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1.
Mikrobiyol Bul ; 54(1): 110-119, 2020 Jan.
Artigo em Turco | MEDLINE | ID: mdl-32050882

RESUMO

Anti-HCV and HCV RNA tests are used in laboratory diagnosis of hepatitis C virus (HCV) infections. False positive results are frequently observed in anti-HCV tests used as screening tests in societies with low prevalence of HCV. The HCV RNA test, which is a confirmatory test, is not performed in every laboratory because it is a high-cost and high-tech test, which can lead to delay in the diagnosis and treatment of patients. In this study, it was aimed to obtain an optimal anti-HCV S/CO value in our laboratory for demonstrating true antibody positivity and viremia in patients by analyzing the relationship between anti-HCV, alanine aminotransferase (ALT) and HCV RNA using retrospective data. Between July 2014 and July 2017, 754.190 anti-HCV tests were performed. Patients aged 18 years or older who were reactive with anti-HCV and those with simultaneous HCV RNA and ALT prompts were included in the study. The second generation CMIA (Abbott, USA) method was used for anti-HCV detection. For quantitative HCV RNA analysis, viral nucleic acid extraction was performed with the QIAsymphony SP/AS (Qiagen, Germany) using the QIAsymphony DSP Virus/Pathogen Midi Kit; and PCR was performed by Rotor-Gene Q (Qiagen, Germany) using Artus HCV QS-RGQ kit. ARCHITECT c and AEROSET systems (Abbott, USA) were used for ALT measurement. HCV genotype determination (622 cases) was performed using GenoSen's HCV Genotyping 1/2/3/4 RG qualitative real time PCR kit (Corbett Research, Australia) and GEN-C 2.0 Reverse Hybridization Strip Assay (NLM Diagnostics, Italy) kit at different periods covered by our study. The optimal threshold value for the relationship between anti-HCV, ALT and HCV RNA was selected based on ROC analysis. Statistical significance was accepted as p<0.05. Of the anti-HCV test results, 10.679 were found to be reactive. 1754 data of 1290 cases with anti-HCV reactivity who were simultaneously tested for HCV RNA and ALT in the same serum were evaluated. Of these, 742 (42%) were found to be HCV RNA positive and 1012 (58%) were found to be HCV RNA negative. ALT and anti-HCV levels of those who were positive for HCV RNA were significantly higher than those with negative HCV RNA (p= 0.001). The threshold point for anti-HCV S/CO according to HCV RNA was found to be 7.13 (sensitivity of 97.4%, specificity of 50.3%, positive predictive value 58.9%, negative predictive value 96.4%), and the cut-off point for ALT was found to be 27.5 IU/L (sensitivity of 77.6%, specificity of 80.8%). For HCV RNA positivity, the area under the ROC curve for anti-HCV and ALT was significantly higher than 0.5 (p= 0.001). No statistically significant difference was found between HCV genotypes in terms of ALT and anti-HCV levels. By using our new threshold in the laboratory workflow, the need to verify with HCV RNA can be reduced, especially in some patients who have been screened for antiHCV for screening purposes. Anti-HCV values below 7.13 S/CO, considering the high negative predictive value of this threshold; a false positive result in a patient presenting for screening can be predicted without waiting for the HCV RNA result. In anti-HCV reactivities determined above 7.13, the possibility of absence of viremia should be considered due to the low positive predictive value.


Assuntos
Hepacivirus , Hepatite C , Viremia , Adolescente , Adulto , Técnicas e Procedimentos Diagnósticos/normas , Alemanha , Hepacivirus/genética , Hepatite C/diagnóstico , Anticorpos Anti-Hepatite C/metabolismo , Humanos , RNA Viral/genética , Estudos Retrospectivos , Viremia/diagnóstico
2.
Mikrobiyol Bul ; 54(1): 135-143, 2020 Jan.
Artigo em Turco | MEDLINE | ID: mdl-32050884

