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2.
Biomed Res Int ; 2020: 7610678, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33029522

RESUMEN

Background: There is a shortage of chemical reagents for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnosis and a surge of SARS-CoV-2 cases, especially in limited-resource settings. Therefore, the combination of an optimal assay kit is necessary. Methods: We compared the ability to screen SARS-CoV-2 among three primer-probe sets in two different master mixes, Invitrogen™ SuperScript™ III One-Step RT-PCR and LightCycler Multiplex RNA Virus Master. Results: The assay with TIB-Molbiol, IDT, and Phu Sa sets for LightCycler Multiplex RNA Virus Master or Invitrogen™ SuperScript™ III One-Step RT-PCR showed positive results from a single reaction of triplicate in the three days of 4.8 copies per reaction. R squared and amplification efficiency were 0.97 and ranged from 107 to 108%, respectively. Conclusions: Our findings indicated that TIB-Molbiol, IDT, and Phu Sa primer-probe sets could be beneficial for the laboratory screening of SARS-CoV-2 by RT-qPCR assay of E gene. There is a need to consider the combination of these reagent sets as a new strategy to increase the testing capacity of screening programs for COVID-19.


Asunto(s)
Betacoronavirus/genética , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/diagnóstico , Cartilla de ADN/genética , Neumonía Viral/diagnóstico , Sondas ARN/genética , Betacoronavirus/aislamiento & purificación , Técnicas de Laboratorio Clínico/estadística & datos numéricos , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/virología , Humanos , Reacción en Cadena de la Polimerasa Multiplex/métodos , Reacción en Cadena de la Polimerasa Multiplex/estadística & datos numéricos , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/virología , ARN Viral/genética , Reacción en Cadena en Tiempo Real de la Polimerasa/métodos , Reacción en Cadena en Tiempo Real de la Polimerasa/estadística & datos numéricos , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa/métodos , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa/estadística & datos numéricos , Sensibilidad y Especificidad
3.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 45(8): 973-979, 2020 Aug 28.
Artículo en Inglés, Chino | MEDLINE | ID: mdl-33053541

RESUMEN

OBJECTIVES: To analyze the CT manifestations,clinical symptoms, laboratory test and the interrelationship of them with secondary invasive pulmonary aspergillosis (IPA) in hematologic patients so as to improve the diagnosis and prognosis of this disease. METHODS: A total of 37 hematologic patients suspected of IPA in a tertiary referral center were selectedfrom Jun. 2004 to Sep. 2016 and the CT characteristics, clinical manifestations, laboratory test of these patients were retrospectively analyzed. RESULTS: There were 8 patients confirmed as IPA by sputum culture or bronchoalveolar lavage fluid culture among the 37 hematologic patients.The sensitivity of CT in the diagnosis of IPA was 75.0%, the specificity was 79.3%, the positive predictive value was 42.9%, and the negative predictive value was 91.3%. Multiple patchy shadows in both lungs were the most common CT signs of suspected and confirmed patients, followed by nodules, air bronchogram, cavitary lesions, consolidation, mass shadows, halo, and crescent sign. Cough, expectoration, and fever were the most common symptoms among the suspected and confirmed patients. ß-D-glucan (G)/galactomannan antigen (GM) tests for the most patients were negative, but the number of people with elevated procalcitonin (PCT) in the confirmed patients (57.1%) was higher than that in the suspected patients (31.4%). Results of sputum culture, PCT, G/GM test, and clinical manifestations were compared between the CT lesion progression group and the absorption group, and no significant difference was observed. CONCLUSIONS: Hematologic patients are susceptible to IPA. CT features showed no obvious specificity, and the G/GM test was normal in most patients. So when hematologic patients have clinical symptoms such as cough, expectoration and fever, the possibility of combination with IPA should be considered as soon as possible, and relevant examinations such as sputum culture, bronchoalveolar lavage fluid culture and pathological examination should be completed for early diagnosis and treatment to improve the prognosis of patients.


