Evolução da prevalência de infecção por COVID-19 no Rio Grande do Sul, Brasil: inquéritos sorológicos seriados / Trends in the prevalence of COVID-19 infection in Rio Grande do Sul, Brazil: repeated serological surveys

Resumo A COVID-19 é uma doença produzida pelo vírus SARS-CoV-2. Esse vírus se espalhou rapidamente pelo mundo, o que levou a Organização Mundial da Saúde a classificar a COVID-19 como uma emergência de saúde internacional e, posteriormente, a declará-la uma pandemia. O número de casos confirmados, no dia 11 de abril de 2020, já passa de 1.700.000, porém esses dados não refletem a real prevalência de COVID-19 na população, visto que, em muitos países, os testes são quase que exclusivamente realizados em pessoas com sintomas, especialmente os mais graves. Para definir políticas de enfrentamento, é essencial dispor de dados sobre a prevalência real de infecção na população. Este estudo tem por objetivos avaliar a proporção de indivíduos já infectados pelo SARS-CoV-2 no Rio Grande do Sul, Brasil, analisar a velocidade de expansão da infecção e estimar o percentual de infectados com e sem sintomas. Serão realizados quatro inquéritos sorológicos repetidos a cada 15 dias, com amostragem probabilística de nove cidades sentinela, em todas as sub-regiões do Estado. As entrevistas e testes ocorrerão no âmbito domiciliar. Serão utilizados testes rápidos para detecção de anticorpos, validados previamente ao início da coleta de dados.

Abstract COVID-19, the disease produced by the virus SARS-CoV-2, has spread quickly throughout the world, leading the World Health Organization to first classify it as an international health emergency and, subsequently, declaring it pandemic. The number of confirmed cases, as April 11, surpassed 1,700,000, but this figure does not reflect the prevalence of COVID-19 in the population as, in many countries, tests are almost exclusively performed in people with symptoms, particularly severe cases. To properly assess the magnitude of the problem and to contribute to the design of evidence-based policies for fighting COVID-19, one must accurately estimate the population prevalence of infection. Our study is aimed at estimating the prevalence of infected individuals in the state of Rio Grande do Sul, Brazil, to document how fast the infection spreads, and to estimate the proportion of infected persons who present or presented symptoms, as well as the proportion of asymptomatic infections. Four repeated serological surveys will be conducted in probability samples of nine sentinel cities every two weeks. Tests will be performed in 4,500 participants in each survey, totaling18,000 interviews. Interviews and tests will be conducted at the participants' household. A rapid test for the detection of antibodies will be used; the test was validated prior to the beginning of the fieldwork.

Medidas de distanciamento social no controle da pandemia de COVID-19: potenciais impactos e desafios no Brasil / Social distancing measures to control the COVID-19 pandemic: potential impacts and challenges in Brazil

Resumo A pandemia de COVID-19 tem desafiado pesquisadores e gestores a encontrar medidas de saúde pública que evitem o colapso dos sistemas de saúde e reduzam os óbitos. Esta revisão narrativa buscou sistematizar as evidências sobre o impacto das medidas de distanciamento social na epidemia de COVID-19 e discutir sua implementação no Brasil. Foram triados artigos sobre o efeito do distanciamento social na COVID-19 no PubMed, medRXiv e bioRvix, e analisados atos do poder público nos níveis federal e estadual para sumarizar as estratégias implementadas no Brasil. Os achados sugerem que o distanciamento social adotado por população é efetivo, especialmente quando combinado ao isolamento de casos e à quarentena dos contatos. Recomenda-se a implementação de medidas de distanciamento social e de políticas de proteção social para garantir a sustentabilidade dessas medidas. Para o controle da COVID-19 no Brasil, é imprescindível que essas medidas estejam aliadas ao fortalecimento do sistema de vigilância nos três níveis do SUS, que inclui a avaliação e uso de indicadores adicionais para monitorar a evolução da pandemia e o efeito das medidas de controle, a ampliação da capacidade de testagem, e divulgação ampla e transparente das notificações e de testagem desagregadas.

