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1.
Int J Infect Dis ; 93: 297-299, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32147538

RESUMO

The ongoing outbreak of COVID-19 that began in Wuhan, China, has constituted a Public Health Emergency of International Concern, with cases confirmed in multiple countries. Currently, patients are the primary source of infection. We report a confirmed case of COVID-19 whose oropharyngeal swab test of SARS-CoV-2 RNA turned positive in convalescence. This case highlights the importance of active surveillance of SARS-CoV-2 RNA for infectivity assessment.


Assuntos
Betacoronavirus/fisiologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , RNA Viral , China/epidemiologia , Testes Diagnósticos de Rotina/normas , Surtos de Doenças , Progressão da Doença , Feminino , Humanos , Pessoa de Meia-Idade , Saúde Pública , RNA Viral/isolamento & purificação , Recidiva , Tempo
3.
PLoS One ; 15(2): e0228545, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32045428

RESUMO

A key requirement for longitudinal studies using routinely-collected health data is to be able to measure what individuals are present in the datasets used, and over what time period. Individuals can enter and leave the covered population of administrative datasets for a variety of reasons, including both life events and characteristics of the datasets themselves. An automated, customizable method of determining individuals' presence was developed for the primary care dataset in Swansea University's SAIL Databank. The primary care dataset covers only a portion of Wales, with 76% of practices participating. The start and end date of the data varies by practice. Additionally, individuals can change practices or leave Wales. To address these issues, a two step process was developed. First, the period for which each practice had data available was calculated by measuring changes in the rate of events recorded over time. Second, the registration records for each individual were simplified. Anomalies such as short gaps and overlaps were resolved by applying a set of rules. The result of these two analyses was a cleaned set of records indicating start and end dates of available primary care data for each individual. Analysis of GP records showed that 91.0% of events occurred within periods calculated as having available data by the algorithm. 98.4% of those events were observed at the same practice of registration as that computed by the algorithm. A standardized method for solving this common problem has enabled faster development of studies using this data set. Using a rigorous, tested, standardized method of verifying presence in the study population will also positively influence the quality of research.


Assuntos
Coleta de Dados/métodos , Conjuntos de Dados como Assunto , Registros Eletrônicos de Saúde/estatística & dados numéricos , Seguimentos , Registro Médico Coordenado , Algoritmos , Continuidade da Assistência ao Paciente/normas , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Coleta de Dados/normas , Bases de Dados Factuais , Conjuntos de Dados como Assunto/normas , Conjuntos de Dados como Assunto/estatística & dados numéricos , Testes Diagnósticos de Rotina/normas , Testes Diagnósticos de Rotina/estatística & dados numéricos , Registros Eletrônicos de Saúde/organização & administração , Registros Eletrônicos de Saúde/normas , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Registro Médico Coordenado/normas , Padrões de Prática Médica/estatística & dados numéricos , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde/normas , Atenção Primária à Saúde/estatística & dados numéricos , Projetos de Pesquisa , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/prevenção & controle , Fatores de Tempo , País de Gales/epidemiologia , Varfarina/uso terapêutico
4.
BMC Infect Dis ; 20(1): 117, 2020 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-32041536

