a multicenter study

(1) Background: The Commercial Kit SIRE Nitratase® PlastLabor, is a drug susceptibility test kit used to detect Mycobacterium tuberculosis resistance to first-line TB treatment drugs. The present study aimed at evaluating its performance in a multicenter study. (2) Methods: To determine its accuracy, the proportion methods in Lowenstein Jensen medium or the BACTECTMMGITTM960 system was used as a gold standard. (3) Results: The study revealed that the respective accuracies of the kit with 190 M. tuberculosis clinical isolates, using the proportion methods in Lowenstein Jensen medium or BACTECTMMGITTM960 system as a gold standard, were 93.9% and 94.6%, 96.9% and 94.6%, 98.0% and 97.8%, and 98.0% and 98.9%, for streptomycin, isoniazid, rifampicin, and ethambutol, respectively. (4) Conclusion: Thus, the kit can rapidly screen resistance to streptomycin, isoniazid, rifampicin, and ethambutol. Additionally, it does not require sophisticated equipment; hence, it can be easily used in the laboratories of low and middle income countries.publishersversionpublishe

Diagnosis of obstructive coronary artery disease using computed tomography angiography in patients with stable chest pain depending on clinical probability and in clinically important subgroups: meta-analysis of individual patient data

OBJECTIVETo determine whether coronary computed tomography angiography (CTA) should be performed in patients with any clinical probability of coronary artery disease (CAD), and whether the diagnostic performance differs between subgroups of patients.DESIGNProspectively designed meta-analysis of individual patient data from prospective diagnostic accuracy studies.DATA SOURCESMedline, Embase, and Web of Science for published studies. Unpublished studies were identified via direct contact with participating investigators.ELIGIBILITY CRITERIA FOR SELECTING STUDIESProspective diagnostic accuracy studies that compared coronary CTA with coronary angiography as the reference standard, using at least a 50% diameter reduction as a cutoff value for obstructive CAD. All patients needed to have a clinical indication for coronary angiography due to suspected CAD, and both tests had to be performed in all patients. Results had to be provided using 2x2 or 3x2 cross tabulations for the comparison of CTA with coronary angiography. Primary outcomes were the positive and negative predictive values of CTA as a function of clinical pretest probability of obstructive CAD, analysed by a generalised linear mixed model; calculations were performed including and excluding non-diagnostic CTA results. The no-treat/treat threshold model was used to determine the range of appropriate pretest probabilities for CTA. The threshold model was based on obtained post-test probabilities of less than 15% in case of negative CTA and above 50% in case of positive CTA. Sex, angina pectoris type, age, and number of computed tomography detector rows were used as clinical variables to analyse the diagnostic performance in relevant subgroups.RESULTSIndividual patient data from 5332 patients from 65 prospective diagnostic accuracy studies were retrieved. For a pretest probability range of 7-67%, the treat threshold of more than 50% and the no-treat threshold of less than 15% post-test probability were obtained using CTA. At a pretest probability of 7%, the positive predictive value of CTA was 50.9% (95% confidence interval 43.3% to 57.7%) and the negative predictive value of CTA was 97.8% (96.4% to 98.7%); corresponding values at a pretest probability of 67% were 82.7% (78.3% to 86.2%) and 85.0% (80.2% to 88.9%), respectively. The overall sensitivity of CTA was 95.2% (92.6% to 96.9%) and the specificity was 79.2% (74.9% to 82.9%). CTA using more than 64 detector rows was associated with a higher empirical sensitivity than CTA using up to 64 rows (93.4% v 86.5%, P=0.002) and specificity (84.4% v 72.6%, P<0.001). The area under the receiver-operating-characteristic curve for CTA was 0.897 (0.889 to 0.906), and the diagnostic performance of CTA was slightly lower in women than in with men (area under the curve 0.874 (0.858 to 0.890) v 0.907 (0.897 to 0.916), P<0.001). The diagnostic performance of CTA was slightly lower in patients older than 75 (0.864 (0.834 to 0.894), P=0.018 v all other age groups) and was not significantly influenced by angina pectoris type (typical angina 0.895 (0.873 to 0.917), atypical angina 0.898 (0.884 to 0.913), non-anginal chest pain 0.884 (0.870 to 0.899), other chest discomfort 0.915 (0.897 to 0.934)).CONCLUSIONSIn a no-treat/treat threshold model, the diagnosis of obstructive CAD using coronary CTA in patients with stable chest pain was most accurate when the clinical pretest probability was between 7% and 67%. Performance of CTA was not influenced by the angina pectoris type and was slightly higher in men and lower in older patients

Prevalence of hepatitis C virus and human immunodeficiency virus in a group of patients newly diagnosed with active tuberculosis in Porto Alegre, Southern Brazil

