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1.
Euro Surveill ; 25(39)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33006300

RESUMO

We found that a single nucleotide polymorphism (SNP) in the nucleoprotein gene of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from a patient interfered with detection in a widely used commercial assay. Some 0.2% of the isolates in the EpiCoV database contain this SNP. Although SARS-CoV-2 was still detected by the other probe in the assay, this underlines the necessity of targeting two independent essential regions of a pathogen for reliable detection.


Assuntos
Betacoronavirus/genética , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Nucleoproteínas/genética , Pandemias , Pneumonia Viral/diagnóstico , Mutação Puntual , Polimorfismo de Nucleotídeo Único , RNA Viral/genética , Reação em Cadeia da Polimerase em Tempo Real , Proteínas Virais/genética , Sequência de Bases , Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico/métodos , Busca de Comunicante , Infecções por Coronavirus/virologia , Primers do DNA , Erros de Diagnóstico , Reações Falso-Negativas , Feminino , Genes Virais , Humanos , Pessoa de Meia-Idade , Nasofaringe/virologia , Nucleoproteínas/análise , Filogenia , Pneumonia Viral/virologia , Reação em Cadeia da Polimerase em Tempo Real/métodos , Romênia , Doença Relacionada a Viagens , Proteínas Virais/análise
2.
BMC Infect Dis ; 20(1): 721, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-33004020

RESUMO

BACKGROUND: Listeria monocytogenes (L. monocytogenes) is a facultative intracellular bacterial pathogen which can invade different mammalian cells and reach to the central nervous system (CNS), leading to meningoencephalitis and brain abscesses. In the diagnosis of L. monocytogenes meningoencephalitis (LMM), the traditional test often reports negative owing to the antibiotic treatment or a low number of bacteria in the cerebrospinal fluid. To date, timely diagnosis and accurate treatment remains a challenge for patients with listeria infections. CASE PRESENTATION: We present the case of a 66-year-old woman whose clinical manifestations were suspected as tuberculous meningoencephalitis, but the case was finally properly diagnosed as LMM by next-generation sequencing (NGS). The patient was successfully treated using a combined antibacterial therapy, comprising ampicillin and trimethoprim-sulfamethoxazole. CONCLUSION: To improve the sensitivity of LMM diagnosis, we used NGS for the detection of L. monocytogenes. Hence, the clinical utility of this approach can be very helpful since it provides quickly and trust results.


Assuntos
Listeria monocytogenes/genética , Meningite por Listeria/microbiologia , Meningoencefalite/microbiologia , Idoso , Ampicilina/uso terapêutico , Antibacterianos/uso terapêutico , Abscesso Encefálico/tratamento farmacológico , Erros de Diagnóstico , Feminino , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Listeria monocytogenes/isolamento & purificação , Meningite por Listeria/diagnóstico , Meningite por Listeria/tratamento farmacológico , Meningoencefalite/diagnóstico , Meningoencefalite/tratamento farmacológico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Tuberculose Meníngea/diagnóstico , Tuberculose Meníngea/microbiologia
3.
Can Respir J ; 2020: 2045341, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33005276

RESUMO

Objective: Coronavirus disease 2019 (COVID-19), caused by the novel coronavirus SARS-CoV-2, was first identified in December 2019 in Wuhan, China, and has since spread globally, resulting in an ongoing pandemic. However, the study of asymptomatic patients is still rare, and the understanding of its potential transmission risk is still insufficient. In this study, epidemiological investigations were conducted in the Zhejiang province to understand the epidemiology and clinical characteristics of asymptomatic patients with COVID-19. Methods: This retrospective study was carried out on 22 asymptomatic patients and 234 symptomatic patients with COVID-19 who were hospitalized in Zhejiang Duodi Hospital from January 21 to March 16, 2020. The characteristics of epidemiology, demography, clinical manifestations, and laboratory data of mild patients were compared and analyzed. Results: The median age was 28 years in asymptomatic patients and 48 years in symptomatic patients. The proportion who were female was 77.3% in asymptomatic patients and 36.3% in symptomatic patients (p < 0.001). The proportion of patients with coexisting diseases was 4.5% in asymptomatic patients and 38.0% in symptomatic patients (p=0.002). The proportion of patients with increased CRP was 13.6% in the asymptomatic group and 61.1% in the symptomatic group (p < 0.001). The proportion of patients received antiviral therapy was 45.5% in the asymptomatic group and 97.9% in the symptomatic group (p < 0.001). The proportion of patients received oxygen therapy was 22.7% in the asymptomatic group and 99.1% in symptomatic patients (p < 0.001). By March 16, 2020, all patients were discharged from the hospital, and no symptoms had appeared in the asymptomatic patients during hospitalization. The median course of infection to discharge was 21.5 days in asymptomatic patients and 22 days in symptomatic patients. Conclusions: Asymptomatic patients are also infectious; relying only on clinical symptoms, blood cell tests, and radiology examination will lead to misdiagnosis of most patients, leading to the spread of the virus. Investigation of medical history is the best strategy for screening asymptomatic patients, especially young people, women, and people without coexisting disease, who are more likely to be asymptomatic when infected. Although the prognosis is good, isolation is critical for asymptomatic patients, and it is important not to end isolation early before a nucleic acid test turns negative.


