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1.
Clin Ter ; 172(4): 336-346, 2021 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-34247217

RESUMO

Introduction: Spider bites are often overestimated because there are no specific clinical or histopathological aspects that characterize them, and skin lesions that resemble a spider bite are often wrongly considered to be a "true spider bite". However, even in case of a true spider bite, it is almost impossible to confirm the biting species, since very often neither physicians nor patients are trained in spider identification. Objective: The aim of this report is to provide clinicians with a rapid and simple recognition of the few Italian medically relevant spiders, in order to take relative medical measures in case of spider bites. Materials and methods: We defined spiders of considerable medical relevance the ones that cause local symptoms with possible systemic involvement, while we defined spiders with mild medical relevance the ones whose bite is not a medical emergency but is particularly painful or can cause lasting symptoms. We focused on the identification of the four spider taxa of major clinical interest through a brief descriptive, photographic and graphic guide, in association to dermatological manifestations. Results: Spiders of considerable medical relevance are Loxosceles rufescens and Latrodectus tredecimguttatus, while spiders of less severe medical relevance are Steatoda paykulliana, S. nobilis, S. grossa, Cheiracanthium punctorium, Amblyocarenum spp. and Macrothele calpeiana (the presence of the latter in Italy is only accidental and very sporadic). The only species capable of causing necrosis is Loxo-sceles rufescens, while Latrodectus tredecimguttatus can cause more systemic symptoms. Discussion and Conclusion: With the aim of promoting a first and rapid recognition of the species, we performed a morphological usable aspect for an initial and quick recognition according to an identification key.


Assuntos
Técnicas e Procedimentos Diagnósticos , Fotografação , Picaduras de Aranhas/diagnóstico , Picaduras de Aranhas/terapia , Aranhas/anatomia & histologia , Aranhas/classificação , Animais , Feminino , Humanos , Itália , Masculino
2.
Rev. cuba. inform. méd ; 13(1): e442, ene.-jun. 2021. tab, graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1251728

RESUMO

El Sistema de Información Hospitalaria XAVIA HIS desarrollado por el Centro de Informática Médica (CESIM) está compuesto por módulos que aseguran la informatización de los procesos de las áreas de la institución hospitalaria. En la actualidad la gestión de los principales medios de diagnóstico se realiza de forma dispersa en diferentes módulos o sistemas. En este trabajo se presenta el módulo de Medios de Diagnóstico, desarrollo que permite la gestión de informes de solicitudes y resultados de forma configurable, así como la planificación de horarios y gestión de citas. Se analizó el proceso de negocio asociado a la gestión de información de medios de diagnóstico, se realizó un estudio de sistemas existentes con propósitos similares y se evaluaron tecnologías para su implementación. Se utilizó AUP-UCI como metodología de desarrollo, Java como lenguaje de programación y otras tecnologías libres y multiplataforma. El patrón arquitectónico implementado fue modelo-vista-controlador. El módulo de Medios de Diagnóstico del sistema XAVIA HIS, permite el soporte de los procesos de atención al paciente y la integración de la información sobre los medios de diagnóstico, además fomenta un aumento en la calidad del servicio. El módulo facilita la configuración de aspectos de solicitud e informe de las pruebas diagnósticas y la planificación de horarios y citas(AU)


Hospital Information System XAVIA HIS developed by the Medical Informatics Center (CESIM) is made up of modules that ensure the computerization of hospital institution areas processes. Currently, the management of the main diagnostic means is realized in a dispersed way in different modules or systems. This paper presents the Diagnostic Means module, development that allows the requests and results reports management in a configurable way, as well as the schedules planning and appointments management. The business process associated with the diagnostic means information management was analyzed, an existing systems study with similar purposes was carried out, and technologies for their implementation were evaluated. AUP-UCI were used as development methodology, Java as programming language and other free and multiplatform technologies. The architectural pattern implemented was model-view-controller. The XAVIA HIS system Diagnostic Means module, allows the patient care processes support and integration of information regarding diagnostic means, also encourages an increase in the service quality. The module facilitates the request and report aspects configuration of the diagnostic tests and the schedules and appointments planning(AU)


