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Introduction: Dynamic changes in liver function tests have been proposed to correctly reclassify the risk of choledocholithiasis; however, information is scarce and insufficient to recommend its use. Methods: Retrospective cohort of patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) due to moderate and high risk of choledocholithiasis according to the 2019 American Society of Gastrointestinal Endoscopy (ASGE) guidelines. We evaluated whether significant changes in liver function tests (bilirubin, transaminases, or alkaline phosphatase), defined as an increase or a reduction ⩾30 or ⩾50% between two measurements taken with a difference of 24-72 h can correctly reclassify the risk of choledocholithiasis beyond the ASGE guidelines. The net reclassification index (NRI) was calculated for patients with and without choledocholithiasis. Results: Among 1175 patients who underwent ERCP, 170 patients were included in the analysis (59.4% women, median 59.5 years). Among patients without a diagnosis of choledocholithiasis, the number of patients correctly reclassified by transaminases was slightly higher than those incorrectly reclassified (NRI = 0.24 for aspartate amino transaminase and 0.20 for alanine amino transaminase). However, among patients with a diagnosis of choledocholithiasis, it led to incorrect reclassification in a greater number of cases (NRI = -0.21 and -0.14, respectively). The benefits of reclassification were minimal for bilirubin and alkaline phosphatase, or for value changes >50%. A subgroup analysis showed similar findings in patients without a history of cholecystectomy and in those with normal bile duct. Conclusion: Dynamic changes in liver function tests do not improve choledocholithiasis risk classification beyond the 2019 ASGE criteria. New criteria should continue to be sought to optimize risk stratification.
RESUMO
Objetivo: Analisar a acurácia do teste rápido da urease para detecção de Helicobacter pylori comparado com o exame histopatológico. Métodos: Estudo prospectivo e descritivo realizado de abril de 2018 a maio de 2019 em um Serviço de Endoscopia e Biliopancreática e em um laboratório de patologia. A amostra foi composta de 64 pacientes, de ambos os sexos, com idade de 35 a 81 anos, que apresentavam queixas dispépticas. Foram realizados exame histopatológico e teste rápido da urease. Os dados foram analisados pelo R Core team 2019 e submetidos a análises descritivas (variáveis categóricas) e inferenciais (teste de associação de qui-quadrado de Pearson e teste de Mann-Whitney). O nível de significância adotado foi de 5%. Resultados: O teste rápido da urease demonstrou que dez pacientes foram verdadeiros-positivos, 39 verdadeiros-negativos, três falsos-positivos, 12 falsos-negativos, com sensibilidade de 45,4% (25,1% a 67,3%), especificidade de 92,9% (79,4% a 98,1%), valor preditivo positivo de 76,9% (45,9% a 93,8%), valor preditivo negativo de 76,5% (62,2% a 86,7%), acurácia de 76,6% (64,0% a 85,9%), razão de chance diagnóstica 10,8 (2,56 a 45,9), índice de Youden 0,38 (0,16 a 0,60) e taxa de erro de 23,4% (14,1% a 36,0%). Conclusão: O teste rápido da urease apresentou baixa capacidade de detectar pacientes infectados, menor acurácia em relação ao estudo anatomopatológico e alta especificidade. O teste pode ser útil no momento da realização da endoscopia, por fornecer resultado rápido e barato para detectar H. pylori. O diagnóstico da bactéria apresenta maior confiabilidade com a realização dos dois métodos para pesquisa de H. pylori.
