Evaluation of positive and false-positive results in syphilis screening of blood donors in Rio de Janeiro, Brazil.

OBJECTIVES: We propose to analyse the positive and false-positive results of treponemal and nontreponemal tests in blood donors from Brazil and to evaluate possible factors associated with the results of treponemal tests. BACKGROUND: Treponemal tests have been used widely for syphilis screening in blood banks. The introduction of these tests in donor screening has caused an impact and a loss of donors who need to be assessed. METHODS: This was a retrospective cross-sectional study of syphilis screening and confirmatory test results of blood donors that were obtained before and after adopting a chemiluminescent immunoassay (CLIA). A comparative analysis was performed using a second sample drawn from positive donors. The possible factors associated with CLIA-positive or CLIA-false-positive results were investigated in a subgroup. Statistical tests were used to compare the proportions and adjusted estimates of association. RESULTS: The reactivity rate increased from 1·01% (N = 28 158) to 2·66% (N = 25 577) after introducing the new test. Among Venereal Disease Research Laboratory (VDRL)- and CLIA-confirmed results, the false-positive rates were 40·5% (N = 180) and 37·4% (N = 359), respectively (P = 0·5266). Older donors (OR = 1·04; P = 0·0010) and donors with lower education levels (OR = 6·59; P = 0·0029) were associated with a higher risk of positivity for syphilis. CONCLUSIONS: CLIA represents an improvement in blood bank serological screening. However, its use in a healthy population appears to result in high rates of false positives. Identifying which characteristics can predict false positives, however, remains a challenge.

Uso da vitamina K como rastreador de eventos adversos hemorrágicos por varfarina: um estudo de caso / Use of vitamin K to track hemorrhagic adverse events caused by warfarin: a case study

The medical use of warfarin requires close monitoring because of its narrow therapeutic index. Thus, methods that enable effective monitoring to detect any adverse events (AEs) associated with this drug are necessary to improve the quality of health care. Many authors have proposed the use of triggers to search actively for possibleAEs. The aim of this study was to assess the possible use of vitamin K as a tracker of adverse bleeding events caused by warfarin in a public hospital specialized in cardiology in Rio de Janeiro. We applied the method of trigger tools (Institute for Healthcare Improvement, 2004; Rozichet al., 2003), which retrospectively analyzed the results of the use of vitamin K (phytomenadione), to screen for adverse bleeding events caused by warfarin, from October 2010 to March 2011. From an analysis of 46 medical records, 14 possible AEs were found. In 23 cases, internal bleeding was the cause of hospitalization. Despite difficulties, especially those related to poor access to data and quality of hospital records, the application of vitamin K as a trigger was found to be of great use in detecting hemorrhagic AEs associated with warfarin. This method has potential applications for monitoring the results of interventions, with a view to reducing the incidence of hemorrhagic adverse events...

O uso de varfarina requer monitoramento rigoroso devido a seu índice terapêutico estreito. Da mesma forma, a aplicação de métodos que permitam o monitoramento adequado de eventos adversos a este medicamento é necessária para que se possa contribuir com a qualidade do cuidado em saúde. O uso de marcadores para o processo de busca ativa de eventos adversos tem sido proposto por muitos autores. Neste trabalho, buscou-se avaliar o potencial de utilização do uso da vitamina K como rastreador de eventos adversos hemorrágicos causados por varfarina em um hospital público de alta complexidade em cardiologia do Rio de Janeiro. O método dos rastreadores ou trigger tools foi aplicado para análise retrospectiva da utilização da vitamina K (fitomenadiona) como rastreador de eventos adversos hemorrágicos causados por varfarina, no período de outubro de 2010 a março de 2011. Com base na análise de 46 prontuários, foram encontrados 14 possíveis eventos adversos. Em 23 casos, a hemorragia foi a causa da internação. Apesar das dificuldades, sobretudo relacionadas ao acesso às informações e à qualidade dos registros, a aplicação da vitamina K como rastreador se mostrou bastante útil na detecção de eventos adversos hemorrágicos por varfarina. A aplicação deste método como estratégia de monitoramento de eventos adversos, tem potencial para uso no acompanhamento dos resultados de intervenções visando à redução da incidência dos eventos adversos hemorrágicos...