Assuntos
Humanos , Sistemas de Informação Hospitalar/normas , Telemedicina , Técnicas e Procedimentos Diagnósticos , Registros Eletrônicos de Saúde , Nível Sete de Saúde/normas
3.
BMC Infect Dis ; 21(1): 568, 2021 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-34126948

RESUMO

PURPOSE: Increasing incidences of syphilis highlight the preoccupation with the occurrence of neurosyphilis. This study aimed to understand the current diagnostic tools and their performance to detect neurosyphilis, including new technologies and the variety of existing methods. METHODS: We searched databases to select articles that reported neurosyphilis diagnostic methods and assessed their accuracy, presenting sensitivity and specificity values. Information was synthesized in tables. The risk of bias was examined using the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy recommendations. RESULTS: Fourteen studies were included. The main finding was a remarkable diversity of tests, which had varied purposes, techniques, and evaluation methodologies. There was no uniform criterion or gold standard to define neurosyphilis. The current basis for its diagnosis is clinical suspicion and cerebrospinal fluid analysis. There are new promising tests such as PCR tests and chemokine measurement assays. CONCLUSIONS: The diagnosis of neurosyphilis is still a challenge, despite the variety of existing and developing tests. We believe that the multiplicity of reference standards adopted as criteria for diagnosis reveals the imprecision of the current definitions of neurosyphilis. An important next step for the scientific community is to create a universally accepted diagnostic definition for this disease.


Assuntos
Neurossífilis/diagnóstico , Quimiocinas/líquido cefalorraquidiano , Técnicas e Procedimentos Diagnósticos/normas , Humanos , Neurossífilis/líquido cefalorraquidiano , Reação em Cadeia da Polimerase , Padrões de Referência , Sensibilidade e Especificidade , Treponema pallidum/isolamento & purificação
4.
Rev. venez. cir. ortop. traumatol ; 53(1): 20-26, jun. 2021. ilus
Artigo em Espanhol | LILACS, LIVECS | ID: biblio-1252895

RESUMO

Cuando fracasa el tratamiento conservador en el Estadio I de Disfunción del Tendón Tibial posterior (DTTP), se debe indicar sinovectomía y debridamiento del tendón. En este estudio evaluamos la evolución con 8 años mínimo de seguimiento, de los pacientes con esta patología tratados vía tenoscópica. Este es un estudio retrospectivo de pacientes operados entre el año 2008 y el año 2011. En ese período de tiempo se intervinieron 11 pacientes con esta patología. Sólo 9 de los 11 pacientes operados pudieron ser evaluados. 7 pacientes mejoraron su sintomatología según el VAS y no progresaron a estadio II. En 3 pacientes se evidenció lesión tendinosa durante la tendoscopía y ameritaron reparación a cielo abierto. La sinovectomía tendoscópica del TTP es un procedimiento quirúrgico efectivo para tratar a los pacientes con DTTP Estadio I, rebeldes a tratamiento conservador(AU)


When conservative treatment fails for Stage I Posterior Tibial tendon dysfunction (PTTD), synovectomy and tendon debridement is indicated. In this study we evaluate tendoscopic treatment results for this pathology with a minimum of 8 years follow up. This is a retrospective study of patients after tendoscopic surgery performed between 2008 and 2011. 9 of the 11 patients were available for evaluation. 7 improved their symptoms according to VAS scale, and did not progress to stage II. In 3 patients tendon tear was visualized during tendoscopy and needed open repair. PTT tendoscopy is an effective surgical treatment to treat Stage I PTTD, failing to conservative treatment(AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Pé Chato , Espectroscopia de Ressonância Magnética , Anti-Inflamatórios não Esteroides/uso terapêutico , Disfunção do Tendão Tibial Posterior/patologia , Tendinopatia , Sinovectomia , Ultrassom , Crioterapia , Técnicas e Procedimentos Diagnósticos , Desbridamento
5.
Bull World Health Organ ; 99(4): 312-318, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: covidwho-1167260