RESUMO

BACKGROUND: Severe febrile illness without a known source (SFWS) is a challenge for clinicians when deciding how to manage a patient, particularly given the wide spectrum of potential aetiologies that contribute to fever. These infections are difficult to distinguish clinically, and accurate diagnosis requires a plethora of diagnostics including blood cultures, imaging techniques, molecular or serological tests, and more. When laboratory services are available, a limited test menu hinders clinical decision-making and antimicrobial stewardship, leading to empiric treatment and suboptimal patient outcomes. To specifically address SFWS, this work aimed to identify priority pathogens for a globally applicable panel for fever causing pathogens. METHOD: A pragmatic two-pronged approach combining currently available scientific data in an analytical hierarchy process and systematically gathered expert input, was designed to address the lack of comprehensive global aetiology data. The expert re-ranked list was then further adapted for a specific use case to focus on community acquired infections in whole blood specimens. The resulting list was further analysed to address different geographical regions (Asia, Africa, and Latin America), and Cohen kappa scores of agreement were calculated. RESULTS: The expert ranked prioritized pathogen list generated as part of this two-pronged approach included typhoidal Salmonella, Plasmodium species and Mycobacterium tuberculosis as the top 3 pathogens. This pathogen list was then further adapted for the SFWS use case to develop a final pathogen list to inform product development. Subsequent analysis comparing the relevance of the SFWS pathogen list to multiple populations and geographical regions showed that the SFWS prioritized list had considerable utility across Africa and Asia, but less so for Latin America. In addition, the list showed high levels of agreement across different patient sub-populations, but lower relevance for neonates and symptomatic HIV patients. CONCLUSION: This work highlighted once again the challenges of prioritising in global health, but it also shows that taking a two-pronged approach, combining available prevalence data with expert input, can result in a broadly applicable priority list. This comprehensive utility is particularly important in the context of product development, where a sufficient market size is essential to achieve a sustainable commercialized diagnostic product to address SFWS.


Assuntos
Testes Diagnósticos de Rotina/normas , Febre/diagnóstico , África/epidemiologia , Ásia/epidemiologia , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/parasitologia , Infecções Comunitárias Adquiridas/virologia , Países em Desenvolvimento , Febre/microbiologia , Febre/parasitologia , Febre/virologia , Saúde Global/normas , Humanos , América Latina/epidemiologia , Prevalência
7.
PLoS One ; 15(1): e0227275, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31923209

RESUMO

The aim of this work was to determine current cagA gene EPIYA motifs present in Colombian Helicobacter pylori isolates using a fast and reliable molecular test. DNA from eighty-five Helicobacter pylori-cagA positive strains were analyzed. Strains were obtained from patients diagnosed with functional dyspepsia at Clínica Fundadores in Bogotá. The 3' region of the cagA gene was amplified through conventional Polymerase Chain Reaction (PCR). Obtained amplicons were sequenced using the Sanger method and analyzed with bioinformatics tools. Additionally, a significant Spearman correlation coefficient was determined between the patients' age and the number of EPIYA-C repeats; with p values < 0.05 considered significant. Estimates were obtained using a 95% CI. The 3´ variable region of the cagA gene was amplified and PCR products of the following sizes corresponded to the following EPIYA motifs: 400 bp: EPIYA AB, 500 bp: EPIYA ABC, 600 bp: EPIYA ABCC and 700 bp: ABCCC. A single PCR band was observed for 58 out of 85 Helicobacter pylori isolates, with an EPIYA distribution motif as follows: 7/85 AB (8.2%), 34/85 ABC (40%), 26/85 ABCC (30.6%) and 18/85 ABCCC (21.2%). However, in 27 out of 85 Helicobacter pylori isolates, two or more bands were observed, where the most predominant cagA genotype were ABC-ABCC (26%, 7/27) and ABCC-ABCCC (22.2%, 6/27). A direct proportionality between the number of EPIYA-C repeats and an increase in the patients' age was observed, finding a greater number of EPIYA ABCC and ABCCC repeats in the population over 50 years old. All isolates were of the Western cagA type and 51.8% of them were found to have multiple EPIYA-C repeats. These standardized molecular test allowed to identify the number of EPIYA C motifs based on band size.


Assuntos
Motivos de Aminoácidos/genética , Antígenos de Bactérias/genética , Proteínas de Bactérias/genética , Testes Diagnósticos de Rotina/normas , Genes Bacterianos/genética , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/epidemiologia , Helicobacter pylori/genética , Adulto , Idoso , Colômbia/epidemiologia , DNA Bacteriano/genética , Dispepsia/microbiologia , Feminino , Genótipo , Infecções por Helicobacter/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase/normas , Sequências Repetitivas de Ácido Nucleico/genética , Análise de Sequência de DNA/normas
8.
Pediatrics ; 145(2)2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31911477

