ABSTRACT
Transplacental transmission of Zika virus has been reported during all trimesters of pregnancy and might lead to central nervous system anomalies, including microcephaly. We report 3 cases of perinatal Zika infection identified during the epidemic in Colombia and provide detailed descriptions of clinical features, diagnosis, and neurodevelopmental outcome at 18 months of age (corrected).
Subject(s)
Microcephaly , Pregnancy Complications, Infectious , Zika Virus Infection , Zika Virus , Colombia/epidemiology , Female , Humans , Infant , Infectious Disease Transmission, Vertical , Microcephaly/epidemiology , Microcephaly/etiology , Pregnancy , Zika Virus Infection/diagnosis , Zika Virus Infection/epidemiologyABSTRACT
Since its 2013 emergence in the Americas, Chikungunya virus (CHIKV) has posed a serious threat to public health. Early and accurate diagnosis of the disease, though currently lacking in clinics, is integral to enable timely care and epidemiological response. We developed a dual detection system: a CHIKV antigen E1/E2-based enzyme-linked immunosorbent assay (ELISA) and a lateral flow test using high-affinity anti-CHIKV antibodies. The ELISA was validated with 100 PCR-tested acute Chikungunya fever samples from Honduras. The assay had an overall sensitivity and specificity of 51% and 96.67%, respectively, with accuracy reaching 95.45% sensitivity and 92.03% specificity at a cycle threshold (Ct) cutoff of 22. As the Ct value decreased from 35 to 22, the ELISA sensitivity increased. We then developed and validated two lateral flow tests using independent antibody pairs. The sensitivity and specificity reached 100% for both lateral flow tests using 39 samples from Colombia and Honduras at Ct cutoffs of 20 and 27, respectively. For both lateral flow tests, sensitivity decreased as the Ct increased after 27. Because CHIKV E1/E2 are exposed in the virion surfaces in serum during the acute infection phase, these sensitive and specific assays demonstrate opportunities for early detection of this emerging human pathogen.
Subject(s)
Antigens, Viral/analysis , Chikungunya Fever/diagnosis , Chikungunya virus/immunology , Chikungunya virus/isolation & purification , Enzyme-Linked Immunosorbent Assay , Immunoassay , Antibodies, Viral/immunology , Antigens, Viral/immunology , Chikungunya Fever/virology , Colombia , Honduras , Humans , Sensitivity and Specificity , Serologic Tests , Viral Envelope Proteins/immunologyABSTRACT
Objetivo Determinar la validez y la confiabilidad de un instrumento de satisfacción del paciente con Síndrome Febril Agudo en urgencias y consulta oportuna de la Red Pública de Bucaramanga. Métodos Estudio de evaluación de tecnologías diagnósticas en personas con Síndrome Febril Agudo entre el 2008 y 2009. Se diseñó un cuestionario telefónico a partir de 3 instrumentos en español. Se evaluó validez de contenido mediante sometimiento a expertos y a profesionales de salud y validez facial en una prueba piloto con 30 usuarios. La reproducibilidad fue realizada por dos enfermeras independientemente en 19 encuestas. Resultados Se realizaron 146 encuestas, de estas 75.3 por ciento fueron contestadas por mujeres, 33.6 por ciento por los mismos pacientes y 52.7 por ciento por las madres de estos cuando eran menores de 15 años. Se realizó análisis factorial obteniendo 3 factores: satisfacción con la atención médica, de enfermería y la organización del centro; al modelo final entraron 16 de 26 ítems. El alfa de Cronbach para cada factor fue 0,89 (IC 95 por ciento: 0,86;0,93), 0,78 (IC95 por ciento: 0.67;0.84) y 0,88 (IC95 por ciento: 0.85;0.91) respectivamente; el coeficiente de kappa fue 0.90 (IC95 por ciento: 0.77;0.97) y el coeficiente de correlación intraclase fue 0.955 (IC95 por ciento: 0.862;0.986) El promedio de las diferencias en la sumatoria de los ítems fue -1.3 (DS: 8,5) y los límites de acuerdo de Bland y Altman fueron -18.9 y 15.3. Discusión Este estudio demuestra validez y confiabilidad del instrumento de satisfacción de usuarios de los servicios de urgencias y consulta oportuna y podría aplicarse en la red pública del sistema de salud Colombiano.
Objective Determining the validity and reliability of a user satisfaction instrument applied to patients attending the emergency department and clinic who were suffering from acute febrile syndrome in Bucaramanga's Public Health Network. Methods A diagnostic technology assessment study was conducted between 2008 and 2009 on patients suffering from acute febrile syndrome. A telephone questionnaire was designed using 3 instruments. Content validity was assessed by experts and health professionals and face validity was assessed in a pilot study involving 30 users. Reproducibility was tested in questionnaires independently applied by two nurses to 19 patients. Results Data from 146 surveys was collected; 75.3 percent were answered by women, 33.6 percent were patients and 52.7 percent were their mothers when patients were under 15. Three factors were identified from factor analysis: satisfaction with medical care, nursing and medical centre organisation. The final model included 16 of the 26 items. Cronbach's Alpha for each factor was 0.89 (0.86-0.93 95 percentCI), 0.78 (0.67- 0.84 95 percentCI) and 0.88 (0.85-0.91 95 percentCI), respectively. The Kappa coefficient was 0.90 (0.77-0.97 95 percentCI) and intra-class correlation coefficient was 0.96 (0.86-0.99 95 percentCI). The average difference of the sum of all items was -1.3 (SD: 8.5) and Bland and Altman limits of agreement were -18.9 and 15.3, respectively. Discussion This study established the validity and reliability of a new instrument concerning user satisfaction used with patients suffering from acute febrile syndrome attending emergency health care which that could be applied in the Colombian Public Health System.
