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Id: biblio-1115828
Autor: Castillo F, Felipe; Aceituno B, Gianella; Bachelet R, Cristian.
Título: Faringoplastía de reposición con suturas barbadas como tratamiento quirúrgico en pacientes con síndrome de apnea-hipopnea obstructiva del sueño / Barbed sutures reposition pharyngoplasty as surgical treatment in obstructive sleep apnea-hypopnea syndrome
Fonte: Rev. otorrinolaringol. cir. cabeza cuello;80(2):137-146, jun. 2020. tab, graf.
Idioma: es.
Resumo: INTRODUCCIÓN: La planificación de cirugías para el manejo del síndrome de apneahipopnea obstructiva del sueño (SAHOS) ha incrementado su precisión desde la introducción de la endoscopía del sueño inducido por fármacos (DISE). OBJETIVO: Evaluar la técnica de faringoplastía de reposición con suturas barbadas (BRP) para el colapso velofaríngeo y/o de paredes laterales orofaríngeas evaluado mediante DISE en pacientes con SAHOS. MATERIAL Y MÉTODO: Ochenta y ocho pacientes fueron evaluados para cirugía mediante antropometría, escala de somnolencia de Epworth (ESS) y poligrafía respiratoria. Veinte y seis de 88 pacientes fueron seleccionados. De los 26, 14 accedieron al tratamiento quirúrgico, el que se seleccionó en base a la DISE. En todos los casos, se realizó BRP. RESULTADOS: A los 3 meses de la cirugía hubo mejoría en 10/14 pacientes (criterios de Sher, disminución del índice de apnea-hipoapnea a <20 o 50% del basal). La ESS bajó en promedio de 12 a 5 puntos (p <0,05). No se reportaron incidentes en el posoperatorio y no han ocurrido eventos adversos. CONCLUSIÓN: La técnica de BRP es una técnica sencilla y útil para la expansión anterior y lateral del paladar blando y orofaringe, con una tasa de éxito similar en esta cohorte a la reportada internacionalmente.

INTRODUCTION: Surgical planning for the management of obstructive sleep apneahypopnea syndrome (OSAHS) has changed since the introduction of drug induced sleep endoscopy (DISE). AIM: To evaluate the technique of barbed sutures reposition pharyngoplasty (BRP) for velopharyngeal collapse and/or oropharyngeal lateral walls after DISE evaluation in OSAHS patients. MATERIAL AND METHOD: 88 patients were evaluated for surgery by anthropometry, Epworth sleepiness scale (ESS) and respiratory polygraphy. 26 of 88 patients were selected. Of the 26, 14 agreed to surgical treatment, which was selected on DISE findings. In all cases, BRP was performed. RESULTS: Three months after surgery there was improvement in 10/14 patients (Sher criteria, apnea-hypopnea index reduction at <20 or 50% of baseline). The ESS improved on average 12 to 5 (p <0.05). No incidents were reported in the post-operative period and no adverse events were reported. CONCLUSION: The BRP technique is a simple and useful technique for the anterior and lateral expansion of the soft palate and oropharynx, with a similar success rate in this cohort to that internationally reported.
Responsável: CL1.1 - Biblioteca Central


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Id: lil-83046
Autor: Huamán G., Manuel; Lanatta L., Marco; Mena O., Víctor.
Título: Faringocoloplastía en el tratamiento de la estenosis cáustica / Pharyngocoloplasty in the treatment of caustic stenosis
Fonte: Rev. gastroenterol. Perú;8(1):18-22, ene.-abr. 1988. ilus.
Idioma: es.
Resumo: Se presenta la experiencia personal de cuatro pacientes portadores de estenosis cáustica con compromiso de esófago y faringe, que fueron sometidos a FARINGOCOLOPLASTIA en el Hospital Nacional Edgardo Rebagliati M. de Lima-Perú, durante el transcurso de un año,(1986-1987). En los pacientes en referencia no hubo mortalidad operatoria y su evolución post-quirúrgica fue favorable, restableciéndose en todos ellos el funcionamiento del tránsito digestivo. No se presentaron dehiscencias ni fístulas en las anastomosis practicadas y la recuperación de la deglución fue óptima casi en la totalidad de los casos, obteniéndose un estado nutricional post-operatorio satisfactorio. En un paciente se registró neumotórax probablemente al efectuar punción venenosa central supraclavicular. la técnica descrita practicada en un sólo tiempo, teniendo en cuenta sus resultados, constituye actualmente una alternativa importante en el manejo de éste tipo de pacientes
Responsável: PE1.1 - Oficina Universitária de Biblioteca


