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1.
PLoS Negl Trop Dis ; 13(8): e0007144, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31430283

RESUMO

The objective of this study was to assess the validity of the new dengue classification proposed by the World Health Organization (WHO) in 2009 and to develop pragmatic guidelines for case triage and management. This retrospective study involved 357 laboratory-confirmed cases of dengue infection diagnosed at King Abdulaziz University Hospital, Jeddah, Saudi Arabia over a 4-year period from 2014 to 2017. The sensitivity of the new classification for identifying severe cases was limited (65%) but higher than the old one (30%). It had a higher sensitivity for identifying patients who needed advanced healthcare compared to the old one (72% versus 32%, respectively). We propose adding decompensation of chronic diseases and thrombocytopenia-related bleeding to the category of severe dengue in the new classification. This modification improves sensitivity from 72% to 98% for identifying patients who need advanced healthcare without altering specificity (97%). It also improves sensitivity in predicting severe outcomes from 32% to 88%. In conclusion, the new classification had a low sensitivity for identifying patients needing advanced care and for predicting morbidity and mortality. We propose to include decompensation of chronic diseases and thrombocytopenia-related bleeding to the category of severe dengue in the new classification to improve the sensitivity of predicting cases requiring advanced care.


Assuntos
Dengue/classificação , Dengue/diagnóstico , Organização Mundial da Saúde , Adolescente , Adulto , Criança , Pré-Escolar , Doença Crônica , Medicina Clínica/métodos , Medicina Clínica/normas , Dengue/fisiopatologia , Feminino , Hemorragia , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Arábia Saudita , Sensibilidade e Especificidade , Dengue Grave/classificação , Dengue Grave/diagnóstico , Índice de Gravidade de Doença , Trombocitopenia , Adulto Jovem
3.
Sensors (Basel) ; 18(10)2018 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-30248969

RESUMO

This paper reviews the theories and applications of electromagnetic⁻acoustic (EMA) techniques (covering light-induced photoacoustic, microwave-induced thermoacoustic, magnetic-modulated thermoacoustic, and X-ray-induced thermoacoustic) belonging to the more general area of electromagnetic (EM) hybrid techniques. The theories cover excitation of high-power EM field (laser, microwave, magnetic field, and X-ray) and subsequent acoustic wave generation. The applications of EMA methods include structural imaging, blood flowmetry, thermometry, dosimetry for radiation therapy, hemoglobin oxygen saturation (SO2) sensing, fingerprint imaging and sensing, glucose sensing, pH sensing, etc. Several other EM-related acoustic methods, including magnetoacoustic, magnetomotive ultrasound, and magnetomotive photoacoustic are also described. It is believed that EMA has great potential in both pre-clinical research and medical practice.


Assuntos
Acústica , Pesquisa Biomédica/métodos , Medicina Clínica/métodos , Fenômenos Eletromagnéticos , Humanos , Lasers , Magnetismo , Micro-Ondas , Ultrassonografia , Raios X
7.
Clin Microbiol Infect ; 24(3): 229-239, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28648861

RESUMO

BACKGROUND: Arthropod-borne virus (Arbovirus) infections are considered an emerging threat for Europe, with an increase in cases in recent decades. The increase in global travel and trade has contributed to the introduction of vectors and viruses into new geographical areas. Tropical arboviruses such as dengue and chikungunya have re-emerged causing local, sporadic outbreaks ignited by travel-imported cases. The recent Zika virus outbreak in the Americas highlighted a need to strengthen preparedness for (re-)emerging arbovirus infections globally. AIMS: To strengthen preparedness for the early identification of (re-)emerging arbovirus outbreaks in Europe and highlight areas for research. SOURCES: An evidence review of published and grey literature together with consultations with European arbovirus experts. CONTENT: This paper presents an overview of endemic and travel-imported arboviruses of clinical significance in Europe. The overview includes syndromic presentation, risk factors for infection and risk of transmission as well as an update on treatments and vaccinations and surveillance notifications and reporting. The paper also presents predictive modelled risks of further geographical expansion of vectors and viruses. IMPLICATIONS: There are a range of arboviruses of clinical significance to Europe. There has been an increase in notifications of endemic and travel-imported arbovirus cases in recent years and an increased geographical range of vectors and viruses. The heterogeneity in surveillance reporting indicates a risk for the early identification of (re-)emerging outbreaks. The data presented show a need to strengthen preparedness for (re-)emerging arbovirus infections and a need for research into neglected arboviruses, risks of non-vector transmission and effective therapeutics and vaccinations.


