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OBJECTIVE: This systematic review evaluated the diagnostic accuracy of Xpert MTB/RIF to detect tuberculous meningitis (TBM). METHODS: PubMed and five other databases were systematically searched through March 2019. All studies evaluating diagnostic accuracy of Xpert MTB/RIF on cerebrospinal fluid (CSF) samples were included. Reference standards were definitive or definite plus probable TBM. The quality of studies was assessed by the QUADAS-2 tool. We performed bivariate random-effects meta-analysis and calculated summary diagnostic statistics. RESULTS: We identified 30 studies (n = 3972 participants), including 5 cohort studies and 25 cross-sectional studies. Reference standards were definite TB (n = 28 studies) or definite plus probable TBM (n = 6 studies). The pooled Xpert MTB/RIF sensitivity was 85% (95% CI, 70-93%), and specificity was 98% (95% CI, 97-99%) with a negative likelihood ratio of 0.15 (95% CI, 0.04-0.27) for definite TBM. For probable TBM cases, pooled sensitivity was 81% (95% CI, 66-90%), and specificity was 99% (95% CI, 97-99%). For both reference standard types, meta-analyses showed a C-statistic area under the curve of 0.98. The QUADAS-2 tool revealed low risk of bias as well as low concerns regarding applicability. Methodological heterogeneity was high among studies. CONCLUSIONS: Xpert MTB/RIF showed high accuracy for TBM diagnosis, but a negative Xpert MTB/RIF test does not rule out TBM. Repeat Xpert testing may be necessary. In clinical practice, Xpert MTB/RIF adds speed and sensitivity when compared to classic TBM diagnostic methods or previous commercial nucleic acid amplification techniques. More studies and better strategies for rapidly confirming a diagnosis of TBM in children are urgently needed.
OBJECTIF: Cette revue systématique a évalué la précision diagnostique de Xpert MTB/RIF pour détecter la méningite tuberculeuse (MTB). MÉTHODES: PubMed et cinq autres bases de données ont fait l'objet d'une recherche systématique jusqu'en mars 2019. Toutes les études évaluant la précision du diagnostic de Xpert MTB/RIF sur des échantillons de liquide céphalo-rachidien (LCR) ont été incluses. Les étalons de référence étaient des MTB définitives ou définitives et probables. La qualité des études a été évaluée par l'outil QUADAS-2. Nous avons effectué une méta-analyse des effets aléatoires bivariés et calculé des statistiques de résumés diagnostiques. RÉSULTATS: Nous avons identifié 30 études (n = 3.972 participants), dont 5 études de cohorte et 25 études transversales. Les étalons de référence étaient la TB définitive (n = 28 études) ou la MTB définitive et probable (n = 6 études). La sensibilité poolée Xpert MTB/RIF était de 85% (IC95%: 70-93%) et la spécificité était de 98% (IC95%: 97-99%) avec un rapport de vraisemblance négatif de 0,15 (IC95%: 0,04-0,27) pour la MTB définitive. Pour les cas probables de la MTB, la sensibilité poolée était de 81% (IC95%: 66-90%) et la spécificité était de 99% (IC95%: 97-99%). Pour les deux types d'étalons de référence, les méta-analyses ont montré une aire statistique C sous la courbe de 0,98. L'outil QUADAS-2 a révélé un faible risque de biais ainsi que de faibles préoccupations concernant l'applicabilité. L'hétérogénéité méthodologique était élevée parmi les études. CONCLUSIONS: Xpert MTB/RIF a montré une grande précision pour le diagnostic de la MTB, mais un test Xpert MTB/RIF négatif n'exclut pas la MTB. La répétition du tests Xpert peut être nécessaire. Dans la pratique clinique, Xpert MTB/RIF ajoute vitesse et sensibilité par rapport aux méthodes de diagnostic classiques de la MTB ou aux précédentes techniques d'amplification d'acide nucléique commerciales. Des études supplémentaires et de meilleures stratégies pour confirmer rapidement un diagnostic de MTB chez les enfants sont nécessaires d'urgence.
