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1.
Gastroenterol. hepatol. (Ed. impr.) ; 43(7): 389-407, ago.-sept. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-188817

RESUMO

INTRODUCCIÓN: La pandemia por COVID-19 ha conllevado la suspensión de la actividad programada en la mayoría de las Unidades de Endoscopia de nuestro medio. El objetivo del presente documento es facilitar el reinicio de la actividad endoscópica electiva de forma eficiente y segura. MATERIAL Y MÉTODOS: Se formularon una serie de preguntas consideradas de relevancia clínica y logística. Para la elaboración de las respuestas, se realizó una búsqueda bibliográfica estructurada en las principales bases de datos y se revisaron las recomendaciones de las principales instituciones de Salud Pública y de endoscopia digestiva. Las recomendaciones finales se consensuaron por vía telemática. RESULTADOS: Se han elaborado un total de 33 recomendaciones. Los principales aspectos que se discuten son: 1) La reevaluación y priorización de la indicación, 2) La restructuración de espacios, agendas y del personal sanitario, 3) El cribado de la infección, 4) Las medidas de higiene y los equipos de protección individual. CONCLUSIÓN: La AEG y la SEED recomiendan reiniciar la actividad endoscópica de forma escalonada, segura, adaptada a los recursos locales y a la situación epidemiológica de la infección por SARS-CoV-2


INTRODUCTION: The COVID-19 pandemic has led to the suspension of programmed activity in most of the Endoscopy Units in our environment. The aim of this document is to facilitate the resumption of elective endoscopic activity in an efficient and safe manner. MATERIAL AND METHODS: A series of questions considered to be of clinical and logistical relevance were formulated. In order to elaborate the answers, a structured bibliographic search was carried out in the main databases and the recommendations of the main Public Health and Digestive Endoscopy institutions were reviewed. The final recommendations were agreed upon through telematic means. RESULTS: A total of 33 recommendations were made. The main aspects discussed are: 1) Reassessment and prioritization of the indication, 2) Restructuring of spaces, schedules and health personnel, 3) Screening for infection, 4) Hygiene measures and personal protective equipment. CONCLUSION: The AEG and SEED recommend restarting endoscopic activity in a phased, safe manner, adapted to local resources and the epidemiological situation of SARS-CoV-2 infection


Assuntos
Humanos , Sociedades Médicas/normas , Endoscopia/normas , Infecções por Coronavirus/epidemiologia , Pandemias/prevenção & controle , Programas de Triagem Diagnóstica/normas , Assistência à Saúde/organização & administração , Sociedades Médicas/organização & administração , Comissão Para Atividades Profissionais e Hospitalares/normas , Contaminação de Equipamentos , Técnicas e Procedimentos Diagnósticos/normas , Endoscopia Gastrointestinal/normas , Gastroscopia/métodos , Colonoscopia , Cápsulas Endoscópicas , Espanha/epidemiologia
2.
Rev. int. androl. (Internet) ; 18(3): 101-106, jul.-sept. 2020. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193601

RESUMO

OBJETIVO: Desarrollar un instrumento visual analógico para diagnosticar a los pacientes con disfunción eréctil, establecer la capacidad de comprensión del mismo en la población y compararlo con la escala «gold standard» en la enfermedad, sentando las bases para su futura validación. MATERIAL Y MÉTODOS: Estudio transversal que incluyó a todos los hombres mayores de 18 años del Servicio de Urología del Hospital Juárez de México cuyo motivo de consulta fue la disfunción eréctil. Los pacientes fueron evaluados utilizando dos herramientas clínicas: el Índice Internacional de Función Eréctil y la Escala Visual Analógica de Función Eréctil Pineda consecutivamente. Las características sociodemográficas de los pacientes incluyeron edad, idioma, nivel educativo, localidad y estado civil. Se valoró la comprensión, el tiempo de respuesta y el grado de disfunción. Las variables cualitativas se analizaron con Chi cuadrado de Pearson χ2 y las cuantitativas con la prueba «U» de Mann-Whitney. RESULTADOS: El registro final incluyó a 227 pacientes, encontrando una edad promedio de 55,6±14 años. La mayoría de la población (94,7%) se comunicaba mediante el idioma español. Existen diferencias estadísticamente significativas entre ambas escalas, en la comprensión, el grado de disfunción, el puntaje final y el tiempo de respuesta, todas con una p de 0,0001. Los pacientes con menor nivel educativo fueron capaces de responder completa y más prontamente el cuestionario Escala Visual Analógica de Función Eréctil Pineda que el Índice Internacional de Función Eréctil, no obstante no podemos asumir absolutamente que lo comprendan mejor. CONCLUSIONES: La Escala Visual Analógica de Función Eréctil Pineda es un prototipo de escala visual que puede utilizarse como alternativa al cuestionario Índice Internacional de Función Eréctil, especialmente en pacientes que presenten limitaciones académicas y lingüísticas


