Diagnostic value of alkaline phosphatase isoenzymes

Among the serum enzymes used for diagnostic purposes the alkaline phosphatase (AP) is one of the oldest and the most frequently applied laboratory tests. Increased activity found in the serum is a consequence of certain hepato-biliary disorders, different bone diseases, endocrine syndromes, kidney illnesses and malignant tumors as well. From the study of the pattern of the isoenzymes of the serum-AP information of practical importance may be gained by which many differential-diagnostic problems can be solved. For the clinical-chemical laboratories methods that use electrophoretic separation on different membranes or gels are recommended. Patterns characteristic for different diseases may well be differentiated from normal constellation. AP-isoenzymes help to reveal cholestases at early stages, some disorders of bone metabolism and malignant processes as well.     

Role of spirometry in primary practice

Spirometry is increasingly used in general practice and improves the possibilities regarding mainly the early detection and treatment of obstructive pulmonary diseases. However, spirometry performed in general practice is less reliable than that performed in lung function laboratories and primary care laboratories, so that spirometry performed by the GP personally appears to be less suitable for monitoring purposes. Spirometry is a useful and feasible tool for GP's, providing that test results are adequately integrated within the GP's management of patients with obstructive lung disease. If sufficient attention on quality assurance of spirometry cannot be guaranteed in general practice, lung function laboratories and primary care laboratories may play an important supportive role.     

International influenza surveillance (author's transl)]

Influenza may be considered a convenient model to set up a methodology for surveillance in a country, which can further be extended to other diseases. The solidarity which exists among Directors of National Influenza Centres is one of the reasons for its success. On positive result, and one which is not negligible, has been the stimulating effect which influenza surveillance had on the development of virus laboratories in tropical regions.     

Rickettsial diseases in Brazil and Portugal: occurrence, distribution and diagnosis

The present study is an update review on the occurrence and diagnosis of rickettsial diseases in Brazil and Portugal, aiming at promoting their epidemiological surveillance in both countries. A literature review was carried out and unpublished data of laboratories and surveillance systems were presented. The results described the occurrence of rickettsial diseases and infections in Brazil and Portugal, including other new and still poorly understood rickettsial infections. Current diagnostic methods were discussed. As in many other countries, rickettsial diseases and infections seem to be an emerging public health problem. Treated as a minor problem for many decades, the interest in these infections has increased in both countries but further studies are needed to establish their role as a public health problem.     

Advantages of working in a developing country during medical specialty training

Training in a developing country provides additional value for Dutch physicians who are training for a medical specialty. Knowledge of and experience with tropical diseases is also important in the Netherlands. The limited access to diagnostic tests and treatments in developing countries forces physicians to perform physical examinations meticulously and prescribe treatments conscientiously. Limited abilities to communicate can lead to an appreciation of the importance of communication and insights regarding optimal methods for communication. By working with staff in developing countries, physicians learn to be flexible in regard to work attitudes and cooperation. Physicians also learn to develop a personal academic programme independently. In addition, physicians become more readily involved in improving standards of living and healthcare in the community as a whole, and in the coordination and organization of work. Lastly, the ability to work professionally with limitations in healthcare is also valuable in medical practice in the Netherlands. Therefore, the decision to do part of the training as a medical specialist in a developing country should be supported. This experience should also count as part of the training.     

Kabisa: an interactive computer-assisted training program for tropical diseases

In Europe, tropical pathology is usually taught in special short courses, intended for those planning to practise in developing countries. The theoretical knowledge to be assimilated during this short period is considerable, and turning such newly acquired knowledge into competence is difficult. Kabisa is a computer-based training program for tropical diseases. Instead of concentrating on strictly tropical diseases, students are trained in recognizing diseases in patients presenting randomly in an imaginary reference hospital in a developing country. Databases are compiled by experts from experiences in various parts of Africa, Asia and tropical America. Seven languages and three levels of competence can be chosen by the student. Updating of all databases is possible by teachers who want to describe a particular setting. A ‘consistency checker'verifies the internal consistency of a new configuration. The logical engine is based upon both a ‘cluster'and a Bayesian logic, with built-in corrections for related disease characteristics. This correction allows calculated probabilities to stay closer to real probabilities, and avoids the ‘probability overshoot'that is inherent to ‘idiot Bayes'calculations. The program provides training in diagnostic skills in an imaginary second-line setting in a tropical country. It puts tropical and cosmopolitan diseases in perspective and combines applied clinical epidemiology and pattern recognition within varying sets of presenting symptoms. Students are guided in searching for the most relevant disease characteristics, in ranking disease probability, and in deciding when to stop investigating.     

