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1.
Acta Neurochir Suppl ; 127: 141-144, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31407074

RESUMO

BACKGROUND: Detection of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) in patients with a poor clinical exam is challenging. Brain tissue oxygen tension monitoring (PbtO2) and cerebral microdialysis (CMD) can detect ischemia and metabolic derangements. Our aim was to evaluate efficacy of these modalities in real-time detection of DCI. METHODS: All patients with aSAH who underwent with multimodality monitoring (MMM) with PbtO2 and/or CMD between the years of 2013 and 2015 at our institution were retrospectively studied. Mean PbTO2, lactate to pyruvate ratio (LPR), and glucose over the 24-h period prior to each angiogram for evaluation and treatment of vasospasm were correlated to the extent of vasospasm observed in the hemisphere with the monitors. The average measurements were also compared in the setting of presence and absence of angiographically significant vasospasm. RESULTS: A total of ten patients with aSAH who underwent MMM were identified. PbtO2 decline correlates with severity of proximal vasospasm (r = -0.66). PbtO2 was significantly lower in the setting of vasospasm (17.6 vs. 25.8, p = 0.003), but LPR (34.5 vs. 26.8, p = 0.1) and glucose (0.8 vs. 1.1, p = 0.6) were not significantly different. CONCLUSION: Proximal vasospasm after aSAH is associated with MMM indicator of tissue ischemia and/or metabolic derangement. PbtO2 and CMD help in real-time detection and management of DCI.


Assuntos
Isquemia Encefálica , Testes Imediatos , Hemorragia Subaracnóidea , Vasoespasmo Intracraniano , Humanos , Estudos Retrospectivos , Hemorragia Subaracnóidea/complicações , Vasoespasmo Intracraniano/diagnóstico , Vasoespasmo Intracraniano/etiologia
2.
Am Surg ; 85(9): 1051-1055, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638523

RESUMO

This retrospective chart review demonstrates the relationship between bedside incentive spirometry (ICS) volumes and risk of pulmonary complications. Two hundred patients admitted for rib fractures between April and October 2016 were reviewed. The inclusion criteria were age 18-98 years, diagnosis of rib or sternal fractures, and no procedures requiring postoperative intubation within 48 hours of admission. The exclusion criteria were intubation before arrival, unable to participate in ICS, or previous tracheostomy. ICS volumes recorded in daily progress notes were collected. Of 200 charts reviewed, 154 met the inclusion criteria. In all, 25 endured at least one pulmonary complication. The average ICS on admission was 1355 cc. Patients who did not experience a complication had significantly higher admission ICS volumes than those who did (1441 ± 660 cc vs 920 ± 451 cc, P = 0.0003). They also achieved higher volumes at discharge (1705 ± 662 cc vs 1211 ± 453 cc, P = 0.006). The groups had similar demographics. An admission ICS volume <1 L was associated with 3.3× relative risk of pulmonary complication. Lower volumes were also associated with discharge to nonhome locations. Bedside ICS is a useful tool to identify patients at risk of pulmonary complications from rib fractures. Patients with admission ICS volume <1 L carry a higher risk of complication.


Assuntos
Pneumopatias/diagnóstico , Pneumopatias/etiologia , Testes Imediatos , Fraturas das Costelas/complicações , Espirometria , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco
3.
Medicine (Baltimore) ; 98(41): e17493, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593114

RESUMO

The aim of this study was to assess the bedside brain function monitoring of color density spectral array (CDSA) for early prognostic evaluation of coma patients in pediatric intensive care unit (PICU).Forty-two consecutive pediatric coma patients were enrolled. The individual conscious state was evaluated according to the Glasgow coma scale (GCS). CDSA parameters including CDSA pattern (CDSAP), sleep-wake cycle (SWC), sleep stage (SS), and drug-induced fast wave activity (DIFWA) were recorded. Three months later, prognosis was evaluated according to pediatric cerebral performance category (PCPC) score, based on which the patients were divided into FP-group (favorable prognosis) and PP-group (poor prognosis).The changeable type of CDSAP, appearance of SWC, SS, and DIFWA were significantly correlated with favorable prognosis. Both GCS and SWC were significantly correlated with the prognosis. However, there was substantial overlap in GCS between FP-group and PP-group. Although the absence of SWC was statistically an independent risk factor for poor prognosis but with a high false positive rate (0.143), a linear logistic regression showed the odds ratio of GCS for predicting prognosis was 0.93 (95% confidence interval: 0.48-1.80; P = .83) and that of SWC was 0.12 (95% confidence interval: 0.03-0.47; P = .03). Furthermore, the absence of SWC was correlated with poor prognosis in nonintracranial infection patients.Our study found that several CDSA factors are associated with prognosis of coma patients in PICU. SWC may be a potential indicator for evaluating the prognosis of coma patients in PICU.


