Evaluation of the OptiMAL test for diagnosis of malaria in Venezuela

We evaluated the OptiMAL rapid dipstick test by comparing it with the conventional standard thick-blood film method, for the detection of malaria in two groups of individuals from different Venezuelan endemic areas. One of the groups consisted of individuals with malaria-like symptoms (n = 113) and the other of asymptomatic individuals (n = 89). The classical microscopy analysis of these populations determined that 67.5% were infected with P. vivax, 31.3% with P. falciparum, and 1.2% with mixed infections. The OptiMAL test showed 96.4% sensitivity, 100% specificity, 100% positive predictive value, 97.5% negative predictive value and optimal concordance (kappa = 0.97), capable of detecting any malaria infection in the evaluated population. However, these parameters were lower when the parasitaemia was < or = 300 parasites/microL. Freezing of the samples did not affect the sensitivity and specificity of the test. We concluded that this rapid malaria test is sensitive and specific for rapid diagnosis of malaria in the field and it is a complement to conventional microscopy.     

Performance of an immunochromatographic test for the rapid diagnosis of malaria

The immunochromatographic test (ICT) for the rapid diagnosis of malaria has been marketed for several years. In a study in which three Centres of Tropical Medicine participated and data were pooled, performance of the test varied considerably when comparing the results between each centre. The sensitivity of ICT in 2,343 patients tested in our services was 100% and the specificity 99.74%. Moreover, two patients with a positive ICT would initially have been missed by expert microscopy, with Plasmodium falciparum malaria being confirmed microscopically some hours later. The principal reasons for the better performance of the test in our series appear to be blood collection in EDTA vials and considerable experience with handling and interpreting the ICT test.     

Immunochromatographic test for the diagnosis of Falciparum malaria

The diagnosis of malaria poses great difficulty at times due to non-availability of microscope, trained personnel or laboratory set up. We undertook the immunochromatographic test in 98 suspected cases of malaria for the detection of antigen of P. falciparum in the blood and to assess its sensitivity and positive predictive value. The sensitivity was 87.06% (confidence interval 77.57 to 92.55%) and the positive predictive value was 93.67%. This is a simple, sensitive and convenient test which can be performed in remote areas.     

Multicenter study to evaluate bloodstream infection by Helicobacter cinaedi in Japan

Helicobacter cinaedi has being recognized as an important human pathogen which causes bloodstream infections. Although the first case of bacteremia with this pathogen in Japan was reported in 2003, the true prevalence of H. cinaedi as a pathogen of bloodstream infections in this country is not yet known. Therefore, the aim of our study was to assess the incidence of bacteremia with H. cinaedi in Japan. We conducted a prospective, multicenter analysis in 13 hospitals during 6 months in Tokyo, Japan. Among positive blood cultures from 1 October 2003 to 31 March 2004, isolates suspected of being Helicobacter species were studied for further microbial identification. Identification of the organisms was based on their biochemical traits and the results of molecular analysis of their 16S rRNA gene sequences. A total of 16,743 blood culture samples were obtained during the study period, and 2,718 samples (17.7%) yielded positive culture results for coagulase-negative staphylococci. Among nine isolates suspected to be Helicobacter species, six isolates were finally identified as H. cinaedi. The positivity rate for H. cinaedi in blood culture was 0.06% of total blood samples and 0.22% of blood samples with any positive culture results. All patients with bacteremia with H. cinaedi were found to have no human immunodeficiency virus (HIV) infection, but many of them had complications with either malignancy, renal failure, or a history of surgical operation. Therefore, our results suggest that bacteremia with H. cinaedi is rare but can occur in compromised hosts other than those with HIV infection in Japan.     

The sensitivity of the OptiMAL rapid diagnostic test to the presence of Plasmodium falciparum gametocytes compromises its ability to monitor treatment outcomes in an area of Papua New Guinea in which malaria is endemic

Using in vivo samples from treatment failure malaria cases, we demonstrate the high sensitivity of the parasite lactase dehydrogenase (pLDH)-based OptiMAL rapid diagnostic test in the detection of P. falciparum gametocytes. This high sensitivity limits the use of pLDH-based tests in the monitoring of treatment outcomes in circumstances where gametocytemia is common.     

