ABSTRACT
Introducción: El síndrome de ojo seco es una enfermedad subdiagnosticada. El método diagnóstico más utilizado es la medición del tiempo de rotura de la lágrima con fluoresceína (TRLf). Sin embargo, no hay una prueba de referencia. Objetivo: Estimar la correlación del TRLf y el tiempo de rotura lagrimal no invasivo (TRLNI) con el puntaje del cuestionario OSDI (Ocular Surface Disease Index). Método: Estudio transversal. Se incluyeron 60 ojos de 30 pacientes mayores de edad que asistían a consulta de oftalmología en una clínica especializada de Cali, Colombia. Se recolectó por medio del cuestionario OSDI la sintomatología asociada y se tomó el TRLNI con el topógrafo corneal por personal calificado. El TRLf se tomó de la historia clínica. Se realizaron correlaciones con método de Kendall, Kappa y Spearman. Resultados: La mediana del TRLf para el ojo derecho (OD) fue de 15.2 s (6.4-22.4) y para el ojo izquierdo (OI) de 15.3 s (6.2-22.6). La mediana del TRLNI para el OD fue de 7.5 s (2.6-17.7) y para el OI de 6.7 s (1.4-17.1). El 36.6% de los pacientes presentaron TRLf < 10 s y el 70.0% por TRLNI. El coeficiente de correlación de Kendall mostró OD tau-b 0,2966 y OI tau-b 0,3065. La correlación del puntaje OSDI y el tiempo de rotura de la lágrima fue negativa, pero no significativa. Conclusiones: El TRLNI fue más corto que el TRLf. La correlación del puntaje del cuestionario OSDI fue moderada para ambos métodos.
Introduction: Dry eye syndrome is a sub diagnose disease. The diagnostic method most commonly used is the fluorescein tear break up time (fBUT). However, there is no gold test. Objective: To estimate the correlation of fBUT, non-invasive tear break up time (NIBUT) and with the score of the Ocular Surface Disease Index (OSDI). Method: Cross-sectional study. 60 eyes of 30 adult patients attending an ophthalmology clinic in Cali, Colombia were included. The associated symptomatology was collected through the OSDI questionnaire and the NIBUT was taken with the corneal topograph by qualified personnel. The fBUT was taken from the medical records. Correlations were made with the method of Kendall, Kappa and Spearman. Results: The median fBUT for the right eye (OD): 15.2 (6.4-22.4 s) and left eye (OS): 15.3 (6.2-22.6). The median of the TRLNI of the OD:7.5 (2.6-17.7 s) and OS 6.7 (1.4-17.1 s). 36.6% of the patients presented fBUT < 10 s and 70.0% due to NIBUT. The Kendall correlation coefficient showed OD: tau-b: 0.2966 and OS: tau-b: 0.3065. The correlation of the OSDI score and tear break time was negative but not significant. Conclusions: NIBUT had shorter tear film rupture time compared to the fluorescein method. The correlation of OSDI questionnaire score was moderate for both methods.
Subject(s)
Humans , Male , Female , Adult , Middle AgedABSTRACT
Since its 2013 emergence in the Americas, Chikungunya virus (CHIKV) has posed a serious threat to public health. Early and accurate diagnosis of the disease, though currently lacking in clinics, is integral to enable timely care and epidemiological response. We developed a dual detection system: a CHIKV antigen E1/E2-based enzyme-linked immunosorbent assay (ELISA) and a lateral flow test using high-affinity anti-CHIKV antibodies. The ELISA was validated with 100 PCR-tested acute Chikungunya fever samples from Honduras. The assay had an overall sensitivity and specificity of 51% and 96.67%, respectively, with accuracy reaching 95.45% sensitivity and 92.03% specificity at a cycle threshold (Ct) cutoff of 22. As the Ct value decreased from 35 to 22, the ELISA sensitivity increased. We then developed and validated two lateral flow tests using independent antibody pairs. The sensitivity and specificity reached 100% for both lateral flow tests using 39 samples from Colombia and Honduras at Ct cutoffs of 20 and 27, respectively. For both lateral flow tests, sensitivity decreased as the Ct increased after 27. Because CHIKV E1/E2 are exposed in the virion surfaces in serum during the acute infection phase, these sensitive and specific assays demonstrate opportunities for early detection of this emerging human pathogen.
Subject(s)
Antigens, Viral/analysis , Chikungunya Fever/diagnosis , Chikungunya virus/immunology , Chikungunya virus/isolation & purification , Enzyme-Linked Immunosorbent Assay , Immunoassay , Antibodies, Viral/immunology , Antigens, Viral/immunology , Chikungunya Fever/virology , Colombia , Honduras , Humans , Sensitivity and Specificity , Serologic Tests , Viral Envelope Proteins/immunologyABSTRACT
Diagnosing dengue in endemic areas remains problematic because of the low specificity of the symptoms and lack of accurate diagnostic tests. This study aimed to develop and prospectively validate, under routine care, dengue diagnostic clinical algorithms. The study was carried out in two phases. First, diagnostic algorithms were developed using a database of 1,130 dengue and 918 non-dengue patients, expert opinion, and literature review. Algorithms with > 70% sensitivity were prospectively validated in a single-group quasi-experimental trial with an adaptive Bayesian design. In the first phase, the algorithms that were developed with the continuous Bayes formula and included leukocytes and platelet counts, in addition to selected signs and symptoms, showed the highest sensitivities (> 80%). In the second phase, the algorithms were applied on admission to 1,039 consecutive febrile subjects in three endemic areas in Colombia of whom 25 were laboratory-confirmed dengue, 307 non-dengue, 514 probable dengue, and 193 undetermined. Including parameters of the hemogram consistently improved specificity without affecting sensitivity. In the final analysis, considering only confirmed dengue and non-dengue cases, an algorithm with a sensitivity and specificity of 65.4% (95% credibility interval 50-83) and 40.1% (34.7-45.7) was identified. All tested algorithms had likelihood ratios close to 1, and hence, they are not useful to confirm or rule out dengue in endemic areas. The findings support the use of hemograms to aid dengue diagnosis and highlight the challenges of clinical diagnosis of dengue.