RESUMO

Sexually transmitted infections (STIs) are important as a public health problem all over the world. There are some difficulties in prevention and control programs of STIs due to clinical and laboratory diagnostic problems.The most common STIs are Chlamydia trachomatis infections, trichomoniasis and gonorrhea. The study aimed to investigate the direct microscopic examination, culture and polymerase chain reaction (PCR) tests in the diagnosis of Trichomonas vaginalis infection; to determine other microbiological agents that may cause vaginal discharge and to evaluate the various social variables in women with vaginal discharge admitted to the outpatient clinic of Obstetrics and Gynecology in Akdeniz University Hospital. Two hundred and fifteen patients were enrolled in the study. The socio-demographic features of the patients were recorded. Vaginal/endocervical swab specimens taken from patients were evaluated by microscopic examination. Swab specimens were inoculated into blood agar, MacConkey agar and chocolate agar for bacterial culture. Modified Trichosel broth with 5% horse blood (Becton Dickinson, USA) was used for Trichomonas spp. culture. The presence of C.trachomatis, Neisseria gonorrhoeae, and T.vaginalis in swab samples were investigated by multiplex PCR assay (BD Max CT/GC/TV, Becton Dickinson, USA). At least one pathogen was detected among 65 (30.3%) samples. T.vaginalis was detected by microscopic examination and PCR in four of 215 (1.9%) patients. Existence of yeast morphology was observed in 21 (9.8%) specimens by microscopic examination. Twenty four (11.2%) patients were diagnosed as bacterial vaginosis microscopically according to Nugent score system. Candida species grew in 32 (14.9%) and Streptococcus agalactiae grew in 2 (0.9%) of the specimens. C.trachomatis was detected in 2 (0.9%) samples and N.gonorrhoeae in 1 (0.5%) sample by PCR. In this study, 95.3% of the patients were married and 96.7% had only one sexual partner in the mean time. The rate of detection of pathogens were statistically higher in women who have had two or more pregnancies (p<0.05). In our study, T.vaginalis together with N.gonorrhoeae and C.trachomatis were investigated by PCR method in women with vaginal discharge. The use of multiplex PCR test allowed simultaneous investigation of multiple pathogens in the patient samples.


Assuntos
Infecções por Chlamydia , Técnicas e Procedimentos Diagnósticos , Gonorreia , Tricomoníase , Vaginite por Trichomonas , Técnicas de Cultura de Células , Infecções por Chlamydia/diagnóstico , Chlamydia trachomatis/genética , Técnicas e Procedimentos Diagnósticos/normas , Feminino , Gonorreia/diagnóstico , Humanos , Microscopia/normas , Reação em Cadeia da Polimerase Multiplex , Neisseria gonorrhoeae/genética , Gravidez , Tricomoníase/diagnóstico , Tricomoníase/parasitologia , Vaginite por Trichomonas/diagnóstico , Trichomonas vaginalis/genética
5.
Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi ; 31(5): 543-545, 2019 Jan 05.
Artigo em Chinês | MEDLINE | ID: mdl-31713391

RESUMO

OBJECTIVE: To understand the laboratory technicians' abilities in blood slide making and reading in 10 prefectures of Yunnan Province which have passed the provincial malaria elimination evaluation, so as to provide the evidence for improving the malaria elimination surveillance and parasite examination. METHODS: Thirty negative blood slides were randomly sampled to evaluate coating, dyeing and clean quality and reading results, and 4 laboratory technicians were sampled to evaluate their reading abilities from each prefecture level and its 2 subordinate counties (districts) respectively, and then the results were analyzed. RESULTS: A total of 869 negative blood samples were evaluated. The coincidence rate was 100%. The proportions of good coating, dyeing and clean quality were 96.09%, 91.71% and 96.89%, respectively. Totally 576 blood slides were used to evaluate the reading ability. The number of correct reading was 505, and the correct rate was 87.67%. Among them, the Plasmodium vivax correct reading rate was 87.76%, the P. falciparum correct reading rate was 87.50%, and the correct reading rate of mixed infections was 47.62%. The laboratory technicians' ability to the mixed infections was significantly lower than the ability to the others (χ2 = 37.169, P < 0.05), however, in the laboratory technicians' abilities, there was no significant difference among the center (s) for disease control and prevention, general hospitals and township hospitals (χ2 = 2.782, P > 0.05), and the prefecture, county and township levels (χ2 = 0.358, P > 0.05) . CONCLUSIONS: The 10 prefectures have passed the provincial evaluation in blood slide making and microscopic examination skill indicators requested, but the medical and public health institutions at all levels still should further improve their laboratory technicians' abilities in blood slide making and microscopic examination skills.