Use of rapid diagnostic tests for diagnosis of malaria in the UK

BACKGROUND: Malaria is currently diagnosed almost exclusively by microscopy in clinical laboratories. The introduction of rapid diagnostic tests (RDTs) may be useful in achieving rapid detection of malaria parasites, especially in situations where malaria is not often seen or where staff are inexperienced. AIM: To explore the use of RDT in UK laboratories. METHODS: The current use of RDTs was surveyed in UK laboratories subscribing to the United Kingdom National External Quality Assessment Scheme blood parasitology and haematology schemes. RESULTS: An overall survey response rate of 60.3% was seen. RDTs were found to be the preferred choice, either alone or in conjunction with microscopy in 31.2% of the samples examined during normal working hours and in 44.3% of the specimens examined on call. CONCLUSIONS: During on-call hours, the use of RDTs was observed to increase and RDTs changed the diagnosis in 12% of laboratories. No established protocol for RDT use was, however, observed in the UK. A protocol that needs to be validated in the laboratory setting is suggested.     

The situation of clinical examination in today's U.S. hospitals

In the U.S., with the spread of managed care such as the Diagnostic Related Group/Prospective Payment System(DRS/PPS) introduced in 1983 into Medicare, the national elderly medical insurance system, and the Health Maintenance organization introduced in 1990 in the private medical insurance system, medical services have become limited, and remuneration of medical practice has been markedly restricted. As a result, hospital management has been pressed, and cooperation, merger, and absorption among hospitals as is observed among general enterprises have occurred. Hospitals have been making efforts to reduce expenses for survival. I introduced a part of the influence of such revisions in medical insurance systems on the medical care system, particularly the clinical examination field, by reporting the present state of the Beth Israel Medical Center(BIMC, New York) for which I have cooperated in the management of the Central Examination Room for many years, and information obtained in the UC. San Francisco Medical Center and Peninsula Hospital I visited when attending the meeting of the American Association of Clinical Chemistry(AACC) held in San Francisco on July 23-27, this year.     

The role of U.S. public hospitals in urban health.

Public hospitals in the United States play a key role in urban health. In many metropolitan communities, public hospitals maintain the health care safety net. Most urban public hospitals have evolved to not only provide care for the indigent but also to serve their communities in other ways, including serving as major providers for tertiary services such as trauma and those that support homeland security; serving as the foundation for primary care services; continuing to train a significant number of physician, nurses, and other medical personnel; and providing laboratories for clinical medical research. Federal budget cuts such as those in the Balanced Budget Act of 1997, recent state budget deficits, competition for Medicaid Managed Care, and the growth in the number of uninsured have led to a decline in revenues among urban public hospitals. To be better stewards of scarce resources, public hospitals have moved to reduce inpatient demand by adopting prevention strategies that are aimed at addressing the determinants of health, the complex interactions among social and economic factors, the physical environment, and individual behavior. These factors contribute to health status and offer opportunities to intervene and improve community health. Urban public hospitals, to be successful in the next stage of their evolution, need to learn to manage the "in-betweens"--partnering with governmental and nongovernmental entities to identify and work together on common health and safety issues. If public hospitals engage the community successfully, building trust and establishing new capability and capacity, urban public hospitals will survive, evolve, and continue their tradition of service.     

An open study to evaluate the efficacy of artemether in severe falciparum malaria

An open clinical trial was conducted in 30 patients of severe falciparum malaria with heavy parasitaemia (parasitized erythrocytes above 5%). Artemether (methyl ether of dihydroartemisinin-active principle isolated from Chinese plant Qinghaosu) was administered as 80 mg intramuscular injection twice on first day and then single dose of 80 mg intramuscular on 2nd to 5th day. The trial could be completed in 28 patients and two patients expired. In our observation falciparum malaria affected the young adults in their most productive period of life i.e. 25-44 yrs. All patients became afebrile by the 4th day with fever clearance time approximately 31.92 +/- 15.30 hr. Twenty-five patients (83.33%) became parasite free by 5th day with mean parasite clearance time approximately 47.04 +/- 19.95 hr. Deranged liver function and renal profile was observed in 63% and 50% patients respectively. Two patients, who died had very high degree of parasitaemia (50% and 16%) with cerebral malaria. One died due to multiorgan failure and other due to massive hematemesis and shock. The type of response achieved by artemether therapy was analysed as per WHO criteria suggested for chloroquine resistance. S response was observed in 25 patients (cure rate 83.33%). Two patients (6.66%) patients showed R II response, one patient (3.33%) showed R III response and R I response was not observed in any patient. No significant side effects were noted. This pilot study demonstrated that intramuscular artemether is a useful addition to antimalarial drugs in this era of multidrug resistant P. falciparum malaria showing high clinical potency with virtually no side effect.     

