RESUMO
Nearly 90% of cervical cancer cases and deaths occur in low- and middle-income countries that lack comprehensive national HPV immunization and cervical cancer screening programs. In these settings, it is difficult to implement screening programs due to a lack of infrastructure and shortage of trained personnel. Screening programs based on visual inspection with acetic acid (VIA) have been successfully implemented in some low-resource settings. However, VIA has poor specificity and up to 90% of patients receiving treatment based on a positive VIA exam are over-treated. A number of studies have suggested that high-resolution cervical imaging to visualize nuclear morphology in vivo can improve specificity by better distinguishing precancerous and benign lesions. To enable high-resolution imaging in low-resource settings, we developed a portable, low-cost, high-resolution microendoscope that uses a mobile phone to detect and display images of cervical epithelium in vivo with subcellular resolution. The device was fabricated for less than $2,000 using commercially available optical components including filters, an LED and triplet lenses assembled in a 3D-printed opto-mechanical mount. We show that the mobile high-resolution microendoscope achieves similar resolution and signal-to-background ratio as previously reported high-resolution microendoscope systems using traditional cameras and computers to detect and display images. Finally, we demonstrate the ability of the mobile high-resolution microendoscope to image normal and precancerous squamous epithelium of the cervix in vivo in a gynecological referral clinic in Barretos, Brazil.
Assuntos
Telefone Celular , Colposcopia/métodos , Microscopia Intravital/métodos , Displasia do Colo do Útero/diagnóstico por imagem , Neoplasias do Colo do Útero/prevenção & controle , Brasil , Colo do Útero/diagnóstico por imagem , Colo do Útero/patologia , Colposcopia/economia , Colposcopia/instrumentação , Países em Desenvolvimento , Desenho de Equipamento , Estudos de Viabilidade , Feminino , Células HeLa , Recursos em Saúde/provisão & distribuição , Humanos , Processamento de Imagem Assistida por Computador/instrumentação , Processamento de Imagem Assistida por Computador/métodos , Microscopia Intravital/economia , Microscopia Intravital/instrumentação , Programas de Rastreamento/economia , Programas de Rastreamento/instrumentação , Programas de Rastreamento/métodos , Aplicativos Móveis , Exame Físico/economia , Exame Físico/instrumentação , Exame Físico/métodos , Impressão Tridimensional , Sensibilidade e Especificidade , Displasia do Colo do Útero/patologia , Neoplasias do Colo do Útero/patologiaRESUMO
BACKGROUND: Skin cancer is the most common malignancy in the white population worldwide. In Brazil, the National Cancer Institute (INCA) estimates that in 2010 there will be 119,780 and 5,930 new cases of non-melanoma skin cancer and melanoma, respectively. The aim of this study was to evaluate the use of a mobile unit in the diagnosis and treatment of skin cancer in several poor regions of Brazil. METHODS: The diagnosis of skin cancer was accomplished through active medical screening in the prevention Mobile Unit (MU) of Barretos Cancer Hospital (BCH). The study population consisted of patients examined in the MU between 2004 and 2007, and their suspicious lesions were subjected to histopathological evaluation. Data were collected prospectively from standardized forms and analyzed. RESULTS: During the screening, 17,857 consultations were carried out. A total of 2012 (11.2%) cases of skin cancer were diagnosed. The predominant histological type reported was basal cell carcinoma (n = 1,642 or 81.6%), followed by squamous cell carcinoma (n = 303 or 15.1%), Bowen's disease (n = 25 or 1.2%), malignant melanoma (n = 23 or 1.1%), basosquamous cell carcinoma (n = 3 or 0.1%), miscellaneous lesions (12 or 0.6%), and metatypical carcinoma (n = 4 or 0.2%). Only 0.6% of lesions were stage III. There were no stage IV non-melanoma skin lesions, as well as no melanomas stages III and IV, found. CONCLUSIONS: It was observed that the MU can be a useful tool for early skin cancer diagnosis and treatment. This program probably is important, especially in developing countries with inadequate public health systems and social inequality.