RESUMO

Since January 2020, the coronavirus disease 2019 (COVID-19) pandemic has had a far-reaching impact on global morbidity and mortality. The effects of varying degrees of implementation of public health and social measures between countries is evident in terms of widely differing disease burdens and levels of disruption to public health systems. Despite Thailand being the first country outside China to report a positive case of COVID-19, the subsequent number of cases and deaths has been much lower than in many other countries. As of 7 January 2021, the number of confirmed COVID-19-positive cases in Thailand was 9636 (138 per million population) and the number of deaths was 67 (1 per million population). We describe the nature of the health workforce and function that facilitated the capacity to respond to this pandemic. We also describe the public health policies (laboratory testing, test-and-trace system and mandatory 14-day quarantine of cases) and social interventions (daily briefings, restriction of mobility and social gatherings, and wearing of face masks) that allowed the virus to be successfully contained. To enhance the capacity of health-care workers to respond to the pandemic, the government (i) mobilized staff to meet the required surge capacity; (ii) developed and implemented policies to protect occupational safety; and (iii) initiated packages to support morale and well-being. The results of the policies that we describe are evident in the data: of the 66 countries with more than 100 COVID-19-positive cases in health-care workers as at 8 May 2020, Thailand ranked 65th.


Assuntos
COVID-19/epidemiologia , COVID-19/prevenção & controle , Controle de Doenças Transmissíveis/organização & administração , Pessoal de Saúde/organização & administração , Política de Saúde , Técnicas e Procedimentos Diagnósticos , Humanos , Saúde Mental , Saúde do Trabalhador , Pandemias , SARS-CoV-2 , Tailândia
6.
Bull World Health Organ ; 99(4): 312-318, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33953449

RESUMO

Since January 2020, the coronavirus disease 2019 (COVID-19) pandemic has had a far-reaching impact on global morbidity and mortality. The effects of varying degrees of implementation of public health and social measures between countries is evident in terms of widely differing disease burdens and levels of disruption to public health systems. Despite Thailand being the first country outside China to report a positive case of COVID-19, the subsequent number of cases and deaths has been much lower than in many other countries. As of 7 January 2021, the number of confirmed COVID-19-positive cases in Thailand was 9636 (138 per million population) and the number of deaths was 67 (1 per million population). We describe the nature of the health workforce and function that facilitated the capacity to respond to this pandemic. We also describe the public health policies (laboratory testing, test-and-trace system and mandatory 14-day quarantine of cases) and social interventions (daily briefings, restriction of mobility and social gatherings, and wearing of face masks) that allowed the virus to be successfully contained. To enhance the capacity of health-care workers to respond to the pandemic, the government (i) mobilized staff to meet the required surge capacity; (ii) developed and implemented policies to protect occupational safety; and (iii) initiated packages to support morale and well-being. The results of the policies that we describe are evident in the data: of the 66 countries with more than 100 COVID-19-positive cases in health-care workers as at 8 May 2020, Thailand ranked 65th.


Assuntos
COVID-19/epidemiologia , COVID-19/prevenção & controle , Controle de Doenças Transmissíveis/organização & administração , Pessoal de Saúde/organização & administração , Política de Saúde , Técnicas e Procedimentos Diagnósticos , Humanos , Saúde Mental , Saúde do Trabalhador , Pandemias , SARS-CoV-2 , Tailândia
7.
Aktuelle Urol ; 52(3): 237-244, 2021 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-34020505

RESUMO

Urinary incontinence causes significant limitations in quality of life and reduces mental and physical health. It is a widespread and chronic disease. About 200 million people are affected by urinary incontinence worldwide. Females are more often affected than males. For the therapy of female urinary incontinence various conservative and surgical treatment measures are available. A comprehensive diagnostic work-up is crucial for effective and successful use of those therapeutical measures. The current paper gives a review of diagnostic options for female urinary incontinence: from non-invasive up to invasive investigations. It presents potential pitfalls and possibilities for improving the diagnostic work-up.


