados mediante PCR multiplex usando oligonucleótidos específicos para los genes cagA, vacA y babA2. Trece de 62 cepas (20,9%) fueron resistentes a claritromicina, 6/13 (46,2%) llevaron la mutación A2143G, mientras que 7/13 (53,8%) presentaron la mutación A2142G. El genotipo vacA s1m1 fue el más frecuente entre las cepas resistentes a claritromicina. En conclusión, las biopsias destinadas al test rápido de ureasa fueron muestras apropiadas para la detección de la resistencia a claritromicina en pacientes infectados con H. pylori. Esto es especialmente útil en aquellos casos en los que el número o el tamaño de las muestras son limitados. Además, este es el primer reporte de estudio de resistencia a claritromicina (mediante técnicas moleculares), directamente de biopsias gástricas en nuestra región.

Tuberculosis pulmonar y métodos diagnósticos laboratoriales actuales / Pulmonar tuberculosis and latest diagnosis laboratory methods

La tuberculosis es una enfermedad altamente contagiosa, causada por Mycobacterium tuberculosis o bacilo de Koch. Puede tener repercusiones mortales en caso de no ser tratada oportunamente, siendo responsable de 1.3 millones de muertes a nivel mundial en el año 2016. Afecta al ser humano sobre todo a nivel pulmonar, manifestándose con tos crónica, producción de esputo, anorexia, pérdida de peso, fiebre, sudoración nocturna y hemoptisis; también puede producir enfermedad extrapulmonar. En los últimos 20 años se han desarrollado nuevos métodos para diagnosticar tuberculosis latente y activa, como ser los ensayos de liberación de interferón-gamma y GeneXpert® Objetivo: recopilar información actualizada sobre tuberculosis pulmonar, epidemiología y métodos diagnósticos.Material yMétodos: se utilizaron buscadores como Google académico, PubMed. Se seleccionaron 42documentos, entre estos: artículos originales, normas nacionales, guías de manejo, informes anuales de organizaciones reconocidas. Criterios de inclusión: publicaciones menores a 5 años, tanto en español, como en inglés. Conclusión: el diagnóstico oportuno de la tuberculosis disminuye la estadística de morbilidad y mortalidad debida a la enfermedad, por tanto, es de suma importancia conocer los métodos diagnósticos actuales existentes en el país, así como las ventajas, desventajas, sensibilidad yespecificidad...(AU)

Diagnostics of tuberculosis and differentiation of nonspecific tuberculin reactions in animals

Abstract Tuberculosis is a serious disease of humans and animals, caused by bacteria of the Mycobacterium genus. This leads to complications in the life of the sick person, and subsequently to death. The cattle, who have been diagnosed with this bacterium, are usually sent to the slaughter, with the result that their livestock is reduced. Mycobacteriosis is also a disease, after determining which cattle are most often sent to slaughter. Such a reduction in livestock numbers has a negative effect on the economy. Of the 300 samples from the animals, 25 cultures of atypical bacteria responding to tuberculin were isolated. A series of tests - intravenous tuberculin test, ophthalmic test, palpebral test, "ZhAT" test, showed that most of the tuberculosis changes in cattle were found in regional lymph nodes more often than in internal organs. In healthy for tuberculosis cows, at the age of 4-9 years, seasonal nonspecific sensitivity to tuberculin is observed. Implementation of the developed express method of glutaraldehyde test on farms in healthy tuberculosis will speed up the diagnosis of tuberculosis and mycobacteriosis in animals that reacted to tuberculin and will exclude short-term nonspecific sensitization of their organism to tuberculin. The introduction of this methodology can be used to diagnose and clearly differentiate the diagnoses of "tuberculosis" and "mycobacteriosis" in cattle. This will cure part of the livestock and reduce the amount of slaughter.

