A false-negative case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is defined as a person with suspected infection and an initial negative result by reverse ...transcription-polymerase chain reaction (RT-PCR) test, with a positive result on a subsequent test. False-negative cases have important implications for isolation and risk of transmission of infected people and for the management of coronavirus disease 2019 (COVID-19). We aimed to review and critically appraise evidence about the rate of RT-PCR false-negatives at initial testing for COVID-19.
We searched MEDLINE, EMBASE, LILACS, as well as COVID-19 repositories, including the EPPI-Centre living systematic map of evidence about COVID-19 and the Coronavirus Open Access Project living evidence database. Two authors independently screened and selected studies according to the eligibility criteria and collected data from the included studies. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. We calculated the proportion of false-negative test results using a multilevel mixed-effect logistic regression model. The certainty of the evidence about false-negative cases was rated using the GRADE approach for tests and strategies. All information in this article is current up to July 17, 2020.
We included 34 studies enrolling 12,057 COVID-19 confirmed cases. All studies were affected by several risks of bias and applicability concerns. The pooled estimate of false-negative proportion was highly affected by unexplained heterogeneity (tau-squared = 1.39; 90% prediction interval from 0.02 to 0.54). The certainty of the evidence was judged as very low due to the risk of bias, indirectness, and inconsistency issues.
There is substantial and largely unexplained heterogeneity in the proportion of false-negative RT-PCR results. The collected evidence has several limitations, including risk of bias issues, high heterogeneity, and concerns about its applicability. Nonetheless, our findings reinforce the need for repeated testing in patients with suspicion of SARS-Cov-2 infection given that up to 54% of COVID-19 patients may have an initial false-negative RT-PCR (very low certainty of evidence).
Protocol available on the OSF website: https://tinyurl.com/vvbgqya.
In the recent years, platelet-rich fibrin (PRF) has gained importance in regenerative medicine due to its attributed tissue-inducing properties. However, it is still unclear whether there are ...benefits from using PRF with open flap debridement (OFD) for the treatment of intrabony defects compared to OFD alone. For this reason, in this study, we performed an overview of systematic reviews with Friendly Summaries of the Body of Evidence using Epistemonikos methodology on the use of PRF with OFD compared to OFD alone for the treatment of intrabony defects. We performed a systematic search in the Epistemonikos database. We extracted data from the included systematic reviews and reanalyzed the data of primary studies and generated a summary of the findings table. We used Review Manager (RevMan) v5.3 software and GRADEpro software for data analysis and data presentation. Eighteen systematic reviews were included after full-text screening, which had 16 clinical trials. Results were reported by the mean difference (MD); the following outcomes were analyzed: change in intrabony defect depth (MD: 1.37 mm more), change in radiographic bone defect filling (MD: 37.26% more), change in probing depth (MD: 1.22 mm more), change in clinical attachment level (MD: 1.32 mm more), and change in gingival margin level (MD: 0.31 more). We concluded that applying PRF with OFD to treat an intrabony defect has some clinical advantages compared to OFD alone.
Introducción: Actualmente, suceden dos fenómenos el crecimiento de la población adulta mayor y la incorporación creciente y masiva de las TIC en la sociedad, que si bien se supone se mueven en ...paralelo, a cada momento interactúan más, al punto de integrarse. Objetivo: Abordar la inclusión digital como alternativa aportante en el proceso de envejecimiento activo. Proposición: La inclusión digital se convierte en una opción que aporta al envejecimiento activo, al proporcionar alternativas para la incorporación del adulto mayor a la(s) sociedad(es) de la información y el conocimiento. Argumentos para la discusión: El envejecimiento, a pesar de ser un proceso biológico, no implica que deba asumirse como una situación de incapacidad o pérdida de condición humana, sino como un ambiente con nuevas demandas, relaciones e intereses, donde las TIC podrán aportar en la calidad de vida, si se consideran aspectos específicos en los procesos de inclusión digital. A manera de aporte, se plantean unas recomendaciones con miras a iniciativas de inclusión digital con adultos mayores residentes de hogares geriátricos. Conclusiones: La inclusión digital se convierte en estrategia relevante, para favorecer procesos de envejecimiento activo, dentro de un marco de equidad y respeto a la diversidad.
