Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 83
Filter
1.
Rev. Hosp. Ital. B. Aires (2004) ; 40(3): 117-125, sept. 2020. ilus, tab
Article in Spanish | LILACS | ID: biblio-1129078

ABSTRACT

En diciembre de 2019 se identificó el virus SARS-CoV-2, cuya rápida propagación global puso en estado de emergencia al mundo entero, llevando al ser humano a una situación sin antecedente cercano. El objetivo de esta revisión es describir los métodos diagnósticos utilizados actualmente para identificar la infección por SARS-CoV-2. Las manifestaciones clínicas y el espectro imagenológico de la enfermedad son muy inespecíficos y no permiten realizar un diagnóstico certero. Por esta razón, es esencial una apropiada toma de muestra respiratoria en el momento y sitio anatómico adecuado para un diagnóstico preciso de COVID-19. La técnica de muestreo más utilizada es el hisopado nasofaríngeo y la prueba diagnóstica más fiable se basa en la retrotranscripción seguida por reacción en cadena de la polimerasa en tiempo real (RT-PCR). No obstante, existen otras técnicas moleculares, como también tests serológicos para detectar anticuerpos o fragmentos antigénicos del SARS-CoV-2. Más allá de la precisión diagnóstica, es importante tener en cuenta la probabilidad basal (pretest) para interpretar correctamente el resultado obtenido y aislar aquellos posibles falsos negativos. Con el objetivo de evitar la saturación del sistema de salud es imprescindible contar con información y métodos diagnósticos precisos para detectar tempranamente los focos de infección y reducir la transmisión comunitaria, utilizando eficazmente los diferentes recursos diagnósticos. (AU)


In December 2019, the SARS-CoV-2 virus was identified for the first time, whose rapid global spread put the entire world in a state of emergency, leading humans to an unprecedented situation with no immediate history. The main purpose of this review is to describe the diagnostic methods currently used to identify SARS-CoV-2 infection. The clinical manifestations and the imaging spectrum of the disease are nonspecific and do not allow an accurate diagnosis to be made. For this reason, an appropriate respiratory sampling at the right time and anatomical site is essential for an accurate diagnosis of COVID-19. The most widely used sampling technique is nasopharyngeal swab, and the most reliable diagnostic test is by reverse transcription followed by real-time polymerase chain reaction (RT-PCR). However, there are other molecular techniques, as well as serological tests to detect antibodies or antigenic fragments of SARS-CoV-2. Beyond the diagnostic precision, it is important to take into account the baseline probability (pre-test) to correctly interpret the result obtained and isolate those possible false negatives. In order to avoid saturation of the health system, it is essential to have accurate information and diagnostic methods to detect outbreaks of infection in early stages and to reduce communitary transmission, making effective use of the various diagnostic resources. Coronavirus infections/diagnosis, viral/diagnosis, pandemics, clinical laboratory techniques, real-time polymerase chain reaction, antigens, viral/analysis. (AU)


Subject(s)
Humans , Serologic Tests/methods , Coronavirus Infections/diagnosis , Real-Time Polymerase Chain Reaction/methods , Argentina , Pneumonia, Viral/diagnosis , Serologic Tests/statistics & numerical data , Polymerase Chain Reaction/methods , Polymerase Chain Reaction/statistics & numerical data , Coronavirus Infections/physiopathology , Coronavirus Infections/prevention & control , Coronavirus Infections/diagnostic imaging , False Negative Reactions , False Positive Reactions , Real-Time Polymerase Chain Reaction/statistics & numerical data , Betacoronavirus
2.
Arq. bras. med. vet. zootec. (Online) ; 70(3): 787-792, maio-jun. 2018. tab
Article in Portuguese | LILACS, VETINDEX | ID: biblio-911354

ABSTRACT

A brucelose na espécie ovina tem recebido destaque, uma vez que se trata de uma enfermidade que acomete o sistema reprodutivo dos animais, provocando sério comprometimento no setor produtivo. Dessa forma, objetivou-se a avaliação de três métodos para o diagnóstico da brucelose ovina: o ensaio imunoenzimático indireto (ELISAi), a técnica imunodifusão em gel de ágar (IDGA) e a reação em cadeia da polimerase (PCR). Para tanto, utilizaram-se 211 amostras de sangue de ovinos oriundos de propriedades de nove municípios da microrregião homogênea de Teresina, Piauí. As 211 amostras de sangue foram submetidas aos testes sorológicos e à PCR, visando detectar anticorpos anti-B. ovis e DNA de Brucella ovis, respectivamente. Foram obtidos resultados positivos nos testes sorológicos, sendo 36 (17,06%) positivos no teste IDGA e sete (3,31%) positivos no teste ELISAi, contudo não houve resultados positivos na técnica de PCR. Dos métodos de diagnóstico utilizados neste estudo, o teste IDGA foi o que apresentou melhor desempenho na detecção de animais reagentes, quando comparado ao teste ELISAi e à PCR em amostras de sangue, e o percentual de animais soropositivos sugere uma ampla distribuição de ovinos infectados por Brucella ovis na região em estudo, o que pode causar prejuízos aos produtores.(AU)


Brucellosis in sheep has received a major focus, since it is a disease that affects the reproductive system of animals, causing serious impairment in the productive sector. Thus, three methods for the diagnosis of ovine brucellosis were evaluated as goal, the indirect Linked Immunosorbent Assay (ELISAi) test, the Immunodiffusion Agar Gel (AGID) technique and the Polymerase Chain Reaction (PCR). Therefore, we used 211 sheep blood samples from properties of nine municipalities of the homogeneous micro-region of Teresina, Piaui. The 211 blood samples were subjected to serologic testing and PCR to detect anti-B. ovis antibodies, and Brucella ovis DNA, respectively. Positive results in serological tests were obtained, 36 (17%) positive in the AGID test and seven (3.3%) positive to the ELISAi test, however, there were no positive results in the PCR technique. Of the diagnostic methods used in this study, the AGID test was the one that presented the best performance in the detection of reactive animals, when compared to ELISAi and PCR in blood samples and, the percentage of seropositive animals suggests a wide distribution of Brucella ovis infected sheep in the study region and could cause loss to producers.(AU)