Asunto(s)
Aspergilosis Pulmonar Invasiva , Humanos , Aspergilosis Pulmonar Invasiva/complicaciones , Aspergilosis Pulmonar Invasiva/diagnóstico , Aspergilosis Pulmonar Invasiva/diagnóstico por imagen , Pulmón , Estudios Retrospectivos , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X
4.
Ann Acad Med Singap ; 49(7): 456-461, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-33000108

RESUMEN

Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 and was declared a global pandemic by the World Health Organization on 11 March 2020. A definitive diagnosis of COVID-19 is made after a positive result is obtained on reverse transcription-polymerase chain reaction assay. In Singapore, rigorous contact tracing was practised to contain the spread of the virus. Nasal swabs and chest radiographs (CXR) were also taken from individuals who were suspected to be infected by COVID-19 upon their arrival at a centralised screening centre. From our experience, about 40% of patients who tested positive for COVID-19 had initial CXR that appeared "normal". In this case series, we described the temporal evolution of COVID-19 in patients with an initial "normal" CXR. Since CXR has limited sensitivity and specificity in COVID-19, it is not suitable as a first-line diagnostic tool. However, when CXR changes become unequivocally abnormal, close monitoring is recommended to manage potentially severe COVID-19 pneumonia.


Asunto(s)
Betacoronavirus , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico por imagen , Pulmón/diagnóstico por imagen , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico por imagen , Adulto , Infecciones por Coronavirus/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Radiografía , Sensibilidad y Especificidad
5.
Comput Math Methods Med ; 2020: 9756518, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33014121

RESUMEN

The COVID-19 diagnostic approach is mainly divided into two broad categories, a laboratory-based and chest radiography approach. The last few months have witnessed a rapid increase in the number of studies use artificial intelligence (AI) techniques to diagnose COVID-19 with chest computed tomography (CT). In this study, we review the diagnosis of COVID-19 by using chest CT toward AI. We searched ArXiv, MedRxiv, and Google Scholar using the terms "deep learning", "neural networks", "COVID-19", and "chest CT". At the time of writing (August 24, 2020), there have been nearly 100 studies and 30 studies among them were selected for this review. We categorized the studies based on the classification tasks: COVID-19/normal, COVID-19/non-COVID-19, COVID-19/non-COVID-19 pneumonia, and severity. The sensitivity, specificity, precision, accuracy, area under the curve, and F1 score results were reported as high as 100%, 100%, 99.62, 99.87%, 100%, and 99.5%, respectively. However, the presented results should be carefully compared due to the different degrees of difficulty of different classification tasks.


Asunto(s)
Betacoronavirus , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico por imagen , Pandemias , Neumonía Viral/diagnóstico por imagen , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Tomografía Computarizada por Rayos X/estadística & datos numéricos , Inteligencia Artificial , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Aprendizaje Profundo , Humanos , Redes Neurales de la Computación , Neumonía/clasificación , Neumonía/diagnóstico por imagen , Neumonía Viral/epidemiología , Interpretación de Imagen Radiográfica Asistida por Computador/estadística & datos numéricos , Radiografía Torácica/estadística & datos numéricos , Sensibilidad y Especificidad
7.
Rev Med Liege ; 75(10): 644-648, 2020 Oct.
Artículo en Francés | MEDLINE | ID: mdl-33030839

RESUMEN

The diagnosis of heart failure can sometimes be challenging for the clinician because presentation circumstances and heart failure phenotypes are varied. The identification and validation of sensitive and specific biomarkers for this condition are still a subject of intensive research. Among them, natriuretic peptides (ANP, BNP, NTproBNP) are widely used and validated as markers of heart failure. Their appropriate use and correct interpretation, however, require knowledge of their indications, specificities and limitations. The European Society of Cardiology has recently issued recommendations in this regard. This article summarizes them in order to facilitate the understanding and the use of natriuretic peptides in clinical practice. It also discusses their use in the etiological diagnosis of pleural effusions caused by heart failure.


Asunto(s)
Insuficiencia Cardíaca , Derrame Pleural , Biomarcadores , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/terapia , Humanos , Péptidos Natriuréticos , Sensibilidad y Especificidad
8.
BMC Med Imaging ; 20(1): 111, 2020 10 02.
Artículo en Inglés | MEDLINE | ID: mdl-33008329

RESUMEN

BACKGROUND: To develop and validate a nomogram for early identification of severe coronavirus disease 2019 (COVID-19) based on initial clinical and CT characteristics. METHODS: The initial clinical and CT imaging data of 217 patients with COVID-19 were analyzed retrospectively from January to March 2020. Two hundred seventeen patients with 146 mild cases and 71 severe cases were randomly divided into training and validation cohorts. Independent risk factors were selected to construct the nomogram for predicting severe COVID-19. Nomogram performance in terms of discrimination and calibration ability was evaluated using the area under the curve (AUC), calibration curve, decision curve, clinical impact curve and risk chart. RESULTS: In the training cohort, the severity score of lung in the severe group (7, interquartile range [IQR]:5-9) was significantly higher than that of the mild group (4, IQR,2-5) (P < 0.001). Age, density, mosaic perfusion sign and severity score of lung were independent risk factors for severe COVID-19. The nomogram had a AUC of 0.929 (95% CI, 0.889-0.969), sensitivity of 84.0% and specificity of 86.3%, in the training cohort, and a AUC of 0.936 (95% CI, 0.867-1.000), sensitivity of 90.5% and specificity of 88.6% in the validation cohort. The calibration curve, decision curve, clinical impact curve and risk chart showed that nomogram had high accuracy and superior net benefit in predicting severe COVID-19. CONCLUSION: The nomogram incorporating initial clinical and CT characteristics may help to identify the severe patients with COVID-19 in the early stage.


