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1.
Euro Surveill ; 25(24)2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32583765

RESUMEN

Containment strategies and clinical management of coronavirus disease (COVID-19) patients during the current pandemic depend on reliable diagnostic PCR assays for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Here, we compare 11 different RT-PCR test systems used in seven diagnostic laboratories in Germany in March 2020. While most assays performed well, we identified detection problems in a commonly used assay that may have resulted in false-negative test results during the first weeks of the pandemic.


Asunto(s)
Betacoronavirus/genética , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/diagnóstico , Equipo para Diagnóstico , Neumonía Viral/diagnóstico , Técnicas de Laboratorio Clínico/instrumentación , Heces/virología , Alemania , Humanos , Laboratorios , Reacción en Cadena de la Polimerasa Multiplex/instrumentación , Reacción en Cadena de la Polimerasa Multiplex/métodos , Pandemias , Reacción en Cadena en Tiempo Real de la Polimerasa/instrumentación , Reacción en Cadena en Tiempo Real de la Polimerasa/métodos , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa/instrumentación , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa/métodos , Sensibilidad y Especificidad
3.
Artículo en Español | PAHO-IRIS | ID: phr-51862

RESUMEN

[RESUMEN]. La Comisión Lancet de Hipertensión determinó que una medida clave para responder a la carga mundial que representa la hipertensión arterial era mejorar la calidad de las mediciones de la presión arterial, mediante la utilización de dispositivos cuya exactitud haya sido validada. En la actualidad existen 3000 dispositivos comercializados, pero muchos no tienen datos publicados sobre pruebas de exactitud conformes a las normas científicas establecidas. La falta de regulación o su ineficiencia, que permiten la autorización de dispositivos para uso comercial sin una validación oficial, posibilitan este problema. Además, han surgido tecnologías nuevas de medición de la presión arterial (por ejemplo, los sensores sin brazalete) sobre las cuales no existe unanimidad en la comunidad científica con respecto a las normas de exactitud de la medición. En conjunto, estos aspectos contribuyen a la disponibilidad generalizada de tensiómetros de consultorio o domiciliarios que ofrecen una exactitud limitada o incierta, que llevan a diagnósticos, manejo y farmacoterapia inapropiados de la hipertensión a escala mundial. Los problemas más importantes relacionados con la exactitud de los dispositivos de medición de la presión arterial se pueden resolver mediante el requisito regulatorio de una validación independiente obligatoria de los dispositivos, en consonancia con la norma ISO universalmente aceptada. Esta es una recomendación básica y constituye una necesidad internacional acuciante. Otras recomendaciones clave son la elaboración de normas de validación específicas para las tecnologías nuevas de medición de la presión arterial y la publicación en línea de listas de los dispositivos nuevos exactos que están a la disposición de los usuarios y los profesionales de salud. Las recomendaciones están en consonancia con las políticas de la Organización Mundial de la Salud sobre los dispositivos médicos y la atención universal de la salud. El cumplimiento de las recomendaciones aumentará la disponibilidad mundial de dispositivos de medición de la presión arterial que sean exactos y tendrá como efecto un mejor diagnóstico y tratamiento, reduciendo así la carga mundial de la hipertensión.


[ABSTRACT]. The Lancet Commission on Hypertension identified that a key action to address the worldwide burden of high blood pressure (BP) was to improve the quality of BP measurements by using BP devices that have been validated for accuracy. Currently, there are over 3 000 commercially available BP devices, but many do not have published data on accuracy testing according to established scientific standards. This problem is enabled through weak or absent regulations that allow clearance of devices for commercial use without formal validation. In addition, new BP technologies have emerged (e.g. cuffless sensors) for which there is no scientific consensus regarding BP measurement accuracy standards. Altogether, these issues contribute to the widespread availability of clinic and home BP devices with limited or uncertain accuracy, leading to inappropriate hypertension diagnosis, management and drug treatment on a global scale. The most significant problems relating to the accuracy of BP devices can be resolved by the regulatory requirement for mandatory independent validation of BP devices according to the universally-accepted International Organization for Standardization Standard. This is a primary recommendation for which there is an urgent international need. Other key recommendations are development of validation standards specifically for new BP technologies and online lists of accurate devices that are accessible to consumers and health professionals. Recommendations are aligned with WHO policies on medical devices and universal healthcare. Adherence to recommendations would increase the global availability of accurate BP devices and result in better diagnosis and treatment of hypertension, thus decreasing the worldwide burden from high BP.


