Frequency of human immunodeficiency virus (HIV) infection among contemporary anti-HIV-1 and anti-HIV-1/2 supplemental test- indeterminate blood donors. The Retrovirus Epidemiology Donor Study

Background: Follow-up studies from the mid-1980s showed that 1 to 5 percent of blood donors testing reactive in anti-human immunodeficiency virus type 1 (HIV-1) enzyme immunoassay (EIA) and testing indeterminate in Western blot were infected with HIV-1 and were in the process of seroconverting. The present study was conducted to establish the rate of HIV infection among contemporary anti-HIV-1/HIV type 2 (HIV-2) EIA- reactive, Western blot-indeterminate donors. Study Design and Methods: Donations (n = 607) with indeterminate HIV supplemental test results were identified by screening 3,021,342 donations given from November 1990 through August 1993 at five participating blood centers. Consenting donors were enrolled and samples taken 4 to 8 weeks after donation. Follow-up sera were tested by EIA and Western blot for anti- HIV-1 seroconversion and by type-specific peptide assays for antibodies to HIV-2 and HIV-1 subtype O. Peripheral blood mononuclear cells and/or plasma from the follow-up samples were tested for HIV-1 DNA and/or RNA by polymerase chain reaction. The rate of HIV-1 infection among Western blot-indeterminate donors was also estimated by multiplying the incidence rate of HIV-1 seroconversion in this donor population by the estimated duration of the EIA-reactive and Western blot-indeterminate window during seroconversion (8.5 days). Results: Supplemental test- indeterminate donors (n = 355) enrolled a median of 38 days after donation; 265 (75%) of these donors were identified as indeterminate after an anti-HIV-1/2 EIA-reactive donation. Enrolled and non-enrolled donors had similar distributions of demographic characteristics and band patterns. Follow-up samples from all 355 donors tested negative for HIV-1 in polymerase chain reaction. Follow-up sera tested Western blot-negative in 54 cases (15%) and Western blot-indeterminate in 299 (84%). Two follow-up sera (0.6%) were interpreted, according to manufacturer's package insert criteria, as Western blot positive with p24 and gp41 bands and/or gp120/160 bands; however, paired testing of index and follow-up sera from these two cases showed identical Western blot and EIA reactivity, and polymerase chain reaction was negative for HIV RNA and DNA, which ruled out HIV infection. The absence of HIV infection in 355 Western blot-indeterminate donors was consistent with our incidence-based model analysis, which yielded an estimate of one HIV-1 infection for every 215 Western blot-indeterminate donations (95% CI, 1/39-1/8333). Conclusion: Contemporary blood donors classified as indeterminate in supplemental HIV testing are infrequently infected with HIV. Donors whose follow-up samples test negative in anti-HIV-1/2 EIAs and negative or persistently indeterminate in Western blots should be considered eligible for reinstatement.     

Antigen testing for human immunodeficiency virus (HIV) and the magnet effect: will the benefit of a new HIV test be offset by the numbers of higher risk,test-seeking donors attracted to blood centers? Retrovirus Epidemiology Donor Study

