Comparative evaluation of serological tests used for the diagnosis of rickettsial diseases prevalent in the temperate region of North India

PurposeThe clinical manifestations of rickettsial diseases mimic other endemic infections with similar presentations thus posing a serious challenge to clinicians for their diagnosis. For the diagnosis of rickettsial disease serological tests like Weil Felix, ELISA and IFA are used. There are limited studies that have evaluated different serological tests for the diagnosis of rickettsial diseases. Therefore, the present study was undertaken to evaluate the ELISA and Weil Felix test for the diagnosis of rickettsial diseases prevalent in this region.MethodsSamples from 281 patients clinically suspected of rickettsial diseases were tested for spotted fever group (SFG), typhus group (TG) and scrub typhus group (STG) by Weil Felix, ELISA and IFA was taken as the gold standard. Baseline titers and cut-off ODs were calculated by taking samples from healthy blood donors.ResultsThe sensitivity, specificity, positive and negative predictive value of Weil Felix test ranged from 30% to 44%, 83.46%–97.86%, 9%–77%, 92–96% respectively. The sensitivity and specificity, positive and negative predictive value of ELISA ranged from 80.77% to 96.15%, 96.33%–98.43%, 70.21%–88.64%, 92.89%–99.60% respectively. Maximum cross-reactions were observed between SFG and STG by the Weil Felix test and between STG and TG by ELISA.ConclusionsELISA was found to be sensitive and specific for the diagnosis of rickettsial diseases. It is easy to perform, does not require a technical expert for result interpretation and a large number of samples can be processed at a time.     

Patient and clinician experiences with cross-border reproductive care: A systematic review

ObjectivesThis review analyzes the experiences of patients and clinicians with regards to international cross-border reproductive care (CBRC) for the purpose of conception.MethodsElectronic databases PubMed, Embase, Web of Science, and Scopus were searched using ‘medical tourism’ AND ‘assisted reproductive technology’ from 1978 to 2020.ResultsPredominant patient motivators for CBRC were cost and legality of assisted reproduction technology (ART) in one's home country, followed by cultural factors like shared language, religion, and cultural familiarity. Clinicians suggested global laws for CBRC would reduce the potential for exploitation of vulnerable populations but believed the enactment of international regulations unlikely and, even if enacted, difficult to enforce.ConclusionsWhile patient and clinician experiences with CBRC varied, patients frequently cited financial and legal reasons for pursuing CBRC, while many providers had concern for the patient’s safety.Clinical practice implicationsThis review recommends clinicians involved in family planning counsel patients seeking treatment abroad by: (i) informing patients of the risks and benefits of treatment abroad, (ii) establishing guidelines and standards for clinicians on resuming patient care post-CBRC, and (iii) creating a directory of reputable CBRC clinicians and experts.     

Higher patient assessed quality of chronic care is associated with lower diabetes distress among adults with early-onset type 2 diabetes: Cross-sectional survey results from the Danish DD2-study

AimAmong adults aged 20–45 years with type 2 diabetes mellitus, we examined the perceived quality of chronic care, and its associations with (i) sociodemographic and clinical characteristics, and (ii) diabetes distress.MethodsIn total, 216/460 (47%) completed a self-administered survey assessing sociodemographic characteristics, patient assessed chronic illness care (PACIC-20, scale of 1–5) and diabetes distress (PAID-20, scale of 0–100), and 197 had full quality of care data for assessment. We obtained clinical data from national registers and used linear and logistic regression models to examine associations.ResultsThe mean (SD) PACIC score was 2.6 (0.9) (score range 1–5). Lower PACIC scores were associated with female sex and current unemployment, and with receiving diabetes care in general practice compared with hospital outpatient clinics [mean difference: −0.4 (95% confidence interval (CI) (−0.7 to −0.2)]. People with upper quartile PACIC scores were less likely to report high diabetes distress compared with people with lower quartile PACIC scores [odds Ratio 0.3 95%CI (0.1–0.8)].ConclusionHigher quality of care was associated with lower diabetes distress among adults with early onset type 2 diabetes mellitus, but respondents reported less than optimal quality in several core areas of chronic care.     

对比观察跨伤椎固定与经伤椎固定在治疗胸腰段脊柱骨折的临床疗效

目的对比观察跨伤椎固定与经伤椎固定在治疗胸腰段脊柱骨折的临床疗效。方法将患者平均分为实验组和对照组,对照组行跨伤椎固定,实验组行经伤椎固定。结果经过治疗后实验组JOA为(23.4±1.8)分,VAS为(2.6±0.8)分,与对照组相比,P0.05,差异不具有统计学意义。实验组手术后与手术前伤椎前后缘之差,以及半年后测量值与术后前后缘之差对比,P0.05,差异具有统计学意义。结论与跨伤椎固定相比,采用经伤椎固定的方法治疗胸腰段脊柱骨折具有更好的临床效果。     