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Id: biblio-997737
Autor: Yamaguchi, Shinsaku.
Título: Clinical outcome of sodium alginate therapy in radiation-induced pharyngeal mucositis: experience of a single Japanese institution
Fonte: Appl. cancer res;39:1-5, 2019. ilus, tab.
Idioma: en.
Resumo: Purpose: We investigated the clinical outcome of sodium alginate treatment in radiation-induced pharyngeal mucositis (RIPM) after neck irradiation. Materials and methods: The study population included 32 patients (11 lung cancer, 10 breast cancer, 7 head and neck cancer, and 4 other primary lesions) who underwent neck external beam radiotherapy at the authors' institution between June 2006 and 2016. The patients received 5% sodium alginate solution orally for RIPM. Those who were followed up for less than 2 months or did not receive 5% sodium alginate were excluded from this retrospective study. RIPM was graded weekly as an acute toxicity according to the Common Terminology Criteria for Adverse Events (CTCAE), version 4. The administration of 10-15 ml of sodium alginate before each meal was continued until the radiotherapy was completed and after resolution of odynophagia. The efficacy of sodium alginate was assessed by two radiation oncologists as follows: Grade I, ineffective; grade II, moderately effective; grade III, very effective. When sodium alginate was ineffective, other analgesics, such as nonsteroidal antiinflammatory drugs (NSAIDS) or opioids, were added. Relationships between the presence/absence of additional analgesics and the radiation dose were investigated. Results: The median duration from the start of irradiation to sodium alginate administration was 15 days (range, 5­36 days). RIPM improved in 29/32 patients (grade: II, n = 22; III, n = 7). Three patients showed no improvement. No sodium alginate-related toxicities occurred. Additional analgesics were required in 5/32 patients. The radiation dose in these 5 patients was significantly higher than that in the sodium alginate-alone group (63.6 ± 7.8 Gy vs 48.3 ± 14.8Gy, P = 0.02). Patients who received > 50 Gy tended to require additional analgesics more frequently than those who received ≤50Gy (P = 0.10). Conclusions: The concurrent administration of sodium alginate and neck irradiation was feasible and tolerable without obvious toxicities. Under certain conditions sodium alginate could be a promising alternative to NSAIDs and opioids in RIPM. The results justify further prospective evaluations with detailed treatment protocols to clarify whether sodium alginate can improve RIPM (AU)
Responsável: BR30.1 - Biblioteca


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Texto completo SciELO Brasil
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Id: biblio-1090552
Autor: Pinto, José Antonio; Godoy, Luciana Balester Mello de; Nunes, Heloisa dos Santos Sobreira; Abdo, Kelly Elia; Jahic, Gabriella Spinola; Cavallini, André Freitas; Freitas, Gabriel Santos; Ribeiro, Davi Knoll; Duarte, Caue.
Título: Lateral-Expansion Pharyngoplasty: Combined Technique for the Treatment of Obstructive Sleep Apnea Syndrome
Fonte: Int. arch. otorhinolaryngol. (Impr.);24(1):107-111, Jan.-Mar. 2020. tab, graf.
Idioma: en.
Resumo: Abstract Introduction Obstructive sleep apnea syndrome (OSAS) is a multifactorial disease characterized by episodes of partial or complete collapse during sleep of different regions of the upper airway. Surgery for OSAS evolved with the introduction of different techniques, considering new surgical concept of reconstruction of the upper airway. Objective To retrospectively evaluate the effectiveness of a new approach aimed at reducing pharyngeal collapse by combining two surgical techniques: lateral and expansion pharyngoplasty. Methods We reviewed the medical records of 38 patients with OSAS undergoing lateral/expansion pharyngoplasty from January 2012 to December 2016. The following data were collected: patient age, gender, and pre- and postoperative body mass index (BMI), Epworth sleepiness scale (ESS) scores, snoring visual analogue scale (VAS) scores, and polysomnography (PSG) results. Results The PSG results showed a significant reduction in the apnea/hypopnea index (AHI) from 22.4 ± 27.3 events/h preoperatively to 13.6 ± 17.9 events/h postoperatively (p = 0.009), with postoperative AHI reduction greater than 50% in 63.2% of the patients. There was also a significant reduction in the microarousal index (19.5 ± 22.6 vs 11.0 ± 13.4 events/h; p = 0.001) and in the minimum oxygen saturation (82.6 ± 10.3 vs 86.9 ± 11.1; p = 0.007). Conclusions Lateral-expansion pharyngoplasty represents a new surgical strategy for the treatment of OSAS in patients with palatal collapse by combining two different techniques: lateral and expansion pharyngoplasty. The two techniques, performed as a one-stage procedure, led to improvements in excessive daytime sleepiness, snoring, and PSG respiratory parameters by acting on lateral and retropalatal collapse, produc- ing favorable results with good applicability in otolaryngology clinical practice.
Responsável: BR66.1 - Divisão de Biblioteca e Documentação


