scholarly journals FALSE-NEGATIVE DENGUE CASES IN RORAIMA, BRAZIL: AN APPROACH REGARDING THE HIGH NUMBER OF NEGATIVE RESULTS BY NS1 AG KITS

2014 ◽  
Vol 56 (5) ◽  
pp. 447-450 ◽  
Author(s):  
Pablo O. A. Acosta ◽  
Fabiana Granja ◽  
Cátia A. Meneses ◽  
Ismael A. S. Nascimento ◽  
Débora D. Sousa ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Secondary Infection ◽  
Dengue Infection ◽  
False Negative ◽  
Laboratory Data ◽  
Detection Methods ◽  
Lower Sensitivity ◽  
Care Providers ◽  
Qrt Pcr ◽  
Ns1 Antigen

Serum samples from 150 NS1-negative (Platelia ELISA) patients presumptively diagnosed with dengue were analyzed by the TaqMan probed real-time reverse transcription PCR (TaqMan qRT-PCR) method. The qRT-PCR positive samples were tested for serotype by semi-nested RT-PCR and a qualitative immunochromatographic assay for IgG and IgM. Molecular detection methods showed 33 (22%) positive samples out of 150 NS1-antigen negative samples. Of these, 72% were collected up to day 2 after the onset of symptoms, when diagnostic sensitivity of NS1-antigen test assays is significantly enhanced. Most of the cases were not characterized as secondary infection. Twenty-eight samples were successfully serotyped, 75% of which for DENV-4, 14% for DENV-2, 7% for DENV-3 and 4% for DENV-1. These findings reaffirm the hyperendemic situation of the state of Roraima and suggest a lower sensitivity of the NS1 test, mainly when DENV-4 is the predominant serotype. Health care providers should therefore be aware of samples tested negative by NS1 antigen assays, especially when clinical symptoms and other laboratory data results show evidence of dengue infection.

scholarly journals Congenital Dengue Infection: A Novel Case of Vertical Transmission of Dengue Virus in Karachi, Pakistan

2021 ◽  
Keyword(s):  
Dengue Virus ◽  
Vertical Transmission ◽  
Health Care Providers ◽  
Blood Platelets ◽  
Dengue Infection ◽  
Maculopapular Rash ◽  
Liver Function Tests ◽  
Care Providers ◽  
Antigen Test ◽  
Ns1 Antigen

Dengue is a viral infection that is transmitted generally among humans through mosquito bite. This article reports a less known mode of transmission i.e., vertical transmission of dengue virus. A male newborn with normal Apgar score developed fever on the 8th day of life. The fever progressed along with an erythematous rash. There was no evidence of mosquito exposure to the baby. However, the mother had mosquito bites two days prior to her delivery. The mother also developed fever on seventh day of delivery and a maculopapular rash during her ninth postpartum day. Baseline investigations of both the mother and the neonate showed thrombocytopenia, anemia, raised liver function tests and positive Dengue NS1 antigen test. The diagnosis of dengue fever was established. This case report demonstrates the possibility of congenital transmission of dengue virus. The health care providers should be aware of and adequately trained for handling such cases. Keywords: Dengue; Blood Platelets; Infections; Thrombocytopenia; Antigens.

Incidence and Pattern of Clinical Dengue Cases among Travelers and NonTravelers in a District of Bangladesh

2020 ◽  
Vol 7 (1) ◽  
pp. 3-7
Author(s):  
Syed Abdul Kader ◽  
Sonia Afrin Rob
Keyword(s):  
Endemic Area ◽  
Dengue Infection ◽  
Laboratory Data ◽  
Data Entry ◽  
Cross Sectional Study ◽  
P Value ◽  
College Hospital ◽  
Cross Sectional ◽  
Test Kit ◽  
Ns1 Antigen