Abstract The COVID-19 pandemic has challenged researchers and policy makers to identify public safety measures forpreventing the collapse of healthcare systems and reducingdeaths. This narrative review summarizes the available evidence on the impact of social distancing measures on the epidemic and discusses the implementation of these measures in Brazil. Articles on the effect of social distancing on COVID-19 were selected from the PubMed, medRXiv and bioRvix databases. Federal and state legislation was analyzed to summarize the strategies implemented in Brazil. Social distancing measures adopted by the population appear effective, particularly when implemented in conjunction with the isolation of cases and quarantining of contacts. Therefore, social distancing measures, and social protection policies to guarantee the sustainability of these measures, should be implemented. To control COVID-19 in Brazil, it is also crucial that epidemiological monitoring is strengthened at all three levels of the Brazilian National Health System (SUS). This includes evaluating and usingsupplementary indicators to monitor the progression of the pandemic and the effect of the control measures, increasing testing capacity, and making disaggregated notificationsand testing resultstransparentand broadly available.

Social distancing in São Paulo State: demonstrating the reduction in cases using time series analysis of deaths due to COVID-19 / Distanciamento social no estado de São Paulo: uso de série temporal dos óbitos por causa da COVID-19 para demonstrar a redução de casos

ABSTRACT: Introduction: Demonstrating the results of Social Distancing Strategies (SDS) became a relevant factor to obtain support by the population in São Paulo State and in Brazil. The delay in the processing of PCR tests and the small number of tests available limits the ability of sanitary authorities to make meaningful data available as to the number of cases or the number of deaths due to COVID-19. Methodology: We use a time series analysis of deaths due to COVID-19 referenced to the date of deaths (as opposed to the date in which the test results were obtained). Results: We demonstrate that the SDS adopted in São Paulo City and State clearly brought meaningful results to delay the growth of COVID-19 cases. We also show that by using this type of time series it is possible to identify different trends for regions, allowing for targeted approaches. Additionally, by using a time series which is death-oriented makes it possible to identify, for São Paulo City, the effects of the SDS with the Social Isolation Index (SII) adopted in the state and to make a gross estimate for the SII, which prevents the growth of the disease. Conclusion: The use of a time series of deaths due to COVID-19 referenced to the date of the event allows a better understanding of the effects of the SDS on the progression of the COVID-19 epidemic in São Paulo State, Brazil.

RESUMO: Introdução: Demonstrar os resultados das estratégias de distanciamento social (EDS) tornou-se um fator relevante para obter apoio da população do estado de São Paulo e do Brasil. A demora no processamento dos testes do tipo RCP e o pequeno número de testes disponíveis limita a capacidade das autoridades sanitárias de disponibilizar dados significativos sobre o número de casos ou o número de óbitos por causa da Covid-19. Metodologia: Usamos uma série temporal de óbitos pela Covid-19 referenciada à data dos óbitos (diferentemente da data em que os resultados dos exames foram obtidos). Resultados: Demonstramos que é visível que as EDS adotadas no município e no estado de São Paulo trouxeram resultados significativos que atrasam o crescimento dos casos de Covid-19. Também mostramos que utilizando esse tipo de série temporal é possível identificar diferentes tendências para as regiões, permitindo abordagens direcionadas. Além disso, utilizando-se uma série temporal orientada ao óbito, é possível identificar, para o município de São Paulo, os efeitos das EDS com o Índice de Isolamento Social (IIS) adotado no estado e fazer uma estimativa bruta para o IIS, que quebra o crescimento da doença. Conclusão: O uso de uma série temporal dos óbitos devidos à Covid-19, referenciada diretamente à data do óbito, permite compreender os efeitos do distanciamento social na evolução da epidemia de COVID-19 no estado de São Paulo, Brasil.

La pandemia de Coronavirus SARS-CoV-2 (COVID-19): Situación actual e implicaciones para México / The SARS-CoV-2 (COVID-19) coronavirus pandemic: current situation and implications for Mexico