Rapid molecular test for tuberculosis: impact of its routine use at a referral hospital / Teste rápido molecular para tuberculose: avaliação do impacto de seu uso na rotina em um hospital de referência

ABSTRACT Objective: To evaluate the impact of the use of the molecular test for Mycobacterium tuberculosis and its resistance to rifampin (Xpert MTB/RIF), under routine conditions, at a referral hospital in the Brazilian state of Bahia. Methods: This was a descriptive study using the database of the Mycobacteriology Laboratory of the Octávio Mangabeira Specialized Hospital, in the city of Salvador, and georeferencing software. We evaluated 3,877 sputum samples collected from symptomatic respiratory patients, under routine conditions, between June of 2014 and March of 2015. All of the samples were submitted to sputum smear microscopy and the Xpert MTB/RIF test. Patients were stratified by gender, age, and geolocation. Results: Among the 3,877 sputum samples evaluated, the Xpert MTB/RIF test detected M. tuberculosis in 678 (17.5%), of which 60 (8.8%) showed resistance to rifampin. The Xpert MTB/RIF test detected M. tuberculosis in 254 patients who tested negative for sputum smear microscopy, thus increasing the diagnostic power by 59.9%. Conclusions: The use of the Xpert MTB/RIF test, under routine conditions, significantly increased the detection of cases of tuberculosis among sputum smear-negative patients.

RESUMO Objetivo: Avaliar o impacto do teste rápido molecular automatizado Xpert MTB/RIF, utilizado para a detecção de Mycobacterium tuberculosis e sua resistência à rifampicina, em condições de rotina, em um hospital de referência no estado da Bahia. Métodos: Estudo descritivo retrospectivo utilizando o banco de dados do Laboratório de Micobacteriologia do Hospital Especializado Octávio Mangabeira, localizado na cidade de Salvador, e um programa de georreferenciamento. Entre junho de 2014 e março de 2015, foram incluídas no estudo 3.877 amostras de escarro coletadas de pacientes sintomáticos respiratórios em condições de rotina. Todas as amostras coletadas foram submetidas tanto à baciloscopia quanto a Xpert MTB/RIF. Os pacientes foram estratificados por sexo, idade e georreferenciamento. Resultados: Das 3.877 amostras de escarro analisadas, Xpert MTB/RIF detectou a presença de M. tuberculosis em 678 pacientes (17,5%). Desses, 60 (8,8%) apresentaram resistência à rifampicina. O Xpert MTB/RIF detectou 254 pacientes com baciloscopia negativa, representando um acréscimo diagnóstico de 59,9%. Conclusões: A implantação do Xpert MTB/RIF, sob condições de rotina, teve um impacto significativo no aumento da detecção de casos de tuberculose em pacientes com baciloscopia negativa.

Certeza diagnóstica mediante interrogatorio y examen físico en estudiantes de medicina interna / Diagnostic certainty through interrogatory and physical examination in internal medicine students

Introducción: el análisis de los errores cometidos durante el proceso diagnóstico al aplicar el método clínico por los estudiantes de medicina interna, en dos momentos de su rotación, permite mejorar la calidad de la atención médica. Objetivo: analizar si existe relación entre el diagnóstico al ingreso y egreso, y los errores detectados durante el interrogatorio y examen físico en los estudiantes de tercer año al iniciar y finalizar la rotación de medicina interna. Métodos: se realizó un estudio descriptivo de los alumnos de tercer año del Hospital Militar Dr. Carlos J. Finlay en el curso académico 2015-2016. Resultados: los errores son más frecuentes en el interrogatorio, tanto en el primero como en el segundo encuentro médico. La concordancia entre el diagnóstico al ingreso y al egreso, mejoró en un 21,7 por ciento entre el primer y el segundo. Conclusiones: la realización de diagnósticos certeros implica mejoramiento de la atención médica con ahorro de recursos económicos(AU)

Introduction: the analysis of the errors made during the diagnostic process when applying the clinical method by the students of internal medicine, in two moments of its rotation, allows to improve the quality of the medical attention. Objective: to analyze if there is a relationship between the diagnosis at admission and discharge and the errors detected during the interrogation and physical examination in the third year students at the beginning and end of the Internal Medicine rotation. Methods: a descriptive study of the third year students of the Military Hospital Dr. Carlos J. Finlay in the academic year 2015 - 2016. Results: errors are more frequent in the interrogation, both in the first and in the second medical encounter. The agreement between the diagnosis on admission and discharge, improved by 21.7 percent between the first and second medical encounter. Conclusions: the realization of accurate diagnoses implies improvement of medical care with savings of economic resources(AU)