Assuntos
Técnicas e Procedimentos Diagnósticos , Erradicação de Doenças , Malária , China/epidemiologia , Técnicas e Procedimentos Diagnósticos/normas , Erradicação de Doenças/métodos , Humanos , Malária/sangue , Malária/diagnóstico , Malária/epidemiologia , Microscopia , Reprodutibilidade dos Testes
6.
Mayo Clin Proc ; 94(10): 2054-2071, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31472931

RESUMO

Histiocytic neoplasms, a rare and heterogeneous group of disorders, primarily include Erdheim-Chester disease, Langerhans cell histiocytosis, and Rosai-Dorfman disease. Due to their diverse clinical manifestations, the greatest challenge posed by these neoplasms is the establishment of a diagnosis, which often leads to a delay in institution of appropriate therapy. Recent insights into their genomic architecture demonstrating mitogen-activated protein kinase/extracellular signal-regulated kinase pathway mutations have now enabled potential treatment with targeted therapies in most patients. This consensus statement represents a joint document from a multidisciplinary group of physicians at Mayo Clinic who specialize in the management of adult histiocytic neoplasms. It consists of evidence- and consensus-based recommendations on when to suspect these neoplasms and what tests to order for the diagnosis and initial evaluation. In addition, it also describes the histopathologic and individual organ manifestations of these neoplasms to help the clinicians in identifying their key features. With uniform guidelines that aid in identifying these neoplasms, we hope to improve the awareness that may lead to their timely and correct diagnosis.


Assuntos
Doença de Erdheim-Chester/diagnóstico , Histiocitose de Células de Langerhans/diagnóstico , Histiocitose Sinusal/diagnóstico , Algoritmos , Técnicas e Procedimentos Diagnósticos/normas , Doença de Erdheim-Chester/terapia , Histiocitose de Células de Langerhans/terapia , Histiocitose Sinusal/terapia , Humanos
7.
Mikrobiyol Bul ; 53(3): 308-318, 2019 Jul.
Artigo em Turco | MEDLINE | ID: mdl-31414632

RESUMO

Blastocystis spp. is one of the most common protozoa in Turkey and throughout the world; laboratory diagnosis, genetic diversity and clinical features are among the most controversial topics related to the parasite. The aims of the present study were to investigate the subtype distribution of Blastocystis spp. Isolates from Aydin, Turkey, to evaluate the efficiency of some diagnostic methods and to evaluate the relationship between Blastocystis spp. infection with demographic factors and clinical findings. According to the direct microscopy results, 100 stool samples with and without Blastocystis spp. were selected by simple random sampling method. All were directly subjected to DNA isolation and cultured in Jones medium. DNA isolation was also carried out in Blastocystis spp. positive cultures with a different kit. Genomic DNA samples were analysed by PCR targeting the Blastocystis spp. small subunit ribosomal RNA (SSU rRNA) gene and subtypes (ST) were determined according to the sequence analyses. Moreover, the samples with undetected ST were further studied with sequence tagged site-PCR (STS-PCR). In addition, the patients with and without Blastocystis spp. were compared in terms of demographic characteristics (gender, age, residence) and clinical findings (itching, diarrhoea, abdominal pain, dyspepsia, nausea, vomiting, constipation and weight loss)., Among 100 stool positive samples diagnosed with direct microscopic examination 81 (81%) and 86 (86%) were found as positive with culture and PCR, retrospectively. Additionally, among 100 Blastocystis spp. negative stool samples five (5%) and seven (7%) samples were found positive with the same methods, respectively. The results of the analysis of Blastocystis spp. with SSU rRNA gene sequencing and STS-PCR methods revealed the subtype distribution of 95 Blastocystis spp. isolates as follows: ST3 (n= 50, 52.6%), ST2 (n= 21, 22.1%), ST1 (n= 17, 17.9%), ST7 (n= 4, 4.2%), ST2 + ST3 (n= 2, 2.1%) and ST1 + ST3 (n= 1, 1.1%). In addition, a complete accordance was observed in subtype distribution between direct DNA isolation from stools and 35 randomly selected isolates from the culture. In our study, the comparison of 107 Blastocystis spp. positive (by any of the methods) cases and 93 negative cases showed that there was no correlation in terms of demographic characteristics and clinical findings. Similarly, there was no significant relationship between symptoms and subtypes. In conclusion, it is recommended that in addition to direct microscopic examination, the use of additional methods such as culture and PCR will be useful in routine laboratory diagnosis of Blastocystis spp. The distribution of Blastocystis subtype in Aydin is mainly in accordance with the global findings. Lack of a relationship between Blastocystis spp. Infection and symptoms in our study was supported the idea that Blastocystis spp. infection is mostly asymptomatic in humans and it may be a member of healthy microbiota.


