RESUMO
Wildlife health assessments help identify populations at risk of starvation, disease, and decline from anthropogenic impacts on natural habitats. We conducted an overview of available health assessment studies in noncaptive vertebrates and devised a framework to strategically integrate health assessments in population monitoring. Using a systematic approach, we performed a thorough assessment of studies examining multiple health parameters of noncaptive vertebrate species from 1982 to 2020 (n = 261 studies). We quantified trends in study design and diagnostic methods across taxa with generalized linear models, bibliometric analyses, and visual representations of study location versus biodiversity hotspots. Only 35% of studies involved international or cross-border collaboration. Countries with both high and threatened biodiversity were greatly underrepresented. Species that were not listed as threatened on the International Union for Conservation of Nature Red List represented 49% of assessed species, a trend likely associated with the regional focus of most studies. We strongly suggest following wildlife health assessment protocols when planning a study and using statistically adequate sample sizes for studies establishing reference ranges. Across all taxa blood analysis (89%), body composition assessments (81%), physical examination (72%), and fecal analyses (24% of studies) were the most common methods. A conceptual framework to improve design and standardize wildlife health assessments includes guidelines on the experimental design, data acquisition and analysis, and species conservation planning and management implications. Integrating a physiological and ecological understanding of species resilience toward threatening processes will enable informed decision making regarding the conservation of threatened species.
Importancia de los exámenes diagnósticos para la conservación de fauna silvestre Resumen Los exámenes diagnósticos de fauna silvestre ayudan a identificar poblaciones en riesgo por desnutrición, enfermedades infecciosas y disminución poblacional, causadas por impactos antropogénicos. Revisamos los estudios disponibles que llevaron a cabo exámenes diagnósticos en fauna silvestre y diseñamos un marco de trabajo para integrar dichos exámenes en monitoreos poblacionales. Empleando un enfoque sistemático, evaluamos aquellos estudios que examinaban múltiples indicadores de salud en vertebrados no cautivos entre 1982 y 2020 (n = 261 estudios). Cuantificamos las tendencias estadísticas, clasificadas por taxones, del diseño del estudio y de los métodos diagnósticos usando modelos lineales generalizados, análisis bibliométricos y representaciones visuales del lugar de estudio versus los hotspots (puntos calientes) de biodiversidad. Sólo el 35% de los estudios incluían colaboraciones internacionales o transfronterizas, y los países ricos en biodiversidad y especies amenazadas estaban gravemente subrepresentados. Las especies no clasificadas como amenazadas en la Lista Roja de la Unión Internacional para la Conservación de la Naturaleza representaban el 49% de las especies examinadas; una tendencia posiblemente asociada al enfoque regional de la mayoría de los estudios. Recomendamos encarecidamente seguir protocolos diagnósticos y manuales de técnicas del estudio de la fauna silvestre, además de usar tamaños muestrales estadísticamente adecuados al establecer rangos de referencia. Los métodos diagnósticos más comunes para todos los taxones fueronanálisis sanguíneos (89%), evaluaciones de composición corporal (81%), exámenes físicos (72%) y análisis fecales (24% de los estudios). Presentamos un marco conceptual para mejorar y estandarizar los exámenes diagnósticos en estudios de fauna silvestre; dicho marco incluye guías para el diseño experimental, para la obtención y el análisis de datos, y para elaborar planes de acción para especies amenazadas. La combinación de conocimientos fisiológicos y ecológicos, relacionados con la resiliencia biológica de especies amenazadas, facilitará una toma de decisiones eficiente para el manejo y para la conservación de la biodiversidad.
Assuntos
Animais Selvagens , Conservação dos Recursos Naturais , Animais , Biodiversidade , Ecossistema , Espécies em Perigo de ExtinçãoRESUMO
Fluoroscopic studies of the gastrointestinal tract are becoming increasing less common due to the introduction of other imaging techniques such as computed tomography and magnetic resonance imaging and to the increased availability of endoscopy. Nevertheless, fluoroscopic studies of the gastrointestinal tract continue to appear in clinical guidelines and some of their indications are still valid. These studies are dynamic, operator-dependent examinations that require training to obtain the maximum diagnostic performance. This review aims to describe the technique and bring the indications for this imaging modality up to date.
Assuntos
Gastroenteropatias/diagnóstico por imagem , Trato Gastrointestinal Superior/diagnóstico por imagem , Fluoroscopia/métodos , HumanosRESUMO
INTRODUCTION: Patient's body size is a significant determinant of aortic dimensions. Overweight and obesity underestimate aortic dilatation when indexing diameters by body surface area (BSA). We compared the indexation of aortic dimensions by height and BSA in subjects with and without overweight to determine the upper normal limit (UNL). METHODS: The MATEAR study was a prospective, observational, and multicenter study (53 echocardiography laboratories in Argentina). We included 879 healthy adult individuals (mean age: 39.7 ± 11.4 years, 399 men) without hypertension, bicuspid aortic valve, aortic aneurysm, or genetic aortopathies. Echocardiograms were acquired and proximal aorta measured at the sinus of Valsalva (SV), sinotubular junction (STJ), and ascending aorta (AA) levels (EACVI/ASE guidelines). We compared absolute and indexed aortic diameters by height and BSA between groups (men with body mass index [BMI] < 25 and BMI ≥ 25, women with BMI < 25 and BMI ≥ 25). RESULTS: Indexing of aortic diameters by BSA showed significantly lower values in overweight and obese subjects compared to normal weight in their respective gender (for women: SV 1.75 cm/m2 in BMI < 25 vs. 1.52 cm/m2 in BMI between 25 and 29.9 vs. 1.41 cm/m2 in BMI ≥ 30; at the STJ: 1.53 cm/m2 vs. 1.37 cm/m2 vs. 1.25 cm/m2; and at the AA: 1.63 cm/m2 vs. 1.50 cm/m2 vs. 1.37 cm/m2; all p < 0.0001 and for men, all p < 0.0001). These differences disappeared when indexing by height in both gender groups (all p = NS). CONCLUSION: While indexing aortic diameters by BSA in obese and overweight subjects underestimate aortic dilation, the use of aortic height index (AHI) yields a similar UNL for individuals with normal weight, overweight, and obesity. Therefore, AHI could be used regardless of their weight.
