Evaluation of the GeneXpert MTB/RIF to diagnose tuberculosis in a public health laboratory

ABSTRACT OBJECTIVES To evaluate the performance of geneXpert MTB/Rif versus conventional methods (bacilloscopy and culture) in the diagnosis of tuberculosis in a Central Public Health Laboratory (LACEN, Tocantins), Northern Brazil. METHODS Retrospective study, with information from 1,973 suspected cases of tuberculosis from patients treated from January 2015 to December 2020. RESULTS From the culture (reference standard), the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the geneXpert MTB/Rif were 100%, 97%, 74%, 100%, and 97%, respectively, against 85%, 98%, 80%, 98%, and 97% of bacilloscopy. CONCLUSIONS The geneXpert MTB/Rif performed similarly to culture and better than bacilloscopy. Although positive cases with negative culture should be evaluated with caution, its routine use is important for the early detection of tuberculosis.

Polyphenol analysis in human milk by a rapid, cost-effective, and accurate micromethod: translational development / Análise de polifenóis no leite humano por meio de um micrométodo rápido, econômico e preciso: desenvolvimento translacional

ABSTRACT Objective: To develop a rapid method for analysing polyphenols, which are potentially active antioxidants against neonatal oxidative stress, from small human milk (HM) volumes. Methods: Acid and alkaline extractions were compared using two dyes: Folin-Ciocalteu and Fast Blue BB. Linearity, sensitivity, recovery percentage, polyphenol content, precision, and stability were assessed in 14 HM samples and compared using the Kruskal-Wallis H test (p<0.05). The best technique was applied to 284 HM samples to determine their polyphenolic content and its association with maternal diet by multifactorial linear regression. Results: Acidic extraction successfully recovered the gallic acid reference standard, whereas alkaline extraction overestimated it. Calibration curves for all methods were linear (R2>0.96) up to 500 mg/L. All bicarbonate-based Folin-Ciocalteu methods assayed were stable and repeatable, whereas Fast Blue BB-based variants were not. HM polyphenols (mean=94.68 mg/L) positively correlated to the dietary intake of hydroxycinnamic acids, the most consumed polyphenolic family in this population. Conclusions: A bicarbonate-based Folin-Ciocalteu micromethod allowed the accurate determination of polyphenols in HM, which might be useful for translational research settings and HM banks.

RESUMO Objetivo: Desenvolver um método rápido para analisar polifenóis, que são antioxidantes potencialmente ativos contra o estresse oxidativo neonatal, em pequenos volumes de leite humano (LH). Métodos: Foram comparadas extrações ácidas e alcalinas usando dois corantes: Folin-Ciocalteu e Fast Blue BB. Foram avaliadas variáveis como linearidade, sensibilidade, percentagem de recuperação, teor de polifenóis, precisão e estabilidade em 14 amostras de LH, comparadas usando o teste de Kruskal-Wallis H (p<0,05). A melhor técnica foi aplicada a 284 amostras de LH para determinar seu teor polifenólico e sua associação com a dieta materna por regressão linear multifatorial. Resultados: A extração ácida recuperou com sucesso o padrão de referência do ácido gálico, enquanto a extração alcalina o superestimou. As curvas de calibração para todos os métodos foram lineares (R2>0,96) até os 500 mg/L. Todos os métodos testados baseados em Folin-Ciocalteu com bicarbonato foram estáveis e repetíveis, enquanto as variantes baseadas em Fast Blue BB não. Os polifenóis do HM (média=94,68 mg/L) correlacionaram-se positivamente com a ingestão dietética de ácidos hidroxicinâmicos, a família de polifenóis mais consumida nesta população. Conclusões: Um micrométodo baseado em bicarbonato de Folin-Ciocalteu permitiu a determinação precisa de polifenóis no HM, o que pode ser útil para configurações de pesquisa translacional e bancos de HM.

Evaluation the scanning accuracy of Blue-Light laboratory scanners in complete edentulous Maxilla with multiple implants with titanium scan bodies / Evaluación de la precisión de escaneado de los escáneres de laboratorio de luz azul en maxilares desdentados completos con implantes múltiples con cuerpos de escaneado de titanio

Abstract To evaluate the accuracy of complete arch scanning with multiple implant titanium scan bodies using laboratory scanners. A master model of an edentulous maxillary arch with 6 implants was fabricated. Titanium scan bodies were inserted into the model. Three laboratory scanners were used: D2000 (3Shape), Vinyl High Resolution (Smart Optics), and inEos X5 (Dentsply Sirona). The master model was consecutively scanned ten times using dental laboratory scanners (LS) without detaching and repositioning the scan bodies. Linear and angular accuracy between adjacent implants was measured using inspection software (Control X, Geomagic). The accuracy of the complete arch scans was calculated. Implant regions were defined as; parallel (R1: #24-26 and #16-14), angled (R2: #22-24 and #14-12), angled to occlusal plane (R3: #12-22), and cross-arch (R4: #16-26). The effect of LS and implant region on accuracy was compared using two-Way ANOVA (α=0.05). Significant greater linear distortion was noted in R4 (61.2±17.9µm) compared to R1 (23.4±15.5µm) and R2 (26±17.7µm) (p<0.01). Greater linear distortions were noted in R4 with D2000 (0.07±0.016 degrees) and Vinyl High Resolution (0.067±0.02 degrees) than inEos X5 (0.032±0.021 degrees) (p>0.05). Greater mean linear precisions were noted in R1 (9±8µm) and R3 (9.3±8.3µm) than R4 (12.6±10.3µm) (p<0.05). The highest linear precision was noted in D2000 (7.2±7.6µm) (p<0.05). The angular precision of D2000 (0.02±0.015 degrees) was the highest (p<0.01). The angular precisión of R4 (0.036±0.018 degrees) was the lowest (p<0.01). This study revealed that the trueness was affected by the implant region and the precision was affected by both LS and implant region.

