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2.
West Afr J Med ; 36(3): 283-285, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31622493

RESUMO

BACKGROUND: Latent Tuberculosis (LTBI) affects approximately a third of the world population. Paediatric health workers caring for adolescent Tuberculosis (TB) patients in high TB endemic regions are particularly susceptible as they are exposed to TB in the community and in the work place. However, there is a paucity of reports on LTBI in paediatric health workers. OBJECTIVES: To identify the factors that could have resulted in latent TB in a paediatric health worker Methods/Results: We present a case of a 38-year old female paediatrician who was diagnosed with LTBI by a positive QuantiFERON-TB gold test during the routine new entry immigrant screening for tuberculosis on arrival in the United Kingdom for postgraduate studies. She was treated with three months course of Rifampicin and Isoniazid (plus pyridoxine). CONCLUSION: Latent TB infection may have been acquired from her involvement in the management of adolescents with adult type TB without the use of personal protective equipment. In this case, routine systematic screening of an at risk individual helped to eliminate TB infection. RECOMMENDATION: Paediatric health workers should use personal protective equipment when managing childhood TB and should also be routinely screened for latent TB.


Assuntos
Antituberculosos/uso terapêutico , Pessoal de Saúde , Isoniazida/uso terapêutico , Tuberculose Latente/tratamento farmacológico , Mycobacterium tuberculosis/isolamento & purificação , Piridoxina/uso terapêutico , Rifampina/uso terapêutico , Adolescente , Adulto , Técnicas de Laboratório Clínico , Feminino , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional , Tuberculose Latente/diagnóstico , Exposição Ocupacional , Resultado do Tratamento
3.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 50(3): 379-384, 2019 May.
Artigo em Chinês | MEDLINE | ID: mdl-31631607

RESUMO

Objective: To develop a PCR method for Entamoeba histolytica( E.histolytica) detection in fecal specimens, and to compare the performance of PCR to that of microscopy and ELISA. Methods: Two pairs of self-designed primers and 2 pairs of primers from references based on small subunit ribosome RNA (SSU rRNA) fragment of E. histolytica standard strain were synthetized. DNA from E. histolytica reference strain were amilified by the conventional PCR using the 4 pairs of primers. 221 stool samples from diarrhea patients were collected and detected for E. histolytica by three methods: Entamoeba trophozoites and cysts detection by microscopy, E. histolytica-specific antigen detection using enzyme-linked immunosorbent assay (ELISA) kit ( E. HISTOLYTICA II), amplification of SSU rRNA fragment of E. histolytica by PCR method. Positive rate of three methods were compared by chi-square test, and Kappa test was applied to determine the concordance among the three methods. Results: Specific fragments of E. histolytica were amplified by the PCR method we developed in this study. Positive rates of PCR, microscopy and ELISA were 2.26%, 0.90% and 9.50%, respectively. The positive rates of the three methods were significantly different ( χ 2 =23.34, P<0.01). The Kappa value of PCR and microscopy was 0.216, and that of PCR and ELISA method was -0.134, both of which showed a weak consistency. PCR results showed best consistency with clinical diagnosis. Conclusion: The PCR method we established in this study has a better performance in accuracy than microscopy and ELISA have in laboratory diagnosis of E. histolytica infection.


Assuntos
Entamoeba histolytica/isolamento & purificação , Entamebíase/diagnóstico , Reação em Cadeia da Polimerase , Técnicas de Laboratório Clínico , Ensaio de Imunoadsorção Enzimática , Fezes/parasitologia , Humanos , Microscopia , Sensibilidade e Especificidade
4.
Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi ; 31(4): 456-459, 2019 Jul 23.
Artigo em Chinês | MEDLINE | ID: mdl-31612690

