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Paats A, Valinotti V, Coronel J, Riquelme S, Colman N. AB1054 CLINICAL CHARACTERISTICS OF PATIENTS WITH UVEITIS FROM AN AUTOIMMUNE OCULAR DISEASE UNIT. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:The eye, particularly the uvea due to its substantial vascularization, can be a target for various inmune reactions. Etiology is unknown in most cases of inflamatory ocular disease. Ocassionally, ocular symptoms may be the first manifestation of some systemic diseases and its appearence, therefore, can lead us to the diagnosis and institution of treatment that, if performed early, can avoid irreversible sequelae.Aim: Describe the experience at 12 months of an autoinmune ocular disease unit.Objectives:to describe the clinical characteristics of patients diagnosed with uveitis and its association with systemic disease.Methods:Retrospective, descriptive study. We included patients diagnosed with uveitis attending the Autoimmune Eye Disease Unit from January 2019 to December 2019. Qualitative variables were expressed as frequencies and percentages and quantitative variables as means and standard deviation.Results:A total of 40 patients were included, 72.5% were women (26/40). Mean age of disease onset was 38 ± 17.2 years and the average diagnostic delay was 19.4 ± 46.8 months. The most frequent chief complaint was decrease in visual acuity, cited in 43.8% of the consults (25/57). Involvement was bilateral in 55% of cases (22/40). In order of decreasing frequency, diagnosis found were: Anterior uveitis in 47.5% (19/40), panuveitis in 35% (14/40), posterior uveitis in 10% (4/40) and intermediate uveitis in 7.5% (3/40). There was a recurrence (2 or more episodes of uveitis) in 65.7% (25/38) of patients and 58.8% (20/34) of them presented some sequelae. Prior to their first episode of uveitis, 12.5% (5/40) of patients had already been diagnosed with an autoimmune disease, the most common of which was spondyloarthropathy (3/5). Meanwhile, 33.3% (13/39) were diagnosed with a systemic disease from their first episode of uveitis. Regarding laboratory tests, 46.4% (13/28) of patients presented acute phase reactants, 13% (3/23) had positive serum antibodies and 41.6% (5/12) were HLA-B27 positive. Concerning treatment, 76.3% of patients required systemic corticosteroids (29/38) and 75% received at least one immunosuppressive drug (30/40). Out of this group, 30% needed a second immunosuppressive drug. Response to treatment was good in 63.6% of patients (21/33), partial in 18.1% (6/33), poor despite treatment in 6% (2/33) and poor due to lack of adherence in 12.1% (4/33).Conclusion:In our cohort, there was a predominance of female, middle-aged patients with bilateral involvement. Anterior uveitis was the most frequent diagnosis. In one-third of patients, the first episode of uveitis led to diagnosis of a systemic disease. Most of our patients presented some type of sequel or local complication and required systemic treatment with corticosteroids and immunosuppressants.Disclosure of Interests:None declared
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Huangfu P, Laurence YV, Alisjahbana B, Ugarte-Gil C, Riza AL, Walzl G, Ruslami R, Moore DAJ, Ioana M, McAllister S, Ronacher K, Koesoemadinata RC, Grint D, Kerry S, Coronel J, Malherbe ST, Griffiths U, Dockrell HM, Hill PC, van Crevel R, Pearson F, Critchley JA. Point of care HbA 1c level for diabetes mellitus management and its accuracy among tuberculosis patients: a study in four countries. Int J Tuberc Lung Dis 2019; 23:283-292. [PMID: 30871659 DOI: 10.5588/ijtld.18.0359] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is common among tuberculosis (TB) patients and often undiagnosed or poorly controlled. We compared point of care (POC) with laboratory glycated haemoglobin (HbA1c) testing among newly diagnosed TB patients to assess POC test accuracy, safety and acceptability in settings in which immediate access to DM services may be difficult. METHODS We measured POC and accredited laboratory HbA1c (using high-performance liquid chromatography) in 1942 TB patients aged 18 years recruited from Peru, Romania, Indonesia and South Africa. We calculated overall agreement and individual variation (mean ± 2 standard deviations) stratified by country, age, sex, body mass index (BMI), HbA1c level and comorbidities (anaemia, human immunodeficiency virus [HIV]). We used an error grid approach to identify disagreement that could raise significant concerns. RESULTS Overall mean POC HbA1c values were modestly higher than laboratory HbA1c levels by 0.1% units (95%CI 0.1-0.2); however, there was a substantial discrepancy for those with severe anaemia (1.1% HbA1c, 95%CI 0.7-1.5). For 89.6% of 1942 patients, both values indicated the same DM status (no DM, HbA1c <6.5%) or had acceptable deviation (relative difference <6%). Individual agreement was variable, with POC values up to 1.8% units higher or 1.6% lower. For a minority, use of POC HbA1c alone could result in error leading to potential overtreatment (n = 40, 2.1%) or undertreatment (n = 1, 0.1%). The remainder had moderate disagreement, which was less likely to influence clinical decisions. CONCLUSION POC HbA1c is pragmatic and sufficiently accurate to screen for hyperglycaemia and DM risk among TB patients.