INTRODUCCIÓN: El tamaño corporal es un determinante significativo de las dimensiones aórticas. El sobrepeso lleva a subestimar la dilatación aórtica. La altura (A) permanece estable durante la adultez, por lo que sería útil para indexar diámetros aórticos en pacientes obesos, aunque desconocemos los valores normales. Comparamos la indexación de diámetros aórticos por (IA) y superficie corporal (SC) en sujetos con y sin sobrepeso para determinar el límite superior normal (LSN, P97.5). MÉTODO: Se realizó un registro nacional, prospectivo, en 53 centros de Argentina. Se realizaron ecocardiogramas a 528 sujetos con índice de masa corporal (IMC) > 25 y 351 sujetos con IMC ≤ 25 seleccionados al azar. La población se subdividió en cuatro grupos según sexo e IMC y se compararon diámetros aórticos absolutos e indexados. RESULTADOS: Se incluyeron 879 individuos (39.7 ± 11.4 años, 399 hombres). La indexación de los diámetros aórticos por SC mostró valores significativamente más bajos en sujetos con sobrepeso y obesidad en comparación con los de peso normal en cada sexo. Estas diferencias desaparecieron al indexar por altura en ambos géneros (todos p = NS). El LSN de los diámetros IA fue de 2.20 cm/m para senos, 1.99 cm/m para unión sino-tubular (UST) y 2.09 cm/m para aorta ascendente. CONCLUSIONES: La indexación de los diámetros aórticos por SC en individuos con sobrepeso y obesidad subestima la dilatación aórtica. El IA permite establecer un LSN sin tener en cuenta el aumento espurio de la SC determinado por la grasa corporal. Podría ser utilizado en ambos sexos y de manera independiente del peso.
Assuntos
Doenças da Aorta , Sobrepeso , Masculino , Adulto , Humanos , Feminino , Pessoa de Meia-Idade , Dilatação , Superfície Corporal , Estudos Prospectivos , Obesidade/complicações , Valores de Referência , Valva AórticaRESUMO
INTRODUCTION: One of the missions of the Spanish Society of Rheumatology is to provide the necessary tools for excellence in health care. Currently, there is no reference point to quantify medical actions in this specialty, and this is imperative. MATERIAL AND METHOD: A list of actions was drawn up and a hierarchical classification system was established by developing a complexity index, calculated based on the completion time and difficulty level of each action. RESULTS: The results of the Delphi method tended to the consensus opinion within a group (mean σ2 - σ1=0.75-1.43=-0.68, mean IQR2 - IQR1=0.8-1.9=-1.1). The values of the complexity index ranged between 48 and 465 points. Among consultation actions, those reaching the highest scores were the first inpatient visit (366) and visits to the patient's home (369). Among diagnostic techniques, biopsies were prominent, those with the highest score were: bone biopsy (465), sural nerve biopsy (416) and synovial biopsy (380). Ultrasound scan scored 204, capillaroscopy 113 and densitometry 112. Among therapeutic techniques, infiltration/ arthrocentesis/articular injection in children reached the highest difficulty (388). The score for ultrasound-guided articular injection was 163. The score for clinical report on disability was 323 and expert report 370. CONCLUSIONS: A nomenclature of 54 actions in Rheumatology was compiled. Biopsies (bone, sural nerve, synovial), inpatient visits, visits to the patient's home, infiltrations in children, and the preparation of the expert report were identified as the most complex actions. Musculoskeletal ultrasound is twice as complex as subsequent visits, capillaroscopy or bone densitometry.
Assuntos
Reumatologia/métodos , Artrocentese/classificação , Biópsia/classificação , Osso e Ossos/patologia , Técnica Delphi , Densitometria/classificação , Visita Domiciliar , Humanos , Injeções Intra-Articulares/classificação , Pacientes Internados , Angioscopia Microscópica/classificação , Reumatologia/classificação , Nervo Sural/patologia , Membrana Sinovial/patologia , Fatores de Tempo , Ultrassonografia/classificaçãoRESUMO
INTRODUCTION: Nasal swab culture is used to identify Staphylococcus aureus colonization, as this is a major risk factor for surgical site infection (SSI) in patients who are going to undergo major heart surgery (MHS). We determined nasal carriage of S. aureus in patients undergoing MHS by comparing the yield of a conventional culture with that of a rapid molecular test (Xpert® SA Nasal Complete, Cepheid). METHODS: From July 2015 to April 2017, all patients who were to undergo MHS were invited to participate in the study. We obtained two nasal cultures from each patient just before entering the operating room, independently of a previous test for the determination of nasal colonization by this microorganism performed before surgery. One swab was used for conventional culture in the microbiology laboratory, and the other was used for the rapid molecular test. We defined nasal colonization as the presence of a positive culture for S. aureus using either of the two techniques. All patients were followed up until hospital discharge or death. RESULTS: Overall, 57 out of 200 patients (28.5%) were colonized by S. aureus at the time of surgery. Thirty-three patients had both conventional culture- and PCR-positive results. Twenty-four patients had a negative culture and a positive PCR test. Only twenty-one percent (12/57) of colonized patients had undergone an attempt to decolonise before the surgical intervention. CONCLUSION: A significant proportion of patients undergoing MHS are colonized by S. aureus in the nostrils on entering the operating room. New strategies to prevent SSI by this microorganism are needed. Rapid molecular tests immediately before MHS, followed by immediate decolonisation, must be evaluated. Trial Registration Clinical Trials.gov NCT02640001.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Nariz/microbiologia , Infecções Estafilocócicas , Humanos , Salas Cirúrgicas , Staphylococcus aureus/isolamento & purificaçãoRESUMO
Abstract Introduction: Patient's body size is a significant determinant of aortic dimensions. Overweight and obesity underestimate aortic dilatation when indexing diameters by body surface area (BSA). We compared the indexation of aortic dimensions by height and BSA in subjects with and without overweight to determine the upper normal limit (UNL). Methods: The MATEAR study was a prospective, observational, and multicenter study (53 echocardiography laboratories in Argentina). We included 879 healthy adult individuals (mean age: 39.7 ± 11.4 years, 399 men) without hypertension, bicuspid aortic valve, aortic aneurysm, or genetic aortopathies. Echocardiograms were acquired and proximal aorta measured at the sinus of Valsalva (SV), sinotubular junction (STJ), and ascending aorta (AA) levels (EACVI/ASE guidelines). We compared absolute and indexed aortic diameters by height and BSA between groups (men with body mass index [BMI] < 25 and BMI ≥ 25, women with BMI < 25 and BMI ≥ 25). Results: Indexing of aortic diameters by BSA showed significantly lower values in overweight and obese subjects compared to normal weight in their respective gender (for women: SV 1.75 cm/m2 in BMI < 25 vs. 1.52 cm/m2 in BMI between 25 and 29.9 vs. 1.41 cm/m2 in BMI ≥ 30; at the STJ: 1.53 cm/m2 vs. 1.37 cm/m2 vs. 1.25 cm/m2; and at the AA: 1.63 cm/m2 vs. 1.50 cm/m2 vs. 1.37 cm/m2; all p < 0.0001 and for men, all p < 0.0001). These differences disappeared when indexing by height in both gender groups (all p = NS). Conclusion: While indexing aortic diameters by BSA in obese and overweight subjects underestimate aortic dilation, the use of aortic height index (AHI) yields a similar UNL for individuals with normal weight, overweight, and obesity. Therefore, AHI could be used regardless of their weight.