[RESUMO]. A Comissão Lancet sobre Hipertensão Arterial identificou que uma iniciativa central para enfrentar a carga mundial da hipertensão arterial seria a melhoria na qualidade da mensuração da pressão arterial pelo uso aparelhos de pressão arterial validados quanto à acurácia. Atualmente, existem mais de 3 000 aparelhos de pressão arterial disponíveis comercialmente; entretanto, muitos não têm dados publicados sobre testes de acurácia realizados de acordo com padrões científicos estabelecidos. Este problema resulta de regulamentação fraca ou inexistente, o que permite a aprovação para uso comercial de dispositivos sem validação formal. Além disso, surgiram novas tecnologias de mensuração da pressão arterial (por exemplo, sensores sem algemas) sem consenso científico quanto aos padrões de acurácia. No conjunto, essas questões contribuem para a oferta generalizada de dispositivos de pressão arterial clínica e domiciliar com acurácia limitada ou incerta, levando a diagnóstico, gerenciamento e tratamento inadequados da hipertensão em escala global. Os problemas mais significativos relacionados com a acurácia dos dispositivos de pressão arterial podem ser resolvidos por regulamentação que imponha a obrigatoriedade de validação independente dos aparelhos de pressão arterial, de acordo com a norma universalmente aceita pela Organização Internacional de Normalização. Esta é uma recomendação fundamental para a qual existe uma necessidade internacional urgente. Outras recomendações essenciais incluem o desenvolvimento de padrões de validação especificamente para novas tecnologias de mensuração da pressão arterial e listas on-line de aparelhos com acurácia adequada que sejam acessíveis aos consumidores e profissionais de saúde. As recomendações estão alinhadas com as políticas da Organização Mundial da Saúde (OMS) sobre dispositivos médicos e atenção universal à saúde. A adesão às recomendações aumentaria a oferta global de dispositivos de pressão arterial com acurácia adequada e resultaria em melhor diagnóstico e tratamento da hipertensão arterial, diminuindo assim a carga mundial dessa doença.


Asunto(s)
Salud Global , Tecnología Biomédica , Estándares de Referencia , Equipo para Diagnóstico , Salud Global , Tecnología Biomédica , Estándares de Referencia , Equipo para Diagnóstico , Salud Global , Tecnología Biomédica , Estándares de Referencia , Equipo para Diagnóstico
4.
IEEE Trans Biomed Circuits Syst ; 13(6): 1141-1151, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31443050

RESUMEN

An 8-channel wearable wireless device for ambulatory surface EEG monitoring and analysis is presented. The entire multi-channel recording, quantization, and motion artifact removal circuitries are implemented on a 4-layer polyimide flexible substrate. The recording electrodes and active shielding are also integrated on the same substrate, yielding the smallest form factor compared to the state of the art. Thanks to the dry non-contact electrodes, the system is quickly mountable with minimal assistance required, making it an ideal ambulatory front- and temporal-lobe EEG monitoring device. The flexible main board is connected to a rechargeable battery on one end and to a 13 × 17 mm 2 rigid board on the other end. The mini rigid board hosts a low-power programmable FPGA and a BLE 5.0 transceiver, which add diagnostic capability and wireless connectivity features to the device, respectively. Design considerations for a wearable EEG monitoring and diagnostic device are discussed in details. The theory of the novel fully-analog method for motion artifact detection and removal is described and the detailed circuit implementation is presented. The device performance in terms of voltage gain (260 V/V), bandwidth (DC-300 Hz), motion artifact removal, and wireless communication throughput (up to 1 Mbps) is experimentally validated. The entire wearable solution with the battery weighs 9.2 grams.


Asunto(s)
Electroencefalografía/instrumentación , Diseño de Equipo/métodos , Monitoreo Ambulatorio/instrumentación , Amplificadores Electrónicos , Artefactos , Equipo para Diagnóstico , Humanos , Procesamiento de Señales Asistido por Computador , Dispositivos Electrónicos Vestibles , Tecnología Inalámbrica/instrumentación
5.
Zhongguo Yi Liao Qi Xie Za Zhi ; 43(4): 238-242, 2019 Jul 30.
Artículo en Chino | MEDLINE | ID: mdl-31460711

RESUMEN

In order to detect freezing of gait of Parkinson's patients automatically, a system based on inertial measurement unit to detect freezing of gait for Parkinson's patients is established. The two inertial measurement units are respectively fixed on the left and right ankles of the patient to be measured, the freezing index is calculated by windowed Fourier transform, the freezing threshold is calculated based on the freezing index during normal walking, and the freezing index and the freezing threshold are compared to complete the detection of freezing of gait. The experimental results show that the number of freezing of gait occurrences in Parkinson's patients is accurately detected, and it has high sensitivity and specificity, which can assist doctors to objectively assess the patient's condition.