Resumen Evaluar la precisión del escaneado de la arcada completa con cuerpos de escaneado de titanio de múltiples implantes utilizando escáneres de laboratorio. Se fabricó un modelo maestro de una arcada maxilar edéntula con 6 implantes. Se insertaron cuerpos de escaneo de titanio en el modelo. Se utilizaron tres escáneres de laboratorio: D2000 (3Shape), Vinyl High Resolution (Smart Optics) e inEos X5 (Dentsply Sirona). El modelo maestro se escaneó consecutivamente diez veces usando escáneres de laboratorio dental (LS) sin separar y reposicionar los cuerpos de escaneo. La precisión lineal y angular entre implantes adyacentes se midió utilizando un software de inspección (Control X, Geomagic). Se calculó la precisión de los escaneos completos del arco. Las regiones del implante se definieron como; paralelo (R1: #24-26 y #16-14), angulado (R2: #22-24 y #14-12), angulado al plano oclusal (R3: #12-22) y cruzado (R4: #16-26). El efecto de LS y la región del implante en la precisión se comparó mediante ANOVA de dos vías (α=0,05). Se observó una distorsión lineal significativamente mayor en R4 (61,2±17,9µm) en comparación con R1 (23,4±15,5µm) y R2 (26 ±17,7µm) (p<0,01). Se observaron mayores distorsiones lineales en R4 con D2000 (0,07±0,016 grados) y vinilo de alta resolución (0,067±0,02 grados) que en inEos X5 (0,032±0,021 grados) (p>0,05). Se observaron precisiones lineales medias mayores en R1 (9±8µm) y R3 (9,3±8,3µm) que en R4 (12,6±10,3µm) (p<0,05). La mayor precisión lineal se observó en D2000 (7,2±7,6 µm) (p<0,05). La precisión angular de D2000 (0,02±0,015 grados) fue la más alta (p<0,01). La precisión angular de R4 (0,036±0,018 grados) fue la más baja (p<0,01). Este estudio reveló que la veracidad se vio afectada por la región del implante y la precisión se vio afectada tanto por LS como por la región del implante.

Primer registro de procedimientos de intervencionismo cardiovascular pediátrico realizados en un laboratorio estatal de hemodinamia pediátrica en El Salvador / First record of pediatric cardiovascular interventional procedures performed in a state pediatric catheterization laboratory in El Salvador

Resumen Objetivo: Describir los tipos de cateterismo cardiaco que se realizan en el único laboratorio de hemodinamia pediátrica dentro de la red de salud pública de El Salvador, en colaboración con organizaciones sin fines de lucro. Material y método: Se realizó un estudio descriptivo retrospectivo de corte transversal en el periodo entre mayo de 2022 a enero de 2023, revisando los expedientes de todos los pacientes que pasaron a cateterismo cardiaco. Resultados: Se realizaron 54 procedimientos dentro de la sala de hemodinamia, 37 pacientes de sexo femenino. El peso fue de 20.6 ± 14.5 kg, de los procedimientos, 47 (87%) fueron terapéuticos y 7 (13%) diagnósticos. La oclusión del conducto arterioso se realizó en el 46% de los pacientes. No se reportaron complicaciones, los pacientes fueron dados de alta luego de 12 horas, todos los insumos fueron donados por fundaciones sin fines de lucro. Conclusiones: Nuestro laboratorio de hemodinamia realiza procedimientos de complejidad variada sin reportar hasta el momento complicaciones mayores. Nos vemos limitados debido al costo alto de algunos dispositivos, a la baja frecuencia de la utilización de estos y a la imposibilidad para adquirirlos en el mercado nacional.

Abstract Objective: To describe the types of cardiac catheterization that are performed in the only pediatric catheterization laboratory within the public health network of El Salvador, in collaboration with non-profit organizations. Material and method: A descriptive, retrospective, cross-sectional study was conducted in the period from May 2022 to January 2023, reviewing the records of all patients who underwent cardiac catheterization. Results: 54 procedures were performed in the catheterization room, 37 female patients. The weight was 20.6 ± 14.5 kg, of the procedures, 47 (87%) were therapeutic and 7 (13%) diagnostic. Occlusion of the ductus arteriosus was performed in 46% of the patients. No complications were reported, the patients were discharged after 12 hours, all supplies were donated by non-profit foundations. Conclusions: Our catheterization laboratory performs procedures of varied complexity without reporting any major complications to date. We are limited due to the high cost of some devices, the low frequency of their use and the impossibility of acquiring them in the national market.