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Id: lil-715405
Autor: Rivera, Antonio; Munguia, Ricardo; Chavez, Edith; Sánchez, José Antonio; Santamaria, Susana; Giono, Silvia.
Título: Degradación de ADN por micoplasmas en exudados faríngeos y vaginales, México / DNA Depletion byclinical isolated mycoplasmas, México
Fonte: Rev. costarric. salud pública;22(2):144-148, jul.-dic. 2013. ilus, graf.
Idioma: es.
Resumo: La limitada capacidad de biosíntesis de precursores esenciales en micoplasmas les ha permitido desarrollar mecanismos moleculares para su adquisición a partir de sus hospederos. Objetivo: Determinar la capacidad de degradación de ADN en micoplasmas aislados de exudados faríngeos y vaginales. Métodos: De las muestras clínicas de exudados faríngeos y vaginales se aislaron micoplasmas por método microbiológico y validaron por PCR. Las que resultaron positivas fueron evaluadas para determinar su capacidad de degradar ADN por método de formación de halo en agar. Resultados: La capacidad de degradar ADN a partir de los aislamientos clínicos de micoplasmas fue evidente y presentó diferencia significativa (P< 0,05) respecto a la cepa de referencia. Conclusiones: Los aislamientos clínicos de micoplasmas tienen actividad de ADNasas, implicando un papel importante para la adquisición de precursores de ácidos nucleicos, y condicionando alteración en las células hospederas.

The limited capacity of essential biosynthetic precursors mycoplasma enabled them to develop molecular mechanisms for acquisition from their hosts. Objective: To determine the ability of DNA degradation in mycoplasma isolated from clinical samples. Methods: From clinical samples of throat and vaginal swabs mycoplasmas were isolated by microbiological method and validated by PCR. The positive samples were evaluated for their ability to degrade DNA halo formation method on agar. Results: the ability to degrade DNA from clinical isolates of mycoplasma was evident and showed a significant difference (P <0.05) compared to the reference strain. Conclusions: Mycoplasma in clinical isolates have DNase activity, implying a role for the acquisition of nucleic acid precursors, and conditioning the host cells´ alteration.
Responsável: CR1.1 - BINASSS - Biblioteca Nacional de Salud y Seguridad Social


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Texto completo SciELO Chile
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Id: biblio-1056457
Autor: Ravelo, Victor; Olate, Gabriela; Moya, Maria Paz; Brito, Leonardo; Garay, Ivonne; Olate, Sergio.
Título: 3-D airway analysis related to facial morphology / Análisis 3-D de la vía aerea relacionado con la morfología facial
Fonte: Int. j. morphol;38(2):423-426, abr. 2020. tab, graf.
Idioma: en.
Resumo: The aim of this investigation was to define the volume and area of the airway in subjects with Class II and Class III skeletal deformity. A cross-sectional study was designed including subjects with facial deformity defined by Steiner's analysis in subjects with indication of orthognathic surgery who presented diagnosis by cone beam computerised tomography. We determined the measurements of maximum area, minimum area and volume of the airway. The data were compared using Spearman's test, with statistical significance defined as p<0.05. 115 subjects were included: 61.7 % Class II and 38.3 % Class III, mean age 27.8 years (± 11.6). A significant difference was observed in the area and volume measurements in the groups studied, with significantly smaller measurements found in Class II (p=0.034). The minimum area was 10.4 mm2 smaller in Class II patients than in Class III, while the general volume of the airway was 4.1 mm3 smaller in Class II than in Class III. We may conclude that Class II subjects present a smaller airway volume than Class III subjects.