Assuntos
Infecções por Arbovirus/diagnóstico , Infecções por Arbovirus/patologia , Medicina Clínica/métodos , Médicos , Competência Profissional , Infecções por Arbovirus/epidemiologia , Infecções por Arbovirus/prevenção & controle , Controle de Doenças Transmissíveis/métodos , Transmissão de Doença Infecciosa/prevenção & controle , Europa (Continente) , Humanos
9.
J Microbiol Immunol Infect ; 51(6): 740-748, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28734676

RESUMO

BACKGROUND/PURPOSE: Dengue clinically dynamically changes over time; the World Health Organization (WHO) dengue classification framework proposed 3 dengue clinical phases-febrile (days 1-3), critical (days 4-6) and recovery (days ≥7) phases. This study aimed to better understand clinical and laboratory characteristics in adults (≥18 years) suffering dengue in different clinical phases at their hospital presentations. METHODS: A retrospective analysis of adults suffering dengue between 2008 and 2014. RESULTS: Of the 669 included dengue adults, 146 (21.8%) were elderly (≥65 years), and 27 (4%) suffered severe dengue. When compared with those in febrile phase, significantly higher incidence of ascites, mucosal bleeding, and/or gastrointestinal bleeding; lower white blood cell (WBC) and platelet counts; higher hematocrit, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) values were found in critical phase. When compared with their younger counterparts, elderly at febrile phase had significantly lower frequencies of bone pain, myalgia, headache and rash; higher frequencies of vomiting, pleural effusion and mucosal bleeding; higher WBC count, AST and ALT levels, and lower platelet count; in critical phase, elderly had significantly higher frequencies of pleural effusion, mucosal bleeding and gum bleeding. Four (0.6%) patients experienced severe dengue in recovery phase. Significantly higher proportions of elderly developed severe dengue in both febrile and critical phases as compared with younger adults. CONCLUSIONS: Elderly had lower frequency of classical dengue symptoms, yet were at higher risk of development of severe dengue during their early dengue course. A small number of patients developed severe dengue at the WHO-proposed recovery phase.


Assuntos
Medicina Clínica/métodos , Dengue Grave/epidemiologia , Adulto , Fatores Etários , Idoso , Medicina Clínica/normas , Dengue/epidemiologia , Dengue/patologia , Dengue/fisiopatologia , Feminino , Hospitais , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Risco , Dengue Grave/patologia , Dengue Grave/fisiopatologia , Índice de Gravidade de Doença , Taiwan/epidemiologia , Organização Mundial da Saúde , Adulto Jovem
11.
Toxicol Sci ; 162(1): 36-42, 2018 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-29106690

RESUMO

Metabolic Syndrome and Associated Diseases: From the Bench to the Clinic, a Society of Toxicology Contemporary Concepts in Toxicology (CCT) workshop was held on March 11, 2017. The meeting was convened to raise awareness of metabolic syndrome and its associated diseases and serve as a melting pot with scientists of multiple disciplines (eg, toxicologists, clinicians, regulators) so as to spur research and understanding of this condition. The criteria for metabolic syndrome include obesity, dyslipidemia (low high-density lipoprotein and/or elevated triglycerides), elevated blood pressure, and alterations in glucose metabolism. It can lead to a greater potential of type 2 diabetes, lipid disorders, cardiovascular disease, hepatic steatosis, and other circulatory disorders. Although there are no approved drugs specifically for this syndrome, many drugs target diseases associated with this syndrome thus potentially increasing the likelihood of drug-drug interactions. There is currently significant research focusing on understanding the key pathways that control metabolism, which would be likely targets of risk factors (eg, exposure to xenobiotics, genetics) and lifestyle factors (eg, microbiome, nutrition, and exercise) that contribute to metabolic syndrome. Understanding these pathways could also lead to the development of pharmaceutical interventions. As individuals with metabolic syndrome have signs similar to that of toxic responses (eg, oxidative stress and inflammation) and organ dysfunction, these alterations should be taken into account in drug development. With the increasing frequency of metabolic syndrome in the general population, the idea of a "normal" individual may need to be redefined. This paper reports on the substance and outcomes of this workshop.