RESUMO

OBJECTIVE: To analyze the epidemiological and clinical data of an imported case of visceral leishmaniasis in Henan Province, and explore the method of laboratory diagnosis of kala-azar. METHODS: The epidemiological and clinical data of an imported visceral leishmaniasis patient were analyzed. Leishmania donovani bodies in bone marrow smears were observed microscopically. The antibody was detected by using rK39 dipstick test strips. Two pairs of specific primers, K13A-K13B and LITSR-L5.8S, were used to amplify kinetoplast DNA and internal transcribed spacer of rDNA of the parasite, respectively. RESULTS: The patient had been in the epidemic area of visceral leishmaniasis, and had symptoms such as irregular fever, splenomegaly, pancytopenia, and inversed ratio of albumin and globulin. The amastigotes of L. donovani were found in the bone marrow smears, and rK39 test strip was positive, and the PCR products of K13A-K13B and LITSR-L5.8S were 87 bp and 285 bp respectively. The similarities of the two fragment sequences to the corresponding sequences of L. donovani were 94% and 100%, respectively. CONCLUSIONS: The case is diagnosed as visceral leishmaniasis according to the epidemiological data, clinical manifestations and laboratory test results of the patient, and the pathogen is L. donovani.


Assuntos
Doenças Transmissíveis Importadas , Leishmania donovani , Leishmaniose Visceral , Anticorpos Antiprotozoários/sangue , Medula Óssea/parasitologia , Técnicas de Laboratório Clínico , Doenças Transmissíveis Importadas/diagnóstico , Doenças Transmissíveis Importadas/parasitologia , Primers do DNA , Humanos , Leishmania donovani/genética , Leishmaniose Visceral/diagnóstico , Reação em Cadeia da Polimerase
5.
Klin Lab Diagn ; 64(9): 560-564, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31610109

RESUMO

Human babesiosis caused by parasitic protozoan Babesia spp. is sporadic zoonotic vector-borne infection. The course of babesiosis and prognosis depend on the type of pathogen and on the patient's immunological status. Significance this disease is a severe, often fatal course with immunocompromissed patients resembling complicated falciparum malaria. In Europe to date, more than 50 cases of confirmed human babesiosis have been reported in most cases caused by Babesia divergens. Possible there are unrecognized cases. Pathogen is an obligate intraerythrocyte parasite of vertebrate animals. The organism is transmitted from animal to man through bite of Ixodidae tick. Asexual reproduction of the parasite occurs in a vertebrate host. The pathogenesis of babesiosis is caused by the destruction of host cells. Intensive haemolysis of red blood cells leads to the development of haemolytic anemia, haematuria, jaundice, and polyorgan failure may develop. The clinical manifestations of the disease are nonspecific. Detection of intraerythrocyte parasites in blood smears stained Gimsa-Romanovsky confirms the proposed diagnosis. Blood smears and some laboratory signs from fatal cases were analyzed in the Reference-centre of E. I. Martsinovskii Institute. Original microphotographs B. divergens are shown. The main morphological forms of the parasite are shown. In addition to the well-known tetrades of parasites «Maltese Cross¼, for the first time, the parasites dividing into 6 interconnected trophozoites - "sextet" - were found. Originally, the invasion of Babesia in a normoblast is shown. An unusually high multiple invasion (14 parasites) of erythrocytes is noted. Because the patients, initially, were incorrectly diagnosed with malaria, the differential diagnosis of Babesia with Plasmodium is described step-by-step. It is important, since the treatment with antimalarial drugs is ineffective. Deviation laboratory signs are discussed. Complex morphological characteristics allowed us to speciated the parasites as B. divergens. DNA was detected in the sample with specific primers Bab di hsp70F/Bab di hsp70R and the probe Bab di hsp70P. The sequence demonstrated 99-100% and 98% similarity to the 18S rRNA gene fragment of B. divergence and Babesia venatorum, respectively. Molecular biological and serological methods of laboratory diagnosis of babesiosis are considered.


Assuntos
Babesia , Babesiose/diagnóstico , Animais , Técnicas de Laboratório Clínico , Primers do DNA , Diagnóstico Diferencial , Eritrócitos/parasitologia , Humanos , Malária Falciparum , Carrapatos/parasitologia
6.
J Med Microbiol ; 68(11): 1622-1628, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31596198