Resumen La pandemia del Coronavirus (COVID-19) es una de las más devastadoras de este siglo. Originada en China en diciembre de 2019 y causada por el virus SARS-CoV-2, en menos de 1 mes ya había sido catalogada como "Emergencia de Salud Pública de Alcance Internacional". A la fecha hay cerca de 3 millones de personas con infección confirmada y ha provocado más de 250,000 fallecimientos en el mundo. Inicialmente afecta las vías respiratorias con neumonías atípica y en casos graves provoca inflamación sistémica con liberación de citoquinas que pueden provocar un rápido deterioro, insuficiencia circulatoria, respiratoria y alteraciones de coagulación con una letalidad cercana al 7%. En México, el primer caso se detectó en febrero del 2020, y a la fecha de esta publicación se cuenta con 29,616 casos confirmados y 2,961 fallecimientos en toda la extensión de país. La baja tasa de muestreo diagnóstico en nuestro país claramente subestima la incidencia e impacto de esta enfermedad. Los grupos mas afectados son aquéllos con factores de riesgo como lo son la edad mayor a 60 años, hipertensión, diabetes o historia de enfermedad cardiovascular. De los casos confirmados, 15% son trabajadores del sector salud. No existe hasta ahora un tratamiento específico o vacuna, de tal manera que es importante contar con las medidas de higiene, aislamiento social y protección personal. Las consecuencias en salud, sociales y económicas podrían ser de gran impacto en los tiempos por venir.

Abstract The Coronavirus pandemic (COVID-19) is one of the most devastating in this century. It originated in China in December 2019 caused by the SARS-Cov-2 virus, and in less than a month it had been classified as an "International Public Health Emergency". To date there are nearly 3 million people infected and more than 250,000 deaths caused by the disease worldwide. Initially it affects the respiratory tract with atypical pneumonia and in severe cases it produces systemic inflammation with cytokine storm that can cause rapid deterioration with circulatory and respiratory failure, coagulopathy and a lethality rate of approximately 7%. In Mexico, the first case was detected in February 2020, and to date there are 26,616 confirmed cases and 2,961 deaths throughout the country. The low number of diagnostic tests conducted in our country clearly underestimates the real incidence and impact of the disease. The most affected groups are those with risk factors such as age over 60, presence of hypertension, diabetes or cardiovascular disease. Of the confirmed cases, 15% are healthcare workers. There is no specific treatment or vaccine yet, so it is important to have hygiene, social isolation and personal protection measures. Health, social and economic consequences could have great impact in the near future.

Raiva humana no Brasil: estudo descritivo, 2000-2017 / La rabia humana en Brasil: estudio descriptivo, 2000-2017 / Human rabies in Brazil: a descriptive study, 2000-2017

Objetivo: descrever o perfil epidemiológico da raiva humana no Brasil. Métodos: estudo descritivo dos casos de raiva humana notificados em 2000-2017; estimou-se a incidência e distribuição espacial. Resultados: 188 casos humanos observados, na maioria homens (66,5%), residentes rurais (67,0%), menores de 15 anos de idade (49,6%), com exposição mais frequente por mordedura (81,9%); o período 2000-2008 apresentou maior frequência (85,6%), com 46,6% dos casos envolvendo cães e 45,9% morcegos; incubação mediana de 50 dias, seguida de sintomatologia predominante de febre (92,6%), agitação (85,2%), parestesia (66,7%) e disfagia/paralisia (51,9%); a maioria (70,2%) não fez profilaxia, os demais (29,8%) realizaram-na de forma inoportuna e/ou incompleta; 13 pacientes foram tratados pelo Protocolo de Recife e dois sobreviveram. Conclusão: houve redução na incidência de raiva humana e mudança no perfil epidemiológico, predominando casos transmitidos por morcegos; sugere-se investigar casos secundários e viabilizar a profilaxia pré-exposição em populações sob maior risco de acidentes com morcegos.

Objetivo: describir el perfil epidemiológico de la rabia humana en Brasil. Métodos: descripción de los casos en 2000-2017, con estimación de la incidencia y distribución espacial. Resultados: se observaron 188 casos humanos, la mayoría de hombres (66,5%), residentes rurales (67,0%), menores de 15 años de edad (49,6%), con exposición más frecuente por mordedura (81,9%); el período 2000-2008 presentó mayor frecuencia (85,6%), con un 46,6% de los casos involucrando a perros y 45,9% a murciélagos; la incubación promedio fue de 50 días, seguida de sintomatología predominante de fiebre (92,6%), agitación (85,2%), parestesia (66,7%) y disfagia/parálisis (51,9%); la mayoría (70,2%) no hizo profilaxis y los demás (29,8%) la realizaron de forma inoportuna y/o incompleta; se trataron 13 pacientes con el Protocolo de Recife y dos sobrevivieron. Conclusión: hubo reducción en la incidencia de rabia humana y cambio en el perfil epidemiológico, predominando casos transmitidos por murciélagos; se sugiere investigar casos secundarios y viabilizar la profilaxis preexposición en poblaciones de mayor riesgo a accidentes por murciélagos.

