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1.
Sci Rep ; 11(1): 6495, 2021 03 22.
Artículo en Inglés | MEDLINE | ID: mdl-33753817

RESUMEN

The majority of Plasmodium falciparum malaria diagnoses in Africa are made using rapid diagnostic tests (RDTs) that detect histidine-rich protein 2. Increasing reports of false-negative RDT results due to parasites with deletions of the pfhrp2 and/or pfhrp3 genes (pfhrp2/3) raise concern about existing malaria diagnostic strategies. We previously identified pfhrp2-negative parasites among asymptomatic children in the Democratic Republic of the Congo (DRC), but their impact on diagnosis of symptomatic malaria is unknown. We performed a cross-sectional study of false-negative RDTs in symptomatic subjects in 2017. Parasites were characterized by microscopy; RDT; pfhrp2/3 genotyping and species-specific PCR assays; a bead-based immunoassay for Plasmodium antigens; and/or whole-genome sequencing. Among 3627 symptomatic subjects, 427 (11.8%) had RDT-/microscopy + results. Parasites from eight (0.2%) samples were initially classified as putative pfhrp2/3 deletions by PCR, but antigen testing and whole-genome sequencing confirmed the presence of intact genes. 56.8% of subjects had PCR-confirmed malaria. Non-falciparum co-infection with P. falciparum was common (13.2%). Agreement between PCR and HRP2-based RDTs was satisfactory (Cohen's kappa = 0.66) and superior to microscopy (0.33). Symptomatic malaria due to pfhrp2/3-deleted P. falciparum was not observed. Ongoing HRP2-based RDT use is appropriate for the detection of falciparum malaria in the DRC.


Asunto(s)
Malaria/diagnóstico , Técnicas de Diagnóstico Molecular/normas , Plasmodium falciparum/genética , Adolescente , Antígenos de Protozoos/genética , Antígenos de Protozoos/inmunología , Niño , Reacciones Falso Negativas , Humanos , Malaria/parasitología , Técnicas de Diagnóstico Molecular/métodos , Plasmodium falciparum/inmunología , Plasmodium falciparum/aislamiento & purificación , Plasmodium falciparum/patogenicidad , Reacción en Cadena de la Polimerasa/métodos , Reacción en Cadena de la Polimerasa/normas , Proteínas Protozoarias/genética , Proteínas Protozoarias/inmunología , Juego de Reactivos para Diagnóstico/normas , Pruebas Serológicas/métodos , Pruebas Serológicas/normas
2.
Br J Ophthalmol ; 103(6): 743-747, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-29973367

RESUMEN

BACKGROUND/AIMS: To conduct an assessment of avoidable blindness, diabetes mellitus and diabetic retinopathy (DR) in adults aged 50 years and older in the National Capital District (NCD) region of Papua New Guinea (PNG). METHODS: A cross-sectional population-based survey was performed for which 25 clusters of 50 people aged ≥50 years were randomly selected from the NCD region. The standardised rapid assessment of avoidable blindness (RAAB) with diabetic retinopathy (+DR) methodology was used. Blindness was defined as presenting visual acuity <3/60 in the better eye. Participants were classified as having diabetes if they were known to have diabetes or if their random blood glucose level was ≥200 mg/dL. Dilated fundus examination and Scottish DR grading were performed. RESULTS: In total, 1192 out of 1250 eligible participants (95.4%) were examined. Of these, 7.8% had known or newly diagnosed diabetes. Seventy-one per cent of participants with known diabetes had a blood glucose level ≥200 mg/dL, and 82.9% had never had an ophthalmological examination for DR. Prevalence of DR and/or maculopathy was 46.4%. The age-adjusted and sex-adjusted prevalence of diabetes was estimated at 8.1% (95% CI 5.7% to 10.4%) in the population aged 50 years or older in the NCD region of PNG. CONCLUSIONS: Prevalence of diabetes in adults aged 50 years and older was lower than reported elsewhere in the region, and lower than other RAAB+DR surveys. Despite this, the prevalence of DR is high compared with other RAAB+DR surveys and demonstrates the need for increased awareness and accessibility to eye services for people with diabetes.