Micronitrous acid extraction-coagglutination test for rapid diagnosis of streptococcal pharyngitis.

A micronitrous acid extraction-coagglutination test for the rapid diagnosis of streptococcal pharyngitis was examined in a busy pediatric clinic and found to be a simple, rapid, and inexpensive procedure with a sensitivity of 78% and a specificity of 98% when compared with blood agar culturing.     

1985 survey of biomedical & clinical engineering departments in U.S. hospitals.

The Journal of Clinical Engineering has conducted a broad scope survey of hospital biomedical and clinical engineering departments throughout the U.S. An earlier report provided salary and job responsibility data. This second report provides, for the first time, numerical data on the administration, facilities, budgets, department workload, personnel workload, employment benefits, quality assurance, and other professional aspects of the departments. The present report represents approximately 6% of all U.S. hospitals, 10% of all U.S. hospital beds, and over $1.1 Billion dollars worth of hospital equipment service responsibilities. Readers are cautioned not to use the statistical averages presented here as standards or guidelines because of the substantial and appropriate differences between departments. Nevertheless, the survey data provide a useful overview of the hospital-based clinical and biomedical engineering field. The survey determined that 58% of hospital biomedical activities are organized as separate departments reporting to hospital administration. From 1984 to 1985, department budgets increased by +12% overall. While all budget categories increased, wages were the greatest factor (+11%). Teaching facilities have substantially higher budgets than non-teaching. Department floor space increased +3.2% from year to year. Nationwide, an average of 226 sq. ft. is used per department staff member. Department test equipment increased by +11.4% from 1984 to 1985. During the same period, the total dollar value of equipment serviced by the departments increased by +10.5% and the number of devices serviced increased by +4.8%. Nationwide, the statistically average department serviced 2,220 devices worth $7,068,000. Department employment is growing at +10.8% per year (teaching department staffs +7.6%; non teaching +15.9%). Employment of BMETs grew by +8.6%; Clinical Engineers by +11.5%. A measure called Devices Per Person was steady at 500 devices per person from year-to-year. A second measure called Beds Per Person was, on average, 95 beds per department staff member (lower in teaching, higher in non teaching). Other averages are 136 Beds/BMET; 402 Beds/CE; and 390 Beds/Supervisor. Hospital employment benefits are detailed. Only 23% of departments are now equipped to use telecommunications. Virtually all departments have major Q.C. procedures in place.     

Enrichment culture coagglutination test for rapid, low-cost diagnosis of salmonellosis.

Specific diagnosis of salmonellosis by conventional culture and identification methods usually requires 2 to 4 days. Since Salmonella may be disseminated from infected individuals during this period, this amount of time required for diagnosis may be too slow to aid in epidemic control. To obtain earlier diagnoses of salmonellosis, a coagglutination test was used for rapid, simplified detection of Salmonella oranienburg antigens in enrichment broth cultures of fecal specimens from infants involved in a nursery outbreak. Two selective enrichment broths were used, selenite cystine and dulcitol selenite. These were compared in parallel for efficiency by subculture on deoxycholate lactose sucrose, MacConkey, xylose lysine deoxycholate, and tryptic soy lactose teepol agars. These overnight enrichment broth cultures of stool specimens were also examined by a coagglutination slide test with stabilized protein A-containing staphylococci sensitized with antisera for Salmonella antigens C1, E, and Vi. Of 113 diarrhea stool specimens tested, 86 were positive by conventional culture, 82 were positive by dulcitol selenite-coagglutination, and 55 were positive by selenite cystine-coagglutination. All these tests were negative on 50 stool specimens from infants in a noninfected nursery. Salmonellae were specifically detected in stool cultures within 20 h by the coagglutination technique. This early detection of Salmonella antigens provided a useful adjunct to culture for rapid diagnosis of salmonellosis.     

Improved rapid slide agglutination test for presumptive diagnosis of canine brucellosis.

A modified rapid slide agglutination test for the presumptive identification of Brucella canis infection in dogs has been developed. The method required mixing 0.1 ml of canine serum with 0.1 ml of 0.2 M 2-mercaptoethanol solution. Equal volumes (0.05 ml) of the treated serum and the B. canis plate antigen were mixed. Agglutination results were read within 2 min. Clinical studies showed 100% agreement between this method and the conventional 2-mercaptoethanol tube agglutination test. Excellent correlation was shown between cultural isolation and the modified rapid slide agglutination test, using sera from experimentally infected dogs.