El objetivo de esta investigación de definir el volumen y área de vía aérea en sujetos con deformidad esqueletal clase II y III. Se diseñó un estudio de corte transversal incluyendo sujetos con deformidad facial definida según análisis de Stainer en sujetos con indicación de cirugía ortognática que presentaran una tomografía computadorizada de haz cónico como elemento diagnóstico; en este examen se determinaron medidas de área mayor, menor de vía aérea y volumen presente; los datos fueron comparados utilizando pruebas estadísticas con el test de spearman considerando el valor de p<0,05 para definir significancia estadística. 115 sujetos fueron incluidos, siendo 61,7 % de tipo clase II y 38,3 % de sujetos clase III, con una edad promedio de 27,8 años (± 11,6). Se observó una diferencia significativa en mediciones de area y volumen en los grupos estudiados, siendo el grupo de clase II significativamente menor (p=0,034). El área de menor tamaño fue 10,4 mm2 en pacientes clase II que en pacientes clase III, mientras que el volumen general de la vía área fue 4,1 menor en los clase II que en los clase III. Es posible concluir que los sujetos de clase II presentan menor volumen de vía área que los sujetos clase III.
Responsável: CL1.1 - Biblioteca Central


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Id: biblio-1019983
Autor: Passos, Ula Lindoso; Genta, Pedro Rodrigues; Marcondes, Bianca Fernandes; Lorenzi-Filho, Geraldo; Gebrim, Eloisa Maria Mello Santiago.
Título: State-dependent changes in the upper airway assessed by multidetector CT in healthy individuals and during obstructive events in patients with sleep apnea / Alterações nas vias aéreas superiores avaliadas por TC multidetectores durante a vigília e o sono em indivíduos saudáveis e em pacientes com apneia do sono durante eventos obstrutivos
Fonte: J. bras. pneumol;45(4):e20180264, 2019. tab, graf.
Idioma: en.
Resumo: ABSTRACT Objective: To determine whether airway narrowing during obstructive events occurs predominantly at the retropalatal level and results from dynamic changes in the lateral pharyngeal walls and in tongue position. Methods: We evaluated 11 patients with severe obstructive sleep apnea (OSA) and 7 healthy controls without OSA during wakefulness and during natural sleep (documented by full polysomnography). Using fast multidetector CT, we obtained images of the upper airway in the waking and sleep states. Results: Upper airway narrowing during sleep was significantly greater at the retropalatal level than at the retroglossal level in the OSA group (p < 0.001) and in the control group (p < 0.05). The retropalatal airway volume was smaller in the OSA group than in the control group during wakefulness (p < 0.05) and decreased significantly from wakefulness to sleep only among the OSA group subjects. Retropalatal pharyngeal narrowing was attributed to reductions in the anteroposterior diameter (p = 0.001) and lateral diameter (p = 0.006), which correlated with an increase in lateral pharyngeal wall volume (p = 0.001) and posterior displacement of the tongue (p = 0.001), respectively. Retroglossal pharyngeal narrowing during sleep did not occur in the OSA group subjects. Conclusions: In patients with OSA, upper airway narrowing during sleep occurs predominantly at the retropalatal level, affecting the anteroposterior and lateral dimensions, being associated with lateral pharyngeal wall enlargement and posterior tongue displacement.

Resumo Objetivo: Determinar se o estreitamento das vias aéreas durante eventos obstrutivos ocorre predominantemente na região retropalatal e resulta de alterações dinâmicas nas paredes laterais da faringe e na posição da língua. Métodos: Avaliamos 11 pacientes com apneia obstrutiva do sono (AOS) grave (grupo AOS) e 7 indivíduos saudáveis sem AOS (grupo controle) durante a vigília e o sono natural (documentado por meio de polissonografia completa). Por meio de TC multidetectores rápida, obtivemos imagens das vias aéreas superiores no estado de vigília e de sono. Resultados: O estreitamento das vias aéreas superiores durante o sono foi significativamente maior na região retropalatal do que na região retrolingual no grupo AOS (p < 0,001) e no grupo controle (p < 0,05). O volume da via aérea retropalatal foi menor no grupo AOS do que no grupo controle durante a vigília (p < 0,05) e diminuiu significativamente da vigília ao sono apenas no grupo AOS. O estreitamento retropalatal da faringe foi atribuído à redução do diâmetro anteroposterior (p = 0,001) e lateral (p = 0,006), que se correlacionou com o aumento do volume das paredes laterais da faringe (p = 0,001) e o deslocamento posterior da língua (p = 0,001). Não ocorreu estreitamento retrolingual da faringe durante o sono no grupo AOS. Conclusões: Em pacientes com AOS, o estreitamento das vias aéreas superiores durante o sono ocorre predominantemente na região retropalatal e afeta as dimensões anteroposterior e lateral, além de estar relacionado com aumento das paredes laterais da faringe e deslocamento posterior da língua.
Responsável: BR1.1 - BIREME