Asunto(s)
Equipo para Diagnóstico , Trastornos Neurológicos de la Marcha , Enfermedad de Parkinson , Equipo para Diagnóstico/normas , Trastornos Neurológicos de la Marcha/diagnóstico , Trastornos Neurológicos de la Marcha/etiología , Humanos , Enfermedad de Parkinson/complicaciones , Sensibilidad y Especificidad , Caminata
7.
New Microbiol ; 42(3): 150-155, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31305935

RESUMEN

The aim of the study is to propose a multidimensional second-level diagnostic assessment to allow follow- up in the event physicians observe the presence of risk factors and/or active co-morbidities in HIV-infected patients. To develop our proposal, we chose the Delphi method that has been used for about 30 years in the healthcare field. The CISAI Group (Coordinamento Italiano per lo Studio dell'Allergia in Infezione da HIV) conducted this study. The first phase of the study provided identification of the questionnaire for second-level diagnostic assessment of HIV-infected patients. From March to July 2018 the questionnaire was submitted to 48 experts from 10 Italian HIV-dedicated sites. The questionnaire consisted of 102 items divided into 7 survey areas. The results can be summarized as follows: infectious disease diagnostics, 18 items reached agreement in 9 cases; osteoporosis diagnostics 12 items with 3 agreements; metabolic and cardiovascular diagnostics 13 items with 4 agreements; nephrology diagnostics 19 items with 8 agreements; hepatology diagnostics 12 items with 9 agreements; CNS diagnostics: 18 items with 7 agreements; psychological diagnostics and quality of life assessment (QoL) 10 items with no agreement. If these considerations are confirmed in required discussions and in-depth analyses, they will be able to produce an important indication in the drafting of national guidelines.


Asunto(s)
Técnica Delfos , Infecciones por VIH , Comorbilidad , Equipo para Diagnóstico/normas , Infecciones por VIH/complicaciones , Infecciones por VIH/diagnóstico , Humanos , Comunicación Interdisciplinaria , Italia , Calidad de Vida , Factores de Riesgo , Encuestas y Cuestionarios
8.
Undersea Hyperb Med ; 46(1): 1-6, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31154680

RESUMEN

Hypoxia is one of the main problems an underwater diver may have to face. The probability of experiencing hypoxia is related to the type of dive and the equipment used. Hypoxia in diving is a potentially fatal event for the diver, as it can lead to the loss of brain functions and consequently to the loss of breathing control, all in the absence of specific premonitory symptoms. It is a risk that may be encountered more frequently by divers who use a closed-circuit rebreather (CCR). For those who use this type of equipment, hypoxia is usually the most frequent cause of death [1]. Our study was aimed at the detection of peripheral oxygen saturation in order to identify, in the future, a preclinical hypoxic condition. We combined the use of pulse oximetry with two forehead sensors on an underwater diver subject who was using an electronic closed-circuit rebreather (ECCR). Despite the known limits of this method and the preliminary status of these findings [2], the recorded data show a clear validity in the use of pulse oximetry in immersion for the detection of peripheral oxygen saturation. In the future, the pulse oximeter could become part of the instrumentation of the diver who uses CCR gear. The device could easily be implemented in these rebreathers. The possibility of being able to perform a basic instrumental analysis means that the diver can become more quickly aware of imminent hypoxia, characterized by the absence of clearly identifiable warning symptoms, and can put in place all the correct procedures for an emergency ascent, avoiding serious consequences.