RESUMO

BACKGROUND: Children frequently receive low-value services that do not improve health, but it is unknown whether the receipt of these services differs between publicly and privately insured children. METHODS: We analyzed 2013-2014 Medicaid Analytic eXtract and IBM MarketScan Commercial Claims and Encounters databases. Using 20 measures of low-value care (6 diagnostic testing measures, 5 imaging measures, and 9 prescription drug measures), we compared the proportion of publicly and privately insured children in 12 states who received low-value services at least once or twice in 2014; the proportion of publicly and privately insured children who received low-value diagnostic tests, imaging tests, and prescription drugs at least once; and the proportion of publicly and privately insured children eligible for each measure who received the service at least once. RESULTS: Among 6 951 556 publicly insured children and 1 647 946 privately insured children, respectively, 11.0% and 8.9% received low-value services at least once, 3.9% and 2.8% received low-value services at least twice, 3.2% and 3.8% received low-value diagnostic tests at least once, 0.4% and 0.4% received low-value imaging tests at least once, and 8.4% and 5.5% received low-value prescription drug services at least once. Differences in the proportion of eligible children receiving each service were typically small (median difference among 20 measures, public minus private: +0.3 percentage points). CONCLUSIONS: In 2014, 1 in 9 publicly insured and 1 in 11 privately insured children received low-value services. Differences between populations were modest overall, suggesting that wasteful care is not highly associated with payer type. Efforts to reduce this care should target all populations regardless of payer mix.


Assuntos
Children's Health Insurance Program/normas , Medicaid/normas , Setor Privado/normas , Setor Público/normas , Seguro de Saúde Baseado em Valor , Adolescente , Criança , Pré-Escolar , Children's Health Insurance Program/estatística & dados numéricos , Estudos Transversais , Testes Diagnósticos de Rotina/normas , Testes Diagnósticos de Rotina/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Revisão da Utilização de Seguros/estatística & dados numéricos , Masculino , Medicaid/estatística & dados numéricos , Medicamentos sob Prescrição/normas , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Estados Unidos , Seguro de Saúde Baseado em Valor/estatística & dados numéricos
9.
Am J Clin Pathol ; 153(1): 14-29, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31598629

RESUMO

OBJECTIVES: To assess the diagnostic accuracy of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in acute inflammation. METHODS: PubMed and Scopus were searched and eligible articles were screened for methodologic quality using the Quality Assessment of the Diagnostic Accuracy Studies-Revised. Meta-analysis with calculation of pooled sensitivity (Se), specificity (Sp), and summary area under the curve (SAUC) was performed. RESULTS: Twenty-nine studies were eligible. Se and Sp were 0.78 and 0.68 (SAUC = 0.80) for ESR in orthopedic infections and 0.79 and 0.70 (SAUC = 0.81) for CRP. For the diagnosis of other various inflammatory conditions, CRP had a superior diagnostic accuracy, with a Se of 0.86, Sp of 0.67, and SAUC of 0.86 compared with a Se of 0.77, Sp of 0.59, and SAUC of 0.75 for ESR. Heterogeneity among studies was elevated. Combined use of ESR and CRP yielded higher diagnostic accuracy. CONCLUSIONS: Despite observed heterogeneity among studies, ESR and CRP have a similar diagnostic accuracy in assessment of inflammation, especially in orthopedic conditions.


Assuntos
Proteína C-Reativa/análise , Testes Diagnósticos de Rotina/normas , Inflamação/sangue , Doença Aguda , Área Sob a Curva , Sedimentação Sanguínea , Humanos , Inflamação/diagnóstico , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
10.
BMC Infect Dis ; 19(1): 1017, 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31791265

