ELISA versus PCR for diagnosis of chronic Chagas disease: systematic review and meta-analysis

<p>Abstract</p> <p>Background</p> <p>Most current guidelines recommend two serological tests to diagnose chronic Chagas disease. When serological tests are persistently inconclusive, some guidelines recommend molecular tests. The aim of this investigation was to review chronic Chagas disease diagnosis literature and to summarize results of ELISA and PCR performance.</p> <p>Methods</p> <p>A systematic review was conducted searching remote databases (MEDLINE, LILACS, EMBASE, SCOPUS and ISIWeb) and full texts bibliography for relevant abstracts. In addition, manufacturers of commercial tests were contacted. Original investigations were eligible if they estimated sensitivity and specificity, or reliability -or if their calculation was possible - of ELISA or PCR tests, for chronic Chagas disease.</p> <p>Results</p> <p>Heterogeneity was high within each test (ELISA and PCR) and threshold effect was detected only in a particular subgroup. Reference standard blinding partially explained heterogeneity in ELISA studies, and pooled sensitivity and specificity were 97.7% [96.7%-98.5%] and 96.3% [94.6%-97.6%] respectively. Commercial ELISA with recombinant antigens studied in phase three investigations partially explained heterogeneity, and pooled sensitivity and specificity were 99.3% [97.9%-99.9%] and 97.5% [88.5%-99.5%] respectively. ELISA's reliability was seldom studied but was considered acceptable. PCR heterogeneity was not explained, but a threshold effect was detected in three groups created by using guanidine and boiling the sample before DNA extraction. PCR sensitivity is likely to be between 50% and 90%, while its specificity is close to 100%. PCR reliability was never studied.</p> <p>Conclusions</p> <p>Both conventional and recombinant based ELISA give useful information, however there are commercial tests without technical reports and therefore were not included in this review. Physicians need to have access to technical reports to understand if these serological tests are similar to those included in this review and therefore correctly order and interpret test results. Currently, PCR should not be used in clinical practice for chronic Chagas disease diagnosis and there is no PCR test commercially available for this purpose. Tests limitations and directions for future research are discussed.</p

The disruption of proteostasis in neurodegenerative diseases

Cells count on surveillance systems to monitor and protect the cellular proteome which, besides being highly heterogeneous, is constantly being challenged by intrinsic and environmental factors. In this context, the proteostasis network (PN) is essential to achieve a stable and functional proteome. Disruption of the PN is associated with aging and can lead to and/or potentiate the occurrence of many neurodegenerative diseases (ND). This not only emphasizes the importance of the PN in health span and aging but also how its modulation can be a potential target for intervention and treatment of human diseases.info:eu-repo/semantics/publishedVersio

O vínculo na atenção à saúde: revisão sistematizada na literatura, Brasil (1998-2007) El vínculo en la atención a la salud: revisión sistematizada en la literatura, Brasil (1998-2007) Bond in health care: a systematic review of literature in Brazil (1998-2007)

O objetivo do estudo foi levantar produções científicas brasileiras que se relacionavam à dimensão vínculo na atenção primária à saúde. O estudo abrangeu o período de 1998 a 2007, a partir das bases de dados LILACS e SciELO por meio das palavras-chave: atenção primária à saúde, acolhimento, tuberculose (indexados), vínculo, adesão, saúde, atenção básica, longitudinalidade e abandono (não indexados). Foram selecionadas 50 produções que posteriormente foram categorizadas. Os achados mostraram que houve um interesse maior pela temática após o ano de 2004, predominando publicações em periódicos que valorizam a saúde coletiva e estudos que se inserem no nível primário de atenção. Entende-se que o vínculo é fator importante para a atenção à saúde e tende a melhorar o conhecimento dos reais problemas da população atendida pelos serviços, além de facilitar o relacionamento dos usuários com os profissionais que os atendem.<br>El objetivo del estudio fue levantar producciones científicas brasileñas que se relacionaban con la dimensión vínculo en la atención primaria a la salud. El estudio abarcó el período de 1998 a 2007, a partir de las bases de datos LILACS y SciELO por medio de las palabras clave: atención primaria a la salud, acogimiento, tuberculosis (indexados), vínculo, adhesión, salud, atención básica, longitudinal y abandono (no indexados). Fueron seleccionadas 50 producciones que posteriormente fueron categorizadas. Los hallazgos mostraron que hubo un interés mayor por la temática después del año de 2004, predominando publicaciones en periódicos que valorizan la salud colectiva y estudios que se sitúan en el nivel primario de atención. Se entiende que el vínculo es un factor importante para la atención a la salud y tiende a mejorar el conocimiento de los reales problemas de la población atendida por los servicios, además de facilitar la relación de los usuarios con los profesionales que los atienden.<br>OBJECTIVE: To review the Brazilian scientific literature on bond in health care. METHODS: The review was limited to the period from 1998 to 2007. A literature search was conducted in the LILACS and SciELO databases using the following key words: primary health care, acceptance, tuberculosis (indexed), bond, adhesion, health, basic care, continuity, and abandon (not indexed). Initially 50 publications were selected and categorized. RESULTS: The findings suggest a greater interest on the topic after 2004. There was a predominance of publications on primary health care in journals that value community health. CONCLUSIONS: Bond was found to be an important factor in primary health care and led to better understanding of the real problems of the population receiving care in those services. In addition, bond facilitated the interactions between clients and health care professionals