Assuntos
Doenças Assintomáticas , Infecções por Coronavirus , Transmissão de Doença Infecciosa/prevenção & controle , Pandemias , Pneumonia Viral , Medição de Risco/métodos , Adulto , Fatores Etários , Doenças Assintomáticas/epidemiologia , Doenças Assintomáticas/terapia , Betacoronavirus/isolamento & purificação , China/epidemiologia , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Erros de Diagnóstico/prevenção & controle , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Oxigenoterapia/estatística & dados numéricos , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Prognóstico , Fatores Sexuais
4.
Medicine (Baltimore) ; 99(33): e21585, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872010

RESUMO

BACKGROUND: The objective of this study is to evaluate the accuracy of radionuclide in diagnosis of bone metastasis (BM) after breast cancer surgery (BCS). METHODS: The electronic databases (Cochrane Library, MEDLINE, EMBASE, Web of Science, CBM, and CNKI) will be systematically and comprehensively searched until June 1, 2020 for eligible studies that reported the diagnosis of radionuclide in BM after BCS. In addition, we will also identify grey literatures, such as conference abstracts, and reference lists of included studies. All process of study identification, data extraction, and study methodological quality evaluation will be performed by 2 independent authors. All divergences will be settled by a third author through discussion. All data analysis will be carried out by RevMan 5.3 software (London, UK). RESULTS: This study will scrutinize the most recent evidence of radionuclide in detection of BM after BCS. CONCLUSION: This study may provide evidence of accuracy of radionuclide in diagnosis of BM following BCS. STUDY REGISTRATION NUMBER: PROSPERO CRD42020187646.


Assuntos
Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/secundário , Neoplasias da Mama/patologia , Técnicas de Diagnóstico por Radioisótopos , Fatores Etários , Neoplasias da Mama/cirurgia , Erros de Diagnóstico , Feminino , Humanos , Projetos de Pesquisa , Sensibilidade e Especificidade , Fatores Socioeconômicos
6.
BMJ Open Respir Res ; 7(1)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32963028

RESUMO

Reviews of COVID-19 CT imaging along with postmortem lung biopsies and autopsies indicate that the majority of patients with COVID-19 pulmonary involvement have secondary organising pneumonia (OP) or its histological variant, acute fibrinous and organising pneumonia, both well-known complications of viral infections. Further, many publications on COVID-19 have debated the puzzling clinical characteristics of 'silent hypoxemia', 'happy hypoxemics' and 'atypical ARDS', all features consistent with OP. The recent announcement that RECOVERY, a randomised controlled trial comparing dexamethasone to placebo in COVID-19, was terminated early due to excess deaths in the control group further suggests patients present with OP given that corticosteroid therapy is the first-line treatment. Although RECOVERY along with other cohort studies report positive effects with corticosteroids on morbidity and mortality of COVID-19, treatment approaches could be made more effective given that secondary OP often requires prolonged duration and/or careful and monitored tapering of corticosteroid dose, with 'pulse' doses needed for the well-described fulminant subtype. Increasing recognition of this diagnosis will thus lead to more appropriate and effective treatment strategies in COVID-19, which may lead to a further reduction of need for ventilatory support and improved survival.