Asunto(s)
Buceo/efectos adversos , Diseño de Equipo , Hipoxia/diagnóstico , Oximetría , Oxígeno/sangre , Adulto , Análisis de los Gases de la Sangre/instrumentación , Análisis de los Gases de la Sangre/métodos , Equipo para Diagnóstico , Humanos , Hipoxia/sangre , Hipoxia/etiología , Inmersión , Masculino , Oximetría/instrumentación , Oximetría/métodos , Síntomas Prodrómicos , Agua de Mar , Evaluación de Síntomas/instrumentación , Temperatura
9.
Zhongguo Yi Liao Qi Xie Za Zhi ; 43(3): 223-225, 2019 May 30.
Artículo en Chino | MEDLINE | ID: mdl-31184085

RESUMEN

In order to improve the quality of medical equipment after-sales service quality and improve the quality of medical equipment maintenance, this paper discusses the establishment of an evaluation index system to evaluate the quality of ultrasonic diagnostic equipment. From the three aspects of maintenance results, maintenance process and maintenance coverage, the quality of the post-maintenance quality of hospital ultrasound diagnostic equipment manufacturers is objectively evaluated.


Asunto(s)
Equipos y Suministros de Hospitales , Administración de Materiales de Hospital , Comercio , Equipo para Diagnóstico , Mantenimiento
10.
J Dairy Sci ; 102(7): 6532-6539, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31103301

RESUMEN

In times of ongoing automatization of dairy cow husbandry, objective and reliable tools for mastitis diagnostic are highly in demand. The objective of this study was to investigate the diagnostic value of a handheld dynamometer and an infrared thermometer to diagnose and score clinical and subclinical mastitis and to compare those values with results from palpation of the udder tissue. Overall, 218 cows with clinical mastitis (i.e., 46 mild, 106 moderate, and 66 severe cases), 142 with subclinical mastitis, and 68 healthy cows were enrolled. Our data provide evidence that the dynamometer is an accurate diagnostic tool to differentiate between healthy udder quarters, and those with subclinical and clinical mastitis. Furthermore, the severity score of clinical mastitis can be estimated by dynamometer. The firmness threshold for the detection of clinical mastitis was 1.002 kg. Using a threshold of 1.175 kg in clinical mastitis quarters, it was possible to differentiate between negative and positive bacteriological results. A differentiation between healthy and clinical mastitis quarters with the infrared thermometer was possible, albeit udder surface temperatures were highly influenced by ambient temperature. Udder surface temperature increased by 0.15 to 0.18°C for each degree of ambient temperature. In conclusion, the utility of an infrared thermometer to estimate the udder health status of dairy cows is limited, whereas the handheld dynamometer appeared to be an accurate and objective method.


Asunto(s)
Mastitis Bovina/diagnóstico , Animales , Bovinos , Equipo para Diagnóstico , Femenino , Rayos Infrarrojos , Glándulas Mamarias Animales/metabolismo , Mastitis , Mastitis Bovina/metabolismo , Leche/metabolismo , Palpación , Termómetros
11.
Disabil Health J ; 12(4): 679-684, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-30940437

RESUMEN

BACKGROUND: People with disabilities continue to experience health disparities resulting from inaccessibility of healthcare practices and medical diagnostic equipment (MDE). OBJECTIVE: The purpose of this study was to evaluate the accessibility of and accommodations for patients with mobility disabilities in clinics of a large healthcare system in the South Atlantic division of the U.S., to determine if accessibility was different based on clinic type, and to identify areas for improvement to increase accessibility. METHODS: This was a cross-sectional study of 214 healthcare professionals conducted between March and June of 2018. Chi square tests and ANOVA were used to compare accessibility between primary care, hospital based, and private diagnostic clinics. RESULTS: A relatively high proportions of respondents reported that their clinic had implemented many accessible features. However, significant differences were found by clinic type with primary care clinics having better access to MDE including height adjustable exam tables, scales with handrails, wheelchair accessible scales, or padded leg supports. However, primary care clinics were less likely to have lifts for transferring patients. The percent of clinics with MDE was higher than that reported in previous studies which may be due to the safe patient handling and mobility program implemented at the healthcare system. Accommodations for patients when a barrier to care is encountered remain an area for improvement. CONCLUSION: While accessibility for people with disabilities was greater in this healthcare system, areas for improvement were identified to help healthcare professional care for their patients with disabilities.