OBJECTIVE: To develop an analog visual instrument to diagnose patients with erectile dysfunction, to establish the ability to understand it in the population and to compare it with the "gold standard" scale for the disease, providing a basis for its future validation. MATERIAL AND METHODS: Cross-sectional study that included all 18 years old men and older, of the urology service of Juarez Hospital of Mexico City, whose reason for consultation was erectile dysfunction. The patients were assessed using two clinical tools: the International Index of Erectile Function and the Erectile Function Pineda Visual Analog Scale consecutively. The sociodemographic features of the patients included age, language, educational level, location and marital status. The comprehension, the response time and the degree of dysfunction were assessed. The qualitative variables were analyzed with Pearson's chi square and the quantitative variables with the Mann-Whitney U test. RESULTS: The final registry included 227 patients, finding an average age of 55.6±14 years. The majority of the population (94.7%) communicated through the Spanish language. There are statistically significant differences between both scales, in the understanding, the degree of dysfunction, the final score and the response time, all with a p=,0001. The patients with lower educational level were able to respond completely and more quickly the Erectile Function Pineda Visual Analog Scale questionnaire than the International Index of Erectile Function. However, we cannot assume that they understand it better. CONCLUSIONS: The Erectile Function Pineda Visual Analog Scale is a prototype of a visual scale that can be used as an alternative to the International Index of Erectile Function questionnaire, especially in patients with academic and linguistic limitations


Assuntos
Humanos , Masculino , Adolescente , Pessoa de Meia-Idade , Disfunção Erétil/diagnóstico , Escala Visual Analógica , Estudos Transversais , Classificações em Saúde , Técnicas e Procedimentos Diagnósticos/instrumentação , Fatores Socioeconômicos , México
3.
Lima; Perú. Ministerio de Salud; 20200900. 10 p.
Monografia em Espanhol | LILACS, MINSAPERU | ID: biblio-1118684

RESUMO

El documento contiene los lineamientos para los estudios de validación de procedimientos diagnósticos del virus SARS-CoV-2.


Assuntos
Controle de Doenças Transmissíveis , Doenças Transmissíveis , Técnicas e Procedimentos Diagnósticos , Vírus da SARS
4.
Med. clín (Ed. impr.) ; 155(4): 143-151, ago. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-190152

RESUMO

INTRODUCTION AND OBJECTIVES: Common laboratory parameters are crucial in aiding coronavirus disease 2019 (COVID-19) case detection. This study aimed to determine the differences between laboratory parameters in (1) COVID-19 versus non-COVID-19 pneumonia, and (2) severe versus non-severe COVID-19 cases. METHODS: Studies were collected until March 2020, and retrieved parameters include leukocyte, neutrophil, thrombocyte, and lymphocyte counts in addition to C-reactive protein (CRP), procalcitonin (PCT) and D-dimer levels. In the presence of heterogeneity, the random-effect model (REM) was used instead of the fixed-effect model (FEM). RESULTS: Seven studies in the first analysis showed significantly lower leukocyte, neutrophil and platelet counts in COVID-19 pneumonia (SMD = -0.42, 95% CI -0.60 to -0.25, p < 0.00001, SMD = -0.23, 95%CI -0.41 to -0.06, p = 0.01, SMD = -0.54, 95% CI -0.91 to -0.16, p = 0.0005) compared to non-COVID-19 pneumonia. Twenty-six studies in the second analysis showed significantly lower lymphocyte and thrombocyte counts (SMD = -0.56, 95% CI -0.71 to -0.40, p < 0.0001, SMD = -0.32, 95% CI -0.49 to -0.15, p = 0.0002) and significantly higher leukocyte, neutrophil, D-dimer, and CRP (SMD = 0.31, 95%CI 0.07-0.56, p = 0.01; SMD = 0.44, 95% CI 0.24-0.64, p < 0.0001; SMD = 0.53, 95%CI 0.31-0.75, p < 0.00001; SMD = 0.97, 95% CI 0.70-1.24, p < 0.00001) in severe COVID-19 compared to non-severe COVID-19. CONCLUSIONS: In conclusion, thrombocyte count is key in both diagnosis and prognosis. Low leukocyte and neutrophil counts are markers of COVID-19 infection, but contrastingly higher counts indicate progressive COVID-19. And although lymphocyte, D-dimer and CRP levels did not demonstrate diagnostic value, all indicate severity of COVID-19. Confirmation of these findings should be performed in future studiesn