Background: There currently is debate on whether to include new assays for viral antigens and nucleic acids in the battery of screening tests applied to all blood donations. Proposals call for implementation of p24 antigen screening tests to help identify donors who are infected with human immunodeficiency virus type 1 (HIV-1) but have not yet seroconverted (window-period donors). There is concern, however, that people at higher risk for HIV infection will be attracted to blood centers in order to obtain the results of an HIV assay that is not routinely available elsewhere. Therefore, the benefit of antigen testing may be offset by an increase in the HIV incidence rate among blood donors. Study Design and Methods: Estimates were obtained from previous reports for the HIV incidence rate among blood donors, the percentage of donations from test-seeking donors, the duration of the HIV-infectious window period, and the performance of p24 antigen screening assays. Sensitivity analyses were performed by using various percentages of test-seeking donors following implementation of antigen testing and various HIV incidence rate ratios of test-seekers to nonseekers. Hypothetical residual HIV risks were calculated for multiple scenarios and compared to the current estimate of HIV risk without antigen screening of blood donations. Results: If antigen testing reduces the window period by 27 percent (e.g., from 22 days to 16 days), and the HIV incidence rate among test-seekers is 30 times that among nonseekers, then the benefit of antigen testing will be eliminated if the percentage of test-seekers (currently estimated at 3.2%) increases to 5.7 percent. If antigen testing reduces the window period by approximately 45 percent (e.g., from 22 days to 10 days or from 13 days to 6 days) and the HIV incidence rate ratio (test-seekers vs. nonseekers) is assumed to be equal to the HIV prevalence ratio (5.3), then the percentage of donations from test-seeking donors would have to increase to 25 percent of all donations to offset the benefit of antigen screening. Conclusion: This model helps identify the key measures for assessing the potential adverse effect of increased test seeking as a consequence of the addition of p24 antigen (or other direct virus) assays to blood donor screening programs. In most scenarios, the beneficial effect of antigen screening exceeded the potential detrimental effect of attracting higher-risk, test-seeking donors. The possibility cannot be ruled out, however, that a subgroup of high-risk, test-seeking donors attracted to the blood centers by a new HIV test will offset the reduction in the residual risk of HIV infection associated with antigen screening.     

Shelf-life of photodynamically sterilized red cell concentrates with various numbers of white cells

BACKGROUND: Phthalocyanines are useful sensitizers for the photodynamic sterilization of red cell concentrates. The use of the phthalocyanine Pc4 (HOSiPcOSi(CH3)2(CH2)3N(CH3)2) and red light is very efficient in killing various viruses. The addition of scavengers of Type I photodynamic reactions and the use of cremophor to deliver Pc4 give protection to the red cells. STUDY DESIGN AND METHODS: Various red cell components, either white cell-enriched, buffy coat-removed, or white cell-reduced, have been used to study the effect of photodynamic treatment with Pc4 on hemoglobin and potassium leakage and on ATP and glucose levels after prolonged storage. RESULTS: After treatment, storage interval-dependent damage to the red cells could be observed. In components with 26 × 10(9) white cells per L, virus inactivation was less efficient than that in components with no or 2 × 10(9) white cells per L. Similarly, red cells were less affected by the treatment in components with a large number of white cells. Pretreatment storage and use within 1 week after photodynamic treatment induce less damage to the red cells at the moment of transfusion. CONCLUSION: Various improvements in the treatment protocol may ultimately lead to the implementation of photodynamic treatment in transfusion practice. In this respect, the white cell content of the red cell concentrates should be taken into account.     

A new narrow band vegetation index for characterizing the degree of vegetation stress due to copper: the copper stress vegetation index (CSVI)

This study proposed a new narrow band index to characterize the Cu (Copper) stress degree on vegetation (Copper Stress Vegetation Index, CSVI). Firstly, the spectral reflectance and biochemical data of wheat, pea, locust and ash were analysed using Pearson correlation coefficient (r) to select wavelengths sensitive to Cu stress. The calculated Pearson correlation coefficients suggested that the reflectance near 550 nm and 700 nm correlated positively with Cu contents in leaves and solutions, and negative correlation was present in the range of 800–900 nm. Secondly, the selected wavelengths of 550 nm, 700 nm, and 850 nm were used to establish CSVI, and it was compared with existing popular vegetation indices (VIs) related to heavy metal stress (Normalized Difference Vegetation Index (NDVI), Red-Edge Position (REP), Difference Vegetation Index (DVI), Photochemical Reflectance Index (PRI)) by calculating Pearson correlation coefficient between VIs and Cu contents in leaves and solutions. Thirdly, verifications of CSVI on other vegetations were conducted, and the performance of CSVI was also compared with that of NDVI, REP, DVI, and PRI. The results suggested that CSVI showed significant correlation with Cu stress degree, and the correlation of CSVI was much stronger than that of other VIs for all the tested vegetations. The proposed CSVI characterizes the Cu stress degree on vegetation with advantages of better effectiveness, straightforward calculation, and robustness for different vegetations. This study focused on the spectral reflectance at the leaf scale, so it is expected that future work extends it to canopy scale and mixed-pixel scale.     