Background: Expansion of Dengue fever caused by a mosquito borne arbovirus to new countries and, from urban to rural settings constitutes an important health problem in the world including Bangladesh. Objective: This study was conducted to evaluate spread of clinical Dengue to previously non-endemic Barisal district and get an idea of how recent this spread is by comparing proportions of non-travelers and travelers to an endemic area among the admitted patients. Methodology: The incidence of dengue infection in Barisal division with and without travel history to known endemic area was investigated in the current cross sectional study from a conveniently selected sample of patients admitted to the medicine department of Sher-e-Bangla medical College Hospital form Barisal district from July 15, through August, to September 15, 2019. Clinical and laboratory data were collected by attending doctors and checked by investigators. The primary diagnostic tool was NS1 antigen detected by SD Bioline Dengue NS1 Ag Test Kit. Data entry and analysis was done by SPSS version 24.0 software. Result: A total number of sample size was 212 admitted patents of whom 138(65.1%) were male, 74 (34.9 %) were female,116 (54.7%) of patients traveled to a known endemic zone, 96 (45.3%) did not; 206 (97.2%) were NS1 positive, 4 (1.9%) were IgM positive, 2 (0.9%) were IgM positive and IgG positive; Of travelling 116 patients, 92(79.3%) were male, 24(20.7%) were female, of travelling 96 patients 46(47.9%) were male, 50(52.1%) were female. p-value was <0.001. Conclusion: The study concluded that Dengue is becoming endemic in previously non-endemic zones like greater Barisal, though travelers still holds the major share of disease burden. Male preponderance in traveling to endemic zone was statistically significant. Bangladesh Journal of Infectious Diseases 2020;7(1):3-7

scholarly journals Low Sensitivity of NS1 Protein Tests Evidenced during a Dengue Type 2 Virus Outbreak in Santos, Brazil, in 2010

2012 ◽  
Vol 19 (12) ◽  
pp. 1972-1976 ◽  
Author(s):  
Alvina Clara Felix ◽  
Camila Malta Romano ◽  
Cristiane de Campos Centrone ◽  
Célia Lima Rodrigues ◽  
Lucy Villas-Boas ◽  
...  
Keyword(s):  
Secondary Infection ◽  
False Negative ◽  
Ns1 Protein ◽  
Negative Results ◽  
False Negative Results ◽  
Large Outbreak ◽  
Ns1 Antigen ◽  
Low Sensitivity ◽  
Dengue Type 2 Virus

ABSTRACTIn 2010, a large outbreak of dengue occurred in Santos, Brazil. The detection of the NS1 antigen was used for diagnosis in addition to the detection of IgG, IgM, and RNA. A large number of NS1 false-negative results were obtained. A total of 379 RNA-positive samples were selected for thorough evaluation. NS1 was reactive in 37.7% of cases. Most of the cases were characterized as a secondary infection by dengue 2 virus. Sequencing of NS1 positive and negative isolates did not reveal any mutation that could justify the diagnostic failure. Use of existing NS1 tests in the Brazilian population may present a low negative predictive value, and they should be used with caution, preferentially after performing a validation with samples freshly obtained during the ongoing epidemic.

scholarly journals Self-Management Maintenance Inhalation Therapy With eHealth (SELFIE): Observational Study on the Use of an Electronic Monitoring Device in Respiratory Patient Care and Research (Preprint)

2019 ◽  
Author(s):  
Esther Kuipers ◽  
Charlotte C Poot ◽  
Michel Wensing ◽  
Niels H Chavannes ◽  
Peter AGM de Smet ◽  
...  
Keyword(s):  
Observational Study ◽  
Positive Predictive Value ◽  
Health Care Providers ◽  
Predictive Value ◽  
Electronic Monitoring ◽  
False Negative ◽  
Inhalation Therapy ◽  
Care Providers ◽  
Convenience Sample ◽  
Patient Reported

BACKGROUND Electronic inhalation monitoring devices (EIMDs) are available to remind patients with respiratory diseases to take their medication and register inhalations for feedback to patients and health care providers as well as for data collection in research settings. OBJECTIVE This study aimed to assess the validity as well as the patient-reported usability and acceptability of an EIMD. METHODS This observational study planned to include 21 community pharmacies in the Netherlands. Patient-reported inhalations were collected and compared to EIMD registrations to evaluate the positive predictive value of these registrations as actual patient inhalations. Patients received questionnaires on their experiences and acceptance. RESULTS A convenience sample of 32 patients was included from across 18 pharmacies, and 932 medication doses were validated. Of these, 796 registrations matched with patient-reported use (true-positive, 85.4%), and 33 inhalation registrations did not match with patient-reported use (false-positive, 3.5%). The positive predictive value was 96.0%, and 103 patient-reported inhalations were not recorded in the database (false-negative, 11.1%). Overall, patients considered the EIMD to be acceptable and easy to use, but many hesitated to continue its use. Reminders and motivational messages were not appreciated by all users, and more user-tailored features in the app were desired. CONCLUSIONS Patients’ interaction with the device in real-world settings is critical for objective measurement of medication adherence. The positive predictive value of this EIMD was found to be acceptable. However, patients reported false-negative registrations and a desire to include more user-tailored features to increase the usability and acceptability of the EIMD.