Assuntos
Programas de Rastreamento/métodos , Unidades Móveis de Saúde , Neoplasias Cutâneas/diagnóstico , Adulto , Idoso , Biópsia/economia , Brasil , Escolaridade , Feminino , Acessibilidade aos Serviços de Saúde/economia , Humanos , Masculino , Programas de Rastreamento/economia , Programas de Rastreamento/enfermagem , Melanoma/diagnóstico , Melanoma/epidemiologia , Melanoma/patologia , Pessoa de Meia-Idade , Unidades Móveis de Saúde/economia , Estadiamento de Neoplasias , Equipe de Assistência ao Paciente/economia , Seleção de Pessoal/métodos , Exame Físico/economia , Exame Físico/enfermagem , Estudos Prospectivos , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/patologiaRESUMO
OBJECTIVE: Evaluate the performance of clinical data and the rapid influenza diagnostic test (RIDT) in diagnosing influenza H1N1, and analyze the cost-benefit of using this diagnostic tool. METHODS: The RIDT was used for patients who came to four hospitals in Mexico City with an influenza-like illness (ILI) in October and November 2009. The diagnostic performance of the ILI clinical data and the RIDT was compared to that of the real-time reverse transcription polymerase chain reaction (rRT-PCR) test. The rRT-PCR test was conducted in a reference laboratory and blinded to the results of the RIDT. An economic evaluation also was conducted to estimate the budgetary impact of using the RIDT. RESULTS: The study included 78 patients, 39 of whom tested positive for influenza H1N1 and 6 tested positive for seasonal influenza A, according to the results of the rRT-PCR. The ILI clinical data yielded a sensitivity of 96% and specificity of 21%; the RIDT yielded a sensitivity of 76% and specificity of 82%; and the ILI clinical data and RIDT together yielded a sensitivity of 96% and specificity of 100%. The positive likelihood quotient for ILI-headaches was 31.5 and that of ILI-odynophagia, 330. The use of RIDT yielded savings of US$12.6 per each suspected case. CONCLUSIONS: Use of the RIDT to aid in the diagnosis of influenza H1N1 increases certainty and lowers the average cost per suspected and infected patient.
Assuntos
Imunoensaio/economia , Vírus da Influenza A Subtipo H1N1/isolamento & purificação , Influenza Humana/diagnóstico , Exame Físico/economia , Adolescente , Adulto , Idoso , Assistência Ambulatorial/economia , Antígenos Virais/análise , Antivirais/economia , Antivirais/uso terapêutico , Criança , Pré-Escolar , Sistemas Computacionais/economia , Análise Custo-Benefício , Erros de Diagnóstico , Diagnóstico Precoce , Feminino , Hospitalização/economia , Hospitais Urbanos , Humanos , Imunoensaio/métodos , Lactente , Vírus da Influenza A Subtipo H1N1/genética , Vírus da Influenza A Subtipo H1N1/imunologia , Influenza Humana/tratamento farmacológico , Influenza Humana/virologia , Masculino , México , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase Via Transcriptase Reversa/economia , Método Simples-Cego , Inquéritos e Questionários , Fatores de Tempo , Adulto JovemRESUMO
OBJETIVO: Evaluar el desempeño de los datos clínicos y la prueba rápida (PR) en el diagnóstico de influenza H1N1, y analizar el costo-beneficio que representa el uso de esta herramienta diagnóstica. MÉTODOS: Se aplicó la PR a pacientes que acudieron a cuatro hospitales en la ciudad de México con sintomatología similar a influenza (SSI) durante el período octubre y noviembre de 2009. Se comparó el desempeño diagnóstico de la SSI más la PR contra el de la reacción en cadena de la polimerasa en transcripción reversa en tiempo real (rRT-PCR). La rRT-PCR fue procesada en un laboratorio de referencia y cegado al resultado de la PR. Además, se llevó a cabo una evaluación económica a partir de la cual se estimó el impacto presupuestal relacionado con la utilización de la PR RESULTADOS: Se incluyó a 78 pacientes, de los cuales 39 fueron positivos para influenza H1N1 y 6 para influenza A estacional, de acuerdo al resultado de la rRT-PCR. La SSI mostró una sensibilidad de 96 por ciento y una especificidad de 21 por ciento, la PR de 76 por ciento y 82 por ciento y el conjunto de SSI más PR de 96 por ciento y 100 por ciento, respectivamente. El Cociente de Verosimilitud positivo de la SSI-cefalea fue de 31,5 y el de SSI-odinofagia fue de 330. El uso de PR mostró un ahorro de US$ 12,6 por cada caso sospechoso. CONCLUSIONES: El uso de la PR como auxiliar en el diagnóstico de influenza H1N1 incrementa la certeza y reduce el costo promedio por paciente sospechoso e infectado.
