BACKGROUND Leprosy is a chronic infectious disease, still endemic in many countries that may lead to neurological, ophthalmic, and motor sequelae if not treated early. Access to timely diagnosis and multidrug therapy (MDT) remains a crucial element in the World Health Organization’s strategy to eliminate the disease as a public health problem. OBJECTIVES This systematic review aims to evaluate the accuracy of rapid point-of-care (POC) tests for diagnosis of leprosy. METHODS Searches were carried out in electronic databases (PubMed, EMBASE, CRD, Cochrane Library and LILACS) in April 2021 for patients with suspicion or confirmatory diagnostic of leprosy, classified in multibacillary (MB) or paucibacillary (PB) cases, performing rapid POC serological tests compared to clinical evaluation, smear microscopy and immunohistochemistry analysis. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2). A meta-analysis was undertaken to generate pooled estimates of diagnostic parameters, presenting sensitivity, specificity and diagnostic odds ratio (DOR) values. The review protocol was registered at PROSPERO, CRD # 42014009658. FINDINGS From 893 potentially relevant references, 12 articles were included reporting 16 diagnostic tests accuracy studies with 5395 individuals enrolled. Meta-analysis of NDO-LID and PGL-I tests data in MB patients showed sensitivity and specificity [95% confidence interval (CI)] of 0.83 (0.71-0.91), 0.91 (0.72-0.97); and 0.92 (0.86-0.96), 0.93 (0.78-0.98); respectively, with high heterogeneity among the studies. MAIN CONCLUSIONS Our results can inform policymakers regarding the possibility of implementing accurate, rapid POC tests for leprosy in public health services, especially within primary health care.
Background: The treatment of rheumatoid arthritis (RA), a chronic systemic inflammatory autoimmune disease, is based on disease-modifying anti-rheumatic drugs (DMARDs). Typically, it starts with conventional synthetic DMARDs (csDMARDs), and depending on the patient’s response to the treatment and the adverse events experienced, biological DMARDs (bDMARDs) are initiated. bDMARDs are more specific to inflammatory factors than csDMARDs and more efficient in inducing remission and low disease activity. Thus, this study aimed to assess the effectiveness of biological therapy in patients with rheumatoid arthritis in administrative health databases.Methods: PubMed, Embase, Lilacs, Ovid, Scopus, and Web of Science databases were searched from inception to 21 October 2021, to identify observational studies that evaluated the effectiveness of biological therapy in patients with rheumatoid arthritis using administrative databases and real-world data. The methodological quality was assessed by the methodological index for non-randomized studies (MINORS). A fixed or random-effects model estimated risk ratios with 95% confidence intervals. The analysis was divided into four groups: tumor necrosis factor inhibitors (TNFi) versus non-TNFi; TNFi versus TNFi (adalimumab, etanercept, and golimumab versus infliximab); bDMARDs versus Janus kinase inhibitors (JAKi); and bDMARDs monotherapy versus combination therapy (bDMARDs and MTX).Results: Twenty-one records were eligible for inclusion in this systematic review and meta-analysis; seven population-based cohorts, eight prospective, and six retrospective cohort studies. Overall, 182,098 rheumatoid arthritis patients were evaluated. In the meta-analysis, lower effectiveness was observed among TNFi users than in non-TNFi (RR: 0.88; 95% CI: 0.81–0.95; p < 0.01; I2 = 94.0%) and bDMARDs than in JAKi (RR: 0.86; 95% CI: 0.79–0.94; p < 0.01; I2 = 93.0%). Higher effectiveness among adalimumab, etanercept, and golimumab than in infliximab (RR: 1.19; 95% CI: 1.05–1.36; p < 0.01; I2 = 96.0%) was found. No significant differences in the effectiveness of bDMARD monotherapy compared to combination therapy (RR: 0.83; 95% CI: 0.68–1.00; p < 0.01; I2 = 81.0%) was observed. E-value analysis indicated that the estimates were not robust against unmeasured confounding.Conclusion: According to the available real-world data, our results suggest that biological therapy effectively treats patients with rheumatoid arthritis, indicating higher effectiveness with non-TNFi and JAKi than with TNFi.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID#CRD42020190838, identifier CRD42020190838.
