Introduction. To end the tuberculosis (TB) epidemic, efficient diagnostic tools are needed. In a previous calibration study, a portable 'point of care' electronic nose device (Aeonose TM ) proved to be a promising tool in a hospital setting. We evaluated this technology to detect TB in an indigenous population in Paraguay.Methods. A total of 131 participants were enrolled. eNose results were compared with anamnesis, physical examinations, chest radiography and mycobacterial cultures in individuals with signs and symptoms compatible with TB. The eNose analysis was performed in two stages: first, the training with a combination of a previous study population plus 47 participants from the new cohort (total n = 153), and second, the 'blind prediction' of 84 participants.Results. 21% of all participants (n = 131) showed symptoms and/or chest radiography abnormalities suspicious of TB. No sputum samples resulted culture positive for Mycobacterium tuberculosis complex. Only one patient had a positive smell print analysis. In the training model, the specificity was 92% (95% confidence interval (CI): 85%-96%) and the negative predictive value (NPV) was 95%.In the blind prediction model, the specificity and the NPV were 99% (95% CI: 93%-99%) and 100%, respectively. Although the sensitivity and positive predictive value of the eNose could not be assessed in this cohort due to the small sample size, no active TB cases were found during a one year of follow-up period. Conclusion.The eNose showed promising specificity and negative predictive value and might therefore be developed as a rule-out test for TB in vulnerable populations.
Perfil epidemiológico y clínico de pacientes con COVID-19 en albergues de Ciudad del Este durante el inicio de la pandemia de Paraguay RESUMEN Introducción: Uno de los componentes principales de la estrategia inicial de las autoridades sanitarias ante la pandemia de la COVID-19 fue la disposición de sitios de cuarentena donde los compatriotas migrantes recibirían monitoreo clínico y virológico antes de ingresar al país.Objetivo: Describir el perfil epidemiológico y clínico de pacientes con COVID-19 de albergues de Ciudad del Este durante el periodo inicial de la pandemia en Paraguay. Metodología: Estudio transversal, en pacientes de nueve albergues de aislamiento por COVID-19. Se i n c l u y e r o n d a t o s d e m o g r á fi c o s , y c l í n i c o s consignados en fichas de individuos con diagnóstico confirmado.Resultados: La muestra consistió en 300 individuos (264 adultos) con una edad promedio de 24,6±8 años. Se consignan las ciudades de procedencia y los destinos según referencia de domicilio. Se detallan también las características clínicas (61,3 formas leves y 38,7% asintomáticos). Se analizaron las diferencias según género y grupos etarios.Conclusión: Este trabajo analiza lo que podría considerarse el primer contingente de individuos con COVID-19 que ha ingresado al Paraguay. El trazado demográfico y las características clínicas no pintan formas severas debido a la escasa comorbilidad encontrada en la muestra.
Introduction: A large number of papers have been published on various aspects of SARS-CoV-2. This article presents a review on modes of transmission and dissemination of the new coronavirus.Method: Through a nominal review, papers in English, Portuguese and Spanish have been selected. The findings were organized into four topics: bioaerosols, factors modulating transmission, modes of transmission and basic aspects of population dissemination. Development:There are new concepts on respiratory particulate emissions which is reaffirmed as the main cause of SARS-CoV-2 transmission, attenuating the fomites relevance. The interaction between the virus, the host and the environment as modulating factors of contagion shows some interesting novelties that may have an impact on the pandemic course. There is a better understanding of the viral incubation period and interpersonal spread, in addition to the importance of asymptomatic and super dissemination phenomena as support for the heterogeneous contagion network. Conclusion:Novel and impactful findings have been generated in just months of pandemic regarding the transmission and dissemination of COVID-19 and this offers new perspectives for the management of biosecurity issues for health personnel as well as health policies for the population.
REPORTE DE CASO / CASE REPORTEnfermedad autoinmune e infecciones inusuales en paciente crítico con COVID-19: reporte de caso RESUMEN Introducción: Los pacientes críticos por COVID-19 están sujetos a varios tipos de complicaciones en la unidad de cuidados intensivos.Presentación del caso: Se trata de un adulto con enfermedad crítica por SARS-CoV-2 que presentó dos episodios sucesivos de sepsis bacteriana y que además desarrolló neumonía por citomegalovirus y virus de varicela zoster (VVZ). Durante el tratamiento exitoso de estas infecciones presentó además vasculitis sistémica con hallazgos de marcadores serológicos de autoinmunidad y partículas virales (VVZ) en piel. Conclusión: Las infecciones secundarias son subvaloradas como variables clínicas para el desenlace en los pacientes críticos por COVID-19. La presencia de vasculitis podría ser expresión de la compleja interacción entre el SARS-CoV-2 y diferentes inmunofenotipos. Creemos que este reporte es uno de los primeros en mencionar la asociación entre varicela, vasculitis y COVID-19.
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