Subject(s)
Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Young Adult , Emergency Medical Services/standards , Fever , Patient Satisfaction , Surveys and Questionnaires , Acute Disease , Fever/diagnosis , Reproducibility of Results , SyndromeABSTRACT
OBJECTIVE: Determining the validity and reliability of a user satisfaction instrument applied to patients attending the emergency department and clinic who were suffering from acute febrile syndrome in Bucaramanga's Public Health Network. METHODS: A diagnostic technology assessment study was conducted between 2008 and 2009 on patients suffering from acute febrile syndrome. A telephone questionnaire was designed using 3 instruments. Content validity was assessed by experts and health professionals and face validity was assessed in a pilot study involving 30 users. Reproducibility was tested in questionnaires independently applied by two nurses to 19 patients. RESULTS: Data from 146 surveys was collected; 75.3 % were answered by women, 33.6 % were patients and 52.7 % were their mothers when patients were under 15. Three factors were identified from factor analysis: satisfaction with medical care, nursing and medical centre organisation. The final model included 16 of the 26 items. Cronbach's Alpha for each factor was 0.89 (0.86-0.93 95 %CI), 0.78 (0.67- 0.84 95 %CI) and 0.88 (0.85-0.91 95 %CI), respectively. The Kappa coefficient was 0.90 (0.77-0.97 95 %CI) and intra-class correlation coefficient was 0.96 (0.86-0.99 95 %CI). The average difference of the sum of all items was -1.3 (SD: 8.5) and Bland and Altman limits of agreement were -18.9 and 15.3, respectively. DISCUSSION: This study established the validity and reliability of a new instrument concerning user satisfaction used with patients suffering from acute febrile syndrome attending emergency health care which that could be applied in the Colombian Public Health System.
Subject(s)
Emergency Medical Services/standards , Fever , Patient Satisfaction , Surveys and Questionnaires , Acute Disease , Adolescent , Adult , Aged , Child , Female , Fever/diagnosis , Humans , Male , Middle Aged , Reproducibility of Results , Syndrome , Young AdultABSTRACT
Objetivo Describir los patrones de consulta por SFA asociado al dengue y evaluar su asociación con la pluviosidad. Métodos En dos clínicas, durante un periodo de 7 meses (de marzo a septiembre) se identificaron 318 casos de SFA indiferenciado que se incluyeron en un seguimiento clínico sistemático. El 31 por ciento (81/281) fueron IgM positivos para dengue. Se evaluó la pluviosidad (litros/metro cuadrado por día) previa como variable explicatoria del patrón de consultas. Resultados Los meses con más casos de SFA fueron junio, julio y septiembre. Los casos de dengue sólo fueron significativamente más frecuentes en julio. Al evaluar los patrones de pluviosidad de las semanas anteriores, la consulta por SFA estuvo asociada con la pluviosidad promedio registrada 5 semanas antes y esta asociación fue independiente de la institución y del mes (Razón de tasas de incidencia ajustada: RTI=1,04; IC95 por ciento 1-1,08; p=0,045). Por otra parte, un promedio de la pluviosidad de 5 semanas consecutivas fue un predictor independiente de consulta por dengue, 4 semanas después (RTI=1,6; IC95 por ciento 1,15-2,22; p=0.006). Se evidenció una relación lineal entre la pluviosidad y las consultas por dengue: pluviosidad (promedio de 5 semanas) x 0,72 (IC95 por ciento 0,60-0,84; p<0,001)=casos por cada 100 000 habitantes en una semana (4 semanas después). Conclusiones La pluviosidad podría predecir el patrón de consulta por dengue en una región endémica.
Objective Describing patterns of acute febrile syndrome (AFS) consultation related to dengue and evaluating association with rainfall. Methods 318 undifferentiated AFS patients were detected in two clinics during a 7-month period (March to September) and then included in systematic clinical follow-up. 31 percent of them (81/281) were IgM positive for dengue. Rainfall (litres/square meter-day) during the previous weeks was evaluated as a variable for predicting consultation patterns. Results June, July and September were the months in which the greatest number of AFS cases occurred. Cases of dengue were only significantly more frequent during July. When evaluating the previous weeks' rainfall patterns, consultation for AFS was seen to be associated with the average rainfall registered 5 weeks beforehand and such association was independent of the institution and/or month (incidence rate ratio IRR=1,04; 1-1.08 95 percentCI, p=0.045). On the other hand, 5 consecutive weeks' average rainfall was an independent predictor of consultation for dengue 4 weeks later on (RTI=1 ,6 ; 1,15-2,22 95 percentCI, p=0.006). A linear relationship was thus proposed (regarding these sentinel clinics) between consultation for dengue and rainfall: lt/mt-day (5 weeks' average rainfall) X 0 ,72 (0,60-0,84 95 percentCI, p<0.001) = cases for each 100 000 habitants per week (4 weeks later). Conclusions: Studying rainfall could predict the pattern of consultation for dengue in endemic regions.