Objective: to describe the epidemiological profile of human rabies in Brazil. Methods: this is a descriptive study of human rabies cases reported in 2000-2017, with an estimate of incidence and spatial distribution. Results: 188 cases were studied, mostly males (66.5%), rural residents (67.0%), children under 15 years (49.6%), with biting being the most frequent form of exposure (81.9%); frequency was highest in the period 2000-2008 (85.6%), with 46.6% of cases involving dogs and 45.9% bats; median incubation was 50 days, followed by, predominantly, symptoms of fever (92.6%), agitation (85.2%), paresthesia (66.7%), and dysphagia/paralysis (51.9%); the majority (70.2%) did not have prophylaxis and for the rest (29.8%) who did have prophylaxis, it was untimely and/or incomplete; 13 patients were treated according to the Recife Protocol, and two survived. Conclusion: human rabies incidence reduced and its epidemiological profile changed, with predominance of cases transmitted by bats; we suggest that secondary cases be investigated, and that pre-exposure prophylaxis be made available to populations at greater risk of accidents involving bats.

Sweat test and cystic fibrosis: overview of test performance at public and private centers in the state of São Paulo, Brazil / Teste do suor e fibrose cística: panorama da realização do teste em centros públicos e privados do estado de São Paulo

ABSTRACT Objective: The sweat test (ST) measures chloride levels in sweat and is considered the gold standard for the diagnosis of cystic fibrosis (CF). However, the reliability of a ST depends on their being performed by experienced technicians and in accordance with strict guidelines. Our aim was to evaluate how sweat stimulation, sweat collection, and chloride measurement are performed at 14 centers (9 public centers and 5 private centers) that routinely perform STs in the state of São Paulo, which has the highest frequency of CF in Brazil. Methods: This was a cross-sectional cohort study, using a standardized questionnaire administered in loco to the staff responsible for conducting STs. Results: No uniformity regarding the procedures was found among the centers. Most centers were noncompliant with the international guidelines, especially regarding the collection of sweat (the samples were insufficient in 10-50% of the subjects tested); availability of stimulation equipment (which was limited at 2 centers); modernity and certification of stimulation equipment (most of the equipment having been used for 3-23 years); and written protocols (which were lacking at 12 centers). Knowledge of ST guidelines was evaluated at only 1 center. Conclusions: Our results show that STs largely deviate from internationally accepted guidelines at the participating centers. Therefore, there is an urgent need for standardization of STs, training of qualified personnel, and acquisition/certification of suitable equipment. These are essential conditions for a reliable diagnosis of CF, especially with the increasing demand due to newborn screening nationwide, and for the assessment of a possible clinical benefit from the use of modulator drugs.

RESUMO Objetivo: O teste do suor (TS) mede os níveis de cloro no suor e é considerado o padrão ouro para o diagnóstico da fibrose cística (FC). Contudo, a confiabilidade do TS depende de sua realização por técnicos experientes e segundo diretrizes rígidas. Nosso objetivo foi avaliar como são realizadas a estimulação e coleta do suor e a dosagem de cloro em 14 centros (9 públicos e 5 privados) que realizam TS rotineiramente no estado de São Paulo, que possui a maior frequência de FC do Brasil. Métodos: Estudo de coorte transversal utilizando um questionário padronizado aplicado in loco ao pessoal responsável pela realização dos TS. Resultados: Não houve uniformidade entre os centros quanto aos procedimentos. A maioria dos centros não era aderente às diretrizes internacionais, especialmente quanto à coleta do suor (amostras insuficientes em 10-50% dos indivíduos testados), disponibilidade de equipamentos de estimulação (limitada em 2 centros), modernidade e certificação dos mesmos (a maioria utilizada há 3-23 anos) e protocolos escritos (ausentes em 12 centros). Avaliou-se o conhecimento sobre diretrizes para TS em apenas 1 centro. Conclusões: Nossos resultados mostram que, nos centros participantes, os TS estão muito distantes das diretrizes internacionalmente aceitas. Portanto, há necessidade urgente de padronização dos TS, de treinamento de pessoal qualificado e de aquisição/certificação de equipamentos adequados. Essas são condições essenciais para um diagnóstico confiável de FC, especialmente com a crescente demanda resultante da triagem neonatal em todo o país, e para a avaliação do possível benefício clínico do uso de moduladores.