Asunto(s)
Infecciones por Coronavirus/diagnóstico por imagen , Pulmón/diagnóstico por imagen , Nomogramas , Neumonía Viral/diagnóstico por imagen , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Área Bajo la Curva , Niño , Diagnóstico Precoz , Humanos , Persona de Mediana Edad , Pandemias , Distribución Aleatoria , Estudios Retrospectivos , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X , Adulto Joven
9.
Beijing Da Xue Xue Bao Yi Xue Ban ; 52(5): 897-901, 2020 Oct 18.
Artículo en Chino | MEDLINE | ID: mdl-33047726

RESUMEN

OBJECTIVE: To evaluate the classification criteria of early rheumatoid arthritis (ERA) and compare the sensitivity and specificity with the criteria of 1987 American College of Rheumatology (ACR) criteria and 2010 ACR/European League Against Rheumatism (EULAR). METHODS: Patients from 4 hospitals, aged more than 16 years, with arthritis, whose disease duration was ≤1 year, and with ≥1 joint pain and swelling were enrolled in the study. The indicators including clinical manifestations, laboratory tests and imaging examinations were observed. The ERA patients were dignosed by two experienced rheumatologists based on the clinical features, drug therapy information and radiography features. RESULTS: (1) A total of 325 patients with arthritis were enrolled, including 98 males (30.15%) and 227 females (69.85%), The average age was (47.53±14.44) years, and the median disease duration was 5 (2, 8) months. Finally, 236 patients were dignosed with ERA, and 89 patients were dignosed with other diseases (Non-ERA, including osteoarthritis, reactive arthritis, undifferentiated arthritis, spondyloarthritis, etc). (2) The sensitivity of ERA criteria was 87.29%, and the specificity was 84.37%. The sensitivity was higher than that of 1987 ACR criteria (χ2=43.641, P < 0.001), and had no significant difference compared with 2010 ACR/EULAR criteria (χ2=0.446, P=0.593). But the specificity of ERA criteria was lower than that of 1987 ACR criteria (χ2=4.891, P=0.027), which was not statistically significant compared with 2010 ACR/EULAR criteria (χ2=0.044, P=1.000). (3) In the patients with arthritis whose disease duration was ≤3 months and ≤6 months, the sensitivity of ERA criteria was 81.71% and 86.79%, respectively, both were higher than the 1987 ACR criteria (χ2=7.131, P=0.008; χ2=22.015, P < 0.001) and had no statistically difference compared with the 2010 ACR/EULAR criteria (χ2=0.220, P=0.755; χ2=0.473, P=0.491). The differences of the three criteria in specificity were not statistically significant. (4) The three different classification criteria were consistent with the clinical diagnosis, among which the ERA criteria and 2010 ACR/EULAR criteria were slightly higher (Kappa>0.6). The results of the consistency comparison between the three criteria showed that the ERA criteria and 2010 ACR/EULAR criteria had a better consistency (Kappa=0.836). CONCLUSION: The sensitivity of ERA classification criteria in the diagnosis of ERA was higher than that of 1987 ACR criteria, and was equivalent to that of 2010 ACR/EULAR criteria. There is no significant difference in specificity between these three criteria. The ERA criteria can also identify patients with RA at a very early stage in arthritis with disease duration ≤3 months.


