Performance of two malaria rapid diagnostic tests in febrile adult patients with and without human immunodeficiency virus-1 infection in Blantyre, Malawi

The performance of two histidine-rich protein type-2-based malaria rapid diagnostic tests (mRDTs) was examined in a rural area with a high prevalence of malaria and human immunodeficiency virus type-1 (HIV-1) infection in 113 and 445 febrile patients ≥ 15 years of age with and without HIV-1 infection, respectively. Patients were tested for HIV-1 infection by using a standard assay and for Plasmodium falciparum by using two mRDTs and microscopy. When microscopy was used as the gold standard, both mRDTs performed similarly in patients with and without HIV-1 infection: Bioline SD Malaria Antigen P.f, sensitivity 94.4% (95% confidence interval [CI]: 81.3-99.3%) versus 97.1% (95% CI:92.8-99.2%) and specificity 50.6% (95% CI: 39.0-62.2%) versus 47.2% (95% CI: 41.4-53.1%); and ICT diagnostics Malaria Pf, sensitivity 94.4% (95% CI: 81.3-99.3%) versus 97.1% (95% CI: 92.8-99.2%) and specificity 50.6% (95% CI:39.0-62.2%) versus 50.3% (95% CI: 44.4-56.1%). Infection with HIV-1 does not appear to affect the performance of these histidine-rich protein type-2 (HRP-2)-based mRDTs.     

Neonatal screening for severe primary immunodeficiency diseases using high-throughput triplex real-time PCR

Severe combined immunodeficiency (SCID) and X-linked agammaglobulinemia (XLA) are inborn errors of immune function that require prompt diagnosis and treatment to prevent life-threatening infections. The lack of functional T or B lymphocytes in these diseases serves as a diagnostic criterion and can be applied to neonatal screening. A robust triplex PCR method for quantitation of T-cell receptor excision circles (TRECs) and κ-deleting recombination excision circles (KRECs), using a single Guthrie card punch, was developed and validated in a cohort of 2560 anonymized newborn screening cards and in 49 original stored Guthrie cards from patients diagnosed with SCID, XLA, ataxia-telangiectasia, Nijmegen-breakage-syndrome, common variable immunodeficiency, immunoglobulin A deficiency, or X-linked hyper-IgM syndrome. Simultaneous measurement of TREC and KREC copy numbers in Guthrie card samples readily identified patients with SCID, XLA, ataxia-telangiectasia and Nijmegen-breakage-syndrome and thus facilitates effective newborn screening for severe immunodeficiency syndromes characterized by the absence of T or B cells.     

The meaning of hypokalemia in heart failure

Maintenance of normal potassium (K(+)) homeostasis has become an increasingly important limiting factor in the therapy of heart failure (HF). With the application of loop diuretics and digoxin, hypokalemia has become a frequent and feared side effect of treatment. Low serum K(+) in HF may be also a marker of increased neurohormonal activity and disease progression. To gain the maximum benefit from treatment, we need to individualize drug use and carefully monitor electrolytes. Symptomatic HF patients (New York Heart Association class III-IV) should be prescribed the lowest dose of diuretic necessary to maintain euvolemia. Mild hypokalemia may be corrected by the use of aldosterone receptor antagonists such as spironolactone or eplerenone. However, a more severe hypokalemia should preferably be corrected using K(+) supplement. Serum K levels should be frequently checked and maintained between 4.0 and 5.5 mEq/l (mmol/l).     

The relationship between clinical outcomes and quality of life in first‐episode mania: a longitudinal analysis

Objectives: Despite growing attention to the relationship between bipolar disorder (BD) and quality of life (QoL), there remains a lack of information about QoL in the early stages of BD, and about the course of QoL in people with BD over time. Here, we report on QoL and symptomatic outcomes over a 1.5‐year period in a Canadian sample of first‐episode mania patients. Methods: Patients (n = 63) with DSM‐IV‐TR BD type I recovering from a recent episode of mania were recruited from a university‐based hospital setting in Vancouver, BC, Canada and assessed at six monthly intervals for 18 months. In addition to symptomatic and cognitive assessments, two self‐report QoL scales [the Quality of Life Enjoyment and Satisfaction Questionnaire (Q‐LES‐Q) and the Medical Outcomes Study Short Form 36 (SF‐36)] were administered. Results: Baseline QoL scores were high, with mean Q‐LES‐Q scores at 70% of the maximum possible score; QoL continued to show a trend towards improvement over time. Multiple hierarchical regressions were used to explore predictors of QoL over time, finding that: (i) length of illness and severity of depressive symptoms at baseline predicted Q‐LES‐Q scores at both baseline and six months; (ii) the number of previous depressive episodes and severity of depression at baseline and 12 months all predicted QoL at 12 months; and (iii) only severity of depressive symptoms at 12 months predicted QoL at 18 months. Conclusions: Our observation that QoL in patients who have recently experienced an episode of mania can be relatively preserved offers hope, both for healthcare providers and for those newly diagnosed. Further, that severity of depressive symptoms even in the early stages of the disease was the consistent predictor of QoL suggests that depressive symptoms need to be aggressively treated to improve QoL.     

Application of biochemical markers CA 19-9, CEA and C-reactive protein in diagnosis of malicious and benign pancreatic tumors

Introduction

We would save many lives and spare a lot of suffering if we could only detect and accurately determine the character and TMN staging of pancreatic tumors (PTs). With improved diagnosis, we could offer specific treatment that would result in better treatment outcome. The aim of study was to determine the significance of neoplastic markers CA 19-9 and CEA for prognosis in inflammatory and carcinomatous PTs.