RESUMO

Introduction. Nosocomial transmission of Mycobacterium tuberculosis is an important health issue and the detection of tuberculosis (TB) cases is the main tool for controlling this disease.Aim. We aimed to assess the possible occurrence of nosocomial transmission of M. tuberculosis in a reference hospital for HIV/AIDS patients and evaluate both the performance of the Xpert MTB/RIF (Xpert) platform and drug resistance profiles.Methodology. We evaluated the performance of the Xpert platform. Samples that tested positive on the BACTEC MGIT 320 (MGIT320) platform were submitted for genotyping and drug susceptibility testing.Results. In this study, pulmonary and extrapulmonary samples from 407 patients were evaluated, and among these, 15.5 % were diagnosed with TB by the MGIT320 platform, with a TB/HIV coinfection rate of 52.4 %. The Xpert platform gave positive results for TB for 11 samples with negative results on the MGIT320 platform. In the genotyping results, 53.3 % of the strains clustered; of these strains, half were in two of the four clusters formed, and the patients had visited the hospital on the same day. Drug resistance was observed in 11.7 % of the strains.Conclusion. Putative nosocomial transmission of M. tuberculosis was detected, showing that genotyping is a powerful approach for understanding the dynamics of M. tuberculosis transmission, especially in a high-burden TB and HIV landscape.


Assuntos
Infecções por HIV/complicações , Técnicas de Diagnóstico Molecular/métodos , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Pulmonar/microbiologia , Síndrome de Imunodeficiência Adquirida/complicações , Antibióticos Antituberculose/farmacologia , Técnicas de Laboratório Clínico , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/microbiologia , Estudos Transversais , Farmacorresistência Bacteriana , Humanos , Testes de Sensibilidade Microbiana , Mycobacterium tuberculosis/classificação , Mycobacterium tuberculosis/efeitos dos fármacos , Mycobacterium tuberculosis/genética , Filogenia , Tuberculose , Tuberculose Pulmonar/diagnóstico
7.
Rev Bras Epidemiol ; 22Suppl 02(Suppl 02): e190002.supl.2, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31596373

RESUMO

INTRODUCTION: This article aims to estimate reference values for laboratory tests of cholesterol, glycosylated hemoglobin and creatinine for the Brazilian adult population. METHODS: A descriptive study carried out with laboratory data from the National Health Survey (Pesquisa Nacional de Saúde - PNS). Samples of blood and urine were collected in a PNS subsample of 8,952 individuals aged 18 years old or older. To determine the reference values, exclusion criteria were applied: presence of previous diseases and outliers, defined by values outside the range estimated by the mean ± 1.96 × standard deviation. Subsequently, reference values were calculated according to gender, age group and race/skin color. RESULTS: Differences in reference values according to gender were observed. Women had higher values of total cholesterol, LDL-c and HDL-c. Glycosylated hemoglobin showed similar values in relation to gender, and creatinine was higher among men. The mean reference values were higher in the elderly population, aged 60 years old or older. The mean, lower and upper limits of total cholesterol and fractions of non-white people were slightly lower. There was no difference according to race/skin color for glycosylated hemoglobin and creatinine. CONCLUSION: The establishment of national reference parameters for laboratory tests, adapted to the sociodemographic and geographic characteristics, provides relevant information for evaluation of diagnosis and treatment of chronic diseases in Brazil.


Assuntos
Colesterol/sangue , Técnicas de Laboratório Clínico/normas , Creatinina/análise , Hemoglobina A Glicada/análise , Adolescente , Adulto , Grupo com Ancestrais do Continente Africano , Brasil , Grupo com Ancestrais do Continente Europeu , Feminino , Inquéritos Epidemiológicos/métodos , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Fatores Sexuais , Adulto Jovem
8.
Rev Bras Epidemiol ; 22Suppl 02(Suppl 02): E190003.SUPL.2, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31596374

RESUMO

OBJECTIVE: To describe reference values for blood counts obtained from laboratory tests in the Brazilian adult population according to laboratory results from the National Health Survey (Pesquisa Nacional de Saúde - PNS), by gender, age group and skin color. METHODS: The initial sample consisted of 8,952 adults. To determine the reference values, individuals with prior diseases and outliers were excluded. Mean values, standard deviation and limits were stratified by gender, age group and skin color. RESULTS: For red blood cells, men presented a mean value of 5.0 million per mm3 (limits: 4.3-5.8) and women, 4.5 million per mm3 (limits: 3.9-5.1). Hemoglobin levels were higher among men with a mean of 14.9 g/dL (13.0-16.9), and in women, 13.2 g/dL (11.5-14.9). The mean number of white blood cells among men was 6.142/mm3 (2.843-9.440) and 6.426/mm3 (2.883-9.969) for women. Other parameters showed close values between the genders. Regarding age groups and skin color, mean values, standard deviation and limits of the exams presented small variations. CONCLUSION: Hematological reference values based on the national survey allow for the establishment of specific reference limits for gender, age and skin color. The results presented here may contribute to the establishment of better evidence and criteria for the care, diagnosis and treatment of diseases.