scholarly journals Distinguishing active pediatric COVID-19 pneumonia from MIS-C

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Daniel D. Reiff ◽  
Melissa L. Mannion ◽  
Nichole Samuy ◽  
Paul Scalici ◽  
Randy Q. Cron
Keyword(s):  
Health Care Providers ◽  
Laboratory Data ◽  
Gastrointestinal Symptoms ◽  
Signs And Symptoms ◽  
Response To Treatment ◽  
Treatment Modalities ◽  
Care Providers ◽  
Male Predominance ◽  
Clinical Notes ◽  
Exposure History

Abstract Importance Active pediatric COVID-19 pneumonia and MIS-C are two disease processes requiring rapid diagnosis and different treatment protocols. Objective To distinguish active pediatric COVID-19 pneumonia and MIS-C using presenting signs and symptoms, patient characteristics, and laboratory values. Design Patients diagnosed and hospitalized with active COVID-19 pneumonia or MIS-C at Children’s of Alabama Hospital in Birmingham, AL from April 1 through September 1, 2020 were identified retrospectively. Active COVID-19 and MIS-C cases were defined using diagnostic codes and verified for accuracy using current US Centers for Disease Control case definitions. All clinical notes were reviewed for documentation of COVID-19 pneumonia or MIS-C, and clinical notes and electronic medical records were reviewed for patient demographics, presenting signs and symptoms, prior exposure to or testing for the SARS-CoV-2 virus, laboratory data, imaging, treatment modalities and response to treatment. Findings 111 patients were identified, with 74 classified as mild COVID-19, 8 patients as moderate COVID-19, 8 patients as severe COVID-19, 10 as mild MIS-C and 11 as severe MIS-C. All groups had a male predominance, with Black and Hispanic patients overrepresented as compared to the demographics of Alabama. Most MIS-C patients were healthy at baseline, with most COVID-19 patients having at least one underlying illness. Fever, rash, conjunctivitis, and gastrointestinal symptoms were predominant in the MIS-C population whereas COVID-19 patients presented with predominantly respiratory symptoms. The two groups were similar in duration of symptomatic prodrome and exposure history to the SARS-CoV-2 virus, but MIS-C patients had a longer duration between presentation and exposure history. COVID-19 patients were more likely to have a positive SAR-CoV-2 PCR and to require respiratory support on admission. MIS-C patients had lower sodium levels, higher levels of C-reactive protein, erythrocyte sedimentation rate, d-dimer and procalcitonin. COVID-19 patients had higher lactate dehydrogenase levels on admission. MIS-C patients had coronary artery changes on echocardiography more often than COVID-19 patients. Conclusions and relevance This study is one of the first to directly compare COVID-19 and MIS-C in the pediatric population. The significant differences found between symptoms at presentation, demographics, and laboratory findings will aide health-care providers in distinguishing the two disease entities.

scholarly journals Bringing the clinical laboratory into the strategy to advance diagnostic excellence

Diagnosis ◽  
2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Ira M. Lubin ◽  
J. Rex Astles ◽  
Shahram Shahangian ◽  
Bereneice Madison ◽  
Ritchard Parry ◽  
...  
Keyword(s):  
Quality Management ◽  
Health Care Providers ◽  
Clinical Laboratory ◽  
Laboratory Data ◽  
Diagnostic Errors ◽  
Care Quality ◽  
Diagnostic Process ◽  
Management Approach ◽  
Care Providers ◽  
Medical Diagnoses

Abstract Objectives Clinical laboratory testing provides essential data for making medical diagnoses. Generating accurate and timely test results clearly communicated to the treating clinician, and ultimately the patient, is a critical component that supports diagnostic excellence. On the other hand, failure to achieve this can lead to diagnostic errors that manifest in missed, delayed and wrong diagnoses. Content Innovations that support diagnostic excellence address: 1) test utilization, 2) leveraging clinical and laboratory data, 3) promoting the use of credible information resources, 4) enhancing communication among laboratory professionals, health care providers and the patient, and 5) advancing the use of diagnostic management teams. Integrating evidence-based laboratory and patient-care quality management approaches may provide a strategy to support diagnostic excellence. Professional societies, government agencies, and healthcare systems are actively engaged in efforts to advance diagnostic excellence. Leveraging clinical laboratory capabilities within a healthcare system can measurably improve the diagnostic process and reduce diagnostic errors. Summary An expanded quality management approach that builds on existing processes and measures can promote diagnostic excellence and provide a pathway to transition innovative concepts to practice. Outlook There are increasing opportunities for clinical laboratory professionals and organizations to be part of a strategy to improve diagnoses.