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Affiliation(s)
- P Huangfu
- Population Health Research Institute, St George's University of London, London
| | - Y V Laurence
- Department of Global Health and Development, Faculty of Public Health and Policy, TB Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - B Alisjahbana
- Infectious Disease Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - C Ugarte-Gil
- Facultad de Medicina Alberto Hurtado and Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - A-L Riza
- Human Genomics Laboratory, Universitatea de Medicina si Farmacie din Craiova, Romania, Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - G Walzl
- Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research and South African Medical Research Council Centre for Tuberculosis Research, Tygerberg, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - R Ruslami
- Infectious Disease Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - D A J Moore
- Facultad de Medicina Alberto Hurtado and Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru, TB Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - M Ioana
- Human Genomics Laboratory, Universitatea de Medicina si Farmacie din Craiova, Romania, Dolj Regional Centre of Medical Genetics, Emergency County Clinical Hospital Craiova, Romania
| | - S McAllister
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - K Ronacher
- Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research and South African Medical Research Council Centre for Tuberculosis Research, Tygerberg, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, Mater Medical Research, The University of Queensland, Translational Research Institute, Brisbane, Queensland, Australia
| | - R C Koesoemadinata
- Infectious Disease Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - D Grint
- Population Health Research Institute, St George's University of London, London
| | - S Kerry
- Population Health Research Institute, St George's University of London, London
| | - J Coronel
- Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia Lima, Peru
| | - S T Malherbe
- Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research and South African Medical Research Council Centre for Tuberculosis Research, Tygerberg, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - U Griffiths
- Department of Global Health and Development, Faculty of Public Health and Policy
| | - H M Dockrell
- Department of Immunology & Infection, London School of Hygiene & Tropical Medicine, London, UK
| | - P C Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - R van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - F Pearson
- Population Health Research Institute, St George's University of London, London
| | - J A Critchley
- Population Health Research Institute, St George's University of London, London
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Falzone YP, Carranza J, Machuca P, Monroig J, Cusmano L, Ortega G, Giamperetti S, Deodato B, Gomez N, Bouzas M, Nogueras C, Cantero M, Riveros J, Coronel J, Lloveras S. 2016 dengue outbreak in Buenos Aires: A case series. Int J Infect Dis 2018. [DOI: 10.1016/j.ijid.2018.04.3465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Coronel J, Martínez B, Robledo N, Villalba P. ECONOMIC EVALUATION OF INTENSIVE FATTENING OF BOVINE IN A LIVESTOCK ESTABLISHMENT OF THE DISTRICT OF TACUATI, DEPARTMENT OF SAN PEDRO, REPUBLIC OF PARAGUAY. Compend cienc vet 2017. [DOI: 10.18004/compend.cienc.vet.2017.07.02.28-33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Trollip AP, Moore D, Coronel J, Caviedes L, Klages S, Victor T, Romancenco E, Crudu V, Ajbani K, Vineet VP, Rodrigues C, Jackson RL, Eisenach K, Garfein RS, Rodwell TC, Desmond E, Groessl EJ, Ganiats TG, Catanzaro A. Second-line drug susceptibility breakpoints for Mycobacterium tuberculosis using the MODS assay. Int J Tuberc Lung Dis 2014; 18:227-32. [PMID: 24429318 DOI: 10.5588/ijtld.13.0229] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To establish breakpoint concentrations for the fluoroquinolones (moxifloxacin [MFX] and ofloxacin [OFX]) and injectable second-line drugs (amikacin [AMK], kanamycin [KM] and capreomycin [CPM]) using the microscopic observation drug susceptibility (MODS) assay. SETTING A multinational study conducted between February 2011 