INTRODUCCIÓN Y OBJETIVOS: Los parámetros comunes de laboratorio son cruciales para ayudar a la detección de casos de enfermedad por coronavirus 2019 (COVID-19). Este estudio tuvo como objetivo determinar las diferencias entre los parámetros de laboratorio en: 1) COVID-19 versus neumonía no COVID-19, y 2) Casos severos versus no severos de COVID-19. MÉTODOS: Los estudios se recolectaron hasta marzo de 2020, y los parámetros recuperados incluyen recuentos de leucocitos, neutrófilos, trombocitos y linfocitos además de los niveles de proteína C reactiva (PCR), procalcitonina (PCT) y dímero-D. En presencia de heterogeneidad, se utilizó el modelo de efectos aleatorios en lugar del modelo de efectos fijos. RESULTADOS: Siete estudios en el primer análisis mostraron recuentos de leucocitos, neutrófilos y plaquetas significativamente más bajos en la neumonía por COVID-19 (SMD = -0,42; IC 95%: -0,60 a -0,25; p<0,00001; SMD = -0,23; IC 95%: -0,41 a -0,06; p = 0,01; SMD = -0,54; IC 95%: -0,91 a -0,16; p = 0,0005) en comparación con la neumonía no COVID-19. Veintiséis estudios en el segundo análisis mostraron recuentos de linfocitos y trombocitos significativamente más bajos (SMD=-0,56; IC 95%: -0,71 a -0,40; p < 0,0001; SMD = -0,32; IC 95%: -0,49 a -0,15; p=0,0002) y leucocitos, neutrófilos, dímero D y PCR significativamente más altos (SMD = 0,31; IC 95%: 0,07-0,56; p = 0,01; SMD = 0,44; IC 95%: 0,24-0,64; p < 0,0001; SMD = 0,53; IC 95%: 0,31-0,75; p < 0,00001; SMD = 0,97; IC 95%: 0,70-1,24; p < 0,00001) en COVID-19 severo en comparación con COVID-19 no severo. CONCLUSIONES: En conclusión, el recuento de trombocitos es clave tanto en el diagnóstico como en el pronóstico. Los recuentos bajos de leucocitos y neutrófilos son marcadores de infección por COVID-19, pero los recuentos contrastantemente más altos indican COVID-19 progresivo. Y aunque los niveles de linfocitos, dímero D y PCR no mostraron valor diagnóstico, todos indican la gravedad de COVID-19. La confirmación de estos hallazgos debe realizarse en futuros estudios


Assuntos
Humanos , Infecções por Coronavirus/diagnóstico , Técnicas e Procedimentos Diagnósticos/normas , Estudos de Coortes , Betacoronavirus , Prognóstico , Pneumonia Viral/diagnóstico , Técnicas e Procedimentos Diagnósticos/instrumentação , Reação em Cadeia da Polimerase , Pró-Calcitonina , Plaquetas , Curva ROC
5.
PLoS Negl Trop Dis ; 14(8): e0008472, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32760070

RESUMO

In order to rapidly inform polices in the international response to the ongoing pandemic of coronavirus disease 19 (COVID-19), we summarize in this review current evidence on epidemiological and clinical features of the infection, transmission routes, problems of nucleic-acid testing, the epidemiological trend in China and impact of interventional measures, and some lessons learned. We concluded that the epidemic is containable with traditional nonpharmacological interventions, mainly through social distancing and finding and isolating suspected patients and close contacts. Nonpharmacological interventions are the only effective measures currently accessible and have suppressed some 90% of the infections in China. Close contacts are the major mechanism of transmission, which makes it possible to control this epidemic through nonpharmacological methods. Nucleic-acid testing alone may miss some 50% of infected patients, and other methods such as chest computerized tomography (CT) or serology should be considered to supplement molecular testing. The development of vaccines and drugs is important, but hesitation to make use of nonpharmacological interventions may mean missing golden opportunities for effective actions.


Assuntos
Betacoronavirus/fisiologia , Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , China/epidemiologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/patologia , Infecções por Coronavirus/transmissão , Técnicas e Procedimentos Diagnósticos , Humanos , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/patologia , Pneumonia Viral/transmissão , Índice de Gravidade de Doença , Viagem
6.
Nat Protoc ; 15(9): 3030-3063, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32807909

RESUMO

Materials that sense and respond to biological signals in their environment have a broad range of potential applications in drug delivery, medical devices and diagnostics. Nucleic acids are important biological cues that encode information about organismal identity and clinically relevant phenotypes such as drug resistance. We recently developed a strategy to design nucleic acid-responsive materials using the CRISPR-associated nuclease Cas12a as a user-programmable sensor and material actuator. This approach improves on the sensitivity of current DNA-responsive materials while enabling their rapid repurposing toward new sequence targets. Here, we provide a comprehensive resource for the design, synthesis and actuation of CRISPR-responsive hydrogels. First, we provide guidelines for the synthesis of Cas12a guide RNAs (gRNAs) for in vitro applications. We then outline methods for the synthesis of both polyethylene glycol-DNA (PEG-DNA) and polyacrylamide-DNA (PA-DNA) hydrogels, as well as their controlled degradation using Cas12a for the release of cargos, including small molecules, enzymes, nanoparticles and living cells within hours. Finally, we detail the design and assembly of microfluidic paper-based devices that use Cas12a-sensitive hydrogels to convert DNA inputs into a variety of visual and electronic readouts for use in diagnostics. Following the initial validation of the gRNA and Cas12a components (1 d), the synthesis and testing of either PEG-DNA or PA-DNA hydrogels require 3-4 d of laboratory time. Optional extensions, including the release of primary human cells or the design of the paper-based diagnostic, require an additional 2-3 d each.