OBJECTIVE: Evaluate the performance of clinical data and the rapid influenza diagnostic test (RIDT) in diagnosing influenza H1N1, and analyze the cost-benefit of using this diagnostic tool. METHODS: The RIDT was used for patients who came to four hospitals in Mexico City with an influenza-like illness (ILI) in October and November 2009. The diagnostic performance of the ILI clinical data and the RIDT was compared to that of the real-time reverse transcription polymerase chain reaction (rRT-PCR) test. The rRT-PCR test was conducted in a reference laboratory and blinded to the results of the RIDT. An economic evaluation also was conducted to estimate the budgetary impact of using the RIDT. RESULTS: The study included 78 patients, 39 of whom tested positive for influenza H1N1 and 6 tested positive for seasonal influenza A, according to the results of the rRT-PCR. The ILI clinical data yielded a sensitivity of 96 percent and specificity of 21 percent; the RIDT yielded a sensitivity of 76 percent and specificity of 82 percent; and the ILI clinical data and RIDT together yielded a sensitivity of 96 percent and specificity of 100 percent. The positive likelihood quotient for ILI-headaches was 31.5 and that of ILI-odynophagia, 330. The use of RIDT yielded savings of US$12.6 per each suspected case. CONCLUSIONS: Use of the RIDT to aid in the diagnosis of influenza H1N1 increases certainty and lowers the average cost per suspected and infected patient.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Imunoensaio/economia , Vírus da Influenza A Subtipo H1N1/isolamento & purificação , Influenza Humana/diagnóstico , Exame Físico/economia , Assistência Ambulatorial/economia , Antígenos Virais/análise , Antivirais/economia , Antivirais/uso terapêutico , Sistemas Computacionais/economia , Análise Custo-Benefício , Erros de Diagnóstico , Diagnóstico Precoce , Hospitalização/economia , Hospitais Urbanos , Imunoensaio/métodos , Vírus da Influenza A Subtipo H1N1/genética , Vírus da Influenza A Subtipo H1N1/imunologia , Influenza Humana/tratamento farmacológico , Influenza Humana/virologia , México , Inquéritos e Questionários , Reação em Cadeia da Polimerase Via Transcriptase Reversa/economia , Método Simples-Cego , Fatores de TempoAssuntos
Apendicite/diagnóstico por imagem , Exame Físico/economia , Tomografia Computadorizada por Raios X/economia , Doença Aguda , Apendicite/diagnóstico , Apendicite/economia , Apendicite/cirurgia , Colômbia , Redução de Custos , Análise Custo-Benefício , Feminino , Humanos , Masculino , Exame Físico/métodos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
Pelvic radiography in blunt trauma patients is routinely used in most trauma centers. The purpose of this review was to evaluate the ability of physical examination alone to detect pelvic fractures. Among patients with blunt trauma admitted to the University Hospital del Valle in Cali, Colombia, over a 3-month period, 608 adult patients, with hemodynamic stability, without spinal involvement, and with a Glasgow Coma Scale score greater than 10 were evaluated. All patients had physical examination, pelvic x-ray and adequate follow-up. Fifty-nine (9.7%) patients had pelvic fractures, with 57 of these fractures detected by physical findings. The remaining two patients had stable fractures that required no treatment. After careful analysis, we conclude that a negative physical examination following blunt trauma has a negative predictive value of 99% probability in excluding pelvic fracture, provided that the patient is not a child, is not in coma, is hemodynamically stable without evidence of blood loss, and has no spinal cord injury. A selective use of pelvic x-ray in patients with blunt trauma is a cost-effective policy.
Assuntos
Fraturas Ósseas/diagnóstico por imagem , Ossos Pélvicos/lesões , Ferimentos não Penetrantes/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise Custo-Benefício , Feminino , Fraturas Ósseas/classificação , Escala de Coma de Glasgow , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Exame Físico/economia , Exame Físico/métodos , Estudos Prospectivos , Radiografia , Sensibilidade e EspecificidadeRESUMO
Se presenta la experiencia con mamografía anual y exámen físico semestral en los primeros 5 años de seguimiento postoperatorio de 107 pacientes con 110 carcinomas de mama en estadios I y II. Se concluyen que la mamografía contribuyó al diagnóstico precoz de 6 carcinomas contralaterales, con un costo de U$S 8,00 por cada detección asintomática. En el control de la mama operada cobra mayor importancia el exámen físico por la dificultades en la interpretación radiológica debido a la ubicación superficial de algunas recidivas y por las secuelas actínica y quirúrgica del tratamiento conservador
Assuntos
Neoplasias da Mama/epidemiologia , Análise Custo-Eficiência , Mamografia/economia , Sensibilidade e Especificidade , Exame Físico/economia , Exame Físico/estatística & dados numéricos , Mamografia/estatística & dados numéricos , Mastectomia/estatística & dados numéricos , Recidiva Local de NeoplasiaRESUMO
Se presenta la experiencia con mamografía anual y exámen físico semestral en los primeros 5 años de seguimiento postoperatorio de 107 pacientes con 110 carcinomas de mama en estadios I y II. Se concluyen que la mamografía contribuyó al diagnóstico precoz de 6 carcinomas contralaterales, con un costo de U$S 8,00 por cada detección asintomática. En el control de la mama operada cobra mayor importancia el exámen físico por la dificultades en la interpretación radiológica debido a la ubicación superficial de algunas recidivas y por las secuelas actínica y quirúrgica del tratamiento conservador