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Id: biblio-1069655
Autor: Nabholz, Thais Verdi; Cukier, Celso; Magnoni, Daniel; Alvarez, Tatiana.
Título: Nutrição da boca, faringe e esôfago - Disfagia / Mouth, pharynge and larynge - Dysphagia
Fonte: In: Cukier, Celso; Magnoni, Daniel; Alvarez, Tatiana. Nutrição baseada na fisiologia dos órgãos e sistemas. São Paulo, Sarvier, 2005. p.100-114, ilus.
Idioma: pt.
Responsável: BR79.1 - CIC - Centro de Informação Cardiovascular Mendonça de Barros
BR79.1


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Texto completo SciELO Cuba
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Id: lil-584299
Autor: Reynaldo González, María de los Ángeles; Trinchet Soler, Rafael; Pérez Fernández, Julia; Álvarez Borges, Francisco Emilio.
Título: Comportamiento de las fístulas faringocutáneas / Behavior of pharyngocutaneous fistula
Fonte: Rev. cuba. cir;49(2), abr.-jun. 2010.
Idioma: es.
Resumo: La fístula faringocutánea se detecta clínicamente por la aparición de saliva simultáneamente con la deglución. Es muy frecuente en el posoperatorio de las laringectomías totales, y puede aparecer espontáneamente por dehiscencia de la sutura faríngea a causa de los movimientos deglutorios del paciente, o bien puede acompañar a una infección o necrosis. Se realizó un estudio ambispectivo, descriptivo, sobre el comportamiento de las fístulas faringocutáneas en el Servicio de Cirugía Oncológica Cervicofacial de Hospital Universitario Vladimir Ilich Lenin, en Holguín. El universo de estudio estuvo constituido por todos los pacientes operados con laringectomía total en el período del 2003 al 2008. Fueron 158 pacientes en total y a todos se les realizó el cierre manual de la hipofaringe. Las fístulas estuvieron presentes en el 5,6 por ciento de los casos. El 77,7 por ciento de los pacientes habían recibido radioterapia antes de la operación y el 66,4 por ciento de éstos tenían traqueostomías en el momento de la intervención quirúrgica. En todos los pacientes con faringostoma se encontró sepsis posquirúrgica y la alimentación oral se comenzó entre los días 10 y 12 en el 88,4 por ciento de los casos. El amplio predominio de pacientes del sexo masculino está en relación directa con los hábitos tóxicos predominantes en este sexo. La traqueostomía prequirúrgica es aceptada por los cirujanos como factor de riesgo para el desarrollo de la fístula, pero en este estudio no fue significativo. El tiempo de comienzo de la alimentación oral en los pacientes con larigectomías debe oscilar entre los días 10 y 14, nunca antes, pues no existe una cicatrización de la hipofaringe que garantice el paso de los alimentos. Además, de esta forma se evita que aparezcan complicaciones como las fístulas faringocutáneas(AU)