Asunto(s)
Artritis Reumatoide , Osteoartritis , Reumatología , Adolescente , Adulto , Artritis Reumatoide/diagnóstico , Artritis Reumatoide/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Sensibilidad y Especificidad , Estados Unidos
10.
Medicine (Baltimore) ; 99(40): e22614, 2020 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-33019481

RESUMEN

BACKGROUND: The relationship between MTHFR (5, 10-methylene tetrahydrofolate reductase) gene polymorphisms and Systemic Lupus Erythematosus (SLE) has been wildly studied, but the results are still conflicting. Therefore, the purpose of this meta and pooled analysis was to identify the role of the MTHFR SNP (single nucleotide polymorphism, rs1801133) in SLE in a large sample of subjects and to assess the risk of SLE. METHODS: Data were collected from EMBASE, PubMed and China National Knowledge Infrastructure from inception to August, 2019. Summary odds ratio (OR) with 95% confidence interval (CI) was applied to assess the association. Subgroup and sensitivity analysis were performed to assess the potential sources of heterogeneity of the pooled estimation. RESULTS: We identified seven eligible studies involving 882 cases and 991 controls. MTHFR rs1801133 T carrier was significantly associated with increased risk of SLE when comparing to C allele [ORs were 1.766 (1.014-3.075) for T carrier vs CC, P = .04]. Furthermore, the results of the subgroup analysis by genotyping methods suggested that T allele significantly contributed to the risk of SLE for both by polymerase chain reaction-TaqMan (PCR-TaqMan) [10.111 (2.634-38.813) for TT vs CC, 3.467 (1.324-9.078) for CT vs CC and 3.744 (1.143-12.264) for TT vs C carrier]. Also the results of the subgroup analysis by ethnicity suggested that T allele significantly contributed to the risk of SLE for Asians [9.679 (4.444-21.082) for TT vs CC, 5.866 (3.021-11.389) for T carrier vs CC and 8.052 (3.861-16.795) for TT vs C carrier]. CONCLUSION: This cumulative meta-analysis showed that the MTHFR SNP (rs1801133) contributed to susceptibility of SLE. However, more multicentre well-designed case-control studies and larger sample sizes are exceedingly required to validate our findings in the future.


Asunto(s)
Lupus Eritematoso Sistémico/genética , Metilenotetrahidrofolato Reductasa (NADPH2)/genética , Polimorfismo de Nucleótido Simple/genética , Alelos , Grupo de Ascendencia Continental Asiática/genética , Portador Sano , Estudios de Casos y Controles , Femenino , Genotipo , Humanos , Lupus Eritematoso Sistémico/etnología , Masculino , Medición de Riesgo , Sensibilidad y Especificidad
11.
G Ital Nefrol ; 37(5)2020 Oct 05.
Artículo en Italiano | MEDLINE | ID: mdl-33026198

RESUMEN

We report the brief experience of the Nephrology Center located in a "no-COVID" Hospital in Massa Marittima. We describe the actions taken to prevent the transmission of the virus SARS-CoV-2 among hemodialysis patients and healthcare workers and the methods for diagnosing COVID-19, with particular attention to serological tests and nasopharyngeal swabs in asymptomatic subjects. The detection of IgM and IgG antibodies through the serological test performed on 34 patients, all negative for nasopharyngeal swabs, showed positivity in 41,18% of cases. These have been classified as false positives following repeated negative nasopharyngeal swabs, the evaluation of clinical and epidemiological history and of clinical manifestations and, finally, a second serological test performed after 18 days, which resulted negative for all patients. Interpreting serological tests is not easy; the strategies for diagnosis should include clinical and epidemiological history and clinical manifestations, as well as the results of confirmation tests and the evaluation over a precise observation period. Otherwise, there is a risk of considering as protected by antibodies subjects that are in fact false positives.


Asunto(s)
Anticuerpos Antivirales/sangre , Betacoronavirus/inmunología , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Unidades de Hemodiálisis en Hospital/estadística & datos numéricos , Pandemias , Neumonía Viral/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades Asintomáticas , Betacoronavirus/aislamiento & purificación , Reacciones Falso Positivas , Femenino , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina G/inmunología , Inmunoglobulina M/sangre , Inmunoglobulina M/inmunología , Italia , Masculino , Persona de Mediana Edad , Nasofaringe/virología , Guías de Práctica Clínica como Asunto , Reproducibilidad de los Resultados , Estudios Retrospectivos , Sensibilidad y Especificidad
12.
Tumour Biol ; 42(10): 1010428320963811, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33028151

RESUMEN

This study aimed at investigating the expression of candidate microRNAs (miRs), at initial diagnosis, during neoadjuvant chemotherapy, and after the tumor resection in locally advanced breast cancer patients. Plasma samples were collected from locally advanced breast cancer patients (n = 30) and healthy subjects (n = 20) for the detection of candidate miRs' expression using the real-time quantitative polymerase chain reaction. At initial locally advanced breast cancer diagnosis, the expression of miR-21, miR-181a, and miR-10b was significantly increased, whereas that of miR-145 and let-7a was significantly decreased, compared to the healthy individuals. The diagnostic accuracy of miR-21 was superior to both carcinoembryonic antigen and carcinoma antigen 15-3 as diagnostic biomarkers for locally advanced breast cancer. By the end of the treatment, the expression of altered miRs rebound to control values. The expression levels of candidate plasma miRs are useful diagnostic biomarkers, as well as monitoring a proper response for locally advanced breast cancer patients to the treatment. Furthermore, miR-10b and miR-21 can be considered as predictive biomarkers for progression-free survival.