Assuntos
Repetições Palindrômicas Curtas Agrupadas e Regularmente Espaçadas/genética , Técnicas e Procedimentos Diagnósticos , Sistemas de Liberação de Medicamentos/métodos , Liberação Controlada de Fármacos , Materiais Inteligentes/química , Resinas Acrílicas/química , Proteínas de Bactérias/metabolismo , Sequência de Bases , Proteínas Associadas a CRISPR/metabolismo , DNA/química , DNA/genética , Endodesoxirribonucleases/metabolismo , Humanos , Células K562 , Polietilenoglicóis/química , RNA Guia/genética
7.
Lancet HIV ; 7(8): e574-e581, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32763220

RESUMO

Novel diagnostic technologies, including nanotechnology, microfluidics, -omics science, next-generation sequencing, genomics big data, and machine learning, could contribute to meeting the UNAIDS 95-95-95 targets to end the HIV epidemic by 2030. Novel technologies include multiplexed technologies (including biomarker-based point-of-care tests and molecular platform technologies), biomarker-based combination antibody and antigen technologies, dried-blood-spot testing, and self-testing. Although biomarker-based rapid tests, in particular antibody-based tests, have dominated HIV diagnostics since the development of the first HIV test in the mid-1980s, targets such as nucleic acids and genes are now used in nanomedicine, biosensors, microfluidics, and -omics to enable early diagnosis of HIV. These novel technologies show promise as they are associated with ease of use, high diagnostic accuracy, rapid detection, and the ability to detect HIV-specific markers. Additional clinical and implementation research is needed to generate evidence for use of novel technologies and a public health approach will be required to address clinical and operational challenges to optimise their global deployment.


Assuntos
Técnicas e Procedimentos Diagnósticos/tendências , Infecções por HIV/diagnóstico , Diagnóstico Precoce , Humanos
8.
J Laryngol Otol ; 134(7): 571-576, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32605666

RESUMO

BACKGROUND: An objective evaluation of coronavirus disease 2019 in the first days of infection is almost impossible, as affected individuals are generally in home quarantine, and there is limited accessibility for the operator who should perform the test. To overcome this limitation, a recently validated psychophysical self-administered test was used, which can be performed remotely in the assessment of early-stage coronavirus disease 2019 patients. METHODS: Olfactory and gustatory functions were objectively assessed in 300 patients in the first 7 days from coronavirus disease 2019 symptom onset. RESULTS: Seventy per cent of the patients presented olfactory and/or gustatory disorders. The dysfunctions detected were mainly complete anosmia (47 per cent) or ageusia (38 per cent). A significant correlation was found between taste dysfunction and female gender (odds ratio = 1.936, p = 0.014) and fever (odds ratio = 2.132, p = 0.003). CONCLUSION: The psychophysical evaluation protocol proposed is an effective tool for the fast and objective evaluation of patients in the early stages of coronavirus disease 2019. Chemosensitive disorders have been confirmed to be frequent and early symptoms of the coronavirus infection, and, in a significant number of cases, they are the first or only manifestation of coronavirus disease 2019.


Assuntos
Infecções por Coronavirus/fisiopatologia , Autoavaliação Diagnóstica , Técnicas e Procedimentos Diagnósticos , Transtornos do Olfato/diagnóstico , Pneumonia Viral/fisiopatologia , Distúrbios do Paladar/diagnóstico , Telemedicina , Ácido Acético , Adulto , Betacoronavirus , Chocolate , Café , Combinação de Medicamentos , Feminino , Sucos de Frutas e Vegetais , Produtos Domésticos , Humanos , Itália , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Antissépticos Bucais , Transtornos do Olfato/fisiopatologia , Pandemias , Extratos Vegetais , Autorrelato , Limiar Sensorial , Fatores Sexuais , Sabões , Especiarias , Distúrbios do Paladar/fisiopatologia , Limiar Gustativo , Terpenos , Cremes Dentais , Vinho
9.
J Neural Transm (Vienna) ; 127(9): 1217-1228, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32725545

RESUMO

While there is abounding literature on virus-induced pathology in general and coronavirus in particular, recent evidence accumulates showing distinct and deleterious brain affection. As the respiratory tract connects to the brain without protection of the blood-brain barrier, SARS-CoV-2 might in the early invasive phase attack the cardiorespiratory centres located in the medulla/pons areas, giving rise to disturbances of respiration and cardiac problems. Furthermore, brainstem regions are at risk to lose their functional integrity. Therefore, long-term neurological as well as psychiatric symptomatology and eventual respective disorders cannot be excluded as evidenced from influenza-A triggered post-encephalitic Parkinsonism and HIV-1 triggered AIDS-dementia complex. From the available evidences for coronavirus-induced brain pathology, this review concludes a number of unmet needs for further research strategies like human postmortem brain analyses. SARS-CoV-2 mirroring experimental animal brain studies, characterization of time-dependent and region-dependent spreading behaviours of coronaviruses, enlightening of pathological mechanisms after coronavirus infection using long-term animal models and clinical observations of patients having had COVID-19 infection are calling to develop both protective strategies and drug discoveries to avoid early and late coronavirus-induced functional brain disturbances, symptoms and eventually disorders. To fight SARS-CoV-2, it is an urgent need to enforce clinical, molecular biological, neurochemical and genetic research including brain-related studies on a worldwide harmonized basis.