Asunto(s)
Ceguera/epidemiología , Retinopatía Diabética/complicaciones , Encuestas Epidemiológicas , Medición de Riesgo/métodos , Agudeza Visual , Distribución por Edad , Anciano , Anciano de 80 o más Años , Ceguera/diagnóstico , Ceguera/etiología , Estudios Transversales , Retinopatía Diabética/diagnóstico , Retinopatía Diabética/epidemiología , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Papúa Nueva Guinea/epidemiología , Prevalencia , Estudios Retrospectivos , Factores de Riesgo
3.
Parasit Vectors ; 12(1): 52, 2019 Jan 23.
Artículo en Inglés | MEDLINE | ID: mdl-30674346

RESUMEN

BACKGROUND: Vector-borne diseases are an important cause of morbidity and mortality in the USA. Effective, convenient prevention methods are needed. Long-lasting permethrin-impregnated (LLPI) clothing can prevent tick bites, however, additional information is needed on the real-world effectiveness and safety of this preventative measure. METHODS: In this pilot study, we recruited state and county park employees from North Carolina to wear LLPI uniforms for three months during the summer of 2016. We collected spot urine samples for biomonitoring of permethrin metabolites at one week, one month and three months after first use of the LLPI uniform. Following three months of wear, we collected pants and socks and analyzed them for permethrin content and mortality to ticks and mosquitoes. RESULTS: Thirteen park employees were included in the analysis. Bioactive amounts of permethrin remained in all clothing swatches tested, although there was great variability. Tick mortality was high, with 78% of pant and 88% of sock swatches having mean knockdown percentages ≥ 85%. In contrast, mosquito mortality was low. Over the study period, the absorbed dosage of permethrin averaged < 4 µg/kg/d of body weight based on measurements of three metabolites. CONCLUSIONS: LLPI clothing retained permethrin and bioactivity against ticks after three months of use in real-world conditions. The estimated absorbed dosage of permethrin was well below the U.S. EPA level of concern, suggesting that LLPI clothing can be used safely by outdoor workers for tick bite prevention.


Asunto(s)
Vestuario , Insecticidas/farmacocinética , Permetrina/farmacocinética , Adsorción , Animales , Mordeduras y Picaduras/prevención & control , Culicidae , Humanos , Repelentes de Insectos/farmacocinética , Mosquitos Vectores , North Carolina , Proyectos Piloto , Mordeduras de Garrapatas/prevención & control , Garrapatas
4.
Eur J Prev Cardiol ; 24(15): 1596-1609, 2017 10.
Artículo en Inglés | MEDLINE | ID: mdl-28762761

RESUMEN

Introduction Despite cardiac rehabilitation being recommended in clinical practice guidelines internationally these services are underutilised, programmes are not standardised and quality improvement methods and outcomes are rarely published. National registries are an important strategy to characterise service delivery, quality and outcomes, yet the number, type and components of national cardiac rehabilitation registries have not been reported. Aims To identify and describe national and international cardiac rehabilitation registries, and summarise their key features. Methods We systematically reviewed the literature reporting on cardiac rehabilitation registries at a national and international level. A search of four databases was conducted in July 2016, with two reviewers independently screening titles/abstracts and full texts for inclusion. Data were extracted from included studies, independently checked by a second reviewer and synthesised qualitatively. Results Eleven articles were included in the review comprising seven national registries and one international registry (of 12 European countries) for a total sample of 265,608 patients. Data were most commonly provided to the registry by a web-based application, and included individual-level data (i.e. sociodemographic characteristics, medical history, and clinical measurements). When reported, service-level data most commonly included wait times, programme enrolment and completion. The overarching governance, funding modes (e.g. industry ( n = 2), government ( n = 1)), and incentives for registry participation (e.g. benchmarking, financial reimbursement, or mandatory requirement) varied widely. Conclusion The use of national and international registries for characterising cardiac rehabilitation and providing a benchmark for quality improvement is in its early stages but shows promise for national and global benchmarking.


Asunto(s)
Rehabilitación Cardiaca/métodos , Cardiopatías/rehabilitación , Benchmarking , Rehabilitación Cardiaca/efectos adversos , Rehabilitación Cardiaca/mortalidad , Rehabilitación Cardiaca/normas , Estado de Salud , Disparidades en Atención de Salud , Cardiopatías/diagnóstico , Cardiopatías/mortalidad , Cardiopatías/fisiopatología , Humanos , Mejoramiento de la Calidad , Indicadores de Calidad de la Atención de Salud , Recuperación de la Función , Sistema de Registros , Resultado del Tratamiento
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