Jaiberth Antonio Cardona-Arias

Meta-analysis of the utility of culture, biopsy, and direct KOH examination for the diagnosis of onychomycosis

BackgroundOnychomycosis is a highly prevalent disease worldwide. There is no standard test for its diagnosis, which remains costly, wasteful, and is sometimes delayed. The diagnostic tests for this disease are few and discordant. The objective was to evaluate the diagnostic validity, performance, and accuracy of culture, nail clipping with Periodic Acid-Schiff –PAS- staining (biopsy), and direct potassium hydroxide (KOH) examination for the study of onychomycosis.MethodsA systematic review was conducted via meta-analysis using 5 databases and 21 search strategies. An ex ante protocol was applied with inclusion and exclusion criteria. Quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool, and the sensitivity, specificity, predictive values, likelihood ratios, diagnostic odds ratios, receiver operating characteristic (ROC) curves, and proportion of correctly diagnosed patients were evaluated with the meta-analysis of studies of evaluations of diagnostic and screening tests (Meta-DiSc) and Epidat using a random effects model.ResultsThe efficiency or accuracy of the three tests is influenced by the methodological quality of the studies. These values are lower for KOH and culture and higher for biopsy in moderate quality studies.ConclusionThe diagnostic tests evaluated in this meta-analysis independently showed acceptable validity, performance, and efficiency, with nail clipping with PAS staining outperforming the other two tests.

Methodological characteristics of sustainability science: a systematic review

Sustainability science has emerged as a research program and a scientific trend that directs all efforts to promote transition of societies toward sustainability. The style of research proposed to tackle unsustainability issues should be characterized by the application of a systems approach, as well as transdisciplinarity, participation, generation of social learning and a problem-solving perspective. However, whether such traits are being actually implemented has not been determined. Furthermore, a mature science is expected to have coherent research typologies, besides a scientific community and shared theoretical assumptions and methodological prescriptions; such types or research on sustainability science is still unknown. This systematic review aimed at analyzing research papers on sustainability carried out in 2013. Three aspects were studied: the scientific community, the theoretical assumptions on the concept of sustainability and the methodological design. Results suggest that the scientific community comes from disciplines different to sustainability, the researchers tend not to define the concept of sustainability and among those who do, and there is a lack of shared assumptions. The present analysis also showed that research on sustainability has not implemented the methodological characteristics mentioned and coherent method typologies were not found. These aspects hinder sustainability science evolution and maturity, given the difficulty to construct theories and consolidate a scientific community that develops coherent methods on such grounds.

Cost-effectiveness analysis of thermotherapy versus pentavalent antimonials for the treatment of cutaneous leishmaniasis

The treatment of cutaneous leishmaniasis is toxic, has contraindications, and a high cost. The objective of this study was to estimate the cost‐effectiveness of thermotherapy versus pentavalent antimonials for the treatment of cutaneous leishmaniasis.