Assuntos
Coma/diagnóstico , Monitores de Consciência/estatística & dados numéricos , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Testes Imediatos , Adolescente , Criança , Pré-Escolar , Colorimetria/métodos , Colorimetria/estatística & dados numéricos , Feminino , Escala de Coma de Glasgow , Humanos , Lactente , Modelos Logísticos , Masculino , Valor Preditivo dos Testes , Prognóstico
4.
Klin Lab Diagn ; 64(8): 459-462, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31479599

RESUMO

The use of point-of-care diagnostics can prevent a number of complications and leading to improved health outcomes for patients in critical condition. Research have shown that elongation of the preanalytic stage leading of errors of studies and changes the results of a number of laboratory parameters. The article presents the key problems associated with the elongation of the preanalytic stage and possible solutions to address the shortcomings of existing diagnostics.


Assuntos
Técnicas de Laboratório Clínico , Medicina de Desastres , Testes Imediatos , Fase Pré-Analítica , Cuidados Críticos , Humanos , Laboratórios
5.
BMC Infect Dis ; 19(1): 769, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481123

RESUMO

BACKGROUND: Health-workers in developing countries rely on clinical algorithms, such as the Integrated Management of Childhood Illnesses (IMCI), for the management of patients, including diagnosis of serious bacterial infections (SBI). The diagnostic accuracy of IMCI in detecting children with SBI is unknown. Prediction rules and guidelines for SBI from well-resourced countries at outpatient level may help to improve current guidelines; however, their diagnostic performance has not been evaluated in resource-limited countries, where clinical conditions, access to care, and diagnostic capacity differ. The aim of this study was to estimate the diagnostic accuracy of existing prediction rules and clinical guidelines in identifying children with SBI in a cohort of febrile children attending outpatient health facilities in Tanzania. METHODS: Structured literature review to identify available prediction rules and guidelines aimed at detecting SBI and retrospective, external validation on a dataset containing 1005 febrile Tanzanian children with acute infections. The reference standard, SBI, was established based on rigorous clinical and microbiological criteria. RESULTS: Four prediction rules and five guidelines, including IMCI, could be validated. All examined rules and guidelines had insufficient diagnostic accuracy for ruling-in or ruling-out SBI with positive and negative likelihood ratios ranging from 1.04-1.87 to 0.47-0.92, respectively. IMCI had a sensitivity of 36.7% (95% CI 29.4-44.6%) at a specificity of 70.3% (67.1-73.4%). Rules that use a combination of clinical and laboratory testing had better performance compared to rules and guidelines using only clinical and or laboratory elements. CONCLUSIONS: Currently applied guidelines for managing children with febrile illness have insufficient diagnostic accuracy in detecting children with SBI. Revised clinical algorithms including simple point-of-care tests with improved accuracy for detecting SBI targeting in tropical resource-poor settings are needed. They should undergo careful external validation against clinical outcome before implementation, given the inherent limitations of gold standards for SBI.


Assuntos
Infecções Bacterianas/diagnóstico , Febre/diagnóstico , Técnicas Microbiológicas/normas , Testes Imediatos/normas , Guias de Prática Clínica como Assunto , Idade de Início , Algoritmos , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/microbiologia , Criança , Pré-Escolar , Feminino , Febre/microbiologia , Humanos , Lactente , Masculino , Técnicas Microbiológicas/métodos , Técnicas Microbiológicas/estatística & dados numéricos , Testes Imediatos/estatística & dados numéricos , Guias de Prática Clínica como Assunto/normas , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Tanzânia/epidemiologia
6.
Chem Commun (Camb) ; 55(76): 11458-11461, 2019 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-31535684

RESUMO

We report a polymer-based sensor that rapidly detects cancer based on changes in serum protein levels. Using three ratiometric fluorescence outputs, this simple system identifies early stage and metastatic lung cancer with a high level of accuracy exceeding many biomarker-based assays, making it an attractive strategy for point-of-care testing.