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Antibióticos Antituberculose/uso terapêutico , Mycobacterium tuberculosis/genética , Rifampina/uso terapêutico , Tuberculose Meníngea/diagnóstico , Humanos , Mycobacterium tuberculosis/efeitos dos fármacos , Técnicas de Amplificação de Ácido Nucleico , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Tuberculose Meníngea/líquido cefalorraquidiano , Tuberculose Meníngea/tratamento farmacológico , Tuberculose Meníngea/microbiologiaRESUMO
BACKGROUND: Cat-scratch disease (CSD) is a zoonotic infection caused by Bartonella henselae and B. clarridgeiae. The typical manifestations of CSD include regional lymphadenitis and fever. However, CSD can have a wide variety of clinical manifestations that can lead to incorrect diagnoses and prolonged hospital stays. CASE PRESENTATION: We present a case of a 3-year-old boy admitted to the pediatric service due to prolonged fever and abdominal pain. He received empirical antimicrobial treatment due to suspicion of infection. Abdominal ultrasound showed hepatosplenic abscesses. An IFA detected the presence of IgG antibodies against B. henselae (1:256). Patient was successfully treated with azithromycin and discharged after 7 weeks. CONCLUSIONS: Hepatosplenic abscesses in CSD are rarely reported, particularly in immunocompetent children, with this, only 36 cases in PubMed, Web of Sciences and Scopus bibliographical databases. High rate of suspicion and serological tests availability are of utmost importance in order to detect it and treat it successfully and promptly.
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Anticorpos Antibacterianos/sangue , Bartonella henselae/imunologia , Doença da Arranhadura de Gato/diagnóstico , Doença da Arranhadura de Gato/patologia , Abscesso Hepático/patologia , Esplenopatias/patologia , Abdome/diagnóstico por imagem , Bartonella henselae/isolamento & purificação , Pré-Escolar , Técnica Indireta de Fluorescência para Anticorpo , Humanos , Imunoglobulina G/sangue , Abscesso Hepático/etiologia , Masculino , Peru , Esplenopatias/etiologia , UltrassonografiaRESUMO
Introduction: A high prevalence of advanced breast cancer (BC) is a common scenario in Latin America. In Peru, the frequency of BC at Stages III/IV is ≈50% despite implementation of a programme for breast cancer screening (BCS) along the country. We carried out a study to assess the feasibility and develop an instrument to evaluate the knowledge, barriers and perception about BCS in a nationwide pilot study in Peru among candidates for BCS. Methods: We conducted a systematic review of 2,558 reports indexed in PubMed, Scopus, Web of Science, Medline-Ovid and EMBASE, regarding to our study theme. In total, 111 were selected and a 51-items survey was developed (eight items about sociodemographic characteristics). Patients were recruited in public hospitals or private clinics, in rural and urban areas of nine departments of Peru. Results: We surveyed 488 women from: Lima (150), Cajamarca (93), Ica (59), Arequipa (56), Loreto (48), Ancash (38), Junín (15), Puerto Maldonado (15) and Huancavelica (14); 27.9% of them were from rural areas. The mean of age was 53.3 years (standard deviation ± 9.1). Regarding education level, 29.8% had primary, 33.2% secondary and 37.0% higher education. In total, 28.7% of women did not know the term 'mammogram' and 47.1% reported never receiving a BCS (36.9% from urban and 73.5% from rural population). In women that underwent BCS, only 67% knew it is for healthy women. In total, 54.1% of patients had low levels of knowledge about risk factors for BC (i.e. 87.5% of women respond that injuries in the breast produce cancer). Cultural, economic and geographic barriers were significantly associated with having a mammogram where 56.9% of participants considered a cost ≤ 7 USD as appropriate. Mammogram was perceived as too painful for 54.9% of women. In addition, women with a self-perception of low-risk for BC and a fatalistic perception of cancer were less likely to have a BCS. Conclusion: We found that it is feasible to conduct a large-scale study in Peru. The results of this pilot study highlight an urgent need of extensive education and awareness about BCS in Peru.
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Objetivo: Realizar una revisión sistemática y metaanálisis para comparar terapias target más quimioterapia con quimioterapia en el tratamiento de pacientes con cáncer de mama triple negativo EC IV o recurrente. Material y Métodos: Una búsqueda sistemática de estudios clínicos aleatorizados para el tratamiento de cáncer de mama triple negativo en EC IV o recurrente. Los desenlaces de interés fueron Sobrevida Global (SG) y sobrevida libre de progresión (SLP). Se registró datos de cada estudio clínico para los desenlaces y se estimó RR. Resultados: 10 estudios fueron incluidos y los participantes oscilaron entre 53 a 902 por estudio. La sobrevida global observamos que la terapia target más quimioterapia en las pacientes con cáncer de mama triple negativo EC IV o recurrente estuvo asociado a una disminución del 15% del riesgo de mortalidad con un RR (IC 95%): 0,85 (0,70 a 1,03). En relación al nivel de riesgo libre de progresión observamos que en la intervención se presentó una disminución del 16% en el riesgo de progresión con un RR (IC 95%): 0,84 (0,74 a 0,95). La sobrevida libre de progresión en las pacientes con la intervención oscilo entre 2,8 a 9,7 meses, mientras que en la terapia convencional osciló entre 1,5 a 6,2 meses. Conclusión: Las pacientes con cáncer de mama EC IV o recurrente triple negativo que recibieron terapia target más quimioterapia presentaron tendencia a la disminución en el riesgo de progresión de enfermedad (SLP) y mortalidad (OS), sin embargo, se requieren más estudios clínicos para validar su significancia.