The pharyngocutaneous fistula is clinically detected by appearance of saliva together with deglutition. It is more frequent in postoperative period of total laryngectomies and may to appear in a spontaneous way by dehiscence of pharyngeal suture provoked by deglutition movements of patient or to go with a infection or necrosis. A descriptive and bilateral study was conducted on the behavior of pharyngocutaneous fistulas in Cervicofacial Oncology Surgery Service of Vladimir Ilich Lenin University Hospital in Holguín province. Study sample included all patients operated on by total laryngectomy from 2003 to 2008. There was a total 158 patients and all underwent a manual closure of hypofarynx. Fistulas were present in the 5,6 percent of cases. The 77,7 percent of patients had underwent radiotherapy before surgery and the 66,4 percent of them underwent tracheostomies at surgical operation. In all patients operated on by pharyngotome there was postsurgical sepsis and feeding was started at 10 and 12 days in the 88,4 percent of cases. The wide predominance of male patients is directly related to usual toxic habits in this sex. Presurgical tracheostomy is accepted by surgeons as a risk factor for development of fistula, but in present paper wasn't significant. Onset of oral feeding in patients presenting with layngectomies must to fluctuate between 10 and 14 days, never before, but there isn't a hypopharynx healing allowing the foods passage. Also, so it is possible to avoid the appearance of complications like the pharyngocutaneous fistulas(AU)
Responsável: CU1.1 - Biblioteca Médica Nacional


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Id: lil-442807
Autor: Fariña, N; Figueredto, L; Sanabria, R; Ocampos, M; Laspina, F; Balmaceda, A; Samudio, M.
Título: Evaluación de un método de aglutinación del látex para la detección del estreptococo grupo A en faringe / Latex evaluation for detection of group A streptococcus in pharyngeal swabs
Fonte: Mem. Inst. Invest. Cienc. Salud (Impr.);3(1):28-30, dic. 2005. tab.
Idioma: es.
Resumo: Las pruebas de detección rápida del antígeno estreptocóccico en hisopados de garganta son ampliamente utilizados en laboratorios y consultorios médicos, pero su sensibilidad al compararse con técnicas de cultivo convencionales no es alta. El objetivo de este trabajo fue determinar la sensibilidad y especificidad de un método de látex (Patho Dx Strep A, DPC) para la detección del estreptococo grupo A en hisopados faríngeo de pacientes con faringitis que concurrieron al laboratorio San Roque de enero a diciembre del año 2003. Para la sensibilidad se seleccionaron 90 pacientes con cultivo positivo y para la especificad 280 pacientes con cultivo negativo. Se tomaron 2 muestras de hisopado faríngeo simultáneamente, una para la prueba del látex y otra para cultivo. Para la prueba directa se utilizó el Kit Patho Dx Strep A (DPC) y el cultivo e identificación se realizaron siguiendo métodos convencionales. De los 90 cultivos positivos, 60 fueron también positivos por la prueba de látex, lo que corresponde a una sensibilidad de la prueba del 66,7%. De los 280 cultivos negativos, 270 fueron negativos por latex, obteniéndose una especificidad del 96%. El valor predictivo positivo fue del 86% y el valor predictivo negativo del 90%. La concordancia absoluta fue del 89%. En nuestro estudio encontramos que la especificidad del Kit Patho Dx Strep A (DPC) fue alta (96%), pero no la sensibilidad que fue del 66,7%. Consideramos que la prueba rápida no puede sustituir al método clásico de cultivo y se recomienda la toma de dos hisopados de faringe, y en caso de obtener la prueba directa negativa, realizar además el cultivo a fin de evitar un diagnóstico y tratamiento incorrecto que puede dejar serias complicaciones.

Kits for rapid detection of streptococcus antigens from swabs pharyngeal are widely used in laboratories and consulting rooms but their sensitivity is low when they are compared with conventional culture methods. The objective of this study was to determine the sensitivity and specificity of a latex agglutination method (Patho Dx Strep A, DPC) for detection of Group A streptococci in pharyngeal swabs from patients with pharyngitis who came to San Roque Laboratory from January to December 2003. In order to determine the sensitivity, 90 patients with positive cultures were selected and 280 patients with negative cultures for the specificity. For both methods latex agglutination test and culture, two samples were swabbed simultaneously. The two methods used were the Patho Dx Strep A, DPC kits for direct test and conventional methods for culture and identification. Out of 90 positive cultures, 60 were also positive for latex, yielding a sensitivity of 66.7%. Out of 280 negative cultures, 270 were also negative for latex, yielding a specificity of 90%. The positive predictive value was 86% and the negative predictive value 90% while overall agreement was 89%. Our finding showed high specificity (96%) but low sensitivity (66,7%) of the Patho Dx Strep A (DPC) kit. We conclude that a rapid test cannot substitute the classical culture method and we recommend taking two throat swabs. If direct tests are negative, the second sample should be cultured to prevent a wrong diagnosis and treatment.
Responsável: PY3.1 - Biblioteca



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