Orphan drug legislation: lessons for neglected tropical diseases

In the last 20 years, orphan drug legislation (ODL) has been adopted in several countries around the world (USA, Japan, Australia, and the European Union) and has successfully promoted R&D investments to develop new pharmaceutical products for the treatment of rare diseases. Without these incentives, many life-saving new drugs would have not been developed and produced. For economic reasons, the development of medicines for the treatment of diseases prevalent in the developing world (or tropical diseases) is lagging behind. Among several factors, the low average per-capita income makes pharmaceutical markets in developing countries appear relatively unprofitable and therefore unattractive for R&D-oriented companies. The case of ODL may offer some useful insights and perspectives for the fight against neglected tropical diseases. First, the measures used in ODL may also be effective in boosting R&D for neglected tropical diseases, if appropriately adapted to this market. Second, small-sized companies, which have played a successful role in the development of orphan drugs for rare diseases, may also represent a good business strategy for the case of tropical diseases.     

Idiopathic cardiomegaly

Cardiomyopathies are certain heart diseases of unknown etiology and pathogenesis, occurring mostly in tropical and subtropical areas, where they constitute a major clinical problem and sometimes a public health problem. The need for international co-operation in the study of such forms of heart disease has long been recognized and WHO convened informal meetings of investigators on various aspects of the subject in 1964, 1965 and 1966. Out of these have arisen co-operative studies co-ordinated by WHO. In November 1967 a fourth informal meeting was held in Kingston, Jamaica, to review the following topics: the progress reports from all co-operating laboratories; the different types of cardiomyopathies; past experience with cardiac registries, and the diagnostic importance of coronary angiography. Steps were taken towards the formulation of a standard terminology, since too many confusing names are currently employed to mean “cardiomegaly of unknown origin”. A common name, “idiopathic cardiomegaly”, was therefore suggested for future use.     

RNA fingerprinting of South American prototype aphthovirus strains

Aphthovirus strains used in South America for vaccine production or as reference for diagnostic purposes were analysed by RNA fingerprinting (RNase T1 maps, one- and two-dimensional gels). The results obtained constitute the basis for a data bank containing available information about the genome structure of strains of aphthovirus prevalent in this continent and can be used as an adjunct to serological and immunological information. These data are currently being used in South American countries to assess the genetic stability of strains during vaccine production; to establish possible vaccine origin of field outbreaks and to monitor the origin, behaviour and fate of new strains in the field.     

The role of the World Health Organization in the control of rickettsial diseases

The World Health Organization (WHO) pays great attention to the problem of rickettsial diseases. A network exists of Collaborating Centres for Rickettsial Reference and Research, which are designated by WHO.A WHO Consultation on the Laboratory Diagnosis of Rickettsial Diseases was held in 1987. In accordance with the recommendations of this consultative group, WHO first established The Project on Global Surveillance System for Rickettsial Diseases, with the immediate objective of obtaining reliable data on the global prevalence and distribution of rickettsial diseases. This information should contribute directly to the principal objective of reducing morbidity and mortality due to rickettsial diseases. An additional objective is to identify and characterize strains of pathogenic rickettsiae from various localities throughout the world. The final objective of the above study is to transfer the existing diagnostic technology to laboratories in developing countries. Under the auspices of this Project a diagnostic kit was developed for identification of antibodies with antigens of R. prowazekii and R. conorii in the indirect immunofluorescence test. About 20 laboratories in various countries are participating in this Project. Training courses have been organized for participants from countries in Africa and South-East Asia. The first stage of the Project will be evaluated in 1991 and, depending on the outcome of the first stage, a larger programme would be considered for subsequent years.Presented at the 4th International Symposium on Riskettsiae and Rickettsial Diseases, Pietany, C.S.F.R., 1–6 October, 1990.     