Assuntos
Contagem de Células Sanguíneas/normas , Técnicas de Laboratório Clínico/normas , Inquéritos Epidemiológicos/normas , Adolescente , Adulto , Fatores Etários , Brasil/etnologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Fatores Sexuais , Adulto Jovem
9.
Rev Bras Epidemiol ; 22Suppl 02(Suppl 02): E190004.SUPL.2, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31596375

RESUMO

INTRODUCTION: This article aims at describing the National Health Survey (Pesquisa Nacional de Saúde- PNS) methodology of collecting laboratory exams data. METHODOLOGY: A subsample of 25% of the census tracts was selected, according to the stratification of the PNS sample, with a probability inversely proportional to the difficulty of collection. The collection of blood and urine was done in the households by a laboratory agent, among residents selected for individual interview. Due to the difficulties found in the field work, the sample did not reach the minimum expected number in some strata, and a post-stratification procedure was proposed for the data analysis. RESULTS: The collection of biospecimens was performed in 8,952 individuals. Laboratory tests were: glycated hemoglobin; total cholesterol; LDL cholesterol; HDL cholesterol; serology for dengue; red blood cell count (erythrogram) and white series count (leukogram); high performance liquid chromatography (HPLC) for diagnosis of hemoglobinopathies; creatinine. Theexcretion of potassium, salt and sodium and creatinine was estimated in the urine. The database of laboratory exams was weighed and made publicly available on the Oswaldo Cruz Foundation's PNS website and can be accessed without prior authorization. CONCLUSION: The total subsample of laboratory exams is of great value, since it allowed us to establish national reference parameters adequate to sociodemographic and geographic characteristics of the Brazilian population, providing relevant and complementary information for the analysis of the health situation of Brazil.


Assuntos
Técnicas de Laboratório Clínico/métodos , Coleta de Dados/métodos , Bases de Dados Factuais , Inquéritos Epidemiológicos/métodos , Adolescente , Adulto , Coleta de Amostras Sanguíneas/métodos , Brasil , Colesterol/sangue , Cromatografia Líquida de Alta Pressão , Dengue/sangue , Contagem de Eritrócitos , Feminino , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Coleta de Urina/métodos , Adulto Jovem
10.
Rev. argent. salud publica ; 10(40): 39-43, 30 de septiembre 2019.
Artigo em Espanhol | LILACS, BINACIS, ARGMSAL | ID: biblio-1024850

RESUMO

La tuberculosis representa un desafío para la salud pública, entre otras causas, por las dificultades diagnósticas. La baciloscopía y el cultivo en medio sólido presentan obstáculos técnicos y demandan tiempo. OBJETIVOS: Realizar una evaluación completa de tecnología sanitaria sobre incorporación de nuevos equipamientos de diagnóstico in vitro para tuberculosis en el sistema de salud pública de Neuquén. MÉTODOS: Un equipo multidisciplinario e independiente analizó los recursos locales, efectuó una búsqueda sistemática con análisis de rendimiento diagnóstico, impacto económico, organizacional y en la equidad. RESULTADOS: Se identificaron como potenciales incorporaciones la microscopía de fluorescencia, los cultivos en medio líquido y la biología molecular. Los tres presentan evidencias de mayor sensibilidad y especificidad que la baciloscopía. La biología molecular acorta los tiempos de diagnóstico, requiere mínima capacitación del personal y presenta un costo muy superior a otras tecnologías. El cultivo en medio líquido acorta el tiempo al diagnóstico y es factible de ser incorporado. CONCLUSIONES: Se observaron tensiones entre escenarios, donde la maximización de la eficiencia incrementa inequidades en el acceso. La metodología de consenso facilita la toma de decisiones sobre incorporación de tecnologías. Se recomienda incorporar microscopía por fluorescencia en laboratorios de cabecera y un equipo de cultivo en medio líquido, centralizando las muestras.