RESUMO

BACKGROUND: Early diagnosis and treatment of neurosyphilis is of great significance for regression. There is no gold standard for the diagnosis of neurosyphilis. We did this study to explore the factors associated with the clinical diagnosis of neurosyphilis and assess their accuracy for the diagnosis of neurosyphilis. METHODS: We retrospectively reviewed 100 cases of syphilis patients who underwent lumbar puncture at a major dermatology hospital in Guangzhou, China between April 2013 and November 2016. Fifty patients who were clinically diagnosed with neurosyphilis were selected as case group. Control group consisted of 50 general syphilis patients who were matched with age and gender. The records of patients were reviewed to collect data of socio-demographic information, clinical symptom, and laboratory indicators. Multivariable logistic regression was used to explore diagnostic indictors, and ROC analysis was used to assess diagnostic accuracy. RESULTS: Neurological symptoms (odds ratio (OR) = 59.281, 95% CI:5.215-662.910, P = 0.001), cerebrospinal fluid (CSF) Treponema pallidum particle agglutination (TPPA) titer (OR = 1.004, 95% CI:1.002-1.006, P < 0.001), CSF protein (OR = 1.005, 95% CI:1.000-1.009, P = 0.041), and CSF white blood cell (WBC) (OR = 1.120, 95% CI:1.017-1.233, P = 0.021) were found to be statistically associated with neurosyphilis. In ROC analysis, CSF TPPA titer had a sensitivity of 90%, a specificity of 84%, and an area under curve (AUC) of 0.941. CONCLUSION: CSF TPPA can potentially be considered as an alternative test for diagnosis of neurosyphilis. Combining with neurological symptoms, CSF protein, CSF WBC, the diagnosis would have a higher sensitivity.


Assuntos
Soronegatividade para HIV , Neurossífilis/diagnóstico , Adulto , Estudos de Casos e Controles , China/epidemiologia , Testes Diagnósticos de Rotina/métodos , Testes Diagnósticos de Rotina/normas , Feminino , Infecções por HIV/líquido cefalorraquidiano , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Neurossífilis/líquido cefalorraquidiano , Neurossífilis/complicações , Neurossífilis/epidemiologia , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Sensibilidade e Especificidade , Sífilis/líquido cefalorraquidiano , Sífilis/complicações , Sífilis/diagnóstico , Sífilis/epidemiologia , Treponema pallidum
11.
Ann Biol Clin (Paris) ; 77(6): 693-696, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31859648

RESUMO

Several hyperthyroidism misdiagnoses cases have been recently described due to biotin intake. Biotin used in immuno-analysis assays which rely on biotin/streptavidin binding properties. In these assays, high plasmatic biotin levels can lead to major analytical interferences resulting in falsely higher (competition tests) or falsely reduced determinations (for sandwiches assays). We performed a simulation test of biotin intake with patient's samples. We studied the effect of biotin on cardiac troponin I and total vitamin D (D2+D3) assays that are using biotin-streptavidin binding on Dimension EXL®. Increasing doses of biotin were added (28 samples for each parameter) before the assays. The results evidenced a significant negative interference of biotin on cardiac troponin I determinations for concentrations of 100 ng/mL and above, with a total loss of signal for higher biotin additions. Such interference may lead to inappropriate therapeutic decisions. Positive interferences were observed on total vitamin D (D2+D3) with less impact for therapeutic decisions.


Assuntos
Ligação Competitiva , Biotina/metabolismo , Testes Diagnósticos de Rotina , Hipertireoidismo/diagnóstico , Estreptavidina/metabolismo , Troponina I/análise , Vitamina D/análise , Adulto , Artefatos , Biotina/administração & dosagem , Biotina/efeitos adversos , Colecalciferol/análise , Colecalciferol/sangue , Doença das Coronárias/sangue , Doença das Coronárias/diagnóstico , Erros de Diagnóstico , Testes Diagnósticos de Rotina/instrumentação , Testes Diagnósticos de Rotina/métodos , Testes Diagnósticos de Rotina/normas , Ergocalciferóis/análise , Ergocalciferóis/sangue , Humanos , Hipertireoidismo/sangue , Imunoensaio/instrumentação , Imunoensaio/métodos , Miocárdio/química , Miocárdio/metabolismo , Troponina I/sangue , Troponina I/metabolismo , Vitamina D/sangue , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/diagnóstico
12.
J Manipulative Physiol Ther ; 42(7): 532-540, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31864436