Assuntos
Infecções por Coronavirus/fisiopatologia , Pneumonia em Organização Criptogênica/diagnóstico , Erros de Diagnóstico , Hipóxia/fisiopatologia , Pulmão/diagnóstico por imagem , Pneumonia Viral/fisiopatologia , Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/tratamento farmacológico , Pneumonia em Organização Criptogênica/tratamento farmacológico , Pneumonia em Organização Criptogênica/etiologia , Pneumonia em Organização Criptogênica/fisiopatologia , Dexametasona/uso terapêutico , Glucocorticoides/uso terapêutico , Humanos , Hipóxia/etiologia , Pulmão/patologia , Pulmão/fisiopatologia , Doenças Pulmonares Intersticiais/diagnóstico , Doenças Pulmonares Intersticiais/tratamento farmacológico , Doenças Pulmonares Intersticiais/etiologia , Doenças Pulmonares Intersticiais/fisiopatologia , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/tratamento farmacológico , Tomografia Computadorizada por Raios X
7.
Can Respir J ; 2020: 1401053, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32934758

RESUMO

Background: The threat of contagious infectious diseases is constantly evolving as demographic explosion, travel globalization, and changes in human lifestyle increase the risk of spreading pathogens, leading to accelerated changes in disease landscape. Of particular interest is the aftermath of superimposing viral epidemics (especially SARS-CoV-2) over long-standing diseases, such as tuberculosis (TB), which remains a significant disease for public health worldwide and especially in emerging economies. Methods and Results: The PubMed electronic database was systematically searched for relevant articles linking TB, influenza, and SARS-CoV viruses and subsequently assessed eligibility according to inclusion criteria. Using a data mining approach, we also queried the COVID-19 Open Research Dataset (CORD-19). We aimed to answer the following questions: What can be learned from other coronavirus outbreaks (focusing on TB patients)? Is coinfection (TB and SARS-CoV-2) more severe? Is there a vaccine for SARS-CoV-2? How does the TB vaccine affect COVID-19? How does one diagnosis affect the other? Discussions. Few essential elements about TB and SARS-CoV coinfections were discussed. First, lessons from past outbreaks (other coronaviruses) and influenza pandemic/seasonal outbreaks have taught the importance of infection control to avoid the severe impact on TB patients. Second, although challenging due to data scarcity, investigating the pathological pathways linking TB and SARS-CoV-2 leads to the idea that their coexistence might yield a more severe clinical evolution. Finally, we addressed the issues of vaccination and diagnostic reliability in the context of coinfection. Conclusions: Because viral respiratory infections and TB impede the host's immune responses, it can be assumed that their lethal synergism may contribute to more severe clinical evolution. Despite the rapidly growing number of cases, the data needed to predict the impact of the COVID-19 pandemic on patients with latent TB and TB sequelae still lies ahead. The trial is registered with NCT04327206, NCT01829490, and NCT04121494.


Assuntos
Coinfecção/epidemiologia , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Tuberculose/epidemiologia , Vacina BCG/uso terapêutico , Betacoronavirus , Técnicas de Laboratório Clínico , Coinfecção/imunologia , Coinfecção/fisiopatologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/fisiopatologia , Citocinas/imunologia , Erros de Diagnóstico , Surtos de Doenças , Humanos , Influenza Humana/epidemiologia , Influenza Humana/fisiopatologia , Coronavírus da Síndrome Respiratória do Oriente Médio , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/imunologia , Pneumonia Viral/fisiopatologia , Vírus da SARS , Síndrome Respiratória Aguda Grave/epidemiologia , Síndrome Respiratória Aguda Grave/fisiopatologia , Índice de Gravidade de Doença , Tuberculose/imunologia , Tuberculose/fisiopatologia , Tuberculose/prevenção & controle
8.
BMC Infect Dis ; 20(1): 654, 2020 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-32894070