Evaluating technologies in reproductive health: case studies of a consumer protection approach.

OBJECTIVE: A consumer-protection assessment and action program aimed at improving reproductive health technologies is reviewed. METHODS: Evaluations employed both literature review, synthesis, market analysis and laboratory testing for conformity to standards of a wide range of products which affect reproductive health on the Brazilian market 1995-1997. Anti-infective gynecological products, ampicillins, condoms, pregnancy tests, hormonal contraceptives, infant formulas, selected teratogens, bromocriptine and prostaglandins were studied. Actions include dissemination in periodicals and the mass media, consumer education, pressure for regulation, negotiations with manufacturers and legal action. RESULTS: The program was effective in improving the supply and regulation of some, but not all products studied. Impact on health and utilization are unknown. CONCLUSION: A significant proportion of products studied are unsafe, ineffective or of sub-standard quality. A combination of careful scientific work, strong links between scientists and social movements, dissemination and legal action, can effectively improve the quality of products which affect reproductive health.

[The importance of clinical examination for the diagnosis of innocent heart murmur in adolescents]. / Importância do exame clínico no diagnóstico de sopro inocente em adolescentes.

PURPOSE: To determine the prevalence of innocent murmur among adolescents, and to evaluate the clinical features in comparison with echocardiogram (two-dimensional, M-mode, Doppler, and color-Doppler) in the assessment of heart murmurs. METHODS: The study was carried out from March to December, 1992, and involved high school students coming from families of the medium and low-medium social classes. Considering the total of 1400 students registered in a public school, 536 adolescents aging from 10 to 20 years were admitted in this study. Twenty seven students with heart murmur were submitted to Echocardiography in order to find any cardiac lesions. RESULTS: Among 536 adolescents, 171 (32%) had some kind of heart murmur. On the basis of the clinical diagnosis, 160 (29.9%) patients were classified as having innocent murmur and 11 (2.1%) as having "pathologic murmur". Out of 27 students submitted to echocardiography, 20 of them with clinical diagnosis of innocent murmur showed normal results. Among seven students with clinical diagnosis of "pathologic murmur", the echocardiography recognized cardiac lesions in two (small ventricular septal defect and rheumatic heart disease: combined mitral incompetence and stenosis, and aortic incompetence). CONCLUSION: From the data obtained, the prevalence of innocent murmur among adolescents was 29.9% on the basis of clinical diagnosis. It is suggested that careful clinical examination by physicians skilled in cardiac examination is the recommended method for the diagnosis of innocent murmur (sensitivity of 100% and specificity of 80%).

[Prevalence of rheumatic fever in children from a public high school in Belo Horizonte]. / Prevalência da febre reumática em crianças de uma escola da rede pública de Belo Horizonte.

PURPOSE: To determine the prevalence of rheumatic fever (RF) among children of a public high school in Belo Horizonte, Brazil. METHODS: The study was performed from March to December/92, and involved high school students coming from families of the medium and low-medium social classes. Considering the total of 1,400 students registered in a public school and the estimated RF prevalence in the developing country, 729 students were randomly chosen to be interviewed and examined by a researcher. The children suspected of being affect by RF were submitted to echocardiography in order to find any cardiac lesions. RESULTS: Due to several different factors, only 550 students aging from 10 to 20 years were admitted in this study. Four children, previously under secondary prophylactics, had already had the diagnosis of RF. Among these children, only one had heart disease (combined mitral incompetence and stenosis, and aortic incompetence). From the other three children, only one had the diagnosis of RF confirmed according to the Jones criteria. CONCLUSION: From the ata obtained, the prevalence of RF was calculated in 3.6/1000.