Integración de contenidos en la carrera de Bioanálisis Clínico desde una perspectiva social de la ciencia y la tecnología

El objetivo de la investigación fue valorar el proceso de integración de contenidos desde la disciplina Diagnóstico Integral de Laboratorio en la carrera de Bioanálisis Clínico desde una perspectiva social de la ciencia y la tecnología. De los métodos empíricos fueron utilizados la revisión documental y el análisis de documentos, así como la caracterización del estado actual del desarrollo de la técnica lámina periférica por los docentes y estudiantes del tercer año, en la que se identificaron insuficiencias que influyen en la preparación de este futuro profesional. A partir de la valoración realizada se argumentó la necesidad de elaborar una estrategia didáctica para la integración de los contenidos en la carrera de Bioanálisis Clínico lo que contribuirá a la preparación de los estudiantes y profesores.

The objective of the research was to assess the process of integration of contents from the Comprehensive Laboratory Diagnosis discipline in the Clinical Bioanalysis degree from a social perspective of science and technology. From the empirical methods, the documentary review and the analysis of documents were used, as well as the characterization of the current state of development of the peripheral lamina technique by teachers and students of the third year, in which insufficiencies were identified that influence the preparation of this future professional. Based on the assessment made, the need to develop a didactic strategy for the integration of the contents in the Clinical Bioanalysis career was argued, which will contribute to the preparation of students and teachers.

El valor de estar acreditados / The value of accreditation

Los laboratorios clínicos desempeñan un papel cada vez más central en el proceso de atención siendo líderes en el campo de la gestión de la calidad de la salud. Desde hace algunos años hay un creciente interés en la mejora de la calidad de aquellas actividades que tienen un alto impacto en la seguridad del paciente. En este contexto la acreditación constituye un recurso estratégico para garantizar un sistema de calidad. En el año 2020 el laboratorio obtiene la acreditación por norma IRAM ISO 15189, siendo el segundo laboratorio público acreditado por un estándar internacional en el país y el primero de un Hospital Pediátrico. Con un alcance inicial que involucra a las áreas de Química, Hematología, Serología, Endocrinología y Biología Molecular, continuamos trabajando para sostener y ampliar este alcance incluyendo entre otras, el área de Microbiología. Nuestra fortaleza más grande: el trabajo en equipo (AU)

Clinical laboratories play an increasingly central role in the care process and are leaders in the field of healthcare quality management. For some years now there has been a growing interest in improving the quality of those activities that have a high impact on patient safety. In this context, accreditation is a strategic resource to warrant the quality of the system. In 2020 the laboratory was granted accreditation by IRAM ISO 15189, being the second public laboratory accredited by an international standard in the country and the first in a pediatric hospital. With an initial coverage involving the areas of Chemistry, Hematology, Serology, Endocrinology, and Molecular Biology, we continue working to sustain and expand this coverage to include, among others, the area of Microbiology. Our greatest strength: teamwork (AU)

Clarified Butter as Xylene Substitute in Routine Histopathology of Oral and Maxillofacial Biopsies

Introduction: An ideal clearing agent should remove alcohol from the tissue specimens to enable the penetration of paraffin wax which provides sturdiness to the tissue specimen. Xylene has toxic effects and is still used because of its accurate clearing property and maintaining the staining quality. Natural alternatives to xylene provide a less toxic environment for histopathological technicians. Aim: The study is to evaluate the accuracy of clarified butter as xylene substitute in routine histopathological tissue processing procedure. Materials and Methods: 40 paired soft tissue specimens were obtained from the Department of Oral pathology and microbiology and subjected to routine histopathological tissue processing with xylene and ghee as clearing agents. Post processing, the tissue specimens were immersed in paraffin wax overnight, embedded, sectioned and stained using hematoxylin and eosin. Histopathological criteria namely nuclear staining, cytoplasmic staining, artefacts and background staining were evaluated and the scores were tabulated and statistical analysis was done using SPSS version 20 by IBM. Results: Our study results showed that tissue specimens processed in xylene and ghee had similar nuclear staining. In cytoplasmic staining, tissue specimens processed in ghee had superior results than xylene processing. Artefacts were present more in xylene processing than ghee processing. Background staining was more appreciated in xylene processed tissue specimens than ghee processing. Conclusion: Substituting xylene with ghee showed better results as a clearing agent in routine histopathological tissue processing. Ghee as a clearing agent is non toxic, cost effective compared to xylene and a safer alternative.