RESUMO

OBJECTIVE: The purpose of this review was to identify different kinematic characteristics between the movements of sit-to-stand-to-sit, sit-to-stand, or stand-to-sit of individuals with and without low back pain (LBP). METHODS: A systematic search was conducted on scientific databases. The analyzed kinematic variables were duration of the movement, reproduction of the movement, ranges of motion, velocity, and acceleration. The studies were appraised for methodological quality using the Downs & Black scale and for the level of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS: After all screening stages, this systematic review comprised 8 cross-sectional studies. When comparing the patients with LBP vs controls, patients with LBP take longer to perform the sit-to-stand-to-sit, sit-to-stand, and stand-to sit movements (eg, 9.33 ± 1.49 seconds vs 8.29 ± 1.23 seconds in the sit-to-stand-to-sit movement), show decreased mobility of the lumbar spine (eg, 26.21° ± 8.76° vs 32.07° ± 6.77° in the sit-to-stand-to-sit movement) and the hip (eg, 51.0° vs 77.25° in the sit-to-stand movement), present decreased velocity of the trunk (eg, 95.31° ± 25.13°/s vs 138.23° ± 23.42°/s in the sit-to-stand-to-sit movement) and the hip (eg, 46° ± 13°/s vs 69° ± 13°/s in the sit-to-stand movement), and decreased overall acceleration of the trunk (eg, 280.19° ± 113.08°/s2 vs 460.16° ± 101.49°/s2 in the sit-to-stand-to-sit movement), besides presenting greater variability of the trunk (eg, 5.53° ± 0.48° vs 4.32° ± 0.46° in the sit-to-stand movement). CONCLUSION: There are kinematic alterations in the lumbar spine, the hip, and the trunk of patients with LBP. However, information about pelvic and overall trunk mobility, velocity, and acceleration of the lumbar spine; and mobility, speed, and acceleration of hip and pelvis remain incipient in individuals with LBP. Based on the Grading of Recommendations Assessment, Development, and Evaluation criteria, the results of this review indicate that there is low scientific evidence on the characteristics of the kinematic variables (duration of the movement, reproduction of the movement, range of motion, velocity, and acceleration) of the trunk, lumbar spine, pelvis, and hip in patients with LBP.


Assuntos
Testes Diagnósticos de Rotina/normas , Dor Lombar/diagnóstico , Postura/fisiologia , Adulto , Fenômenos Biomecânicos , Estudos Transversais , Feminino , Humanos , Dor Lombar/fisiopatologia , Vértebras Lombares , Região Lombossacral , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde/métodos , Amplitude de Movimento Articular
13.
Scand J Trauma Resusc Emerg Med ; 27(1): 113, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31842931

RESUMO

BACKGROUND: To date, the decision to set up therapeutic extra-corporeal life support (ECLS) in hypothermia-related cardiac arrest is based on the potassium value only. However, no information is available about how the analysis should be performed. Our goal was to compare intra-individual variation in serum potassium values depending on the sampling site and analytical technique in hypothermia-related cardiac arrests. METHODS: Adult patients with suspected hypothermia-related refractory cardiac arrest, admitted to three hospitals with ECLS facilities were included. Blood samples were obtained from the femoral vein, a peripheral vein and the femoral artery. Serum potassium was analysed using blood gas (BGA) and clinical laboratory analysis (CL). RESULTS: Of the 15 consecutive patients included, 12 met the principal criteria, and 5 (33%) survived. The difference in average potassium values between sites or analytical method used was ≤1 mmol/L. The agreement between potassium values according to the three different sampling sites was poor. The ranges of the differences in potassium using BGA measurement were - 1.6 to + 1.7 mmol/L; - 1.18 to + 2.7 mmol/L and - 0.87 to + 2 mmol/L when comparing respectively central venous and peripheral venous, central venous and arterial, and peripheral venous and arterial potassium. CONCLUSIONS: We found important and clinically relevant variability in potassium values between sampling sites. Clinical decisions should not rely on one biological indicator. However, according to our results, the site of lowest potassium, and therefore the preferred site for a single potassium sampling is central venous blood. The use of multivariable prediction tools may help to mitigate the risks inherent in the limits of potassium measurement. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03096561.


