Evaluation of the Vitros ECiQ immunodiagnostic system for detection of anti-Toxoplasma immunoglobulin G and immunoglobulin M antibodies for confirmatory testing for acute Toxoplasma gondii infection in pregnant women

Infection with Toxoplasma gondii is often asymptomatic and, when acquired during pregnancy, may lead to connatal toxoplasmosis in the offspring. The newly introduced Vitros anti-Toxoplasma immunoglobulin G (IgG) and IgM assays, designed for the Vitros ECiQ immunodiagnostic system, a fully automated system based on chemiluminescence, were evaluated as a screening method for the serological detection of acute and chronic Toxoplasma infections in the sera of 719 pregnant women. The combination of the Vitros IgG and IgM assays demonstrated a sensitivity and a specificity of 100% for the successful detection of all acute T. gondii infections by comparison with the Sabin-Feldman dye test as the reference test. The Vitros IgG assay parameter revealed a sensitivity of 95.0%, a specificity of 100.0%, a positive predictive value of 100.0%, a negative predictive value of 86.2%, and an overall agreement of 96.2% by comparison with the dye test. Comparison of the Vitros Toxoplasma IgM assay with the immunosorbent agglutination assay yielded values of 77.1%, 99.0%, 97.7%, 88.5%, and 91.1%, respectively. Subsequent receiver operating characteristic curve analysis for the accurate detection of Toxoplasma IgM in acute (n = 90) and chronic (n = 461) infections demonstrated high sensitivity (92.2%) and specificity (81.6%). The combination of a Toxoplasma-specific IgG assay with specific IgM antibody detection has improved the diagnosis of T. gondii infection by decreasing follow-up testing. Nonetheless, positive Toxoplasma IgM test results during pregnancy necessitate confirmatory testing by a reference laboratory to ensure fast and, above all, accurate test results.     

Substance use and abuse in pediatric transplant recipients: What the transplant provider needs to know

Substance abuse is infrequently addressed during pre‐ and post‐transplant care. However, the significant increase in the use of nicotine‐ and marijuana‐containing products in the general and transplant adolescent population is concerning. In addition, alcohol use/abuse remains prevalent in the US population as it is highly accessible. Pediatric transplant providers should be prepared to screen for the use of any of these substances (eg, alcohol, nicotine, marijuana, cocaine, opiates, amphetamines) and to counsel them about the dangers of substance use and abuse including the unique dangers of the substances as a transplant recipient. Formal screening tools (in children as young as 9 years) should always be used as casual assessment of substance abuse has a high failure rate. This review summarizes the substances most commonly used in adolescent transplant recipients and the approach that transplant providers should take in order to prevent, decrease, or halt use in this patient population.     

Plasma concentrations of free amino acids during 3 weeks treatment of massively obese children with a very low calorie diet

Eight grossly obese children (2 girls, 8 boys, age 12.6±2.1 mean±SD years, mean overweight 73.3±14%) were treated for 3 weeks with a very low calorie diet (VLCD), containing 1022 kJ/240 kcal, 33 g protein, 25.5g carbohydrate and 0.7g fat/day. Mean weight loss after 3 weeks was 9.47±2.8kg and mean nitrogen loss was calculated to be 113.3±71.2 g. While serum electrolytes, enzymes, glucose, urea and creatinine remained almost unchanged, distinct alterations of 23 free amino acids in plasma could be observed. A transient increase of plasma valine, leucine, isoleucine and alpha-aminobutyrate during the 1st week was followed by a constant fall in the 2nd and 3rd week. Glycine, proline, serine and threonine showed a progressive increase, while cystine, histidine and, above all, alanine decreased, the diminution of alanine being most rapid during the 1st week. No significant changes were observed in plasma concentrations of arginine, asparagine, aspartic acid, citrulline, glutamic acid, glutamine, lysine, tyrosine, ornithine, phenylalanine and taurine. Total plasma amino acid content did not change during diet compared to the pre-diet period. The behavior of plasma amino acids shows a typical pattern within four groups, reflecting various interorgan substrate fluxes during hypocaloric dieting.     

Orthodontics and vertical distraction osteogenesis of the maxilla

A female patient (age 26) visited the orthodontist for correction of the reduced exposure of the upper incisors during laughing. She also reported crowding of the lower incisors and an association between lisping and her open bite. The diagnosis in this case: a Class III malocclusion case with incisor crowding and an open bite. Because her main complaint was reduced upper incisor exposure while talking and laughing, which would not be corrected with orthodontic appliances only, the position of the maxilla was corrected during orthodontic treatment by means of vertical intra-oral maxillary distraction. An acceptable and relatively stable result was achieved.     

Sexuality of women attended in family health program: a social poetic production

The concept of promotion of health is one of the main axes of current health policies in Brazil. The adoption of this concept implies a change in the care model involving valuing a greater autonomy of subjects to work improving their conditions of life. From this perspective, several elements of health practices have to be reviewed, sexuality among them. Thus, we aimed at producing sexuality concepts as of the knowledge of women cared for in a health unity. This is a qualitative study adopting a social poetic approach. The results pointed out several affections that involve the concept of sexuality going beyond the biological aspect. We understand that this study may help professionals caring for women in a health unity because it broadens the concept of sexuality allowing for reflection on the nursing practice in collective health.