Background:Breast cancer is the most common malignancy in women worldwide. Patients with triple negative breast cancer represent a subgroup with unfavorable prognosis especially in advanced stages of the disease. Several first-line therapeutic agents have been described. Objective: To perform a systematic review and meta-analysis to compare target therapies plus chemotherapy with chemotherapy in the treatment of patients with triple negative breast cancer Stage IV or recurrent. Asystematic search identified randomized Material and Methods: clinical studies for the treatment of triple negative breast cancer in Stage IV or recurrent. The outcomes of interest were overall survival (OS) and progression-free survival (PFS). Data from each clinical study were recorded for the outcomes and the relative risk was estimated. Results:10 studies were included and participants ranged from 53 to 902 per study. Regarding overall survival, we observed that target therapy plus chemotherapy in patients with triple-negative Stage IV or recurrent breast cancer was associated with a 15% decrease in the risk of mortality with a RR (95% CI): 0.85 (0.70 to 1.03). In relation to the level of progression-free risk, we observed that the intervention showed a 16% decrease in the risk of progression with a RR (95% CI): 0.84 (0.74 to 0.95). Progression-free survival in patients with the intervention ranged from 2.8 to 9.7 months, while in conventional therapy it ranged from 1.5 to 6.2 months. Conclusion:Patients with Stage IV or recurrent triple negative breast cancer who received target therapy plus chemotherapy showed a trend towards decreased risk of disease progression (PFS) and mortality (OS), however, more clinical studies are required to validate its significance.
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Objetivo:Ofrecer un alcance de la relevancia del diagnóstico oportuno del cáncer testicular, a partir de un caso infrecuente de rabdomiosarcoma paratesticular en un adulto. Se trata de un paciente varón Reporte de Caso:de 39 años, que ingresa al servicio de cirugía - urología por un aumento de volumen de contenido escrotal, de forma progresiva desde hace 2 años, con crecimiento paulatino de la masa. En la ecografía testicular se evidencia un notorio aumento de volumen de bolsas escrotales por aparente tumoración o masa de consistencia dura, de estructura heterogénea y aspecto sólido de bordes mal definidos. Considerando los hallazgos clínicos, marcadores testiculareseimagenológicossediagnosticóuntumorparatesticular derecho. Se realizó una orquiectomía derecha más exéresis de tumor paratesticular derecho. Patología concluyó en rabdomiosarcoma embrionario paratesticular con cápsula rota. Paciente fue dado de alta con seguimiento por consulta externa y referido a hospital oncológico de cuarto nivel.
Objetive:Offer a scope of the relevance of the timely diagnosis of testicular cancer, based on a infrequent case of paratesticular rhabdomyosarcoma in an adult.The patient is a 39-year-old male who was admitted to Case report:the urology-surgery department because of an increase in scrotal volume, which has been progressive over the past two years, with gradual growth of the mass. Testicular ultrasound shows a notorious increase in volume of scrotal bags due to an apparent tumour or mass of hard consistency, of heterogeneous structure and solid aspect with ill-defined edges. Considering the clinical findings, testicular markers and imaging, a right paratesticular tumor was diagnosed. Aright orchiectomy plus right paratesticular tumor exeresis was performed. Pathology concluded in paratesticular embryonic rhabdomyosarcoma with a broken capsule. Patient was discharged with outpatient follow-up and referred to the fourth level cancer hospital
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RESUMEN Objetivo: Ofrecer un alcance de la relevancia del diagnóstico oportuno del cáncer testicular, a partir de un caso infrecuente de rabdomiosarcoma paratesticular en un adulto. Reporte de Caso: Se trata de un paciente varón de 39 años, que ingresa al servicio de cirugía - urología por un aumento de volumen de contenido escrotal, de forma progresiva desde hace 2 años, con crecimiento paulatino de la masa. En la ecografía testicular se evidencia un notorio aumento de volumen de bolsas escrotales por aparente tumoración o masa de consistencia dura, de estructura heterogénea y aspecto sólido de bordes mal definidos. Considerando los hallazgos clínicos, marcadores testiculares e imagenológicos se diagnosticó un tumor paratesticular derecho. Se realizó una orquiectomía derecha más exéresis de tumor paratesticular derecho. Patología concluyó en rabdomiosarcoma embrionario paratesticular con cápsula rota. Paciente fue dado de alta con seguimiento por consulta externa y referido a hospital oncológico de cuarto nivel.