Laboratory derangements and clinical picture of Covid-19 in pediatric age group: A retrospective study

Aim: To assess the clinical presenta?on and laboratory derangements of pediatric covid-19 pa?ents admi?ed to the ter?ary care hospital. Methodology: The present retrospec?ve study was started a?er the approval of the Ins?tu?onal Ethics Commi?ee. Clinical (Sp02, final diagnosis and outcome) and biochemical parameters (Complete Blood Count, Liver Func?on Test, Renal Func?on Test, Lactate De-Hydrogenase, D-dimer, C-Reac?ve Protein, and Serum ferri?n) of pediatric covid-19 pa?ents were collected from Central Laboratory and Medical Record Department of our ins?tu?on. Pa?ent names were anonymized and data were analyzed. The results are expressed in percentages. Results: A total of 16 pediatric covid-19 pa?ent details were iden?fied and collected who were admi?ed during our study period. Out of 16 pa?ents, 09 (56.2%) were female and the remaining 07 (43.7%) were male. Out of 16, 05 pa?ents had mild covid, 07 were moderate and the remaining 04 suffered from severe covid-19 infec?on. The mean values of oxygen satura?on, LDH, D-dimer, CRP, and Ferri?n were 88%, 249.4U/L, 1140.9 ng/ml, 16.17 mg/dl, and 61.7 µg/L respec?vely. Mean values of 17.9 mg/dl and 0.4 mg/dl were recorded for blood urea and S.crea?nine. Regarding liver func?on tests, mean values of 1.7mg/dl, 0.2mg/dl, 1.5mg/dl, 82.4 U/L, 55 U/L, 135.6 U/L respec?vely noted for total bilirubin, direct, indirect, SGOT, SGPT and ALP. Regarding pa?ent outcomes, all the pa?ents were covered and discharged from the hospital. Conclusion: The present study has found an increase in laboratory mean values of liver func?on tests but the mean values of C-Reac?ve protein, LDH, and d-dimer which are the acute inflammatory markers are highly disrupted compared to normal ranges.

La hipertensión arterial en animales de laboratorio / High blood pressure in experimental animals

Las Ciencias Médicas y Biológicas requieren, prioritariamente, que la investigación y la experimentación sean desarrolladas sobre organismos completos (los modelos animales). Su utilización ha permitido desarrollar innumerables ensayos preclínicos para evaluar los mecanismos patógenos y terapéuticos de diversas enfermedades, así como el estudio de las causas, naturaleza y cura de múltiples desórdenes de la salud humana. En este trabajo se muestra una panorámica general de los biomodelos de hipertensión arterial donde se describen: conceptos, características, origen, importancia, utilidad y procedimientos experimentales durante su fase de inducción. También se pondera la justificación de los biomodelos empleados en los estudios preclínicos de esta enfermedad. De igual forma, se describen los antecedentes para medir las alteraciones, las técnicas y los métodos directos e indirectos de medición de la presión arterial, la cual fue provocada experimentalmente en los animales de laboratorio para realizar los estudios de hipertensión humana.

Medical and biological sciences require, as a priority, that research and experimentation be carried out on complete organisms (animal models). Its use has allowed the development of innumerable preclinical tests to evaluate pathogenic and therapeutic mechanisms of various diseases, as well as to study the causes, nature and cure of multiple human health disorders. In this work, we show a general overview of arterial hypertension biomodels where concepts, characteristics, origin, importance, utility and experimental procedures during their induction phase are described. The justification of the biomodels used in preclinical studies of this disease is also considered. Antecedents are also described to measure alterations, techniques and direct and indirect methods of measurement of arterial pressure, which was provoked experimentally in the laboratory animals to carry out the studies of human hypertension.

An overview of mycetoma and its diagnostic dilemma: Time to move on to advanced techniques

The neglected tropical disease mycetoma can become extremely devastating, and can be caused both by fungi and bacteria; these are popularly known as eumycetoma and actinomycetoma respectively. The classical triad of the disease is subcutaneous swelling, multiple discharging sinuses and the presence of macroscopic granules. The present study aims to highlight the existing diagnostic modalities and the need to incorporate newer and more advanced laboratory techniques like pan fungal/pan bacterial 16S rRNA gene polymerase chain reaction (PCR) and sequencing, Matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS), rolling circle amplification (RCA), loop-mediated isothermal amplification (LAMP) and recombinase polymerase amplification (RPA). It is important for the medical team to be aware of the various diagnostic options (both existing and future), so that diagnosis of such a debilitating disease is never missed, both by clinicians and microbiologists/pathologists. The newer diagnostic methods discussed in this article will help in rapid, accurate diagnosis thus facilitating early treatment initiation, and decreasing the overall morbidity of the disease. In the Indian context, newer technologies need to be made available more widely. Making clinicians aware and promoting research and development in mycetoma diagnostics is the need of the hour.

Laboratory reports as a learning tool – Early clinical exposure in 1st-year MBBS physiology (Hematology)

Background: Early clinical exposure (ECE) aims to bridge the gap between pre-clinical and clinical subjects. ECE exposes students to the health-care system at an early stage of professional life, follows patient-centered approach, and increases motivation for classroom learning. Most of the studies have reported a positive attitude of students toward ECE. However, very few studies have reported the difficulties that may be faced by the students during implementation of ECE. Aim and Objectives: The aim of this was to explore the attitude of students and difficulties faced if any during implementation of ECE in 1st MBBS Physiology (Hematology) with the help of laboratory reports and clinical scenarios. Materials and Methods: One hundred and ten students participated after completion of theory and practical classes of hematology. Clinical scenarios and laboratory forms were prepared based on actual laboratory reports of patients from pathology department. Group discussions and discussion with faculty was done. Attitude of the students was noted. Results: Most of the students found this method to be interesting and better than routine methods, helped in better understanding of theory and practical concepts, and helped in better preparation for examinations and better clinical correlations. However, about half of the students agreed or were not sure about the difficulty of ECE. Conclusion: The positive attitude of the students shows that ECE provides a successful integration of basic science and clinical subjects. It also helps in understanding the relevance of a basic science subject. Concepts of the subjects are made easier and interesting by ECE. However, the difficulties faced by the students should be kept in mind and more practice sessions may be done