Resumen Introducción: El tamaño corporal es un determinante significativo de las dimensiones aórticas. El sobrepeso lleva a subestimar la dilatación aórtica. La altura (A) permanece estable durante la adultez, por lo que sería útil para indexar diámetros aórticos en pacientes obesos, aunque desconocemos los valores normales. Comparamos la indexación de diámetros aórticos por (IA) y superficie corporal (SC) en sujetos con y sin sobrepeso para determinar el límite superior normal (LSN, P97.5). Método: Se realizó un registro nacional, prospectivo, en 53 centros de Argentina. Se realizaron ecocardiogramas a 528 sujetos con índice de masa corporal (IMC) > 25 y 351 sujetos con IMC ≤ 25 seleccionados al azar. La población se subdividió en cuatro grupos según sexo e IMC y se compararon diámetros aórticos absolutos e indexados. Resultados: Se incluyeron 879 individuos (39.7 ± 11.4 años, 399 hombres). La indexación de los diámetros aórticos por SC mostró valores significativamente más bajos en sujetos con sobrepeso y obesidad en comparación con los de peso normal en cada sexo. Estas diferencias desaparecieron al indexar por altura en ambos géneros (todos p = NS). El LSN de los diámetros IA fue de 2.20 cm/m para senos, 1.99 cm/m para unión sino-tubular (UST) y 2.09 cm/m para aorta ascendente. Conclusiones: La indexación de los diámetros aórticos por SC en individuos con sobrepeso y obesidad subestima la dilatación aórtica. El IA permite establecer un LSN sin tener en cuenta el aumento espurio de la SC determinado por la grasa corporal. Podría ser utilizado en ambos sexos y de manera independiente del peso.
RESUMO
OBJECTIVE: To assess whether there is a relationship between the prescription of antibiotics and the performance of complementary tests with frequency of use and loyalty in Primary Care. METHODS: Analytical descriptive study performed through a network of Primary Care sentinel paediatricians (PAPenRed). Each paediatrician reviewed the spontaneous visits (in Primary Care and in Emergency Departments) of 15 patients for 12 months, randomly chosen from their quota. The prescription of antibiotics and the complementary tests performed on these patients were also collected. RESULTS: A total of 212 paediatricians took part and reviewed 2,726 patients. It was found that 8.3% were moderate over-users (mean + 1-2 standard deviations) and 5.2% extreme over-users (mean + 2 standard deviations). Almost half (49.6%) were high-loyalty patients (more than 75% of visits with their doctor). The incidence ratio of antibiotic prescriptions for moderate over-users was 2.13 (1.74-2.62) and 3.25 (2.55-4.13) for extreme over-users, compared to non-over-user children. The incidence ratio for the diagnostic tests were 2.25 (1.86-2.73) and 3.48 (2.78-4.35), respectively. The incidence ratios for antibiotic prescription were 1.34 (1.16-1.55) in patients with medium-high loyalty, 1.45 (1.15-1.83) for medium-low loyalty, and 1.08 (0.81-1.44) for those with low loyalty, compared to patients with high loyalty. The incidence ratios to perform diagnostic tests were 1.46 (1.27-1.67); 1.60 (1.28 - 2.00), and 0.84 (0.63-1.12), respectively. CONCLUSIONS: Antibiotics prescription and complementary tests were significantly related to medical overuse. They were also related to loyalty, but less significantly.
