Rapid diagnostic tests and ELISA for diagnosing chronic Chagas disease: Systematic revision and meta-analysis

Factors de risc mèdic; Medicina diagnòstica; Tripanosoma cruziFactores de riesgo médicos; Medicina diagnóstica; Tripanosoma cruziMedical risk factors; Diagnostic medicine; Trypanosoma cruziObjective To determine the diagnostic validity of the enzyme-linked immunosorbent assay (ELISA) and Rapid Diagnostic Tests (RDT) among individuals with suspected chronic Chagas Disease (CD). Methodology A search was made for studies with ELISA and RDT assays validity estimates as eligibility criteria, published between 2010 and 2020 on PubMed, Web of Science, Scopus, and LILACS. This way, we extracted the data and assessed the risk of bias and applicability of the studies using the QUADAS-2 tool. The bivariate random effects model was also used to estimate the overall sensitivity and specificity through forest-plots, ROC space, and we visually assessed the heterogeneity between studies. Meta-regressions were made using subgroup analysis. We used Deeks’ test to assess the risk of publication bias. Results 43 studies were included; 27 assessed ELISA tests; 14 assessed RDTs; and 2 assessed ELISA and RDTs, against different reference standards. 51.2 % of them used a non-comparative observational design, and 46.5 % a comparative clinical design (“case-control” type). High risk of bias was detected for patient screening and reference standard. The ELISA tests had a sensitivity of 99% (95% CI: 98–99) and a specificity of 98% (95% CI: 97–99); whereas the Rapid Diagnostic Tests (RDT) had values of 95% (95% CI: 94–97) and 97% (95% CI: 96–98), respectively. Deeks’ test showed asymmetry on the ELISA assays. Conclusions ELISA and RDT tests have high validity for diagnosing chronic Chagas disease. The analysis of these two types of evidence in this systematic review and meta-analysis constitutes an input for their use. The limitations included the difficulty in extracting data due to the lack of information in the articles, and the comparative clinical-type design of some studies.SHSC, LXRL, CSC, PT were funded by the Universidad de Boyacá, Colombia. LAG was funded by the Universitat Autónoma de Barcelona, Barcelona, Spain. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Prevenció de les exposicions accidentals a sang i material biològic

Sang; Material biològic; ExposicióSangre; Material biológico; ExposiciónBlood; Biological material; ExposureL’objectiu d’aquestes recomanacions és prevenir les exposicions accidentals i informar sobre les mesures que cal adoptar després d’un accident. De l’anàlisi de les exposicions accidentals declarades al Servei de Medicina Preventiva de l’Hospital Vall d’Hebron, durant un període de cinc anys, cal destacarne que la meitat s’han produït en l’habitació del pacient o en el box d’exploració

Reactogenicity to the mRNA-1273 Booster According to Previous mRNA COVID-19 Vaccination

COVID-19-vaccination; Adverse reactions; Booster doseVacunación de COVID-19; Reacciones adversas; Dosis de refuerzoVacunació de COVID-19; Reaccions adverses; Dosi de reforçThe objective of this study was to assess the local and systemic adverse reactions after the administration of a COVID-19 mRNA-1273 booster between December 2021 and February 2022 by comparing the type of mRNA vaccine used as primary series (mRNA-1273 or BNT162b2) and homologous versus heterologous booster in health care workers (HCW). A cross-sectional study was performed in HCW at a tertiary hospital in Barcelona, Spain. A total of 17% of booster recipients responded to the questionnaire. The frequency of reactogenicity after the mRNA-1273 booster (88.5%) was similar to the mRNA-1273 primary doses (85.8%), and higher than the BNT162b2 primary doses (71.1%). The reactogenicity was similar after receiving a heterologous booster compared to a homologous booster (88.0% vs. 90.2%, p = 0.3), and no statistically significant differences were identified in any local or systemic reactions. A higher frequency of medical leave was identified in the homologous booster dose group vs. the heterologous booster dose group (AOR 1.45; 95% CI: 1.00–2.07; p = 0.045). Our findings could be helpful in improving vaccine confidence toward heterologous combinations in the general population and in health care workers

Mesures excepcionals d’optimització i alternatives als EPI en situació d’emergència de COVID-19

Equips de protecció individual; EPI; Mesures d'optimització; Coronavirus SARS-CoV-2; COVID-19; 2019-nCoVEquipos de protección individual; EPI; Medidas de optimización; Coronavirus SARS-CoV-2; COVID-19; 2019-nCoVPersonal protective equipment; EPI; Optimization measures; Coronavirus SARS-CoV-2; COVID-19; 2019-nCoVEl propòsit del present document és facilitar les recomanacions més segures possibles relacionades amb l’optimització dels equips de protecció individual (EPI) en el present context de pandèmia per COVID-19 i per actuar davant de possibles desabastiments d’aquests equipaments

Sensitivity and Specificity of two rapid tests for the diagnosis of infection by Trypanosoma cruzi in a Colombian population

To evaluate diagnostic precision of two rapid diagnostic tests (RDT's) on patients with chronic Chagas disease. Prospective study with the following inclusion criteria: subjects older than 3 years, signed informed consent. Exclusion criterion: subjects could not have previously received treatment for infection with T. cruzi. The study population were participants in a screening process undertaken in rural and urban zones of the department Boyacá, Colombia. Two RDT's were performed to all participants: the Chagas Detect Plus InBios (CDP) and the Chagas Stat-Pak (CSP) and as a reference standard the ELISA Chagas III GrupoBios and the Chagas ELISA IgG+IgM I Vircell tests were used. In the case of discordant results between the two ELISA tests, an indirect immunofluorescence was done. Three hundred-five (305) subjects were included in the study (38 patients with leishmaniasis), of which 215 tested negative for T cruzi and 90 tested positive according to the reference standard. The sensitivity of the RDT's were 100% (CI 95% 95.9-100), and the specificity of the CDP was 99.1% (CI 95% 96.6-99.8) and for CSP was 100% (CI 95% 98.3-100). The agreement of CDP was 99.5% and for CSP was 100% with Kappa values of (k = 99.1; CI 95% 92.6-99.8%) and (k = 100; CI 95% 94.3-100), respectively. RDT's did not present cross-reactions with samples from patients who were positive for leishmaniasis. The findings demonstrate excellent results from the RDT's in terms of validity, safety, and reproducibility. The results obtained provide evidence for the recommendation for using these tests in a Colombian epidemiological context principally in endemic areas in which laboratory installations necessary to perform conventional tests are not available, or they are scarce and to help in diagnosing chronic Chagas disease in order to provide access to treatment as soon as possible. Chagas is a disease caused by the parasite Trypanosoma cruzi, and is one of the most important public health concerns affecting the population of Latin America. This disease presents an acute phase that generally goes undiagnosed and a chronic phase with cardiac manifests principally, is diagnosed through serological tests that are not available in the majority of regions endemic for Chagas disease (CD), the results may take weeks to be returned due to logistical and operational reasons that comprise the main obstacles in initiating treatment of the disease. In the present article, quality indices of two RDT's were evaluated during a field study in the department of Boyacá Colombia, these tests are easy to administer, require only minimal quantities of sample, provide rapid results and do not require electrical equipment or refrigeration. The sensitivity of the two RDT's was 100% and the specificity of CDP was 99.1% and for CSP was 100% according to reference tests. The results obtained support the recommendation of using RDT's in order to help diagnose chronic Chagas disease and thus to improve access to treatment for the populations studied as soon as possibl