Subject(s)
Animals , Brucellosis, Bovine/diagnosis , Immunodiffusion/statistics & numerical data , Immunoenzyme Techniques/statistics & numerical data , Polymerase Chain Reaction/statistics & numerical data , Serology
3.
Arq. bras. med. vet. zootec. (Online) ; 70(4): 1163-1171, jul.-ago. 2018. ilus, tab
Article in Portuguese | LILACS, VETINDEX | ID: biblio-946388

ABSTRACT

O herpesvírus bovino tipo-1 (BoHV-1) é um vírus amplamente distribuído no Brasil e no mundo, havendo um crescente número de estudos envolvendo métodos de diagnóstico e o seu impacto na reprodução animal. O objetivo deste trabalho foi identificar o material genético do BoHV-1 no sêmen de touros infectados experimentalmente por meio da técnica de PCR e avaliar a influência do vírus sobre a qualidade espermática desses animais. A técnica de PCR foi satisfatória, permitindo identificar a presença do material genético do vírus no sêmen de todos os animais a partir de sete dias pós-infecção, com persistência de 21 até 28 dias. Apesar da presença do vírus BoHV-1 por um longo período no sêmen dos animais experimentais, não foram observados efeitos deletérios na qualidade do sêmen fresco e nem após a criopreservação.(AU)


Bovine Herpesvirus type-1 (BoHV-1) is a virus widely distributed in Brazil and worldwide, with a growing number of studies involving diagnostic methods and their impact on animal reproduction. The objective of this work was to identify the genetic material of BoHV-1 in the semen of experimentally infected bulls through the PCR technique, and to evaluate the influence of the virus on the sperm quality of these animals. The PCR technique was satisfactory, allowing for the identification of the presence of the genetic material of the virus in the semen of all the animals from 7 days post infection, with persistence of 21 to 28 days. Despite the presence of the BoHV-1 virus over a long period in the semen of the experimental animals, no deleterious effects were observed on the quality of either fresh semen or semen after the cryopreservation.(AU)


Subject(s)
Animals , Male , Cattle , Cattle/virology , Herpesvirus 1, Bovine/classification , Semen Analysis/veterinary , Polymerase Chain Reaction/statistics & numerical data
4.
Arq. bras. med. vet. zootec. (Online) ; 70(6): 1680-1684, nov.-dez. 2018. tab, ilus
Article in English | LILACS, VETINDEX | ID: biblio-969565

ABSTRACT

The present work had the objective of detecting the occurrence of Equine Piroplasmosis in horses housed in the 3rd Guards Cavalry Regiment (GCR) - Brazilian Army (BA) ˗ Porto Alegre, RS-Brazil, as well as to demonstrate the proactivity of PCR (Polymerase Chain Reaction) technique, aiming at the judicious use of the resources involved in the training and employment of Equines in the Brazilian Army. Fifty horses of the 3rd GCR - Porto Alegre ˗ RS, which are employed for Sport, Military Ceremonial, Law and Order Guarantee Operations (LOGO), were evaluated by means of the 18s r RNA screening with PCR technique, thirty eight horses with Babesia Caballi and Theileria Equi were detected, which corresponds to an incidence of 76% of the horses effective analyzed at the time. In this way, it can be verified that the Military activity have its "performance and effectiveness" factors threatened in case the health of the principal of his means employed, that is the horse, is compromised. The PCR technique then offers a reliable and feasible tool for the detection of Equine Piroplasmosis in BA horses.(AU)


O presente trabalho teve como objetivo detectar a ocorrência de Piroplasmose equina em cavalos alojados no 3º Regimento de Cavalaria de Guarda (RCG) - Exército Brasileiro (EB) - Porto Alegre, RS, Brasil, bem como demonstrar a forma proativa do método da PCR (reação em cadeia de polimerase), objetivando o uso criterioso dos recursos envolvidos no treinamento e emprego de equinos no Exército Brasileiro. Foram avaliados 50 cavalos da 3ª GCR-Porto Alegre, RS, empregados nas modalidades de: esporte, cerimonial militar e operações de garantia da lei e da ordem (GLO), por meio da triagem da região do genoma 18S rRNA mediante a aplicação do método da PCR. Foram positivas as amostras de 38 equinos para Babesia caballi e Theileria Equi, o que corresponde a uma incidência de 76% dos cavalos efetivos analisados na época. Dessa forma, verifica-se que as atividades militares tem seus fatores de "desempenho e efetividade" ameaçados no caso da saúde do principal de seus meios empregados, o Cavalo, estar comprometida. A técnica de PCR, então, oferece uma ferramenta confiável e viável para a detecção de Piroplasmose em equinos do EB.(AU)


Subject(s)
Animals , Babesiosis/diagnosis , Polymerase Chain Reaction/statistics & numerical data , Genes, rRNA , Horses/abnormalities
5.
Arq. bras. med. vet. zootec. (Online) ; 70(6): 1699-1702, nov.-dez. 2018. ilus
Article in English | LILACS, VETINDEX | ID: biblio-969636

ABSTRACT

Canine Leproid Granuloma Syndrome (CLGS), also known as canine leprosy, is a cutaneous nodular infectious disease caused by Mycobacterium sp.. Despite being reported worldwide, it is still quite unknown and underdiagnosed. Diagnosis may be achieved by cytopathology or histopathology of skin lesions, but identification of the infectious agent is complex, since bacterial in vitro growth is not possible, relying upon molecular techniques such as PCR to confirm Mycobacterium DNA in the sample. We report a CLGS case in Niteroi, Rio de Janeiro state, Brazil, diagnosed by cytopathology and submitted to molecular identification of the agent. PCR amplification of hsp65 gene was performed and revealed 100% genetic homology to M. murphy strain. This is the first CLGS report with molecular identification in Rio de Janeiro state, and this finding should raise awareness about CLGS as a differential diagnosis among granulomatous skin diseases in this region.(AU)


A síndrome de granuloma leproide canino (SGLC), também conhecida como lepra canina, é uma doença infecciosa cutânea nodular causada por Mycobacterium sp. Apesar de ser relatada mundialmente, ainda é bastante desconhecida e subdiagnosticada. O diagnóstico pode ser conseguido por citopatologia ou histopatologia de lesões cutâneas, mas a identificação do agente infeccioso é complexa, uma vez que o crescimento in vitro bacteriano não é possível, dependendo de técnicas moleculares como a PCR para confirmar o DNA de Mycobacterium na amostra. Relatou-se um caso da SGLC em Niterói, estado do Rio de Janeiro, Brasil, diagnosticado por citopatologia e submetido à identificação molecular do agente. Foi realizada amplificação por PCR do gene hsp65, que revelou 100% de homologia genética com a cepa M. murphy. Este é o primeiro relato da SGLC com identificação molecular no estado do Rio de Janeiro, o que mostra a importância de se acrescentar a SGLC ao diagnóstico diferencial das doenças granulomatosas de pele nessa região.(AU)