Submitted by Sandra Infurna ([email protected]) on 2017-05-04T13:46:04Z No. of bitstreams: 1 christian_niel_etal_IOC_2017.pdf: 311849 bytes, checksum: 4e5c5a9c1eef1cdd7d151673fd203597 (MD5)Approved for entry into archive by Sandra Infurna ([email protected]) on 2017-05-04T13:56:22Z (GMT) No. of bitstreams: 1 christian_niel_etal_IOC_2017.pdf: 311849 bytes, checksum: 4e5c5a9c1eef1cdd7d151673fd203597 (MD5)Made available in DSpace on 2017-05-04T13:56:22Z (GMT). No. of bitstreams: 1 christian_niel_etal_IOC_2017.pdf: 311849 bytes, checksum: 4e5c5a9c1eef1cdd7d151673fd203597 (MD5) Previous issue date: 2017Secretaria Estadual da Saúde do Rio Grande do Sul. Fundação Estadual de Produção e Pesquisa em Saúde. Centro de Desenvolvimento Científico e Tecnológico. Porto Alegre, RS, Brasil.Secretaria Estadual da Saúde do Rio Grande do Sul. Fundação Estadual de Produção e Pesquisa em Saúde. Centro de Desenvolvimento Científico e Tecnológico. Porto Alegre, RS, Brasil.Secretaria Estadual da Saúde do Rio Grande do Sul. Fundação Estadual de Produção e Pesquisa em Saúde. Centro de Desenvolvimento Científico e Tecnológico. Porto Alegre, RS, Brasil.Universidade Luterana do Brasil. Canoas, RS, Brasil.Secretaria Estadual da Saúde do Rio Grande do Sul. Fundação Estadual de Produção e Pesquisa em Saúde. Centro de Desenvolvimento Científico e Tecnológico. Porto Alegre, RS, Brasil.Secretaria Estadual da Saúde do Rio Grande do Sul. Fundação Estadual de Produção e Pesquisa em Saúde. Instituto de Pesquisas Biológicas. Laboratório Central do Estado. Porto Alegre, RS, Brasil.Universidade de Santa Cruz do Sul. Programa de Pós-Graduação em Promoção da Saúde. Santa Cruz do Sul, RS, Brasil.Secretaria Estadual da Saúde do Rio Grande do Sul Hospital Sanatório Partenon Porto Alegre, RS, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz, Laboratório de Virologia Molecular. Rio de Janeiro, RJ, Brasil.Secretaria Estadual da Saúde do Rio Grande do Sul. Fundação Estadual de Produção e Pesquisa em Saúde. Centro de Desenvolvimento Científico e Tecnológico. Porto Alegre, RS, Brasil / Universidade Luterana do Brasil. Canoas, RS, Brasil.Porto Alegre is the Brazilian state capital with second highest incidence of tuberculosis (TB) and the highest proportion of people infected with human immunodeficiency virus (HIV) among patients with TB. Hepatitis C virus (HCV) infection increases the risk of anti-TB drug-induced hepatotoxicity, which may result in discontinuation of the therapy

Prevalence of hepatitis C virus and human immunodeficiency virus in a group of patients newly diagnosed with active tuberculosis in Porto Alegre, Southern Brazil

BACKGROUND Porto Alegre is the Brazilian state capital with second highest incidence of tuberculosis (TB) and the highest proportion of people infected with human immunodeficiency virus (HIV) among patients with TB. Hepatitis C virus (HCV) infection increases the risk of anti-TB drug-induced hepatotoxicity, which may result in discontinuation of the therapy. OBJECTIVES The aim of this study was (i) to estimate prevalence of HCV and HIV in a group of patients newly diagnosed with active TB in a public reference hospital in Porto Alegre and (ii) to compare demographic, behavioural, and clinical characteristics of patients in relation to their HCV infection status. METHODS One hundred and thirty-eight patients with TB were tested for anti-HCV antibody, HCV RNA, and anti-HIV1/2 antibody markers. HCV RNA from real-time polymerase chain reaction (PCR)-positive samples was submitted to reverse transcription and PCR amplification. The 5′ non-coding region of the HCV genome was sequenced, and genotypes of HCV isolates were determined. FINDINGS Anti-HCV antibody, HCV RNA, and anti-HIV antibodies were detected in 27 [20%; 95% confidence interval (CI), 13-26%], 17 (12%; 95% CI, 7-18%), and 34 (25%; 95% CI, 17-32%) patients, respectively. HCV isolates belonged to genotypes 1 (n = 12) and 3 (n = 4). Some characteristics were significantly more frequent in patients infected with HCV. Among them, non-white individuals, alcoholics, users of illicit drugs, imprisoned individuals, and those with history of previous TB episode were more commonly infected with HCV (p < 0.05). MAIN CONCLUSIONS HCV screening, including detection of anti-HCV antibody and HCV RNA, will be important to improving the management of co-infected patients, given their increased risk of developing TB treatment-related hepatotoxicity