ABSTRACT Objetive: Offer a scope of the relevance of the timely diagnosis of testicular cancer, based on a infrequent case of paratesticular rhabdomyosarcoma in an adult. Case report: The patient is a 39-year-old male who was admitted to the urology-surgery department because of an increase in scrotal volume, which has been progressive over the past two years, with gradual growth of the mass. Testicular ultrasound shows a notorious increase in volume of scrotal bags due to an apparent tumour or mass of hard consistency, of heterogeneous structure and solid aspect with ill-defined edges. Considering the clinical findings, testicular markers and imaging, a right paratesticular tumor was diagnosed. A right orchiectomy plus right paratesticular tumor exeresis was performed. Pathology concluded in paratesticular embryonic rhabdomyosarcoma with a broken capsule. Patient was discharged with outpatient follow-up and referred to the fourth level cancer hospital.
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RESUMEN Diversas terapias son empleadas para el manejo del enfisema subcutáneo en adultos, pero no se ha encontrado alguna referencia del drenaje subcutáneo mediante la técnica de Beck en pacientes pediátricos. Presentamos el caso clínico de una paciente de catorce años de edad con un trauma cerrado debido a una caída desde una altura de diez metros. Al ingreso, la paciente muestra pérdida de conciencia y desarrolla un síndrome de distrés respiratorio, por lo que se le indica ventilación mecánica. Siete días después se produce un enfisema subcutáneo y se realiza una inserción con angiocatéter fenestrado empleando la técnica de Beck. El enfisema en la zona superior del tórax y el rostro disminuyó a las 24 horas, y a las 72 horas la resolución fue completa.
ABSTRACT Several therapies are used for the management of subcutaneous emphysema in adults, but no reference to subcutaneous drainage using Beck's technique has been found in pediatric patients. This is the clinical case of a 14-year-old female patient who presented a blunt force trauma that resulted from a ten-meter-high fall. On admission, she was unconscious and developed respiratory distress syndrome, thus mechanical ventilation was indicated. Seven days later, subcutaneous emphysema occurred, and a fenestrated angiocatheter was inserted using Beck's method. At 24 hours, the emphysema was reduced in the upper chest and face, and, at 72 hours, complete resolution was observed.
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Introducción: Los profesionales de ciencias de la salud presentan problemas para la elaboración de artículos de investigación científica, aun cuando esta actividad debería formar parte de su ejercicio profesional. Hasta el momento no se han realizado estudios formales para determinar cuáles son los inconvenientes para desarrollar esta competencia. Objetivo: Describir las dificultades para la elaboración de artículos de investigación científica en estudiantes de posgrado en ciencias de la salud. Métodos: Se realizó un estudio transversal, a través de una encuesta anónima a 148 estudiantes de posgrado en salud de dos universidades públicas en la ciudad de La Paz, mediante un cuestionario estructurado a cada programa de formación. Se analizaron las características de los factores implicados en la elaboración de artículos de investigación, a través de un análisis descriptivo e inferencial multivariado mediante regresión logística. Se consideraron distintos factores como género, estudios de especialidad y maestría, procedencia de los participantes y ejercicio de la docencia. Resultados: Se obtuvo que no ejercer la docencia constituía una mayor probabilidad, que impedía la publicación científica en farmacéuticos (OR 7,6; IC 3,71-17,1; p = 0), bioquímicos (OR 13,3; IC 6,17-31,92; p = 0) y médicos (OR 2,7; IC 1,10-6,82; p = 0,05). Conclusiones: En los profesionales de salud como farmacéuticos, bioquímicos y médicos, el no ejercer la docencia se asocia con una mayor dificultad para elaborar artículos de investigación(AU)
Introduction: Health science professionals present problems for the elaboration of scientific research articles, even though this activity should be part of their professional practice. So far, no formal studies have been carried out to determine what the drawbacks to developing this competence are. Objective: To describe the difficulties for the elaboration of scientific research articles faced by postgraduate students in health sciences. Methods: A cross-sectional study was carried out by means of conducting an anonymous survey with 148 postgraduate health students from two public universities in La Paz City, using a structured questionnaire for each training program. The characteristics of the factors involved in the elaboration of research articles were analyzed through descriptive and multivariate inferential analysis using logistic regression. Different factors were considered, such as gender, specialty or master studies, origin of the participants, and teaching practice. Results: It was found that not teaching was a greater probability limiting scientific publication in pharmacists (OR 7.6, CI 3.71-17.1, p = 0), biochemicals (OR 13.3, CI 6, 17-31.92; p = 0), and physicians (OR 2.7, CI 1.10-6.82; p = 0.05). Conclusions: In health professionals, such as pharmacists, biochemists and physicians, not teaching is associated with greater difficulty in preparing research articles(AU)