Assuntos
Biomarcadores Tumorais/sangue , Proteínas Sanguíneas/análise , Corantes Fluorescentes/química , Neoplasias Pulmonares/diagnóstico por imagem , Polímeros/química , Animais , Fluorescência , Humanos , Neoplasias Pulmonares/sangue , Neoplasias Pulmonares/secundário , Camundongos , Camundongos Transgênicos , Estrutura Molecular , Neoplasias Experimentais/sangue , Neoplasias Experimentais/diagnóstico por imagem , Neoplasias Experimentais/secundário , Testes Imediatos
7.
J Med Microbiol ; 68(9): 1341-1352, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31355743

RESUMO

Introduction. Timely detection of invasive aspergillosis (IA) caused by fungal pathogens, i.e. Aspergillus fumigatus and Aspergillus flavus, in immunocompromised patients is crucial in preventing high mortality.Aim. To develop a simple immunoassay for the detection of galactomannan (GM), an IA biomarker.Methodology. GM from A. fumigatus and A. flavus clinical strains was purified and characterized by X-ray diffraction, IR spectroscopy and 13C/1H nuclear magnetic resonance (NMR) for polyclonal antibody (pAb) production in rabbits. An enzyme-linked immunosorbent assay (ELISA) was standardized using concanavalin A to capture Aspergillus GM and pAbs to detect it. Gold nanoparticles (AuNPs) were synthesized and conjugated to pAbs for the development of a dot-blot immunoassay. The developed dot-blot was evaluated with 109 clinical serum and bronchoalveolar lavage samples.Results. Spectroscopy studies characterized the d-galactofuranosyl groups of GM responsible for the immune response and generation of pAbs. The ELISA employing pAbs showed a sensitivity of 1 ng ml-1 for Aspergillus GM. Furthermore, a sensitive, visual, rapid dot-blot assay developed by the conjugation of pAbs to AuNPs (~24±5 nm size, -36±2 mV zeta potential) had a detection limit of 1 pg ml-1 in serum. The pAbs interacted with Aspergillus spp. but did not cross-react with other fungal pathogen genera such as Penicillium and Candida. Evaluation of the dot-blot with 109 clinical samples showed high sensitivity (80 %) and specificity (93.2 %), with an overall assay accuracy of 89%.Conclusion. The developed nano-gold immunodiagnostic assay has immense potential for practical use in rapid, specific and sensitive on-site diagnosis of IA, even under resource-limited settings.


Assuntos
Aspergilose/diagnóstico , Ouro/química , Testes Imunológicos/métodos , Nanopartículas Metálicas/química , Animais , Anticorpos Antibacterianos/química , Anticorpos Antibacterianos/imunologia , Antígenos de Fungos/sangue , Antígenos de Fungos/imunologia , Aspergillus/imunologia , Aspergillus/isolamento & purificação , Aspergillus flavus/imunologia , Aspergillus flavus/isolamento & purificação , Aspergillus fumigatus/imunologia , Aspergillus fumigatus/isolamento & purificação , Humanos , Immunoblotting , Mananas/análise , Mananas/imunologia , Testes Imediatos , Coelhos , Sensibilidade e Especificidade
9.
BMC Health Serv Res ; 19(1): 519, 2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31340833

RESUMO

BACKGROUND: World Health Organization (WHO) has created an essential list of in-vitro diagnostics. Supply chain management (SCM) is said to be the vehicle that ensures that developed point-of-care (POC) tests reach their targeted settings for use. We therefore, mapped evidence on SCM of and accessibility to POC testing (availability and use of POC tests) in low- and middle-income countries (LMICs). METHODS: We conducted a systematic scoping review using Arksey and O'Malley's framework as a guide. We searched PubMed; CINAHL; MEDLINE; WEB of Science; Science Direct; and Google Scholar databases for studies that focused on POC diagnostic tests and SCM. The review included studies that were undertaken in 140 countries defined by the World Bank as LMICs published up to August 2017. Two reviewers independently screened the abstracts and full articles against the eligibility criteria. The study used the mixed methods appraisal tool version 2011 to assess the risk of bias for the included studies. NVivo version 11 was employed to extract themes from all included studies and results presented using a narrative approach. RESULTS: Of 292 studies identified in this review, only 15 published between 2009 and 2017 included evidence on POC diagnostics and SCM. Of the 15 studies, three were conducted in Zambia, one each in Mozambique, Uganda, Guatemala; South Africa, one in Burkina Faso, Zimbabwe, and one multi-country study (Tanzania, Uganda, China, Peru and Zambia and Brazil). Six studies were not country specific since they were not primary studies. Majority of the studies reported stock-outs of HIV, syphilis, and malaria POC tests. There was a moderate to substantial level of agreement between the reviewers' responses at full article screening stage (Kappa statistic = 0.80, p < 0.01). Nine studies underwent methodological quality appraisal and all, scored between 90 and 100%. CONCLUSIONS: The results demonstrated limited published research on SCM of and accessibility to POC testing in LMICs. Further studies aimed at investigating SCM of POC tests in resource-limited settings to identify the barriers/challenges and provide a context-specific evidence-based solutions for policy/decision makers, implementers, and POC developers, funders, and development partners would be essential. PROSPERO REGISTRATION NUMBER: CRD42016043711.