Subject(s)
Animals , Dogs , Polymerase Chain Reaction/statistics & numerical data , Mycobacterium/cytology , Mycobacterium/pathogenicity , Mycobacterium Infections , Dogs
6.
Braz. j. pharm. sci ; 52(1): 163-169, Jan.-Mar. 2016. tab
Article in English | LILACS | ID: lil-789081

ABSTRACT

ABSTRACT Leprosy is a neglected tropical disease and an important public health problem, especially in developing countries. It is a chronic infectious disease that is caused by Mycobacterium leprae, which has a predilection for the skin and peripheral nerves. Although it has low sensitivity, slit-skin smear (SSS) remains the conventional auxiliary laboratory technique for the clinical diagnosis of leprosy. Polymerase chain reaction (PCR) is a molecular biology technique that holds promise as a simple and sensitive diagnostic tool. In the present study, the performance of two PCR methods, using different targets, PCR-LP and PCR-P, were compared with SSS with regard to leprosy diagnosis in a reference laboratory. M. leprae DNA was extracted from 106 lymph samples of 40 patients who had clinical suspicion of leprosy. The samples were subjected to both PCR techniques and SSS. Amplification of the human b-globin gene was used as PCR inhibitor control. The specificity of both PCR techniques was 100%, and sensitivity was 0.007 and 0.015 µg/ml for PCR-LP and PCR-P, respectively. No significant difference was found between either the PCR-LP or PCR-P results and SSS results (p > 0.05). Although PCR is not yet a replacement for SSS in the diagnosis of leprosy, this technique may be used as an efficient auxiliary tool for early detection of the disease, especially in endemic regions. This strategy may also be useful in cases in which SSS results are negative (e.g., in paucibacillary patients) and cases in which skin biopsy cannot be performed.


RESUMO A hanseníase é uma doença tropical negligenciada e ainda um importante problema de saúde pública, especialmente nos países em desenvolvimento. É uma doença infecciosa crônica causada pelo Mycobacterium leprae, que tem predileção pela pele e nervos periféricos. Embora com baixa sensibilidade, o esfregaço de linfa (SSS) continua sendo o método laboratorial convencional auxiliar no diagnóstico clínico da hanseníase. A biologia molecular representada pela Reação em Cadeia da Polimerase (PCR) trouxe a expectativa de ser uma ferramenta diagnóstica simples e sensível. No presente estudo, o desempenho de dois métodos de PCR usando alvos diferentes, PCR-P e PCR-LP, foi comparado com SSS no diagnóstico da hanseníase em um laboratório de referência. DNA de M. leprae foi extraído de 106 amostras de linfa de 40 pacientes que apresentavam suspeita clínica de hanseníase. As amostras foram submetidas tanto a PCR como SSS. A amplificação do gene humano β-globina foi usada como controle de inibição da PCR. A especificidade de ambas as técnicas de PCR foi de 100% e a sensibilidade foi de 0,007 μg/mL e 0,015 μg/mL para a PCR-P e PCR-LP, respectivamente. Não se observou diferença estatística entre os resultados da PCR-LP e PCR-P, quando comparado com SSS (p > 0,05). Apesar de a PCR ainda não substituir o SSS no diagnóstico da hanseníase, esta técnica pode ser usada como ferramenta auxiliar eficiente para a detecção precoce da doença, especialmente em regiões endêmicas. Esta estratégia pode também ser útil nos casos em que os resultados de SSS forem negativos (ex. em pacientes paucibacilares) e em casos onde a biópsia da pele não pode ser realizada.


Subject(s)
Humans , Leprosy/diagnosis , Polymerase Chain Reaction/statistics & numerical data , Mycobacterium leprae , Polymerase Chain Reaction/methods
7.
Neotrop. ichthyol ; 14(3): e150128, 2016. tab, graf, ilus
Article in English | LILACS, VETINDEX | ID: lil-794736

ABSTRACT

The Atlantic goliath grouper, Epinephelus itajara , is a critically endangered species, threatened by illegal fishing and the destruction of its habitats. A number of other closely related grouper species found in the western Atlantic are also fished intensively. While some countries apply rigorous legislation, illegal harvesting followed by the falsification of fish products, which impedes the correct identification of the species, is a common practice, allowing the catch to be marketed as a different grouper species. In this case, molecular techniques represent an important tool for the monitoring and regulation of fishery practices, and are essential for the forensic identification of a number of different species. In the present study, species-specific primers were developed for the Cytochrome Oxidase subunit I gene, which were applied in a multiplex PCR for the simultaneous identification of nine different species of Epinephelidae: Epinephelus itajara , E. quinquefasciatus , E. morio , Hyporthodus flavolimbatus , H. niveatus , Mycteroperca acutirostris , M. bonaci , M. marginata , and M. microlepis . Multiplex PCR is a rapid, reliable and cost-effective procedure for the identification of commercially-valuable endangered fish species, and may represent a valuable tool for the regulation and sustainable management of fishery resources.(AU)


O mero, Epinephelus itajara , encontra-se criticamente ameaçado, resultado da pesca ilegal e destruição dos habitas. Filogeneticamente relacionadas a este táxon encontram-se garoupas que atualmente são intensamente pescadas no Atlântico Oeste. Apesar de leis mais restritivas aplicadas em alguns países, a captura ilegal com a descaracterização morfológica é uma prática comum que impossibilita a identificação correta da espécie permitindo que seja comercializada como garoupas, badejos ou chernes. A este respeito, técnicas moleculares representam ferramentas importantes para o monitoramento e fiscalização da pesca, provando ser essencial, na identificação forense de diversas espécies. Primers espécie-específicos foram desenvolvidos com base no gene Citocromo Oxidase subunidade I que aplicados em PCR-Multiplex possibilitam a identificação simultânea de nove espécies Epinephelidae: Epinephelus itajara , E. quinquefasciatus , E. morio , Hyporthodus flavolimbatus , H. niveatus , Mycteroperca acutirostris , M. bonaci , M. marginata e M. microlepis . A identificação via PCR multiplex de espécies de peixes ameaçadas e comercialmente importantes é um método rápido, prático, seguro e de baixo custo, que poderá ser útil o controle do uso e manejo sustentável de recursos pesqueiros.(AU)


Subject(s)
Animals , Classification and Identification by Risk Substances, Products and Materials , Perciformes/genetics , Perciformes/immunology , Fishing Industry , Polymerase Chain Reaction/statistics & numerical data , Polymerase Chain Reaction/veterinary
8.
Salvador; s.n; 2016. 151 p. ilus, tab.
Thesis in Portuguese | LILACS | ID: biblio-1001019

ABSTRACT

INTRODUÇÃO: A leishmaniose visceral (LV) é, principalmente, causada pelo protozoário Leishmania infantum nas Américas, podendo acometer o Homem e animais. Dentre estes, o cão é considerado o principal reservatório doméstico do parasito. O curso da LV canina (LVC) varia entre os animais, podendo alguns se mostrar resistentes à infecção, se mantendo subclínicos, e outros susceptíveis, que irão desenvolver sinais da doença. O estado de resistência ou susceptibilidade à LVC reflete na gravidade da infecção do animal, e não pode ser definido pelo quadro clínico apresentado ou por qualquer parâmetro isolado de resposta imune. OBJETIVO: Avaliar a carga parasitária como biomarcador parasitológico, as proteínas LJM11/LJM17 como biomarcadores de exposição à saliva do vetor, e identificar biomarcadores inflamatórios de gravidade da infecção por L. infantum em cães. Primeiramente, foi realizada a padronização de uma ferramenta diagnóstica de PCR quantitativa (qPCR), utilizando diferentes amostras biológicas (aspirado esplênico, linfonodos, pele, sangue, medula óssea e swab conjuntival) de cães sintomáticos provenientes da área endêmica de Jequié-BA. A avaliação da carga parasitária de L. infantum teve seu desempenho comparado com outras técnicas diagnósticas (cultura de aspirado esplênico, teste rápido e ELISA para LVC) empregando a análise de classe latente (ACL). Para essa análise, foi construída uma variável latente a ser empregada como padrão ouro para avaliação da acurácia desses métodos. Na avaliação inicia dos cães sintomáticos, a qPCR detectou DNA do parasita em 100%...


INTRODUCTION: In the Americas, visceral leishmaniasis (VL) is caused by the protozoan Leishmania infantum, which can affect humans and animals. Among these, dog is considered the main domestic reservoir of this parasite. Canine VL (CVL) clinical outcome varies among animals, some of which may be resistant to infection remaining subclinical, and others may be susceptible showing signs of the disease. The state of resistance or susceptibility to CVL reflects on the severity of infection in the animal and cannot be defined solely by the clinical condition presented or by any isolated parameter of the immune response. OBJECTIVE: Assess parasite load as parasitological biomarkers, LJM11/LJM17 proteins as sandfly saliva exposure biomarkers, and identify inflammatory biomarkers that indicates L. infantum infection severity in dogs. Firstly, we performed the standardization of a quantitative PCR diagnostic tool (qPCR) using different biological samples (splenic aspirate, lymph nodes, skin, blood, bone marrow and conjunctival swab) of symptomatic dogs from the endemic area of Jequié-BA. The evaluation of the parasitic load of L. infantum had its performance compared to other diagnostic techniques (splenic aspirate culture, rapid test and CVL ELISA) using latent class analysis (LCA). In this analysis, a latent variable was constructed to be used as a gold standard to evaluate the accuracy of these methods. In the initial evaluation of the symptomatic dogs, qPCR detected DNA from the parasite in 100%...


Subject(s)
Humans , Biomarkers, Pharmacological/analysis , Biomarkers, Pharmacological/blood , Biomarkers, Pharmacological/urine , Polymerase Chain Reaction/statistics & numerical data , Polymerase Chain Reaction/methods
9.
Braz. j. pharm. sci ; 51(2): 361-366, Apr.-June 2015. tab, ilus
Article in English | LILACS | ID: lil-755061

ABSTRACT

The hemoglobinopathies are included among the most common genetic diseases in the world. In Brazil, hemoglobinopathies are related to the diversity of racial backgrounds and the degree of interbreeding. The study focused on the prevalence of hemoglobinopathies using conventional and confirmatory laboratory tests in children from public schools in Ribeirão Preto-SP. The study involved the participation of 427 children between six and nine years of age. Hematologic evaluation, hemoglobin electrophoresis on cellulose acetate at alkaline pH, quantification of hemoglobin fractions by high performance liquid chromatography (HPLC) and detection of -α3.7 deletion for α thalassemia by polymerase chain reaction were performed. The results of hemoglobin electrophoresis on cellulose acetate and HPLC of the children studied showed the presence of 30 children (7%) with hemoglobinopathies. Eleven children presented results indicating suspicion of S/β-thalassemia; their parents and/or siblings were evaluated and confirmed the presence of only Hb S. The analysis of deletion -α3.7to characterize α-thalassemias sampling performed on 207 participants identified 26 children (12.6%) with deletion -α3.7. Thus, 54 (12.6%) of the children studied present this genetic alteration. For the detection of α-thalassemias it is necessary to use confirmatory methods such as molecular analysis and evaluation of family members in doubtful cases to facilitate genetic counseling in families, in which deletion -α3.7 is more frequent in Brazil...


As hemoglobinopatias estão incluídas nas doenças genéticas mais comuns no mundo. No Brasil, as hemoglobinopatias são relatadas pela diversidade racial e o grau de miscigenação. O estudo focou a prevalência das hemoglobinopatias usando métodos laboratoriais convencionais como a eletroforese de hemoglobina em acetato de celulose em pH alcalino e confirmatório por reação em cadeia de polimerase (PCR) em crianças de escolas públicas de Ribeirão Preto-SP. O estudo envolveu a participação de 427 crianças entre 6-9 anos de idade. Determinaram-se os valores hematológicos, efetuou-se eletroforese de hemoglobina em acetato de celulose em pH alcalino, quantificação das frações de hemoglobina por HPLC e a detecção da deleção -α3,7 pela PCR. Os resultados da eletroforese de hemoglobina em acetato de celulose e do HPLC, nas crianças estudadas, mostraram a presença de 30 crianças (7%) com hemoglobinopatias. Onze crianças apresentaram resultado indicando a suspeita de S/β-talassemia; seus pais e/ou irmãos confirmaram a presença de apenas a Hb S. A análise da deleção -α3,7, uma das alterações que estão presentes na α-talassemia, realizada em 207 participantes, identificou 26 crianças (12,6%) com a deleção -α3,7. Dessa forma, 54 (12,6%) das crianças estudadas apresentam hemoglobinopatias. Para a deleção da α-talassemias é necessário utilizar métodos confirmatórios como as análises moleculares e avaliação de membros da família, em casos duvidosos, facilitando o aconselhamento genético nas famílias, sendo a deleção -α3,7 mais frequente no Brasil...


Subject(s)
Humans , Male , Female , Child , Blood Protein Electrophoresis , Hemoglobinopathies , Chromatography, High Pressure Liquid/statistics & numerical data , Hemoglobins/analysis , Polymerase Chain Reaction/statistics & numerical data , Hematologic Tests/methods , Hematologic Tests
10.
Article in English | IMSEAR | ID: sea-158469

ABSTRACT

Background & objectives: Pleural effusion is a common occurrence in patients with late-stage chronic kidney disease (CKD). In developing countries, many effusions remain undiagnosed after pleural fluid analysis (PFA) and patients are empirically treated with antitubercular therapy. The aim of this study was to evaluate the role of adenosine deaminase (ADA), nucleic acid amplification tests (NAAT) and medical thoracoscopy in distinguishing tubercular and non-tubercular aetiologies in exudative pleural effusions complicating CKD. Methods: Consecutive stage 4 and 5 CKD patients with pleural effusions underwent PFA including ADA and PCR [65 kDa gene; multiplex (IS6110, protein antigen b, MPB64)]. Patients with exudative pleural effusion undiagnosed after PFA underwent medical thoracoscopy. Results: All 107 patients underwent thoracocentesis with 45 and 62 patients diagnosed as transudative and exudative pleural effusions, respectively. Twenty six of the 62 patients underwent medical thoracoscopy. Tuberculous pleurisy was diagnosed in six while uraemic pleuritis was diagnosed in 20 subjects. The sensitivity and specificity of pleural fluid ADA, 65 kDa gene PCR, and multiplex PCR were 66.7 and 90 per cent, 100 and 50 per cent, and 100 and 100 per cent, respectively. Thoracoscopy was associated with five complications in three patients. Interpretation & conclusions: Uraemia remains the most common cause of pleural effusion in CKD even in high TB prevalence country. Multiplex PCR and thoracoscopy are useful investigations in the diagnostic work-up of pleural effusions complicating CKD while the sensitivity and/or specificity of ADA and 65 kDa gene PCR is poor.


Subject(s)
Adenosine Deaminase/metabolism , Humans , Kidney Diseases , Pleural Effusion , Pleurisy/complications , Polymerase Chain Reaction/methods , Polymerase Chain Reaction/statistics & numerical data , Tuberculosis, Pleural/complications , Thoracoscopy/methods , Thoracoscopy/statistics & numerical data
11.
Arq. bras. med. vet. zootec ; 67(1): 309-314, 2/2015. tab, graf
Article in Portuguese | LILACS | ID: lil-741115

ABSTRACT

Para avaliar a viabilidade da metodologia da Reação em Cadeia da Polimerase associada com o Polimorfismo de Fragmentos de DNA (PCR-RFLP) na identificação de fraude intencional e contaminação acidental em produtos cárneos de origem bubalina, in natura e processados, foram testadas amostras puras e amostras de carnes com misturas controladas, produzidas em laboratório, com adição de 1%, 5%, 10% e 50% de carne bovina em carne de búfalo, homogeneizada crua e em amostras autoclavada. Foram comparados, ainda, diferentes métodos de extração, usando um kit comercial e a técnica clássica, utilizando fenol/clorofórmio. O resultado estatístico foi obtido por tabela de contingência, analisada pelo teste do qui-quadrado (χ2) e do exato de Fisher. A especificidade encontrada foi altamente significativa (P<0,0001). Observou-se também sensibilidade altamente significativa nas diluições a partir de 10% (P<0,0001). A técnica tem alta especificidade e sensibilidade para detectar até mesmo contaminação de 1%, mas a repetibilidade desse resultado impede a aplicação oficial desse método para a inspeção de contaminação acidental, sendo recomendada somente para inspeção de fraude a partir de 10% de substituição. Em carnes autoclavadas, a eficácia do teste é menor. A técnica pode ser empregada para certificação de produto específico (selo de identidade de espécie).


The present study aimed at evaluate the viability of PCR-RFLP (Polymerase Chain Reaction - Restriction Fragment Length Polymorphism) for identification of fraud and/or accidental contamination in buffalo meat - fresh and processed. Pure, autoclaved and controlled fraud samples, produced in the laboratory with the addition of 1, 5, 10 and 50% of beef in raw homogenized buffalo meat samples, were tested. Furthermore, different extraction methods, using a commercial kit and classical technique using phenol-chloroform, were compared. The statistical result was obtained by contingency table analyzed by chi-square and the Fisher exact test. The specificity was highly significant (p <0.0001), and the sensitivity was highly significant in dilutions from 10% (p <0.0001). Despite its accuracy and precision, capable to detect a contamination level of 1%, PCR-RFLP technique is not recommended for inspection in cases of accidental contamination. This is due to the need of test repetition in levels of contamination lower than 10%. The efficiency of this test is lower to autoclaved meat. The PCR-RFPL technique can be used for certification of food made with specific species (species identification certification stamp).


Subject(s)
Animals , Cattle , Polymerase Chain Reaction/statistics & numerical data , Polymerase Chain Reaction/veterinary , Meat/analysis , Cattle
12.
Arq. bras. med. vet. zootec ; 67(1): 94-102, 2/2015. tab
Article in Portuguese | LILACS | ID: lil-741121

ABSTRACT

Neste estudo, 67 ejaculados foram avaliados, antes e depois da técnica de swim-up, em relação à qualidade seminal e à presença do CAEV. Das 67 amostras testadas por PCRn, antes do swim-up, 47 (70,15%) foram positivas para o DNA pró-viral. No entanto, quatro amostras adicionais foram positivas ao RT-nested PCR após o swim-up, o que permite dizer que, pelo menos, 76,12% (51/67) delas estavam infectadas antes da lavagem. Todavia, em 23,88% (16/67) das amostras não foi detectada a presença do CAEV. Após a aplicação da técnica de swim-up, constatou-se, pela PCRn e RT-nested PCR, que houve uma redução significativa (χ²= 9,078; p<0,001) da presença do CAEV nas amostras seminais, pois 28 de 51 amostras positivas resultaram livres do vírus (54,90%), tanto para DNA pró-viral quanto para o vírus livre. Em relação à motilidade individual progressiva (MIP) e vigor espermático obtidos antes e depois da técnica de swim-up, observou-se uma diminuição significativa em suas médias, sendo o MIP de 86,42% para 71,49%, já o vigor espermático de 4,16 para 3,93. Conclui-se que a eliminação do CAEV no sêmen é de caráter intermitente, e que a associação da PCRn e RT-nested PCR é uma opção segura para a certificação sanitária individual das amostras seminais quanto à presença ou ausência do CAEV. Finalmente, a técnica de swim-up promove uma redução na infectividade de amostras de sêmen contaminadas, e, além disso, é possível promover a recuperação de espermatozoides viáveis.


In this study, 67 ejaculates were assessed before and after the swim-up technique in relation to semen quality and presence of CAEV. Of the 67 samples tested by Nested PCR, before swim-up 47 (70.15%) were positive for viral DNA. Furthermore, four additional samples were positive for RT-nested PCR after swim-up, which allows us to affirm that at least 76.12% (51/67) were infected before washing. However, 23.88% (16/67) of the samples did not detect the presence of CAEV. After application of the swim-up technique it was found, by Nested PCR and RT-nested PCR, that there was a significant decrease (χ² = 9.078, p <0.001) in the presence of CAEV in semen samples, once 28 of 51 positive samples were free from the virus (54.90%) for both proviral DNA and the free form of the virus. Regarding individual progressive motility (IPM) and spermatic vigor obtained before and after the swim-up technique, a significant decrease was observed in the average, being 86.42% of the IPM to 71.49% and the spermatic vigor from 4.16 for the 3.93. It is concluded that the removal of CAEV in semen has an intermittent character, and the combination of PCR and RT-nested PCR is a safe option for health certification of individual semen samples for the presence or absence of CAEV. Finally, the swim-up technique promotes a reduction in the infectivity of contaminated semen samples, and it is possible to promote the recovery of high individual progressive motility sperm and sperm vigor.


Subject(s)
Animals , Male , Polymerase Chain Reaction/statistics & numerical data , Polymerase Chain Reaction/veterinary , Arthritis-Encephalitis Virus, Caprine/isolation & purification , Semen Analysis/veterinary
13.
Journal of the Egyptian Society of Parasitology. 2014; 44 (1): 79-96
in English | IMEMR | ID: emr-154431

ABSTRACT

A zoonosis is an animal disease that is transmissible to humans. Humans are usually an accidental host that acquires disease through close contact with an infected animal, who may or may not be symptomatic. Children are at highest risk for infection because they are more likely to have close contact with pets. Pets are responsible for transmission of an extensive array of bacterial, fungal, and parasitic zoonotic pathogens. The route of transmission can be through the saliva [e.g., bites or contaminated scratches], feces, respiratory secretions, direct contact, or by the animal acting as a vehicle and source of tick or flea exposure. Although pets have been implicated in transmission of zoonoses to their owners, risk of transmission from contact with pets is low and may be further reduced by simple precautions


Subject(s)
Animals , Pets/parasitology , Horses/parasitology , Equidae/parasitology , Escherichia coli , Salmonella Infections , Salmonella/microbiology , Salmonella/complications , Polymerase Chain Reaction/statistics & numerical data
14.
Egyptian Journal of Hospital Medicine [The]. 2014; 55 (April): 204-217
in English | IMEMR | ID: emr-165992

ABSTRACT

Heparanase is an endoglycosidase that degrades heparin sulfate, the main polysaccharide constituent of the extracellular matrix and basement membrane. Expression of the heparanase gene is associated with the invasive, angiogenic, and metastatic potential of diverse malignant tumors and cell lines. to investigate possible relation/correlation between Heparanase gene expression and quantitation in pediatric Acute leukemia patients and clinicopathologic variables as well as patients outcome in an attempt to determine it's prognostic value and the possibility of using it as a new target for treatment. Forty pediatric acute leukemia patients [20 acute myeloid leukemia [AML] and 20 acute lymphoblastic leukemia [ALL] as well as 11 normal volunteers were analyzed for the expression and level of Heparanase gene using real time quantitative reverse transcriptase polymerase chain reaction [RTQ-PCR] to investigate a possible relation, association, or correlation with the clinical and laboratory features of patients at diagnosis, and patient outcome after treatment and follow up. Comparing the 3 groups as regards the Heparanase gene level there was high statistical significant difference [p<0.001] being maximum in AML and minimum in controls, with mean Relative quantitation [RQ] level 2336.2 +/- 10405.2 in AML ,median 8.0 and range [3.1-46543.0], while mean RQ in ALL was 1.7 +/- 1.0 ,median 1.7 and range [0.1-3.1] and in controls mean was 0.8+/-0.3, median 0.8 and range [0.4-1.4].Comparison between each 2 groups as regards heparanase level was of high statistically significant difference, p value being [p<0.001] when comparing AML/ALL and AML/controls and [p=0.035] when comparing ALL/controls. Cut off value for heparanase gene was calculated using Roc curve and was found to be 1.413 with 80% sensitivity and 100% specificity. According to this cut off level, 20/20 [100%] AML cases were heparanase positive, 12/20 [60%] [[ALL] cases were heparanase positive and 8/20 ALL patients were negative, while all controls [100%] were negative. This was of high statistical significance [p<0.001]. Comparing the overall survival [OS] of AML/ALL there was no statistically significant difference [p=0.2916], while comparing the disease free survival [DPS] of AML/ALL was of statistical significant difference [0.0312]. Comparing the final status of the disease [complete remission [CR]/ progressive disease [PD] or death] as regards the heparanase gene level RQ, showed a high statistical significant difference [p<0.005] with the level being higher in patients with PD/death. There was no significant correlation between all group and heparanase gene level as regards age, TLC, hemoglobin, platelets and peripheral blood blasts [p=0.353,0.704,0.844,0.54 and 0.097] respectively, while there was significant negative correlation on comparing bone marrow blast% and heparanase gene level [r=-0.408 and p=0.09]. Heparanse gene is expressed in acute leukemia being higher in AML than ALL and controls. Patients with higher heparanase gene showed poorer outcome. These findings suggest that heparanase gene may be a novel significant therapeutic target for acute leukemia