Assuntos
Antibacterianos/uso terapêutico , Testes Diagnósticos de Rotina/estatística & dados numéricos , Prescrições de Medicamentos/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Criança , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , EspanhaRESUMO
Introducción: en diciembre del año 2019 surgió en China una neumonía viral; el virus fue identificado como un coronavirus SARS-CoV-2, que se propagó rápidamente de tal manera que se convirtió en pandemia. La alta contagiosidad y la presencia de portadores asintomáticos dificultaron el diagnóstico de la infección y la toma de decisiones sanitarias. Objetivo: el objetivo de esta revisión bibliográfica es presentar y describir las principales técnicas utilizadas actualmente para el diagnóstico de COVID-19 y establecer su relación con los conocimientos de distintas disciplinas y tecnologías emergentes que confluyen en la Biotecnología bioquímico-farmacéutica orientada a la Salud humana. Metodología: se realizó una revisión de la bibliografía disponible en PubMed a partir de enero de 2020 sobre las pruebas diagnósticas que se encuentran actualmente en uso, en el ámbito sanitario, para la detección y seguimiento de la enfermedad COVID-19. También se realizaron búsquedas a través de Google y Google Académico para publicaciones de organismos de Salud en referencia a métodos diagnósticos. Resultados: se presenta una importante cantidad de pruebas diagnósticas, basadas en diferentes tecnologías, que desempeñan un papel clave en la pandemia de COVID-19. Algunas de ellas muy sofisticadas, como la secuenciación genómica de próxima generación, otras más estándar, pero igualmente robustas, como la reacción en cadena de la polimerasa (PCR). También otras adaptadas para el brote pandémico, como la amplificación isotérmica de ácidos nucleicos mediada por bucle. Todas las mencionadas se consideran de tipo molecular, pero también existen las pruebas serológicas, como ELISA, que incluyen ensayos en plasma o de tipo inmunológico. Estas sirven para detectar anticuerpos frente a la exposición al virus o antígenos en personas potencialmente infectadas. Conclusiones: los procesos de investigación y desarrollo biotecnológicos aplicados al diagnóstico y los conocimientos científicos previos permitieron una respuesta tanto nacional como internacional rápida y eficaz en medio de una inédita pandemia global. En esta revisión destacamos las principales técnicas, en qué estadio se deben usar y qué información nos aportan. (AU)
Introduction: in December 2019, a viral pneumonia emerged in China, identifying the virus as a SARS-CoV-2 coronavirus, which spread rapidly in such a way that it became a pandemic. The high contagiousness and the presence of asymptomatic carriers make difficulted to diagnose the infection and to make health decisions. Target: the objective of this review is to present and describe the main techniques currently used for the diagnosis of COVID-19, and to establish their relationship with the knowledge of different disciplines and emerging technologies that converge in biochemical-pharmaceutical biotechnology oriented to human health. Methodology: a review of the literature available in Pubmed from January 2020 on the diagnostic tests that are currently in use in the health field, for the detection and monitoring of COVID-19 disease, was carried out. Searches were also carried out through Google and Google Scholar for publications of Health organizations in reference to diagnostic methods. Results: a significant number of diagnostic tests are presented, based on different technologies, which play a key role in the COVID-19 pandemic. Some of them are very sophisticated, such as next-generation genomic sequencing, others more standard, but equally robust, such as polymerase chain reaction. Also others adapted for the pandemic outbreak such as loop-mediated isothermal amplification of nucleic acids. All of the aforementioned are considered molecular, but there are also serological tests, such as ELISA, which include plasma or immunological tests. These serve to detect antibodies against exposure to the virus or antigens in potentially infected people. Conclusions: biotechnological research and development processes applied to diagnosis and previous scientific knowledge allowed a rapid and effective national and international response in the midst of an unprecedented global pandemic. In this review we highlight the main techniques, at what stage they should be used and what information they provide us. (AU)
Assuntos
Humanos , Biotecnologia/tendências , Teste para COVID-19/métodos , SARS-CoV-2/isolamento & purificação , COVID-19/diagnóstico , Ensaio de Imunoadsorção Enzimática , Biomarcadores , Sensibilidade e Especificidade , Técnicas e Procedimentos Diagnósticos , Teste de Ácido Nucleico para COVID-19 , Teste Sorológico para COVID-19RESUMO
Abstract By November 2021, at the time of preparing this article, the disease caused by the new coronavirus (Coronavirus Disease 2019 - COVID-19), declared as a pandemic by the World Health Organization (WHO) on March 11, 2020, had affected more than 128 million people and claimed upwards of 5 million lives. Many of the patients who suffered from this disease will need elective procedures, and this will require knowledge on how to perform the surgery, what tests to order and the extent of preoperative optimization. The objective of this work was to conduct a narrative review of the current evidence regarding time to the performance of an elective procedure in a patient who suffered from COVID-19, the preoperative tests that need to be ordered, and the degree of clinical optimization required according to the complexity of the surgery and individual patient clinical condition. A search was conducted in the Pubmed/Medline, Science Direct, OVID and SciELO databases, as well as in the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) web-based platforms. Although the evidence is still limited, different scientific societies have issued relevant guidelines pertaining to the timing of an elective procedure after COVID-19 infection. For patients who were asymptomatic, the time is 4 weeks after the initial diagnosis of SARS-CoV-2, whereas for symptomatic patients with a mild to moderate course, the time is at least 7 weeks, and 12 weeks if ICU admission was required. There are no guidelines pertaining to preoperative tests or the degree of clinical optimization, although institutional protocols have been developed based on expert consensus on the topic.
Resumen La enfermedad por el nuevo coronavirus COVID-19 (Coronavirus Disease 2019) declarada pandemia por la Organización Mundial de la Salud (OMS) el 11 de marzo de 2020, ha registrado más de 128 millones de casos a escala mundial, con más de cinco millones de muertes a noviembre de 2021, fecha de elaboración de este artículo. Muchos de los pacientes que tuvieron esta enfermedad se someterán a procedimientos electivos, y es necesario saber realizar la cirugía, los exámenes por solicitar y el grado de optimización preoperatoria. El objetivo de este trabajo es elaborar una revisión narrativa de la evidencia actual respecto al tiempo de realización de un procedimiento electivo en un paciente que tuvo COVID-19, los exámenes preoperatorios que se deben solicitar y el grado de optimización clínica según la complejidad de la cirugía y el estado clínico del paciente. Para ello, se realizó una búsqueda en bases de datos (Pubmed/Medline, Science Direct, OVID, SciELO), así como en plataformas web de la Organización Mundial de la Salud (OMS) y los Centers for Diseases Control and Prevention (CDC). Aunque la evidencia aún es limitada, diferentes sociedades científicas han dado pautas relevantes respecto al tiempo de realización de un procedimiento electivo despues de sufrir COVID-19. Para el caso de pacientes que fueron asintomáticos es de 4 semanas después del diagnóstico de infección por SARS-CoV-2, mientras que para pacientes sintomáticos con un curso de la enfermedad leve a moderado es de mínimo 7 semanas, y de 12 semanas si requirió ingreso a cuidados intensivos. No hay guías que orienten en cuanto a la solicitud de exámenes preoperatorios y el grado de optimización clínica, pero sí protocolos institucionales basados en consenso de expertos que abordan esta temática.
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Pâncreas DivisumRESUMO
CLINICAL CASE: A 45 year-old woman with unknown ophthalmology history complained of pain, redness and visual acuity (VA) loss in her left eye for the last three weeks. A serous iris cyst with an overlying peripheral corneal leukoma was located in the iris stroma using ultrasonic biomicroscopy. It was assumed that it was secondary to a penetrating trauma from her childhood. The cyst healed and VA improved after fine-needle aspiration and partial posterior synechiolysis. DISCUSSION: Iris inclusion cysts may appear many years after penetrating trauma or surgery. Fine-needle aspiration is a good choice for its diagnosis and treatment.
