Author
Mayara Lisboa Bastos
Other affiliations: McGill University, McGill University Health Centre, Federal University of Rio de Janeiro ...read more
Bio: Mayara Lisboa Bastos is an academic researcher from Rio de Janeiro State University. The author has contributed to research in topics: Tuberculosis & Regimen. The author has an hindex of 15, co-authored 39 publications receiving 1503 citations. Previous affiliations of Mayara Lisboa Bastos include McGill University & McGill University Health Centre.
Topics: Tuberculosis, Regimen, Medicine, Latent tuberculosis, Population
Papers
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TL;DR: Higher quality clinical studies assessing the diagnostic accuracy of serological tests for covid-19 are urgently needed, as available evidence does not support the continued use of existing point-of-care serological Tests for coronavirus disease-2019.
Abstract: Objective To determine the diagnostic accuracy of
serological tests for coronavirus disease-2019
(covid-19). Design Systematic review and meta-analysis. Data sources Medline, bioRxiv, and medRxiv from 1 January to
30 April 2020, using subject headings or
subheadings combined with text words for the
concepts of covid-19 and serological tests for
covid-19. Eligibility criteria and data
analysis Eligible studies measured sensitivity or
specificity, or both of a covid-19 serological
test compared with a reference standard of viral
culture or reverse transcriptase polymerase chain
reaction. Studies were excluded with fewer than
five participants or samples. Risk of bias was
assessed using quality assessment of diagnostic
accuracy studies 2 (QUADAS-2). Pooled sensitivity
and specificity were estimated using random
effects bivariate meta-analyses. Main outcome measures The primary outcome was overall sensitivity and
specificity, stratified by method of serological
testing (enzyme linked immunosorbent assays
(ELISAs), lateral flow immunoassays (LFIAs), or
chemiluminescent immunoassays (CLIAs)) and
immunoglobulin class (IgG, IgM, or both).
Secondary outcomes were stratum specific
sensitivity and specificity within subgroups
defined by study or participant characteristics,
including time since symptom onset. Results 5016 references were identified and 40 studies
included. 49 risk of bias assessments were carried
out (one for each population and method
evaluated). High risk of patient selection bias
was found in 98% (48/49) of assessments and high
or unclear risk of bias from performance or
interpretation of the serological test in 73%
(36/49). Only 10% (4/40) of studies included
outpatients. Only two studies evaluated tests at
the point of care. For each method of testing,
pooled sensitivity and specificity were not
associated with the immunoglobulin class measured.
The pooled sensitivity of ELISAs measuring IgG or
IgM was 84.3% (95% confidence interval 75.6% to
90.9%), of LFIAs was 66.0% (49.3% to 79.3%), and
of CLIAs was 97.8% (46.2% to 100%). In all
analyses, pooled sensitivity was lower for LFIAs,
the potential point-of-care method. Pooled
specificities ranged from 96.6% to 99.7%. Of the
samples used for estimating specificity, 83%
(10 465/12 547) were from populations tested
before the epidemic or not suspected of having
covid-19. Among LFIAs, pooled sensitivity of
commercial kits (65.0%, 49.0% to 78.2%) was lower
than that of non-commercial tests (88.2%, 83.6% to
91.3%). Heterogeneity was seen in all analyses.
Sensitivity was higher at least three weeks after
symptom onset (ranging from 69.9% to 98.9%)
compared with within the first week (from 13.4% to
50.3%). Conclusion Higher quality clinical studies assessing the
diagnostic accuracy of serological tests for
covid-19 are urgently needed. Currently, available
evidence does not support the continued use of
existing point-of-care serological tests. Study registration PROSPERO CRD42020179452.