Comparison of culture and PCR methods in the diagnosis of bacterial meningitis

Abstract Our aim in this study is to compare the standard culture method with the multiplex PCR and the Speed-Oligo® Bacterial Meningitis Test (SO-BMT) – a hybridization-based molecular test method – during the CSF examination of the patients with the pre-diagnosis of acute bacterial meningitis. For the purposes of this study, patients with acute bacterial meningitis treated at the Dicle University Medical Faculty Hospital, Infectious Diseases and Clinical Microbiology Clinic between December 2009 and April 2012 were retrospectively evaluated. The diagnosis of bacterial meningitis was made based on the clinical findings, laboratory test anomalies, CSF analysis results, and the radiological images. Growth was observed in the CSF cultures of 10 out of the 57 patients included in the study (17.5%) and Streptococcus pneumoniae was isolated in all of them. The CSF samples of 34 patients (59.6%) were positive according to the SO-BMT and S. pneumoniae was detected in 33 of the samples (97.05%), while Neisseria meningitidis was found in 1 sample (2.95%). In a total of 10 patients, S. pneumoniae was both isolated in the CSF culture and detected in the SO-BMT. The culture and the SO-BMT were negative in 23 of the CSF samples. There was no sample in which the CSF culture was positive although the SO-BMT was negative. While SO-BMT seems to be a more efficient method than bacterial culturing to determine the pathogens that most commonly cause bacterial meningitis in adults, further studies conducted on larger populations are needed in order to assess its efficiency and uses.

Prevalence of child malnutrition at a university hospital using the World Health Organization criteria and bioelectrical impedance data

Malnutrition constitutes a major public health concern worldwide and serves as an indicator of hospitalized patients’ prognosis. Although various methods with which to conduct nutritional assessments exist, large hospitals seldom employ them to diagnose malnutrition. The aim of this study was to understand the prevalence of child malnutrition at the University Hospital of the Ribeirão Preto Medical School, University of São, Brazil. A cross-sectional descriptive study was conducted to compare the nutritional status of 292 hospitalized children with that of a healthy control group (n=234). Information regarding patients’ weight, height, and bioelectrical impedance (i.e., bioelectrical impedance vector analysis) was obtained, and the phase angle was calculated. Using the World Health Organization (WHO) criteria, 35.27% of the patients presented with malnutrition; specifically, 16.10% had undernutrition and 19.17% were overweight. Classification according to the bioelectrical impedance results of nutritional status was more sensitive than the WHO criteria: of the 55.45% of patients with malnutrition, 51.25% exhibited undernutrition and 4.20% were overweight. After applying the WHO criteria in the unpaired control group (n=234), we observed that 100.00% of the subjects were eutrophic; however, 23.34% of the controls were malnourished according to impedance analysis. The phase angle was significantly lower in the hospitalized group than in the control group (P<0.05). Therefore, this study suggests that a protocol to obtain patients’ weight and height must be followed, and bioimpedance data must be examined upon hospital admission of all children.

Study of implementation and direct cost estimates for diagnostic tests for human visceral leishmaniasis in an urban area in Brazil / Estudo da implantação e estimativas de custo direto de testes diagnósticos para leishmaniose visceral humana em uma área urbana no Brasil / Estudio de la implementación y el costo directo estimado de pruebas de diagnóstico de la leishmaniasis visceral humana en una zona urbana en Brasil

Abstract This work reports the process and costs of comprehensively implementing two tests to decentralize the diagnosis of visceral leishmaniasis (VL) in an endemic city in Brazil: a rapid test (IT LEISH) and a direct agglutination test (DAT-LPC). The implementation began by training health professionals to perform the tests. Estimation of the training costs considered the proportional remuneration of all professionals involved and the direct costs of the tests used for training. The study was conducted between November 2011 and November 2013. During that time, 17 training sessions were held, and 175 professionals were trained. The training cost for each professional was US$ 7.13 for the IT LEISH and US$ 9.93 for the DAT-LPC. The direct costs of the IT LEISH and DAT-LPC were estimated to be US$ 6.62 and US$ 5.44, respectively. This first evaluation of the implementation of these diagnostic tests indicates the feasibility of decentralizing both methods to extend access to VL diagnosis in Brazil.