Asunto(s)
Instituciones de Atención Ambulatoria , Personas con Discapacidad , Accesibilidad a los Servicios de Salud , Limitación de la Movilidad , Atención Primaria de Salud , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Estudios Transversales , Equipo para Diagnóstico , Femenino , Personal de Salud , Humanos , Masculino , Persona de Mediana Edad , Movimiento y Levantamiento de Pacientes , Sudeste de Estados Unidos , Encuestas y Cuestionarios , Adulto Joven
12.
Arch Phys Med Rehabil ; 100(11): 2032-2038, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-30922882

RESUMEN

OBJECTIVE: To explore attitudes and practices of physicians relating to accessible medical diagnostic equipment in serving patients with mobility disability. DESIGN: Open-ended individual telephone interviews, which reached data saturation. Interview recordings were transcribed verbatim for qualitative conventional content analysis. SETTING: Massachusetts, the United States, October 2017-January 2018. PARTICIPANTS: Practicing physicians from 5 clinical specialties (N=20). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Common themes concerning physical accessibility. RESULTS: Mean ± SD time in practice was 27.5±12.5 years; 14 practices had height-adjustable examination tables; and 7 had wheelchair-accessible weight scales. The analysis identified 6 broad themes: height-adjustable examination tables have advantages; height-adjustable examination tables have drawbacks; transferring patients onto examination tables is challenging; rationale for examining patients in their wheelchairs; perceptions of wheelchair-accessible weight scales; and barriers and facilitators to improving physical accessibility. Major barriers identified by participants included costs of equipment, limited space, and inadequate payment for extra time required to care for persons with disability. Even physicians with accessible examination tables sometimes examined patients seated in their wheelchairs. CONCLUSIONS: Even if physicians have accessible equipment, they do not always use it in examining patients with disability. Future efforts will need to consider ways to eliminate these access barriers in clinical practice. Given small sample size, results are not generalizable to physicians nationwide and globally.


Asunto(s)
Actitud del Personal de Salud , Equipo para Diagnóstico/normas , Personas con Discapacidad , Accesibilidad a los Servicios de Salud/normas , Médicos/psicología , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estados Unidos , Silla de Ruedas
13.
J Biomech ; 86: 218-224, 2019 03 27.
Artículo en Inglés | MEDLINE | ID: mdl-30827702

RESUMEN

The Interactive Balance System (IBS), a posturography device for assessing posture control, is widely used in clinical and rehabilitation settings. However, data on the validity of the device are unavailable. Fluctuations of the center of pressure (COP) were measured in 24 healthy participants (age: 29 ±â€¯5 (mean ±â€¯SD) years, 12 females) synchronously using the IBS, which was rigidly mounted on a Kistler platform. Four different bipedal conditions were examined: eyes open or closed on stable or soft surfaces. Time series were compared using congruity (CON, proportion of the measurement time during which values of both devices changed similarly in direction), whereas IBS-specific postural outcomes were correlated with traditional postural control outcomes of the Kistler force platform. The time-displacement curves showed similar shapes for CON (>0.9) for each of the four standing conditions without differences between male and female participants (P > 0.39). The path length results of both devices showed very high linear associations, explaining on average 92% (medio-lateral) or 96% (anterior-posterior) of the common variance. The Kistler path length of the anterior-posterior direction revealed nearly perfect linear associations with the stability index of the IBS (r2 > 0.99). The results of this study indicate that the IBS provides valid posturographic results. Since the medial-lateral and anterior-posterior trajectories of the IBS can be used to calculate COP fluctuations, comparisons between different measurement systems are possible.


Asunto(s)
Biofisica/instrumentación , Equipo para Diagnóstico/normas , Postura , Adulto , Femenino , Voluntarios Sanos , Humanos , Masculino , Equilibrio Postural , Adulto Joven
14.
Trop Med Int Health ; 24(4): 477-483, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30706604

RESUMEN

OBJECTIVES: In view of erroneous type 2 diabetes prevalence reported in 3 small Pacific Island countries, a study was conducted to investigate whether this error occurred in other countries which have conducted WHO STEPS surveys associated with glucose thresholds for point-of-care (POC) measuring devices calibrated to plasma. METHODS: Published STEPS surveys conducted over 2001-2017 were obtained. For each survey, information was obtained on diabetes prevalence, POC glucose measuring device, blood sample tested and the fasting glucose threshold used for prevalence calculations. POC device user manuals were obtained to determine calibration. The current WHO glucose threshold for type 2 diabetes was used: ≥7.0 mmol/l for plasma glucose; ≥6.1 mmol/l for whole blood glucose. RESULTS: POC devices were used in 75 of the STEPS surveys identified to measure blood glucose. An incorrect glucose threshold was employed in 17 surveys (23%) to define diabetes. The correct threshold was applied in 20 surveys (27%). Estimates from meta-analysis and meta-regression show that diabetes prevalence in surveys using the incorrect glucose thresholds have prevalences 50% higher than surveys which use the correct glucose threshold. A definite conclusion could not be made for 38 surveys (51%) because of the absence or unclear information on the glucose metre and/or the threshold employed. CONCLUSION: WHO STEPS surveys with likely incorrect published diabetes prevalences have been conducted across the globe, resulting in a 50% artefactual inflation. Inaccurate reporting of diabetes prevalence from widely cited STEPS surveys would have significant impacts on disease burden monitoring, policy development and resource allocation.