Laboratory Monitoring of Non-Vitamin K Antagonist Oral Anticoagulants and Their Use in Special Populations / 中山大学学报(医学科学版)

In the past few decades， heparin and warfarin have been the main anticoagulants used to treat and prevent venous thromboembolism. Recent studies at home and abroad have shown that non-vitamin K antagonist oral anticoagulants （NOACs） have similar or better efficacy and safety in the prevention and treatment of venous thromboembolism and non-valvular atrial fibrillation. NOACs do not require routine coagulation monitoring when used at a fixed dose. However， in special populations or specific scenarios such as emergency surgery， etc.， an overdose or underdose and abnormal metabolism of NOACs may reduce the drug efficacy and safety， so monitoring and evaluating the anticoagulant effect of NOACs is more conducive to the prognosis of patients.This paper briefly reviewed the common laboratory monitoring methods of NOACs and their use in special populations， aiming to explain different monitoring methods for different NOACs and the applicability of NOACs in special populations， and hoping to provide reference for clinical standard monitoring and use of NOACS.

Awareness and knowledge of the pelvic inflammatory disease, its risk factors and diagnostic procedures among female undergraduates in tertiary institutions in Rivers State, Nigeria

Aims@#This study was designed to evaluate awareness and knowledge of pelvic inflammatory disease (PID), its risk factors and diagnostic procedures among female undergraduates in tertiary institutions in Rivers State, Nigeria.@*Methodology and results@#A questionnaire-based survey design was conducted among 325 undergraduate students. Completed questionnaires were retrieved immediately. Descriptive and inferential (chi-square test) statistical tools were used for data analysis. Out of the 325 respondents, 186(57.2%) had heard of PID, 162(49.8%) did not know the possible risk factors of PID, 161(49.5%) perceived their awareness level of PID to be poor, while 30(9.2%) had good awareness level of PID. The majority 185(56.9%) of the respondents, do not know the mode of transmission of PID. There was a statistically significant relationship between the student’s age and the level of awareness statement at (p<0.05). On the student’s knowledge, only the statement: Do you know PID could be symptomless, showed a statistically significant relationship with the student’s course of study (χ2=12.815, p=0.00).@*Conclusion, significance and impact of study@#Most respondents have heard of PID via social media and seminars and have even seen those who had the disease. They still claim that their awareness level was poor since they do not know the mode of transmission and ill effects of PID, and so they cannot be protected against the disease. A sensitization campaign on risk factors, symptoms and mode of spread of the disease has to be carried out in the institutions to save the students at high risk of the infection.

Advances of development and application amino acid biosensors / 生物工程学报

Amino acids are the basic building blocks of protein that are very important to the nutrition and health of humans and animals, and widely used in feed, food, medicine and daily chemicals. At present, amino acids are mainly produced from renewable raw materials by microbial fermentation, forming one of the important pillar industries of biomanufacturing in China. Amino acid-producing strains are mostly developed through random mutagenesis- and metabolic engineering-enabled strain breeding combined with strain screening. One of the key limitations to further improvement of production level is the lack of efficient, rapid, and accurate strain screening methods. Therefore, the development of high-throughput screening methods for amino acid strains is very important for the mining of key functional elements and the creation and screening of hyper-producing strains. This paper reviews the design of amino acid biosensors and their applications in the high-throughput evolution and screening of functional elements and hyper-producing strains, and the dynamic regulation of metabolic pathways. The challenges of existing amino acid biosensors and strategies for biosensor optimization are discussed. Finally, the importance of developing biosensors for amino acid derivatives is prospected.

Survey on the Construction Status of Forensic Virtual Autopsy Laboratory and the Applicability of Laboratory Accreditation / 法医学杂志

OBJECTIVES@#To survey the development status and actual needs of virtual autopsy technology in China and to clarify the applicability of forensic virtual autopsy laboratory accreditation.@*METHODS@#The questionnaire was set up included three aspects：(1) the current status of virtual autopsy technology development; (2) the accreditation elements such as personnel, equipment, entrustment and acceptance, methods, environmental facilities; (3) the needs and suggestions of practicing institutions. A total of 130 forensic pathology institutions were surveyed by online participation through the Questionnaire Star platform.@*RESULTS@#Among the 130 institutions, 43.08% were familiar with the characteristics of virtual autopsy technology, 35.38% conducted or received training in virtual autopsy, and 70.77% have establishment needs (including maintenance). Relevant elements were suitable for laboratory accreditation.@*CONCLUSIONS@#Virtual autopsy identification has gained social recognition. There is a demand for accreditation of forensic virtual autopsy laboratory. After the preliminary assessment, considering the characteristics and current situation of this technology, China National Accreditation Service for Conformity Assessment (CNAS) can first carry out the accreditation pilot of virtual autopsy project at large comprehensive forensic institutions with higher identification capability, and then CNAS can popularize the accreditation in a wide range when the conditions are suitable.