Assuntos
Opacidade da Córnea/etiologia , Cistos/cirurgia , Ferimentos Oculares Penetrantes/complicações , Doenças da Íris/cirurgia , Paracentese , Cistos/diagnóstico por imagem , Cistos/etiologia , Dor Ocular/etiologia , Feminino , Humanos , Doenças da Íris/diagnóstico por imagem , Doenças da Íris/etiologia , Implante de Lente Intraocular , Microscopia Acústica , Pessoa de Meia-Idade , Paracentese/instrumentação , Facoemulsificação , Fatores de TempoRESUMO
Spirometry is the main pulmonary function test and is essential for the evaluation and monitoring of respiratory diseases. Its utility transcends the field of Respiratory Medicine, is becoming increasingly important in primary care and applications have even been described outside the field of respiratory diseases. This document is therefore intended to serve as support for all health professionals who use spirometry, providing recommendations based on the best scientific evidence available. An update of the indications and contraindications of the test is proposed. The document sets out recommendations on the requirements necessary for conventional spirometers and portable office equipment, as well as on spirometer hygiene and quality control measures. Spirometric parameters that must be considered, performance of manoeuvres, criteria for acceptability and repeatability of measurements and their quality control are defined. A proposal is also established for presentation of the results and an evaluation and interpretation is proposed according to information generated in recent years. Finally, lines of adaptation and integration of spirometry in the field of new technologies are considered.
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Espirometria , Fatores Etários , Broncodilatadores/administração & dosagem , Calibragem , Contraindicações , Registros Eletrônicos de Saúde , Contaminação de Equipamentos/prevenção & controle , Desenho de Equipamento , Humanos , Controle de Infecções , Monitorização Ambulatorial/instrumentação , Controle de Qualidade , Valores de Referência , Reprodutibilidade dos Testes , Doenças Respiratórias/diagnóstico , Doenças Respiratórias/fisiopatologia , Espirometria/instrumentação , Espirometria/métodos , Espirometria/normas , Fatores de TempoRESUMO
La biopsia punch es una herramienta diagnóstica útil en el estudio de las enfermedades cutáneas, particularmente en dermatología. En los últimos años se han desarrollado nuevas técnicas con usos que van más allá del diagnóstico y se incluyen en el campo de la terapéutica médica, dermatológica y cirugía general. El objetivo de la presente revisión es servir de actualización en biopsia punch, también llamada en sacabocados, tanto para médicos especialistas como no especialistas.
Punch biopsy was considered a sole diagnostic method for years. In the former years, new techniques have been developed. New uses now consider punch biopsy an essential part of the therapeutic arsenal in both dermatology and general surgery. The objective of this review is to serve as an update in punch biopsy.
Assuntos
Humanos , Biópsia/métodos , Procedimentos Cirúrgicos Dermatológicos , Pele/patologiaRESUMO
Objective. To determine the correlation between microbiological culture and otic cytology for diagnoses of external otitis by Malassezia in dogs. Materials and Methods. 158 ear swabs of dogs with clinical diagnosis of external otitis were analyzed by cytology, mycological culture and metabolic tests. Results. Were obtained a positive results by cytology of 62% and 75.3% by culture. The 31.1% of isolates were identified as M. pachydermatis, 12.6% as M. furfur and 56.3% were classified as Malassezia spp., because was not possible to define the species. We found a positive concordance between cytology and culture for Malassezia spp., of 0.76 with a kappa index of 0.448 (95% CI 0.30 to 0.60) which represents a moderate strength of concordance between the two techniques, without regard the identified species. Conclusions. The use of a diagnostic test is not enough to establish the participation of Malassezia spp., as a causal disease agent.
Objetivo. Determinar la concordancia entre el cultivo microbiológico y la citología ótica para el diagnóstico de otitis externa causada por Malassezia spp. en caninos. Materiales y Métodos. Se analizaron 158 muestras de hisopados de caninos con diagnóstico clínico de otitis externa, todas las muestras fueron analizadas mediante citología, cultivo micológico y pruebas metabólicas. Resultados. Se obtuvo una positividad mediante citología del 62% y por cultivo del 75.3%. El 31.1% de los aislamientos fueron identificados como M. pachydermatis, el 12.6% como M. furfur y un 56.3% se clasificó como Malassezia spp., dado que bioquímicamente no fue posible hallar su especie. Se determinó una concordancia observada entre técnicas positivas para Malassezia spp. de 0.76 con índice Kappa de 0.448 IC 95% (0.30 - 0.60) lo que representa una fuerza de concordancia moderada entre las dos técnicas, sin tener en cuenta la especie identificada. Conclusiones. El uso de una prueba diagnóstica no es suficiente para establecer la participación de Malassezia pachydermatis como agente causal de enfermedad.
Assuntos
Malassezia , Cães , Otite Externa , Guias de Prática Clínica como AssuntoRESUMO
Most diminutive polyps (< 5 mm) detected during colonoscopy are hyperplastic, with no cancer risk. Endoscopic diagnosis would prevent unnecessary resection. Objective: To assess diagnostic accuracy of a simple endoscopic classification of diminutive polyps, applicable with current standard endoscopes. Methods: Subjects included patients with diminutive polyps, detected during colonoscopy. A generational cohort served for suggesting an endoscopic classification that was prospectively validated in a new cohort. Colonoscopies were performed by two experienced endoscopists, with standard colonoscopes (CFH180AL, Evis Exera II; Olympus), with narrow-band imaging (NBI). Endoscopic diagnosis was assessed in terms of Sensitivity, Specificity, Positive (PPV) and Negative Predictive Values (NPV) and Accuracy, using histological diagnosis as gold standard. Results: Generational cohort included 42 polyps. To classify polyps as neoplastic or non-neoplastic we used pit pattern (regular or irregular) and vascular marks (visible or non-visible). Validation cohort included 235 polyps, 63 percent of them hyperplastic. Neoplastic polyps were more frequent in proximal colon (49.2 percent) than in rectosigmoid (21.4 percent; p < 0.05). Endoscopic diagnosis revealed: Sensitivity = 75 percent; Specificity = 70 percent; PPV = 59 percent; NPV = 82 percent, and Accuracy = 72 percent. Diagnostic performance was better in rectosigmoid compared to proximal colon (NPV 90 percent vs 74 percent, respectively; p = NS). Both endoscopists showed significant differences in terms of their sensitivity (89 percent vs 60 percent, respectively; p < 0.05). The endoscopist with best results reached NPV = 97 percent in the rectosigmoid (n = 60). Conclusions: The proposed classification can be used in real-time. Endoscopic assessment may replace histological assessment of diminutive polyps of the rectosigmoid. Formal training is needed to reach the required diagnostic accuracy.