RESUMO

BACKGROUND: Brucellosis is a zoonotic disease caused by brucella. It has been an increasing trend in recent years (Wang H, Xu WM, Zhu KJ, Zhu SJ, Zhang HF, Wang J, Yang Y, Shao FY, Jiang NM, Tao ZY, Jin HY, Tang Y, Huo LL, Dong F, Li ZJ, Ding H, Liu ZG, Emerg Microbes Infect 9:889-99, 2020). Brucellosis is capable to invade multiple systems throughout the body, lacking in typical clinical manifestations, and easily misdiagnosed and mistreated. CASE PRESENTATION: We report a case of a male, 5-year-and-11-month old child without relevant medical history, who was admitted to hospital for 20 days of fever. When admitted to the hospital, we found that he was enervated, irritable and sleepy, accompanied with red eyes phenomenon. After anti-infection treatment with meropenem, no improvement observed. Lumbar puncture revealed normal CSF protein, normal cells, and negative culture. Later, doppler echocardiography suggested coronary aneurysms, and incomplete Kawasaki Disease with coronary aneurysms was proposed. The next day, brucellosis agglutination test was positive. Metagenomic next-generation sequencing (mNGS) of cerebrospinal fluid suggested B.melitensis, which was confirmed again by blood culture. The child was finally diagnosed as brucellosis with meningocephalitis, coronary aneurysm and keratitis. According to our preliminary research and review, such case has never been reported in detail before. After diagnosis confirmation, the child was treated with rifampicin, compound sulfamethoxazole, and ceftriaxone for cocktail anti-infection therapy. Aspirin and dipyridamole were also applied for anticoagulant therapy. After medical treatment, body temperature of the child has reached normal level, eye symptoms alleviated, and mental condition gradually turned normal. Re-examination of the doppler echocardiographic indicated that the coronary aneurysm was aggravated, so warfarin was added for amplification of anticoagulation treatment. At present, 3 months of follow-up, the coronary artery dilatation gradually assuaged, and the condition is continued to alleviate. CONCLUSION: Brucellosis can invade nervous system, coronary artery, and cornea. Brucellosis lacks specific signs for clinical diagnosis. The traditional agglutination test and the new mNGS are convenient and effective, which can provide the reference for clinical diagnosis.


Assuntos
Brucella melitensis/isolamento & purificação , Brucelose/complicações , Brucelose/diagnóstico , Aneurisma Coronário/complicações , Aneurisma Coronário/diagnóstico , Ceratite/complicações , Ceratite/diagnóstico , Meningoencefalite/complicações , Meningoencefalite/diagnóstico , Testes de Aglutinação , Animais , Anti-Infecciosos/uso terapêutico , Anticoagulantes/uso terapêutico , Brucelose/tratamento farmacológico , Ceftriaxona/uso terapêutico , Pré-Escolar , Erros de Diagnóstico , Febre/tratamento farmacológico , Humanos , Ceratite/tratamento farmacológico , Masculino , Meningoencefalite/tratamento farmacológico , Rifampina/uso terapêutico , Sulfametoxazol/uso terapêutico , Resultado do Tratamento , Zoonoses/diagnóstico , Zoonoses/tratamento farmacológico
9.
Int Heart J ; 61(5): 913-921, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32921668

RESUMO

Previous study has identified marked differences in patient characteristics and causes of inappropriate shock (IAS) between Japan and the Western societies in terms of subcutaneous implantable cardioverter-defibrillator (S-ICD). However, evidence of IAS in Asian populations including Japan has been limited to one observational study.Thus, we conducted a single-center registry study that tracks the postoperative course of 61 consecutive patients who received S-ICD from February 2016 to January 2020. Our findings showed that IAS occurred in 9.8% of the study population (6/61), which is comparable to the previously reported incidence. Remarkably, T-wave oversensing did not result in an IAS (0/6). Instead, myopotential oversensing was determined to have caused the most IAS events (4/6), while atrial fibrillation ranked second (2/6). A provocation maneuver (e.g., abdominal clench, push-ups, lifting a heavy item) reproduced myopotential noise disguised as R-waves, which should potentially trigger an IAS if uninterrupted. R-wave amplitude of the IAS group appeared relatively low compared to that of the non-IAS group although this finding was not tested significant. Furthermore, no temporal changes were noted in R-wave amplitude between the time of implantation and IAS events, suggesting that it is neither constantly low nor acutely dropped R-wave amplitude but a relatively high noise level that drives IAS. All the myopotential-IAS patients were found to be male. Right-sided lead implantation was associated with a higher incidence of IAS.This study highlights the fact that IAS continues to occur due to myopotential noise oversensing instead of T-wave oversensing. To minimize the risk of IAS, it is desirable to search and secure high R-wave voltage.


