Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.777
Filtrar
2.
J Allergy Clin Immunol ; 146(1): 35-43, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32479758

RESUMO

Severe acute respiratory syndrome coronavirus 2 infection and development of coronavirus disease 2019 presents a major health care challenge of global dimensions. Laboratory diagnostics of infected patients, and the assessment of immunity against severe acute respiratory syndrome coronavirus 2, presents a major cornerstone in handling the pandemic. Currently, there is an increase in demand for antibody testing and a large number of tests are already marketed or are in the late stage of development. However, the interpretation of test results depends on many variables and factors, including sensitivity, specificity, potential cross-reactivity and cross-protectivity, the diagnostic value of antibodies of different isotypes, and the use of antibody testing in identification of acutely ill patients or in epidemiological settings. In this article, the recently established COVID-19 Task Force of the German Society for Clinical Chemistry and Laboratory Medicine (DGKL) addresses these issues on the basis of currently available data sets in this rapidly moving field.


Assuntos
Anticorpos Antivirais/sangue , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Testes Imunológicos/métodos , Pneumonia Viral/diagnóstico , Testes Sorológicos/métodos , Betacoronavirus , Infecções por Coronavirus/sangue , Infecções por Coronavirus/imunologia , Humanos , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/imunologia
4.
PLoS One ; 15(2): e0228857, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32053643

RESUMO

OBJECTIVE: Hepatocellular carcinoma (HCC) has become a pressing health problem facing the world today due to its high morbidity, high mortality, and late discovery. As a diagnostic criteria of HCC, the exact threshold of Alpha-fetoprotein (AFP) is controversial. Therefore, this study was aimed to systematically estimate the performance of AFP in diagnosing HCC and to clarify its optimal threshold. METHODS: Medline and Embase databases were searched for articles indexed up to November 2019. English language studies were included if both the sensitivity and specificity of AFP in the diagnosis of HCC were provided. The basic information and accuracy data included in the studies were extracted. Combined estimates for sensitivity and specificity were statistically analyzed by random-effects model using MetaDisc 1.4 and Stata 15.0 software at the prespecified threshold of 400 ng/mL, 200 ng/mL, and the range of 20-100 ng/mL. The optimal threshold was evaluated by the area under curve (AUC) of the summary receiver operating characteristic (SROC). RESULTS: We retrieved 29,828 articles and included 59 studies and 1 review with a total of 11,731 HCC cases confirmed by histomorphology and 21,972 control cases without HCC. The included studies showed an overall judgment of at risk of bias. Four studies with AFP threshold of 400 ng/mL showed the summary sensitivity and specificity of 0.32 (95%CI 0.31-0.34) and 0.99 (95%CI 0.98-0.99), respectively. Four studies with AFP threshold of 200 ng/mL showed the summary sensitivity and specificity of 0.49 (95%CI 0.47-0.50) and 0.98 (95%CI 0.97-0.99), respectively. Forty-six studies with AFP threshold of 20-100 ng/mL showed the summary sensitivity and specificity of 0.61 (95%CI 0.60-0.62) and 0.86 (95%CI 0.86-0.87), respectively. The AUC of SROC and Q index of 400 ng/mL threshold were 0.9368 and 0.8734, respectively, which were significantly higher than those in 200 ng/mL threshold (0.9311 and 0.8664, respectively) and higher than those in 20-100 ng/mL threshold (0.8330 and 0.7654, respectively). Furthermore, similar result that favored 400 ng/mL were shown in the threshold in terms of AFP combined with ultrasound. CONCLUSION: AFP levels in serum showed good accuracy in HCC diagnosis, and the threshold of AFP with 400 ng/mL was better than that of 200 ng/mL in terms of sensitivity and specificity no matter AFP is used alone or combined with ultrasound.


Assuntos
Carcinoma Hepatocelular/diagnóstico , alfa-Fetoproteínas/análise , alfa-Fetoproteínas/metabolismo , Área Sob a Curva , Biomarcadores Tumorais/sangue , Biometria , Carcinoma Hepatocelular/metabolismo , Estudos de Casos e Controles , Confiabilidade dos Dados , Bases de Dados Factuais , Humanos , Testes Imunológicos , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/metabolismo , Curva ROC , Sensibilidade e Especificidade
5.
BMC Infect Dis ; 20(1): 130, 2020 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-32050915