Asunto(s)
Sesgo , Glucemia/metabolismo , Calibración , Diabetes Mellitus Tipo 2/epidemiología , Equipo para Diagnóstico , Artefactos , Diabetes Mellitus Tipo 2/sangre , Ayuno , Salud Global , Humanos , Plasma , Sistemas de Atención de Punto , Vigilancia de la Población , Prevalencia , Valores de Referencia , Encuestas y Cuestionarios , Organización Mundial de la Salud
15.
Neuquém; Argentina. Ministerio de Salud; 26 feb. 2019. ilus, tab.
No convencional en Español | BRISA/RedTESA | ID: biblio-1006312

RESUMEN

INTRODUCIÓN: La tuberculosis (en adelante TB) es una enfermedad causada por Mycobacterium tuberculosis, una bacteria transmitida principalmente por la inhalación de microgotas expelidas al toser, hablar y respirar. Según su localización anatómica puede clasificarse en TB pulmonar y extrapulmonar, también se divide según la co-infección con VIH y la resistencia a medicamentos. La TB es una de las principales causas de mortalidad en el mundo. En 2016, 10,4 millones de personas enfermaron de TB y 1,7 millones murieron por esta enfermedad (entre ellas 0,4 millones de personas con VIH). Más del 95% de las muertes ocurre en países de ingresos bajos y medianos. En Argentina se considera que la enfermedad tiene una carga moderada. En 2016 se notificaron 11560 casos con aumento de la tasa de notificación de 24,9 a 26,5 por 100000 habitantes. Esto determinó el aumento sostenido de la enfermedad, a lo que se sumó un incremento de casos de TB en grupos jóvenes. La provincia de Neuquén es una población de baja endemia con 50 casos incidentes anuales y con un 5 % de casos nuevos o recaídas. Casi no hay reportes de casos de multi-resistencia a drogas. El rango etario más afectado es el de 45 a 64 años, quienes podrían diseminar la enfermedad en caso de ser bacilíferos. EVALUACIÓN DE TECNOLOGÍAS: A partir de un pedido de incorporación se analizaron dos tecnologías principales y se revisaron las recomendaciones y factibilidad de incorporar otras tecnologías en distintos niveles de complejidad para mejorar la detección precoz de Mycobacterium tuberculosis. Se trabajó en la priorización de tecnologías, en la distribución actual con enfoque de mapa sanitario y analizando la organización del sistema de salud y la red prestacional de laboratorio. Las principales tecnologías sanitarias solicitadas fueron: Cultivo en medio líquido, BACTEC MGIT de BECKTON DICKINSON: tecnología fluorescente basada en el consumo de oxígeno para la detección del crecimiento bacteriano del complejo M. tuberculosis. Xpert MTB/RIF de Cepheid: tecnología de amplificación de ácidos nucleicos para la detección del complejo M. tuberculosis y la resistencia a la rifampicina. METODOLOGÍA: Se conformó un equipo multidisciplinario e independiente que luego de diversas reuniones definió preguntas de investigación que abarcó el informe. BÚSQUEDA Y ANÁLISIS DE LA EVIDENCIA CIENTÍFICA: Se realizó una búsqueda no sistemática de bibliografía científica priorizando la inclusión de revisiones sistemáticas y meta-análisis, evaluaciones de tecnologías sanitarias e informes de seguridad, guías OMS y otras Guías de Práctica Clínica basadas en la evidencia. CONSENSO: Se mantuvieron reuniones y rondas de preguntas por mail para lograr consenso sobre los aspectos donde variaban las opiniones. CONCLUSIONES: 1. Se recomienda mejorar la calidad del sistema de información clínica, de laboratorio y epidemiológica. En el 2019 se planifica la mejora del sistema informático junto com proyectos de capacitaciones a personal de salud de toda la provincia para impulsar la notificación de todos los casos. 2. Se recomienda implementar microscopía de fluorescencia en los laboratorios de los hospitales cabeceras de zona según factibilidad. 3. Realizar capacitaciones al personal de salud de las diversas zonas para estimular el pedido de baciloscopías, el adecuado seguimiento de contactos y de tratamientos. 4. A pesar de que la tecnología Gene Xpert muestre numerosas ventajas con respecto al BACTEC MGIT, se trata de un método muy costoso; Teniendo en cuenta que nuestra provincia no es una zona endémica ni presenta resistencia a fármacos se recomienda a favor de la implementación del cultivo en medio líquido automatizado, BACTEC MGIT de BECKTON DICKINSON.