Assuntos
Tuberculose , Técnicas de Laboratório Clínico , Avaliação da Tecnologia Biomédica
11.
Klin Lab Diagn ; 64(8): 459-462, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31479599

RESUMO

The use of point-of-care diagnostics can prevent a number of complications and leading to improved health outcomes for patients in critical condition. Research have shown that elongation of the preanalytic stage leading of errors of studies and changes the results of a number of laboratory parameters. The article presents the key problems associated with the elongation of the preanalytic stage and possible solutions to address the shortcomings of existing diagnostics.


Assuntos
Técnicas de Laboratório Clínico , Medicina de Desastres , Testes Imediatos , Fase Pré-Analítica , Cuidados Críticos , Humanos , Laboratórios
12.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 46(3): 95-101, jul.-sept. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182714

RESUMO

Objetivo: Medir la frecuencia con la que resultan positivos los marcadores del laboratorio clínico en pacientes con preeclampsia severa (PS) admitidas en una unidad de cuidados intensivos (UCI). Diseño: Estudio transversal. Ámbito: UCI de la Unidad Médica de Alta Especialidad Hospital de Ginecología y Obstetricia N.o 3 del Centro Médico Nacional La Raza del Instituto Mexicano del Seguro Social, Ciudad de México, México. Pacientes: Un total de 212 pacientes embarazadas con PS admitidas en la UCI del 1 de junio al 31 de diciembre del 2016. Intervenciones: Se consultaron los resultados del laboratorio clínico de su admisión a la UCI para identificar el porcentaje de aparición de los marcadores positivos de la PS. Variables de interés: Marcadores de la PS: hemoglobina (Hb) <10g/dL, cuenta plaquetaria (Plaq) <100.000plaquetas/μL, glucosa ˃180mg/dL, creatinina sérica (Cr) >1,1mg/dL, ácido úrico (Au) >4,0mg/dL, aspartato aminotransferasa (AST) >70U/L, deshidrogenasa láctica (DHL) >600U/L, pH arterial <7,32, déficit de base del fluido extracelular (DB fec) >8mmol/L y lactato >4mmol/L. Resultados: Marcadores positivos en el 93,39% (n=198) de los casos con la siguiente distribución: Au ˃4mg/dL, 88,48% (n=169, media de 6,2±1,04mg/dL); AST˃70U/L, 25,13% (n=48, media de 180,4±73,08U/L); Plaq<100.000plaquetas/μL, 24,08% (n=46, media de 71.600±22.970plaquetas/μL); DHL˃600U/L, 21,98% (n=42, media de 1.021,3±476U/L); Cr˃1,1mg/dL, 13,08% (n=25, media de 1,33±0,34mg/dL); pH arterial <7,32, 7,32% (n=14, media de 7,30±0,01); DB fec ˃8mmol/L, 6,28% (n=12, media de 9±0,2mmol/L); glucosa ˃180mg/dL, 3,30% (n=7, media de 187,85±2,67mg/dL); lactato ˃4mmol/L, 1,04% (n=2), y Hb˂10g/dL, 0%. Conclusiones: Los marcadores positivos más frecuentes fueron Au, AST, Plaq, DHL y Cr