RESUMO

BACKGROUND: Extrapulmonary tuberculosis (EPTB) poses diagnostic challenges due to the paucibacillary nature of the disease. The immunochemistry-based MPT64 antigen detection test (MPT64 test) has shown promising results for diagnosing EPTB in previous studies performed in low-resource settings, with higher sensitivity than microscopy and culture. The aim of this study was to investigate the performance of the MPT64 test in a routine clinical setting in a high-income low TB prevalence country. METHODS: Extrapulmonary samples sent for TB diagnostics to microbiology and pathology laboratories at three regional tertiary care hospitals in Norway in a one-year period were included and subjected to the MPT64 test in parallel to the routine TB diagnostic tests. RESULTS: Samples from 288 patients were included and categorised as confirmed TB cases (n = 26), clinically diagnosed TB cases (n = 5), non-TB cases (n = 243) and uncategorised (n = 14), using a composite reference standard (CRS). In formalin-fixed biopsies, the sensitivity (95% CI) of the MPT64 test, microscopy, PCR-based tests pooled, and culture was 37% (16-62), 20% (4-48), 37% (16-62) and 50% (23-77), respectively, against the CRS. The MPT64 test showed a good positive predictive value (88%) and an excellent specificity (99, 95% CI 92-100) in formalin-fixed biopsies. In fine-needle aspirates, pus and fluid samples, the test performance was lower. CONCLUSIONS: The MPT64 test was implementable in pathology laboratories as part of routine diagnostics, and although the sensitivity of the MPT64 test was not better than culture in this setting, the test supplements other rapid diagnostic methods, including microscopy and PCR-based tests, and can contribute to strengthen the diagnosis of EPTB in formalin-fixed biopsies in the absence of culture confirmation.


Assuntos
Antígenos de Bactérias/imunologia , Testes Imunológicos/métodos , Tuberculose/diagnóstico , Adulto , Biópsia por Agulha Fina , Feminino , Humanos , Renda , Masculino , Microscopia , Pessoa de Meia-Idade , Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/imunologia , Mycobacterium tuberculosis/patogenicidade , Noruega/epidemiologia , Reação em Cadeia da Polimerase , Prevalência , Sensibilidade e Especificidade , Tuberculose/epidemiologia
6.
BMC Infect Dis ; 20(1): 91, 2020 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-32000709

RESUMO

BACKGROUND: We compared the cryptococcal antigen detection and imaging findings between immunocompetent and immunocompromised patients in whom pulmonary cryptococcosis had been diagnosed. The aim of our study was to determine whether the patient's immune status and radiography affect the detection of cryptococcal antigen. METHODS: According to whether they took immunosuppressive drugs or not, seventy and eight adult patients with pulmonary cryptococcosis were divided into two groups: the immunocompetent group and the immunocompromised group. According to the detection of CrAg, each group was divided into the CrAg+ group and the CrAg- group. Then, clinical records, laboratory examinations and computed tomography findings were collected and analyzed. RESULTS: No difference was found in baseline characteristics, clinical symptoms, and laboratory investigations. By comparing CrAg detection in these two groups, it was found that the number of CrAg+ cases in the immunocompetent group was more than that in the immunocompromised group. And in the immunocompetent group, diffuse lesions were more common in CrAg+ group and limited lesions were more frequently observed in CrAg- group. CONCLUSIONS: The patient's immune status and radiography would affect the detection of cryptococcal antigen. And serum CrAg could be a useful tool for the diagnosis of pulmonary cryptococcosis in immunocompetent patients with extensive lung involvement.


Assuntos
Antígenos de Fungos/sangue , Criptococose/diagnóstico por imagem , Criptococose/imunologia , Cryptococcus neoformans/imunologia , Hospedeiro Imunocomprometido , Pneumopatias Fúngicas/diagnóstico por imagem , Pneumopatias Fúngicas/imunologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criptococose/tratamento farmacológico , Testes Diagnósticos de Rotina/métodos , Feminino , Seguimentos , Humanos , Testes Imunológicos , Imunossupressores/uso terapêutico , Pneumopatias Fúngicas/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Adulto Jovem
7.
Mol Immunol ; 120: 1-12, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32044430

RESUMO

Mus m 1.0102 is a member of the mouse Major Urinary Protein family, belonging to the Lipocalins superfamily. Major Urinary Proteins (MUPs) are characterized by highly conserved structural motifs. These include a disulphide bond, involved in protein oxidative folding and protein structure stabilization, and a free cysteine residue, substituted by serine only in the pheromonal protein Darcin (MUP20). The free cysteine is recognized as responsible for the onset of inter- or intramolecular thiol/disulphide exchange, an event that favours protein aggregation. Here we show that the substitution of selected cysteine residues modulates Mus m 1.0102 protein folding, fold stability and unfolding reversibility, while maintaining its allergenic potency. Recombinant allergens used for immunotherapy or employed in allergy diagnostic kits require, as essential features, conformational stability, sample homogeneity and proper immunogenicity. In this perspective, recombinant Mus m 1.0102 might appear reasonably adequate as lead molecule because of its allergenic potential and thermal stability. However, its modest resistance to aggregation renders the protein unsuitable for pharmacological preparations. Point mutation is considered a winning strategy. We report that, among the tested mutants, C138A mutant acquires a structure more resistant to thermal stress and less prone to aggregation, two events that act positively on the protein shelf life. Those features make that MUP variant an attractive lead molecule for the development of a diagnostic kit and/or a vaccine.