Assuntos
Testes Diagnósticos de Rotina/normas , Parada Cardíaca/etiologia , Parada Cardíaca/terapia , Hipotermia/complicações , Potássio/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Gasometria , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Deficiência de Potássio , Estudos Prospectivos
14.
PLoS Negl Trop Dis ; 13(12): e0007884, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31877142

RESUMO

Hantavirus Pulmonary Syndrome is an, often fatal, emerging zoonotic disease in the Americas caused by hantaviruses (family: Hantaviridae). In Brazil, hantavirus routine diagnosis is based on serology (IgM-ELISA) while RT-PCR is often used to confirm acute infection. A Semi-nested RT-PCR and an internally controlled RT-qPCR assays were developed for detection and quantification of four hantaviruses strains circulating in the Brazilian Amazon: Anajatuba (ANAJV) and Castelo dos Sonhos (CASV) strains of Andes virus (ANDV) species; and Rio Mamoré (RIOMV) and Laguna Negra (LNV) strains of LNV species. A consensus region in the N gene of these hantaviruses was used to design the primer sets and a hydrolysis probe. In vitro transcribed RNA was diluted in standards with known concentration. MS2 bacteriophage RNA was detected together with hantavirus RNA as an exogenous control in a duplex reaction. RT-qPCR efficiency was around 100% and the limit of detection was 0.9 copies/µL of RNA for RT-qPCR and 10 copies/µL of RNA for Semi-nested RT-PCR. There was no amplification of either negative samples or samples positive to other pathogens. To assess the protocol for clinical sensitivity, specificity and general accuracy values, both assays were used to test two groups of samples: one comprising patients with disease (n = 50) and other containing samples from healthy individuals (n = 50), according to IgM-ELISA results. A third group of samples (n = 27) infected with other pathogens were tested for specificity analysis. RT-qPCR was more sensitive than semi-nested RT-PCR, being able to detect three samples undetected by conventional RT-PCR. RT-qPCR clinical sensitivity, specificity and general accuracy values were 92.5%, 100% and 97.63%, respectively. Thus, the assays developed in this study were able to detect the four Brazilian Amazon hantaviruses with good specificity and sensitivity, and may become powerful tools in diagnostic, surveillance and research applications of these and possibly other hantaviruses.


Assuntos
Testes Diagnósticos de Rotina/métodos , Síndrome Pulmonar por Hantavirus/diagnóstico , Reação em Cadeia da Polimerase em Tempo Real/métodos , Reação em Cadeia da Polimerase Via Transcriptase Reversa/métodos , Adulto , Brasil , Testes Diagnósticos de Rotina/normas , Hantavirus/classificação , Hantavirus/isolamento & purificação , Humanos , Reação em Cadeia da Polimerase/métodos , Reação em Cadeia da Polimerase/normas , Reação em Cadeia da Polimerase em Tempo Real/normas , Padrões de Referência , Reação em Cadeia da Polimerase Via Transcriptase Reversa/normas , Sensibilidade e Especificidade , Adulto Jovem
15.
Vet Microbiol ; 239: 108452, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31767099

RESUMO

Bovine viral diarrhea (BVD), one of the most important infectious diseases in cattle, causes major economic losses and significant impact on animal welfare worldwide. The major source for virus spread is persistently infected, immunotolerant calves and, therefore, their early identification is of utmost importance for disease prevention. Here, a ring trial was initiated to control the performance of diagnostic tests used in German regional laboratories in charge of the diagnostics within the country's BVD control program. A panel of five ear notch and five serum samples was provided for virological analysis. By an antigen ELISA, which was applied 26 times, the status of every sample was correctly identified in any case. In addition, a total of 54 real-time RT-PCR result sets was generated and also in most cases correctly classified. In addition to the virological test panel, a set of six sera and four milk samples was sent to the participating laboratories to be analyzed by serological methods. With serum neutralization tests, an excellent diagnostic sensitivity was achieved. However, one serum and both milk samples - positive for BVDV antibodies - repeatedly tested false negative by some of the used ELISA kits. All negative serum and milk samples were correctly identified by every commercial antibody ELISA. In conclusion, the BVDV proficiency test demonstrated that the used antigen/genome test systems allowed predominantly reliable diagnostics, while for four of the applied nine antibody ELISA kits adjustments are recommended.