Assuntos
Infecções por Blastocystis , Blastocystis , Código de Barras de DNA Taxonômico , Técnicas e Procedimentos Diagnósticos/normas , Variação Genética , Parasitologia/métodos , Blastocystis/classificação , Blastocystis/genética , Infecções por Blastocystis/diagnóstico , Infecções por Blastocystis/parasitologia , DNA de Protozoário/genética , Fezes/parasitologia , Humanos , Parasitologia/normas , Filogenia , Estudos Retrospectivos , Turquia
8.
Emergencias (Sant Vicenç dels Horts) ; 31(4): 234-238, ago. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-182763

RESUMO

Objetivo: Cuantificar los episodios asistenciales del servicio de urgencias originados a iniciativa del paciente sin seguimiento posterior en atención pimaria (EIPSS), e identificar factores asociados a ello. Método: Estudio retrospectivo observacional de pacientes atendidos en Urgencias de un hospital de tercer nivel durante 2 años, mediante muestreo sistemático por conglomerados correspondiente al 0,05% de los episodios de cada mes, con alta a domicilio. Se analizaron variables demográficas, tiempos asistenciales, abordaje previo en atención primaria por el mismo episodio (APAP), nivel de triaje, diagnóstico, importe de la prescripción al alta e indicación de seguimiento y realización del mismo. Se utilizó un modelo multivariante de regresión logística para la estimación del grado de asociación. Resultados: Se analizaron 1.277 episodios, encontrándose un EIPSS en el 48,1% de ellos. Estos fueron más frecuentes entre los más jóvenes (p = 0,002), sin APAP (OR: 1,74; IC 95% 1,34-2,28), en los que accedieron de 22-04 h (OR: 2,43; IC 95%: 1,55-3,80%), con un nivel de triaje 4-5 (OR: 1,33; IC 95%: 1,04-1,69), con una urgencia oftalmológica como motivo de consulta (OR: 1,64; IC 95%: 1,12-2,41), con un coste de la prescripción menor de 3 Euros (OR: 2,39; IC 95%: 1,87-3,06) y en quienes fue indicado seguimiento al alta (OR: 1,9; IC 95%: 1,37-2,65). Conclusiones: La mitad de los pacientes que acuden por iniciativa propia al SUH y se van de alta a domicilio no realizan seguimiento posterior por atención primaria (AP). En este grupo de pacientes, el urgenciólogo debería insistir en la importancia de la asistencia previa y posterior por AP


Objective: To estimate the volume of patient-initiated visits to the emergency department without follow-up by a primary care physician, and to identify factors related to this practice. Methods: Retrospective, observational study of patients attended in a tertiary care hospital emergency department. We used a cluster/systematic sampling method to select 0.05% of the episodes discharged home every month. The following data were extracted: demographic variables, care times, prior primary care for the same episode, triage level, diagnosis, cost of prescriptions on discharge, instructions for follow-up, and adherence to those instructions. Associations were explored using multivariate logistic regression modelling. Results: A total of 1277 episodes were analyzed; 48.1% were patient-initiated visits without primary care follow-up. These visits were associated with the following variables: young patients (P = .002) without prior primary care (odds ratio [OR], 1.74; 95% CI, 1.34-2.28); visits between 10 PM and 4 AM (OR, 2.43; 95% CI, 1.55-3.80); triage level 4-5 (OR, 1.33; 95% CI, 1.04-1.69); ophthalmologic emergency (OR, 1.64; 95% CI, 1.12-2.41); a prescription cost of less than Euros3 (OR, 2.39; 95% CI, 1.87-3.06); and instruction to seek follow-up on discharge (OR, 1.9; 95% CI, 1.37-2.65). Conclusions: Half of patients who independently seek care from the emergency department and are discharged home do not later seek care at their primary care clinic. The emergency physician should insist on the importance of ongoing primary care