703 citations
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New York City Department of Health and Mental Hygiene1, University of Groningen2, World Health Organization3, Shahid Beheshti University of Medical Sciences and Health Services4, Statens Serum Institut5, California Department of Public Health6, Rio de Janeiro State University7, Post Graduate Institute of Medical Education and Research8, McGill University9, University of Pennsylvania10, Radboud University Nijmegen11, Institut de recherche pour le développement12, University Health Network13, Albert Einstein College of Medicine14, National Institutes of Health15, Centers for Disease Control and Prevention16, University of Colorado Denver17, Centre for Health Protection18, Oswaldo Cruz Foundation19, University of Cape Town20, University of Sydney21, University of Paris22, Médecins Sans Frontières23, University of California, San Francisco24, Emory University25, Brigham and Women's Hospital26, Samsung Medical Center27, Federal University of Rio de Janeiro28, Hofstra University29, New Generation University College30, Karolinska Institutet31, St. Joseph's Healthcare Hamilton32, Sofia Medical University33, Harvard University34, Columbia University35, Cornell University36, University of Texas Health Science Center at Tyler37, Partners In Health38, University of Ulsan39, University of Sassari40, Queen Mary University of London41, The Chinese University of Hong Kong42
TL;DR: Treatment outcomes were significantly better with use of linezolid, later generation fluoroquinolones, bedaquiline, clofazimine, and carbapenems for treatment of multidrug-resistant tuberculosis, and the need for trials to ascertain the optimal combination and duration of these drugs is emphasised.
404 citations
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TL;DR: The proportion of asymptomatic infection among COVID-19 positive persons appears high and transmission potential seems substantial, and high quality studies in representative general population samples are required.
Abstract: Background The study objective was to conduct a systematic review and meta-analysis on the proportion of asymptomatic infection among coronavirus disease 2019 (COVID-19) positive persons and their transmission potential. Methods We searched Embase, Medline, bioRxiv, and medRxiv up to 22 June 2020. We included cohorts or cross-sectional studies which systematically tested populations regardless of symptoms for COVID-19, or case series of any size reporting contact investigations of asymptomatic index patients. Two reviewers independently extracted data and assessed quality using pre-specified criteria. Only moderate/high quality studies were included. The main outcomes were proportion of asymptomatic infection among COVID-19 positive persons at testing and through follow-up, and secondary attack rate among close contacts of asymptomatic index patients. A qualitative synthesis was performed. Where appropriate, data were pooled using random effects meta-analysis to estimate proportions and 95% confidence intervals (95% CI). Results Of 6,137 identified studies, 71 underwent quality assessment after full text review, and 28 were high/moderate quality and were included. In two general population studies, the proportion of asymptomatic COVID-19 infection at time of testing was 20% and 75%, respectively; among three studies in contacts it was 8.2% to 50%. In meta-analysis, the proportion (95% CI) of asymptomatic COVID-19 infection in obstetric patients was 95% (45% to 100%) of which 59% (49% to 68%) remained asymptomatic through follow-up; among nursing home residents, the proportion was 54% (42% to 65%) of which 28% (13% to 50%) remained asymptomatic through follow-up. Transmission studies were too heterogenous to meta-analyse. Among five transmission studies, 18 of 96 (18.8%) close contacts exposed to asymptomatic index patients were COVID-19 positive. Conclusions Despite study heterogeneity, the proportion of asymptomatic infection among COVID-19 positive persons appears high and transmission potential seems substantial. To further our understanding, high quality studies in representative general population samples are required.
235 citations
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TL;DR: In this paper, the difference in sensitivity for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection between nasopharyngeal swabs and saliva was determined.
Abstract: Background Nasopharyngeal swabs are the primary sampling method used for detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but they require a trained health care professional and extensive personal protective equipment. Purpose To determine the difference in sensitivity for SARS-CoV-2 detection between nasopharyngeal swabs and saliva and estimate the incremental cost per additional SARS-CoV-2 infection detected with nasopharyngeal swabs. Data sources Embase, Medline, medRxiv, and bioRxiv were searched from 1 January to 1 November 2020. Cost inputs were from nationally representative sources in Canada and were converted to 2020 U.S. dollars. Study selection Studies including at least 5 paired nasopharyngeal swab and saliva samples and reporting diagnostic accuracy for SARS-CoV-2 detection. Data extraction Data were independently extracted using standardized forms, and study quality was assessed using QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2). Data synthesis Thirty-seven studies with 7332 paired samples were included. Against a reference standard of a positive result on either sample, the sensitivity of saliva was 3.4 percentage points lower (95% CI, 9.9 percentage points lower to 3.1 percentage points higher) than that of nasopharyngeal swabs. Among persons with previously confirmed SARS-CoV-2 infection, saliva's sensitivity was 1.5 percentage points higher (CI, 7.3 percentage points lower to 10.3 percentage points higher) than that of nasopharyngeal swabs. Among persons without a previous SARS-CoV-2 diagnosis, saliva was 7.9 percentage points less (CI, 14.7 percentage points less to 0.8 percentage point more) sensitive. In this subgroup, if testing 100 000 persons with a SARS-CoV-2 prevalence of 1%, nasopharyngeal swabs would detect 79 more (95% uncertainty interval, 5 fewer to 166 more) persons with SARS-CoV-2 than saliva, but with an incremental cost per additional infection detected of $8093. Limitation The reference standard was imperfect, and saliva collection procedures varied. Conclusion Saliva sampling seems to be a similarly sensitive and less costly alternative that could replace nasopharyngeal swabs for collection of clinical samples for SARS-CoV-2 testing. Primary funding source McGill Interdisciplinary Initiative in Infection and Immunity. (PROSPERO: CRD42020203415).