Assuntos
Betacoronavirus , Encéfalo/patologia , Infecções por Coronavirus/patologia , Diagnóstico , Pneumonia Viral/patologia , Barreira Hematoencefálica/patologia , Barreira Hematoencefálica/virologia , Encéfalo/virologia , Técnicas e Procedimentos Diagnósticos/tendências , Humanos , Pandemias , Fatores de Tempo
11.
Int J Infect Dis ; 98: 237-240, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32619756

RESUMO

The dramatic increase in suspected COVID-19 cases in Africa has placed an enormous burden on public and private clinical facilities. To date, the most commonly used method for identifying and confirming the virus is the laboratory-based reverse transcription-polymerase chain reaction (RT-PCR) test. Unfortunately, testing capacities have been limited in many parts of Africa because of inadequate test kits, which have restricted scaling up beyond the few public health laboratories at designated locations. In this mini-review, we present Africa's preparedness and readiness for testing, why testing is crucial, the need to immediately strengthen existing facilities, and what it involves as part of combined approaches for managing the COVID-19 crisis. The review highlights the urgent need for speedy expansion and distribution of several laboratory testing platforms, including real-time PCR and serological assays to both public health facilities and fully accredited private clinical laboratories.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/virologia , Pneumonia Viral/virologia , África/epidemiologia , Betacoronavirus/genética , Betacoronavirus/fisiologia , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Técnicas e Procedimentos Diagnósticos , Humanos , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia
12.
J Biomed Sci ; 27(1): 72, 2020 Jun 04.
Artigo em Inglês | MEDLINE | ID: covidwho-526710

RESUMO

On March 11, 2020, the World Health Organization declared the worldwide spread of the infectious disease COVID-19, caused by a new strain of coronavirus, SARS-CoV-2, as a pandemic. Like in all other infectious diseases, the host immune system plays a key role in our defense against SARS-CoV-2 infection. However, viruses are able to evade the immune attack and proliferate and, in susceptible individuals, cause severe inflammatory response known as cytokine storm, particularly in the lungs. The advancement in our understanding of the mechanisms underlying the host immune responses promises to facilitate the development of approaches for prevention or treatment of diseases. Components of immune system, such as antibodies, can also be used to develop sensitive and specific diagnostic methods as well as novel therapeutic agents. In this review, we summarize our knowledge about how the host mounts immune responses to infection by SARS-CoV-2. We also describe the diagnostic methods being used for COVID-19 identification and summarize the current status of various therapeutic strategies, including vaccination, being considered for treatment of the disease.


Assuntos
Betacoronavirus/fisiologia , Infecções por Coronavirus/imunologia , Técnicas e Procedimentos Diagnósticos/instrumentação , Pneumonia Viral/imunologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Humanos , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Pneumonia Viral/virologia
13.
J Biomed Sci ; 27(1): 72, 2020 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-32498686

RESUMO

On March 11, 2020, the World Health Organization declared the worldwide spread of the infectious disease COVID-19, caused by a new strain of coronavirus, SARS-CoV-2, as a pandemic. Like in all other infectious diseases, the host immune system plays a key role in our defense against SARS-CoV-2 infection. However, viruses are able to evade the immune attack and proliferate and, in susceptible individuals, cause severe inflammatory response known as cytokine storm, particularly in the lungs. The advancement in our understanding of the mechanisms underlying the host immune responses promises to facilitate the development of approaches for prevention or treatment of diseases. Components of immune system, such as antibodies, can also be used to develop sensitive and specific diagnostic methods as well as novel therapeutic agents. In this review, we summarize our knowledge about how the host mounts immune responses to infection by SARS-CoV-2. We also describe the diagnostic methods being used for COVID-19 identification and summarize the current status of various therapeutic strategies, including vaccination, being considered for treatment of the disease.