Assuntos
Incontinência Urinária por Estresse , Incontinência Urinária , Técnicas e Procedimentos Diagnósticos , Feminino , Humanos , Qualidade de Vida , Incontinência Urinária/diagnóstico , Incontinência Urinária/etiologia , Incontinência Urinária/terapia
9.
Rev. colomb. cir ; 36(3): 403-410, 20210000. tab, fig
Artigo em Espanhol | LILACS | ID: biblio-1253926

RESUMO

La utilidad de una prueba diagnóstica se cuantifica mediante el cálculo de las medidas de probabilidad y las medidas de razones de probabilidad. Las medidas de probabilidad son la sensibilidad, la especificidad, valor predictivo positivo y el valor predictivo negativo. La sensibilidad y la especificidad se usan para escoger la mejor prueba a utilizar, entre varias disponibles; sin embargo, no pueden ser utilizadas para estimar la probabilidad de determinada enfermedad en un paciente en particular. En la práctica clínica es esencial saber cuál es la probabilidad de que un paciente con un resultado positivo en una prueba diagnóstica presente la enfermedad y cuál es la probabilidad de que un paciente con un resultado negativo en una prueba diagnóstica no presente la enfermedad. Los valores predictivos positivos y negativos nos brindan la respuesta a esta cuestión, sin embargo, dependen tanto de la sensibilidad y especificidad, como de la prevalencia de la enfermedad en la muestra del estudio. Las medidas de razones de probabilidad también describen el rendimiento o utilidad de una prueba diagnóstica y poseen dos propiedades importantes: resumen el mismo tipo de información que la sensibilidad y la especificidad, y pueden utilizarse para calcular la probabilidad de la enfermedad después de una prueba positiva o negativa. El propósito de esta publicación fue definir el concepto de razones de probabilidad, exponer sus principales fortalezas y explicar cómo se calculan las razones de probabilidad cuando la prueba de interés expresa sus resultados en forma dicotómica, en más de dos categorías o de forma ordinal


The usefulness of a diagnostic test is quantified by calculating the probability measures and the probability ratio measures. Probability measures are sensitivity, specificity, positive predictive value, and negative predictive value. Sensitivity and specificity are used to choose the best test to use, among several available; however, they cannot be used to estimate the probability of a certain disease in a particular patient. In clinical practice it is essential to know what is the probability that a patient with a positive result in a diagnostic test will present the disease and what is the probability that a patient with a negative result in a diagnostic test will not present the disease. The positive and negative predictive values provide us with the answer to this question, however, it depends both on the sensitivity and specificity, and on the prevalence of the disease in the study sample. Probability ratio measures also describe the performance or usefulness of a diagnostic test and possess two important properties: they summarize the type of information that sensitivity and specificity, and they can be used to calculate the probability of disease after a positive or positive test. negative. The purpose of this publication was to define the concept of probability ratio measures, expose its main strengths, and explain how probability ratio measures are calculated when the test of interest expresses its results dichotomously, in more than two categories or ordinally


Assuntos
Humanos , Técnicas e Procedimentos Diagnósticos , Probabilidade , Diagnóstico , Testes Laboratoriais
10.
J Vet Diagn Invest ; 33(4): 621-631, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33739176

RESUMO

Lawsonia intracellularis is an obligate intracellular bacterium associated with enteric disease in pigs. Clinical signs include weight loss, diarrhea, and, in some cases, sudden death. The hallmark lesion is the thickening of the intestinal mucosa caused by increased epithelial cell replication, known as proliferative enteropathy. The immune response to L. intracellularis is not well defined, and detection of the infection, especially in the early stages, is still a significant challenge. We review here the main approaches used to identify this important but poorly understood pathogen. Detection of L. intracellularis infection as the cause of clinical disease is confounded by the high prevalence of the pathogen in many countries and that several other pathogens can produce similar clinical signs. A single L. intracellularis-specific ELISA and several amplification assays are available commercially to aid detection and surveillance, although histopathology remains the primary way to reach a conclusive diagnosis. There are major gaps in our understanding of L. intracellularis pathogenesis, especially how the host responds to infection and the factors that drive infection toward different clinical outcomes. Knowledge of pathogenesis will increase the predictive value of antemortem tests to guide appropriate interventions, including identification and treatment of subclinically affected pigs in the early stages of disease, given that this important manifestation reduces pig productivity and contributes to the economic burden of L. intracellularis worldwide.