151 citations
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Federal University of Rio de Janeiro1, World Health Organization2, Hong Kong Department of Health3, University of Washington4, Hospital Universitario La Paz5, Brigham and Women's Hospital6, University of Cape Town7, South African Medical Research Council8, University Medical Center Groningen9, The Chinese University of Hong Kong10, McGill University11, Montreal Chest Institute12
TL;DR: DST for ethambutol, pyrazinamide, and second-line tuberculosis drugs appears to provide clinically useful information to guide selection of treatment regimens for MDR and XDR tuberculosis.
Abstract: Background. Individualized treatment for multidrug-resistant (MDR) tuberculosis and extensively drug-resistant (XDR) tuberculosis depends upon reliable and valid drug susceptibility testing (DST) for pyrazinamide, ethambutol, and second-line tuberculosis drugs. However, the reliability of these tests is uncertain, due to unresolved methodological issues. We estimated the association of DST results for pyrazinamide, ethambutol, and second-line drugs with treatment outcomes in patients with MDR tuberculosis and XDR tuberculosis. Methods. We conducted an analysis of individual patient data assembled from 31 previously published cohort studies of patients with MDR and XDR tuberculosis. We used data on patients' clinical characteristics including DST results, treatment received, outcomes, and laboratory methods in each center. Results. DST methods and treatment regimens used in different centers varied considerably. Among 8955 analyzed patients, in vitro susceptibility to individual drugs was consistently and significantly associated with higher odds of treatment success (compared with resistance to the drug), if that drug was used in the treatment regimen. Various adjusted and sensitivity analyses suggest that this was not explained by confounding. The adjusted odds of treatment success for ethambutol, pyrazinamide, and the group 4 drugs ranged from 1.7 to 2.3, whereas for second-line injectables and fluoroquinolones, odds ranged from 2.4 to 4.6. Conclusions. DST for ethambutol, pyrazinamide, and second-line tuberculosis drugs appears to provide clinically useful information to guide selection of treatment regimens for MDR and XDR tuberculosis.
116 citations
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TL;DR: The results indicate that COVID-19 is hazardous not only for the elderly but also for middle-aged adults, for whom the infection fatality rate is two orders of magnitude greater than the annualized risk of a fatal automobile accident and far more dangerous than seasonal influenza.
Abstract: Determine age-specific infection fatality rates for COVID-19 to inform public health policies and communications that help protect vulnerable age groups. Studies of COVID-19 prevalence were collected by conducting an online search of published articles, preprints, and government reports that were publicly disseminated prior to 18 September 2020. The systematic review encompassed 113 studies, of which 27 studies (covering 34 geographical locations) satisfied the inclusion criteria and were included in the meta-analysis. Age-specific IFRs were computed using the prevalence data in conjunction with reported fatalities 4 weeks after the midpoint date of the study, reflecting typical lags in fatalities and reporting. Meta-regression procedures in Stata were used to analyze the infection fatality rate (IFR) by age. Our analysis finds a exponential relationship between age and IFR for COVID-19. The estimated age-specific IFR is very low for children and younger adults (e.g., 0.002% at age 10 and 0.01% at age 25) but increases progressively to 0.4% at age 55, 1.4% at age 65, 4.6% at age 75, and 15% at age 85. Moreover, our results indicate that about 90% of the variation in population IFR across geographical locations reflects differences in the age composition of the population and the extent to which relatively vulnerable age groups were exposed to the virus. These results indicate that COVID-19 is hazardous not only for the elderly but also for middle-aged adults, for whom the infection fatality rate is two orders of magnitude greater than the annualized risk of a fatal automobile accident and far more dangerous than seasonal influenza. Moreover, the overall IFR for COVID-19 should not be viewed as a fixed parameter but as intrinsically linked to the age-specific pattern of infections. Consequently, public health measures to mitigate infections in older adults could substantially decrease total deaths.