国内部分医院β-内酰胺类抗生素皮肤试验现状调查分析

摘 要 目的：采用问卷调查了解并分析我国医院β-内酰胺类抗生素皮肤试验的实际操作情况。方法：通过电子邮件或传真方式对国内100家医院的临床药师进行问卷调查。问卷内容涵盖医院的名称、级别;β-内酰胺类药物皮肤试验方法,包括皮试液的来源和浓度、操作方法、观察时间、阳性结果的判定标准;涉及过敏史时,β-内酰胺类药物的皮肤试验以及针对口服青霉素制剂是否需要皮肤试验等14个方面的相关问题。结果：共收到信息完整的反馈问卷80份（反馈比80%）。调查显示各医院β-内酰胺类药物皮肤试验流程各有不同。不同医院在抗生素皮试品种、皮试方法、涉及过敏史时药物的选择以及口服青霉素制剂是否进行皮试等方面均存在明显差异。结论：本研究反映了现阶段我国医疗机构在β-内酰胺类抗生素皮肤试验方面缺乏统一标准,亟需尽快出台相关临床指南或共识,以保证临床使用该类药物的安全性与规范性。     

高浓缩钚材料贯穿辐射场计算方法研究

目的 为满足高浓缩钚材料操作人员辐射安全评价和核安全审评的要求,需要对高浓缩钚材料周围形成的贯穿辐射场进行计算分析,解决高浓缩钚材料发射的γ射线和中子射线贯穿机理和强度的计算问题。方法 本文在对高浓缩钚材料的组成及所含放射性核素的辐射特性进行深入分析的基础上,基于γ射线宽束减弱规律和中子分出截面理论,研究提出了适用于高浓缩钚材料γ剂量率和中子剂量率计算模式。结果 贴近高浓缩钚材料表面γ剂量率和中子通量理论计算值与实际测量值同一量级,表明计算模型是正确的。距离钚材料表面0、30、100 cm处γ剂量率实际测量值均大于计算值,并且距离越远相对误差越大;中子模拟计算值与实际测量值相对误差随距离的增加而减小。结论 通过原理分析和实测验证,证明本文提出的高浓缩钚材料辐射场计算方法是合理可行的,能够满足科学性和准确性要求。     

无鼾男性人群上气道截面大小与体格指标的相关性研究

目的探讨正常无鼾男性人群上气道横截面大小与身高、体重、体重指数(body mass index,BMI)的相关性。方法正常无鼾男性志愿者30人,年龄38.67±10.74(平均值±标准差)岁。所有志愿者进行核磁共振扫描,利用计算机固有软件测量上气道鼻咽、腭咽、舌咽及喉咽的截面积大小,分析其与身高、体重、BMI的相关性。结果体重与腭咽截面积最小值、最大值及平均值负相关,并与舌咽截面积最小值负相关;BMI与腭咽截面积最大值及平均值负相关。结论随着体重、BMI的增加,气道截面积有变小的趋势;身高与上气道截面大小无明显关系;体重、BMI对腭咽与舌咽截面积的影响较大。     

Comparison of United States and Korean dental hygiene students using the Hiroshima university-dental behavioural inventory(HU-DBI)

OBJECTIVE: To compare cross-national differences of dental health behaviour among dental hygiene students. DESIGN: Cross-cultural differences. Setting: United States (USA) and Korea. SUBJECTS AND METHODS: One hundred and twenty-six dental hygiene students in USA and 246 in Korea were surveyed using the Hiroshima University-Dental Behavioural Inventory (HU-DBI) (in English and Korean versions respectively). RESULTS: There were considerable differences in oral health behaviour between USA and Korean dental hygiene students. Of great significance were findings that while only a small proportion of the USA students (1%) reported gum bleeding when they brushed their teeth, 37% of the Korean students did so (P<0.001). Furthermore, only 19% of the Korean students had been told by their dentist that they were performing a high level of plaque control, contrasted with 76% of the USA students. Logistic regression model showed that it was possible to distinguish USA students from Korean peers with a probability of more than 90% by using the HU-DBI. CONCLUSIONS: There were considerable differences in dental health attitudes/behaviour among dental hygiene students in the two countries. The variation in the favourable attitudes/behaviour toward oral health appeared to reflect the students' clinical training experience in Korea.     

Dental caries prevalence and treatment needs of 5- to 12-year-old children in relation to area-based income and immigrant background in Greece

Objectives: To investigate the association between certain socio‐demographic characteristics and dental health status of 5‐ to 12‐year‐old children attending public kindergarten and primary schools in Piraeus, Greece. Methods: Gender, age, place of residence, immigrant background and area‐based income were associated with dental caries prevalence, treatment needs and oral hygiene level in 5,116 children. Results: The mean number of decayed, missing and filled deciduous teeth (dmft) and Unmet Restorative Treatment Needs Index (UTN) at 6‐year‐olds were 1.54 and 84.6% respectively, and the DMFT and UTN at 12‐year‐olds were 1.35 and 71.8%. Caries experience/severity significantly increased with age, whereas treatment needs and oral hygiene level decreased (P < 0.001). Immigrant background and low area‐based income was associated with poorer oral health outcomes. The above associations retained statistical significance after multivariate analysis. Children who live in areas with lower average income present 1.20 to 2.14 greater risk of having higher caries severity and poorer oral hygiene in comparison to those living in more affluent areas, and children with an immigrant background have 1.68 to 4.34 higher likelihood to present higher dmft and DMFT values, higher unmet treatment needs, and poorer oral hygiene levels compared to their Greek counterparts above and beyond the effect of the other risk factors assessed. Conclusions: The present study revealed a socio‐demographic gradient in oral health status and treatment needs of children in Piraeus, Greece.