Assuntos
Infecções por Desulfovibrionaceae/veterinária , Técnicas e Procedimentos Diagnósticos/veterinária , Lawsonia (Bactéria)/isolamento & purificação , Doenças dos Suínos/diagnóstico , Animais , Infecções por Desulfovibrionaceae/diagnóstico , Infecções por Desulfovibrionaceae/microbiologia , Técnicas e Procedimentos Diagnósticos/instrumentação , Sus scrofa , Suínos , Doenças dos Suínos/microbiologia
11.
Front Public Health ; 9: 640009, 2021.
Artigo em Inglês | MEDLINE | ID: covidwho-1154264

RESUMO

A simple, common-sense, three-component procedure-the Carrier Separation Plan (CSP)-can immediately halt the transmission of SARS-CoV-2 or a comparable pathogen, allow the safe reopening of an entire economy without the need for social distancing, and quickly eradicate the pathogen from the population (assuming the pathogen can be killed by the immune systems of the carriers). The three components are (a) nearly simultaneous self-testing for the pathogen by an entire population, followed rapidly by (b) nearly simultaneous self-isolation of carriers, and (c) secondary screening at entrances to facilities where people congregate. After a period of preparation lasting roughly 5-10 weeks, these steps could and probably should be taken in a single day. The power of this methodology has already been demonstrated in varying degrees with groups ranging in size from 1,000 to 11 million. Although this plan might seem daunting, its costs are minimal compared to the losses we have incurred by relying on half measures, and the US and other countries have the technological, logistical, and industrial capacities to implement this plan in a matter of weeks. With proper messaging during the weeks leading up to the testing, compliance in such a program is likely to be high given the potential benefits, and because participation is voluntary and testing is noninvasive, the legal and ethical issues associated with such a program are minimal - trivial, in fact, compared to those associated with imposing a months-long lockdown on an entire population. A SIRD/CSP model suggests that the single-day testing and separation procedure will substantially lower the number of infections, even if compliance with the procedure is modest. Modeling also suggests that when long-term secondary screening is added to the 1-day procedure, over time, the pathogen is eradicated from the population. This can occur even when compliance with secondary screening is itself relatively low.


Assuntos
COVID-19/prevenção & controle , Controle de Doenças Transmissíveis/métodos , Técnicas e Procedimentos Diagnósticos/normas , Programas de Rastreamento/métodos , Distanciamento Físico , Vigilância da População/métodos , Saúde Pública/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Guias de Prática Clínica como Assunto , SARS-CoV-2
12.
Medicine (Baltimore) ; 100(12): e25083, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: covidwho-1150005

RESUMO

ABSTRACT: The purpose of this study was to investigate the predictive value of combined clinical and imaging features, compared with the clinical or radiological risk factors only. Moreover, the expected results aimed to improve the identification of severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) patients who may have critical outcomes.This retrospective study included laboratory-confirmed SARS-COV-2 cases between January 18, 2020, and February 16, 2020. The patients were divided into 2 groups with noncritical illness and critical illness regarding severity status within the hospitalization. Univariable and multivariable logistic regression models were used to explore the risk factors associated with clinical and radiological outcomes in patients with SARS-COV-2. The ROC curves were performed to compare the prediction performance of different factors.A total of 180 adult patients in this study included 20 critical patients and 160 noncritical patients. In univariate logistic regression analysis, 15 risk factors were significantly associated with critical outcomes. Of importance, C-reactive protein (1.051, 95% confidence interval 1.024-1.078), D-dimer (1.911, 95% CI, 1.050-3.478), and CT score (1.29, 95% CI, 1.053-1.529) on admission were independent risk factors in multivariate analysis. The combined model achieved a better performance in disease severity prediction (P = .05).CRP, D-dimer, and CT score on admission were independent risk factors for critical illness in adults with SARS-COV-2. The combined clinical and radiological model achieved better predictive performance than clinical or radiological factors alone.