Resumo Este trabalho relata o processo e os custos da implantação de dois testes para descentralizar o diagnóstico da leishmaniose visceral (LV) em um município endêmico no Brasil: um teste rápido (IT LEISH) e um teste de aglutinação direta (DAT-LPC). A implantação iniciou com o treinamento dos profissionais de saúde do município na realização dos testes diagnósticos. Os itens incluídos nas estimativas de custo das capacitações foram a remuneração proporcional de todos os profissionais envolvidos e os custos diretos dos testes usados. O estudo foi conduzido entre novembro de 2011 e novembro de 2013. Durante esse período, 17 capacitações foram realizadas e 175 profissionais treinados. O custo relacionado a cada profissional de saúde capacitado na realização do IT LEISH foi de US$ 7,13 e na realização do DAT-LPC, de US$ 9,93. O custo direto do IT LEISH e do DAT-LPC foi estimado em US$ 6,62 e US$ 5,44, respectivamente. Esta primeira avaliação da implantação desses dois testes aponta para a viabilidade da descentralização de ambos os métodos, que aumentam o acesso ao diagnóstico da LV no Brasil.

Resumen Este trabajo relata la puesta en funcionamiento y los costos de pruebas de diagnóstico de VL en un municipio endémico en Brasil: el test rápido (IT LEISH) y la prueba de aglutinación directa (DAT-LPC). Esta puesta en marcha comenzó por capacitar al personal sanitario del municipio para la realización de las pruebas. Para estimar los costos de la capacitación, se consideró la remuneración proporcional de todo el personal involucrado y los costos directos derivados de la aplicación de las pruebas. El estudio fue realizado entre noviembre de 2011 y noviembre de 2013. En ese periodo se realizaron 17 capacitaciones y se formaron 175 profesionales. Se calcula que el costo derivado de capacitar cada profesional para realizar el IT LEISH fue de 7.13 US$ y 9.93 US$ para el DAT-LPC. Los costos directos del IT LEISH y del DAT-LPC se estimaron en 6,62 US$ y 5,44 US$ respectivamente. La primera evaluación de la puesta en funcionamiento de las dos pruebas en este municipio señala que es viable descentralizar su realización, lo que amplía el acceso al diagnóstico de la VL en Brasil.

Whole-body diffusion-weighted magnetic resonance imaging versus FDG-PET/CT for initial lymphoma staging: systematic review on diagnostic test accuracy studies / Ressonância magnética de corpo total com difusão comparada à FDG-PET/CT no estadiamento inicial do linfoma: revisão sistemática de estudos de acurácia diagnóstica

CONTEXT AND OBJECTIVE: Positron emission tomography with [18]F-fluoro-2-deoxyglucose (FDG-PET/CT) has been advocated as the method of choice for lymphoma staging, since it enables whole-body analysis with high sensitivity for detection of affected areas and because it combines capacities for anatomical and functional assessment. With technological advances, magnetic resonance imaging (MRI) has emerged as an alternative to FDG-PET/CT. This systematic review with meta-analysis aimed to compare whole-body diffusion-weighted MRI (WB-MRI) with FDG-PET/CT for lymphoma staging. DESIGN AND SETTING: Systematic review on diagnostic test accuracy studies conducted at a public university. METHODS: The Medline, Scopus, Embase and Lilacs databases were searched for studies published up to September 2013 that compared WB-MRI and FDG-PET/CT for lymphoma staging. The reference lists of included studies were checked for any relevant additional citations. RESULTS: Six studies that evaluated the initial lymphoma staging in 116 patients were included. WB-MRI and FDG-PET/CT agreed in 90.5% of the cases (κ = 0.871; P < 0.0001). In most of the studies, when there was disagreement between the methods, WB-MRI overstaged in relation to FDG-PET/CT. The sensitivity of WB-MRI and FDG-PET/CT, in comparison with the clinical-radiological standard, ranged from 59 to 100% and from 63 to 100% respectively. CONCLUSION: WB-MRI is a highly sensitive method for initial lymphoma staging. It has excellent agreement with FDG-PET/CT and is a great alternative for managing lymphoma patients, without using ionizing radiation or an intravenous contrast agent. .