A Síndrome da Imunodeficiência Adquirida (Aids) é resultante da infecção pelo vírus da imunodeficiência humana (HIV), que induz imunodepressão profunda nos pacientes acometidos e consequentemente permite o aparecimento de infecções oportunistas e/ou neoplasias. No Brasil foram registrados 757.042 casos de indivíduos com Aids no período de 1980 até 2014 e com número de óbitos com cerca de 12,5 mil a cada ano. Com o objetivo de diminuir os índices de infecção pelo HIV, foram incorporadas estratégias de acolhimento, diagnóstico e tratamento nas políticas de saúde pública do Brasil. Dentre os principais avanços na vigilância e controle da Aids está a incorporação da investigação da infecção pelo vírus HIV através de exames diagnósticos, como uma das ferramentas para alcançar a meta mundial 90‑90‑90 no ano de 2020. A criação dos Centros de Orientação e Aconselhamento Sorológico, em 1988, foi um marco para o início da ampliação de acesso ao diagnóstico de HIV. Outra conquista foi a evolução dos algoritmos diagnósticos, presentes no Manual Técnico para o diagnóstico da Infecção pelo HIV, contemplando necessidades específicas e garantindo formas de testagem para cada realidade. Os programas e projetos, como o “Viva Melhor Sabendo” e o “A hora é agora”, permitem acessar populações‑chave e expandir o número de pessoas diagnosticadas. Conclui‑se que são crescentes as iniciativas para a ampliação do acesso ao diagnóstico da infecção pelo HIV, estando em consonância com os princípios da equidade, integralidade e universalidade de acesso aos serviços de saúde do Sistema Único de Saúde.
Acinetobacter baumannii has been associated with antimicrobial resistance and ability to form biofilms. Furthermore, its adherence to host cells is an important factor to the colonization process. Therefore, this study intended to identify some virulence factors that can explain the success of A. baumannii in causing nosocomial infections. We studied 92 A. baumannii isolates collected from hospitals in Rio de Janeiro, Brazil. Isolates were identified and the susceptibility to antimicrobials was determined. Oxacilinase type β-lactamase encoding genes were amplified by polymerase chain reaction, and genetic diversity was investigated by pulsed-field gel electrophoresis (PFGE). In addition, biofilm formation on polystyrene plates using crystal violet staining was quantified, and adherence to human cell lines was evaluated. Eighty-six isolates were multidrug-resistant, of which 93% were carbapenem-resistant. All isolates had the bla OXA-51 gene and 94% had the bla OXA-23 gene, other searched bla OXA genes were not detected. PFGE typing showed two predominant clones, and biofilm production was observed in 79% of isolates. A. baumannii isolates adhered better to HEp-2 cell compared with A-549 cell. Clones A, B, E, and F showed a significantly increased adherence to HEp-2 compared with adherence to A-549 cell. Our findings revealed that A. baumannii isolates had high frequencies of resistance to antimicrobial agents, ability to form biofilm, and capacity to adhere to HEp-2 cells.
Introdução: No Brasil, a preocupação com as infecções hospitalares, ou “infecções relacionadas à assistência à saúde” (IRAS), vem crescendo desde a década de 1990, quando foram publicados uma série de documentos acerca desse assunto. O monitoramento de informações sobre IRAS é de extrema importância, pois se percebe um aumento desse tipo de infecções ao longo do tempo.Objetivo: Identificar as principais estratégias que o Brasil tem utilizado para o controle de IRAS.Métodos: Realizou-se uma análise documental das principais políticas, normas e boletins informativos sobre IRAS publicados no Brasil. Foram analisados cerca de cinco documentos principais que compõem a base normativa brasileira nos últimos 20 anos, bem como documentos específicos do hotsite de Segurança do Paciente da Agência Nacional de Vigilância Sanitária (ANVISA).Resultados: Percebe-se que o Brasil tem avançado nas bases normativas nos últimos anos para o controle das IRAS, no entanto, ainda há escassez de estudos sobre os resultados dessas ações. Nota-se que a quantidade e/ou disponibilidade de recursos humanos e tecnológicos nesse sentido está aquém do que seria necessário para o cumprimento do arcabouço legal da área.Conclusões: As iniciativas para o aprimoramento do sistema de vigilância ou ainda a criação de um plano/política na área são estímulos que devem se traduzir em ações concretas para que haja um controle mais eficaz das IRAS no Brasil.
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