La histoplasmosis es una infección micótica que se adquiere por inhalación causando enfermedad pulmonar en su forma primaria. Puede diseminarse a otros órganos sobre todo en pacientes ...inmunodeprimidos en quienes alcanza una alta mortalidad. Es endémica en ciertas zonas, en especial las templadas y tropicales. Las manifestaciones clínicas varían según la diseminación y estado inmunológico de la persona. El diagnóstico se lo realiza por la identificación histopatológica, cultivo y serología.
Paciente femenina adulta joven afroamericana sin antecedentes clínicos que presenta cuadro de un año de evolución caracterizado por pérdida involuntaria de peso, alopecia, lesiones dérmicas hiperpigmentadas, diarrea y adenopatías cervicales cuyo estudio histopatológico fue compatible con histoplasmosis. Estudios de extensión sugirieron, pero no confirmaron, una patología autoinmune asociada.
En Ecuador no existe registro de casos de histoplasmosis a pesar de ser considerada una micosis endémica en la zona. El estudio de inmunocompetencia en el caso presente fue sugestivo de un lupus eritematoso sistémico con manifestaciones solapadas. Los pacientes con Lupus Eritematoso Sistémico son susceptibles a infecciones oportunistas por hongos dado a defectos inmunológicos intrínsecos con alteración de la inmunidad celular.
La histoplasmosis es una enfermedad endémica en nuestro medio, infradiagnosticada por la diversidad del cuadro clínico y su asociación con otras patologías.
Dental caries have been traditionally managed with the non-selective removal of carious tissue (total removal). However, the adverse effects and fear that this technique produces in patients has ...promoted the use of more conservative caries removal techniques such as chemo-mechanical removal, but there is still controversy regarding its effectiveness and safety.
We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings tables using the GRADE approach.
We identified seven systematic reviews including 34 studies overall, of which 30 correspond to randomized trials. We concluded that chemo-mechanical caries removal probably reduces the need for anesthesia. Additionally, chemo-mechanical caries removal may decrease the pain experienced by the patient, decrease the risk of restoration failure and increase the time of the procedure for the removal of deep caries, but the certainty of the evidence is low. We are uncertain whether chemo-mechanical caries removal reduces the risk of pulp exposure as the certainty of the evidence has been assessed as very low.
BackgroundTesting used in screening, diagnosis and follow-up of COVID-19 has been a subject of debate. Several organisations have developed formal advice about testing for COVID-19 to assist in the ...control of the disease. We collated, delineated and appraised current worldwide recommendations about the role and applications of tests to control SARS-CoV-2/COVID-19.MethodsWe searched for documents providing recommendations for COVID-19 testing in PubMed, EMBASE, LILACS, the Coronavirus Open Access Project living evidence database and relevant websites such as TRIP database, ECRI Guidelines Trust, the GIN database, from inception to 21 September 2020. Two reviewers applied the eligibility criteria to potentially relevant citations without language or geographical restrictions. We extracted data in duplicate, including assessment of methodological quality using the Appraisal of Guidelines for Research and Evaluation-II tool.ResultsWe included 47 relevant documents and 327 recommendations about testing. Regarding the quality of the documents, we found that the domains with the lowest scores were ‘Editorial independence’ (Median=4%) and ‘Applicability’ (Median=6%). Only six documents obtained at least 50% score for the ‘Rigour of development’ domain. An important number of recommendations focused on the diagnosis of suspected cases (48%) and deisolation measures (11%). The most frequently recommended test was the reverse transcription-PCR (RT-PCR) assay (87 recommendations) and the chest CT (38 recommendations). There were 22 areas of agreement among guidance developers, including the use of RT-PCR for SARS-Cov-2 confirmation, the limited role of bronchoscopy, the use chest CT and chest X-rays for grading severity and the co-assessment for other respiratory pathogens.ConclusionThis first scoping review of recommendations for COVID-19 testing showed many limitations in the methodological quality of included guidance documents that could affect the confidence of clinicians in their implementation. Future guidance documents should incorporate a minimum set of key methodological characteristics to enhance their applicability for decision making.