La mayoría de los pólipos < 5 mm detectados durante una colonoscopia son hiperplásticos, sin riesgo de cáncer. Su diagnóstico endoscópico evitaría resecciones innecesarias. Objetivo: Evaluar la precisión diagnóstica de una clasificación endoscópica de pólipos colónicos diminutos, aplicable con endoscopios habituales. Métodos: Se incluyeron pacientes con pólipos diminutos detectados durante colonoscopia. Una cohorte de generación sirvió para proponer una clasificación endoscópica, que se validó prospectivamente en una segunda cohorte. Las colonoscopias fueron realizadas por dos endoscopistas experimentados, con colonoscopios estándar (CFH180AL, Evis Exera II; Olympus), con narrow-band imaging (NBI). El diagnóstico endoscópico fue evaluado en términos de sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo y precisión, usando el diagnóstico histológico como gold standard. Resultados: La cohorte de generación incluyó 42 pólipos. Para clasificar los pólipos como neoplásico o no neoplásico se utilizó el patrón superficial (regular o irregular) y las marcas vasculares (visibles o no visibles). La cohorte de validación incluyó 235 pólipos, 63 por ciento hiperplásticos. Los pólipos neoplásicos fueron más frecuentes en colon proximal (49,2 por ciento) que en rectosigmoides (21,4 por ciento; p < 0,05). El diagnóstico endoscópico indicó: Sensibilidad = 75 por ciento; Especificidad = 70 por ciento; VPP = 59 por ciento; VPN = 82 por ciento y Certeza Diagnóstica = 72 por ciento, y fue mejor en rectosigmoides que en colon proximal (VPN = 90 vs 74 por ciento, respectivamente; p = NS). Se observaron diferencias significativas en la sensibilidad al comparar ambos (89 vs 60 por ciento, respectivamente; p < 0,05). El endoscopista con mejor resultado alcanzó VPN = 97 por ciento en rectosigmoides (n = 60). Conclusiones: La clasificación propuesta es utilizable en tiempo real...
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Colonoscopia/métodos , Pólipos do Colo/diagnóstico , Adenoma/diagnóstico , Hiperplasia/diagnóstico , Valor Preditivo dos Testes , Estudos Prospectivos , Pólipos do Colo/patologia , Sensibilidade e EspecificidadeRESUMO
El síndrome de congestión pélvica es una condición clínica caracterizada por la presencia dedolor pélvico crónico y una semiología particular asociada con la presencia de dilataciónde los vasos venosos pélvicos, con o sin reflujo presente. Para su diagnóstico es necesario el hallazgode várices pélvicas, pero no toda mujer con várices pélvicas tiene el síndrome. El método diagnósticoestándar es la venografía selectiva ovárica, aunque recientemente métodos no invasivos, como el ultrasonido doppler y la resonancia magnética dinámica tienen amplia aplicación clínica. El tratamiento varía desde el manejo médico mediante la supresión ovárica con progestágenos a altasdosis o análogos de la hormona liberadora de gonadotropina, pasando por el manejo quirúrgicolaparoscópico o laparotómico de ligadura de venas ováricas bilaterales, ventrosuspensión uterinae histerectomía con salpingooforectomía; así como tratamientos de intervención radiológica, como la embolización de vasos venosos pélvicos. Este artículo busca revisar la literatura del síndromede congestión pélvica con el objetivo de conocer una enfermedad frecuentemente pasada por altoy las alternativas diagnósticas y terapeúticas para tratar dichas pacientes. Esta revisión se realizópor búsqueda electrónica que incluye Medline, Pubmed, The Cochrane Library (incluyendo the Cochrane Database of systematic Reviews) y EMBASE. Los títulos de búsqueda (MeSH) en inglés y español, incluyendo todos los subtítulos y palabras claves fueron varicose veins, pelvic congestionsíndrome, várices pélvicas, síndrome de congestiónpélvica. Fueron incluidos artículos y revisiones de temasentre 1952 y 2008.
Pelvic congestion syndrome is the clinical conditioncharacterized by chronic pelvic pain, with a particular semiology associated with the presenceof pelvic varicose veins, with or withoutreflux. For the development of a pelvic congestion syndrome is necessary the presence of pelvicvaricose veins, but not all women with pelvic varicose veins has a pelvic congestion syndrome.The standard diagnostic method is the selective ovarian venography; although lately notinvasive methods such as Doppler ultrasound and dynamic magnetic resonance imaging havewide clinical application. Medical treatment for handling pelvic congestion syndrome variesfrom ovarian suppression with high doses of Progestagens or analogues of GnRH or invasivesurgical laparoscopic/laparatomic ligation of bilateral ovarian veins, uterine ventrosuspensionand hysterectomy with salpingoooforectomy; as well as embolization of pelvic venous vessels.This article seeks to review the literature ofpelvic congestion syndrome in order to meet a condition often overlooked and diagnostic andtherapeutic alternatives to treat these patients. This review was conducted by electronic search including Medline, Pubmed, The Cochrane Library(including the Cochrane Database of Systematic Reviews) and EMBASE. The subject headings (MeSH) in English and Spanish, including all subheadings and key words were varicoseveins, pelvic congestion syndrome, pelvic várices , pelvic congestion syndrome. Articlesand reviews of issues from 1952 and 2008 were included.