Asunto(s)
Humanos , Tuberculosis/diagnóstico , Equipo para Diagnóstico , Replicación de Secuencia Autosostenida/instrumentación , Microscopía Fluorescente/instrumentación , Argentina , Evaluación de la Tecnología Biomédica , Análisis Costo-Eficiencia
16.
Emerg Med J ; 36(3): 159-162, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30630841

RESUMEN

OBJECTIVE: The Wood's lamp, a handheld instrument that uses long-wave ultraviolet (UV) light with magnification of 2-3 times, is commonly used by non-ophthalmologists for examining patients with eye complaints. The goal of current research was to determine the sensitivity and specificity of the Wood's lamp for common eye abnormalities. STUDY DESIGN: We examined a convenience sample of patients, 18 years of age and older, who presented for eye complaints to an urgent clinic of a large ophthalmology practice. This prospective observational trial was performed from December 2016 until July 2017. An ophthalmologist examined the patient's eyes with a Wood's lamp, followed by examination of the eyes using a slit lamp. The Wood's lamp was compared with the slit lamp, which served as the gold standard. RESULTS: There were 73 patients recruited. The mean age of study subjects (29 female and 44 male) was 49 years. The overall sensitivity of the Wood's lamp was 52% (38/73; 95% CI 40% to 64%). Based on the principal final diagnosis made with the slit lamp, the Wood's lamp only detected 9 of 16 corneal abrasions, 5 of 10 corneal ulcers, 5 of 9 corneal foreign bodies, 0 of 4 cases of non-herpetic keratitis, 1 of 2 cases of herpes keratitis, 1 of 5 rust rings and 18 of 28 other diagnoses. CONCLUSIONS AND RELEVANCE: Examination using the Wood's lamp fails to detect many common eye abnormalities. Our findings support the need for a slit lamp examination of patients with eye complaints whenever possible.


Asunto(s)
Equipo para Diagnóstico/normas , Anomalías del Ojo/diagnóstico , Adulto , Anciano , Conjuntiva/lesiones , Córnea/anomalías , Medicina de Emergencia/instrumentación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ohio , Estudios Prospectivos , Sensibilidad y Especificidad , Rayos Ultravioleta
17.
Foot (Edinb) ; 38: 70-75, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30665198

RESUMEN

STUDY DESIGN: Randomized clinical trial. BACKGROUND: Muscle stiffness is a potential complication after injury and has been shown to be a risk factor for injury in healthy individuals. OBJECTIVES: The primary purpose of this study was to assess the short-term effects of manual therapy (MT) on muscle stiffness of the gastrocnemius in both a relaxed and contracted state. The secondary purpose was to assess the reliability of a novel clinical tool (MyotonPRO) to measure muscle stiffness in the gastrocnemius in both a passive and contracted state. METHODS: Eighty-four consecutive healthy individuals were randomized to receive Manual Therapy (MT group) directed at the right-side ankle and foot or no treatment (CONTROL group). Muscle stiffness of the gastrocnemius was assessed bilaterally in all participants at baseline and then immediately after intervention in a relaxed and contracted state. Group (MT vs. CONTROL) by side (ipsilateral vs. contralateral) by time (pre vs. post) effects were compared through a 3-way interaction utilizing mixed model ANOVA. Reliability of the MyotonPRO was assessed with two-way mixed model intraclass correlation coefficients. RESULTS: There was a significant 3-way interaction for muscle stiffness of the gastrocnemius in a relaxed state (p<0.01), but not contracted state (p=0.54). All conditions had increased resting muscle stiffness from pre to post measures except for the ipsilateral limb of the MT group. There was not a significant interaction for muscle stiffness in a contracted state. Reliability estimates (ICC) for muscle stiffness measures ranged between 0.898 and 0.986. CONCLUSION: The change in muscle stiffness of the gastrocnemius in a relaxed state depended upon whether individuals received MT. Muscle stiffness measures were highly reliable based on single measurements. LEVEL OF EVIDENCE: Therapy, level 2.