Assuntos
Testes Imediatos , Alocação de Recursos/organização & administração , Acesso aos Serviços de Saúde , Humanos , Análise de Sistemas
10.
Int J Nanomedicine ; 14: 4293-4307, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31354261

RESUMO

Purpose: Antibodies are key reagents in the development of immunoassay. We attempted to develop high-performance CPP immunoassays using high-affinity monoclonal antibodies prepared via cytokine-assisted immunization. Methods: We used fetal liver tyrosine kinase 3 ligand (Flt3L), CC subtype chemokine ligand 20 (CCL20), and granulocyte-macrophage colony-stimulating factor (GM-CSF) to assist traditional subcutaneous immunization of preparing high-affinity monoclonal antibodies, and further to develop high-performance immunoassay methods for CPP. Results: This novel immune strategy significantly enhanced immune response against CPP. Six anti-CPP monoclonal antibodies (mAbs) with high affinity were successfully screened and selected for application in a fully automated magnetic chemiluminescence immunoassay (CLIA). This robust and rapid assay can efficiently detect CPP in the range of 1.2-1250 pmol L-1 with a detection limit of 6.25 pmol L-1. Significantly, the whole incubation process can be completed in 30 min as compared to about 4.5 hr for the control ELISA kit. Furthermore, this assay exhibited high sensitivity and specificity, low intra-assay and inter-assay coefficients of variation (CVs < 15%). The developed assay was applied in the detection of CPP in 115 random serum samples and results showed a high correlation with data obtained using a commercially available ELISA kit (correlation coefficient, 0.9737). Conclusion: Our assay could be applied in the point-of-care testing of CPP in the serum samples, and also the method developed in this study could be adopted to explore the detection and diagnosis of other biomarkers for various diseases.


Assuntos
Anticorpos Monoclonais/imunologia , Citocinas/metabolismo , Glicopeptídeos/sangue , Imunização , Imunoensaio/métodos , Medições Luminescentes/métodos , Testes Imediatos , Animais , Anticorpos Monoclonais/biossíntese , Feminino , Humanos , Concentração de Íons de Hidrogênio , Limite de Detecção , Nanopartículas de Magnetita/química , Camundongos Endogâmicos BALB C , Sensibilidade e Especificidade
11.
N Engl J Med ; 381(2): 111-120, 2019 07 11.
Artigo em Inglês | MEDLINE | ID: mdl-31291514

RESUMO

BACKGROUND: Point-of-care testing of C-reactive protein (CRP) may be a way to reduce unnecessary use of antibiotics without harming patients who have acute exacerbations of chronic obstructive pulmonary disease (COPD). METHODS: We performed a multicenter, open-label, randomized, controlled trial involving patients with a diagnosis of COPD in their primary care clinical record who consulted a clinician at 1 of 86 general medical practices in England and Wales for an acute exacerbation of COPD. The patients were assigned to receive usual care guided by CRP point-of-care testing (CRP-guided group) or usual care alone (usual-care group). The primary outcomes were patient-reported use of antibiotics for acute exacerbations of COPD within 4 weeks after randomization (to show superiority) and COPD-related health status at 2 weeks after randomization, as measured by the Clinical COPD Questionnaire, a 10-item scale with scores ranging from 0 (very good COPD health status) to 6 (extremely poor COPD health status) (to show noninferiority). RESULTS: A total of 653 patients underwent randomization. Fewer patients in the CRP-guided group reported antibiotic use than in the usual-care group (57.0% vs. 77.4%; adjusted odds ratio, 0.31; 95% confidence interval [CI], 0.20 to 0.47). The adjusted mean difference in the total score on the Clinical COPD Questionnaire at 2 weeks was -0.19 points (two-sided 90% CI, -0.33 to -0.05) in favor of the CRP-guided group. The antibiotic prescribing decisions made by clinicians at the initial consultation were ascertained for all but 1 patient, and antibiotic prescriptions issued over the first 4 weeks of follow-up were ascertained for 96.9% of the patients. A lower percentage of patients in the CRP-guided group than in the usual-care group received an antibiotic prescription at the initial consultation (47.7% vs. 69.7%, for a difference of 22.0 percentage points; adjusted odds ratio, 0.31; 95% CI, 0.21 to 0.45) and during the first 4 weeks of follow-up (59.1% vs. 79.7%, for a difference of 20.6 percentage points; adjusted odds ratio, 0.30; 95% CI, 0.20 to 0.46). Two patients in the usual-care group died within 4 weeks after randomization from causes considered by the investigators to be unrelated to trial participation. CONCLUSIONS: CRP-guided prescribing of antibiotics for exacerbations of COPD in primary care clinics resulted in a lower percentage of patients who reported antibiotic use and who received antibiotic prescriptions from clinicians, with no evidence of harm. (Funded by the National Institute for Health Research Health Technology Assessment Program; PACE Current Controlled Trials number, ISRCTN24346473.).


