Is MR Spectroscopy Really the Best MR-Based Method for the Evaluation of Fatty Liver in Diabetic Patients in Clinical Practice?

Objective: To investigate if magnetic resonance spectroscopy (MRS) is the best Magnetic Resonance (MR)-based method when compared to gradient-echo magnetic resonance imaging (MRI) for the detection and quantification of liver steatosis in diabetic patients in the clinical practice using liver biopsy as the reference standard, and to assess the influence of steatohepatitis and fibrosis on liver fat quantification.Methods: Institutional approval and patient consent were obtained for this prospective study. Seventy-three patients with type 2 diabetes (60 women and 13 men; mean age, 5469 years) underwent MRI and MRS at 3.0 T. the liver fat fraction was calculated from triple-and multi-echo gradient-echo sequences, and MRS data. Liver specimens were obtained in all patients. the accuracy for liver fat detection was estimated by receiver operator characteristic (ROC) analysis, and the correlation between fat quantification by imaging and histolopathology was analyzed by Spearman's correlation coefficients.Results: the prevalence of hepatic steatosis was 92%. All gradient-echo MRI and MRS findings strongly correlated with biopsy findings (triple-echo, rho = 0.819; multi-echo, rho = 0.773; MRS, rho = 0.767). Areas under the ROC curves to detect mild, moderate, and severe steatosis were: triple-echo sequences, 0.961, 0.975, and 0.962; multi-echo sequences, 0.878, 0.979, and 0.961; and MRS, 0.981, 0.980, and 0.954. the thresholds for mild, moderate, and severe steatosis were: triple-echo sequences, 4.09, 9.34, and 12.34, multi-echo sequences, 7.53, 11.75, and 15.08, and MRS, 1.71, 11.69, and 14.91. Quantification was not significantly influenced by steatohepatitis or fibrosis.Conclusions: Liver fat quantification by MR methods strongly correlates with histopathology. Due to the wide availability and easier post-processing, gradient-echo sequences may represent the best imaging method for the detection and quantification of liver fat fraction in diabetic patients in the clinical practice.D'Or Institute for Research and EducationFundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ)DOr Inst Res & Educ, Rio de Janeiro, BrazilUniv Fed Rio de Janeiro, Rio de Janeiro, BrazilUniv Estado Rio de Janeiro, Rio de Janeiro, BrazilUniv São Paulo, Inst Phys Sao Carlos, Sao Carlos, SP, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilUniv Paris Diderot Sorbonne, Paris, FranceUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc

Meta-analysis of factors related to health services that predict treatment default by tuberculosis patients

The identification of factors that predict tuberculosis (TB) treatment default can help control this problem. The current study used a systematic review to investigate associations between TB treatment default and previously studied factors related to health services. Abstracts were searched in the MEDLINE and LILACS databases and in the bibliography of the full texts under evaluation. Studies were included if TB treatment default was evaluated by comparing two or more groups and data could be extracted. A total of 41 studies were included for combining data. It was possible to combine five exposures: "difficult access to health services"; "need for hospitalization"; "training or support for adherence"; "delay in initiating treatment"; "long wait before medical attendance". "Difficult access to health services", "training or support for adherence", and "need for hospitalization" were associated with TB treatment default. All exposures demonstrated heterogeneity, which was only explained in one. Publication bias was only detected for one exposure

Commercial enzyme-linked immunosorbent assay versus polymerase chain reaction for the diagnosis of chronic Chagas disease: a systematic review and meta-analysis