Assuntos
Alérgenos/química , Alérgenos/imunologia , Proteínas/química , Proteínas/imunologia , Alérgenos/genética , Substituição de Aminoácidos , Animais , Linhagem Celular , Cisteína/química , Humanos , Testes Imunológicos , Ligantes , Camundongos , Modelos Moleculares , Mutagênese Sítio-Dirigida , Conformação Proteica , Dobramento de Proteína , Estabilidade Proteica , Estrutura Secundária de Proteína , Proteínas/genética , Proteínas Recombinantes/química , Proteínas Recombinantes/genética , Proteínas Recombinantes/imunologia , Espectrometria de Fluorescência , Espectroscopia de Infravermelho com Transformada de Fourier
10.
J Med Virol ; 92(4): 408-417, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31944312

RESUMO

Respiratory tract viral infection caused by viruses or bacteria is one of the most common diseases in human worldwide, while those caused by emerging viruses, such as the novel coronavirus, 2019-nCoV that caused the pneumonia outbreak in Wuhan, China most recently, have posed great threats to global public health. Identification of the causative viral pathogens of respiratory tract viral infections is important to select an appropriate treatment, save people's lives, stop the epidemics, and avoid unnecessary use of antibiotics. Conventional diagnostic tests, such as the assays for rapid detection of antiviral antibodies or viral antigens, are widely used in many clinical laboratories. With the development of modern technologies, new diagnostic strategies, including multiplex nucleic acid amplification and microarray-based assays, are emerging. This review summarizes currently available and novel emerging diagnostic methods for the detection of common respiratory viruses, such as influenza virus, human respiratory syncytial virus, coronavirus, human adenovirus, and human rhinovirus. Multiplex assays for simultaneous detection of multiple respiratory viruses are also described. It is anticipated that such data will assist researchers and clinicians to develop appropriate diagnostic strategies for timely and effective detection of respiratory virus infections.


Assuntos
Infecções por Adenovirus Humanos/diagnóstico , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Influenza Humana/diagnóstico , Infecções por Picornaviridae/diagnóstico , Infecções por Vírus Respiratório Sincicial/diagnóstico , Infecções Respiratórias/diagnóstico , Humanos , Imunoensaio , Testes Imunológicos , Reação em Cadeia da Polimerase Multiplex , Técnicas de Amplificação de Ácido Nucleico , Reação em Cadeia da Polimerase em Tempo Real , Rhinovirus , Vírus/crescimento & desenvolvimento , Vírus/isolamento & purificação
12.
Med Clin North Am ; 104(1): 25-44, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31757236

RESUMO

Anaphylaxis is an acute systemic allergic reaction that can be life threatening. In adults, the most common causes of anaphylaxis are foods, drugs, and insect stings. This article reviews the definition, classification, evaluation, differential diagnosis, prognosis, complications, and management of anaphylaxis. Tailored for internists, the article focuses on anaphylactic medication allergies. It provides a guide to optimally evaluate and manage patients with antibiotic allergy using a simple, rapid risk stratification technique, graded antibiotic challenge (test dose), and/or allergist-guided drug desensitization. It also reviews other causes of anaphylaxis that internists are likely to encounter, and an approach to their management.


Assuntos
Anafilaxia/diagnóstico , Medicina Interna/métodos , Diagnóstico Diferencial , Humanos , Testes Imunológicos/métodos
15.
Indian Pediatr ; 56(11): 951-957, 2019 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-31729325

RESUMO

Childhood allergies pose huge economic burden and adverse effects on quality of life. Serum IgE has been considered a surrogate allergy marker for decades. Availability of several over-the-counter allergy tests add to confusion of partially trained caregivers. The present review focuses on current status of allergy testing in Indian scenario. Various in-vitro and in-vivo diagnostic modalities are available for allergy detection. Skin prick tests are useful for aero-allergies whereas oral challenge tests are best for identifying suspected food allergies. An allergy test should be individualized based on clinical features, diagnostic efficacy, and cost-benefit analysis.


Assuntos
Hipersensibilidade/diagnóstico , Testes Imunológicos , Criança , Análise Custo-Benefício , Humanos , Hipersensibilidade/classificação , Hipersensibilidade/psicologia , Testes Imunológicos/economia , Testes Imunológicos/métodos , Qualidade de Vida , Resultado do Tratamento
18.
Bioanalysis ; 11(17): 1593-1604, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31697206

RESUMO

Understanding of the determinants of immunogenicity, the testing paradigm, the impact of antibody attributes on clinical outcomes and regulatory guidance is leading to harmonized practices for immunogenicity assessment of biotherapeutics. However, generation of robust immunogenicity data for inclusion in product labels to support clinical practice continues to be a challenge. Assays, protocols and antibody positive controls/standards need to be developed in sufficient time to allow assessment of clinical immunogenicity using validated methods and optimized protocols. Standardization and harmonization play a significant role in achieving acceptable results. Harmonization in the postapproval setting is crucial for a valid interpretation of the product's immunogenicity and its clinical effects. Efforts are ongoing to standardize assays where possible for antibody measurement and for measuring product/drug levels by producing reference standards. Provision of such standards will help toward personalized treatment strategies with better patient outcomes.