Assuntos
Antibacterianos/uso terapêutico , Proteína C-Reativa/análise , Prescrição Inadequada/prevenção & controle , Testes Imediatos , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Idoso , Biomarcadores/sangue , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/sangue
12.
New Microbiol ; 42(3): 133-138, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31157397

RESUMO

The dental clinic is an appropriate place to promote the prevention of hepatitis C virus (HCV) infection and fast access for care of HCV-positive subjects with new-generation anti-HCV drugs. This study aimed to determine the socio-demographic profile of subjects screened for HCV virus in a dental clinic to acquire useful information for future campaigns of prevention. An easy, free-of-charge, screen salivary test was offered to patients referred to the dental clinic of San Raffaele Scientific Research Hospital in Milan, Italy for dental procedures. These patients were also asked to complete an anonymous questionnaire on demographics and risk behaviours. A total of 1388 of 2097 (66.19%) questionnaires were evaluable. The demographics of the population responding to this initiative was primarily Italians citizen (96.47%), homogeneous gender distribution (55.55%), age over 50 (609 subjects; 43.88%), with high-level education and stable professional positions. 905 subjects (65.20%) were never tested for HCV before. The test showed positive reactivity in 22 cases (1.05%); of these, 21 subjects were known to be HCV-positive, and the test confirmed their status. One subject was newly diagnosed as HCV-positive. The percentage of subjects who were never tested for HCV infection appears too high (905 subjects, i.e., 65.20%), especially among subjects with high level of education and professions, and among adults over 40 or young people (18-25). The easy screening test in dental clinic can help raise awareness, promote early diagnosis and prevention, and provide a fast link to care for HCV infection.


Assuntos
Clínicas Odontológicas , Hepacivirus , Anticorpos Anti-Hepatite C , Testes Imediatos , Saliva/virologia , Adolescente , Adulto , Demografia , Feminino , Hepatite C/diagnóstico , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Testes Imediatos/normas , Gravidez , Adulto Jovem
13.
Lakartidningen ; 1162019 Apr 02.
Artigo em Sueco | MEDLINE | ID: mdl-31192385

RESUMO

Internal and external factors influence the future of laboratory medicine. In the coming years point of care testing and faster and cheaper methods of genome sequencing are predicted to become more important. Changes in laboratory organization and demography with an aging population will likewise impact the coming years. An increased information flow between laboratories and clinicians, where symptoms, findings and vital signs are combined with laboratory results and their change over time, has the potential of generating refined reports. Sharing of equipment between laboratory specialities as well as working in conjunction with clinicians in influencing patterns of testing through guidelines and algorithms may also aid in saving precious resources.