Assuntos
Betacoronavirus/fisiologia , Infecções por Coronavirus/imunologia , Técnicas e Procedimentos Diagnósticos/instrumentação , Pneumonia Viral/imunologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Humanos , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Pneumonia Viral/virologia
14.
Autoimmun Rev ; 19(8): 102588, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32540447

RESUMO

The commercial tests currently available as second-level tests to detect ANA sub-specificities are generally used independently from the ANA immunofluorescence (IIF) pattern. The aim of this study was to evaluate the efficacy of the use of a customizable pattern-oriented antigenic panel by immunoblot (IB) using the International Consensus on ANA Patterns (ICAP) classification scheme, in order to introduce a novel and updated autoimmune diagnostic flowchart. 710 sera referred for routine ANA testing were selected on the basis of the ANA pattern according to the ICAP nomenclature (nuclear speckled AC-2,4,5; nucleolar AC-8,9,10,29; cytoplasmic speckled AC-18,19,20) and on an IIF titer ≥1:320. They were then assayed by three experimental IB assays using a panel of selected antigens. ICAP-oriented IB detected 515 antibody reactivities vs. 457 of traditional anti-ENA in the nuclear speckled pattern group, 108 vs. 28 in the nucleolar pattern group, and 43 vs. 34 in the cytoplasmic speckled pattern. This pilot study may lead the way for a new approach introducing an ICAP pattern-oriented follow up testing as a valid alternative to the existing standard panels, thus enabling more patients with autoimmune rheumatic disease to be accurately diagnosed.


Assuntos
Algoritmos , Anticorpos Antinucleares , Doenças Autoimunes , Técnicas e Procedimentos Diagnósticos , Immunoblotting , Anticorpos Antinucleares/sangue , Doenças Autoimunes/sangue , Doenças Autoimunes/diagnóstico , Técnica Indireta de Fluorescência para Anticorpo , Humanos , Immunoblotting/normas , Projetos Piloto
16.
PLoS One ; 15(6): e0233920, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32497132

RESUMO

INTRODUCTION: The run chart is one form of statistical process control chart that is particularly useful for detecting persistent shifts in data over time. The Anhøj rules test for shifts by looking for unusually long runs (L) of data points on the same side of the process centre (mean or median) and unusually few crossings (C) of the centre depending on the number of available data points (N). Critical values for C and L have mainly been studied in isolation. But what is really of interest is the joint distribution of C and L, which has so far only been studied using simulated data series. We recently released an R package, crossrun that calculates exact values for the joint probabilities of C and L that allowed us to study the diagnostic properties of the Anhøj rules in detail and to suggest minor adjustments to improve their diagnostic value. METHODS: Based on the crossrun R package we calculated exact values for the joint distribution of C and L for N = 10-100. Furthermore, we developed two functions, bestbox() and cutbox() that automatically seek to adjust the critical values for C and L to balance between sensitivity and specificity requirements. RESULTS: Based on exact values for the joint distribution of C and L for N = 10-100 we present measures of the diagnostic value of the Anhøj rules. The best box and cut box procedures improved the diagnostic value of the Anhøj rules by keeping the specificity and sensitivity close to pre-specified target values. CONCLUSIONS: Based on exact values for the joint distribution of longest run and number of crossings in random data series this study demonstrates that it is possible to obtain better diagnostic properties of run charts by making minor adjustment to the critical values for C and L.


Assuntos
Biometria , Biometria/métodos , Técnicas e Procedimentos Diagnósticos , Humanos , Funções Verossimilhança , Probabilidade , Sensibilidade e Especificidade
17.
Clin Auton Res ; 30(4): 295-297, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32529405

RESUMO

COVID-19 is a global pandemic that is wreaking havoc with the health and economy of much of human civilization. In this document from the American Autonomic Society, we identify the potential risks of exposure to patients, physicians, and allied healthcare staff. We provide guidance for conducting autonomic function testing safely in this environment.


Assuntos
Sistema Nervoso Autônomo/fisiologia , Betacoronavirus , Infecções por Coronavirus/fisiopatologia , Técnicas e Procedimentos Diagnósticos/normas , Pandemias , Pneumonia Viral/fisiopatologia , Sociedades Médicas/normas , Infecções por Coronavirus/diagnóstico , Humanos , Equipamento de Proteção Individual/normas , Pneumonia Viral/diagnóstico
18.
Buenos Aires; s.n; 3 jun. 2020.
Não convencional em Espanhol | LILACS, BRISA/RedTESA | ID: biblio-1100256