Requests of laboratory tests for the diagnosis and management of calcium-phosphate disorders in Spain / Solicitud de pruebas de laboratorio para el diagnóstico y manejo de los desórdenes del metabolismo fosfocálcico en España

Background: Knowledge about the variability in the request of calcium-phosphate metabolism laboratory tests in primary care is important to design strategies to improve health system efficiency. Aim: To compare the inter-practice variability in calcium-phosphate metabolism laboratory tests requested by general practitioners from diverse regions across Spain. Material and Methods: One hundred and forty one clinical laboratories were invited to participate in an observational cross-sectional study. They informed the number of serum calcium, phosphate, parathyroid hormone and 25-hydroxyvitamin D requested by general practitioners. Appropriateness indicators were calculated as number of test requests per 1,000 inhabitants and ratio of related tests requests. The differences according to hospital setting, region and type of management were analyzed. Results: We recruited 76 laboratories (17,679,195 inhabitants). General practitioners requested 3,260,894 calcium-phosphate metabolism tests. The rate of request ranged from 2.97 per 1,000 inhabitants for 25-hydroxyvitamin D to 98.89 per 1,000 inhabitants for calcium. The rates of request for calcium, phosphate, parathyroid hormone in some areas were 30, 100 and 340 times higher than in other areas. Parathyroid hormone and 25-hydroxyvitamin D were highly requested in private management areas. There were also differences in phosphate, parathyroid hormone and 25-hydroxyvitamin D requesting between regions across Spain. Conclusions: The high variability observed is difficult to explain by differences in patient case mix between regions. Depending on the area, calcium could be under requested to detect primary hyperparathyroidism.

Objetivo: Conocer la variabilidad en la solicitud de pruebas de laboratorio en atención primaria es importante para diseñar estrategias que mejoren la eficiencia del sistema de salud. La propuesta de este estudio fue comparar la variabilidad en la solicitud de pruebas para la evaluación del metabolismo fosfocálcico por médicos de atención primaria de diversas regiones de España. Material y Método: Se invitó a participar a 141 laboratorios clínicos de diversas regiones españolas. Completaron una encuesta con el número de determinaciones de calcio, fósforo, hormona paratiroidea y 25-hidroxivitamina D solicitadas por médicos de atención primaria de sus áreas. Se calcularon las tasas en relación a la población y se construyeron indicadores de adecuación. Los resultados se compararon por características del hospital, región y tipo de gestión. Resultados: Obtuvimos los datos de 76 laboratorios (17.679.195 habitantes). Los médicos de atención primaria solicitaron 3.260.894 pruebas de metabolismo fosfocálcico. La tasa de solicitud varió de 2,97 por 1.000 habitantes de 25-hidroxivitamin D a 98,89 por 1.000 habitantes de calcio. Las tasas de calcio, fósforo, hormona paratiroidea en algunas áreas fue 30, 100 y 340 veces más alta respecto a otras. Hormona paratiroidea y 25-hidroxivitamina D fueron más solicitadas significativamente en hospitales con gestión privada. También hubo diferencias en fósforo, hormona paratiroidea y 25-hidroxivitamina D solicitas entre distintas regiones de España. Discusión: La alta variabilidad observada es difícil de explicar por las diferencias de las características de los pacientes. Dependiendo de la región podría haber una infra solicitud para la detección del hiperparatiroidismo primario.

Resultados laboratoriais comparativos em fêmeas nelore de diferentes categorias provenientes de fazendas com e sem a presença de Pteridium arachnoideum nas pastagens / Comparative laboratory results of female nelore cattle in different farm categories with and without the presence of Pteridium arachnoideum in pastures / Resultados de laboratorio comparativos en hembras nelore de diferentes categorías provenientes de granjas con y sin la presencia de Pteridium arachnoideum en pastajes

A Pteridium arachnoideum, anteriormente classificada como Pteridium aquilinum, popularmente conhecida por samambaia, é um dos vegetais tóxicos mais preocupantes em vários países, incluindo o Brasil. No estado do Paraná há várias regiões onde a planta possui característica endêmica. Pesquisadores brasileiros caracterizaram, experimentalmente, três formas clínicas das doenças causadas pela samambaia aos bovinos: diátese hemorrágica, hematúria enzoótica dos bovinos e carcinomas epidermoides do trato digestório superior. No presente trabalho, estudaram-se os valores hematológicos, bioquímicos e de urinálise em duas diferentes fases do desenvolvimento animal, sendo 58 novilhas e 55 vacas, originadas de propriedades rurais com características zootécnicas semelhantes e com a presença ou não da samambaia. A finalidade foi estabelecer um protocolo para triagem e adotar medidas na melhoria do manejo, evitando-se mais prejuízos. Neste estudo, houve uma queda no número de hemácias de vacas e novilhas provenientes de propriedades rurais com presença de samambaia. O número de plaquetas foi significativamente superior em ambas as faixas etárias nos bovinos provenientes de propriedades rurais com samambaia. Por outro lado, não houve alterações significativas no leucograma, indicando que não havia em nenhuma das duas categorias, resposta inflamatória sistêmica.(AU)

Pteridium arachnoideum, previously classified as Pteridium aquilinum, popularly known as bracken fern, is one of the most preoccupying poisonous vegetables in several countries, including Brazil. Brazilian researchers experimentally characterized three clinical forms of diseases caused by bracken fern in cattle: bleeding diathesis, bovine enzootic hematuria and squamous cell carcinoma in the upper digestive tracts. This work studies the hematological, biochemical and urinalysis values of two different phases of the animal development, being 58 heifers and 55 cows from farms with similar zootechnical characteristics, with and without the presence of bracken fern. In this study, there was a fall in the number of red blood cells in the cows and heifers from farms with the presence of bracken fern. The number of platelets was significantly higher in all of the age groups of animals from farms with bracken fern. There were no significant changes in the leucocyte count, indicating there was no systemic inflammatory response in any of the two categories.(AU)

El Pteridium arachnoideum, previamente clasificado como Pteridium aquilinum, popularmente conocido como helecho, es una de las plantas tóxicas más preocupantes en varios países, entre ellos Brasil. En el estado de Paraná hay varias regiones en las que la planta tiene característica endémica. Investigadores brasileños han caracterizado, experimentalmente, tres formas clínicas de la enfermedad causada por el helecho en la especie bovina: diátesis hemorrágica, hematuria enzoótica de ganado y carcinomas de células escamosas del tracto digestivo superior. En este trabajo se ha estudiado los valores hematológicos, bioquímicos y análisis de orina en dos etapas diferentes del desarrollo animal, compuesto por 58 novillas y 55 vacas, pertenecientes a granjas con características zootécnicas similares y con presencia o no de helecho. El objetivo ha sido establecer un protocolo para la detección y adoptar medidas para mejorar la gestión, evitando pérdidas. En este estudio se observó una disminución en el número de hematíes de vacas y novillas de propiedades rurales con la presencia de helecho. El recuento de plaquetas fue significativamente mayor en ambas edades de bovinos provenientes de propiedades con helecho. Por otro lado, no hubo cambios significativos en el recuento de glóbulos blancos, señalando que no había en ninguna de las dos categorías, respuesta inflamatoria sistémica.(AU)

Comparative study of the accuracy of different technique for the laboratory diagnosis of schistosomiasis mansoni in areas of low endemicity in Barra Mansa City, Rio de Janeiro State, Brazil

Schistosomiasis constitutes a major public health problem, with an estimated 200 million people infected worldwide. Many areas of Brazil show low endemicity of schistosomiasis, and the current standard parasitological techniques are not sufficiently sensitive to detect the low-level helminth infections common in areas of low endemicity (ALEs). This study compared the Kato-Katz (KK); Hoffman, Pons, and Janer (HH); enzyme-linked immunosorbent assay- (ELISA-) IgG and ELISA-IgM; indirect immunofluorescence technique (IFT-IgM); and qPCR techniques for schistosomiasis detection in serum and fecal samples, using the circumoval precipitin test (COPT) as reference. An epidemiological survey was conducted in a randomized sample of residents from five neighborhoods of Barra Mansa, RJ, with 610 fecal and 612 serum samples. ELISA-IgM (21.4%) showed the highest positivity and HH and KK techniques were the least sensitive (0.8%). All techniques except qPCR-serum showed high accuracy (82­95.5%), differed significantly from COPT in positivity , and showed poor agreement with COPT. Medium agreement was seen with ELISA-IgG (Kappa = 0.377) and IFA (Kappa = 0.347). Parasitological techniques showed much lower positivity rates than those by other techniques. We suggest the possibility of using a combination of laboratory tools for the diagnosis of schistosomiasis in ALEs.