Características e diagnóstico laboratorial das infecções causadas pelo hantavírus: revisão integrativa / Characteristics and laboratory diagnosis of infections caused by hantavirus: integrative review

A hantavirose é uma zoonose de distribuição mundial que utiliza como vetores roedores, musaranhos, toupeiras e morcegos. Os sintomas da infecção pelo hantavírus assemelham-se aos de diversas doenças, por isso o diagnóstico laboratorial é crucial para o tratamento precoce. Objetivo: Realizar uma revisão da literatura sobre as características e diagnóstico laboratorial da hantavirose. Métodos: Trata-se de uma revisão integrativa da literatura com base no modelo PRISMA, com seleção de estudos nas bases de dados Portal de Periódicos da Capes, PubMed/Medline, SciELO, ScienceDirect e Biblioteca Virtual em Saúde (BVS). Foram empregados os descritores: hantavírus, diagnóstico laboratorial, exames e zoonose, em português e inglês, no período de 2015 a 2022, sendo selecionados 19 artigos científicos em atendimento aos critérios de inclusão. Resultados e Discussão: Diversas técnicas diagnósticas podem ser empregadas em casos de hantavirose, sendo a biologia molecular a mais empregada, conjuntamente com a imunologia. Há outros recursos utilizados para monitoramento e evolução da doença, como a bioquímica, a hematologia e a imagenologia. Para a ocorrência de hantavirose é necessário um ambiente propício, clima específico e contato com hospedeiro suscetível, podendo evoluir para quadros assintomáticos ou sintomáticos com complicações graves. Conclusão: O diagnóstico dessa doença é desafiador e requer investigação detalhada que inclua a sintomatologia do paciente, o histórico de exposição a animais reservatórios e os resultados de exames laboratoriais. Como desfechos negativos da hantavirose incluem-se a febre hemorrágica com síndrome renal, a síndrome pulmonar por hantavírus e o óbito

Hantavirus is a worldwide distributed zoonosis that uses rodents, shrews, moles and bats as vectors. The symptoms of hantavirus infection resemble those of many diseases, so laboratory diagnosis is crucial for early treatment. Objective: The present study aimed to conduct a literature review on the characteristics and laboratory diagnosis of hantavirus. Methods: This is an integrative literature review based on the PRISMA model, with a selection of studies in the Capes Portal de Periódicos, PubMed/Medline, SciELO, ScienceDirect and Virtual Health Library databases, using the descriptors: hantavirus, laboratory diagnosis, exams, and zoonosis, in portuguese and english, from 2015 to 2022, and nineteen scientific articles that met the inclusion criteria were selected. Results and Discussion: Several techniques can be used in cases of hantavirus, with molecular biology being the most evidenced along with immunology. There are other parameters that are used for monitoring and evolution of the disease, such as biochemistry, hematology, and imaging. For the hantavirus disease, an adequate environment, specific climate and contact with a susceptible host are necessary, which may lead to asymptomatic conditions or symptoms with more serious complications. Conclusion: The diagnosis of this disease is challenging and requires detailed investigation that includes the patient's symptoms, the history of exposure to reservoir animals and the results of laboratory tests. Negative outcomes of hantavirus infection include hemorrhagic fever with renal syndrome, hantavirus pulmonary syndrome, and death

Sistema Obligatorio de Garantía de Calidad en Salud: aplicación al laboratorio clínico / Mandatory Quality Assurance System in Health: application to the clinical laboratory

En 1993, el Estado estableció el Sistema General de Seguridad Social en Salud, en el que se introdujeron los diferentes mecanismos legales para promover la calidad en las instituciones prestadoras de servicios de salud en el país. A partir de allí, se implantaron diferentes decretos. En la actualidad, el Sistema Obligatorio de Garantía de Calidad en Salud (SOGCS) se encuentra reglamentado en el Decreto 780 de 2016, Decreto Único Reglamentario del Sector Salud. El SOGCS está integrado por cuatro componentes principales: el Sistema Único de Habilitación (SUH), la Auditoría para el Mejoramiento de la Calidad, el Sistema Único de Acreditación (SUA) y el Sistema de Información para la Calidad en Salud, para dirigir y evaluar el desempeño de estas instituciones en términos de calidad y satisfacción social; además, se adoptó el Manual de Inscripción de Prestadores y Habilitación de Servicios de Salud, el cual contiene las condiciones mínimas que deben cumplir los servicios de salud ofertados y prestados en el país, para brindar seguridad a los usuarios en el proceso de la atención en salud. Dicho manual tiene por objeto definir las condiciones de verificación para la habilitación, como la capacidad técnico-administrativa, suficiencia patrimonial y financiera, y la capacidad tecnológica y científica. En este artículo se revisarán algunos conceptos generales del Sistema Obligatorio de Garantía de Calidad en Salud, así como los estándares y criterios de habilitación para laboratorios clínicos