Asunto(s)
Músculo Esquelético/fisiopatología , Manipulaciones Musculoesqueléticas , Adolescente , Adulto , Equipo para Diagnóstico , Femenino , Voluntarios Sanos , Humanos , Masculino , Persona de Mediana Edad , Contracción Muscular/fisiología , Reproducibilidad de los Resultados
18.
Sensors (Basel) ; 19(2)2019 Jan 20.
Artículo en Inglés | MEDLINE | ID: mdl-30669504

RESUMEN

In this paper, we present the concept of a novel diagnostic device for on-site analyses, based on the use of advanced bio-sensing and photonics technologies to tackle emerging and endemic viruses causing swine epidemics and significant economic damage in farms. The device is currently under development in the framework of the EU Commission co-funded project. The overall concept behind the project is to develop a method for an early and fast on field detection of selected swine viruses by non-specialized personnel. The technology is able to detect pathogens in different types of biological samples, such as oral fluids, faeces, blood or nasal swabs. The device will allow for an immediate on-site threat assessment. In this work, we present the overall concept of the device, its architecture with the technical requirements, and all the used innovative technologies that contribute to the advancements of the current state of the art.


Asunto(s)
Equipo para Diagnóstico , Enfermedades de los Porcinos/diagnóstico , Porcinos/virología , Virosis/diagnóstico , Animales , Técnicas Biosensibles , Reproducibilidad de los Resultados
19.
Sensors (Basel) ; 19(2)2019 Jan 16.
Artículo en Inglés | MEDLINE | ID: mdl-30654582

RESUMEN

Interest in sensors and their applications is rapidly evolving, mainly driven by the huge demand of technologies whose ultimate purpose is to improve and enhance health and safety. Different electromagnetic technologies have been recently used and achieved good performances. Despite the plethora of literature, limitations are still present: limited response control, narrow bandwidth, and large dimensions. MetaSurfaces, artificial 2D materials with peculiar electromagnetic properties, can help to overcome such issues. In this paper, a generic tool to model, design, and manufacture MetaSurface sensors is developed. First, their properties are evaluated in terms of impedance and constitutive parameters. Then, they are linked to the structure physical dimensions. Finally, the proposed method is applied to realize devices for advanced sensing and medical diagnostic applications: glucose measurements, cancer stage detection, water content recognition, and blood oxygen level analysis. The proposed method paves a new way to realize sensors and control their properties at will. Most importantly, it has great potential to be used for many other practical applications, beyond sensing and diagnostics.


Asunto(s)
Técnicas Biosensibles , Equipo para Diagnóstico , Impedancia Eléctrica , Azúcares/análisis , Propiedades de Superficie
20.
Ann Biomed Eng ; 47(2): 576-589, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30341740

RESUMEN

During defecation, solid, semisolid or liquid stools are eliminated via the anus in a complex physiological process. Up to 25% of the population are affected by anorectal disorders that are poorly recognized and treated. We developed a new bionics device, a simulated stool named Fecobionics, to replace several current tests of anorectal function. Fecobionics was developed to simulate the defecation process that depends on rectal forces, the anorectal size angle, and anorectal size and sensitivity. Fecobionics provided axial pressure signatures, measurement of bending (anorectal angle) and geometric mapping in a single examination. It had the consistency and shape of normal stool. The device had a soft core with embedded electronics and a bag for distension. The paper describes the device development and validation. Furthermore, data were obtained in preliminary experiments in pigs, healthy human subjects and patients with focus on four important features of the system, i.e. measurements of pressure signatures, bending characteristics, impedance measurements and data transmission. Accurate pressure and orientation data as well as geometric profiles were successfully obtained on the bench as well as in vivo in pigs and human subjects during defecation. Fecobionics is a novel technology imitating defecation. The clinical future ultimately depends on its ability to impact on daily treatment of anorectal disorders. A potential long-term clinical application is use of the device for biofeedback training for dyssynergic defecation.


Asunto(s)
Canal Anal/fisiopatología , Biónica/instrumentación , Defecación , Equipo para Diagnóstico , Recto/fisiopatología , Humanos
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