Assuntos
Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Necessidades e Demandas de Serviços de Saúde/organização & administração , Serviços Médicos de Emergência/organização & administração , Atenção Primária à Saúde , Serviços Médicos de Emergência/estatística & dados numéricos , Sobremedicalização/estatística & dados numéricos , Estudos Retrospectivos , Análise por Conglomerados , Análise Multivariada , Técnicas e Procedimentos Diagnósticos/normas , Codificação Clínica , Razão de Chances , Intervalos de Confiança
9.
Res Nurs Health ; 42(4): 246-255, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31148216

RESUMO

Delirium is an acute disorder affecting up to 80% of intensive care unit (ICU) patients. It is associated with a 10-fold increase in cognitive impairment, triples the rate of in-hospital mortality, and costs $164 billion annually. Delirium acutely affects attention and global cognitive function with fluctuating symptoms caused by underlying organic etiologies. Early detection is crucial because the longer a patient experiences delirium the worse it becomes and the harder it is to treat. Currently, identification is through intermittent clinical assessment using standardized tools, like the Confusion Assessment Method for ICU. Such tools work well in clinical research but do not translate well into clinical practice because they are subjective, intermittent and have low sensitivity. As such, healthcare providers using these tools fail to recognize delirium symptoms as much as 80% of the time. Delirium-related biochemical derangement leads to electrical changes in electroencephalographic (EEG) patterns followed by behavioral signs and symptoms. However, continuous EEG monitoring is not feasible due to cost and need for skilled interpretation. Studies using limited-lead EEG show large differences between patients with and without delirium while discriminating delirium from other causes. The Ceribell is a limited-lead device that analyzes EEG. If it is capable of detecting delirium, it would provide an objective physiological monitor to identify delirium before symptom onset. This pilot study was designed to explore relationships between Ceribell and delirium status. Completion of this study will provide a foundation for further research regarding delirium status using the Ceribell data.


Assuntos
Cuidados Críticos/métodos , Cuidados Críticos/normas , Delírio/diagnóstico , Técnicas e Procedimentos Diagnósticos/normas , Pesquisa em Enfermagem/normas , Guias de Prática Clínica como Assunto , Projetos de Pesquisa/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto
10.
Medicina (Kaunas) ; 55(6)2019 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-31212673

RESUMO

Background and objectives: Identification of cancer biomarkers that are differentially expressed (DE) between two biological conditions is an important task in many microarray studies. There exist several methods in the literature in this regards and most of these methods designed especially for unpaired samples, those are not suitable for paired samples. Furthermore, the traditional methods use p-values or fold change (FC) values to detect the DE genes. However, sometimes, p-value based results do not comply with FC based results due to the smaller pooled variance of gene expressions, which occurs when variance of each individual condition becomes smaller. There are some methods that combine both p-values and FC values to solve this problem. But, those methods also show weak performance for small sample cases in the presence of outlying expressions. To overcome this problem, in this paper, an attempt is made to propose a hybrid robust SAM-FC approach by combining rank of FC values and rank of p-values computed by SAM statistic using minimum ß-divergence method, which is designed for paired samples. Materials and Methods: The proposed method introduces a weight function known as ß-weight function. This weight function produces larger weights corresponding to usual and smaller weights for unusual expressions. The ß-weight function plays the significant role on the performance of the proposed method. The proposed method uses ß-weight function as a measure of outlier detection by setting ß = 0.2. We unify both classical and robust estimates using ß-weight function, such that maximum likelihood estimators (MLEs) are used in absence of outliers and minimum ß-divergence estimators are used in presence of outliers to obtain reasonable p-values and FC values in the proposed method. Results: We examined the performance of proposed method in a comparison of some popular methods (t-test, SAM, LIMMA, Wilcoxon, WAD, RP, and FCROS) using both simulated and real gene expression profiles for both small and large sample cases. From the simulation and a real spike in data analysis results, we observed that the proposed method outperforms other methods for small sample cases in the presence of outliers and it keeps almost equal performance with other robust methods (Wilcoxon, RP, and FCROS) otherwise. From the head and neck cancer (HNC) gene expression dataset, the proposed method identified two additional genes (CYP3A4 and NOVA1) that are significantly enriched in linoleic acid metabolism, drug metabolism, steroid hormone biosynthesis and metabolic pathways. The survival analysis through Kaplan-Meier curve revealed that combined effect of these two genes has prognostic capability and they might be promising biomarker of HNC. Moreover, we retrieved the 12 candidate drugs based on gene interaction from glad4u and drug bank literature based gene associations. Conclusions: Using pathway analysis, disease association study, protein-protein interactions and survival analysis we found that our proposed two additional genes might be involved in the critical pathways of cancer. Furthermore, the identified drugs showed statistical significance which indicates that proteins associated with these genes might be therapeutic target in cancer.