Assuntos
Desfibriladores Implantáveis , Cardioversão Elétrica/estatística & dados numéricos , Músculo Esquelético/fisiologia , Taquicardia Ventricular/diagnóstico , Fibrilação Ventricular/diagnóstico , Adolescente , Adulto , Idoso , Criança , Erros de Diagnóstico , Falha de Equipamento , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Taquicardia Ventricular/terapia , Fibrilação Ventricular/terapia , Adulto Jovem
10.
BMC Infect Dis ; 20(1): 681, 2020 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-32943003

RESUMO

BACKGROUND: The purpose of this case report was to report a case of Cryptococcus laurentii infection in the left knee of a previously healthy 29 year old male patient. CASE PRESENTATION: After an initial misdiagnosis and 7 months of failed treatment, the patient received nearly a month of treatment with voriconazole (200 mg IV q12 h) and knee irrigation with amphotericin B until the infection was controlled. The treatment continued with fluconazole for nearly 7 months and approximately 5 weeks of antibiotic treatment for a skin bacterial coinfection. In the end, the patient's symptoms disappeared completely, the left knee recovered well, and there was no recurrence of infection. CONCLUSION: The key points of successful treatment in this case were the thorough debridement, the adequate course of knee irrigation with antifungal drugs and more than 6 months of oral antifungal drugs that were able to eradicate the infection.


Assuntos
Antifúngicos/uso terapêutico , Criptococose/tratamento farmacológico , Criptococose/microbiologia , Joelho/microbiologia , Administração Oral , Adulto , Anfotericina B/uso terapêutico , Antifúngicos/administração & dosagem , Artrite Infecciosa/microbiologia , Criptococose/cirurgia , Cryptococcus/isolamento & purificação , Desbridamento , Erros de Diagnóstico , Fluconazol/uso terapêutico , Infecção Focal/tratamento farmacológico , Infecção Focal/microbiologia , Infecção Focal/cirurgia , Humanos , Joelho/diagnóstico por imagem , Joelho/cirurgia , Masculino , Dermatopatias Bacterianas/tratamento farmacológico , Voriconazol/uso terapêutico
11.
Medicine (Baltimore) ; 99(36): e21961, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899032

RESUMO

This retrospective study was aimed to determine the factors suggesting the need for computed tomography (CT) scanning when ultrasound (US) imaging results are negative or non-diagnostic in children suspicious for acute appendicitis in the emergency department.Patients less than 18 years old who underwent abdominal ultrasound and CT to rule out acute appendicitis were enrolled. Patients were classified into 2 groups: the false-negative group, in which patients had negative or non-diagnostic results on the initial US and a final diagnosis of acute appendicitis on the following abdominal CT, and the true-negative group, in which patients had negative or non-diagnostic US results and were negative on abdominal CT. Logistic regression and propensity score matching with the predicting factors were performed.The presence of vomiting (odds ratio (OR), 7.78; 95% confidence interval (CI), 1.92-41.04) and poor oral intake (OR, 4.67; 95% CI, 1.21-21.15) with a high white blood cell (WBC) count (OR 1.26; 95% CI, 1.09-2.37), segmented neutrophil ratio (OR, 1.09; 95% CI, 1.03-1.16), and C-reactive protein (CRP) (OR, 1.49; 95% CI, 1.09-2.37) were suggestive of the false-negative group. The propensity-matched population also showed significant associations with vomiting (OR, 7.86; 95% CI, 1.65-37.40) and poor oral intake (OR, 5.50; 95% CI, 1.28-23.69) with an elevated WBC count (OR, 1.27; 95% CI, 1.08-1.50), segmented neutrophil ratio (OR, 1.09; 95% CI, 1.03-1.16), and CRP (OR, 1.51; 95% CI, 1.03-2.22).A CT scan should be considered in children with suspected acute appendicitis if they have vomiting, high CRP, and high WBC count, despite negative or non-diagnostic US results.