Assuntos
Produtos Biológicos/imunologia , Testes Imunológicos/normas , Anticorpos Neutralizantes/análise , Anticorpos Neutralizantes/imunologia , Produtos Biológicos/uso terapêutico , Medicamentos Biossimilares , Aprovação de Drogas , Humanos , Padrões de Referência
19.
Artigo em Inglês | MEDLINE | ID: mdl-31703438

RESUMO

Background: Despite a potential link between immunoglobulin E (IgE) levels and cardiovascular disease, the effect of elevated total IgE levels on long-term mortality risk remains unclear. We prospectively investigated the association between total serum IgE levels and all-cause and cardiovascular mortality in US adults. Methods: We analyzed data from the 2005-2006 National Health and Nutrition Examination Survey (NHANES) and the NHANES (2005-2006) Linked Mortality Public File. The 2005-2006 NHANES data of 1496 older adults aged ≥50 years and who underwent a serum total IgE antibody test in the initial survey were included. Results: After a median follow-up of 119 months, a significant association was observed between total serum IgE levels and cardiovascular mortality, with subjects with the highest total IgE exhibiting a 3.19-fold (HR = 3.19; 95% confidence interval: 1.71-5.96) increase in the risk of cardiovascular mortality compared with those with the lowest total IgE (≤16.80 kU/L). Furthermore, the mortality rate increased with an increase in total IgE levels, regardless of baseline history of cardiovascular diseases (e.g., myocardial infarction, stroke, and noninvasively diagnosed large-vessel peripheral arterial disease). Conclusions: This finding suggests that the elevation of IgE levels may be a risk factor for increased cardiovascular mortality.


Assuntos
Doenças Cardiovasculares/imunologia , Doenças Cardiovasculares/mortalidade , Imunoglobulina E/sangue , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/sangue , Estudos de Coortes , Feminino , Humanos , Testes Imunológicos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio , Inquéritos Nutricionais , Estudos Prospectivos , Fatores de Risco , Estados Unidos/epidemiologia
20.
Asian Pac J Cancer Prev ; 20(11): 3385-3389, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31759363

RESUMO

INTRODUCTION: An elevated serum PSA is the only biomarker routinely used in screening for prostate cancer to indicate a prostate biopsy. However, it is not specific for prostate cancer and the neutrophil/lymphocyte ratio has been suggested as an alternative. We present a prospective study of men with an elevated PSA and compare the neutrophil/lymphocyte ratio, free percent PSA, PSA density and the presence of circulating prostate cells to detect clinically significant prostate cancer at first biopsy. PATIENTS AND METHODS: Prospective study of consecutive men with a PSA 4-10 ng/ml referred for initial prostate biopsy, the results were compared with the neutrophil/lymphocyte ratio, free percent PSA and PSA density. Circulating prostate cells (CPCs) were detected using immunocytochemistry. The blood sample was taken immediately before the prostate biopsy. RESULTS: 1,223 men participated, 38% (467) of whom had prostate cancer detected, of these 322 were clinically significant. The area under the curves were for neutrophil/lymphocyte ratio, free percent PSA, PSA density and CPC detection were 0.570, 0.785, 0,620 and 0.844 respectively. Sensitivity/specificity were 0.388/0.685, 0.419/0.897, 0.598/0.624 and 0.966/0.786 respectively. The neutrophil/lymphocyte ratio did not differentiate between benign and malignant disease. CONCLUSIONS: The neutrophil/lymphocyte ratio did not discriminate between benign and malignant prostatic disease in patients with a PSA between 4-10ng/ml.


Assuntos
Linfócitos/patologia , Células Neoplásicas Circulantes/patologia , Neutrófilos/patologia , Antígeno Prostático Específico/metabolismo , Neoplasias da Próstata/patologia , Idoso , Biópsia/métodos , Humanos , Imuno-Histoquímica/métodos , Testes Imunológicos/métodos , Linfócitos/metabolismo , Masculino , Pessoa de Meia-Idade , Células Neoplásicas Circulantes/metabolismo , Neutrófilos/metabolismo , Estudos Prospectivos , Próstata/metabolismo , Próstata/patologia , Neoplasias da Próstata/metabolismo , Sensibilidade e Especificidade
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA