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1.
PLoS One ; 16(1): e0245848, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33508007

RESUMO

BACKGROUND: COVID-19 (COronaVIrus Disease 2019) is an infectious respiratory disease caused by the novel SARS-CoV-2 virus. Point of Care (POC) tests have been developed to detect specific antibodies, IgG and IgM, to SARS-CoV-2 virus in human whole blood. They need to be easily usable by the general population in order to alleviate the lockdown that many countries have initiated in response to the growing COVID-19 pandemic. A real-life study has been conducted in order to evaluate the performance of the COVID-PRESTO® POC test and the results were recently published. Even if this test showed very high sensitivity and specificity in a laboratory setting when used by trained professionals, it needs to be further evaluated for practicability when used by the general public in order to be approved by health authorities for in-home use. METHODS: 143 participants were recruited between March 2020 and April 2020 among non-medical populations in central France (nuclear plant workers, individuals attending the Orleans University Hospital vaccination clinic and Orleans University Hospital non-medical staff). Instructions for use, with or without a tutorial video, were made available to the volunteers. Two separate objectives were pursued: evaluation of the capability of participants to obtain an interpretable result, and evaluation of the users' ability to read the results. RESULTS: 88.4% of the test users judged the instructions for use leaflet to be clear and understandable. 99.3% of the users obtained a valid result and, according to the supervisors, 92.7% of the tests were properly performed by the users. Overall, 95% of the users gave positive feedback on the COVID PRESTO® as a potential self-test. Neither age nor education had an influence. CONCLUSION: COVID-PRESTO® was successfully used by an overwhelming majority of participants and its use was judged very satisfactory, therefore showing promising potential as a self-test to be used by the general population. This POC test can become an easy-to-use tool to help detect whether individuals are protected or not, particularly in the context of a second wave or a mass vaccination program.


Assuntos
/diagnóstico , /isolamento & purificação , Adulto , Idoso , /epidemiologia , Controle de Doenças Transmissíveis , Feminino , França/epidemiologia , Testes Hematológicos/métodos , Humanos , Imunoglobulina G/sangue , Imunoglobulina G/imunologia , Imunoglobulina M/sangue , Imunoglobulina M/imunologia , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Testes Imediatos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
2.
Epidemiol Infect ; 149: e23, 2021 01 11.
Artigo em Inglês | MEDLINE | ID: mdl-33427157

RESUMO

This study applied causal criteria in directed acyclic graphs for handling covariates in associations for prognosis of severe coronavirus disease 2019 (COVID-19) cases. To identify non-specific blood tests and risk factors as predictors of hospitalisation due to COVID-19, one has to exclude noisy predictors by comparing the concordance statistics (area under the curve - AUC) for positive and negative cases of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Predictors with significant AUC at negative stratum should be either controlled for their confounders or eliminated (when confounders are unavailable). Models were classified according to the difference of AUC between strata. The framework was applied to an open database with 5644 patients from Hospital Israelita Albert Einstein in Brazil with SARS-CoV-2 reverse transcription - polymerase chain reaction (RT-PCR) exam. C-reactive protein (CRP) was a noisy predictor: hospitalisation could have happened due to causes other than COVID-19 even when SARS-CoV-2 RT-PCR is positive and CRP is reactive, as most cases are asymptomatic to mild. Candidates of characteristic response from moderate-to-severe inflammation of COVID-19 were: combinations of eosinophils, monocytes and neutrophils, with age as risk factor; and creatinine, as risk factor, sharpens the odds ratio of the model with monocytes, neutrophils and age.


Assuntos
/diagnóstico , Testes Hematológicos , /sangue , /epidemiologia , Testes Hematológicos/métodos , Testes Hematológicos/normas , Hospitalização , Humanos , Prognóstico , Fatores de Risco , Índice de Gravidade de Doença
3.
Ann Biol Clin (Paris) ; 78(5): 519-526, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-33026347

RESUMO

Digital morphology hematology analyzers are becoming more prevalent in laboratories Aims: investigate practices and assess the benefits and limits of digital automated microscopy in hematology. METHODS: questionnaire sent by e-mail in 2018 to French public and private laboratories. RESULTS: out of 118 responses (56 private, 62 public), 117 participants had a CellaVision® microscope, 1 had a West Medica®. Practices were sometimes different, especially in the choice of smears to be digitized or for quality controls (16.1% had internal quality controls, 48.3% external quality controls); 62.1% never used the red blood cell (RBC) characterization tool; the number of cells counted varied from 100 to 400. The study reported a high rate of agreement for these benefits: traceability (95.7%), staff training (94.1%), eye strain (91.4%), risk of error (87.2%), time saving (83.6%). Among the disadvantages, apart from the inadequate search for platelets clumps (93.2%), the agreement rates were often lower: adaptation to digital images (61.2%), difficult assessment of atypical morphologies (49.6%) or RBC morphology (49.6%). CONCLUSION: despite well-established benefits, standardization of practices and technical improvement are still needed.


Assuntos
Automação Laboratorial , Testes Hematológicos/instrumentação , Hematologia/instrumentação , Processamento de Imagem Assistida por Computador , Microscopia/instrumentação , Atitude do Pessoal de Saúde , Automação Laboratorial/instrumentação , Automação Laboratorial/métodos , Automação Laboratorial/estatística & dados numéricos , Computadores , Testes Diagnósticos de Rotina/instrumentação , Testes Diagnósticos de Rotina/métodos , Testes Diagnósticos de Rotina/estatística & dados numéricos , Testes Diagnósticos de Rotina/tendências , França/epidemiologia , Testes Hematológicos/métodos , Testes Hematológicos/estatística & dados numéricos , Testes Hematológicos/tendências , Hematologia/métodos , Hematologia/estatística & dados numéricos , Hematologia/tendências , Humanos , Processamento de Imagem Assistida por Computador/instrumentação , Processamento de Imagem Assistida por Computador/métodos , Processamento de Imagem Assistida por Computador/estatística & dados numéricos , Processamento de Imagem Assistida por Computador/tendências , Satisfação no Emprego , Microscopia/métodos , Microscopia/estatística & dados numéricos , Microscopia/tendências , Prática Profissional/estatística & dados numéricos , Prática Profissional/tendências , Controle de Qualidade , Inquéritos e Questionários
5.
Acta Biomed ; 91(3): e2020003, 2020 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-32921701

RESUMO

BACKGROUND: The COVID-19 outbreak is now a pandemic disease reaching as much as 210 countries worldwide with more than 2.5 million infected people and nearly 200.000 deaths. Amplification of viral RNA by RT-PCR represents the gold standard for confirmation of infection, yet it showed false-negative rates as large as 15-20% which may jeopardize the effect of the restrictive measures taken by governments. We previously showed that several hematological parameters were significantly different between COVID-19 positive and negative patients. Among them aspartate aminotransferase and lactate dehydrogenase had predictive values as large as 90%. Thus a combination of RT-PCR and blood tests could reduce the false-negative rate of the genetic test. METHODS: We retrospectively analyzed 24 patients showing multiple and inconsistent RT-PCR, test during their first hospitalization period, and compared the genetic tests results with their AST and LDH levels. RESULTS: We showed that when considering the hematological parameters, the RT-PCR false-negative rates were reduced by almost 4-fold. CONCLUSIONS: The study represents a preliminary work aiming at the development of strategies that, by combining RT-PCR tests with routine blood tests, will lower or even abolish the rate of RT-PCR false-negative results and thus will identify, with high accuracy, patients infected by COVID-19.


Assuntos
Betacoronavirus/genética , Infecções por Coronavirus/diagnóstico , Pandemias , Pneumonia Viral/diagnóstico , RNA Viral/análise , Reação em Cadeia da Polimerase em Tempo Real/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Aspartato Aminotransferases/sangue , Biomarcadores/sangue , Infecções por Coronavirus/sangue , Infecções por Coronavirus/epidemiologia , Diagnóstico Diferencial , Reações Falso-Negativas , Feminino , Seguimentos , Testes Hematológicos/métodos , Humanos , Itália/epidemiologia , L-Lactato Desidrogenase/sangue , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/sangue , Pneumonia Viral/epidemiologia , Reprodutibilidade dos Testes , Estudos Retrospectivos
6.
Acta Biomed ; 91(3): e2020009, 2020 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-32921707

RESUMO

BACKGROUND: In Italy, one of the country most affected by the COVID-19 pandemic, the first autochthonous case appeared in Lombardy on February 20th, 2020. One month later, the number of -COVID-19 patients in Lombardy exceeded 17000 and about 3500 had died. Because of this rapid increase in infected people scientists wonder whether SARS-CoV-2 was already highly circulating in Lombardy before such date. Plasma levels of aspartate aminotransferase (AST) and lactate dehydrogenase (LDH) were shown to be -highly increased in COVID-19 patients. Monitoring their levels in Emergency Room patients during the months preceding February 20th, 2020, might shade light on the prevalence of the disease in the pre-COVID-19 period. METHODS: We retrospectively analyzed the AST and LDH levels from more than 30.000 patients admitted to the San Raffaele Hospital Emergency Room (ER) between September 2019 and May 2020 as well as between September 2018 and May 2019. The number of patients diagnosed with respiratory tract diseases were also analyzed. RESULTS: Data showed that the ER averaged AST and LDH levels are highly sensitive to the presence of COVID-19 patients. During, the months preceding February 20th, 2020, AST and LDH levels, as well as the number of patients diagnosed with respiratory tract diseases were similar to their 2019 counterparts. CONCLUSIONS: No significant evidence showing that a large number of COVID-19 patients were admitted to the San Raffaele Hospital ER before February 20th, 2020, was found. Thus, the virus was likely circulating, within the Hospital catchment area, either in low amounts or through asymptomatic individuals. Because of the high LDH and AST levels' variations induced by COVID-19, routine blood tests might be exploited as a surveillance indicator for a possible second wave.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico , Testes Hematológicos/métodos , Programas de Rastreamento/métodos , Monitorização Fisiológica/métodos , Pandemias , Pneumonia Viral/diagnóstico , Aspartato Aminotransferases/sangue , Biomarcadores/sangue , Infecções por Coronavirus/sangue , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Itália/epidemiologia , L-Lactato Desidrogenase/sangue , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/sangue , Pneumonia Viral/epidemiologia , Prevalência , Estudos Retrospectivos
7.
Ann Surg ; 272(4): 604-610, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32932316

RESUMO

OBJECTIVES: Sepsis and sterile both release "danger signals' that induce the systemic inflammatory response syndrome (SIRS). So differentiating infection from SIRS can be challenging. Precision diagnostic assays could limit unnecessary antibiotic use, improving outcomes. METHODS: After surveying human leukocyte cytokine production responses to sterile damage-associated molecular patterns (DAMPs), bacterial pathogen-associated molecular patterns, and bacteria we created a multiplex assay for 31 cytokines. We then studied plasma from patients with bacteremia, septic shock, "severe sepsis," or trauma (ISS ≥15 with circulating DAMPs) as well as controls. Infections were adjudicated based on post-hospitalization review. Plasma was studied in infection and injury using univariate and multivariate means to determine how such multiplex assays could best distinguish infective from noninfective SIRS. RESULTS: Infected patients had high plasma interleukin (IL)-6, IL-1α, and triggering receptor expressed on myeloid cells-1 (TREM-1) compared to controls [false discovery rates (FDR) <0.01, <0.01, <0.0001]. Conversely, injury suppressed many mediators including MDC (FDR <0.0001), TREM-1 (FDR <0.001), IP-10 (FDR <0.01), MCP-3 (FDR <0.05), FLT3L (FDR <0.05), Tweak, (FDR <0.05), GRO-α (FDR <0.05), and ENA-78 (FDR <0.05). In univariate studies, analyte overlap between clinical groups prevented clinical relevance. Multivariate models discriminated injury and infection much better, with the 2-group random-forest model classifying 11/11 injury and 28/29 infection patients correctly in out-of-bag validation. CONCLUSIONS: Circulating cytokines in traumatic SIRS differ markedly from those in health or sepsis. Variability limits the accuracy of single-mediator assays but machine learning based on multiplexed plasma assays revealed distinct patterns in sepsis- and injury-related SIRS. Defining biomarker release patterns that distinguish specific SIRS populations might allow decreased antibiotic use in those clinical situations. Large prospective studies are needed to validate and operationalize this approach.


Assuntos
Citocinas/sangue , Sepse/sangue , Sepse/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/sangue , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Relatórios Anuais como Assunto , Diagnóstico Diferencial , Cirurgia Geral , Testes Hematológicos/métodos , Humanos , Estudos Prospectivos , Sepse/imunologia , Sociedades Médicas , Síndrome de Resposta Inflamatória Sistêmica/imunologia , Estados Unidos
9.
Medicine (Baltimore) ; 99(34): e21718, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846790

RESUMO

BACKGROUND: Programmed death receptor-1 (PD-1)/programmed death ligand 1 (PD-L1) inhibitors have been demonstrated to improve the prognosis of patients with advanced non-small cell lung cancer (NSCLC) compared with chemotherapy. However, there were still some non-responders. Thus, how to effectively screen the responder may be an important issue. Recent studies revealed the immune-related indicator, neutrophil-lymphocyte ratio (NLR), may predict the therapeutic effects of anti-PD1/PD-L1 antibodies; however, the results were controversial. This study was to re-evaluate the prognostic potential of NLR for NSCLC patients receiving PD1/PD-L1 inhibitors by performing a meta-analysis. METHODS: Eligible studies were identified by searching online databases of PubMed, EMBASE and Cochrane Library. The predictive values of NLR for overall survival, (OS), progression free survival (PFS) and overall response rate (ORR) were estimated by hazard ratio (HR) with 95% confidence interval (CI). RESULTS: Twenty-four studies involving 2196 patients were included. The pooled analysis demonstrated that elevated NLR before PD-1/PD-L1 inhibitor treatment was a predictor of poor OS (HR = 2.17; 95% CI: 1.64 - 2.87, P < .001), PFS (HR = 1.54; 95% CI: 1.34 - 1.78, P < .001) and low ORR (HR = 0.64; 95% CI: 0.44 - 0.95, P = .027) in NSCLC patients. Subgroup analysis revealed the predictive ability of NLR for OS and PFS was not changed by ethnicity, sample size, cut-off, HR source, study design or inhibitor type (except the combined anti-PD-L1 group); while its association with ORR was only significant when the cut-off value was less than 5 and the studies were prospectively designed. CONCLUSION: Our findings suggest patients with lower NLR may benefit from the use of PD-1/PD-L1 inhibitors to prolong their survival period.


Assuntos
Antígeno B7-H1/antagonistas & inibidores , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Testes Hematológicos/métodos , Neoplasias Pulmonares/tratamento farmacológico , Receptor de Morte Celular Programada 1/antagonistas & inibidores , Carcinoma Pulmonar de Células não Pequenas/patologia , Humanos , Neoplasias Pulmonares/patologia , Linfócitos , Neutrófilos
10.
Ann Biol Clin (Paris) ; 78(5): 574-580, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32716002

RESUMO

Laboratories need to set up effective overall management of their internal quality control (IQC) and external quality assessment (EQA) results as key elements in statistical process control. Quality targets need to be defined, with methods to ensure durable control with respect to the relevant specifications. The hemostasis laboratory of the Lyon Hospitals Board (HCL, Lyon, France) uses model 3 from the Milan consensus conference, which is the state of the art in terms of quality targets, and uses a common EQA provider supplying as many real patient samples as possible. Giving priority to adopted methods, the lab optimizes the use of manufacturers' prior data: maximum acceptable inter assay coefficient of variation (CV) and prior IQC target values. Bayesian inference brings the method under control with respect to the manufacturers' prior data without the need for a preliminary phase. It links the IQC and EQA plans by the maximum acceptable CVs defined by the manufacturer.


Assuntos
Testes Hematológicos/estatística & dados numéricos , Testes Hematológicos/normas , Laboratórios Hospitalares/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde , Teorema de Bayes , Testes de Coagulação Sanguínea/instrumentação , Testes de Coagulação Sanguínea/métodos , Testes de Coagulação Sanguínea/normas , Testes de Coagulação Sanguínea/estatística & dados numéricos , Serviços de Laboratório Clínico/organização & administração , Serviços de Laboratório Clínico/normas , Serviços de Laboratório Clínico/estatística & dados numéricos , França/epidemiologia , Testes Hematológicos/instrumentação , Testes Hematológicos/métodos , Hemostasia/fisiologia , Humanos , Laboratórios Hospitalares/organização & administração , Laboratórios Hospitalares/normas , Ensaio de Proficiência Laboratorial/organização & administração , Ensaio de Proficiência Laboratorial/normas , Ensaio de Proficiência Laboratorial/estatística & dados numéricos , Prática Profissional/organização & administração , Prática Profissional/normas , Prática Profissional/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde/métodos , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Garantia da Qualidade dos Cuidados de Saúde/normas , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Controle de Qualidade , Estudos Retrospectivos
11.
J Vis Exp ; (160)2020 06 29.
Artigo em Inglês | MEDLINE | ID: mdl-32658205

RESUMO

A multiplexed droplet PCR (mdPCR) workflow and detailed protocol for determining epigenetic-based white blood cell (WBC) differential count is described, along with a thermoplastic elastomer (TPE) microfluidic droplet generation device. Epigenetic markers are used for WBC subtyping which is of important prognostic value in different diseases. This is achieved through the quantification of DNA methylation patterns of specific CG-rich regions in the genome (CpG loci). In this paper, bisulfite-treated DNA from peripheral blood mononuclear cells (PBMCs) is encapsulated in droplets with mdPCR reagents including primers and hydrolysis fluorescent probes specific for CpG loci that correlate with WBC sub-populations. The multiplex approach allows for the interrogation of many CpG loci without the need for separate mdPCR reactions, enabling more accurate parametric determination of WBC sub-populations using epigenetic analysis of methylation sites. This precise quantification can be extended to different applications and highlights the benefits for clinical diagnosis and subsequent prognosis.


Assuntos
Metilação de DNA/fisiologia , Testes Hematológicos/métodos , Reação em Cadeia da Polimerase Multiplex/métodos , Polímeros/química , Humanos , Leucócitos Mononucleares/química
12.
Ann Biol Clin (Paris) ; 78(4): 383-397, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32666924

RESUMO

The SFBC-CNBH-CNRHP "Neonatal bilirubin" working group performed a biological and clinical study on bilirubin use in neonates for reliable diagnosis and appropriate management of neonatal jaundice. A brief report of a national survey on analytical and biological practices in France is shown. The guidelines of the French Society of Neonatology (SFN) founded the decision of phototherapy set up upon an accurate lab measurement of total serum bilirubin. An abacus is proposed with defined thresholds, as a function of neonate lifetime in hours. However, several studies evidenced poor comparability of results obtained with the different available methods. This situation is partly due to the lack of reference materials, especially for high bilirubin concentrations. Clinical consequences might be observed. We present in this paper the results of a national harmonization study to progress on this issue. Beyond the analytical aspects, the clinical consequences of harmonization defects were investigated. Finally, guidelines for clinical laboratories are proposed, to be locally adapted.


Assuntos
Testes Hematológicos/normas , Hiperbilirrubinemia Neonatal/diagnóstico , Icterícia Neonatal/diagnóstico , Triagem Neonatal/normas , Guias de Prática Clínica como Assunto , Bilirrubina/sangue , França , Testes Hematológicos/métodos , Humanos , Hiperbilirrubinemia Neonatal/sangue , Hiperbilirrubinemia Neonatal/terapia , Recém-Nascido , Icterícia Neonatal/sangue , Icterícia Neonatal/terapia , Laboratórios/normas , Ensaio de Proficiência Laboratorial/normas , Triagem Neonatal/métodos , Fototerapia/métodos , Fototerapia/normas , Padrões de Referência
13.
J Med Syst ; 44(8): 135, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32607737

RESUMO

The COVID-19 pandemia due to the SARS-CoV-2 coronavirus, in its first 4 months since its outbreak, has to date reached more than 200 countries worldwide with more than 2 million confirmed cases (probably a much higher number of infected), and almost 200,000 deaths. Amplification of viral RNA by (real time) reverse transcription polymerase chain reaction (rRT-PCR) is the current gold standard test for confirmation of infection, although it presents known shortcomings: long turnaround times (3-4 hours to generate results), potential shortage of reagents, false-negative rates as large as 15-20%, the need for certified laboratories, expensive equipment and trained personnel. Thus there is a need for alternative, faster, less expensive and more accessible tests. We developed two machine learning classification models using hematochemical values from routine blood exams (namely: white blood cells counts, and the platelets, CRP, AST, ALT, GGT, ALP, LDH plasma levels) drawn from 279 patients who, after being admitted to the San Raffaele Hospital (Milan, Italy) emergency-room with COVID-19 symptoms, were screened with the rRT-PCR test performed on respiratory tract specimens. Of these patients, 177 resulted positive, whereas 102 received a negative response. We have developed two machine learning models, to discriminate between patients who are either positive or negative to the SARS-CoV-2: their accuracy ranges between 82% and 86%, and sensitivity between 92% e 95%, so comparably well with respect to the gold standard. We also developed an interpretable Decision Tree model as a simple decision aid for clinician interpreting blood tests (even off-line) for COVID-19 suspect cases. This study demonstrated the feasibility and clinical soundness of using blood tests analysis and machine learning as an alternative to rRT-PCR for identifying COVID-19 positive patients. This is especially useful in those countries, like developing ones, suffering from shortages of rRT-PCR reagents and specialized laboratories. We made available a Web-based tool for clinical reference and evaluation (This tool is available at https://covid19-blood-ml.herokuapp.com/ ).


Assuntos
Infecções por Coronavirus/diagnóstico , Testes Hematológicos/métodos , Aprendizado de Máquina , Pneumonia Viral/diagnóstico , Betacoronavirus , Humanos , Pandemias , Reação em Cadeia da Polimerase em Tempo Real
14.
Ann Biol Clin (Paris) ; 78(4): 399-409, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32540797

RESUMO

The discovery of eosinophilia above 1.5 G/L should not be considered innocuous, requiring monitoring for etiology and possible secondary organ damage. Among these, cardiac localization is the most worrying, sometimes indolent, to be systematically sought by ultrasound and magnetic resonance. The potential etiologies are very numerous, mostly reactive and corticosensitive, much more rarely clonal in relation to a malignant hemopathy usually chronic and myeloid, sometimes sensitive to tyrosine kinase inhibitors.


Assuntos
Técnicas de Laboratório Clínico/métodos , Eosinofilia/diagnóstico , Eosinofilia/etiologia , Testes Hematológicos/métodos , Técnicas de Laboratório Clínico/história , Técnicas de Laboratório Clínico/normas , Diagnóstico Diferencial , Eosinofilia/história , Testes Hematológicos/história , Testes Hematológicos/normas , História do Século XXI , Humanos
15.
Allergol. immunopatol ; 48(3): 259-264, mayo-jun. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-192028

RESUMO

The clinical history is of importance in the investigation of allergic diseases but does have limitations. Many allergic conditions will be over-diagnosed if anamnesis alone is used for diagnostic criteria. Serum total immunoglobulin E (TIgE) quantification, as well as panels containing allergens prevalent in the studied population, may serve as screening tests and facilitate the diagnosis of allergic disease or its exclusion. We assessed the positivity of two versions of these tests, Phadiatop Europe® (PhEU) and Phadiatop Infant® (PhInf), as well as total IgE (TigE) values in patients with a medical diagnosis of allergic disease and non-allergic individuals. METHODS: A cross-sectional study performed in eleven Brazilian pediatric allergy centers with patients divided into groups according to the primary condition and a group of assessed control subjects. They were submitted to TIgE measurement and screening tests (PhEu and PhInf). RESULTS: TIgE mean serum levels were significantly higher among allergic patients, especially those with asthma/rhinitis or atopic dermatitis. The positivity of the screening tests, considering the total population, was 63.8% for PhEU and 72.6% for PhInf. These increased when we evaluated only the allergic subjects. The concordance index of the two tests was Kappa = 0.7 and higher among those of greater age. CONCLUSIONS: In the assessed population, there were significantly higher levels among those with positive screening tests and PhInf showed better performance in the identification of sensitized individuals, regardless of age. This is the first study to evaluate Phadiatop and Phadiatop Infant in the same population


No disponible


Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Adolescente , Testes Hematológicos/métodos , Hipersensibilidade/diagnóstico , Imunoglobulina E/sangue , Técnicas Imunológicas/métodos , Hipersensibilidade/imunologia , Brasil , Estudos Transversais , Alérgenos/imunologia , Dermatite Atópica/imunologia , Asma/imunologia , Rinite Alérgica/imunologia , Sensibilidade e Especificidade
16.
Sci Rep ; 10(1): 8606, 2020 05 25.
Artigo em Inglês | MEDLINE | ID: mdl-32451400

RESUMO

We describe the development and clinical evaluation of an automated smartphone-linked sensor capable of chemical-free, quantitative measurement of hemoglobin concentration ([Hb]) in whole blood samples. We have demonstrated that our sensor could analyze an unprocessed blood specimen with a mean processing time of <8 s and provided the [Hb] results with ~99% accuracy against a reference hematology analyzer with coefficient of variation (CV) of 1.21% measured at [Hb] = 11.2 g/dL. Its diagnostic capability for anemia was evaluated by measuring [Hb] of 142 clinical blood specimens and comparing the results with those from an automated hematology analyzer (ADVIA 2120i, Siemens AG, Germany) and a portable hemoglobinomteter (Hb201+, Hemocue, Sweden). The sensor yielded comparable sensitivities and specificities of 87.50% and 100.00% for males, and 94.44% and 100.00% for females, respectively, for anemic detection. The results suggested that our optical sensor based on the intrinsic photothermal response of Hb molecules and advances in consumer electronics, particularly smartphone capabilities, enables a direct, chemical-free [Hb] assay accessible to people in both developed and developing countries.


Assuntos
Testes Hematológicos/métodos , Hemoglobinas/análise , Anemia/diagnóstico , Feminino , Testes Hematológicos/instrumentação , Humanos , Limite de Detecção , Masculino , Aplicativos Móveis , Reprodutibilidade dos Testes , Smartphone
17.
Clin Chem Lab Med ; 58(7): 1095-1099, 2020 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-32301746

RESUMO

Objectives The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to date, the epidemic has gradually spread to 209 countries worldwide with more than 1.5 million infected people and 100,000 deaths. Amplification of viral RNA by rRT-PCR serves as the gold standard for confirmation of infection, yet it needs a long turnaround time (3-4 h to generate results) and shows false-negative rates as large as 15%-20%. In addition, the need of certified laboratories, expensive equipment and trained personnel led many countries to limit the rRT-PCR tests only to individuals with pronounced respiratory syndrome symptoms. Thus, there is a need for alternative, less expensive and more accessible tests. Methods We analyzed the plasma levels of white blood cells (WBCs), platelets, C-reactive protein (CRP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), γ-glutamyl transpeptidase (GGT), alkaline phosphatase and lactate dehydrogenase (LDH) of 207 patients who, after being admitted to the emergency room of the San Raffaele Hospital (Milan, Italy) with COVID-19 symptoms, were rRT-PCR tested. Of them, 105 tested positive, whereas 102 tested negative. Results Statistically significant differences were observed for WBC, CRP, AST, ALT and LDH. Empirical thresholds for AST and LDH allowed the identification of 70% of either COVID-19-positive or -negative patients on the basis of routine blood test results. Conclusions Combining appropriate cutoffs for certain hematological parameters could help in identifying false-positive/negative rRT-PCR tests. Blood test analysis might be used as an alternative to rRT-PCR for identifying COVID-19-positive patients in those countries which suffer from a large shortage of rRT-PCR reagents and/or specialized laboratory.


Assuntos
Biomarcadores/sangue , Infecções por Coronavirus/diagnóstico , Testes Hematológicos/métodos , Pneumonia Viral/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Alanina Transaminase/análise , Alanina Transaminase/sangue , Fosfatase Alcalina/análise , Fosfatase Alcalina/sangue , Aspartato Aminotransferases/análise , Aspartato Aminotransferases/sangue , Betacoronavirus/patogenicidade , Plaquetas , Proteína C-Reativa/análise , Infecções por Coronavirus/sangue , Feminino , Humanos , Itália , L-Lactato Desidrogenase/análise , L-Lactato Desidrogenase/sangue , Laboratórios , Leucócitos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/sangue , RNA Viral , Reação em Cadeia da Polimerase em Tempo Real/métodos , Estudos Retrospectivos , gama-Glutamiltransferase/análise , gama-Glutamiltransferase/sangue
18.
Blood Cancer J ; 10(4): 41, 2020 04 14.
Artigo em Inglês | MEDLINE | ID: mdl-32286270