and August 2012 in Peru, India, Moldova and South Africa. DESIGN In the first phase, breakpoints for the fluoroquinolones and injectable second-line drugs (n = 58) were determined. In the second phase, MODS second-line drug susceptibility testing (DST) as an indirect test was compared to MGIT™ DST (n = 89). In the third (n = 30) and fourth (n = 156) phases, we determined the reproducibility and concordance of MODS second-line DST directly from sputum. RESULTS Breakpoints for MFX (0.5 μg/ml), OFX (1 μg/ml), AMK (2 μg/ml), KM (5 μg/ml) and CPM (2.5 μg/ml) were determined. In all phases, MODS results were highly concordant with MGIT DST. The few discrepancies suggest that the MODS breakpoint concentrations for some drugs may be too low. CONCLUSION MODS second-line DST yielded comparable results to MGIT second-line DST, and is thus a promising alternative. Further studies are needed to confirm the accuracy of the drug breakpoints and the reliability of MODS second-line DST as a direct test.
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Affiliation(s)
- A P Trollip
- Biomedical Sciences, Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, Medical Research Council Centre for Molecular and Cellular Biology, Stellenbosch University, Cape Town, South Africa
| | - D Moore
- TB Centre and Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK; Laboratorio de Investigación de Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - J Coronel
- Laboratorio de Investigación de Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - L Caviedes
- Laboratorio de Investigación de Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - S Klages
- Biomedical Sciences, Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, Medical Research Council Centre for Molecular and Cellular Biology, Stellenbosch University, Cape Town, South Africa
| | - T Victor
- Biomedical Sciences, Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, Medical Research Council Centre for Molecular and Cellular Biology, Stellenbosch University, Cape Town, South Africa
| | - E Romancenco
- Microbiology and Morphology Laboratory, Phthisiopneumology Institute, Chisinau, Moldova
| | - V Crudu
- Microbiology and Morphology Laboratory, Phthisiopneumology Institute, Chisinau, Moldova
| | - K Ajbani
- Department of Microbiology, Parmanand Deepchand Hinduja National Hospital and Medical Research Centre Tertiary Care Hospital, Mumbai, India
| | - V P Vineet
- Department of Microbiology, Parmanand Deepchand Hinduja National Hospital and Medical Research Centre Tertiary Care Hospital, Mumbai, India
| | - C Rodrigues
- Department of Microbiology, Parmanand Deepchand Hinduja National Hospital and Medical Research Centre Tertiary Care Hospital, Mumbai, India
| | - R L Jackson
- University of California San Diego School of Medicine, La Jolla, California, USA
| | - K Eisenach
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - R S Garfein
- University of California San Diego School of Medicine, La Jolla, California, USA
| | - T C Rodwell
- Division of Global Public Health, University of California San Diego School of Medicine, La Jolla, California, USA
| | - E Desmond
- Mycobacteriology and Mycology Section, Microbial Diseases Laboratory, California Department of Public Health, Richmond, California, USA
| | - E J Groessl
- University of California San Diego, Veterans' Affairs San Diego Healthcare System, La Jolla, California, USA
| | - T G Ganiats
- University of California San Diego Health Services Research Center, UCSD, La Jolla, California, USA
| | - A Catanzaro
- University of California San Diego School of Medicine, La Jolla, California, USA
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Coronel J, Roper MH, Herrera C, Bonilla C, Jave O, Gianella C, Sabogal I, Huancaré V, Leo E, Tyas A, Mendoza-Ticona A, Caviedes L, Moore DAJ. Validation of microscopic observation drug susceptibility testing for rapid, direct rifampicin and isoniazid drug susceptibility testing in patients receiving tuberculosis treatment. Clin Microbiol Infect 2013; 20:536-41. [PMID: 24107197 PMCID: PMC4302318 DOI: 10.1111/1469-0691.12401] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 07/22/2013] [Accepted: 09/16/2013] [Indexed: 12/01/2022]
Abstract