Asunto(s)
Biomarcadores de Tumor , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/genética , MicroARN Circulante , MicroARNs , Adulto , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/terapia , Terapia Combinada , Femenino , Regulación Neoplásica de la Expresión Génica , Humanos , Estimación de Kaplan-Meier , Persona de Mediana Edad , Clasificación del Tumor , Metástasis de la Neoplasia , Estadificación de Neoplasias , Pronóstico , Reacción en Cadena en Tiempo Real de la Polimerasa , Sensibilidad y Especificidad
13.
Clin Appl Thromb Hemost ; 26: 1076029620954913, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33030036

RESUMEN

INTRODUCTION: Sulodexide represents a mixture of fast-moving heparin (FMH) and dermatan sulfate (DS) and has been used for the management of venous diseases such as DVT and related disorders. The purpose of this study is to compare sulodexide and its components with unfractionated heparin (UFH) to determine its suitability for the indications in which UFH is used. MATERIALS AND METHOD: Active pharmaceutical ingredients (API) versions of sulodexide, FMH and DS were obtained from Alfasigma. API versions of UFH were obtained from Medefil Inc. Normal human citrated plasma was obtained from blood bank of the Loyola University Medical Center. Each of the individual agents were supplemented in plasma at a graded concentration of 0.0-10 µg/mL. Clotting assays (PiCT, aPTT, PT and TT), anti-Xa and anti-IIa and thrombin generation studies were carried out. Results were compiled as mean ± SD of 3 individual determination. RESULT: In the clot based (PiCT, aPTT and TT), anti-Xa and IIa assays, both the UFH and FMH produced stronger activities in these assays followed by sulodexide. DS did not show any anticoagulant activity. In the thrombin generation assay, FMH and UFH produced comparable inhibition of thrombin generation as measured by various parameters. Sulodexide was slightly weaker in this assay, whereas DS produced relatively weaker effects. CONCLUSION: In comparison to sulodexide, both UFH and FMH exhibit comparable anticoagulant activity despite differences in their molecular weight. These results suggest that sulodexide can be developed as a parenteral anticoagulant for indications in which UFH is used.


Asunto(s)
Anticoagulantes/farmacología , Coagulación Sanguínea/efectos de los fármacos , Glicosaminoglicanos/farmacología , Trombina/farmacología , Anticoagulantes/administración & dosificación , Antitrombinas/administración & dosificación , Antitrombinas/farmacología , Glicosaminoglicanos/administración & dosificación , Heparina/administración & dosificación , Heparina/farmacología , Humanos , Italia , Sensibilidad y Especificidad , Trombina/administración & dosificación
14.
BMC Infect Dis ; 20(1): 747, 2020 Oct 12.
Artículo en Inglés | MEDLINE | ID: mdl-33046047

RESUMEN

BACKGROUND: Sudden exacerbations and respiratory failure are major causes of death in patients with severe coronavirus disease 2019(COVID-19) pneumonia, but indicators for the prediction and treatment of severe patients are still lacking. METHODS: A retrospective analysis of 67 collected cases was conducted and included approximately 67 patients with COVID-19 pneumonia who were admitted to the Suzhou Fifth People's Hospital from January 1, 2020 to February 8, 2020. The epidemiological, clinical and imaging characteristics as well as laboratory data of the 67 patients were analyzed. RESULTS: The study found that fibrinogen (FIB) was increased in 45 (65.2%) patients, and when FIB reached a critical value of 4.805 g/L, the sensitivity and specificity、DA, helping to distinguish general and severe cases, were 100 and 14%、92.9%, respectively, which were significantly better than those for lymphocyte count and myoglobin. Chest CT images indicated that the cumulative number of lung lobes with lesions in severe patients was significantly higher than that in general patients (P < 0.05), and the cumulative number of lung lobes with lesions was negatively correlated with lymphocyte count and positively correlated with myoglobin and FIB. Our study also found that there was no obvious effect of hormone therapy in patients with severe COVID-19. CONCLUSIONS: Based on the retrospective analysis, FIB was found to be increased in severe patients and was better than lymphocyte count and myoglobin in distinguishing general and severe patients. The study also suggested that hormone treatment has no significant effect on COVID-19.