Objective: To measure the frequency of positive results for clinical laboratory markers in patients with severe preeclampsia (SP) admitted in an intensive care unit (ICU). Design: Cross-sectional study. Setting: ICU of the High-Specialty Medical Unit, Hospital of Gynecology and Obstetrics No. 3, National Medical Center La Raza, Mexican Institute of Social Security, Mexico City, Mexico. Patients: 212 pregnant patients with SP admitted to the ICU between June 1 and December 31, 2016. Interventions: Laboratory results were consulted to identify the percentage of positive markers of SP. Variables of interest: SP markers: hemoglobin (Hb) <10g/dL, platelet count (Plat) <100,000 platelets/μL, glucose ˃180mg/dL, serum creatinine (Cr) >1.1mg/dL, uric acid (Ua) >4.0mg/dL, aminotransferase aspartate (AST) >70U/L, lactic deshydrogenase (LDH) >600U/L, blood pH <7.32, deficit of base of extra cellular fluid (DB ecf) >8mmol/L and lactate >4mmol/L. Results: Positive markers 93.39% (n=198) with the following distribution: Ua˃4mg/dL, 88.48% (n=169, mean 6.2±1.04mg/dL); AST˃70U/L, 25.13% (n=48, mean 180.4±73.08U/L); Plat<100,000platelets/μL, 24.08% (n=46, mean 71,600±22,970platelets/μL); LDH˃600U/L, 21.98% (n=42, mean 1,021.3±476U/L); Cr˃1.1mg/dL, 13.08% (n=25, mean 1.33±0.34mg/dL); blood pH<7.32, 7.32% (n=14, mean 7.30±0.01); DB ecf˃8mmol/L, 6.28% (n=12, mean 9±0.2mmol/L); glucose ˃180mg/dL, 3.30% (n=7, mean 187.85±2.67mg/dL); lactate ˃4mmol/L, 1.04% (n=2), and Hb˂10g/dL, 0%. Conclusions: The most frequent positive markers of SP were Ua, AST, Plat, LDH and Cr


Assuntos
Humanos , Feminino , Gravidez , Adulto , Pré-Eclâmpsia/diagnóstico , Unidades de Terapia Intensiva , Biomarcadores/análise , Técnicas de Laboratório Clínico , Estudos Transversais , Síndrome HELLP/diagnóstico , México
13.
Pan Afr Med J ; 33(Suppl 2): 8, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31404295

RESUMO

Introduction: Following a declaration by the World Health Organization that Liberia had successfully interrupted Ebola virus transmission on May 9th, 2015; the country entered a period of enhanced surveillance. The number of cases had significantly reduced prior to the declaration, leading to closure of eight out of eleven Ebola testing laboratories. Enhanced surveillance led to an abrupt increase in demand for laboratory services. We report interventions, achievements, lessons learned and recommendations drawn from enhancing laboratory capacity. Methods: Using archived data, we reported before and after interventions that aimed at increasing laboratory capacity. Laboratory capacity was defined by number of laboratories with Ebola Virus Disease (EVD) testing capacity, number of competent staff, number of specimens tested, specimen backlog, daily and surge testing capacity, and turnaround time. Using Stata 14 (Stata Corporation, College Station, TX, USA), medians and trends were reported for all continuous variables. Results: Between May and December 2015, interventions including recruitment and training of eight staff, establishment of one EVD laboratory facility, implementation of ten Ebola GeneXpert diagnostic platforms, and establishment of working shifts yielded an 8-fold increase in number of specimens tested, a reduction in specimens backlog to zero, and restoration of turn-around time to 24 hours. This enabled a more efficient surveillance system that facilitated timely detection and containment of two EVD clusters observed thereafter. Conclusion: Effective enhancement of laboratory services during high demand periods requires a combination of context-specific interventions. Building and ensuring sustainability of local capacity is an integral part of effective surveillance and disease outbreak response efforts.


Assuntos
Fortalecimento Institucional , Surtos de Doenças/prevenção & controle , Doença pelo Vírus Ebola/epidemiologia , Laboratórios/organização & administração , Técnicas de Laboratório Clínico , Doença pelo Vírus Ebola/diagnóstico , Doença pelo Vírus Ebola/prevenção & controle , Humanos , Libéria/epidemiologia
14.
Nature ; 572(7767): 116-119, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31367026

RESUMO

The early prediction of deterioration could have an important role in supporting healthcare professionals, as an estimated 11% of deaths in hospital follow a failure to promptly recognize and treat deteriorating patients1. To achieve this goal requires predictions of patient risk that are continuously updated and accurate, and delivered at an individual level with sufficient context and enough time to act. Here we develop a deep learning approach for the continuous risk prediction of future deterioration in patients, building on recent work that models adverse events from electronic health records2-17 and using acute kidney injury-a common and potentially life-threatening condition18-as an exemplar. Our model was developed on a large, longitudinal dataset of electronic health records that cover diverse clinical environments, comprising 703,782 adult patients across 172 inpatient and 1,062 outpatient sites. Our model predicts 55.8% of all inpatient episodes of acute kidney injury, and 90.2% of all acute kidney injuries that required subsequent administration of dialysis, with a lead time of up to 48 h and a ratio of 2 false alerts for every true alert. In addition to predicting future acute kidney injury, our model provides confidence assessments and a list of the clinical features that are most salient to each prediction, alongside predicted future trajectories for clinically relevant blood tests9. Although the recognition and prompt treatment of acute kidney injury is known to be challenging, our approach may offer opportunities for identifying patients at risk within a time window that enables early treatment.