Determination of the knowledge level,attitudes, and behaviors of islamic religious officials toward blood donation

The aim of the present study was to determine knowledge level, attitudes, and behaviors of Islamic religious officials toward blood donation. This study included 334 religious officials rendering service in the province of Kahramanmaras, located in the Mediterranean region of Turkey. A questionnaire was administered to gather sociodemographic data of the participants and their knowledge levels, attitudes, and behaviors toward blood donation. The questionnaire consisted of 11 questions that yielded a total of 11 points. The religious officials in the study included 206 imams (61.7%, males) and 128 Quran course instructors (38.3%, females). Of study participants, 134 (40.1%) reported a previous experience of blood donation and 200 (59.9%) denied previous experience of blood donation. The mean knowledge score was 7.09 ± 2.54 points for males and 6.89 ± 2.18 points for females. Male and female participants achieved comparable scores (p = 0.476). Of the participants, 291 (87.1%) agreed and nine (2.7%) disagreed with the expression, “Blood donation is permissible in Islam;” 34 (10.2%) participants had no idea. The present study revealed considerable deficiencies in knowledge about blood donation among religious officials. In addition, the rate of blood donation and willingness to donate blood were low among religious officials. Although the level of knowledge about blood donation was similar in males and females, it was an interesting finding that the blood donation rate was significantly higher in males than in females.     

Analysis and injury paterns of walnut tree falls in central anatolia of turkey

Aim

The aim of the study was to compare the New Orleans Criteria and the New Orleans Criteria according to their diagnostic performance in patients with mild head injury.

Methods

The study was designed and conducted prospectively after obtaining ethics committee approval. Data was collected prospectively for patients presenting to the ED with Minor Head Injury. After clinical assessment, a standard CT scan of the head was performed in patients having at least one of the risk factors stated in one of the two clinical decision rules.

Patients with positive traumatic head injury according to BT results defined as Group 1 and those who had no intracranial injury defined as Group 2. Statistical analysis was performed with SPSS 11.00 for Windows. ROC analyze was performed to determine the effectiveness of detecting intracranial injury with both decision rules. p < 0.05 was considered statistically significant.

Results

175 patients enrolled the study. Male to female ratio was 1.5. The mean age of the patients was 45 ± 21,3 in group 1 and 49 ± 20,6 in group 2. The most common mechanism of trauma was falling. The sensitivity and specificity of CCHR were respectively 76.4% and 41.7%, whereas sensitivity and specificity of NOC were 88.2% and 6.9%.

Conclusion

The CCHR has higher specificity, PPV and NPV for important clinical outcomes than does the NOC.

     

Incidence and risk factors of surgical site infection in general surgery in a developing country

Purpose

To investigate the incidence of surgical site infections (SSIs) according to risk factors, etiological agents, antimicrobial resistance rates of pathogens, and antimicrobial prophylaxis (AMP) in a developing country.

Methods

Prospective surveillance of SSIs was carried out in general surgery (GS) units between May 2005 and April 2009.

Results

SSI was diagnosed in 415 (10.8 %) patients. Cefazolin was used as AMP in 780 (49 %) operations, whereas broad-spectrum antibiotics were used in the remaining operations. AMP was administered for >24 h in 69 and 64 % of the GS patients. The most significant risk factors for SSI after GS were total parenteral nutrition, transfusion, and a drainage catheter. The most common pathogen was Escherichia coli, but all the isolated pathogens were multiresistant.