Assuntos
Serviços de Laboratório Clínico/tendências , Laboratórios/tendências , Pessoal de Laboratório Médico/tendências , Serviços de Laboratório Clínico/organização & administração , Aconselhamento Diretivo/tendências , Testes Genéticos/tendências , Humanos , Laboratórios/organização & administração , Papel do Médico , Testes Imediatos/tendências , Dinâmica Populacional/tendências
14.
Wien Klin Wochenschr ; 131(15-16): 362-368, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31214922

RESUMO

PURPOSE: The clinical presentation, complications and mortality in molecularly confirmed influenza A and B infections were analyzed. METHODS: This retrospective observational single-centre study included all influenza positive patients older than 18 years who were hospitalized and treated at the flu isolation ward during 2017/2018. The diagnosis was based on point-of-care tests with the AlereTM. RESULTS: Of the 396 patients tested positive for influenza, 24.2% had influenza A and 75.8% influenza B. Influenza A patients were younger (median age 67.5 years vs. 77 years, p < 0.001), were more often smokers (27.7% vs. 16.8%, p = 0.021), had chronic pulmonary diseases more frequently (39.6% vs. 26.3%, p = 0.013), presented with a higher body temperature (38.6 °C vs. 38.3 °C, p = 0.004), leucocyte count (8 G/L vs. 6.8 G/L, p = 0.002), C­reactive protein (CRP) level (41 mg/l vs. 23 mg/l, p < 0.001) and had dyspnea more often (41.7% vs. 28%, p = 0.012). Influenza B patients had an underlying chronic kidney disease in 37% vs. 18.8% (p < 0.001) and presented with vomiting on admission more frequently (21.7% vs. 11.5%, p = 0.027). Influenza A patients were admitted for 8 days vs. 7 days (p = 0.023). There were no differences in the rate of complications; however, 22 (5.6%) patients died during the hospital stay. The in-hospital mortality was higher in influenza A patients (8.3% vs 4.7%, p = 0.172). CONCLUSION: Some differences were found between influenza A and B virus infections but symptoms were overlapping, which necessitates polymerase chain reaction point-of-care testing for accurate diagnosis. Influenza A was a more severe disease than influenza B during the period 2017/2018.


Assuntos
Vírus da Influenza A/isolamento & purificação , Vírus da Influenza B/isolamento & purificação , Influenza Humana , Testes Imediatos , Reação em Cadeia da Polimerase/métodos , Idoso , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Influenza Humana/diagnóstico , Masculino , Estudos Retrospectivos , Fatores de Risco
15.
J Stroke Cerebrovasc Dis ; 28(8): 2337-2342, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31182266

RESUMO

INTRODUCTION: Monitoring of acute ischaemic stroke patients during thrombolysis or thrombectomy is based mostly on frequent physical examinations, since no objective measurement of cerebrovascular haemodynamics is available in routine clinical practice. Near-infrared spectroscopy (NIRS) is a bed-side, noninvasive assessment tool that could help monitor these patients and potentially guide therapeutic interventions. Our goal in this pilot study was to investigate whether NIRS is a suitable method to monitor leptomeningeal collateral circulation via changes in cortical oxygen saturation in the first 24 hours of acute ischaemic stroke. PATIENTS AND METHODS: Our study included 5 patients with acute anterior circulation infarcts. All patients received thrombolytic therapy and 1 had thrombectomy. 24-hour continuous NIRS monitoring was performed on all participants. RESULTS: We aimed to give a detailed description of each NIRS recording and explain how the observed findings could correlate with changes in anterior watershed territory collateral circulation and clinical outcome. CONCLUSION: Our pilot study supports the use of NIRS monitoring in acute ischaemic stroke. We believe that this technique could provide real-time information on the dynamic changes of leptomeningeal collateral circulation and help monitor the effects of thrombolysis and thrombectomy.


Assuntos
Infarto Encefálico/diagnóstico , Infarto Encefálico/terapia , Fibrinolíticos/administração & dosagem , Monitorização Ambulatorial/métodos , Sistemas Automatizados de Assistência Junto ao Leito , Testes Imediatos , Espectroscopia de Luz Próxima ao Infravermelho , Trombectomia , Terapia Trombolítica/métodos , Idoso , Idoso de 80 Anos ou mais , Infarto Encefálico/sangue , Infarto Encefálico/fisiopatologia , Circulação Cerebrovascular , Circulação Colateral , Imagem de Difusão por Ressonância Magnética , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Valor Preditivo dos Testes , Trombectomia/efeitos adversos , Terapia Trombolítica/efeitos adversos , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
16.
A A Pract ; 12(11): 388-389, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31162163

RESUMO

An 86-year-old female with previously diagnosed congenitally absent right internal carotid artery presented for total shoulder arthroplasty. Bedside ultrasonography confirmed the anomaly and identified several arterial collateral vessels. No aberrant vessels were seen traversing the brachial plexus. The patient received brachial plexus blockade and general anesthesia for the procedure. Carotid agenesis is associated with increased prevalence of intracranial aneurysm. Patients are often asymptomatic due to adequate blood supply from collateral vessels. Ultrasonography for brachial plexus blockade or central line access may yield initial diagnosis or confirm a preexisting anomaly that has anesthetic implications. These prospects encourage vigilance in perioperative imaging.