571 citations
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TL;DR: The combination of bedaquiline, pretomanid, and linezolid led to a favorable outcome at 6 months after the end of therapy in a high percentage of patients with highly drug-resistant forms of tuberculosis; some associated toxic effects were observed.
Abstract: Background Patients with highly drug-resistant forms of tuberculosis have limited treatment options and historically have had poor outcomes. Methods In an open-label, single-group study in...
437 citations
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New York City Department of Health and Mental Hygiene1, University of Groningen2, World Health Organization3, Shahid Beheshti University of Medical Sciences and Health Services4, Statens Serum Institut5, California Department of Public Health6, Rio de Janeiro State University7, Post Graduate Institute of Medical Education and Research8, McGill University9, University of Pennsylvania10, Radboud University Nijmegen11, Institut de recherche pour le développement12, University Health Network13, Albert Einstein College of Medicine14, National Institutes of Health15, Centers for Disease Control and Prevention16, University of Colorado Denver17, Centre for Health Protection18, Oswaldo Cruz Foundation19, University of Cape Town20, University of Sydney21, University of Paris22, Médecins Sans Frontières23, University of California, San Francisco24, Emory University25, Brigham and Women's Hospital26, Samsung Medical Center27, Federal University of Rio de Janeiro28, Hofstra University29, New Generation University College30, Karolinska Institutet31, St. Joseph's Healthcare Hamilton32, Sofia Medical University33, Harvard University34, Columbia University35, Cornell University36, University of Texas Health Science Center at Tyler37, Partners In Health38, University of Ulsan39, University of Sassari40, Queen Mary University of London41, The Chinese University of Hong Kong42
TL;DR: Treatment outcomes were significantly better with use of linezolid, later generation fluoroquinolones, bedaquiline, clofazimine, and carbapenems for treatment of multidrug-resistant tuberculosis, and the need for trials to ascertain the optimal combination and duration of these drugs is emphasised.
404 citations
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TL;DR: In this paper, a prospective study of the first 100 consecutive patients (50 SARS-CoV-2 laboratory-positive and 50 laboratory-negative) presenting to our Neuro-Covid-19 clinic between May and November 2020 was conducted.
Abstract: OBJECTIVE: Most SARS-CoV-2-infected individuals never require hospitalization. However, some develop prolonged symptoms. We sought to characterize the spectrum of neurologic manifestations in non-hospitalized Covid-19 "long haulers". METHODS: This is a prospective study of the first 100 consecutive patients (50 SARS-CoV-2 laboratory-positive (SARS-CoV-2+ ) and 50 laboratory-negative (SARS-CoV-2- ) individuals) presenting to our Neuro-Covid-19 clinic between May and November 2020. Due to early pandemic testing limitations, patients were included if they met Infectious Diseases Society of America symptoms of Covid-19, were never hospitalized for pneumonia or hypoxemia, and had neurologic symptoms lasting over 6 weeks. We recorded the frequency of neurologic symptoms and analyzed patient-reported quality of life measures and standardized cognitive assessments. RESULTS: Mean age was 43.2 ± 11.3 years, 70% were female, and 48% were evaluated in televisits. The most frequent comorbidities were depression/anxiety (42%) and autoimmune disease (16%). The main neurologic manifestations were: "brain fog" (81%), headache (68%), numbness/tingling (60%), dysgeusia (59%), anosmia (55%), and myalgias (55%), with only anosmia being more frequent in SARS-CoV-2+ than SARS-CoV-2- patients (37/50 [74%] vs. 18/50 [36%]; p < 0.001). Moreover, 85% also experienced fatigue. There was no correlation between time from disease onset and subjective impression of recovery. Both groups exhibited impaired quality of life in cognitive and fatigue domains. SARS-CoV-2+ patients performed worse in attention and working memory cognitive tasks compared to a demographic-matched US population (T-score 41.5 [37, 48.25] and 43 [37.5, 48.75], respectively; both p < 0.01). INTERPRETATION: Non-hospitalized Covid-19 "long haulers" experience prominent and persistent "brain fog" and fatigue that affect their cognition and quality of life.
345 citations
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TL;DR: Based on a systematic review and meta-analysis of published evidence on COVID-19 until July, 2020, the IFR of the disease across populations is 0.68% (0.53-0.82%).
336 citations