Assuntos
Apendicite/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Apendicite/fisiopatologia , Proteína C-Reativa/análise , Estudos de Casos e Controles , Criança , Diagnóstico Tardio , Erros de Diagnóstico , Feminino , Humanos , Masculino , Pontuação de Propensão , Curva ROC , Estudos Retrospectivos , Ultrassonografia , Vômito/etiologia
12.
PLoS One ; 15(9): e0239492, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32960929

RESUMO

Timely diagnosis of COVID-19 infected individuals and their prompt isolation are essential for controlling the transmission of SARS-CoV-2. Though quantitative reverse transcriptase PCR (qRT-PCR) is the method of choice for COVID-19 diagnostics, the resource-intensive and time-consuming nature of the technique impairs its wide applicability in resource-constrained settings and calls for novel strategies to meet the ever-growing demand for more testing. In this context, a pooled sample testing strategy was evaluated in the setting of emerging disease outbreak in 3 central Indian districts to assess if the cost of the test and turn-around time could be reduced without compromising its diagnostic characteristics and thus lead to early containment of the outbreak. From 545 nasopharyngeal and oropharyngeal samples received from the three emerging districts, a total of 109 pools were created with 5 consecutive samples in each pool. The diagnostic performance of qRT-PCR on pooled sample was compared with that of individual samples in a blinded manner. While pooling reduced the cost of diagnosis by 68% and the laboratory processing time by 66%, 5 of the 109 pools showed discordant results when compared with induvial samples. Four pools which tested negative contained 1 positive sample and 1 pool which was positive did not show any positive sample on deconvolution. Presence of a single infected sample with Ct value of 34 or higher, in a pool of 5, was likely to be missed in pooled sample analysis. At the reported point prevalence of 4.8% in this study, the negative predictive value of qRT-PCR on pooled samples was around 96% suggesting that the adoption of this strategy as an effective screening tool for COVID-19 needs to be carefully evaluated.


Assuntos
Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Surtos de Doenças/prevenção & controle , Pneumonia Viral/diagnóstico , Betacoronavirus , Técnicas de Laboratório Clínico/economia , Técnicas de Laboratório Clínico/normas , Infecções por Coronavirus/economia , Erros de Diagnóstico/estatística & dados numéricos , Humanos , Índia , Programas de Rastreamento/economia , Programas de Rastreamento/métodos , Pandemias , Projetos Piloto , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Manejo de Espécimes/métodos , Fatores de Tempo
14.
Medicine (Baltimore) ; 99(31): e21385, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756129

RESUMO

BACKGROUND: To perform a cost-error analysis based on a quasi-experimental pre-post study of the preanalytical errors in 2 hospital laboratories. The real cost and theoretical cost are defined as the cost resulting from errors with or without the training intervention. The real impact associated to the training program was estimated, calculated as the total associated to the preanalytical errors cost difference. The costs were measured using Andalusian Public Health Service fees. Cost analysis of an educational intervention presented in a previous study from 2017. Preanalytical errors were detected in the laboratories of the University Hospital Virgen de la Victoria (Málaga, Spain) and in the University Hospital Juan Ramón Jiménez (Huelva, Spain). METHODS: The founded errors were divided into blood and urine samples. Univariate sensitivity analysis was used to assess how parameter uncertainty impacted on overall results. Variations of parameters between 0% and 5% were substituted into the base case. RESULTS: The real impact associated with educational intervention in LAB1 was an increase of &OV0556;16,961.378, and the expected impact was an increase &OV0556;78,745.27 (difference of &OV0556;61,783.9). In LAB2, the real impact in the same period amounted to &OV0556;260,195.37, and the expected impact was &OV0556;193,905.83 (difference of -&OV0556;66,289.54). The results were different in the 2 laboratories, proving the intervention in only one of them to be more effective. CONCLUSIONS: Costs analysis determined that this training intervention can provide saves in the costs, as the effectiveness of the educational sessions in reducing preanalytical errors currently results in a significant decrease of the costs associated with these errors.


