ABSTRACT
We evaluated the performance of a commercial rapid diagnostic test (RDT) in a field setting for the diagnosis of abdominal cystic echinococcosis (CE) using sera collected during an ultrasound population screening in a highly endemic region of the Peruvian Andes. Abdominal CE was investigated by ultrasonography. Sera collected from individuals with abdominal CE (cases) and age- and gender-matched volunteers with no abdominal CE (controls) were tested independently in two laboratories (Peru and Italy) using the VIRapid® HYDATIDOSIS RDT and RIDASCREEN® Echinococcus IgG enzyme-linked immunosorbent assay. Performance indexes of single and serially combined tests were calculated and applied to hypothetical screening and clinical scenarios. Test concordance was also evaluated. Prevalence of abdominal CE was 6.00% (33 of 546) by ultrasound. Serum was obtained from 33 cases and 81 controls. The VIRapid test showed similar sensitivity (76% versus 74%) and lower specificity (79% versus 96%) than results obtained in a hospital setting. RDTs showed better performance when excluding subjects reporting surgery for CE and if weak bands were considered negative. Concordance between tests was moderate to very good. In hypothetical screening scenarios, ultrasound alone or confirmed by RDTs provided more reliable prevalence figures than serology alone, which overestimated it by 5 to 20 times. In a simulation of case diagnosis with pre-test probability of CE of 50%, positive and negative post-test probabilities of the VIRapid test were 78% and 22%, respectively. The application of the VIRapid test alone would not be reliable for the assessment of population prevalence of CE, but could help clinical decision making in resource-limited settings.
Subject(s)
Antibodies, Helminth/blood , Diagnostic Tests, Routine/methods , Echinococcosis/diagnosis , Echinococcosis/therapy , Echinococcus/genetics , Serologic Tests/methods , Adolescent , Adult , Aged , Aged, 80 and over , Animals , Child , Child, Preschool , Echinococcosis/epidemiology , Epidemiological Monitoring , Female , Humans , Male , Middle Aged , Peru/epidemiology , Young AdultABSTRACT
Objetivo. Describir la producción científica sobre la terapia floral (TF) y su uso en enfermedades con manifestación orgánica que se publicó en la literatura médica, en los últimos cinco años. Materiales y métodos. Estudio de revisión bibliográfica y documental en Internet, en sitios especializados de medicina complementaria como BVS MTCI Américas Medicinas Tradicionales Complementarias e Integrativas, artículos sobre terapia floral o flores de Bach y su aplicación en enfermedades con manifestación orgánica. Resultados. Dos estudios de uso de terapia floral en hipertensión arterial, una con tratamiento conjunto con captopril, otro de terapia floral como rescate, muestran resultadosfavorables para los pacientes. El uso de la terapia floral en dos niños con vitíligo obtuvo resultados positivos a las 4 semanas, y a los 5 años de seguimiento no se presentó despigmentación. El uso de la terapia floral en pacientes con síndrome de túnel carpiano luego del tratamiento con crema de TF indicó resultados satisfactorios. Conclusiones. La terapia floral viene mostrando más beneficios en el control de las enfermedades con mayor manifestación clínica de tipo orgánico.
Objective. To describe the scientific production on Floral Therapy (FT) and its use in diseases with organic manifestation that was published in the medical literature, in the last five years. Material and methods. Study of bibliographic and documentary review on the Internet, in specialized sites of Complementary Medicine such as BVS MTCI Americas Complementary and Integrative Traditional Medicines, articles with floral therapy or Bach flowers, its application in diseases with organic manifestation. Results. two studies of the use of floral therapy in Hypertension, one with joint treatment with Captopril, another of floral therapy as rescue, both studies show favorable results for patients. The use of floral therapy in two children with Vitiligo, floral therapy cream was used with positive results at 4 weeks, at 5 years of follow-up they do not show depigmentation. The use of floral therapy in patients with Carpal Tunnel Syndrome after treatment with FT cream the results were satisfactory. Conclusion. Floral therapy has been showing more benefits in the control of diseases with greater clinical manifestation of an organic type.