Subject(s)
Glucuronidase/genetics , Leukemia, Basophilic, Acute/genetics , Polymerase Chain Reaction/statistics & numerical data
15.
Alexandria Journal of Veterinary Sciences [AJVS]. 2014; 40: 51-62
in English | IMEMR | ID: emr-160055

ABSTRACT

A survey was conducted to determine the prevalence of Aeromonas spp. in 75 random samples [25 each of raw cow's milk, local plain yoghurt and Domiati cheese] collected from different dairy shops, supermarket and street peddlers in Diarb Negm and Zagazig cities Sharkia Governorate, Egypt. Investigations involved proteolytic and lipolytic activities of isolated Aeromonas spp. and the effect of heat- treatment, acidity, pH and Sodium chloride concentration on prevalence of Aeromonas bacteria. Prevalence of Aeromonas spp. was proved in 32, 44 and 20.0% of examined raw cow's milk, local plain yoghurt and Domiati cheese samples with mean count of 9.8 x10[3], 1.4 x10[5] and 6.9 x10[3]/ml, respectively. Identification of confirmed raw cow's milk isolates revealed that A. trota, A. hydrophila, A. janda and A. caviae were the predominant strains with percentages of 40, 25, 25 and 10.0% respectively. While local plain yoghurt isolates could be identified as A. caviae, A. sobria, A. hydrophila, A. trota and A. schubertii with percentages of 36.4, 22.7, 18.2, 13.6 and 9.1% respectively. Meanwhile identification of 10 confirmed Domiati cheese cultures revealed that the predominant strains were A. hydrophila, A. caviae and A. trota with percentages of 30, 50 and 20% respectively. All laboratory pasteurized milk samples revealed no count and there is marked decrease in the count of Aeromonas spp. as the acidity% of the examined raw cow's milk samples increase. While the count decrease when the pH value of the examined local plain yoghurt samples decrease and the NaCl% of the examined Domiati cheese samples increase. Characterization of isolated Aeromonas strains pointed that 50% of A. hydrophila, 60% of A. caviae, 40% of A. sobria, 53.8% of A. Trota, 100% of A. janda and 50% of A. schubertii were psychrotrophic. A. hydrophila exhibited proteolytic and lipolytic activities at the percentage of 41.7 and 16.7% respectively but in case of A. caviae strains the percentages were 46.7% and 20% respectively and with A. trota were 30.8 and 15.4% respectively. 60% of A. sobria and 100% of A. janda and A. schubertii strains showed proteolytic activity only. The public health importance and economic significance of existing microorganisms as well as the suggestive measures for improving the quality of raw milk and dairy products were discussed


Subject(s)
Animals , Aeromonas/immunology , Dairy Products/microbiology , Milk/microbiology , Polymerase Chain Reaction/statistics & numerical data
16.
Alexandria Journal of Veterinary Sciences [AJVS]. 2014; 40: 75-84
in English | IMEMR | ID: emr-160057

ABSTRACT

A total of 257 serum samples including, equine [56], birds [95] and human [106] were collected from rural area in Behera Province during the period extended from the beginning of June to the end of October 2013 to be examined for presence of antibodies against West Nile virus by ELISA. In addition, a total of 943 mosquitoes [25 mosquitoes groups] were collected by CDC light trap from the same place and during the same period where homogenized tissue samples of mosquitoes were obtained to be examined for presence of viral RNA of WNV by real time RT-PCR. The serological examination of serum samples clarified that the prevalence of IgG antibodies against WNV was 100, 4.2 and 58.5% in equine, birds and human serum samples, respectively. Moreover, some epidemiological aspects of human samples were studied including gender, age and health status. Statistical analysis indicated significant differences in detection of IgG antibodies against WNFV in different genders where the higher detection rate was observed in females [42.30%], than in males [35%], in different age groups where the higher detection rate was observed in age group 40 - < 60 years [83.33%] followed by age group 20 - <40 years [42.85%], then the age group 60 - < 80 [37.50%] and the least detection rate of IgG was observed in age group 1 - < 20 years [16.66%] and in health status where the highest detection rate was recorded in meningitis patients [80.9%] followed by FUO patients [64.4%] and lastly apparent healthy individuals [40%]. On the other side, real time RT-PCR examination of samples of mosquitoes clarified no detection of the viral RNA of WNV in all examined samples. The obtained results confirmed the endimicity of WNV in equine in Egypt and the role played by birds in transmission of WNV to human. Although, examined mosquitoes were found to negative for presence of the viral RNA, their role in transmission of WNV could not denied


Subject(s)
Humans , Animals, Laboratory , Animals , Insecta , Horse Diseases/microbiology , Birds/microbiology , Humans , Culicidae/microbiology , Polymerase Chain Reaction/statistics & numerical data
17.
Assiut Medical Journal. 2014; 38 (2): 73-80
in English | IMEMR | ID: emr-160288

ABSTRACT

Wuchereria Bancroft; the principal etiologic agent of lymphatic filariasis is mosquito dependant in the biological transmission. Dirofilariasis is essentially a disease of canines which can also be trans-mitted to humans by culicine mosquitoes. Wolbachia are Rickettsia-like, obligatory intracellular bacteria that infect the reproductive and somatic tissues of some arthropods and nematodes. Our study aimed to identify the possible association between filarial parasites and Wolbachia by single and multiplex PCR. 1600 female mosquitoes collected from: four localities in Assiut Governorate, Egypt were microscopically identified and divided into 64 mosquito pools according to their genera and collection site. Single PCR was firstly conducted on mosquitoes followed by multiplex PCR for simultaneous detection of the three filarial parasites [Wucheraria bancrofti, Dirofilaria immitis, and Dirofilaria repens] and Wolbachia in mosquitoes. The results indicated that: Out of 64 mosquito pools, 8 pools were positive for Wuchererio bancrofti with estimated rate of infection [ERI 0.53%], 3 for each of Dirofilaria immitis and Dirofilaria repens [ERI 0.19%] and 6 pools were positive for Wolbachia [ERI 0.39%], five of them with filarial parasites [W. Bancrofti, D. immitis and D repens] [83.3%], with a significant P. value [< 0.05]. We concluded that there was a strong association between the presence of Wolbachia and filarial parasites that should be considered during the treatment of patients with filarial diseases by the use of specific anti-Wolbachia antibiotic in addition to the usual anti-filarial drugs