Quality control of DNA testing in hereditary diseases

The laboratories performing diagnostic studies regarding hereditary diseases and the specialists providing hereditary counselling are housed in clinical genetic centres. The laboratories are subject to the Special Medical Performances Act and have had licenses from the Ministry. The DNA diagnostic laboratories united in the National Committee on DNA Diagnostics, engaged among other things in quality control. The large number of tests requested and the dramatic consequences for the patient and his relatives necessitate high quality standards. The laboratories made a division of labour for analysis of most disorders, in order to acquire and maintain expertise in spite of rarity of most hereditary diseases. For adequate handling of requests for DNA diagnostic tests, it is important that the patient material be sent directly to the laboratory specialized in the disorders in question, for the request form to be filled out completely and for the patient data to be stated on the blood tube. A regularly updated review of the DNA diagnostics in the Netherlands can be found on the website: http://www.unimaas.nl/ approximately LOD/lod.htm. This list indications per centre and information such as required material and maximal results deadlines.     

Streptococcal diseases worldwide: present status and prospects

Infections caused by streptococci pathogenic for man are some of the most common bacterial diseases in temperate zones and occur very frequently in tropical and subtropical countries. The highest morbidity occurs from infections caused by group A streptococci; these infections can lead to rheumatic fever and acute glomerulonephritis. The incidence of rheumatic fever and the prevalence of rheumatic heart disease are several times higher in tropical countries than temperate countries.     

Diagnostic applications of DNA probes

This review has described several of the most common molecular biologic techniques that are, or will be, employed in the diagnostic laboratory. The potential advantages of these DNA probe assays in the diagnosis of infectious diseases include: rapid detection and identification of infectious agents; the ability to screen selected specimens using batteries of probes; and the detection of nonviable or difficult-to-culture organisms. The potential disadvantages of DNA probe assays include: the use of isotopic detection methods for optimum sensitivity; limited diagnostic sensitivity of current assays; slow turna-round time for some assay formats; expense of current reagents; limited availability of many probes; lack of technical expertise in most diagnostic laboratories; and the requirement for antimicrobial susceptibility testing (requires culture). Given the above advantages and disadvantages, there are several key issues that must be considered before adopting DNA probe technology in the diagnostic laboratory; the cost of performing routine culture and identification versus the cost of screening with probes--both the number and type of specimens and the time savings that may be realized by eliminating routine cultures; the prevalence of the infectious agent--even the best DNA probe assay may not be useful or practical in a low-prevalence situation; the need for additional equipment and space; and the interpretation of false-positive and false-negative results--additional research is needed in this area. However, laboratories must consider these issues when using a test other than the current gold standard (i.e., culture). DNA probe technology is with us and expanding rapidly. The intelligent application of this new technology will require communication between laboratorians and clinicians and careful consideration of the many advantages and disadvantages discussed above.     

Investigating interactions between HIV infection and tropical diseases

The health of developing country populations in Africa where there is a high incidence of human immunodeficiency virus (HIV) infection is already seriously compromised by malnutrition and endemic diseases such as tuberculosis. Not only may HIV infection compromise currently used methods for the treatment of tropical diseases, but there may be a synergistic relationship between HIV and other diseases. Epidemiologic studies are thus needed to identify and quantify and such interactions. At present, evidence of such interactions may be limited by the fact that tropical diseases are most prevalent in rural areas while HIV cases have so far been concentrated in urban areas. However, any unexplained rise in the incidence or severity of a specific disease in areas where HIV is prevalent should be investigated as a possible interaction effect. Likewise, if the progression from HIV infection to acquired immunodeficiency syndrome (AIDS) seems to be occurring particularly rapidly in an area, AIDS patients should be examined for the presence of other diseases that may be triggering AIDS. Possible interactions between HIV infection and tropical diseases can be set forth in a schematic form in which both are divided into 3 infection states--uninfected, infected without clinical symptoms, and infected and diseases--and arrows are used to represent the transitions between states and possible interactions.     