Asunto(s)
Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/patología , Neumonía Viral/epidemiología , Neumonía Viral/patología , Adulto , Betacoronavirus/patogenicidad , China/epidemiología , Infecciones por Coronavirus/diagnóstico , Femenino , Fibrinógeno/análisis , Hospitalización , Humanos , Pulmón/patología , Recuento de Linfocitos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/diagnóstico , Estudios Retrospectivos , Sensibilidad y Especificidad
15.
J Med Internet Res ; 22(10): e21299, 2020 10 06.
Artículo en Inglés | MEDLINE | ID: mdl-33001828

RESUMEN

BACKGROUND: A large number of web-based COVID-19 symptom checkers and chatbots have been developed; however, anecdotal evidence suggests that their conclusions are highly variable. To our knowledge, no study has evaluated the accuracy of COVID-19 symptom checkers in a statistically rigorous manner. OBJECTIVE: The aim of this study is to evaluate and compare the diagnostic accuracies of web-based COVID-19 symptom checkers. METHODS: We identified 10 web-based COVID-19 symptom checkers, all of which were included in the study. We evaluated the COVID-19 symptom checkers by assessing 50 COVID-19 case reports alongside 410 non-COVID-19 control cases. A bootstrapping method was used to counter the unbalanced sample sizes and obtain confidence intervals (CIs). Results are reported as sensitivity, specificity, F1 score, and Matthews correlation coefficient (MCC). RESULTS: The classification task between COVID-19-positive and COVID-19-negative for "high risk" cases among the 460 test cases yielded (sorted by F1 score): Symptoma (F1=0.92, MCC=0.85), Infermedica (F1=0.80, MCC=0.61), US Centers for Disease Control and Prevention (CDC) (F1=0.71, MCC=0.30), Babylon (F1=0.70, MCC=0.29), Cleveland Clinic (F1=0.40, MCC=0.07), Providence (F1=0.40, MCC=0.05), Apple (F1=0.29, MCC=-0.10), Docyet (F1=0.27, MCC=0.29), Ada (F1=0.24, MCC=0.27) and Your.MD (F1=0.24, MCC=0.27). For "high risk" and "medium risk" combined the performance was: Symptoma (F1=0.91, MCC=0.83) Infermedica (F1=0.80, MCC=0.61), Cleveland Clinic (F1=0.76, MCC=0.47), Providence (F1=0.75, MCC=0.45), Your.MD (F1=0.72, MCC=0.33), CDC (F1=0.71, MCC=0.30), Babylon (F1=0.70, MCC=0.29), Apple (F1=0.70, MCC=0.25), Ada (F1=0.42, MCC=0.03), and Docyet (F1=0.27, MCC=0.29). CONCLUSIONS: We found that the number of correctly assessed COVID-19 and control cases varies considerably between symptom checkers, with different symptom checkers showing different strengths with respect to sensitivity and specificity. A good balance between sensitivity and specificity was only achieved by two symptom checkers.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Autoevaluación Diagnóstica , Internet , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Evaluación de Síntomas/instrumentación , Adolescente , Adulto , Algoritmos , Betacoronavirus , Centers for Disease Control and Prevention, U.S. , Técnicas de Laboratorio Clínico , Recolección de Datos , Humanos , Persona de Mediana Edad , Pandemias , Valor Predictivo de las Pruebas , Informática en Salud Pública , Reproducibilidad de los Resultados , Autoinforme , Sensibilidad y Especificidad , Estados Unidos , Adulto Joven
16.
Emergencias ; 32(5): 340-344, 2020 09.
Artículo en Inglés, Español | MEDLINE | ID: mdl-33006834