Assuntos
Erros de Diagnóstico/economia , Capacitação em Serviço/economia , Laboratórios Hospitalares/normas , Análise Custo-Benefício , Erros de Diagnóstico/prevenção & controle , Testes Diagnósticos de Rotina/economia , Testes Diagnósticos de Rotina/normas , Humanos , Ensaios Clínicos Controlados não Aleatórios como Assunto , Atenção Primária à Saúde/organização & administração , Manejo de Espécimes/normas
15.
Artigo em Chinês | MEDLINE | ID: mdl-32791614

RESUMO

Objective:To analyze the causes of misdiagnosis of patients with glomus jugulare tumor. Method:The clinical data of 116 patients with glomus jugulare tumor were retrospectively analyzed. Result:Among the 116 patients, 65 were misdiagnosed, the average duration of misdiagnosis was 4.90 years. The misdiagnosed diseases were chronic otitis media or cholesteatoma in 25 cases, neurological tinnitus or hearing loss in 16 cases, facial paralysis in 6 cases, external auditory canal masses in 4 cases, secretory otitis media in 3 cases, neck mass in 3 cases, intracranial neoplasma in 2 cases, middle ear cancer in 1 case, vocal cord paralysis in 1 case, stomatitis in 1 case, optic nerve head edema in 1 case, middle ear hemangioma in 1 case and vascular tinnitus in 1 case. Conclusion:The misdiagnosis of glomus jugulare tumor can be summarized as follows: the patients' first symptoms were not specific; lack of auxiliary examination, especially imaging examination; physicians have insufficient understanding of imaging and pathological examination of glomus jugulare tumor.


Assuntos
Paralisia Facial , Tumor do Glomo Jugular , Zumbido , Erros de Diagnóstico , Humanos , Estudos Retrospectivos
16.
PLoS One ; 15(8): e0237239, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790692

RESUMO

Disconcerting levels of misdiagnosis are common in point-of-care rapid HIV testing programmes in sub-Saharan Africa. To investigate potential pathways to misdiagnosis, we interviewed 28 HIV testers in Zimbabwe and conducted weeklong observations at four testing facilities. Approaching adherence to national HIV testing algorithms as a social and scripted practice, dependent on the integration of certain competences, materials and meanings, our thematic analysis revealed three underlying causes of misdiagnosis: One, a lack of confidence in using certain test-kits, coupled with changes in testing algorithms and inadequate training, fed uncertainties with some testing practices. Two, difficult work conditions, including high workloads and resource-depleted facilities, compounded these uncertainties, and meant testers got distracted or resorted to testing short-cuts. Three, power struggles between HIV testers, and specific client-tester encounters created social interactions that challenged the testing process. We conclude that these contexts contribute to deviances from official and recommended testing procedures, as well as testing and interpretation biases, which may explain cases of misdiagnoses. We caution against user-error explanations to misdiagnosis in the absence of a broader recognition of how broader structural determinants affect HIV testing practices.


Assuntos
Infecções por HIV/diagnóstico , Erros de Diagnóstico , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Programas de Rastreamento , Testes Imediatos , Pesquisa Qualitativa , Incerteza , Zimbábue/epidemiologia
17.
J Craniomaxillofac Surg ; 48(10): 1009-1017, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32811716

RESUMO

AIM OF STUDY: a retrospective study was done to assess symptoms correlated with and responsible for the misdiagnosis of Eagle's syndrome with Cranio-Mandibular Disorders. MATERIALS AND METHODS: Our study comprised patients suffering from vague craniofacial pain resulting from elongated styloid processes, presented to the outpatient clinic of the oral and maxillofacial surgery department, October 6 University Hospital. The length of styloid processes was measured on 3D-CT X-rays. All our patients were operated by surgical treatment in the form of shortening of the styloid process (styloidectomy) under general anaesthesia and followed up clinically as well as radiographically for 12 months. RESULTS: Patients were assessed preoperatively as well as postoperatively throughout the following scheduled regular follow up intervals at 1 week and at 1,3,6 and 12 months postoperatively for the following parameters. VAS pain score gradually decreased from a median of 9, with a minimum of 7 and a maximum of 10 pre-operatively to a median of 1.5, with a minimum of 0 and a maximum of 3 at twelve months. Freidman test revealed a statistically significant difference by time. Maximum unassisted mouth opening was assessed. Mouth opening significantly decreased from 30.23 ± 3.28 pre-operatively to 26.08 ± 2.83 after one week, then gradually increased to reach its highest level (43.56 ± 0.72) at twelve months. CONCLUSION: When dealing with cases of vague craniofacial pain, possibility of Eagle syndrome should be considered.