Assuntos
Pesquisa Biomédica/tendências , Medicina Clínica/tendências , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Poluentes Ambientais/toxicidade , Síndrome Metabólica/induzido quimicamente , Animais , Pesquisa Biomédica/métodos , Medicina Clínica/métodos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/genética , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/imunologia , Humanos , Estilo de Vida , Síndrome Metabólica/etiologia , Síndrome Metabólica/genética , Síndrome Metabólica/imunologia
12.
N Z Med J ; 130(1461): 66-72, 2017 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-28859068

RESUMO

The apprenticeship model, which forms the backbone of the current medical education system, has a strong historical precedent (and indeed multiple strengths). It is, however, important to acknowledge that its application to modern medicine is far from perfect, particularly with the breadth and complexity of current hospital systems. Demands on clinician resources, the sheer volume of knowledge our trainees must amass, short attachments and rigorous assessment schedules are all major challenges to a relatively simplistic educational system. Identifying and addressing these vulnerabilities is essential to enhancing the educational experiences of both undergraduate medical students and junior doctors.


Assuntos
Estágio Clínico/normas , Medicina Clínica/métodos , Educação de Graduação em Medicina/normas , Modelos Educacionais , Estudantes de Medicina , Competência Clínica/normas , Medicina Clínica/educação , Humanos , Corpo Clínico Hospitalar/educação , Nova Zelândia
13.
Dtsch Med Wochenschr ; 142(18): 1390-1395, 2017 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-28902385

RESUMO

Standard operating procedures (SOP) in hospital care have the potential to improve treatment quality and transparency. However, after arriving at the decision to generate a SOP for the own hospital or ward, the upcoming question is often, how to start?The present article tries to give some interdisciplinary guidance about reasonable structures and contents of SOPs that could be understood as a basic matrix for individual work.


Assuntos
Medicina Clínica , Medicina Clínica/métodos , Medicina Clínica/normas , Departamentos Hospitalares , Humanos , Equipe de Assistência ao Paciente , Guias de Prática Clínica como Assunto
15.
Curr Pharm Biotechnol ; 18(6): 445-455, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28571562

RESUMO

BACKGROUND: Biomarkers are indispensable tools for screening, diagnosis, and prognosis in cardiovascular diseases and their clinical application increases steadily. As cardiovascular diseases include various pathophysiological processes, no single biomarker, even natriuretic peptides, can be regarded as ideal fulfilling all necessary criteria for a comprehensive diagnostic or prognostic assessment revealing optimal clinical application. Hence, multi-marker approaches using different biomarkers reflecting different pathophysiologies were highlighted recently. Advances in biomedical technologies expanded the spectrum of novel blood-derived biomarkers, such as micro-RNA (miRNA) or "omics"- data potentially providing a more advanced knowledge about pathogenesis of cardiovascular disease. CONCLUSION: This review describes the advantages and limitations of blood circulating biomarkers with regard to proteins, metabolomics and transcriptional level both within single as well as multi-marker strategies. Moreover, their usefulness is focused on clinical decision-making in cardiovascular diseases.