CONTEXTO E OBJETIVO: A tomografia por emissão de pósitrons com 2-[18F]-fluoro-2-deoxi-D-glicose (FDG-PET/CT) tem sido defendida como método de escolha para o estadiamento do linfoma por realizar o estudo do corpo inteiro com boa sensibilidade para detecção das áreas acometidas e por combinar as capacidades de avaliação anatômica e funcional. Com os avanços tecnológicos, a ressonância magnética tem se apresentando como alternativa à FDG-PET/CT. Esta revisão sistemática com metanálise visa comparar a ressonância magnética de corpo inteiro (WB-MRI) com difusão com a FDG-PET/CT no estadiamento do linfoma. TIPO DE ESTUDO E LOCAL: Revisão sistemática de estudos de acurácia diagnóstica conduzida em universidade pública. MÉTODOS: Foi conduzida uma busca nos bancos de dados Medline, Embase, Scopus e Lilacs por estudos publicados até setembro de 2013 comparando a WB-MRI com a FDG-PET/CT no estadiamento do linfoma. As referências bibliográficas dos estudos incluídos foram checadas com a finalidade de encontrar citações adicionais relevantes. RESULTADOS: Foram incluídos seis estudos que avaliaram o estadiamento inicial do linfoma de 116 pacientes. A WB-MRI e a FDG-PET/CT concordaram em 90,5% dos casos (κ = 0,871; P < 0,0001). Na maioria dos estudos, quando houve discordância, a WB-MRI estabeleceu estadiamento superior à FDG-PET/CT. A sensibilidade da WB-MRI e da FDG-PET/CT, em relação ao padrão clínico-radiológico, variou de 59% a 100% e de 63% a 100%, respectivamente. CONCLUSÃO: A WB-MRI apresenta alta sensibilidade no estadiamento inicial do linfoma, excelente concordância com a FDG-PET/CT e representa uma ótima alternativa no manejo de pacientes com linfoma, sem utilizar radiação ionizante ou meio de contraste intravenoso. .

Perspectivas actuales sobre el diagnóstico genómico en pediatría / Current perspectives on genome-based diagnostic tests in Pediatrics

El diagnóstico etiológico es un objetivo primordial para el manejo clínico de cada paciente. Algunos niños con cuadros clínicos complejos son objeto de una lista interminable de exámenes, lo que se ha denominado "odisea diagnóstica", y que, sin embargo, muchas veces no deja resultados concluyentes. En los últimos años, estamos siendo testigos de una verdadera revolución de la medicina genómica con la incorporación al ámbito clínico de tecnologías que prometen aumentar la capacidad de hacer diagnóstico y disminuir los tiempos. Con énfasis en pediatría, se actualizan conceptos sobre las principales ventajas y limitaciones del diagnóstico genómico, en contraposición con las metodologías usuales.

Etiological diagnosis is essential in the clinical management of individual patients. Some children with complex medical conditions are subjected to numerous testing, known as "diagnostic odyssey", which often gives no conclusive results. In recent years, a revolution in genomic medicine is underway with the use of technologies that promise to increase the ability to make a diagnosis and reduce the time involved. The main advantages and limitations of genomic diagnosis, as opposed to usual methodologies are reviewed with an emphasis on Pediatrics.

Quantitative real-time polymerase chain reaction for detecting Mycoplasma hyosynoviae and Mycoplasma hyorhinis in pen-based oral, tonsillar, and nasal fluids