Assuntos
Artroplastia do Ombro/métodos , Artéria Carótida Interna/anormalidades , Idoso de 80 Anos ou mais , Bloqueio do Plexo Braquial , Artéria Carótida Interna/diagnóstico por imagem , Feminino , Humanos , Período Perioperatório , Testes Imediatos , Ultrassonografia
17.
Talanta ; 202: 96-110, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31171232

RESUMO

Along with the considerable potential and increasing demand of the point-of-care testing (POCT), corresponding detection platforms have attracted great interest in both academic and practical fields. The first few generations of conventional detection devices tend to be costly, complicated to operate and hard to move on account of early limitations in the level of technological development and relatively high requirement of performance. Owing to the requirements for rapidity, simplicity, accuracy and cost controlling in the POCT, reader systems are urgently needed to be developed, upgraded and modified constantly, realizing on-site testing and healthcare management without a specific place or cumbersome operation. Accordingly, numerous rapid detection platforms with diverse size and performance have emerged such as bench-top apparatuses, handheld devices and intelligent detection devices. This review discusses various devices developed mainly for the detection of lateral flow test strips (LFTSs) or microfluidic strips in the POCT and summarizes these devices by size and portability. Furthermore, on the basis of various detection methods and diverse probes usually containing specific nanoparticles composites, three most common aspects of detection rationale in the POCT are selected to elaborate each kind of detection platforms in this paper: colorimetric assay, luminescent detection and magnetic signal detection. Herein, we focus on their structures, detection mechanisms and assay results, accompany with discussions and comments on the performances, costs and potential application, as well as advantages and limitations of each technique. In addition, perspectives on the future advances of detection platforms and some conclusions are proposed.


Assuntos
Colorimetria , Medições Luminescentes , Técnicas Analíticas Microfluídicas , Testes Imediatos , Humanos , Espectroscopia de Ressonância Magnética , Nanopartículas/química
18.
J Vet Emerg Crit Care (San Antonio) ; 29(4): 399-406, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31225690

RESUMO

OBJECTIVE: To compare intravenous and intraosseous blood aspirates using point-of-care diagnostic equipment available in veterinary hospitals. DESIGN: Prospective study. SETTING: Private referral hospital. ANIMALS: Dogs undergoing a tibial plateau leveling osteotomy or extracapsular anterior cruciate ligament stabilization procedure were enrolled. METHODS: Under general anesthesia, simultaneous 0.5 mL intravenous and intraosseous blood samples were collected from the jugular vein and proximal tibia, respectively. Samples were evaluated in duplicate within 10 minutes of collection and averaged for each of the following parameters: blood urea nitrogen (BUN), glucose, packed cell volume, total plasma protein (TPP), plasma lactate, sodium, potassium, chloride, urea, glucose, pH, anion gap, pO2, and pCO2 . Normalcy was tested with Kolmogorov-Smirnov test. A Student's t-test and Bland-Altman plot were used to compare intravenous and intraosseous samples. RESULTS: Twelve dogs were recruited into the study. There were statistically significant differences between intravenous and intraosseous samples for sodium (P = 0.0216), chloride (P = 0.0225), BUN (P = 0.014), and potassium (P < 0.0001), respectively. No significant differences were detected for the other parameters evaluated. DISCUSSION: The intraosseous space provides an easily accessible, noncollapsible alternative for assessing blood parameters. Omitting potassium, the statistically significant differences noted between sites was not felt to be clinically significant. Although statistically insignificant, the large difference in hematocrit values indicates that the samples should not be used interchangeably. CONCLUSION: Intraosseous aspirates, excluding potassium and hematocrit, appear to be a reliable alternative for assessing most point-of-care analytes in healthy dogs, although a larger sample size should be investigated. The application of these data in shock patients is unknown.