Conclusion

AMP is effective for reducing the risk of SSI; however, the prolonged use of AMP and broad-spectrum antibiotics may be associated with the emergence of resistant bacterial strains.     

Sonographic biometry of spleen among school age children in Nsukka,Southeast, Nigeria

Background

Normative value of spleen size among school age children is important for objective assessment of the spleen.

Objectives

This study was aimed at determining sonographically the normal limits of the spleen size according to age, sex, and somatometric parameters among school age children.

Methods

A cross sectional study was done on 947 apparently healthy subjects (496 boys and 451 girls) aged 6 – 17 years. The subjects were recruited from some primary and secondary schools within Nsukka metropolis and also from out patients in the study centre. A pilot study was done to determine the intra- and inter rater reliability of sonographic measurements of the spleen. The sonographic examination was performed on Shenzhen DP-1100 machine with 3.5 and 5 MHz convex transducers. Spleen sizes were obtained with the subject in a right lateral decubitus position.

Results

Measurement of spleen length was reliable while measurement of spleen width was less reliable within and between sonographers. Dimensions of the spleen were not statistically different in boys and girls (p > 0.05). Height correlated best with spleen dimensions.

Conclusions

Normogram of the spleen size with respect to height is important in the determination of some pathology associated with changes in its size.     

Psychiatric symptoms and diagnoses in thyroid disorders: a cross-sectional study

Objective

Endocrine dysfunction may produce symptoms that are difficult to distinguish from the clinical manifestations of psychiatric disorders. In particular, the function of the hypothalamic–pituitary–thyroidal axis is known to be associated with a number of psychiatric abnormalities, such as depression and anxiety. In this study, we tested the hypothesis that depression is more commonly encountered in hypothyroidism, while anxiety is more prevalent in hyperthyroidism. Additionally, we aimed to evaluate the correlations of the intensity of the psychiatric symptomatology in these patients with the specific parameters of thyroid function, such as levels of TSH, T3 and T4.

Method

Patients newly diagnosed as having thyroid disorders were included in the study. They were classified into five study groups (according to the results of thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4) and autoantibody (anti-thyroglobulin antibodies and anti-microsomal antibodies) measurements): hypothyroid, hyperthyroid, subclinical hypothyroid, subclinical hyperthyroid, and euthyroid Hashimoto's thyroiditis. Psychopathological symptoms were evaluated on the 17-item Hamilton Rating Scale for Depression (HDRS), Brief Symptom Inventory (BSI), BSI Sub-scales and Hospital Anxiety and Depression Scale (HAD). Psychiatric diagnoses were performed using DSM-IV-SCID (Structured Clinical Interview for DSM). The relationship between the results of the psychiatric evaluation and thyroid function tests was assessed statistically by ANOVA and Pearson correlation tests.

Results

Eighty patients (68 female and 12 male), with a mean age of 42.5±13.4 years, were evaluated. A positive correlation between the total BSI scores and TSH levels (r?=?0.65, P?=?0.01) was noted in the hypothyroid (n=25) group. Hyperthyroid patients (n=22) showed a positive correlation between HDRS scores and fT4 levels (r?=?0.62, P?=?0.01). The BSI scores in hypo- and hyperthyroidism were significantly higher than normal (P<0.05). In the subclinical hypothyroid (n=7), subclinical hyperthyroid (n=11), and euthyroid Hashimoto's thyroiditis (n=15) groups no correlation was found between thyroid function tests and HDRS, BSI, and HAD scores.

Conclusion

The results indicate that patients with thyroid disorders have high levels of anxiety and depressive symptoms. Thirty-five patients (43%) out of 80 had an axis I psychiatric disorder. However, our findings did not support an association between high levels of depression and hypothyroidism or between high levels of anxiety and hyperthyroidism. Moreover, this study did not reveal any specific psychiatric manifestation of hypothyroidism or hyperthyroidism.