RESUMEN

OBJECTIVES: To assess the diagnostic yield of point-of-care ultrasound imaging in patients suspected of having noncritical severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection but no apparent changes on a chest radiograph. MATERIAL AND METHODS: Cross-sectional analysis of a case series including patients coming to an emergency department in March and April 2020 with mild-moderate respiratory symptoms suspected to be caused by SARS-CoV-2. A point-of-care ultrasound examination of the lungs was performed on all participants as part of routine clinical care. Ultrasound findings were compared according to the results of SARS-CoV-2 test results. RESULTS: Fifty-eight patients with a median (interquartile range) age of 44.5 (34-67) years were enrolled; 42 (72.4%) were women. Twenty-seven (46.5%) had confirmed SARS-CoV-2 infection. Ultrasound findings were consistent with interstitial pneumonia due to coronavirus disease 2019 (COVID-19) in 33 (56.9%). Most were in cases with testconfirmed COVID-19 (100% vs 22.2% of cases with no confirmation; P < .001). The most common ultrasound findings in confirmed COVID-19 cases were focal and confluent B-lines in the basal and posterior regions of the lung (R1, 85.2%; R2, 77.8%; L1, 88.9%; and L2, 88.9%) and associated pleural involvement (70.4%, 70.4%, 81.5%, and 85.2%, respectively). The sensitivity of point-of-care ultrasound in the diagnosis of COVID-19 was 92.6% (95% CI, 75.7%-99.1%). Specificity was 85.2% (95% CI, 66.3%-95.8%); positive predictive value, 75.8% (95% CI, 59.6%- 91.9%); negative predictive value, 92% (95% CI, 74.0%-99.0%); and positive and negative likelihood ratios, 6.2 (95% CI, 6.0-6.5) and 0.1 (95% CI, 0.1-0.1), respectively. CONCLUSION: Point-of-care lung ultrasound could be useful for the diagnosis of noncritical SARS-CoV-2 infection when chest radiographs are inconclusive.


Asunto(s)
Betacoronavirus , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico por imagen , Pulmón/diagnóstico por imagen , Pandemias , Neumonía Viral/diagnóstico por imagen , Sistemas de Atención de Punto , Adulto , Anciano , Infecciones por Coronavirus/diagnóstico , Estudios Transversales , Diagnóstico Precoz , Femenino , Humanos , Enfermedades Pulmonares Intersticiales/diagnóstico por imagen , Enfermedades Pulmonares Intersticiales/etiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Sensibilidad y Especificidad , Diseño de Software , Ultrasonografía
17.
Biosens Bioelectron ; 169: 112643, 2020 Dec 01.
Artículo en Inglés | MEDLINE | ID: mdl-33007615

RESUMEN

Detection of antibodies to upper respiratory pathogens is critical to surveillance, assessment of the immune status of individuals, vaccine development, and basic biology. The urgent need for antibody detection tools has proven particularly acute in the COVID-19 era. We report a multiplex label-free antigen microarray on the Arrayed Imaging Reflectometry (AIR) platform for detection of antibodies to SARS-CoV-2, SARS-CoV-1, MERS, three circulating coronavirus strains (HKU1, 229E, OC43) and three strains of influenza. We find that the array is readily able to distinguish uninfected from convalescent COVID-19 subjects, and provides quantitative information about total Ig, as well as IgG- and IgM-specific responses.


Asunto(s)
Anticuerpos Antivirales/sangre , Infecciones por Coronavirus/sangre , Coronavirus/aislamiento & purificación , Virus de la Influenza A/aislamiento & purificación , Gripe Humana/sangre , Neumonía Viral/sangre , Betacoronavirus/aislamiento & purificación , Técnicas Biosensibles/instrumentación , Técnicas Biosensibles/métodos , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/virología , Diseño de Equipo , Células HEK293 , Humanos , Gripe Humana/diagnóstico , Gripe Humana/virología , Coronavirus del Síndrome Respiratorio de Oriente Medio/aislamiento & purificación , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/virología , Análisis por Matrices de Proteínas/instrumentación , Análisis por Matrices de Proteínas/métodos , Virus del SRAS/aislamiento & purificación , Sensibilidad y Especificidad
18.
Artículo en Inglés | MEDLINE | ID: mdl-33014893

RESUMEN

Objective: To explore the diagnostic value of serum severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleocapsid (N) protein assay in the early stages of SARS-COV-2 infection. Methods: Serum N protein level in SARS-COV-2 infected patients and non-SARS-COV-2 infected population was measured by enzyme-linked immunosorbent assay (ELISA) double antibody sandwich assay. Colloidal gold immunochromatography assay was used to detect serum N protein antibodies in the above populations. Results: Fifty cases of SARS-CoV-2 nucleic acid-positive and SARS-CoV-2 antibody-negative patients had a serum N protein positivity rate of 76%. Thirty-seven patients who were positive for serum SARS-CoV-2 antibody after infection had a serum SARS-CoV-2 N protein positivity rate of 2.7%. Serum N protein test results of 633 non-SARS-COV-2 infected patients, including pregnant women, patients with other respiratory infections, and individuals with increased rheumatoid factor were all negative, with serum N protein concentration <10.00 pg/mL at 100% specificity. Using SPSS 19.0 to calculate the receiver operating characteristic curve, the area under the curve was determined to be 0.9756 (95% confidence interval 0.9485-1.000, p < 0.0001), and sensitivity and specificity were 92% (95% confidence interval 81.16-96.85%) and 96.84% (95% confidence interval 95.17-97.15%), respectively. The best CUT-OFF value was 1.850 pg/mL. Conclusion: The measurement of serum SARS-COV-2 N protein has a high diagnostic value for infected patients before the antibody appears and shortens the window period of serological diagnosis. It is recommended that the manufacturer establish two different CUT-OFF values according to the purpose of the application. One CUT-OFF value is used for the diagnosis of clinical SARS-COV-2 infection, and the other is used to screen out as many suspected cases as possible.