Assuntos
Lesão Renal Aguda/diagnóstico , Técnicas de Laboratório Clínico/métodos , Lesão Renal Aguda/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Simulação por Computador , Conjuntos de Dados como Assunto , Reações Falso-Positivas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/complicações , Curva ROC , Medição de Risco , Incerteza , Adulto Jovem
16.
Presse Med ; 48(7-8 Pt 1): 816-824, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31439443

RESUMO

Diagnosis of mature B cell malignancies is highly multidisciplinary. Biological tools provide diagnostic, prognostic and theranostic information. Biological hematology allows considering mature B cell diseases from two perspectives : cellular and molecular approaches. Cytomorphology and flow cytometry are tools from cell hematology. Conventional cytogenetics, FISH and molecular biology are tools from molecular hematology. NGS is a new technique that could dramatically change diagnostic and therapeutic management of B cell malignancies in the near future. Integration of clinical, pathological and biological data allows for personalized management of these diseases.


Assuntos
Técnicas de Laboratório Clínico/métodos , Leucemia de Células B/diagnóstico , Linfoma de Células B/diagnóstico , Integração de Sistemas , Hibridização Genômica Comparativa/métodos , Citodiagnóstico/métodos , Análise Citogenética/métodos , Análise Mutacional de DNA/métodos , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Humanos , Imunofenotipagem/métodos , Hibridização in Situ Fluorescente/métodos , Leucemia de Células B/genética , Leucemia de Células B/patologia , Linfoma de Células B/genética , Linfoma de Células B/patologia , Técnicas de Diagnóstico Molecular/métodos , Imagem Multimodal/métodos , Imagem Multimodal/tendências
17.
Rev Assoc Med Bras (1992) ; 65(6): 745-754, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31340297

RESUMO

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.


Assuntos
Técnicas de Laboratório Clínico/normas , Doenças Sexualmente Transmissíveis/diagnóstico , Brasil , Tomada de Decisão Clínica , Técnicas de Laboratório Clínico/métodos , Humanos , Fatores de Risco , Sensibilidade e Especificidade
18.
Med Mycol ; 57(Supplement_3): S259-S266, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31292661

RESUMO

The field of diagnostic mycology represents much more than culture and microscopy and is rapidly embracing novel techniques and strategies to help overcome the limitations of conventional approaches. Commercial molecular assays increase the applicability of PCR testing and may identify markers of antifungal resistance, which are of great clinical concern. Lateral flow assays simplify testing and turn-around time, with potential for point of care testing, while proximity ligation assays embrace the sensitivity of molecular testing with the specificity of antibody detection. The first evidence of patient risk stratification is being described and together with the era of next generation sequencing represents an exciting time in mycology.


Assuntos
Micologia/tendências , Micoses/diagnóstico , Técnicas de Laboratório Clínico/tendências , Humanos
19.
Rev Chilena Infectol ; 36(2): 145-166, 2019 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-31344152

RESUMO

The confrontation of the differential and etiological diagnosis of the infectious diseases of cancer patients, including hematopoietic stem cells transplant (HSCT) recipients, must correspond to an informed, timely decision that directly affects medical behavior that determines a better survival and quality of life for patients. The main goal of this work was to contribute to the management of these patients developing a useful tool for the clinician to make these decisions. For that, infections were grouped by compromised systems, differentiating the possible etiological agents in bacteria, viruses, fungi and parasites, highlighting the relevant diagnostic tests, mentioning the recommended techniques together with the optimal sample type for proper processing. In addition, under each group of techniques we added the item "level of requirement" to suggest what, in the opinion of the authors and the existing evidence, must be mandatory to have at local level or can be derivable to another laboratory.