Comparison between elisa and various stains techniques in laboratory diagnosis of cryptosporidiosis

Cryptosporidium spp. is an important parasitic protozoa causing diarrhea which is a severe life-threatening diarrhea especially in immunocompromised hosts. We aimed to evaluate the usefulness of detection of Cryptosporidium spp. copro-antigen from fecal specimens by using enzyme linked immunosorbent assay [ELISA] test and comparing its sensitivity and specificity with some staining methods. The results revealed that Modified Acid-Fast stain is considered better than Giemsa in detecting Cryptosporidium species oocysts in faecal smears as their sensitivity were 67.5% and 53.75% respectively. On contrary, ELISA technique is considered the best method used for detection of cryptosporidial infection as its sensitivity is 90%

Low rate of placental pathological examination in a tertiary care hospital in Sana'a, Yemen

The aim of this study was to evaluate the rate of submission of placentas for pathological examination and compare the observed and expected numbers of placentas submitted. Records were reviewed for all deliveries occurring at a tertiary care hospital in Sana'a, Yemen, during 2007. Data from pathology department records were compared with data on pathology request forms. The observed and expected numbers of placentas examined were compared. Of 11 472 placentas delivered, 1501 were expected to be pathologically examined, based on College of American Pathologists indications. Only 73 of these [4.9%] had actually been examined. The examination rates for conditions associated with the possible recurrence risks in the subsequent pregnancies were low, below 20%. Only 42% of the pathology request forms gave detailed clinical histories and 0% gave information about Apgar scores. Placental pathological examination was under-utilized in this hospital

Doctors' Use of Laboratory Tests in the Diagnosis and Treatment of Patients

The provincial health budgets in South Africa are under enormous pressure and; annually; budgets are exceeded by most hospitals and clinics. Laboratory tests requested by clinicians are contributing to the problem of over-expenditure. The aim of this study was to determine from patients' files whether doctors were using laboratory tests prudently during their treatment of patients in the outpatient department (OPD) of the National District Hospital in Bloemfontein. A descriptive study was carried out using all the files of patients who visited the OPD in a three-month period (1 July to 30 September 2005) for whom laboratory tests were requested by the attending physician. The majority (31.3) of patients for whom laboratory tests were requested presented to the OPD with cardiovascular complaints or diagnoses; followed by endocrine (27.8) and musculoskeletal (16.3) complaints or diagnoses. Between one and three tests were requested for most patients; i.e. 33and 15; respectively. The most frequently requested tests were erythrocyte sedimentation rate (8.1); urea and electrolytes (7.7); urine microscopy; culture and sensitivity (6.4); cholesterol (6.1); full blood count (5.7) and thyroid profile (TSH 4.6; T4 2.6and thyroid functions 2.3). In 70.4of cases; results were documented and; in 59.1; the physician's management plans indicated the incorporation of laboratory test results into the patient's treatment regimen. Our findings indicated inappropriate documentation and application of test results. Interventions to improve physician behaviour include education; guidelines; feedback; leadership and redesign of requisition forms

Contribución del sistema integrado de vigilancia Sarampión/Rubéola al diagnóstico de otras enfermedades febriles eruptivas en Paraguay 2003-2005 / Contribution of the system integrated of monitoring Measles/Rubéola to the etiológico diagnosis of other eruptive febrile diseases in Paraguay 2003-2005

Presenta resultados de análisis serológicos realizados con el fin de conocer causas de brotes de fiebre y erupción ocurridos en los años 2004 y 2005 en Paraguay en una población de pacientes de cuaqluier edad en ausencia de sarampión, rubéola y dengue de los pacientes que ingresaron al sistema de vigilancia sarampión/rubéola

Utilización del Laboratorio y caracterización de pacientes ambulatorios en el Hospital Nacional, desde julio hasta diciembre del año 2000

Estúdiase el número de pacientes ambulatorios que requirieron estudios laboratoriales. Se basa en los datos obtenidos de una investigación...