Objective: To analyze the accuracy of the rapid urease test for Helicobacter pylori detection when compared with the histopathological examination. Methods: This is a prospective and descriptive study conducted from April 2018 to May 2019, at an Endoscopy and Biliopancreatic Service and in a pathology laboratory. The sample consisted of 64 male and female patients aged 35 to 81 years old with dyspeptic complaints. Histopathological examination and rapid urease test were performed. Data were analyzed by R Corel team 2019 and underwent descriptive (categorical variables) and inferential (Pearson's Chi-squared association test and Mann-Whitney test) analyzes. The significance level adopted was 5%. Results: The rapid urease test showed that ten patients were true positive, 39 true negative, three false-positive, and 12 false-negative, and sensitivity was of 45.4% (25.1% to 67.3%), specificity 92.9% (79.4% to 98.1), positive predictive value of 76.9% (45.9-93.8%), negative predictive value of 76.5% (62.2% to 86.7%), accuracy of 76.6% (64.0% to 85.9%), diagnostic odds ratio of 10.8 (2.56% to 45.9), Youden index 0.38 (0.38% to 0.60), and error rate 23.4 (14.1% to 36.0%). Conclusion: The rapid urease test showed low ability to detect infected patients, lower accuracy compared to the pathological study, and high specificity. The test may be useful at the time of endoscopy, as it provides a quick and inexpensive result to detect H. pylori. The diagnosis of the bacterium is more reliable when both methods for H. pylori investigation are performed
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Urease/análise , Helicobacter pylori/enzimologia , Infecções por Helicobacter/diagnóstico , Mucosa Gástrica/patologia , Biópsia , Estudos Prospectivos , Sensibilidade e Especificidade , Gastroscopia , Dispepsia/diagnósticoRESUMO
É uma doença infecciosa causada por um protozoário parasita chamado Trypanosoma cruzi,nome dado por seu descobridor, o cientista brasileiro Carlos Chagas, em homenagem a outro cientista, também brasileiro, Oswaldo Cruz. Essa doença é conhecida popularmente como doença do coração crescido, além disso, os locais com mais índices dessa doença são as regiões do Norte e Sudeste e tem como formas de diagnósticos exames de sorologiaparasitários e xenodiagnóstico. E uma das principais formas de prevenção da doença vem sendo o uso de telas e repelentes.
It is an infectious disease caused by a protozoan parasite calledTrypanosoma cruzi, named after its discoverer, the Brazilian scientistCarlos Chagas, in honor of another scientist, also, Brazilian, Oswaldo Cruz. This disease is popularly known as a disease of the heart grown, in addition, the sites with the most indexes of this disease are the regions of the North and southeast and have as diagnostic methods serologica tests parasitic and xenodiagnosis. And one of the main forms of prevention of the disease has been the use of screens and repellents.
Assuntos
Trypanosoma cruzi , Doença de Chagas/etiologia , Doença de Chagas/fisiopatologia , Doença de Chagas/prevenção & controle , Doença de Chagas/terapia , Doença de Chagas/epidemiologia , Ensaios Enzimáticos ClínicosRESUMO
Fundamento: la proteína amiloide A sérica es producida en respuesta a la liberación de citoquinas por parte de monocitos y macrófagos, después de un estímulo de fase aguda como es la infección. Objetivo: determinar los niveles séricos de amiloide A y su asociación con pacientes diagnosticados con periodontitis crónica. Métodos: se realizó un estudio observacional de corte transversal, el universo estuvo constituido por 80 pacientes con periodontitis crónica y 28 personas sin periodontitis como grupo control. El diagnóstico de periodontitis crónica se basó en criterios definidos con anterioridad. Todos los participantes respondieron un cuestionario relacionado con características sociodemográficas. Para calcular los niveles de amiloide A sérico se realizó una prueba de ensayo enzimático. Resultados: los niveles de amiloide A sérico patológicos se asociaron con la periodontitis (p=0,002) y se correlacionaron de manera significativa con mayor edad (r=2,42; p=0,01); sin embargo, la regresión logística ajustada por edad mostró asociación estadística significativa solo con periodontitis (OR=5,6; intervalo de confianza del 95 % 1,7-19). Conclusiones: la probabilidad de presentar niveles patológicos de amiloide A sérico en pacientes con periodontitis crónica es seis veces la de los pacientes sin periodontitis, lo cual podría ser un factor de riesgo para enfermedades cardiovasculares.
Background: serum amyloid A protein is produced in response to the cytokines released by monocytes and macrophages after an acute-phase stimulus such as infection. Objective: to determine the serum levels of amyloid A protein and its association with patients diagnosed with chronic periodontal disease. Methods: a cross-sectional observational study was conducted. The universe was composed of 80 patients with chronic periodontitis and 28 people without periodontal affections as a control group. Diagnosis of chronic periodontal disease was based on criteria stated previously. All the participants answered a questionnaire related to sociodemographic characteristics. A clinical enzymatic trial was carried out to calculate the levels of pathological serum amyloid A. Results: pathological levels of serum amyloid A were associated with periodontitis (p=0,002) and were correlated significantly with older age (r=2, 42; p=0, 01). Nevertheless, logistic regression adjusted by age showed remarkable statistical association only with periodontal disease (OR=5, 6; interval from 95 % 1, 7-19). Conclusions: probability of presenting pathological levels of serum amyloid A in patients with chronical periodontal disease is six times the one of the patients without this affection. That could me a risk factor for cardiovascular diseases.