Submitted by Fábio Marques ([email protected]) on 2018-09-17T15:56:51Z No. of bitstreams: 1 Commercial enzyme-linked immunosorbent assay versus polymerase_Rodolfo_Castro_etal_INI_Lapclin-AIDS_2016.pdf: 3967546 bytes, checksum: f43000e3cde7142b8a2c0987e53572f7 (MD5)Approved for entry into archive by Regina Costa ([email protected]) on 2018-10-03T17:49:55Z (GMT) No. of bitstreams: 1 Commercial enzyme-linked immunosorbent assay versus polymerase_Rodolfo_Castro_etal_INI_Lapclin-AIDS_2016.pdf: 3967546 bytes, checksum: f43000e3cde7142b8a2c0987e53572f7 (MD5)Made available in DSpace on 2018-10-03T17:49:55Z (GMT). No. of bitstreams: 1 Commercial enzyme-linked immunosorbent assay versus polymerase_Rodolfo_Castro_etal_INI_Lapclin-AIDS_2016.pdf: 3967546 bytes, checksum: f43000e3cde7142b8a2c0987e53572f7 (MD5) Previous issue date: 2016Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica em Doença de Chagas, Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil./ Universidade Federal do Estado do Rio de Janeiro, Instituto de Saúde Coletiva, Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Farmacogenética, Rio de Janeiro, RJ, BrasilChronic Chagas disease diagnosis relies on laboratory tests due to its clinical characteristics. The aim of this research was to review commercial enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR) diagnostic test performance. Performance of commercial ELISA or PCR for the diagnosis of chronic Chagas disease were systematically searched in PubMed, Scopus, Embase, ISI Web, and LILACS through the bibliography from 1980-2014 and by contact with the manufacturers. The risk of bias was assessed with QUADAS-2. Heterogeneity was estimated with the I2 statistic. Accuracies provided by the manufacturers usually overestimate the accuracy provided by academia. The risk of bias is high in most tests and in most QUADAS dimensions. Heterogeneity is high in either sensitivity, specificity, or both. The evidence regarding commercial ELISA and ELISA-rec sensitivity and specificity indicates that there is overestimation. The current recommendation to use two simultaneous serological tests can be supported by the risk of bias analysis and the amount of heterogeneity but not by the observed accuracies. The usefulness of PCR tests are debatable and health care providers should not order them on a routine basis. PCR may be used in selected cases due to its potential to detect seronegative subjects

An exploratory study about healthcare professionals and students food consumption during the COVID-19 pandemic

Summary: Background & Aims: It is foreseeable that behaviors will be modified in the pandemic, including food consumption, which can influence the quality of the diet. And it is already known that a healthy diet influences the immune system, as cells depend on vitamins and minerals to function properly. Therefore, the objective is to verify the food consumption of health professionals and students in the context of the COVID-19 pandemic in Rio de Janeiro. Methods: Cross-sectional, observational and descriptive study. Students and health professionals were invited to participate in the study through electronic media dissemination. Data were collected through a self-completed online questionnaire. The questionnaire contained questions about personal and socioeconomic characteristics, whether you have already been infected with COVID-19, questions about sleep, mood, supplement use and food consumption, with questions from the Brazilian Ministry of Health mini-questionnaire, as well as a question about change, in the context of the pandemic, food consumption according to the level of processing (in natura, minimally processed, processed and ultra-processed). For each question analyzed, comparisons between non-cases and prevalent cases of COVID-19 were presented. Results: A total of 362 participants were evaluated, with a predominance of females (82.60%), aged between 18 and 40 years. A higher percentage of participants, regardless of COVID-19 prevalence, reported consuming healthy foods the day before compared to unhealthy foods. On the other hand, when asked about the increase in the frequency and/or amount of food intake according to the level of processing, an increase in the consumption of processed and ultra-processed foods was especially observed. Another important finding of our study was the participants' perception of a change in mood and sleep, and that this change may have led to changes in food consumption. Finally, we highlighted the regular use of supplements during the COVID-19 pandemic by more than half of the participants. Conclusions: Although a higher percentage of participants, regardless of the prevalence of COVID-19, reported consumption of healthy foods in the previous day, when asked about the increase in food consumption, in the context of the pandemic, according to the level of processing, there was an increase especially by the majority of processed and ultra-processed food participants