scholarly journals Prevalence of metabolic syndrome among patients with schizophrenia in Ethiopia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Feyissa Challa ◽  
Tigist Getahun ◽  
Meron Sileshi ◽  
Zeleke Geto ◽  
Teshome S. Kelkile ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
General Population ◽  
Health Care Providers ◽  
Negative Symptoms ◽  
Clinical Chemistry ◽  
Addis Ababa ◽  
Laboratory Data ◽  
Hdl Cholesterol ◽  
Care Providers ◽  
Cross Sectional

Abstract Background Globally, the prevalence of metabolic syndrome (MetS) is higher among patients with schizophrenia than the general population, and this leads to higher morbidity and mortality in this population. The aim of this study was to investigate the MetS prevalence among patients with schizophrenia in Ethiopia. Methods We conducted a cross-sectional analysis of baseline data of 200 patients with schizophrenia recruited from Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia. Lipid profile and blood glucose levels were measured using Roche Cobas 6000 clinical chemistry analyzer. The prevalence of MetS was assessed based on National Cholesterol Education Program Adult Treatment Panel III criteria. Patients’ demographic information, clinical and laboratory data, lifestyle habits, particularly smoking and Khat chewing, were evaluated vis-à-vis MetS. Results The overall prevalence of MetS in patients with schizophrenia was 21.5% (17.1% male, 29.6% female) where Low HDL-cholesterol value was the most common metabolic disorders components in both males and females subgroups. In the multivariate analysis, the positive and negative symptoms score (PANSS, AOR = 1.03, 95% CI 1.001–1.054) was associated factors with MetS. Conclusion In Ethiopia, patients with schizophrenia were found to have higher prevalence of MetS than the general population. Physicians/health care providers should routinely screen patients with schizophrenia for MetS and initiate timely management of those who develop the syndrome to reduce the health cost from caring for NCDs, improve the patients’ quality of life, and prevent premature mortality.

scholarly journals Lower Cutoffs for LC-MS/MS Urine Drug Testing Indicates Better Patient Compliance

2017 ◽  
Vol 7 (20;7) ◽  
pp. E1107-E1113
Author(s):  
Kevin Krock
Keyword(s):  
Health Care Providers ◽  
Drug Testing ◽  
Illicit Drugs ◽  
Patient Adherence ◽  
False Negative ◽  
Test Results ◽  
Care Providers ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Cutoff Levels

Background: Urine drug testing is used by health care providers to determine a patient’s compliance to their prescribed regimen and to detect non-prescribed medications and illicit drugs. However, the cutoff levels used by clinical labs are often arbitrarily set and may not reflect the urine drug concentrations of compliant patients. Objectives: Our aim was to test the hypothesis that commonly used cutoffs for many prescribed and illicit drugs were set too high, and methods using these cutoffs may yield a considerable number of false-negative results. The goals of this study were to outline the way to analyze patient results and estimate a more appropriate cutoff, develop and validate a high sensitivity analytical method capable of quantitating drugs and metabolites at lower than the commonly used cutoffs, and determine the number of true positive results that would have been missed when using the common cutoffs. Study Design: This was a retrospective study of urine specimens submitted for urine drug testing as part of the monitoring of prescription drug compliance described in chronic opioid therapy treatment guidelines. Setting: The study was set in a clinical toxicology laboratory, using specimens submitted for routine analysis by health care providers in the normal course of business. Methods: Lognormal distributions of test results were generated and fitted with a trendline to estimate the required cutoff level necessary to capture the normal distributions of each drug for the patient population study. A validated laboratory derived liquid chromatography tandem mass spectrometry (LC-MS/MS) analysis capable of achieving the required cutoff levels was developed for each drug and/or metabolite. Results: The study shows that a lognormal distribution of patient urine test results fitted with a trendline is appropriate for estimating the required cutoff levels needed to assess medication adherence. The study showed a wide variation in the false-negative rate, ranging from 1.5% to 94.3% across a range of prescribed and illicit drugs. Limitations: The patient specimens were largely sourced from patients in either a long-term pain management program or in treatment for substance use disorder in the US. These specimens may not be representative of patients in other types of treatment or in countries with different approaches to these issues. Conclusions: The high-sensitivity method reduces false-negative results which could negatively impact patient care. Clinicians using less sensitive methods for detecting and quantifying drugs and metabolites in urine should exercise caution in assessing patient adherence using and changing the treatment plan based on those results. Key words: Urine drug testing, patient adherence, clinical toxicology, immunoassay, LC-MS, definitive drug testing, REMS, negative test results, false negative