Assuntos
COVID-19/epidemiologia , COVID-19/fisiopatologia , Técnicas e Procedimentos Diagnósticos/estatística & dados numéricos , Adulto , Idoso , Proteína C-Reativa/análise , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2 , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X
13.
Rev. colomb. cir ; 36(2): 193-204, 20210000. fig, tab
Artigo em Espanhol | LILACS | ID: biblio-1222629

RESUMO

El propósito de esta publicación es describir los fundamentos de los estudios diagnósticos, proporcionando elementos de juicio para evaluar la validez, puntualizar sobre las medidas de utilidad o rendimiento de las mismas y resaltar la importancia de los estudios diagnósticos en la práctica clínica usual. Dentro de los fundamentos de las pruebas diagnósticas se explican los principios básicos sobre las pruebas diagnósticas, la estructura de estas y se detalla cómo se analizan los resultados de la prueba diagnóstica de interés y los resultados de la prueba diagnóstica de referencia. Se evalúa la validez de una prueba diagnóstica examinando tres criterios importantes que sustentan la solidez metodológica de este tipo de estudio: representatividad, constatación y determinación. Por otro lado, se estudia el primer tipo de medidas de rendimiento de una prueba diagnóstica, las medidas de probabilidad (sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo). Cuando los resultados de una prueba diagnóstica son expresados en una escala cuantitativa continua es necesario escoger "el mejor punto de corte" que se corresponda con una alta sensibilidad y especificidad, para así distinguir los enfermos de los sanos. Con este fin, podemos utilizar las propiedades de la curva COR (acrónimo de Característica Operativa del Receptor). En la presente publicación se describe y pormenoriza la construcción de la curva COR y se puntualiza sobre la mejor manera de analizarla y sacarle provecho. Por último, se ilustra cómo un estudio diagnóstico cambia el paradigma de manejo de una enfermedad


The purpose of this publication is to describe the fundamentals of diagnostic studies, providing elements of judgment to evaluate their validity, to point out their usefulness or performance measures, and to highlight the importance of diagnostic studies in usual clinical practice. Within the fundamentals of diagnostic tests, the basic principles of diagnostic tests, their structure, and how the results of the diagnostic test of interest and the results of the reference diagnostic test are analyzed and explained. The validity of a diagnostic test is eva-luated by examining three important criteria that support the methodological soundness of this type of study: representativeness, verification, and determination. On the other hand, the first type of performance measures of a diagnostic test are studied, the probability measures (sensitivity, specificity, positive predictive value, ne-gative predictive value). When the results of a diagnostic test are expressed on a continuous quantitative scale, it is necessary to choose the best cut-off point that corresponds to high sensitivity and specificity, in order to distinguish the sick from the healthy. To this end, we can use the properties of the ROC (Receiver Operating Characteristics) curve. In this publication, the construction of the ROC curve is described and detailed, and the best way to analyze it and take advantage of it is specified. Finally, it illustrates how a diagnostic study changes the paradigm of disease management


Assuntos
Humanos , Técnicas e Procedimentos Diagnósticos , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Testes Laboratoriais
15.
Cancer Epidemiol ; 72: 101926, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33689927

RESUMO

BACKGROUND: More than 11,500 abdominal cancers are yearly diagnosed in Denmark. Nevertheless, little is known about which investigations the patients undergo before a diagnosis of abdominal cancer. We aimed to investigate the frequency and timing of selected diagnostic investigations during the year preceding an abdominal cancer diagnosis. METHODS: We conducted a nationwide registry-based cohort study of patients aged ≥ 18 years who were diagnosed with a first-time abdominal cancer in 2014-2018. We included the following cancer types: oesophageal, gastric, colon, rectal, liver, gall bladder/biliary tract, pancreatic, endometrial, ovarian, kidney, and bladder cancer. Investigations of interest were transvaginal ultrasound, abdominal ultrasound, colonoscopy, gastroscopy, endoscopic retrograde cholangiopancreatography, cystoscopy, hysteroscopy, abdominal computed tomography and abdominal magnetic resonance imaging. Generalised linear models were used to calculate incidence rate ratios to enable comparison of monthly rates of investigations. RESULTS: All types of investigations were performed, with varying frequency, across the 11 abdominal cancer types in the year preceding the diagnosis. Increased use of investigations revealed that the timing of the onset differed for the different abdominal cancers, with increases seen 2-6 months before the diagnosis. Abdominal ultrasound, colonoscopy and computed tomography were the investigations with the earliest increase. CONCLUSION: In the year before a diagnosis of an abdominal cancer, some patients appear to undergo investigations typically used to detect another cancer type. This indicates that a window of opportunity exists to diagnose some abdominal cancers at an earlier time point. Future studies should explore an alternative clinical pathway to promote earlier diagnosis of abdominal cancers.


