Performance of indirect immunofluorescence assay, immunochromatography assay and reverse transcription-polymerase chain reaction for detecting human respiratory syncytial virus in nasopharyngeal aspirate samples

Comparison of the use of indirect immunofluorescence assay (IFA), immunochromatography assay (ICA-BD) and reverse transcription-polymerase chain reaction (RT-PCR) for detecting human respiratory syncytial virus (HRSV) in 306 nasopharyngeal aspirates samples (NPA) was performed in order to assess their analytical performance. By comparing the results obtained using ICA-BD with those using IFA, we found relative indices of 85.0 percent for sensitivity and 91.2 percent for specificity, and the positive (PPV) and negative (NPV) predictive values were 85.0 percent and 91.2 percent, respectively. The relative indices for sensitivity and specificity as well as the PPV and NPV for RT-PCR were 98.0 percent, 89.0 percent, 84.0 percent and 99.0 percent, respectively, when compared to the results of IFA. In addition, comparison of the results of ICA-BD and those of RT-PCR yielded relative indices of 79.5 percent for sensitivity and 95.4 percent for specificity, as well as PPV and NPV of 92.9 percent and 86.0 percent, respectively. Although RT-PCR has shown the best performance, the substantial agreement between the ICA-BD and IFA results suggests that ICA-BD, also in addition to being a rapid and facile assay, could be suitable as an alternative diagnostic screening for HRSV infection in children.

Heridas cortopunzantes en pabellón: sus riesgos y prevención / Puncture and stab wounds in operating room: its risks and prevention

Se inicia un programa de vigilancia activo y permanente de las heridas corto punzantes en los pabellones quirúrgicos del Hospital del Salvador. De 25 accidentes notificados, el 68 por ciento corresponde a pinchazos, el 16 por ciento a cortes-quemaduras, siendo los cirujanos objeto del 76 por ciento de las lesiones, las arsenaleras del 16 por ciento y el resto del personal del 8 por ciento . El riesgo de contraer graves o mortales enfermedades por esta vía es real, entre otras, hepatitis B 20 por ciento , SIDA 0,5 por ciento , riesgo que debe ser minimizado a través de un programa de vigilancia activo y de medidas de control entre las que destacan: definir campo operatorio, uso de barreras protectoras, instrumental adecuado, mesa intermedia entre cirujanos y arsenaleras, extremar normas sobre Precauciones Universales y por sobre todo, educar y tomar conciencia del riesgo

Vómitos postcolecistectomía laparoscópica y su profilaxis con droperidol / Vomiting laparoscopy cholecystectomy and your prophylaxis with droperidol

Los vómitos son una complicación frecuente en el postoperatorio, con una incidenciaque va desde un 2 a un 75 por ciento , dependiendo de diversos factores. Nuestro objetivo es determinar la frecuencia del vómito postoperatorio en colecistectomía laparoscópica en relación al que se presenta después de colecistectomía tradicional, y los beneficios de su profilaxis con droperidol. Se estudiaron 112 mujeres ASA I y II sometidas a igual régimen anestésico, siendo el universo homogéneo en edad, talla, sexo y peso. Se realizaron cuatro grupos en dos partes: Grupo 1: 30 pacientes con colecistectomía tradicional/ Grupo 2: 30 pacientes con colecistectomía laparoscópica/ Grupo 3: 17 pacientes con colecistectomía laparoscópica y droperidol 2,5 mg/ Grupo 4: 35 pacientes con colecistectomíalaparoscópica y droperidol 20 µgr/kg. Después de la colecistectomía laparoscópica hay un mayor porcentaje de pacientes que vomitan en relación a las que se operaron a cielo abierto: 90 vs. 65 por ciento (p< 0,05), siendo el número de episodios de vómitos por paciente también mayor: 4,7 ñ 3,5 vs. 1,9 ñ 2,2 por ciento (p< 0,05). En los pacientes que recibieron 2,5 mg de droperidol el número de vómitos por paciente disminuyó a 2,5 ñ 2,7 y en las que recibieron 20 µgr/kg de droperidol disminuyeron a 3,1 ñ 3,1. Conclusiones: el vómito es más frecuente después de la colecistectomía laparoscópica que después que la que se efctúa a cielo abierto. El droperidol disminuye esta frecuencia. No encontramos diferencia entre las dos dosificaciones de droperidol

Deteccao de antigenos bacterianos em pneumonia aguda: metodos de preparacao das amostras de urina, soro e liquido pleural para os testes de imunodiagnostico / Detection of bacterial antigens in acute pneumonia: methods of preparing the urine, serum and pleural fluid samples for immunodiagnostic assays