RESUMO

CONTEXTO CLÍNICO: A finales de 2019, se identificó un nuevo coronavirus como la causa de un grupo de casos de neumonía en la ciudad china de Wuhan. Este brote de la enfermedad por coronavirus 2019 (COVID-19) producida por el virus SARS-CoV-2 se extendió posteriormente para convertirse en una pandemia mundial. La posibilidad de infección por COVID-19 debe considerarse principalmente en pacientes con fiebre y / o síntomas del tracto respiratorio que residen o han viajado recientemente a áreas con transmisión comunitaria o que han tenido contacto cercano con un caso confirmado o sospechoso de COVID-19. Los médicos también deben considerar la posibilidad de infección por SARS-CoV-2 en pacientes con enfermedad respiratoria grave cuando no se ha identificado otra causa. La evidencia actual sugiere que el virus se transmite entre las personas a través del contacto cercano y a través de las gotas y secreciones. Estas gotas pueden caer en la boca, la nariz o los ojos de personas cercanas o ser posiblemente inhaladas por el individuo y alojarse en los pulmones. Se ha documentado la transmisión de SARS-CoV-2 desde individuos asintomáticos, individuos dentro del período de incubación, y también desde personas infectadas pero con muy poca sintomatología, llamados oligosintomáticos. Sin embargo, se desconoce el grado en que ocurre la transmisión asintomática o pre-sintomática y cuánto contribuye a la pandemia. El porcentaje de casos asintomáticos se estimo entre 1,6% en registros de China hasta casi 50% de los casos detectados en un crucero, con lo cual existe incertidumbre acerca del real valor. Las personas con mayor riesgo de contraer la enfermedad son aquellas que están en contacto estrecho con los individuos infectados, ya sean estos asintomáticos o con sintomas evidentes de enfermedad. Esto inevitablemente expone a los trabajadores de la salud a un mayor riesgo de infección. En la Argentina, el 17 de abril de 2020, el Ministerio de Salud comunicó que entre el número total de infectados, un 14% se trataba de personal de la salud.9 En el Reino Unido, el reporte de casos de trabajadores de la salud sintomáticos con test positivo fue del 18% (282/1533) en un centro de salud, de los cuales 25 de ellos trabajaron en contacto con pacientes, al menos durante 24 horas debido a la levedad de los síntomas que presentaban. En China e Italia se reportaron a su vez cifras de proporción de trabajadores de la salud entre los casos detectados, de un 10% y 9% respectivamente.1 Esta cifra cobra relevancia no solo por el riesgo aumentado de contagio, sino porque durante el pico del brote, los sistemas de salud ven sus capacidades operativas forzadas a trabajar casi al límite de sus posibilidades y aquellos recursos escasos (como el personal sanitario) deben preservarse al máximo. Por lo tanto, los trabajadores de la salud tendrían un mayor riesgo de infección con la enfermedad por coronavirus y podrían transmitirlo a pacientes vulnerables con quienes establecen un contacto estrecho, además del hecho de interactuar con múltiples individuos a diario. El testeo de infección presente o pasada entre los trabajadores de la salud, sería también una estrategia tendiente a reducir la diseminación viral a partir de trabajadores de la salud infectados asintomáticos y a asistir en la definición de la necesidad de su autoaislamiento. TECNOLOGÍA: Para la detección de COVID-19 los test disponibles son de dos tipos13,14 Uno de ellos es el diagnóstico microbiológico de la enfermedad aguda que implica la detección de ARN viral en las secreciones del individuo mediante la prueba de reacción en cadena de la transcriptasa-polimerasa inversa de una muestra del tracto respiratorio superior (rt-PCR). Hasta ahora, es la prueba de uso más extendido para el diagnóstico de COVID-19, realizada con hisopos nasofaríngeos u otras muestras del tracto respiratorio superior. En la mayoría de las personas con infección sintomática por COVID-19, el ARN viral en el hisopado nasofaríngeo se vuelve detectable desde el primer día de los síntomas y alcanza su punto máximo dentro de la primera semana de su aparición. OBJETIVO: El objetivo del presente informe es evaluar la evidencia disponible acerca de la eficacia, seguridad y aspectos relacionados al diagnóstico de COVID-19 en trabajadores de la salud assintomáticos. MÉTODOS: Se realizó una búsqueda en las principales bases de datos bibliográficas, en buscadores genéricos de internet, y financiadores de salud. Se priorizó la inclusión de revisiones sistemáticas (RS), ensayos clínicos controlados aleatorizados (ECAs), evaluaciones de tecnologías sanitarias (ETS), evaluaciones económicas, guías de práctica clínica (GPC) y recomendaciones de diferentes organizaciones de salud. CONCLUSIONES: No se identificó evidencia acerca de la efectividad de realizar el test diagnóstico de COVID-19 en trabajadores asintomáticos de la salud como medida de reducción de la diseminación viral. Organismos de salud internacionales como la Organización Mundial de la Salud, Centro de Control de Infecciones de los Estados Unidos y Centro Europeo de Control de Infecciones no indican la realización masiva del test en trabajadores de la salud asintomáticos, considerando en algunas ocasiones el testeo sólo si es que el trabajador de la salud se encuentra dentro de un centro de cuidados cerrado y con al menos un caso confirmado de COVID-19 entre los residentes o los trabajadores del centro de salud. En la Argentina, en el caso de los trabajadores de la salud, se recomienda el testeo mediante PCR sólo frente a la presencia de síntomas leves y antecedente de contacto estrecho con personas infectadas, no indicándose en caso de ser asintomáticos o sin antecedente de contacto. En la región, Chile recomienda realizar la detección de anticuerpos en trabajadores de la salud asintomáticos que se encuentren dentro de grupos de interés epidemiológico como comunidades o recintos donde se ha identificado alta circulación del virus o han estado expuestos a personas enfermas. En Colombia se indica el test en trabajadores de la salud asintomáticos siempre que hayan estado en contacto estrecho con un caso positivo o en caso de tratarse de una estrategia de tamizaje sobre trabajadores de la salud en áreas seleccionadas, mientras que Brasil sólo realiza el test de antígeno en caso de presentar síntomas compatibles con la enfermedad. Evidencia proveniente de acciones de testeo masivo con fines epidemiológicos o de vigilancia, en personal de la salud, mostró un porcentaje de positividad de detección de antígeno viral entre 1% a 7% en trabajadores asintomáticos, y del 4% al 18% entre trabajadores sintomáticos. Estos resultados deben interpretarse en el contexto epidemiológico en el cual se obtuvieron. Según la opinión de expertos, en contextos de escasez de suministros para el diagnóstico, se debería priorizar el uso de los test diagnósticos en pacientes graves y luego en trabajadores de la salud que presenten síntomas, solo pudiendo considerar la estrategia de testeo de trabajadores de la salud asintomáticos en un contexto de abundancia de suministros y aún así existiendo incertidumbre acerca de la utilidad de llevar a cabo esta medida.