Assuntos
Doença das Mucosas por Vírus da Diarreia Viral Bovina/diagnóstico , Testes Diagnósticos de Rotina/veterinária , Animais , Anticorpos Antivirais/análise , Anticorpos Antivirais/sangue , Doença das Mucosas por Vírus da Diarreia Viral Bovina/imunologia , Bovinos , Testes Diagnósticos de Rotina/normas , Vírus da Diarreia Viral Bovina/imunologia , Erradicação de Doenças , Ensaio de Imunoadsorção Enzimática/normas , Ensaio de Imunoadsorção Enzimática/veterinária , Alemanha , Leite , Reação em Cadeia da Polimerase em Tempo Real/normas , Reação em Cadeia da Polimerase em Tempo Real/veterinária , Sensibilidade e Especificidade
16.
Public Health Rep ; 134(2_suppl): 53S-57S, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31682562

RESUMO

This study describes the efforts and outcomes associated with the establishment of a clinical sample repository during the 2016 Zika virus epidemic. To overcome the challenge of limited access to clinical samples to support diagnostic test development, multiple US Department of Health and Human Services (HHS) agencies formed a partnership to create the HHS Zika Specimen Repository. In 2016-2017, the Biomedical Advanced Research and Development Authority and the Centers for Disease Control and Prevention collected patient specimens (4420 convalescent sera aliquots from 100 donors and 7171 plasma aliquots from 239 donors), confirmed Zika virus test results, assembled 1 panel for molecular testing (n = 25 sets) and 7 panels for serologic testing (n = 92), and distributed the panels to test developers. We manufactured 8 test panels and distributed 74 sets of panels to 32 commercial companies, public health partners, and research institutions. Manufacturers used these panels to generate data that supported 14 US Food and Drug Administration (FDA) emergency use authorizations and 1 FDA approval. To develop a repository that can respond immediately to future disease outbreaks, we recommend that organizations pre-position procedures, resources, and partnerships to optimize each partner's contribution.


Assuntos
Testes Diagnósticos de Rotina/normas , Surtos de Doenças/estatística & dados numéricos , Saúde Pública/normas , Parcerias Público-Privadas/tendências , United States Dept. of Health and Human Services/tendências , Infecção por Zika virus/epidemiologia , Zika virus/isolamento & purificação , Surtos de Doenças/prevenção & controle , Humanos , Estados Unidos , Zika virus/genética , Infecção por Zika virus/sangue
17.
J Fish Dis ; 42(11): 1471-1491, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31637760

RESUMO

Samples from multiple animals may be pooled and tested to reduce costs of surveillance for infectious agents in aquatic animal populations. The primary advantage of pooling is increased population-level coverage when prevalence is low (<10%) and the number of tests is fixed, because of increased likelihood of including target analyte from at least one infected animal in a tested pool. Important questions and a priori design considerations need to be addressed. Unfortunately, pooling recommendations in disease-specific chapters of the 2018 OIE Aquatic Manual are incomplete and, except for amphibian chytrid fungus, are not supported by peer-reviewed research. A systematic review identified only 12 peer-reviewed aquatic diagnostic accuracy and surveillance studies using pooled samples. No clear patterns for pooling methods and characteristics were evident across reviewed studies, although most authors agreed there is a negative effect on detection. Therefore, our purpose was to review pooling procedures used in published aquatic infectious disease research, present evidence-based guidelines, and provide simulated data examples for white spot syndrome virus in shrimp. A decision tree of pooling guidelines was developed for use by peer-reviewed journals and research institutions for the design, statistical analysis and reporting of comparative accuracy studies of individual and pooled tests for surveillance purposes.