Assuntos
Neoplasias Abdominais/diagnóstico , Técnicas e Procedimentos Diagnósticos/estatística & dados numéricos , Neoplasias Abdominais/epidemiologia , Adolescente , Adulto , Idoso , Estudos de Coortes , Dinamarca/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Adulto Jovem
16.
Medicine (Baltimore) ; 100(12): e25083, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33761668

RESUMO

ABSTRACT: The purpose of this study was to investigate the predictive value of combined clinical and imaging features, compared with the clinical or radiological risk factors only. Moreover, the expected results aimed to improve the identification of severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) patients who may have critical outcomes.This retrospective study included laboratory-confirmed SARS-COV-2 cases between January 18, 2020, and February 16, 2020. The patients were divided into 2 groups with noncritical illness and critical illness regarding severity status within the hospitalization. Univariable and multivariable logistic regression models were used to explore the risk factors associated with clinical and radiological outcomes in patients with SARS-COV-2. The ROC curves were performed to compare the prediction performance of different factors.A total of 180 adult patients in this study included 20 critical patients and 160 noncritical patients. In univariate logistic regression analysis, 15 risk factors were significantly associated with critical outcomes. Of importance, C-reactive protein (1.051, 95% confidence interval 1.024-1.078), D-dimer (1.911, 95% CI, 1.050-3.478), and CT score (1.29, 95% CI, 1.053-1.529) on admission were independent risk factors in multivariate analysis. The combined model achieved a better performance in disease severity prediction (P = .05).CRP, D-dimer, and CT score on admission were independent risk factors for critical illness in adults with SARS-COV-2. The combined clinical and radiological model achieved better predictive performance than clinical or radiological factors alone.


Assuntos
COVID-19/epidemiologia , COVID-19/fisiopatologia , Técnicas e Procedimentos Diagnósticos/estatística & dados numéricos , Adulto , Idoso , Proteína C-Reativa/análise , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2 , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X
17.
Am J Hum Genet ; 108(4): 696-708, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33743207

RESUMO

The complexities of gene expression pose challenges for the clinical interpretation of splicing variants. To better understand splicing variants and their contribution to hereditary disease, we evaluated their prevalence, clinical classifications, and associations with diseases, inheritance, and functional characteristics in a 689,321-person clinical cohort and two large public datasets. In the clinical cohort, splicing variants represented 13% of all variants classified as pathogenic (P), likely pathogenic (LP), or variants of uncertain significance (VUSs). Most splicing variants were outside essential splice sites and were classified as VUSs. Among all individuals tested, 5.4% had a splicing VUS. If RNA analysis were to contribute supporting evidence to variant interpretation, we estimated that splicing VUSs would be reclassified in 1.7% of individuals in our cohort. This would result in a clinically significant result (i.e., P/LP) in 0.1% of individuals overall because most reclassifications would change VUSs to likely benign. In ClinVar, splicing VUSs were 4.8% of reported variants and could benefit from RNA analysis. In the Genome Aggregation Database (gnomAD), splicing variants comprised 9.4% of variants in protein-coding genes; most were rare, precluding unambiguous classification as benign. Splicing variants were depleted in genes associated with dominant inheritance and haploinsufficiency, although some genes had rare variants at essential splice sites or had common splicing variants that were most likely compatible with normal gene function. Overall, we describe the contribution of splicing variants to hereditary disease, the potential utility of RNA analysis for reclassifying splicing VUSs, and how natural variation may confound clinical interpretation of splicing variants.