Assuntos
Infecção Hospitalar/diagnóstico , Infecção Hospitalar/microbiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Laboratórios Hospitalares/normas , Neoplasias/complicações , Biópsia/normas , Técnicas de Laboratório Clínico/métodos , Técnicas de Laboratório Clínico/normas , Infecção Hospitalar/terapia , Exposição Ambiental/efeitos adversos , Humanos , Imunocompetência , Neoplasias/terapia
20.
Rev. Fac. Cienc. Méd. Univ. Cuenca ; 37(1): 21-30, Junio 2019. tab, ilus
Artigo em Espanhol | LILACS | ID: biblio-1000435

RESUMO

Objetivo: determinar la presencia de parásitos en expendedores y hortalizas de los mercados públicos de Cuenca. Materiales y métodos: es un estudio analítico transversal. La muestra fue de 144 expendedores de hortalizas, realizado en cuatro mercados de Cuenca. Inicialmente se informó a los comerciantes sobre las características de la investigación, se solicitó el respectivo consentimiento informado, se aplicó una encuesta y se les pidió una muestra de heces, posteriormente se compró una lechuga y perejil para su análisis respectivo. A la materia fecal se le realizó un examen coproparasitológico y concentrado de heces mediante el método de Ritchie simplificada, técnica en fresco con solución salina y lugol, para su observación al microscopio; las hortalizas se les colocó por separado en un vaso de precipitado con 400 ml de agua destilada, se dejó 24 horas en reposo, posterior a ello se colocó 8 ml de esta agua en un tubo de ensayo y se centri-fugó, el sedimento se observó al microscopio. El procesamiento de muestras cumplió las normas de calidad y bioseguridad. Los datos fueron analizados mediante programa estadístico IBM SPSS Statistics 20 y el programa Epi info 7 (versiones de prueba).Resultados: se determina presencia de parásitos en los comerciantes en un 68.10%, los principales protozoarios observados son quistes de Enta-moeba histolytica 19.03% y oocitos de Cryptosporidium parvum 16.45%. La contaminación por parásitos en el perejil fue del 44.40 % y en la lechuga el 38.90 %. En ambos productos se destaca la presencia de larvas filariformes de Uncinaria spp.Conclusiones: se observa la presencia de parásitos en expendedores y productos de venta. Los parásitos intestinales más frecuentes son losquistes de Entamoeba coli y oocitos de Criptosporidium parvum. En las hortalizas destaca la presencia de las larvas filariformes de Uncinaria spp


Objective: determine the presence of parasites in sellers and vegetables of the public markets of Cuenca.Materials and methods: it is a transversal analyti-cal study. The sample consisted of 144 sellers; it was made in four markets in Cuenca. Initially the merchants were informed about the characteristics of the investigation, the informed consent was re-quested, a survey was applied and a stool sample was requested, later a lettuce and some parsley were purchased for their respective analysis. The faecal matter was subjected to a coproparasitolo-gical examination and stool concentrate using the simplified Ritchie method, fresh technique with saline solution and lugol, and for the observation through a microscope; the vegetables were pla-ced separately in a beaker with 400 ml of distilled water for 24 hours, later about 8 ml of this water was placed in a test tube and it was centrifuged, the sediment was observed with microscope. The processing of samples met the standards of quality and biosafety. The data were analyzed using the IBM SPSS Statistics 20 program and the Epi info 7 program (trial versions). Results: the presence of parasites in sellers is determined by 68.10%, the main protozoa obser-ved are Entamoeba histolytica 19.03% cysts and 16.45% Cryptosporidium parvum oocytes. The pa-rasite contamination in parsley was 44.40% and in lettuce 38.90%. In both products, there is the pre-sence of filariform larvae of Uncinaria sppConclusions: the presence of parasites in sellers and products is observed. The most frequent intes-tinal parasites are the cysts of Entamoeba coli and oocytes of Criptosporidium parvum. In the vegeta-bles, the presence of the filariform larvae of Unci-naria spp is prominent.


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Parasitos , Verduras , Contaminação de Alimentos , Oócitos , Técnicas de Laboratório Clínico , Entamoeba histolytica
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