Assuntos
Biomarcadores/metabolismo , Pesquisa Biomédica/métodos , Doenças Cardiovasculares/diagnóstico , Medicina Clínica/métodos , Biomarcadores/sangue , Doenças Cardiovasculares/sangue , Humanos , Metabolômica , MicroRNAs/sangue , Prognóstico , Proteômica
16.
Comput Math Methods Med ; 2017: 5271091, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28611849

RESUMO

Two nonparametric methods for the identification of subgroups with outstanding outcome values are described and compared to each other in a simulation study and an application to clinical data. The Patient Rule Induction Method (PRIM) searches for box-shaped areas in the given data which exceed a minimal size and average outcome. This is achieved via a combination of iterative peeling and pasting steps, where small fractions of the data are removed or added to the current box. As an alternative, Classification and Regression Trees (CART) prediction models perform sequential binary splits of the data to produce subsets which can be interpreted as subgroups of heterogeneous outcome. PRIM and CART were compared in a simulation study to investigate their strengths and weaknesses under various data settings, taking different performance measures into account. PRIM was shown to be superior in rather complex settings such as those with few observations, a smaller signal-to-noise ratio, and more than one subgroup. CART showed the best performance in simpler situations. A practical application of the two methods was illustrated using a clinical data set. For this application, both methods produced similar results but the higher amount of user involvement of PRIM became apparent. PRIM can be flexibly tuned by the user, whereas CART, although simpler to implement, is rather static.


Assuntos
Medicina Clínica/métodos , Simulação por Computador , Interpretação Estatística de Dados , Estatísticas não Paramétricas , Humanos
17.
JAMA Intern Med ; 177(7): 1020-1025, 2017 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-28505266

RESUMO

Importance: No guidelines exist currently for guideline panels and others considering changes to disease definitions. Panels frequently widen disease definitions, increasing the proportion of the population labeled as unwell and potentially causing harm to patients. We set out to develop a checklist of issues, with guidance, for panels to consider prior to modifying a disease definition. Observations: We assembled a multidisciplinary, multicontinent working group of 13 members, including members from the Guidelines International Network, Grading of Recommendations Assessment, Development and Evaluation working group, and the World Health Organisation. We used a 5-step process to develop the checklist: (1) a literature review of issues, (2) a draft outline document, (3) a Delphi process of feedback on the list of issues, (4) a 1-day face-to-face meeting, and (5) further refinement of the checklist. The literature review identified 12 potential issues. From these, the group developed an 8-item checklist that consisted of definition changes, number of people affected, trigger, prognostic ability, disease definition precision and accuracy, potential benefits, potential harms, and the balance between potential harms and benefits. The checklist is accompanied by an explanation of each item and the types of evidence to assess each one. We used a panel's recent consideration of a proposed change in the definition of gestational diabetes mellitus (GDM) to illustrate use of the checklist. Conclusions and Relevance: We propose that the checklist be piloted and validated by groups developing new guidelines. We anticipate that the use of the checklist will be a first step to guidance and better documentation of definition changes prior to introducing modified disease definitions.


Assuntos
Lista de Checagem , Doença , Guias como Assunto , Terminologia como Assunto , Medicina Clínica/métodos , Current Procedural Terminology , Gerenciamento Clínico , Humanos
20.
Nanotoxicology ; 11(2): 147-149, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28055261

RESUMO

Nanotechnology has transformed materials engineering. However, despite much excitement in the scientific community, translation of nanotechnology-based developments has suffered from significant translational gaps, particularly in the field of biomedicine. Of the many concepts investigated, very few have entered routine clinical application. Safety concerns and associated socioeconomic uncertainties, together with the lack of incentives for technology transfer, are undoubtedly imposing significant hurdles to effective clinical translation of potentially game-changing developments. Commercialisation aspects are only rarely considered in the early stages and in many cases, the market is not identified early on in the process, hence precluding market-oriented development. However, methodologies and in-depth understanding of mechanistic processes existing in the environmental, health and safety (EHS) community could be leveraged to accelerate translation. Here, we discuss the most important stepping stones for (nano)medicine development along with a number of suggestions to facilitate future translation.


Assuntos
Medicina Clínica , Nanomedicina , Nanotecnologia/métodos , Pesquisa Biomédica , Medicina Clínica/economia , Medicina Clínica/métodos , Medicina Clínica/normas , Saúde Ambiental , Humanos , Nanomedicina/economia , Nanomedicina/métodos , Nanomedicina/normas , Segurança
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