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Humanos , Publicações , Especialização , Estudos Transversais , Competência Mental , Ciências da SaúdeRESUMO
La leptospirosis humana es una enfermedad causada por bacterias del género Leptospira. Las leptospiras infectan al organismo a través de la piel y mucosas lesionadas. En el sitio de ingreso producen poca reacción inflamatoria local. Los síntomas clínicos varían desde un cuadro parecido a la gripe, hasta ictericia o incluso falla renal y hepática, y están asociados con altas tasas de mortalidad. Se sabe que hay una infección transplacentaria que puede provocar un aborto espontáneo, muerte fetal o leptospirosis congénita. El aborto espontáneo es más común si la infección ocurre en los primeros meses del embarazo. El objetivo de este reporte de caso es dar a conocer la presentación, manifestaciones y abordaje terapéutico en cuidados intensivos de un recién nacido con antecedente materno de leptospirosis en el primer trimestre de embarazo, así como la revisión de la literatura con estructura de búsqueda sistemática
Human leptospirosis is a disease caused by bacteria of the genus Leptospira. Leptospiras infect the body through the skin and damaged mucous membranes. At the site of admission, they produce little local inflammatory reaction. Clinical symptoms range from flu-like symptoms to jaundice or even kidney and liver failure, and are associated with high mortality rates. It is known that there is a transplacental infection that can cause miscarriage, fetal death or congenital leptospirosis. Miscarriage is more common if the infection occurs in the first months of pregnancy. The objective of this case report is to disclose the presentation, manifestations and therapeutic approach in intensive care of a newborn infant with maternal history of leptospirosis in the first trimester of pregnancy, as well as the review of the literature using a systematic search
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El glicocálix endotelial es una estructura sin forma definida que recubre la capa luminal del endotelio vascular y que está constituido, principalmente, por tres elementos: proteoglicanos, glucosaminoglicanos y glicoproteínas. Cumple distintas funciones, como regular la permeabilidad vascular a las moléculas y líquidos, la transducción de las fuerzas mecánicas de tensión y las cascadas de fibrinólisis y coagulación vascular; además, protege de la adhesión leucocitaria, plaquetaria y de patógenos. Los determinantes de lesión del glicocálix pueden ser de varios tipos, por ejemplo, incremento las fuerzas de tensión, especies reactivas de oxígeno (O2), aumento, a nivel plasmático, de sustancias como el sodio (hipernatremia), glucosa (hiperglicemia) y colesterol (hipercolesterolemia), y las moléculas proinflamatorias. Cualquiera de las noxas citadas, individualmente o combinadas, lesionan el glicocálix y la disfunción resultante se expresará clínicamente como disfunción endotelial, aumento de la permeabilidad vascular, paso de lipoproteínas al subendotelio, activación de la coagulación o aumento de la adhesión de plaquetas y leucocitos al endotelio.
Endothelial glycocalyx is an undefined structure covering the luminal layer of the vascular endothelium and consisting mainly of three elements: proteoglycans, glycosaminoglycans and glycoproteins. It has different functions, such as the regulation of vascular permeability to liquids and molecules; transduction of the mechanical forces of vascular tension; regulation of coagulation and fibrinolysis cascades; and protection of leukocyte, platelet and pathogen adhesion. The determinants of a glycocalyx lesion can be of several typese.g., increased tensile forces; reactive oxygen (O2) species; increased plasma level of substances such as sodium (hypernatremia), glucose (hyperglycemia) and cholesterol (hypercholesterolemia); and pro-inflammatory molecules. Any of the above-mentioned noxas, alone or combined, injure the glycocalyx. Its dysfunction will be clinically expressed as endothelial dysfunction, increased vascular permeability, filtration of lipoproteins to the subendothelium, activation of coagulation, or increased adhesion of leukocytes and platelets to the endothelium.