Asunto(s)
Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/diagnóstico , Proteínas de la Nucleocápside/sangre , Neumonía Viral/diagnóstico , Anticuerpos Antivirales/sangre , Betacoronavirus/aislamiento & purificación , Biomarcadores/sangre , Infecciones por Coronavirus/sangre , Ensayo de Inmunoadsorción Enzimática/métodos , Femenino , Humanos , Masculino , Pandemias , Neumonía Viral/sangre , Embarazo , Sensibilidad y Especificidad
19.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1560-1563, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-33018290

RESUMEN

The characteristics of diabetic retinopathy (DR) fundus images generally consist of multiple types of lesions which provided strong evidence for the ophthalmologists to make diagnosis. It is particularly significant to figure out an efficient method to not only accurately classify DR fundus images but also recognize all kinds of lesions on them. In this paper, a deep learning-based multi-label classification model with Gradient-weighted Class Activation Mapping (Grad-CAM) was proposed, which can both make DR classification and automatically locate the regions of different lesions. To reducing laborious annotation work and improve the efficiency of labeling, this paper innovatively considered different types of lesions as different labels for a fundus image so that this paper changed the task of lesion detection into that of image classification. A total of five labels were pre-defined and 3228 fundus images were collected for developing our model. The architecture of deep learning model was designed by ourselves based on ResNet. Through experiments on the test images, this method acquired a sensitive of 93.9% and a specificity of 94.4% on DR classification. Moreover, the corresponding regions of lesions were reasonably outlined on the DR fundus images.


Asunto(s)
Aprendizaje Profundo , Diabetes Mellitus , Retinopatía Diabética , Retinopatía Diabética/diagnóstico por imagen , Fondo de Ojo , Humanos , Sensibilidad y Especificidad
20.
Medicine (Baltimore) ; 99(40): e21965, 2020 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-33019389

RESUMEN

BACKGROUND: The epidermal growth factor receptor (EGFR) mutation status related to the treatment approach for advanced non-small cell lung cancer (NSCLC) patients. This study aimed to evaluate the diagnostic accuracy of peripheral blood circulating tumor DNA (ctDNA) in EGFR mutated advanced NSCLC patients. METHOD: The related database was systematically searched with keywords until January 19, 2020. Studies contained the histopathological and cytological advanced NSCLC samples were included, and the diagnostic data were recorded for calculating sensitivity and specificity. I statistics were used for detecting heterogeneity across studies, and the meta-regression was performed to seek the source of heterogeneity. RESULT: A total of 32 studies with 4527 advanced NSCLC patients were included in our meta-analysis. Among them, 87% of the patients were diagnosed as stage IV. The pooled sensitivity of peripheral blood ctDNA was 0.70 (95% CI: 0.63-0.75, I = 81.76) and the pooled specificity was 0.98 (95% CI: 0.96-0.99, I = 88.33). The meta-regression showed that the prospective study design and the ARMS detection method were the main source of heterogeneity for sensitivity (P < .05), and the publication country (Asia or non-Asia) was the main source of heterogeneity for specificity (P < .01). CONCLUSION: ctDNA biopsy has high specificity and diagnostic accuracy in detection of EGFR mutation in advanced NSCLC patients. When the ctDNA gene test result is negative, we should fully consider the risk of missed diagnosis, and further tissue biopsy is still needed to undertake.


Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/genética , ADN Tumoral Circulante/sangre , Neoplasias Pulmonares/genética , Biomarcadores/sangre , Carcinoma de Pulmón de Células no Pequeñas/sangre , Receptores ErbB/sangre , Femenino , Pruebas Genéticas , Humanos , Neoplasias Pulmonares/sangre , Masculino , Persona de Mediana Edad , Mutación , Estudios Prospectivos , Sensibilidad y Especificidad
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