Material and methods

We based our research upon a group of 170 patients. The patients were treated in our Oncologic Surgery Department from January 2007 to December 2010 for PTs. The patients were divided into four groups depending on the character of the tumor and underwent the following treatments: group 1 – 34 patients with carcinoma of the ampulla of Vater, group 2 – 64 patients with PTs at different stages (1, 2, 3) according to TMN classification, group 3 – 62 patients with PTs at stage 4 on the TMN scale (unresectable tumors), group 4 – 28 patients with inflammatory PTs.

Results

The results of Ca 19-9 in group 2 were 736.00 (25–75% 220.40–4285.00) ng/ml before surgery, 53.00 (25–75% 12.60–84.00) ng/ml in the 7 days after surgery, 29.4 (25–75% 7.90–113.00) ng/ml at day 30, and 119.00 (25–75% 96.30–621.00) ng/ml 3 months after the operation. These results were significantly higher than the control group but were significantly lower than the results for group 3 (unresectable tumors). The highest average concentration and median for CA 19-9 and CEA were noted in patients with unresectable PTs (the 3^rd group). The average concentration for CEA was lowest in group 4, but much higher than the lab limits.

Conclusions

The sensitivity of the CA 19-9 marker may be as high as 88%. Values of CA 19-9 above 852 U/ml may indicate TNM stage 4, consistent with an unresectable PT. In the cases where CA 19-9 is within normal limits but C-reactive protein is above normal limits (often thirty times the upper limit), in comparison to the control group and to patients with pancreatic neoplasms, strong consideration should be given towards the inflammatory characteristics of the pancreatic changes and conservative treatment should be applied.     

Treatment of non-ST-elevation myocardial infarction and ST-elevation myocardial infarction in patients with chronic kidney disease

Renal dysfunction is frequent in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Chronic kidney disease (CKD) is associated with very poor prognosis and is an independent predictor of early and late mortality and major bleeding in patients with NSTE-ACS. Patients with NSTE-ACS and CKD are still rarely treated according to guidelines. Medical registers reveal that patients with CKD are usually treated with too high doses of antithrombotics, especially anticoagulants and inhibitors of platelet glycoprotein (GP) IIb/IIIa receptors, and therefore they are more prone to bleeding. Drugs which are excreted mainly or exclusively by the kidney should be administered in a reduced dose or discontinued in patients with CKD. These drugs include enoxaparin, fondaparinux, bivalirudin, and small molecule inhibitors of GP IIb/IIIa inhibitors. In long-term treatment of patients after myocardial infarction, anti-platelet therapy, lipid-lowering therapy and β-blockers are used. Chronic kidney disease patients before qualification for coronary interventions should be carefully selected in order to avoid their use in the group of patients who could not benefit from such procedures. This paper presents schemes of non-ST and ST-segment elevation myocardial infarction treatment in CKD patients in accordance with the current recommendations of the European Society of Cardiology (ESC).     

Operative field temperature during transnasal endoscopic cranial base procedures

Background

Data regarding the safety of endoscopic skull base exploration are very scarce. With this method, fragile vital structures (cranial nerves, the optic complex, brainstem, hypothalamus or cerebral ventricles) are exposed to direct illumination within a closed space. Also, high-speed drills, cauterization and ultrasonic aspiration deliver a significant load of thermal energy. The aim of this study was to record the temperature close to the structures of the skull base and in the intradural space during the procedures performed using extended endoscopic transnasal approaches.

Methods

The temperature of the skull base was continuously recorded during six transnasal endoscopic procedures. Implantable copper-constantan thermocouples were inserted: one into the esophagus and another through the nostril to reach the operative field at the skull base.

Results

At the beginning of the procedure, the temperature of the operative field was on average 36.8 °C?±?0.80 °C, i.e. only 1 °C higher than the esophageal temperature. Then it grew continuously during the whole procedure, to eventually reach a level of 42–43 °C at the final stage, whereas the esophageal temperature remained stable. Occasionally, the temperature increased up to 45 °C during cauterization and ultrasonic aspiration, and even up to 62 °C during high-speed drilling.

Conclusion

Endoscopic skull base surgery is associated with an incessant increase of the temperature of the intraoperative field. The temperature can peak suddenly to levels which can potentially harm neural structures and influence the rate of postoperative complications.     

When can it be not optimal to adopt a new technology? A viability theory solution to a two‐stage optimal control problem of new technology adoption

Politicians often deplore economic agents’ behaviour when they do not accept new technologies. For a new technology to be adopted, the new technology value function needs to dominate the old technology value function. If this is the case, a technology switch will occur. We characterise the value functions, without computing them, using the fact that their hypographs are viability kernels of some auxiliary control problems and study whether the graphs intersect. If they do not, the corresponding value functions do not dominate each other, and the switch cannot occur at a positive time. Using this characterisation, we analyse a technology adoption problem and show how to recognise the models, for which the switch will occur at time zero or never, without solving an optimal control problem. We conclude that the current control regime may not change if the economic agents’ preferences are modelled as an integral of discounted differences between a reward from the flow variable (control) and a penalty from the stock variable (state).Copyright © 2011 John Wiley & Sons, Ltd.