objectives To analyse the accuracy of American tegumentary leishmaniasis (ATL) diagnostic methods and evaluate the quality of the existing publications by means of a systematic review. methods Diagnostic tests evaluated in at least two studies with common reference standards were included in the sensitivity and/or specificity meta-analyses. Quality and susceptibility to bias were analysed using the QUADAS-2 and STARD tools. results The title and abstract of 3387 publications were evaluated after deduplication resulting from database searches. Thirty-eight studies were included in the review, and 26 of them had results inserted in meta-analyses. The diagnostic methods with the highest pooled sensitivity values were ELISA, polymerase chain reaction (PCR), indirect immunofluorescence reaction and Montenegro's intradermal reaction. Cytometry was assessed in only two studies and presented 100% sensitivity in both. Smear slide microscopy and histopathology showed low pooled values of sensitivity. For specificity, the highest pooled values were identified for PCR. High values were also identified for ELISA, except for studies in which the reference standard for defining negative participants included individuals with Chagas' disease or paracoccidioidomycosis, which also occurred for cytometry. IFR had lower specificities than ELISA. There was a predominance of case-control designs of phase 1 or 2 and only four studies were strongly recommended as evidence generators. Several reference standards were adopted, and different methods were assessed in a small number of studies. conclusion PCR showed the highest accuracy for the diagnosis of ATL, and its use should be encouraged in clinical practice. ELISA is recommended for the screening of suspected individuals, but the possibility of cross-reactions should be considered. New validation studies for the tests evaluated in few publications and studies of phase 3 with appropriate methods are needed.
Background Responsible companion animal guardianship (RCAG) comprises a set of concepts involving activities, behavior and care that guardians must provide to ensure the welfare of their animals. When such principles are disregarded, the risk of animals developing zoonotic diseases, such as canine visceral leishmaniasis (CVL), increases. This disease is a public health problem in many urban settings in Brazil because dogs are the main reservoirs of Leishmania and are involved in the transmission of the parasites to humans. Our analytical cross-sectional epidemiological survey aimed to investigate the prevalence of CVL in a city in southeastern Brazil and to establish the association between the disease and a number of predictor variables including dog traits, socioeconomic status of guardians, ecological features of the domicile and RCAG. Results Our study showed that the global prevalence of CVL in the sample canine population was 6.7% (47/704). All variables related to better dog care were associated with lower chances of infection. Multiple regression analysis revealed that the chances of animals being seropositive for CVL were significantly (p < 0.05) higher when guardians had no formal education or possessed a university degree (vs. those with complete primary or secondary schooling) and when dogs were sheltered outside the house and had free access to the streets. An additional novel finding was that dogs that were acquired as puppies presented half of the chance of developing the disease in comparison with those acquired at the adult stage. Geographically weighted logistic regression coefficients showed that the strengths of the predictor/CVL associations varied depending on the studied geographical space. Both models demonstrated that the associations were always in the same directions. Conclusions Our findings indicate that regardless of age and mode of acquisition, adult dogs should be submitted to clinical evaluation and tests for CVL. RCAG can exert positive effects on the control of CVL.
O Exército Brasileiro é uma importante estrutura para a defesa nacional e o Tiro de Guerra é parte da constituição do serviço militar. Os atiradores devem ter formação em educação em saúde, anatomia e primeiros socorros, qualificada para o desenvolvimento seguro das atividades práticas. A universidade pode colaborar com os militares na formação dos atiradores através de ações extensionistas. Esse relato de experiência tem como objetivo descrever as ações de educação em saúde realizadas por um programa de extensão da Universidade Federal de São João Del-Rei, Campus Centro-Oeste Dona Lindu, no Tiro de Guerra de Divinópolis - Minas Gerais. As ações foram realizadas no segundo semestre de 2018, com 80 atiradores que participaram de encontros teóricos e práticos em educação em saúde com foco nos primeiros socorros. Para avaliar a satisfação dos atiradores, um questionário seguindo a escala Likert e respostas dicotômicas SIM ou NÃO, foi aplicado após os encontros. Os resultados mostraram que 98% dos atiradores concordaram que o conteúdo ministrado foi relevante para a própria formação e 100% que foram claras as falas dos extensionistas. Foram avaliadas como excelente a didática e o material didático utilizado por 68,8% e 73,8% dos participantes, respectivamente. Sobre o encontro prático, mais de 70% opinou como excelente a qualidade do material utilizado, a didática e o tempo disposto para a realização de cada uma das atividades. A ação extensionista promoveu impacto positivo para os discentes e para os atiradores e possibilitou abordagem multidisciplinar ativa de construção de conhecimento.