Fatal outcomes of imported dengue fever in adult travelers from non-endemic areas are associated with primary infections

2021 ◽  
Author(s):  
Ralph Huits ◽  
Eli Schwartz
Keyword(s):  
Health Care Providers ◽  
Case Reports ◽  
Secondary Infection ◽  
Fatal Outcome ◽  
Case Fatality ◽  
Severe Dengue ◽  
Care Providers ◽  
Denv Serotypes ◽  
Secondary Infections ◽  
The Impact

Abstract Background The case-fatality rate of dengue in travelers is low. Secondary dengue virus (DENV) infections are considered a risk factor for fatal outcome in endemic populations; however, the impact of secondary infections on mortality in travelers has not been studied systematically. We performed a descriptive analysis of case reports of dengue fatalities in travelers. Methods We searched Medline for clinical case reports, using the free terms and MeSH headings: ‘Dengue’ OR ‘Severe Dengue’ AND ‘Travel-Related Illness’ OR ‘travel’ AND ‘Mortality’ OR ‘Fatal Outcome’. We analyzed case reports of fatal dengue in returning travelers published from 1995 to 2020, with the objective to detail risk factors for dengue mortality in this population. We verified the authors’ classifications of primary or secondary dengue infections; infections were considered as primary by absence of anti-DENV immunoglobulin (Ig)G or by IgM-to-IgG ratios greater than or equal to 1.8 in the first 7 days post symptom onset. Results We identified nine detailed reports of dengue with fatal outcome among travelers from non-endemic countries. Eight fatalities were female. The median age was 32 years (range 21–63). Out of nine fatal cases, seven travelers had a primary DENV infection, one had a secondary infection and, in one, these data were not reported. The infecting DENV serotypes were DENV-1 (n = 2), DENV-2 (n = 2) and DENV-3 (n = 3); DENV-1 or 2 (n = 1) and in one case, the serotype could not be determined. Conclusions Dengue-related deaths in travelers are rare. Most dengue cases in travelers are primary infections. Contrary to prevailing conceptions, we found that fatal outcomes of dengue in travelers from non-endemic countries were reported mainly with primary DENV infections. We alert health care providers that primary DENV infections are not always harmless and that in adult travelers from non-endemic countries, primary infections may contribute more to dengue-related mortality than secondary infections.

scholarly journals A Comparison of Ethyl Glucuronide and Ethanol Testing in Arizona’s State Physician Health Monitored Aftercare Program

2006 ◽  
Vol 92 (1) ◽  
pp. 7-10
Author(s):  
Marianne Jansen ◽  
Leonard B. Bell ◽  
Michel A. Sucher ◽  
Kimbal E. Cooper ◽  
James D. Stoehr
Keyword(s):  
Health Care ◽  
Alcohol Use ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
False Negative ◽  
Monitoring Program ◽  
Ethyl Glucuronide ◽  
Care Providers ◽  
Physician Health ◽  
A Minor

ABSTRACT Aftercare monitoring programs for health care professionals with documented substance abuse problems are managed differently by various states and their respective licensing boards. Many programs have reported surreptitious alcohol use as a significant concern, yet there is no clear indication of the best methods for detecting alcohol use since the detection of ethanol is difficult due to its limited half-life in saliva, urine and serum. Ethyl glucuronide (EtG), a minor metabolite of alcohol metabolism, is only present in urine when alcohol has been consumed. EtG testing may therefore improve the detection of alcohol use by health care professionals in monitored aftercare programs. This study compared urine ethanol (Medpro B panel) and urine EtG in specimens from 126 clients enrolled in Arizona’s physician health aftercare monitoring program. Each client was tested twice per month for a two-month period in 2004. Of the 504 tests, there were no positive urine ethanol results using a standard, lab determined minimum cutoff level of 20mg/dL. There were four positive EtG results (one percent positive rate) using a minimum cutoff level of 100ng/mL. The four positive EtG results imply the presence of four false negative urine ethanol results. Therefore, the results suggest that the EtG test is more sensitive for alcohol detection and should be considered for future improvements in the testing and monitoring of health care providers enrolled in aftercare programs.

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