RESUMO
BACKGROUND: Point of care ultrasound (POCUS) is specific for acute cholecystitis (AC), but surgeons request radiology imaging (RI) prior to admitting patients with POCUS-diagnosed AC. OBJECTIVES: We sought to determine the test characteristics of POCUS for AC when performed and billed by credentialed emergency physicians (EPs), the accuracy rate of RI when performed after POCUS, and the time added when RI is requested after POCUS demonstrates AC. METHODS: We performed a dual-site retrospective cohort study of admitted adult ED patients who had received biliary POCUS from November 1, 2020 to April 30, 2022. Patients with previously diagnosed AC, liver failure, ascites, hepatobiliary cancer, or cholecystectomy were excluded. Descriptive statistics and 95% confidence intervals for point estimates were calculated. Medians were compared using a Wilcoxon signed-rank test. Test characteristics of POCUS for AC were calculated using inpatient intervention for AC as the reference standard. RESULTS: Of 473 screened patients, 143 were included for analysis: 80 (56%) had AC according to our reference standard. POCUS was positive for AC in 46 patients: 44 true positives and two false positives, yielding a positive likelihood ratio of 17.3 (95%CI 4.4-69.0) for AC. The accuracy rate of RI after positive POCUS for AC was 39.0%. Median time from ED arrival to POCUS and ED arrival to RI were 115 (IQR 64, 207) and 313.5 (IQR 224, 541) minutes, respectively; p < 0.01. CONCLUSION: RI after positive POCUS performed by credentialed EPs takes additional time and may increase diagnostic uncertainty.
RESUMO
BACKGROUND: Single cell mRNA sequencing technologies have transformed our understanding of cellular heterogeneity and identity. For sensitive discovery or clinical marker estimation where high transcript capture per cell is needed only plate-based techniques currently offer sufficient resolution. RESULTS: Here, we present a performance evaluation of four different plate-based scRNA-seq protocols. Our evaluation is aimed towards applications taxing high gene detection sensitivity, reproducibility between samples, and minimum hands-on time, as is required, for example, in clinical use. We included two commercial kits, NEBNext® Single Cell/ Low Input RNA Library Prep Kit (NEB®), SMART-seq® HT kit (Takara®), and the non-commercial protocols Genome & Transcriptome sequencing (G&T) and SMART-seq3 (SS3). G&T delivered the highest detection of genes per single cell. SS3 presented the highest gene detection per single cell at the lowest price. Takara® kit presented similar high gene detection per single cell, and high reproducibility between samples, but at the absolute highest price. NEB® delivered a lower detection of genes but remains an alternative to more expensive commercial kits. CONCLUSION: For the tested kits we found that ease-of-use came at higher prices. Takara can be selected for its ease-of-use to analyse a few samples, but we recommend the cheaper G&T-seq or SS3 for laboratories where a substantial sample flow can be expected.
Assuntos
Benchmarking , Transcriptoma , Análise de Sequência de RNA/métodos , Reprodutibilidade dos Testes , Sequenciamento de Nucleotídeos em Larga Escala/métodos , RNA Mensageiro/genética , Perfilação da Expressão Gênica/métodos , Análise de Célula ÚnicaRESUMO
Las parasitosis intestinales representan uno de los problemas más importantes de salud en Venezuela desde los puntos de vista de salud pública y desarrollo socioeconómico. El objetivo de este trabajo fue determinar la prevalencia de enteroparásitos en niños menores de 12 años de 45 comunidades del estado Anzoátegui, Venezuela. Se analizaron 5.876 muestras mediante examen directo y concentración por Kato, y se describieron las características geotopográficas por municipios, señalándose el parásito marcador de la localidad. La prevalencia general fue de 74,6%, siendo significativamente mayor en niños de 4-9 años (53,8%). Globalmente predominaron los protozoarios (82,5%), Blastocystis spp. (25,9%), Giardia intestinalis (20,6%) y Entamoeba coli (18,4%). Entre los helmintos los más comunes fueron Ascaris lumbricoides (6,9%), Trichuris trichiura (6,4%) y anquilostomideos (2,7%). Se concluyó que existe una elevada prevalencia de enteroparasitosis en la población infantil evaluada de la geografía anzoatiguense, abarcando costa, región montañosa con su piedemonte y las planicies de la mesa de Guanipa. El poliparasitismo a expensas de comensales observado en algunas comunidades, alerta sobre las precarias condiciones de salubridad que poseen, particularmente respecto a la calidad sanitaria del agua de consumo. Se sugiere realizar actividades de intervención educativa frecuentes para disminuir este problema de salud pública.
Intestinal parasitic diseases represent one of the most important health problems in Venezuela from both public health and socioeconomic development points of view. The main objective of this study was to determine the prevalence of enteroparasites in children under 12 years old at 45 communities of Anzoategui State, Venezuela. The study included the analysis of 5,876 samples taken by direct examination and Kato concentration, and the geotopographic characteristics were described by municipality, identifying the marker parasite per locality. The overall prevalence was 74.6%, significantly higher in children 4-9 years old (53.8%). Globally, protozoa predominated (82.5%): Blastocytis spp. (25.9%), Giardia intestinalis (20.6%) and Entamoeba coli (18.4%). Among helmints, the most common were Ascaris lumbricoides (6.9%), Trichuris trichiura (6.4%), and hookworms (2.7%). It was concluded that there is a high prevalence of enteroparasites in the child population of the Anzoategui State geography evaluated, which includes a mountainous region with its piedmont and the plane regions of the Guanipa mesa. The polyparasitism at the expense of commensals observed in some communities reflects their precarious sanitary conditions, especially regarding the quality of the drinking water available, suggesting that health education activities be carried out frequently to decrease this public health problem.
RESUMO
El objetivo de este estudio fue determinar la prevalencia de Enterobius vermicularis en la población de menores de 12 años de edad, del área rural de la zona norte del estado Anzoátegui, Venezuela. Las poblaciones en estudio se describieron según municipios, características socioeconómicas de sus residentes y geotopografía. Fueron evaluados 2.423 niños mediante el método ovoscópico de Graham. La aplicación de la prueba de la cinta adhesiva permitió estimar una prevalencia de 19,4% de enterobiosis. Las diferencias entre las frecuencias de infección según edades y género no fueron significativas. Se evidenció un mayor porcentaje de infección en el género masculino que en el femenino (53,2% vs 46,8%) y, en general, en el rango etario de 7 a 12 años. Esta enterohelmintiosis presenta subregistros en el país, pues el método de la cinta adhesiva no se realiza de forma rutinaria para el diagnóstico sino la técnica coproparasitológica, que posee menor sensibilidad para visualizar los huevos o las formas adultas del verme.
The purpose of this study was to determine Enterobius vermicularis prevalence in children under 12 years old from rural areas of the northern part of Anzoátegui State, Venezuela. The populations under study were described by municipality, socio-economical characteristics of their residents, and geotopography. A total of 2,423 children were evaluated through the Graham ovoscopic method. The application of the adhesive band test gave a 19.4% estimated enterobiosis prevalence. Frequency of infection differences related to age and gender were not significant. There was a higher infection percentage in males than in females (53.2% versus 46.8%), and in general, the age range varied between 7 and 12 years. This enterohelminthiasis presents subregistrations in the country since the adhesive tape method is not used routinely for diagnosis but rather the coproparasitological technique, which is less sensitive for visualizing the eggs or adult forms of the parasite.