Assuntos
Biomarcadores Tumorais/análise , Técnicas e Procedimentos Diagnósticos/normas , Biomarcadores Tumorais/genética , Simulação por Computador , Técnicas e Procedimentos Diagnósticos/instrumentação , Técnicas e Procedimentos Diagnósticos/estatística & dados numéricos , Perfilação da Expressão Gênica/instrumentação , Perfilação da Expressão Gênica/métodos , Humanos , Prognóstico
11.
N Biotechnol ; 52: 121-125, 2019 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-31102798

RESUMO

In May 2017, the European In Vitro Diagnostic Regulation (IVDR) entered into force and will apply to in vitro diagnostics from May 26th, 2022. This will have a major impact on the in vitro diagnostics (IVD) industry as all devices falling under the scope of the IVDR will require new or re-certification. It will also affect health institutions developing and using in-house devices. The IVDR also has implications with respect to product performance validation and verification including the pre-analytics of biological samples used by IVD developers and diagnostic service providers. In parallel to the IVDR, a series of standards on pre-analytical sample processing has been published by the International Organization for Standardization (ISO) and the European Committee for Standardization (CEN). These standards describe pre-analytical requirements for various types of analyses in various types of biospecimens. They are of relevance for IVD product developers in the context of (re)certification under the IVDR and to some extent also to devices manufactured and used only within health institutions. This review highlights the background and the rational for the pre-analytical standards. It describes the procedure that leads to these standards, the major implications of the standards and the requirements on pre-analytical workflows. In addition, it discusses the relationship between the standards and the IVDR.


Assuntos
Técnicas e Procedimentos Diagnósticos/normas , Fase Pré-Analítica/normas , Controle Social Formal , Equipamentos e Provisões/normas , Humanos , Padrões de Referência
12.
Curr Diabetes Rev ; 15(6): 471-479, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30961503

RESUMO

BACKGROUND: Diabetes Mellitus (DM) is a chronic life-long progressive multisystem heterogeneous metabolic disorder with complex pathogenesis. INTRODUCTION: Hyperglycemia is not only one of the classical signs of DM, but it also serves as the pivotal prerequisite for the diagnosis of the disease. However, with the advancement in the field of analytical biochemistry, a number of alternative and specific biomarkers have been discovered which can be used for better diagnosis of the DM. In this review, we have discussed various aspects of DM and different biomarkers used in assessing glycemia. METHODOLOGY: A thorough literature survey was conducted to identify various studies that reported the use of conventional and non-conventional markers for the assessment of glycemia in DM patients. CONCLUSION: The accurate detection and hence diagnosis of DM has become easy and more specific with the use of various biomarkers.


Assuntos
Biomarcadores , Diabetes Mellitus , Biomarcadores/sangue , Glicemia/análise , Diabetes Mellitus/sangue , Diabetes Mellitus/diagnóstico , Técnicas e Procedimentos Diagnósticos/normas , Técnicas e Procedimentos Diagnósticos/tendências , Humanos
14.
Fortschr Neurol Psychiatr ; 87(4): 215-216, 2019 04.
Artigo em Alemão | MEDLINE | ID: mdl-30999378
15.
Blood Press ; 28(3): 146-156, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30982364