Assuntos
Humanos , Pneumonia Viral/diagnóstico , Pessoal de Saúde , Infecções por Coronavirus/diagnóstico , Técnicas e Procedimentos Diagnósticos/instrumentação , Avaliação da Tecnologia Biomédica , Avaliação em Saúde
19.
Int J Infect Dis ; 97: 190-196, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32497795

RESUMO

BACKGROUND: Discriminating active tuberculosis (ATB) from latent tuberculosis infection (LTBI) remains challenging. This study aimed to investigate a diagnostic model based on a combination of iron metabolism and the TB-specific antigen/phytohemagglutinin ratio (TBAg/PHA ratio) in T-SPOT.TB assay for differentiation between ATB and LTBI. METHODS: A total of 345 participants with ATB (n=191) and LTBI (n=154) were recruited based on positive T-SPOT.TB results at Tongji hospital between January 2017 and January 2020. Iron metabolism analysis was performed simultaneously. A diagnostic model for distinguishing ATB from LTBI was established according to multivariate logistic regression. RESULTS: The TBAg/PHA ratio showed 64.00% sensitivity and 90.10% specificity in distinguishing ATB from LTBI when a threshold of 0.22 was used. All iron metabolism biomarkers in the ATB group were significantly different from those in the LTBI group. Specifically, serum ferritin and soluble transferrin receptor in ATB were significantly higher than LTBI. On the contrary, serum iron, transferrin, total iron binding capacity, and unsaturated iron binding capacity in ATB were significantly lower than LTBI. The combination of iron metabolism indicators accurately predicted 60.00% of ATB cases and 91.09% of LTBI subjects, respectively. Moreover, the combination of iron metabolism indexes and TBAg/PHA ratio resulted in a sensitivity of 88.80% and specificity of 90.10%. Furthermore, the performance of models established in the Qiaokou cohort was confirmed in the Caidian cohort. CONCLUSIONS: The data suggest that the combination of iron metabolism indexes and TBAg/PHA ratio could serve as a biomarker to distinguish ATB from LTBI in T-SPOT-positive individuals.


Assuntos
Antígenos de Bactérias/análise , Técnicas e Procedimentos Diagnósticos , Ferro/sangue , Tuberculose Latente/diagnóstico , Fito-Hemaglutininas/sangue , Tuberculose/diagnóstico , Adulto , Biomarcadores/sangue , Estudos de Coortes , Análise Discriminante , Feminino , Humanos , Tuberculose Latente/sangue , Tuberculose Latente/microbiologia , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis , Sensibilidade e Especificidade , Tuberculose/sangue , Tuberculose/microbiologia
20.
Washington, D.C.; OPS; 2020-06-17.
em Espanhol | PAHO-IRIS | ID: phr-52295

RESUMO

Esta segunda edición de Medios auxiliares para el diagnóstico de las parasitosis intestinales tienen por objeto servir tanto de manual dirigido a los trabajadores de laboratorio y sobre el terreno en países con endemicidad, como de material didáctico para los estudiantes y las personas en formación. En este documento se ofrece orientación para elegir la preparación en los diferentes métodos copromicroscópicos y la técnica de tinción principal para el diagnóstico de los parásitos intestinales (nematodos, trematodos, cestodos y protozoos). Las microfotografías presentan la apariencia y las características diagnósticas de los diferentes parásitos en las diversas preparaciones. Los medios auxiliares se elaboraron en un formato plastificado impermeable que es sólido y fácil de usar en la mesa de laboratorio. Se recomienda su uso a todos los profesionales de salud que se ocupan del diagnóstico corriente de las parasitosis intestinales.


Assuntos
Doenças Parasitárias , Materiais de Ensino , Técnicas e Procedimentos Diagnósticos , Microscopia , Enteropatias , Enteropatias Parasitárias
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