Immunosurveillance and the evaluation of national immunization programmes: a population-based approach

Mass vaccination can change the epidemiological dynamics of infectious diseases. It may result in a limited persistence of natural and vaccine-induced immunity and a higher mean age of infection, which may lead to a greater risk of complications. The epidemiological situation should be monitored and immunosurveillance based on the assessment of specific antibodies against vaccine-preventable diseases in human serum is one of the tools. In order to estimate the immunity of the Dutch population reliably, a large-scale, population-based, collection of serum samples was established (8359 sera in a nation-wide sampling and 1589 sera from municipalities with low vaccine coverage). In contrast to collecting residual sera from laboratories, this approach gains extensive information by means of a questionnaire regarding the determinants of the immune status and the risk factors for the transmission of infectious diseases in general. The population-based approach gives a better guarantee that the data are representative than collecting sera from laboratories does.     

Gender differences in determinants and consequences of health and illness

This paper uses a framework developed for gender and tropical diseases for the analysis of non-communicable diseases and conditions in developing and industrialized countries. The framework illustrates that gender interacts with the social, economic and biological determinants and consequences of tropical diseases to create different health outcomes for males and females. Whereas the framework was previously limited to developing countries where tropical infectious diseases are more prevalent, the present paper demonstrates that gender has an important effect on the determinants and consequences of health and illness in industrialized countries as well. This paper reviews a large number of studies on the interaction between gender and the determinants and consequences of chronic diseases and shows how these interactions result in different approaches to prevention, treatment, and coping with illness. Specific examples of chronic diseases are discussed in each section with respect to both developing and industrialized countries.     

Diagnosis of diabetes mellitus: limited use for portable blood-glucose measuring devices

In the Netherlands, guidelines for the diagnosis of diabetes mellitus are confusing and differ from the international guidelines. Capillary blood-glucose testing using a blood-glucose device is allowed used as a diagnostic tool, although this test is imprecise. The Dutch laboratories measure blood-glucose concentrations by a more precise accurate method, but sometimes measure glucose levels in capillary whole blood and sometimes in venous plasma. These results are not comparable, because the results of capillary measurements are lower than the plasma measurements. In daily practice, health-care professionals are using different methods and are often not aware of the differences in glucose values that may result. They do not realise that glucose devices and laboratory glucose measurements may differ and that capillary- and plasma-glucose values are not interchangeable. Uniformity within the Dutch laboratories with regard to the glucose measurements is urgently needed, as is revision of the Dutch guidelines concerning the diagnosis of diabetes mellitus. This should be based solely on venous plasma-glucose values determined in a laboratory. Portable blood-glucose devices should not be used as a diagnostic tool for diabetes mellitus. These should only be used for blood-glucose control monitoring during treatment or as a screening tool.     

Veterinary diagnostic laboratories and their support role for Veterinary Services

National Veterinary Services administer a number of regulatory programmes, such as foreign animal disease (FAD) surveillance and exclusion of FADs, and certification of regions as free from disease. Laboratory testing is an important part of any surveillance or control programme. Most countries have a national laboratory which performs testing for FADs and provides support for national disease eradication and control programmes. State laboratories provide testing for surveillance programmes and export purposes, in addition to diagnosis of clinical cases. Many national and state laboratories are developing quality assurance programmes to assure the reliability of testing results. Veterinary Services are reliant on the diagnostic expertise of the laboratory system of that country to be able to respond to FAD introductions and to provide the surveillance programmes needed to detect the introduction of diseases and to certify freedom from disease.     

“和谐使命-2014”医务人员热带病认知调查

“和谐使命2014”任务区是热带病高发地区,本文对执行任务的医务人员热带病认知水平进行调查研究,结果显示整体热带病认知水平较低,诊治能力有待提高。任务前的卫生宣教是快速提升热带病诊治能力的有效方法,宣传手册、举办讲座和教学视频是受欢迎的卫生宣教方式。     

Incentivising appropriate care: the case of immunizations

Incentivising appropriate care is a two-way street. Patients need to take greater responsibility and provider payment systems need to reward the best quality care. Today we are seeing the reemergence of many vaccine-preventable diseases that we thought were eradicated long ago for all practical purposes. In the U.S., diphtheria, polio, measles, mumps, and rubella all are on an upsurge. In this era of stringent cost containment and "managed care," preventive childhood immunizations offer one of the highest financial returns on investment we can achieve. So why have our inner cities become worse than some third-world countries in terms of low immunization rates for preschool age children and high infant mortality? We argue that "it's the money."