Assuntos
Ossificação Heterotópica/diagnóstico por imagem , Ossificação Heterotópica/diagnóstico , Ossificação Heterotópica/cirurgia , Osso Temporal/diagnóstico por imagem , Osso Temporal/cirurgia , Erros de Diagnóstico , Dor Facial/diagnóstico , Dor Facial/etiologia , Humanos , Estudos Retrospectivos , Osso Temporal/anormalidades
18.
Dermatol Online J ; 26(6)2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32815692

RESUMO

Red puffy hand syndrome is an uncommon clinical manifestation of intravenous drug abuse, which presents with bilateral, painless and non-pitting erythema and edema of the dorsal hands. The pathophysiology is believed to primarily be the result of lymphatic blockage from either direct toxicity of the injected drug, drainage of impurities, or infection complications. A woman in her 40's with remote intravenous drug use presented with over a decade of fixed, painless erythema and swelling of bilateral dorsal hands. Owing to an elevated rheumatoid factor, which would later be attributed to patient's untreated hepatitis C, these findings were mistaken for rheumatoid arthritis and unnecessarily treated with methotrexate and prednisone. Upon proper recognition of her underlying Red puffy hand syndrome, systemic medications were discontinued and appropriate care was initiated with lymphedema decongestion and occupational therapy. Red puffy hand syndrome, albeit rare, is an important manifestation of intravenous drug abuse; its recognition will spare patients from unnecessary systemic treatments.


Assuntos
Artrite Reumatoide/diagnóstico , Erros de Diagnóstico , Edema/diagnóstico , Mãos/patologia , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Edema/etiologia , Feminino , Humanos
19.
Dermatol Online J ; 26(6)2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32815698

RESUMO

Porokeratosis ptychotropica (PP) is a rare variant of porokeratosis characterized by pruritic, scaly papules and plaques localized to the perianal and gluteal cleft regions. Clinically, PP resembles other common disorders, resulting in frequent misdiagnosis. The diagnosis of PP often takes several years to make, therefore many reported cases in the literature described the late stages of PP. We report a case of PP diagnosed at an early stage. By presenting our patient, we aim to raise further awareness of PP to avoid a delay in diagnosis, thus preventing long term complications of this rare entity.


Assuntos
Poroceratose/diagnóstico , Pele/patologia , Nádegas , Erros de Diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Poroceratose/patologia
20.
IEEE J Biomed Health Inform ; 24(10): 2787-2797, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32816680

RESUMO

Coronavirus Disease 2019 (COVID-19) has rapidly spread worldwide since first reported. Timely diagnosis of COVID-19 is crucial both for disease control and patient care. Non-contrast thoracic computed tomography (CT) has been identified as an effective tool for the diagnosis, yet the disease outbreak has placed tremendous pressure on radiologists for reading the exams and may potentially lead to fatigue-related mis-diagnosis. Reliable automatic classification algorithms can be really helpful; however, they usually require a considerable number of COVID-19 cases for training, which is difficult to acquire in a timely manner. Meanwhile, how to effectively utilize the existing archive of non-COVID-19 data (the negative samples) in the presence of severe class imbalance is another challenge. In addition, the sudden disease outbreak necessitates fast algorithm development. In this work, we propose a novel approach for effective and efficient training of COVID-19 classification networks using a small number of COVID-19 CT exams and an archive of negative samples. Concretely, a novel self-supervised learning method is proposed to extract features from the COVID-19 and negative samples. Then, two kinds of soft-labels ('difficulty' and 'diversity') are generated for the negative samples by computing the earth mover's distances between the features of the negative and COVID-19 samples, from which data 'values' of the negative samples can be assessed. A pre-set number of negative samples are selected accordingly and fed to the neural network for training. Experimental results show that our approach can achieve superior performance using about half of the negative samples, substantially reducing model training time.


Assuntos
Betacoronavirus , Técnicas de Laboratório Clínico/estatística & dados numéricos , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/diagnóstico , Pandemias , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/diagnóstico , Interpretação de Imagem Radiográfica Assistida por Computador/estatística & dados numéricos , Aprendizado de Máquina Supervisionado , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Algoritmos , Estudos de Coortes , Biologia Computacional , Infecções por Coronavirus/classificação , Aprendizado Profundo , Erros de Diagnóstico/estatística & dados numéricos , Humanos , Redes Neurais de Computação , Pandemias/classificação , Pneumonia Viral/classificação , Estudos Retrospectivos
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