Drug susceptibility testing (DST) is often needed in patients clinically failing tuberculosis (TB) therapy. Most studies of phenotypic direct drug susceptibility tests, such as microscopic observation drug susceptibility (MODS) tests, have been performed in patients not receiving TB treatment. The effect of ongoing TB treatment on the performance of MODS direct DST has not been previously explored, but patients failing such therapy constitute an important target group. The aim of this study was to determine the performance of MODS direct rifampicin and isoniazid DST in patients clinically failing first-line TB treatment, and to compare MODS direct DST with indirect proportion method DST. Sputa from 264 TB patients were cultured in parallel in Lowenstein–Jensen (LJ) and MODS assays; strains were tested for rifampicin and isoniazid susceptibility by the proportion method at the national reference laboratory. Ninety-three samples were culture-positive by LJ and MODS (concordance of 96%; kappa 0.92). With conventional MODS plate DST reading (performed on the same day as the sample is classified as culture-positive), the isoniazid DST concordance was 96.8% (kappa 0.89), and the concordance for rifampicin susceptibility testing was 92.6% (kappa 0.80). Reading of MODS DST plates 1 week after cultures had been determined to be culture-positive improved overall performance marginally—the isoniazid DST concordance was 95.7% (kappa 0.85); and the rifampicin DST concordance was 96.8% (kappa 0.91). Sensitivity for detection of multidrug-resistant TB was 95.8%. MODS testing provided reliable rifampicin and isoniazid DST results for samples obtained from patients receiving TB therapy. A modified DST reading schedule for such samples, with a final reading 1 week after a MODS culture turns positive, marginally improves the concordance with reference DST.
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Affiliation(s)
- J Coronel
- Laboratorio de Investigación de Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Peru
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Cetina L, González-Enciso A, Cantú D, Coronel J, Pérez-Montiel D, Hinojosa J, Serrano A, Rivera L, Poitevin A, Mota A, Trejo E, Montalvo G, Muñoz D, Robles-Flores J, de la Garza J, Chanona J, Jiménez-Lima R, Wegman T, Dueñas-González A. Brachytherapy versus radical hysterectomy after external beam chemoradiation with gemcitabine plus cisplatin: a randomized, phase III study in IB2–IIB cervical cancer patients. Ann Oncol 2013; 24:2043-2047. [DOI: 10.1093/annonc/mdt142] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Mendoza A, Castillo E, Gamarra N, Huamán T, Perea M, Monroi Y, Salazar R, Coronel J, Acurio M, Obregón G, Roper M, Bonilla C, Asencios L, Moore DAJ. Reliability of the MODS assay decentralisation process in three health regions in Peru. Int J Tuberc Lung Dis 2011; 15:217-i. [PMID: 21219684 PMCID: PMC3103709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
OBJECTIVE To deliver rapid isoniazid (INH) and rifampicin (RMP) drug susceptibility testing (DST) close to the patient, we designed a decentralisation process for the microscopic observation drug susceptibility (MODS) assay in Peru and evaluated its reliability. METHODS After 2 weeks of training, laboratory staff processed ≥ 120 consecutive sputum samples each in three regional laboratories. Samples were processed in parallel with MODS testing at an expert laboratory. Blinded paired results were independently analysed by the Instituto Nacional de Salud (INS) according to pre-determined criteria: concordance for culture, DST against INH and RMP and diagnosis of multidrug-resistant tuberculosis (MDR-TB) ≥ 95%, McNemar's P > 0.05, kappa index (κ) ≥ 0.75 and contamination 1-4%. Sensitivity and specificity for MDR-TB were calculated. RESULTS The accreditation process for Callao (126 samples, 79.4% smear-positive), Lima Sur (n = 130, 84%) and Arequipa (n = 126, 80%) took respectively 94, 97 and 173 days. Pre-determined criteria in all regional laboratories were above expected values. The sensitivity and specificity for detecting MDR-TB in regional laboratories were >95%, except for sensitivity in Lima Sur, which was 91.7%. Contamination was 1.0-2.3%. Mean delay to positive MODS results was 9.9-12.9 days. CONCLUSION Technology transfer of MODS was reliable, effective and fast, enabling the INS to accredit regional laboratories swiftly.