Mycoplasma (M.) hyorhinis and M. hyosynoviae are pathogens known to cause disease in pigs post-weaning. Due to their fastidious nature, there is increased need for culture-independent diagnostic platforms to detect these microorganisms. Therefore, this study was performed to develop and optimize quantitative real-time PCR (qPCR) assays to rapidly detect M. hyorhinis and M. hyosynoviae in pen-based oral fluids as well as nasal and tonsillar fluids as proxies for samples used in swine herd surveillance. Two methods of genomic DNA extraction, automated versus manual, were used to compare diagnostic test performance. A wean-to-finish longitudinal study was also carried out to demonstrate the reproducibility of using pen-based oral fluids. Overall, pen-based oral and tonsillar fluids were more likely to be positive for both types of bacteria whereas only M. hyorhinis was detected in nasal fluids. DNA extraction protocols were shown to significantly influence test result. Although the initial detection time somewhat differed, both organisms were repeatedly detected in the longitudinal study. Overall, this study evaluated two qPCR methods for rapid and specific detection of either mycoplasma. Results from the present investigation can serve as a foundation for future studies to determine the prevalence of the two microorganisms, environmental load, and effectiveness of veterinary interventions for infection control.

Immunological assays employed for the elucidation of an histoplasmosis outbreak in São Paulo, SP

Several reports showed outbreaks of histoplasmosis acquired while bat-inhabited caves were visited by tourists, miners or researchers. We evaluated the performance of double immunodifusion (DI) and immunoblotting (IB) assays, employed for the histoplasmosis outbreak elucidation occurred in Vale do Paraíba, São Paulo. The existence of epidemiologic link, four patients with clinical signs suggestive of histoplasmosis and mycological confirmation has made that all 35 individuals involved to the cave visit were subjected to serological evaluation. By DI, we observed reactivity against H. capsulatum antigen in a single serum examined nearly 20 days after exposure to fungal propagules. On the other hand, IB showed reactivity against H and M fractions in 50% of samples evaluated. The analysis of the second sample batch, collected two months after the exposure showed that 96.7% were reactive by DI with antibodies titers ranging from 1 to 16 and 100% of reactivity against H and M fractions, by IB, suggesting an acute infection. The analysis of the overall agreement between the methods showed to be reasonable (κ = 0.37). This study confirms the importance and efficacy of more sensitive methodologies, such as IB assay, to early elucidation of disease, especially in cases of patients without mycological information.

Development and assessment of a latex agglutination test based on recombinant MSP5 to detect antibodies against Anaplasma marginale in cattle

The recombinant protein MSP5 has been established as an important antigen for serological diagnosis of Anaplasma marginale by enzyme-linked immunosorbent assay (ELISA). However, due to the high cost of specialized equipment, this technique is not accessible to all laboratories, especially in developing countries in areas where the disease is endemic. The present study describes the standardization of a latex agglutination test (LAT) to detect antibodies against A. marginale based on recombinant MSP5. Compared with indirect enzyme-linked immunosorbent assay (iELISA), the relative sensitivity and specificity of the LAT were 95.21% and 91.86% respectively, with an almost perfect agreement between tests (kappa index = 0.863). These results can be considered important for the serological diagnosis of A. marginale, as they indicate that the test represents a rapid and low cost alternative to ELISA.

Diagnosis of Helicobacter pylori infection by invasive and noninvasive tests

Although several invasive and noninvasive tests have been developed for the diagnosis of Helicobacter pylori infection, all of the tests have their limitations. We conducted a study to investigate and compare the suitability of rapid urease test (RUT), serology, histopathology and stool antigen tests with polymerase chain reaction (PCR) for detection of H. pylori, and correlate the diagnostic methods with PCR. Eighty nine patients (61 adults, 28 children) referred to the Firoozgar Hospital and Children Medical Center Hospital for diagnostic upper gastrointestinal endoscopy entered to the study and noninvasive tests such as immunoassay for serological antibodies against H. pylori and detection of its antigen in feces were measured. The biopsies were utilized for histological examination, RUT and PCR. The H. pylori statuses were evaluated by the positivity of ureC PCR in biopsy specimens and 53 subjects had H. pylori positive result. Histopathology showed high overall performance in adults and children with sensitivity and specificity 100% and 90%, respectively. Sensitivity, specificity, and accuracy for stool antigen test were 87.8%, 75% and 82%, respectively. Correlation of RUT, serology (IgG), histopathology and stool antigen tests with PCR were 0.82, 0.32, 0.91 and 0.63, respectively. In conclusion, the RUT and histopathology are as accurate as the PCR of biopsy and stool antigen test can consider as appropriate noninvasive test for detection of H. pylori infection.