Assuntos
Crustáceos/virologia , Testes Diagnósticos de Rotina/normas , Monitoramento Epidemiológico/veterinária , Doenças dos Peixes/epidemiologia , Guias como Assunto , Vírus da Síndrome da Mancha Branca 1/fisiologia , Animais , Doenças Transmissíveis/epidemiologia , Doenças Transmissíveis/veterinária , Vigilância da População/métodos , Prevalência
18.
PLoS Negl Trop Dis ; 13(10): e0007773, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31658252

RESUMO

In 2012, the U.S. Defense Threat Reduction Agency Joint Science and Technology Office initiated a program to develop novel point-of-need diagnostic devices for surveillance of emerging infectious diseases including dengue, malaria, plague, and melioidosis. Prior to distribution of devices to observe their correct use among community members in Iquitos, Peru, and Phnom Penh, Cambodia, research was conducted to: 1) assess acceptability of use, including the motivation to use a rapid diagnostic test (RDT) before or instead of seeking care at a health facility, 2) explore comprehension of RDT use instructions, and 3) examine possible strategies for large scale RDT distribution and use at each site. In February 2014, 9 focus group discussions (FGD) with community members and 5 FGD with health professionals were conducted in Iquitos, and 9 FGD with community members and 9 in-depth interviews with health professionals in Phnom Penh. In both places, participants agreed to use the device themselves (involving finger prick) or could identify someone who could do so in their home or neighborhood. The main incentive to RDT use in both sites was the ability for device results to be used for care facilitation (post confirmatory tests), specifically reduced wait times to be seen or obtain a diagnosis. Comprehension of RDT use instructions was assessed in Iquitos by asking some participants to apply the device to research team members; after watching a short video, most steps were done correctly. In Phnom Penh, participants were asked to describe each step after reading the instructions; they struggled with comprehension. Health professionals' main concerns in both sites were their community's ability to accurately use the test, handle complicated instructions, and safety (i.e., disposal of lancets). Health system structure and ability to use home diagnostic devices varied in the two disease endemic sites, with substantial challenges in each, suggesting the need for different strategies for RDT large scale community use, and illustrating the value of formative research before deployment of novel technologies.


Assuntos
Testes Diagnósticos de Rotina/métodos , Testes Diagnósticos de Rotina/normas , Pessoal de Saúde/educação , Adolescente , Adulto , Camboja , Dengue/diagnóstico , Educação/métodos , Feminino , Grupos Focais , Instalações de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Malária/diagnóstico , Masculino , Melioidose/diagnóstico , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Peru , Peste/diagnóstico , Manejo de Espécimes/métodos , Adulto Jovem
20.
Acta Trop ; 199: 105118, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31369728

RESUMO

Well-defined diagnostic gold standards are rarely available for the diagnosis of rare diseases such as some tropical infections. Algorithms for reliable test evaluation without gold standard are therefore desirable. On the basis of previous work of Gart and Buck (1966); Rogan and Gladen (1978), and Hui and Walter (1980), a modeling approach for the comparison of diagnostic tests without a gold standard - and thus without reliably characterized reference sample material - is established especially for situations not fulfilling the requirement of conditional independence of the diagnostic tests evaluated. In the approach introduced, each test is conducted within two populations with different values of prevalence and the test results are used to define two virtual reference tests. The model is useful for the comparison of tests for rare tropical diseases where no gold standard can be provided.


Assuntos
Infecções por Actinomycetales/diagnóstico , Testes Diagnósticos de Rotina/normas , Doenças Raras/diagnóstico , Tropheryma/isolamento & purificação , Algoritmos , Testes Diagnósticos de Rotina/métodos , Humanos , Modelos Teóricos , Reação em Cadeia da Polimerase/métodos , Reação em Cadeia da Polimerase/normas , Prevalência , Sensibilidade e Especificidade , Tropheryma/genética , Clima Tropical
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