Assuntos
Humanos , Feminino , Testes Diagnósticos de Rotina , Embolização Terapêutica , Doença Inflamatória Pélvica , Flebografia , Varizes , LaparoscopiaRESUMO
The aim of this study was to investigate the occurrence of Toxoplasma gondii and compare the results obtained in the Modified Agglutination Test (MAT), Polimerase Chain Reaction (PCR) and bioassay in mice. In order to accomplish this, 40 free-range chickens from eight farms in neighboring areas to the Pantanal in Nhecolândia, Mato Grosso do Sul, were euthanized and blood samples, brain and heart were collected. The occurrence of anti-T. gondii antibodies found in chickens was 67.5% (27 samples), considering as a cutoff point the dilution 1:5. Among the samples analyzed, 7 (25.9%) were positive in the dilution 1:5, 3 (11.1%) in 1:10, 2 (7.4%) in 1:20, 3 (11.1%) in 1:320, 1 ( 3.7%) in 1:640, 3 (11.1%) in 1:1280, 2 (7.4%) in 1:2560, 4 (14.8%) in 1:5120 and 2 (7.4%) in 1:10.240. From the mixture of tissue samples (brain and heart) from the chickens analyzed, 16 (40%) presented electrophoretic bands compatible with T. gondii by PCR (gene B1). In the comparison of techniques, 59.26% positivity in PCR was revealed among animals that were seropositive in MAT (cutoff 1:5). From 141 inoculated mice, six (4.44%) died of acute toxoplasmosis between 15 and 23 days after inoculation. Surviving mice were sacrificed at 74 days after inoculation, and a total of 28 cysts were found in the brains of 10 distinct groups. From the seropositive hens, 27 bioassays were performed and 11 (40.7%) isolates were obtained. A greater number of isolations happened in mice that were inoculated with tissues from chickens that had high titers for anti-T. gondii antibodies. Chronic infection in mice was observed in nine groups (33.3%) from five different properties. Among the surviving mice, 25.6% were positive for T. gondii in MAT (1:25). From mice positive in PCR, 87.5% were also positive in MAT. Among the PCR-negative mice, 5.2% were positive for T. gondii in MAT. It can be concluded through this study that the occurrence of infecton by T. gondii in the rural properties studied was high, that PCR directed to gene B1 does not confirm the viability of the parasite, but it can be used as a screening method for the selection of chickens infected by T. gondii, that the animals with titer greater than 10 must be prioritized for the selection of animals for bioassay, since for them, the chances of isolating the parasite are greater and that seroconversion in experimentally infected mice is not a good indicator for isolating the agent.
Os objetivos deste estudo foram investigar a ocorrência de Toxoplasma gondii e comparar os resultados obtidos no Teste de Aglutinação Modificada (MAT), Reação em Cadeia pela Polimerase (PCR) e o bioensaio em camundongos. Para tanto, 40 galinhas de criação livre de oito fazendas em áreas limítrofes ao Pantanal da Nhecolândia, Mato Grosso do Sul, foram eutanasiadas e amostras de sangue, o cérebro e o coração foram coletados. A frequência de anticorpos anti-T. gondii encontrada nas galinhas foi de 67,5% (27 amostras), considerando como ponto de corte a diluição 1:5. Entre as amostras analisadas, 7 (25,9%) foram positivas na diluição 1:5, 3 (11,1%) em 1:10, 2 (7,4%) em 1:20, 3 (11,1%) em 1:320, 1 ( 3,7%) em 1:640, 3 (11,1%) em 1:1.280, 2 (7,4%) em 1:2.560, 4 (14,8%) em 1:5.120 e 2 (7,4%) em 1:10.240. A partir da mistura de amostras de tecidos (cérebro e coração) das galinhas analisadas, 16 (40%) apresentaram bandas eletroforéticas compatíveis com T. gondii por PCR (gene B1). Na comparação das técnicas, revelou-se 59,26% de positividade na PCR entre os animais soropositivos no MAT (ponto de corte 1:5). Dos 141 camundongos inoculados, seis (4,44%) morreram de toxoplasmose aguda entre 15 e 23 dias após a inoculação. Os camundongos que sobreviveram foram sacrificados 74 dias após a inoculação, sendo encontrados 28 cistos nos cérebros de 10 grupos distintos. Das galinhas soropositivas, foram realizados 27 bioensaios e obtidos 11 (40,7%) isolados. Um maior número de isolamentos ocorreu em camundongos que foram inoculados com tecidos de galinhas que tinham altos títulos de anticorpos anti-T. gondii. Infecção crônica em camundongos foi observada em nove grupos (33,3%) de cinco propriedades diferentes. Entre os camundongos que sobreviveram, 25,6% foram positivos para T. gondii no MAT (1:25). Dos camundongos positivos na PCR, 87,5% também foram positivos no MAT. Já entre os camundongos PCR negativos 5,2% foram positivos para T. gondii no MAT. Concluiu-se através deste estudo que a ocorrência de infecção pelo T. gondii nas propriedades rurais estudadas foi alta, que a PCR direcionada ao gene B1, não confirma a viabilidade do parasita, porém pode ser utilizada como método de triagem para a seleção de galinhas infectadas por T. gondii, que os animais com título maior que 10 devem ser priorizados para a seleção de animais para bioensaio, pois para eles, as chances de isolamento do parasita são maiores e que a soroconversão em camundongos infectados experimentalmente não é um bom indicador de isolamento do agente.
Assuntos
Animais , Bioensaio/veterinária , Galinhas/parasitologia , Toxoplasmose Animal , Toxoplasma/isolamento & purificação , Patologia Molecular , Reação em Cadeia da Polimerase/veterinária , Testes Sorológicos/veterinária , Testes de Aglutinação/veterináriaRESUMO
El síndrome de ovario poliquístico es una endocrinopatía común y de etiología desconocida, que afecta hasta el 10% de las mujeres, y cuyas manifestaciones clínicas incluyen irregularidades menstruales, signos de hiperandrogenismo y obesidad. Se ha encontrado asociación con resistencia a la insulina, con incremento del riesgo de diabetes mellitus tipo 2 y eventos cardiovasculares. Así mismo, se describe riesgo de preeclampsia, hiperplasia endometrial, cáncer endometrial e infertilidad. Este síndrome es un desorden heterogéneo, con evidencia genética basada en estudios de familias con herencia autosómica dominante y se ha identificado un alto número de genes candidatos, tres de los más estudiados han sido el gen del receptor de insulina, la región codificadora de globulina fijadora de hormonas sexuales y el gen relacionado con el receptor de andrógenos.
The polycystic ovary syndrome is a common endocrine disorder of unknown etiology, which affects 10% of the women, whose clinical manifestations include menstrual irregularities, signs of hyperandrogenism and obesity. It has been found associations with resistance to the insulin with increase risk of type 2 diabetes mellitus and cardiovascular disease. Likewise risk is described of preeclampsia, endometrial hyperplasia, endometrial cancer and infertility. This syndrome is a heterogeneous disorder, with genetic evidence based on studies of families with inheritance autosomal dominant and has themselves identifying a high candidates genes number. Three of the most studied have been the gene of the receiver of insulin, the region encode of sex hormone binding globulin and the gene related to the receiver of androgens.