Foi desenvolvido um metodo de precipitacao de antigenos polissacaridicos de S. pneumoniae e H influenzae tipo b na urina, atraves do tratamento com uma solucao de etnol-acetona 1:1 seguido de um tratamento a quente com EDTA 0,1M. Foram empregadas as tecnicas de contra-imunoeletroforese e latex aglutinacao para a deteccao de antigenos polissacarideos em amostras pareadas de urina e soro e ainda de liquido pleural, de criancas com diagnostico clinico e radiologico de pneumonia aguda. Contra-imunoeletroforese e latex aglutinacao apresentaram melhores indices de sensibilidade em urina do que em soro e tiveram otimo desempenho tanto para urina de volume inicial relativamente pequeno como de grande volume, colhidas antes ou durante os primeiros dias de antibioticoterapia. Os resultados obtidos em contra-imunoeletroforese e latex aglutinacao mostraram que a solucao etanol-acetona 1:1 fornece melhor rendimento na precipitacao de antigeno polissacaridico enquanto que o aquecimento com EDTA diminui a probabilidade de ocorrencia de resultados falso-positivos e de reatividade cruzada entre S. pneumoniae e H. influenzae tipo b. A urina mostrou-se como importante meio de deteccao de antigenos bacterianos no diagnostico de pneumonia bacteriana aguda, principalmente se a antibioticoterapia previa obstrui o crescimento bacteriano nos meios de cultura.

Diffusion-in-gel enzyme-linked immunosorbent assay (DIG-ELISA) for Chagas'disease serodiagnosis

Diffusion-in-gel enzyme-linked immunosorbent assay (DIG-ELISA) was standardized and evaluated for the diagnosis of Chagas'disease in comparison with the conventional serological tests indirect immunofluorescence (IFI), passive hemagglutination (PHA) and complement fixation (CF). A total of 236 serum samples positive and negative for the serodiagnosis of Chagas'disease were studied. The group included 50 serum samples serologically positive for leishmaniasis and 36 positive for malaria. The best diagnostic performance of DIG-ELISA was observed when serum samples were diluted to 1:8 and a diameter of zero mm (no color) was taken as the cut-off. Under these conditions, the relative indices of sensitivity, specificity and agreement were 100%. High positive correlation coeficients were obtained between DIG-ELISA and IFI (r1=0.9010), PHA (r2=0.8943) and CF (r3=0.8269). We conclude that DIG-ELISA provides an alternative technique for screening chagasic infections, as well as for seroepidemiological surveys mainly because it is simple, easy to carry out and does not require expensive equipment

YAG laser angioplasty in lower extremity: sole therapy as well as adjunct to balloon dilatation.

To evaluate efficacy of the YAG laser in severe occlusive arterial lesions of lower extremity, 64 lesions were considered for either laser recanalisation (LR) or laser assisted balloon angioplasty (LABA). Indications for the procedure were incapacitating intermittent claudication (28), rest pain (17) and tissue loss (19). Of those 64, 46 (72%) were recanalised whereas 38 (59%) recanalised to adequate diameter. In stenoses, segmental occlusions and total length occlusions, successful recanalisation resulted in 12/12 (100%), 28/35 (80%) and 6/17 (35%) cases respectively. As compared to stenoses and segmental occlusions, successful recanalisation rate was significantly low in total length occlusions (p less than 0.001). Addition of balloon dilatation to LR decreased the requirement of additional by-pass surgery from 6/16 (60%) to 2/30 (7%) (p less than 0.05). Addition of balloon dilatation to LR had improved the results.

Disturbios hidreletroliticos agudos em Unidade de Terapia Intensiva. Casuistica e protocolo terapeutico. / Acute water-electrolyte disorders in Intensive Care Unit. Case study and therapeutic record

Os autores apresentam a casuistica e o protocolo terapeutico adotado na UTI do Pronto-Socorro Infantil Sabara, frente aos disturbios hidreletroliticos agudos. Sao ressaltados os passos fundamentais da correcao desses disturbios e a importancia da utilizacao correta do protocolo terapeutico

Hipernatremia em terapia intensiva. / Hypernatremia in intensive therapy

Os autores apresentam a conduta terapeutica adotada na UTI do pronto-socorro infantil Sabara frente as criancas que apresentem desidratacao hipermatremica consequente balanco negativo de Na e agua.Os resultados sao comentados a luz dos trabalhos classicos da literatura