In 1993, the State established the General System of Social Security in Health, in which different legal mechanisms were introduced to promote quality in the institutions providing health services in the country. From then on, different decrees were implemented. Currently, the Mandatory Health Quality Assurance System (SOGCS) is regulated by Decree 780 of 2016, the Sole Regulatory Decree of the Health Sector. SOGCS is made up of four main components: the Single Qualification System (SUH), the Audit for Quality Improvement, the Single Accreditation System (SUA) and the Health Quality Information System, to direct and evaluate the performance of these institutions in terms of quality and social satisfaction; in addition, the Health Services Provider Registration and Qualification Manual was adopted, which contains the minimum conditions that health services in the country must meet to provide security to users in the health care process. The purpose of this manual is to define the verification conditions for accreditation, such as technical-administrative capacity, patrimonial and financial sufficiency, and technological and scientific capacity. This article will review some general concepts of the Mandatory System of Quality Assurance in Health, as well as the standards and qualification criteria for clinical laboratories

Conservação de peças anatômicas em cloreto de sódio: um estudo com produto de fecundação / Conservation of anatomical parts in sodium chloride: a study with fertilization product / Conservación de partes anatómicas en cloruro sódico: un estudio con producto de fertilización

Introdução: Os materiais de origem humana geralmente são conservados em formaldeído, para possibilitar o estudo da anatomia humana, tal conservante possui baixo custo e boa fixação, contudo é toxico. Diante do exposto é necessário, o estudo de outros métodos de conservação, menos prejudiciais, como a solução de NaCl 30%. Objetivo: Comparar a conservação de peças anatômicas em solução de NaCl à 30% e formaldeído a 10%. Método: Pesquisa experimental, exploratória e descritiva, realizada com dois produtos de abortamento, no laboratório de anatomia de uma universidade pública, no estado do Paraná/BR. Foi realizada fixação em solução de formol 10%, em seguida uma amostra foi lavado em água corrente e armazenado em solução de NaCl à 30%. Após 6 meses da conservação em solução salina, foram coletadas amostras, estas foram submetidas a análise de crescimento bacteriano. Avaliou-se tonalidade e turgor cutâneo, odor e peso, bem como crescimento bacteriano. O estudo seguiu os preceitos éticos (CAAE: 53740121.9.0000.9247). Resultados: Foram realizadas observações após 24h, 7, 30, 60, 90 e 180 dias. O feto em solução de NaCl não possui odor, e diminuição do turgor da pele. Ambas a amostras não apresentaram crescimento bacteriano. Considerações finais: A solução de NaCl a 30% desidrata a pele, mas não altera significativamente a forma e estrutura, ainda não possui odor e nem toxicidade, o que garante benefícios a saúde de quem os manipula, bem como tal concentração de NaCl inibe de forma efetiva o crescimento bacteriano nos tecidos e na própria solução, se demostrando eficaz na conservação.

Introduction: The materials of human origin are usually preserved in formaldehyde, to enable the study of human anatomy, this preservative has low cost and good fixation, however it is toxic. Therefore, it is necessary to study other less harmful preservation methods, such as 30% NaCl solution. Objective: To compare the preservation of anatomical specimens in 30% NaCl solution and 10% formaldehyde solution. Method: Experimental, exploratory and descriptive research, carried out with two abortion products, in the anatomy laboratory of a public university, in the state of Paraná/BR. Fixation in 10% formaldehyde solution was performed, after which a sample was washed in running water and stored in a 30% NaCl solution. After 6 months of preservation in saline solution, samples were collected and submitted to bacterial growth analysis. Skin tone and turgor, odor, weight, and bacterial growth were evaluated. The study followed the ethical precepts (CAAE: 53740121.9.0000.9247). Results: Observations were made after 24h, 7, 30, 60, 90 and 180 days. The fetus in NaCl solution had no odor, and decreased skin turgor. Both samples showed no bacterial growth. Final considerations: The 30% NaCl solution dehydrates the skin, but does not alter significantly the shape and structure, and also has no odor or toxicity, which guarantees health benefits to those who handle them, and such concentration of NaCl inhibits effectively the bacterial growth in the tissues and in the solution itself, proving to be effective in conservation.

Introducción: Los materiales de origen humano suelen conservarse en formol, para posibilitar el estudio de la anatomía humana, este conservante tiene bajo coste y buena fijación, sin embargo es tóxico. Por ello, es necesario estudiar otros métodos de conservación menos nocivos, como la solución de NaCl al 30%. Objetivo: Comparar la conservación de especímenes anatómicos en solución de NaCl al 30% y en solución de formaldehído al 10%. Método: Investigación experimental, exploratoria y descriptiva, realizada con dos abortos, en el laboratorio de anatomía de una universidad pública, en el estado de Paraná/BR. Fue realizada fijación en solución de formaldehído al 10%, después de lo cual la muestra fue lavada en agua corriente y almacenada en solución de NaCl al 30%. Tras 6 meses de conservación en solución salina, se recogieron las muestras y se sometieron a análisis de crecimiento bacteriano. Se evaluaron el tono y la turgencia de la piel, el olor, el peso y el crecimiento bacteriano. El estudio siguió los preceptos éticos (CAAE: 53740121.9.0000.9247). Resultados: Las observaciones se realizaron después de 24h, 7, 30, 60, 90 y 180 días. El feto en solución de NaCl no tenía olor, y la turgencia de la piel disminuyó. Ambas muestras no mostraron crecimiento bacteriano. Consideraciones finales: La solución de NaCl al 30% deshidrata la piel, pero no altera significativamente la forma y estructura, además no tiene olor ni toxicidad, lo que garantiza beneficios para la salud de quienes los manipulan, y dicha concentración de NaCl inhibe eficazmente el crecimiento bacteriano en los tejidos y en la propia solución, demostrando ser eficaz en la conservación.