Assuntos
Processamento Alternativo/genética , Técnicas e Procedimentos Diagnósticos , Doença/genética , RNA/análise , Análise de Sequência de RNA , Incerteza , Estudos de Coortes , Simulação por Computador , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , RNA/genética , Sítios de Splice de RNA/genética
18.
Front Public Health ; 9: 640009, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33768086

RESUMO

A simple, common-sense, three-component procedure-the Carrier Separation Plan (CSP)-can immediately halt the transmission of SARS-CoV-2 or a comparable pathogen, allow the safe reopening of an entire economy without the need for social distancing, and quickly eradicate the pathogen from the population (assuming the pathogen can be killed by the immune systems of the carriers). The three components are (a) nearly simultaneous self-testing for the pathogen by an entire population, followed rapidly by (b) nearly simultaneous self-isolation of carriers, and (c) secondary screening at entrances to facilities where people congregate. After a period of preparation lasting roughly 5-10 weeks, these steps could and probably should be taken in a single day. The power of this methodology has already been demonstrated in varying degrees with groups ranging in size from 1,000 to 11 million. Although this plan might seem daunting, its costs are minimal compared to the losses we have incurred by relying on half measures, and the US and other countries have the technological, logistical, and industrial capacities to implement this plan in a matter of weeks. With proper messaging during the weeks leading up to the testing, compliance in such a program is likely to be high given the potential benefits, and because participation is voluntary and testing is noninvasive, the legal and ethical issues associated with such a program are minimal - trivial, in fact, compared to those associated with imposing a months-long lockdown on an entire population. A SIRD/CSP model suggests that the single-day testing and separation procedure will substantially lower the number of infections, even if compliance with the procedure is modest. Modeling also suggests that when long-term secondary screening is added to the 1-day procedure, over time, the pathogen is eradicated from the population. This can occur even when compliance with secondary screening is itself relatively low.


Assuntos
COVID-19/prevenção & controle , Controle de Doenças Transmissíveis/métodos , Técnicas e Procedimentos Diagnósticos/normas , Programas de Rastreamento/métodos , Distanciamento Físico , Vigilância da População/métodos , Saúde Pública/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Guias de Prática Clínica como Assunto , SARS-CoV-2
19.
Poult Sci ; 100(3): 100895, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33518305

RESUMO

The purpose of this study was to explore a specific, simple, and sensitive method for diagnosis of avian infectious laryngotracheitis virus. Recombinase-aided amplification (RAA) and lateral flow dipstick (LFD) were combined for labeling the optimized RAA probe with 6-carboxyfluorescein (FAM) and the 5'-end of the downstream primer with biotin, respectively. By optimizing the reaction time, temperature, and primer concentration of RAA, a RAA-LFD assay, which could be used for detection of infectious laryngotracheitis, was established. After the specificity and sensitivity test, the target gene fragments could be amplified by RAA-LFD assay in 20 min under isothermal conditions (37°C), and the amplification products could be visually observed and determined by LFD within 3 min. There was no cross-reaction with nucleic acids of other avian pathogens, the lowest detectable limit of RAA-LFD was 102 copies/µL, and the sensitivity of this method was 100 times higher than that of conventional PCR with the lowest detectable limit of 104 copies/µL. The results showed that RAA-LFD assay was highly sensitive, easy to use, and more suitable for clinical detection.


Assuntos
Doenças das Aves , Técnicas e Procedimentos Diagnósticos , Infecções por Herpesviridae , Herpesvirus Galináceo 1 , Técnicas de Amplificação de Ácido Nucleico , Animais , Doenças das Aves/diagnóstico , Doenças das Aves/virologia , Técnicas e Procedimentos Diagnósticos/normas , Técnicas e Procedimentos Diagnósticos/veterinária , Infecções por Herpesviridae/diagnóstico , Infecções por Herpesviridae/veterinária , Infecções por Herpesviridae/virologia , Herpesvirus Galináceo 1/genética , Técnicas de Amplificação de Ácido Nucleico/normas , Técnicas de Amplificação de Ácido Nucleico/veterinária , Recombinases/metabolismo , Sensibilidade e Especificidade
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