RESUMO

Newly diagnosed AL amyloidosis patients were evaluated to develop a model for early assessment of treatment benefit at 6 months, integrating both hematologic (HR) and organ response (OR) assessment (testing cohort, Mayo: n = 473; validation cohort, Pavia: n = 575). Multiple OR were assessed as follows: All OR (AOR): response in all organs, mixed OR (MOR): response in some organs, no OR (NOR)]. AOR rates at 6 months improved with deepening HR; complete response (CR; 38%, 35%), very good partial response (VGPR; 30%, 26%), and partial response (PR; 16%, 21%), respectively. A composite HR/OR (CHOR) model was developed using incremental scoring based on hazard ratios with scores of 0-3 for HR (0-CR, 1-VGPR, 2-PR, 3-no response) and 0-2 for OR (0-AOR, 1-MOR, 2-NOR). Patients could be divided into two distinct CHOR groups (scores 0-3 and 4-5), with median OS in group 1 and group 2: Not reached vs. 34 months, p < 0.001 [Mayo] and 87 vs. 23 months, p < 0.001 [Pavia]. In conclusion, we developed a model that can assess multiple organs concurrently, and integrate both HR and OR assessments to determine early clinical benefit with treatment, which may be used as a surrogate end-point in trials and to compare outcomes with different therapies.


Assuntos
Antineoplásicos/uso terapêutico , Testes Hematológicos/métodos , Transplante de Células-Tronco Hematopoéticas/mortalidade , Amiloidose de Cadeia Leve de Imunoglobulina/mortalidade , Escores de Disfunção Orgânica , Idoso , Estudos de Coortes , Terapia Combinada , Feminino , Humanos , Amiloidose de Cadeia Leve de Imunoglobulina/patologia , Amiloidose de Cadeia Leve de Imunoglobulina/terapia , Masculino , Pessoa de Meia-Idade , Indução de Remissão , Taxa de Sobrevida , Resultado do Tratamento
19.
J Pediatr ; 220: 139-145, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32113658

RESUMO

OBJECTIVE: To assess the association between serially measured N-terminal pro-B-type natriuretic peptide (NT-proBNP) serum levels and disease severity in children with pulmonary arterial hypertension (PAH), and to assess its predictive value for death or (heart-)lung transplantation. STUDY DESIGN: This was a longitudinal cohort study of the Dutch National Network for Pediatric Pulmonary Hypertension conducted between 2003 and 2017. Data on NT-proBNP and disease severity markers (World Health Organization Functional Class [WHO-FC], 6-minute walking distance [6MWD], and tricuspid annular plane systolic excursion [TAPSE]) were collected every 3 to 6 months from 82 children with PAH. The outcome measure was death or (heart-)lung transplantation. Also, NT-proBNP levels over time were compared between survivors and nonsurvivors. RESULTS: The median patient age was 8.8 years (IQR, 4.6-13.5 years), and 61% were female. The median duration of follow-up was 4.8 years (IQR, 1.9-10.0 years). At all times during the course of disease, higher NT-proBNP levels were associated with higher WHO-FC (ß = 0.526; 95% CI, 0.451-0.600), lower 6MWD z-score (ß = -0.587; 95% CI, -0.828 to -0.346), lower TAPSE z-score (ß = -0.783; 95% CI, -1.016 to -0.549), and elevated risk of death or (heart-)lung transplantation (hazard ratio 16.61; 95% CI, 7.81-35.33). Compared with survivors, nonsurvivors had NT-proBNP levels that were higher at first measurement and increased exponentially over time (P = .005). Changes in NT-proBNP serum level over time were predictive of outcome. CONCLUSIONS: Throughout the disease course of pediatric PAH, serial measurements of NT-proBNP are associated with disease severity and transplant-free survival. Monitoring NT-proBNP levels over time provides important prognostic information that can support clinical decision making in combination with other established prognostic markers.


Assuntos
Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Hipertensão Arterial Pulmonar/sangue , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Testes Hematológicos/métodos , Humanos , Estudos Longitudinais , Masculino , Monitorização Fisiológica , Valor Preditivo dos Testes , Índice de Gravidade de Doença
20.
Sci Rep ; 10(1): 5101, 2020 03 20.
Artigo em Inglês | MEDLINE | ID: mdl-32198369

RESUMO

Blood damage (hemolysis) can occur during clinical procedures, e.g. dialysis, due to human error or faulty equipment, and it can cause significant harm to the patient or even death. We propose a simple technique to monitor changes in hemolysis levels continuously and in real time. As red blood cells rupture, the overall conductivity of the blood increases. Here, we demonstrate that small changes in porcine blood hemolysis can be detected through a simple resistance measurement.


Assuntos
Testes Hematológicos/métodos , Hemoglobinas/análise , Hemólise/fisiologia , Monitorização Fisiológica/métodos , Animais , Eritrócitos/citologia , Eritrócitos/patologia , Humanos , Modelos Animais , Suínos
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