Cognitive abilities and medical students' practice of physical exams: A quasi-experimental study

ABSTRACT BACKGROUND: To highlight the importance of clinical simulations and simulated laboratories for student training, especially in physical examination teaching. OBJECTIVE: To evaluate the gains obtained by medical students in their cognitive and practical performance of physical examinations (abdominal, cardiological, and pulmonary), as well as satisfaction and self-confidence in what they have learned, after concentrated practice developed in a skills and simulation laboratory. DESIGN AND SETTING: A quantitative and quasi-experimental study in which 48 students were evaluated at the Faculdade de Odontologia de Bauru, São Paulo, Brazil. METHODS: A quantitative and descriptive study was conducted with regularly enrolled 2nd year medical students over 18 years of age who had content prior to data collection regarding anamnesis and physical examination remotely taught in a Moodle virtual learning environment. For data collection, the participants were subjected to a concentrated period of skill training (abdominal, cardiological, and pulmonary). Every day after the skill training session, they were subjected to a practical evaluation and completed a theoretical test before and after the practical activities. At the end of all activities, they answered the instrument to assess the simulated practices (self-confidence and satisfaction). RESULTS: Among the 49 students evaluated, positive and significant theoretical and practical gains were identified in all three components (abdominal, cardiological, and pulmonary) (P = 0.000), as well as in the general evaluation (Theoretical 1 and Theoretical 2) (P = 0.000), satisfaction, and self-confidence (P = 0.000). CONCLUSION: Concentrated laboratory practice resulted in positive improvements in students' physical examination skills.

Indicadores morfométricos de la corteza cerebral frontal de gazapos de ratas Wistar con diabetes pregestacional

Introducción: La diabetes es una enfermedad que afecta el embarazo provoca complicaciones fetales; dentro de ellas son frecuentes las malformaciones congénitas. Por la imposibilidad práctica y ética de estudiar este proceso en gestantes es imprescindible realizar estudios experimentales empleando procedimientos morfométricos para determinar si la diabetes afecta el neurodesarrollo. Objetivo: Caracterizar morfométricamente la sustancia gris de gazapos de ratas Wistar normales y con diabetes mellitus pregestacional. Métodos: Se realizó un estudio experimental básico de serie de casos a 20 gazapos de ratas Wistar de los cuales 10 eran descendientes de diabetes pregestacional. Se caracterizaron indicadores morfométricos del tejido nervioso como espesor de corteza e indicadores nucleares como el perímetro. Resultados: La media de la altura de la sustancia gris cortical mostró un valor de 1,224 ± 303,7 μm para el grupo control y 1,014 ± 376,0 para los casos, al aplicar el test de diferencias de medias se encontró diferencia significativa (p ≤ 0,05) a favor del grupo control. Los valores de la media del perímetro nuclear en el grupo control fue de 42,80 ± 7,23 μm y en el grupo experimental el promedio fue de 39,68 ± 6,52 μm, al aplicar el test de diferencias de medias se encontró diferencia significativa (p ≤ 0,05) a favor del grupo control al presentar mayor perímetro nuclear. Conclusiones: El mayor espesor cortical y perímetro nuclear correspondió al grupo control evidenciándose el efecto deletéreo de la diabetes mellitus en el neurodesarrollo.

Introduction: Diabetes is a disease that affects pregnancy causing fetal complications; within them congenital malformations are frequent. Due to the practical and ethical impossibility of studying this process in pregnant women, it is essential to carry out experimental studies using morphometric procedures to determine if diabetes affects neurodevelopment. Objective: To characterize morphometrically the gray matter of kits from normal Wistar rats and those with pregestational diabetes mellitus. Methods: A basic experimental study of a series of cases was carried out on 20 young Wistar rats, of which 10 were descendants of pregestational diabetes. Morphometric indicators of the nervous tissue were characterized as thickness of the cortex and nuclear indicators such as perimeter. Results: The average height of the cortical gray matter showed a value of 1.224 ± 303.7 μm for the control group and 1.014 ± 376.0 μm for the cases. When applying the mean difference test, a significant difference was found (p ≤ 0.05) in favor of the control group. The values of the measurement of the nuclear perimeter in the control group was 42.80 ± 7.23 μm and in the experimental group the average was 39.68 ± 6.52 μm. When applying the mean different test, a significant difference was found (p ≤ 0.05) at favor of control group presenting greater nuclear perimeter. Conclusions: The greatest cortical thickness and nuclear perimeter corresponded to the control group, evidencing the deleterious effect os diabetes mellitus on neurodevelopment.