Assuntos
Humanos , Diagnóstico Clínico , Síndrome do Ovário Policístico/diagnóstico , Genética , Receptor de InsulinaRESUMO
INTRODUÇÃO: Em alguns pacientes a síndrome do intestino irritável e a constipação funcional se confundem, principalmente quando o sintoma predominante na síndrome do cólon irritável é a constipação. Dentre os vários exames alguns testes fisiológicos ano retais avaliam a função esfincteriana e sensibilidade retal OBJETIVO: Verificar se existem diferenças entre as manometrias anais dos pacientes com constipação funcional e síndrome do intestino irritável. MÉTODO: Trata-se de estudo de 55 manometrias e testes de sensibilidade anais realizadas em pacientes atendidos no ambulatório de Fisiologia Anal do Serviço de Clínica Cirúrgica do Hospital Universitário de Taubaté com diagnóstico de constipação intestinal ou síndrome do intestino irritável no período de janeiro de 2006 a maio de 2007. Todos os pacientes possuíam colonoscopia a normal e foram incluídos nos critérios diagnósticos de Roma II para Constipação Funcional e Síndrome do Intestino Irritável. As manometrias foram realizadas com aparelho ALACER, de perfusão com 8 canais. RESULTADOS: Não foram encontradas diferenças entre as manometrias quanto às pressões de repouso, contração e evacuação, assim como nos valores de sensibilidade retal. Encontramos diferenças quanto à dor abdominal desencadeada nos pacientes com síndrome do intestino irritável no momento do volume máximo tolerável em que 69,2 por cento destes pacientes apresentaram dor abdominal. CONCLUSÃO: Os pacientes com a síndrome do intestino irritável apresentam dor à distensão da ampola retal, que não ocorre nos pacientes constipados, na aferição do volume máximo tolerável, não houve diferença em relação aos outros dados da manometria.
INTRODUCTION: In some patients the irritable bowel syndrome and the functional constipation is confuse, mainly when the predominant symptom in the irritable bowel syndrome is the constipation. Amongst some examinations the anal manometry evaluates the esfincter function and retal sensitivity. METHOD: A study of 55 anal manometry was performed at the clinic of anal physiology of the Service of Surgical Clinic of the University of Toubate Hospital in patients with diagnosis of intestinal constipation or irritable bowel syndrome from january 2006 to may 2007. All the patients presented normal colonoscopy and were included in the diagnostic criteria of Rome II for Functional Constipation and Irritable Bowel Syndrome. Manometry was performed with Alacer a perfusion device with 8 channels. RESULTS: There had not been found differences between the manometry about the pressures of rest, contraction and evacuation, as well as in the values of rectal sensitivity. We find differences in abdominal pain in patients with irritable bowel syndrome at the moment of the tolerable maximum volum where 69.2 percent of these patients had presented abdominal pain. CONCLUSION: Patients with the irritable bowel syndrome present pain with rectal tolerable maximum volume, that does not occur in constipated patients, in the gauging of the tolerable maximum volume, which did not have difference in relation to the other data of the manometry.
Assuntos
Humanos , Constipação Intestinal , Sistema Digestório , Manometria , Síndrome do Intestino Irritável/diagnósticoRESUMO
O diagnóstico rápido da tuberculose (TB) é fundamental para a redução da taxa detransmissão da doença e conseqüentemente do número de pessoas infectadas peloindivíduo doente além de possibilitar a prevenção do óbito e as seqüelas causadaspela progressão da doença sem tratamento. A baciloscopia possui baixasensibilidade e o maior problema da cultura para micobactérias é o longo tempo de incubação necessário, até oito semanas. Novos testes, apesar do custo elevado, podem representar um avanço no combate à doença. O teste AmplifiedMycobacterium tuberculosis Direct (MTD; Gen-Probe; San Diego, CA) é capaz dedetectar o rRNA do complexo M. tuberculosis em aproximadamente 3 horas, porémé necessário um melhor entendimento da performance deste teste para clientelapaucibacilar, que é o caso de pacientes HIV positivo, já que a qualidade de suasamostras normalmente dificulta o diagnóstico laboratorial tanto pela baciloscopiaquanto pela cultura. Este estudo foi realizado no Laboratório de Bacteriologia eBioensaios do Instituto de Pesquisa Clínica Evandro Chagas da Fundação OswaldoCruz e tem como objetivo comparar o teste Amplified Mycobacterium tuberculosisDirect com métodos de referência para o diagnóstico laboratorial de tuberculose empacientes HIV positivo na forma de um estudo retrospectivo de acurácia diagnósticacomparando os resultados do MTD com cultura em LJ e BACTEC MGIT 960. Foramanalisadas amostras respiratórias de 118 pacientes, 74,4% do sexo masculino, eidade média de 36,61 ± 10,6 anos. O MTD identificou 31% das amostras comocomplexo M. tuberculosis (M.tb). Entre as culturas em BACTEC MGIT 960, 29,7 por centoforam isolados como M.tb e as culturas em LJ isolaram 27,1%...
Rapid diagnosis of tuberculosis (TB) is important to reduce the rate of diseasetransmission and the number of infected people, enabling prevention of death andsequel caused by disease progression without treatment. The bacilloscopy has lowsensitivity and mycobacteria culture takes long incubation time, up to eight weeks.New tests, despite the high cost, may represent a breakthrough in combating thedisease. The Amplified Mycobacterium tuberculosis Direct Test (MTD, Gen-Probe,San Diego, CA) is capable of detecting the rRNA of the M. tuberculosis in about 3hours, but a better understanding of the performance of this test in paucibacillaryclientele is needed, which is the case of HIV positive patients, since the quality oftheir samples usually difficult both for the laboratory diagnosis by smear and culture.This study was conducted at the Laboratory of Bacteriology and bioassays of theClinical Research Institute Evandro Chagas, Oswaldo Cruz Foundation, and aims tocompare the Amplified Mycobacterium tuberculosis Direct Test with referencemethods for the laboratory diagnosis of tuberculosis in HIV positive patients with aretrospective study of diagnostic accuracy by comparing the results of MTD with LJand BACTEC MGIT 960. We analyzed respiratory samples from 118 patients, 74.4%, mean age 36.61 ± 10.6 years...