Background. Corn cultivation – one of the main crops in the world – is important in Ecuador for human and animal nutrition, but one of the main limitations in production is the damage caused by the ...insect pest Spodoptera frugiperda (J.E. Smith) (Lepidoptera: Noctuidae). Objective. Therefore, the objective of this research is to evaluate the effectiveness over time of three bio-insecticides on pest incidence in maize hybrid INIAP H601 in Mocache, Los Ríos, Ecuador in the dry season. Methodology. A completely randomized design was used with five treatments and four replicates: (1) Natural neem (Azadirachta indica) leaf extract in doses of 1.88 L; (2) Bassigeos (Beauveria bassiana) in doses of 5 L; (3) Neem + B. bassiana mix in doses of 7 L; (4) Chemical bait in doses of 80 kg.ha-1; and (5) Control group without application, processed by a linear model of repeated measures. Results. A significant variation was observed in the treatments due to the influence of time. Implications. Corn agricultural production has a long tradition and importance in Ecuador, especially in the Province of Los Ríos where productions are affected by S. frugiperda whose major control is by using polluting chemical products. Conclusions. Because the effect of the applied bio-insecticide treatments changes overtime, pest incidence is modified through a linear model of repeated measures. The lowest incidence percentages are achieved with the use of B. bassiana (Bb), A. indica (neem) and Bb + Neem mix after day 15, whereas the chemical control group achieves it throughout the evaluated time interval.
Introducción: el calcio es el electrolito más abundante del cuerpo humano y la hipercalcemia es el trastorno común causado normalmente por el hiperparatiroidismo primario o malignidad, su manejo ...depende de la presentación y causa subyacente. Además, una proporción de casos se presentan como una emergencia, lo que conlleva a una mortalidad significativa.
Objetivo: mostrar un caso inusual de presentación clínica de hipercalcemia asociada a hiperparatiroidismo primario y, asimismo, dar una breve revisión acerca del enfoque y el manejo de esta patología.
Presentación del caso: paciente femenina de 32 años, antecedente de adenoma paratiroideo no resecado y pancreatitis, asiste por tres días de dolor abdominal de tipo cólico y de moderada intensidad, acompañado de episodios eméticos de contenido alimentario, paraclínicos iniciales con hipercalcemia severa, electrocardiograma con bloqueo auriculoventricular grado I, gases arteriales con alcalosis respiratoria aguda e hiperlactatemia. También se le practicó un TAC de abdomen donde este apareció con tumores pardos. Se ingreso? a la UCI para la administración de líquidos endovenosos, diuréticos de asa y cinacalcet, pero no presentó mejoría, por lo que se indicó terapia de hemodiálisis.
Discusión y conclusión: la hipercalcemia es un hallazgo frecuente. El hiperparatiroidismo primario y la neoplasia maligna son las dos causas más frecuentes de aumento de los niveles de calcio sérico y, en conjunto, representan alrededor del 90?% de todos los casos, donde los valores en suero varían entre el calcio total (8,5 y 10,5 mg/dl) y el iónico (1,16-1,31). La concentración sérica de Ca 2+ esta? estrechamente relacionada por las acciones de la hormona paratiroidea y el calcitriol, donde el hiperparatiroidismo primario ocurre como resultado de adenomas, hiperplasias y carcinoma. Las manifestaciones clínicas y la severidad van a estar correlacionadas con el tiempo de duración de la enfermedad, los niveles de calcio y de PTH.
Dentro del tratamiento, este será guiado por su causa, sin embargo, es posible clasificarlo en tratamiento urgente y no urgente. Además, el enfoque de la hipercalcemia aguda severa es un reto diagnóstico dadas las múltiples causas que pueden llevar a este trastorno hidroelectrolítico y la rápida instauración de tratamiento que se requiere cuando es detectada.
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