Incidence of abnormalities in laboratory tests found in surveillance of adults over 40 years of age.

National health check-up systems have been used for 5 years in Japan for adults who are over 40 years of age. As part of a national project, Osaka prefecture is also conducting a program for health check-up testing and cancer screening for this age group. This surveillance revealed that incidence of obesity, hypertension, cholesterolemia, albuminuria, or abnormal ECG was high. Analysis of surveillance results should contribute to understanding the present status and recent trends in diseases in the aged. With continuation of this surveillance for a number of years, trends in life-style related diseases in Japan should be detectable.

La historia clínica: instrumento diagnóstico para la rinitis alérgica / The diagnostic value of the medical history in the allergic rhinitis

Objetivo. Determinar el valor diagnóstico de la historia clínica en casos de rinitis alérgica. Material y métodos. Se estudiaron 112 sujetos, de uno y otro sexo, de entre 2 y 31 años de edad. Se formaron dos grupos, pareados, uno de casos y otro de controles. Se les realizó: historia clínica, exámenes de laboratorio y gabinete. Como estándar de oro para el diagnóstico se utilizaron las pruebas cutáneas. Se determinó sensibilidad (S), especificidad (E), valor predictivo positivo (VP+), valor predictivo negativo (VP-) y valor de p. Resultados. De la población total, 53.57 por ciento correspondieron al sexo femenino y el resto al masculino. El tiempo medio de evolución de la rinitis fue de cuatro años, con un promedio de cinco cuadros agudos por mes. En 80 por ciento de los pacientes la rinitis fue de tipo perenne. El 57.14 por ciento reportaron antecedentes familiares de alergia (S=57 por ciento, E=100 por ciento, p=0.0001). Los datos clínicos reportados fueron: estornudos en 75 por ciento de los casos (S=75 por ciento, E=100 por ciento, p=0.0001), obstrucción nasal en 50 por ciento (S=50 por ciento, E=100 por ciento, P=0.0001). 30.35 por ciento rebasaron el límite superior de eosinófilos circulantes (S=30.35 por ciento, E=91 por ciento, P=0.0049), 26.78 por ciento tuvieron concentraciones elevadas de IgE (S=26 por ciento, E=87.5 por ciento, p=0.0002), en 78.57 por ciento se encontraron eosinófilos en moco nasal (S=39.28 por ciento, E=89.28, p=0.0009) y en 10.34 por ciento se identificó parasitosis intestinal (p=NS). Conclusión. De acuerdo con los resultados se propone una amplia difusión entre el equipo de salud del primer nivel de atención a fin de promover una actitud de cambio, donde se utilice a la historia clínica como instrumento de diagnóstico oportuno para la rinitis alérgica

Evaluación del uso de una prueba rápida inmunocromatográfica por promotores de salud para el diagnóstico de malaria en áreas rurales de la amazonía peruana, 1999: informe técnico / Evaluation of the use of a immunochromatographic rapid test by health promoters for the malaria diagnosis in rural areas of the peruvian amazonia, 1999: technical report

Muestra que el uso de pruebas rápidas es una alternativa apropiada y aplicable para el diagnóstico oportuno de la malaria en áreas rurales de la selva con limitado acceso a los servicios de salud

Salmonella: comparación de dos métodos para su detección en alimentos para aves / Comparison of two methods for detection of Salmonella in broiler feed

El método de hibridación colorimétrico de Gene Traktm (GENE TRAK Systems, 31 New York Avenue, Framingham, M.A.) fue comparado con la metodología convencional propuesta por International Commission for Microbiological Standard Foods (ICMSF) en la detección de Salmonella en muestras de alimentos balanceados y materias primas de origen animal y vegetal utilizadas en la formulación de los mismos. Se procesaron 249 muestras que incluyen muestras inoculadas y 9 muestras no inoculadas. De un total de 240 muestras no inoculadas, 62,9 por ciento no acusaron presencia de Salmonella por ningún método, 27,9 por ciento fue positivo por ambos métodos y el 9,2 por ciento dio positivo por Gene Trak no pudiéndose confirmar después de cinco determinaciones por el método convencional. Esta metodología se presenta como un método interesante de detección con importantes ventajas frente al convencional: facilidad para procesar un gran número de muestras sin despliegue de gran cantidad de material, acortamiento del tiempo en obtener resultados y alta sensibilidad