INTRODUÇÃO: Linfoma não Hodgkin (LNH) é um grupo heterogêneo de neoplasias do sistema linfático, originado de células B ou T em distintos estágios de maturação. O linfoma de Burkitt (LB) é um linfoma com proliferação intensa de células B maduras. OBJETIVOS: Relatar um caso de linfoma de Burkitt com apresentação principal no trato gastrointestinal. RELATO DE CASO: RF, feminino, 76 anos, internada pelo quadro de infecção do trato urinário com sinais de alarme (leucocitose e pré síncope), anemia e hiponatremia. Relata que há 10 dias iniciou com quadro de fraqueza progressiva, lipotimia e dor abdominal. Nega febre. Prescrito antibioticoterapia, reposição de sódio e solicitado exames laboratoriais. Paciente evoluiu com dor abdominal difusa e em queimação, distensão abdominal e constipação instestinal por 3 dias. Ao exame físico abdome distendido, indolor a palpação, sem sinais de peritonite. Presença de sangue oculto nas fezes. Tomografia de abdome e tórax: linfonodomegalias mediastinal e no hilo pulmonar esquerdo, compatível com disseminação secundária; baço de dimensões aumentadas, apresentando três lesões hipovasculares; massa abdominal localizada no flanco esquerdo com aparente contato com alças de delgado; múltiplos implantes peritoneais no grande omento à esquerda e no flanco esquerdo; linfonodomegalia na cadeia ilíaca externa e inguinal esquerdas, compatíveis com disseminação secundária. À colonoscopia observou-se tumoração sugestiva de neoplasia em sigmoide. Biópsia revela proliferação de células linfocitoides associadas à ulceração, sugestiva de linfoma de Burkitt. Solicitado interconsulta com a hematologia. DISCUSSÃO: O LB é um linfoma altamente agressivo, com localização frequente extranodal. Seus sintomas podem incluir dor abdominal, vômitos, obstrução intestinal, sangramento gastrointestinal ou síndromes que mimetizam apendicite aguda ou intussuscepções. O diagnóstico diferencial do LB é realizado com outros linfomas de célula B de alto grau, sendo mais comum com linfoma difuso de grandes células B. Firma-se o diagnóstico por meio de exame histopatológico e reação de imuno-histoquímica. Por serem capazes de dobrar de tamanho em 25 horas os protocolos incluem abordagens quimioterápicas com mínimo intervalo. CONCLUSÃO: O caso demonstra que o trabalho em equipe multidisciplinar é essencial para a definição do diagnóstico, fundamental para uma boa condução do caso. Exalta-se também a importância do rastreamento de tumores.
There is a substantial gap in our knowledge regarding the efficacy of exergames on the reduction of fall risk in older adults. This systematic review analyzes the findings of clinical trials describing the efficacy of exergames to improve balance or reduce the risk of falls in individuals above 60 years of age who are residents in community centers or nursing homes. We searched Google Scholar, PubMed, and Embase up to January 2023. Initially, 52,294 records were screened. After applying the inclusion and exclusion criteria, 20 studies were included in this systematic review. Meta-analyses revealed statistically significant reductions in the risk of falls and improvements in balance. Exergaming tended to produce positive benefits according to the results obtained using different instruments (TUG, PPA, BBS, and others), control groups, and times of intervention. Nevertheless, a substantial proportion of studies exhibited a high risk of bias and only one had a long follow-up period. Although a large body of evidence supports the view that exergaming is suitable for reducing fall risk and improving balance in older adults, some gaps remain in our knowledge about such benefits.
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