Subject(s)
Insecta , Wolbachia/isolation & purification , Polymerase Chain Reaction/statistics & numerical data , Culicidae , Multiplex Polymerase Chain Reaction/statistics & numerical data
18.
Assiut Medical Journal. 2014; 38 (2): 111-122
in English | IMEMR | ID: emr-160292

ABSTRACT

Hydatidosis is one of the most important parasitic zoonosis and remains a public health and economic problem all over the world. The disease is endemic in many parts of the world. Reports on the species and strains of Echinococcus present in Egypt appear controversial. In the present study hydatid cysts were collected from freshly slaughtered camel at local abattoir, Assiut, Egypt. Hydatid cysts were genetically characterized by polymerase chain reaction [PCR] amplification and sequencing of internal transcribed spacer genes one and two [ITS1 and ITS2] of nuclear ribosomal DNA [rDNA] by using specific primers. The lengths of ITS1 and ITS2 sequences were 583 bp and 517 bp respectively for hydatid sample sequenced. Comparisons of ITS sequences of the examined hydatid sample in the present study revealed that collected hydatid represented Echinococcus Canadensis, which provides foundation for further studies on Echinococcus in Egypt. The data obtained will facilitate the development of diagnostic tools necessary to study the population genetic structure and epidemiology of this enigmatic parasite


Subject(s)
Humans , Echinococcosis/genetics , DNA Barcoding, Taxonomic/statistics & numerical data , Genes/genetics , Camelus/parasitology , Zoonoses/genetics , Polymerase Chain Reaction/statistics & numerical data , Phylogeny
19.
Indian J Dermatol Venereol Leprol ; 2013 Nov-Dec; 79(6): 789-794
Article in English | IMSEAR | ID: sea-154682

ABSTRACT

Background: The diagnosis of pure neural leprosy (PNL) remained subjective because of over-dependence of clinical expertise and a lack of simple yet reliable diagnostic tool. The criteria for diagnosis, proposed by Jardim et al., are not routinely done by clinicians in developing country as it involves invasive nerve biopsy and sophisticated anti-PGL-1 detection. We conducted a study using fi ne needle aspiration cytology (FNAC) coupled with Ziehl Neelsen staining (ZN staining) and Multiplex- Polymerase Chain Reaction (PCR) specifi c for M. leprae for an objective diagnosis of pure neural leprosy (PNL), which may be simpler and yet reliable. Aim: The aim of the study is to couple FNAC with ZN staining and multiplex PCR to diagnose pure neural leprosy patients rapidly, in simpler and yet reliable way. Methods: Thirteen patients of PNL as diagnosed by two independent consultants were included as case, and 5 patients other than PNL were taken as control in the study. Fine needle aspiration was done on the affected nerve, and aspirates were evaluated for cytology, ZN staining and multiplex- PCR. Results: Out of the 13 cases where fi ne needle aspiration was done, M. leprae could be elicited in the nerve tissue aspirates in 5 cases (38.4%) with the help of conventional acid-fast staining and 11 cases (84.6%) with the help of multiplex PCR. On cytological examination of the aspirates, only 3 (23%) cases showed specifi c epithelioid cells, whereas 8 (61.5%) cases showed non-specifi c infl ammation, and 2 (15.3%) cases had no infl ammatory cells. Conclusion: Our study demonstrates that in the fi eld of laboratory diagnosis of PNL cases, FNAC in combination with ZN staining for acid-fast bacilli (AFB) and Multiplex-PCR can provide a rapid and defi nitive diagnosis for the majority of PNL cases. FNAC is a less-invasive, outdoor-based and simpler technique than invasive nerve biopsy procedure. Thus, this study may enlighten the future path for easy and reliable diagnosis of PNL.


Subject(s)
Adolescent , Adult , Biopsy, Fine-Needle/statistics & numerical data , Cytodiagnosis/statistics & numerical data , Female , Humans , Leprosy, Tuberculoid/diagnosis , Leprosy, Tuberculoid/genetics , Male , Middle Aged , Mycobacterium leprae/genetics , Mycobacterium leprae/isolation & purification , Peripheral Nerves/pathology , Pilot Projects , Polymerase Chain Reaction/statistics & numerical data , Young Adult
20.
Journal of the Egyptian Public Health Association [The]. 2013; 88 (1-2): 52-56
in English | IMEMR | ID: emr-180702

ABSTRACT

Background: Viral respiratory infections are associated with nearly 80% of asthma exacerbation episodes. These can have severe adverse outcomes in patients with established asthma


Aim: The aim of the study was to identify the viral causes of acute respiratory infection that precipitate acute asthma exacerbation in Egyptian asthmatic children


Patients and methods: The current prospective study was conducted in Cairo University Children's Hospitals from December 2010 to December 2011. All asthmatic children [n=130] aged 2-12 years admitted with asthma exacerbation due to severe lower respiratory tract infection were included. All cases were subjected to nasopharyngeal or throat swabs that were analyzed for common respiratory viruses, including respiratory syncytial virus [RSV], human metapneumovirus [hMPV], influenza B [Flu B], human parainfluenza virus [hPIV], influenza A [H1N1], and adenovirus [ADV] using the real-time PCR technique. All patients were followed up to record the outcome


Results: PCR analysis was positive for one respiratory virus in 54 asthmatic patients [41.5%] and was negative in 76 patients [58.5%], with a high predominance of RSV [51.9%] and hMPV [25.9%] especially in winter and early spring months. Hypoxia was detected in all patients with RSV infection; of these patients, 21.4% were admitted to the ICU, 14.3% required mechanical ventilation, and 14.3% died. In contrast, among those with hMPV infection, hypoxia was detected in 71.4%; none required ICU admission or mechanical ventilation


Conclusion and recommendations: Viral etiology of lower respiratory tract infections constitutes an important cause of acute asthma exacerbation in asthmatic children admitted to children's hospitals in Cairo, supporting the need for large-scale multicentric studies on asthmatic patients over multiple years using a wider-panel PCR for detection of respiratory viruses


Subject(s)
Humans , Male , Female , Aged , Respiratory Tract Infections/virology , Asthma/etiology , Child , Polymerase Chain Reaction/statistics & numerical data , Treatment Outcome , Prospective Studies , Hospitals, University
SELECTION OF CITATIONS
SEARCH DETAIL