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Affiliation(s)
- A Mendoza
- Centro Nacional de Salud Pública, Instituto Nacional de Salud de Perú, Lima, Peru.
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Comina G, Mendoza D, Velazco A, Coronel J, Sheen P, Gilman RH, Moore DAJ, Zimic M. Development of an automated MODS plate reader to detect early growth of Mycobacterium tuberculosis. J Microsc 2011; 242:325-30. [PMID: 21250995 DOI: 10.1111/j.1365-2818.2010.03477.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In this work, an automated microscopic observation drug susceptibility (MODS) plate reader has been developed. The reader automatically handles MODS plates and after autofocussing digital images are acquired of the characteristic microscopic cording structures of Mycobacterium tuberculosis, which are the identification method utilized in the MODS technique to detect tuberculosis and multidrug resistant tuberculosis. In conventional MODS, trained technicians manually move the MODS plate on the stage of an inverted microscope while trying to locate and focus upon the characteristic microscopic cording colonies. In centres with high tuberculosis diagnostic demand, sufficient time may not be available to adequately examine all cultures. An automated reader would reduce labour time and the handling of M. tuberculosis cultures by laboratory personnel. Two hundred MODS culture images (100 from tuberculosis positive and 100 from tuberculosis negative sputum samples confirmed by a standard MODS reading using a commercial microscope) were acquired randomly using the automated MODS plate reader. A specialist analysed these digital images with the help of a personal computer and designated them as M. tuberculosis present or absent. The specialist considered four images insufficiently clear to permit a definitive reading. The readings from the 196 valid images resulted in a 100% agreement with the conventional nonautomated standard reading. The automated MODS plate reader combined with open-source MODS pattern recognition software provides a novel platform for high throughput automated tuberculosis diagnosis.
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Affiliation(s)
- G Comina
- Laboratorio de Ingeniería Física, Universidad Nacional de Ingeniería, Peru
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Coronel J, Roper M, Mitchell S, Castillo E, Gamarra N, Drobniewski F, Luna G, Mendoza A, Moore DAJ. MODS accreditation process for regional reference laboratories in Peru: validation by GenoType® MTBDRplus. Int J Tuberc Lung Dis 2010; 14:1475-1480. [PMID: 20937190 PMCID: PMC3103710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
SETTING Although considerable effort has been put into the development and evaluation of new diagnostics for tuberculosis (TB) and multidrug-resistant TB (MDR-TB), little attention has thus far been paid to the technical aspects of initiating quality-assured routine service use. For implementation of the microscopic-observation drug susceptibility (MODS) methodology in the Peruvian reference laboratory network, a laboratory accreditation process was devised; MODS results from an expert reference laboratory (Universidad Peruana Cayetano Heredia [UPCH]) were used as the standard against which implementing laboratory MODS results were judged to ensure that, prior to use for patient care, implementing laboratories achieved the same high performance with MODS as previously demonstrated in the research laboratory. OBJECTIVE To evaluate the validity of MODS-based accreditation and the concordance of MODS drug susceptibility testing (DST) with molecular testing. DESIGN Head-to-head comparison of MODS DST results from implementing Peruvian regional reference laboratories and the accrediting expert MODS laboratory (UPCH) with GenoType® MTBDRplus DST. RESULTS The concordance of phenotypic MODS rifampicin (RMP) DST with GenoType MTBDRplus was respectively 97.4%, 97.9% and 97.1% for the two implementing regional laboratories and UPCH, and respectively 94.7%, 95.7% and 94.6% for isoniazid (INH) DST. CONCLUSION High and consistent levels of MODS/MTBDRplus concordance for INH and RMP DST confirm the validity of the use of rapid methods as reference standards for accreditation.