Assuntos
Medula Óssea/fisiologia , Cães/sangue , Emergências/veterinária , Testes Imediatos , Equilíbrio Ácido-Base , Animais , Gasometria , Nitrogênio da Ureia Sanguínea , Cloretos/sangue , Hematócrito/veterinária , Infusões Intraósseas/métodos , Veias Jugulares , Ácido Láctico/sangue , Projetos Piloto , Potássio/sangue , Estudos Prospectivos
19.
Analyst ; 144(13): 3925-3935, 2019 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-31094395

RESUMO

Sepsis, a life-threatening syndrome that contributes to millions of deaths annually worldwide, represents a moral and economic burden to the healthcare system. Although no single, or even a combination of biomarkers has been validated for the diagnosis of sepsis, multiple studies have shown the high specificity of CD64 expression on neutrophils (nCD64) to sepsis. The analysis of elevated nCD64 in the first 2-6 hours after infection during the pro-inflammatory stage could significantly contribute to early sepsis diagnosis. Therefore, a rapid and automated device to periodically measure nCD64 expression at the point-of-care (POC) could lead to timely medical intervention and reduced mortality rates. Current accepted technologies for measuring nCD64 expression, such as flow cytometry, require manual sample preparation and long incubation times. For POC applications, however, the technology should be able to measure nCD64 expression with little to no sample preparation. In this paper, we demonstrate a smartphone-imaged microfluidic biochip for detecting nCD64 expression in under 50 min. In our assay, first unprocessed whole blood is injected into a capture chamber to immunologically capture nCD64 along a staggered array of pillars, which were previously functionalized with an antibody against CD64. Then, an image of the capture channel is taken using a smartphone-based microscope. This image is used to measure the cumulative fraction of captured cells (γ) as a function of length in the channel. During the image analysis, a statistical model is fitted to γ in order to extract the probability of capture of neutrophils per collision with a pillar (ε). The fitting shows a strong correlation with nCD64 expression measured using flow cytometry (R2 = 0.82). Finally, the applicability of the device to sepsis was demonstrated by analyzing nCD64 from 8 patients (37 blood samples analyzed) along the time they were admitted to the hospital. Results from this analysis, obtained using the smartphone-imaged microfluidic biochip were compared with flow cytometry. Again, a correlation coefficient R2 = 0.82 (slope = 0.99) was obtained demonstrating a good linear correlation between the two techniques. Deployment of this technology in ICU could significantly enhance patient care worldwide.


Assuntos
Dispositivos Lab-On-A-Chip , Técnicas Analíticas Microfluídicas/métodos , Neutrófilos/imunologia , Receptores de IgG/sangue , Sepse/diagnóstico , Smartphone , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Feminino , Citometria de Fluxo , Humanos , Masculino , Técnicas Analíticas Microfluídicas/instrumentação , Pessoa de Meia-Idade , Testes Imediatos
20.
J Nanobiotechnology ; 17(1): 67, 2019 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-31101112

RESUMO

BACKGROUND: Immunochromatographic strips (ICSs) are a practical tool commonly used in point-of-care testing (POCT) applications. However, ICSs that are currently available have low sensitivity and require expensive equipment for quantitative analysis. These limitations prohibit their extensive use in areas where medical resources are scarce. METHODS: We developed a novel POCT platform by integrating a gas generation biosensor with Au@Pt Core/Shell nanoparticle (Au@PtNPs)-based ICSs (G-ICSs). The resulting G-ICSs enabled the convenient and quantitative assessment of a target protein using the naked eye, without the need for auxiliary equipment or complicated computation. To assess this platform, C-reactive protein (CRP), a biomarker commonly used for the diagnosis of acute, infectious diseases was chosen as a proof-of-concept test. RESULTS: The linear detection range (LDR) of the G-ICSs for CRP was 0.05-6.25 µg/L with a limit of detection (LOD) of 0.041 µg/L. The G-ICSs had higher sensitivity and wider LDR when compared with commonly used AuNPs and fluorescent-based ICSs. When compared with results from a chemiluminescent immunoassay, G-ICS concordance rates for CRP detection in serum samples ranged from 93.72 to 110.99%. CONCLUSIONS: These results demonstrated that G-ICSs have wide applicability in family diagnosis and community medical institutions, especially in areas with poor medical resources.


Assuntos
Biomarcadores/análise , Proteína C-Reativa/análise , Gases/análise , Ouro/química , Nanopartículas Metálicas/química , Anticorpos Monoclonais/química , Técnicas Biossensoriais/métodos , Cromatografia de Afinidade/métodos , Peróxido de Hidrogênio/química , Limite de Detecção , Oxirredução , Oxigênio/química , Tamanho da Partícula , Testes Imediatos , Impressão Tridimensional , Propriedades de Superfície
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