RESUMO

PURPOSE: Orthostatic hypotension (OH) is a common and clinically important disorder. Published papers vary regarding the definitions of OH and methodologies of evaluation. Moreover, substantial gaps in the skills and knowledge required for assessment of OH have been reported by clinicians. We aimed to provide current information regarding the definition, classification and evaluation of OH. METHODS: We performed a comprehensive search of medical databases, using the following keywords: "postural hypotension" or "orthostatic hypotension", combined with: "definition", "classification", "diagnosis", "evaluation" or "meaning". We selected for this review the most relevant recent publications and key papers in the field, published in the English language. RESULTS: Current data regarding definitions, classification and the evaluation of OH are reviewed. The various aspects of OH assessment are extensively discussed. Considerable discrepancies exist between the published guidelines regarding the methodology of OH diagnosing. We propose an algorithm for OH evaluation and a standardized protocol for bedside determination of OH by healthcare providers. CONCLUSIONS: Correct assessment of OH is essential for its accurate diagnosis. The methodology of OH evaluation has not been sufficiently standardized. We emphasize the clinical importance of the uniform investigation of OH, according to the current guidelines for OH definition and meaning.


Assuntos
Hipotensão Ortostática , Algoritmos , Técnicas e Procedimentos Diagnósticos/normas , Humanos , Hipotensão Ortostática/classificação , Hipotensão Ortostática/diagnóstico , Testes Imediatos/normas
18.
Nurs Outlook ; 67(4): 462-475, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30795850

RESUMO

BACKGROUND: Precision health considers individual lifestyle, genetics, behaviors, and environment context and facilitates interventions aimed at helping individuals achieve well-being and optimal health. PURPOSE: To present the Nursing Science Precision Health (NSPH) Model and describe the integration of precision health concepts within the domains of symptom and self-management science as reflected in the National Institute of Nursing Research P30 Centers of Excellence and P20 Exploratory Centers. METHODS: Center members developed the NSPH Model and the manuscript based on presentations and discussions at the annual NINR Center Directors Meeting and in follow-up telephone meetings. DISCUSSION: The NSPH Model comprises four precision components (measurement; characterization of phenotype including lifestyle and environment; characterization of genotype and other biomarkers; and intervention target discovery, design, and delivery) that are underpinned by an information and data science infrastructure. CONCLUSION: Nurse scientist leadership is necessary to realize the vision of precision health as reflected in the NSPH Model.


Assuntos
Técnicas e Procedimentos Diagnósticos/normas , Cuidados de Enfermagem/normas , Guias de Prática Clínica como Assunto , Medicina de Precisão/enfermagem , Medicina de Precisão/normas , Autogestão/métodos , Humanos , Modelos de Enfermagem , Pesquisa em Enfermagem
20.
Hautarzt ; 70(1): 36-43, 2019 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-30617520

RESUMO

α-Gal syndrome results from sensitization to the carbohydrate epitope galactose-α-1,3-galactose (α­gal). The allergen occurs in mammalian meat and innards, but also in other foods and medical products of animal origin. Allergic reactions generally occur delayed after allergen intake with a latency period, depending on the individual tolerance threshold and the influence of cofactors. Details in the patient's medical history can help to establish the suspected diagnosis of α­gal syndrome. Confirmation of the diagnosis requires the expertise of specialists, experienced with the implementation and interpretation of in vitro and in vivo diagnostic tests. Whereas skin prick testing with commercial whole-meat extracts often does not provide reliable results, allergen-specific IgE (α-gal) is generally detectable in affected patients. Cell-based tests such as the basophil activation test are currently only employed in an experimental setting. To evaluate, whether a sensitization is clinically relevant, an in-patient oral food challenge should be performed, using for example cooked pork or porcine kidney in addition to suspected cofactors.


Assuntos
Técnicas e Procedimentos Diagnósticos , Hipersensibilidade Alimentar , Galactose , Imunoglobulina E , Alérgenos/imunologia , Animais , Técnicas e Procedimentos Diagnósticos/normas , Técnicas e Procedimentos Diagnósticos/tendências , Hipersensibilidade Alimentar/diagnóstico , Hipersensibilidade Alimentar/imunologia , Galactose/imunologia , Humanos , Imunoglobulina E/sangue , Carne , Testes Cutâneos/normas
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