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Affiliation(s)
- J Coronel
- Laboratorio de Investigación de Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru
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Bae WH, Salas A, Brady MF, Coronel J, Colombo CGL, Castro B, Gilman RH, Moore DAJ. Reducing the string test intra-gastric downtime for detection of Mycobacterium tuberculosis. Int J Tuberc Lung Dis 2008; 12:1436-1440. [PMID: 19017454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVES To explore the potential for reducing the procedural duration of the string test for the diagnosis of tuberculosis (TB) using microscopic observation drug susceptibility (MODS) culture. METHODS Twelve patients already diagnosed with pulmonary TB, four each with sputum smear acid-fast bacilli grade 1+, 2+ and 3+, underwent four consecutive string tests of varying intra-gastric downtime (IGDT) of 30 min, 1, 2 and 4 h. Each retrieved string was cut into three-one oesophageal and two gastric sections. Eluates from one of the gastric sections and the oesophageal section were cultured in MODS after a decontamination procedure; eluate from the other gastric section was cultured in MODS with no decontamination. RESULTS No significant difference was observed in the retrieval efficacy of Mycobacterium tuberculosis (P = 0.29) or time to positive MODS culture (P = 0.80) among string tests of varying IGDTs. Every patient with a sample that was positive after a 4-h IGDT also had positive culture of a 1-h IGDT sample. A pre-inoculation sample decontamination step significantly reduced culture contamination (P < 0.001). CONCLUSION In smear-positive patients, reducing the IGDT to 1 h did not affect the M. tuberculosis retrieval efficacy of the string test. Future evaluations in non-expectorating human immunodeficiency virus and paediatric populations should include a 1-h IGDT.
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Affiliation(s)
- W H Bae
- Harvard College, Cambridge, Massachusetts, USA
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Cetina L, Garcia-Arias A, Uribe MDJ, Candelaria M, Rivera L, Oñate-Ocaña L, Coronel J, Dueñas-Gonzalez A. Concurrent chemoradiation with carboplatin for elderly, diabetic and hypertensive patients with locally advanced cervical cancer. EUR J GYNAECOL ONCOL 2008; 29:608-612. [PMID: 19115688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Chemoradiation based on cisplatin is the standard treatment of locally advanced cervical cancer, however, a subset of patients are either elderly and/or have comorbidities such as diabetes and hypertension. These conditions may compromise the administration of cisplatin. We report our Institution experience with weekly carboplatin as a radiosensitizer for the management of this subset of patients. PATIENTS AND METHODS We reviewed the files of 59 patients with locally advanced cervical cancer who were treated with primary chemoradiation with weekly carboplatin. Response rate, toxicity and survival were analyzed. RESULTS Mean age was 62 years (range, 36-83 years). The majority of cases were squamous cell carcinoma (88.14%), and distribution according to FIGO Stage was IB2 8.4%, IIA 13.5%, IIB 52.5%, IIIA 3.3% and IIIB 18.6%; Overall, 100% and 91% of patients completed external beam and intracavitary therapy. Seventy-nine percent received from five to six planned cycles of weekly carboplatin. Complete responses were achieved in 49 (83.05 %) patients, whereas ten patients (16.95%) had either persistent or progressive disease. The most common toxicities were grades 1 and 2 hematological and gastrointestinal. At median follow-up (20 months; range 2-48 months), 16 patients (32.65%) have relapsed. Estimated 30-month overall survival is 63%. CONCLUSIONS Weekly carboplatin concurrent with pelvic radiation is well tolerated in patients with locally advanced carcinoma of the cervix who are older than 70 years and/or have diabetes mellitus and/or high blood pressure, however, the apparently slighty lower survival observed cautions against its routine use.
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Affiliation(s)
- L Cetina
- Unidad de Investigación Biomédica en Cáncer Inst Inv. Biomédicas UNAM, INCAN, Tlalpan, México
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