Performance of IgG and IgG1 anti-HTLV-1 reactivity by an indirect immunofluorescence flow cytometric assay for the identification of persons infected with HTLV-1, asymptomatic carriers and patients with myelopathy

In this study, the performance of IgG and IgG1 anti-HTLV-1 reactivity obtained by a flow cytometric assay was evaluated to verify its applicability for the diagnosis of persons infected with HTLV-1, including asymptomatic carriers and patients with myelopathy. The ability to identify patients with myelopathy among persons infected with HTLV-1 was also examined. Western blot assays were performed to assess the reactivity profiles of sera from asymptomatic carriers and patients with myelopathy against viral proteins. The data showed that IgG1 detected by flow cytometric assay is effective for the diagnosis of persons infected with HTLV-1 with 97% sensitivity and 100% specificity. IgG and IgG1 exhibited high performance in distinguishing patients with myelopathy from asymptomatic carriers. Using serum dilutions and cut-off points established previously a second HTLV-1 carrier group was tested using flow cytometric assay to detect IgG and IgG1. The data demonstrated sensitivity of 93% and 98%, respectively, confirming the high reactivity of persons infected with HTLV-1 detected by this method. Western blot assays confirmed the high specificity of MT-2 cells as a reliable source of viral antigen since only sera from persons infected with HTLV-1 recognised MT-2 proteins. Furthermore, a high reactivity to Gag and Env proteins was observed, especially among patients with myelopathy. These data suggest that flow cytometric detection of IgG1 is a valuable, non-conventional serological method to diagnose HTLV-1 infection and for research purposes.     

Serum biochemical markers for post-concussion syndrome in patients with mild traumatic brain injury

Mild traumatic brain injury (MTBI) is a major public health problem in the United States. A significant subset of MTBI patients develop persistent and distressing neurological, cognitive, and behavioral symptoms, known as the post-concussion syndrome (PCS). To date, multiple studies have assessed the relationship between brain-related proteins found in the serum at the time of injury, and the development of PCS. We conducted a systematic review of prospective cohort studies that assessed the ability of serum biochemical markers to predict PCS after MTBI. A total of 11 studies assessing three different potential biochemical markers of PCS--S100 proteins, neuron-specific enolase (NSE), and cleaved Tau protein (CTP)--met selection criteria. Of these markers, S100 appeared to be the best researched. We conclude that no biomarker has consistently demonstrated the ability to predict PCS after MTBI. A combination of clinical factors in conjunction with biochemical markers may be necessary to develop a comprehensive decision rule that more accurately predicts PCS after MTBI.     

Validation of the Daily Living Tasks Dependent on Vision (DLTV) questionnaire in a U.S. population with age-related macular degeneration

PURPOSE: The Daily Living Tasks Dependent on Vision questionnaire (DLTV) has been used to assess functional impairment among patients with age-related macular degeneration (AMD). This study evaluated the psychometric properties of the DLTV using patient-reported rates of use of services and devices in an outpatient population. METHODS: The DLTV was included in a survey mailed to members of an AMD advocacy organization. Included in the survey were questions about demographic and clinical characteristics as well as questions about use of low vision aids and care-giving. Respondents provided informed consent. Data were analyzed in SAS. RESULTS: Four respondents of 803 did not complete the DLTV; missing data were uncommon. Most (56%) respondents were male; the mean age was 73 years. Internal consistency reliability of the DLTV was 0.9699. Construct validity was demonstrated with moderate to high correlations between the DLTV and use of services and devices. The DLTV demonstrated discriminant validity and could distinguish between respondents with different levels of impairment, i.e., those who reported regular care-giving compared to those without regular care-giving. CONCLUSIONS: In this outpatient population, the DLTV demonstrated reliability and validity. This analysis complements existing research and supports the use of the DLTV in AMD patients.     

The burden of age-related macular degeneration

As age-related macular degeneration (AMD) becomes more prevalent as a result of longer life expectancy and the number of elderly people worldwide, it will become increasingly important to understand its potential health and economic impact for appropriate healthcare planning. This review identified published literature on costs and resource use associated with AMD. Despite the increasing prevalence of AMD, the worldwide burden of illness is unknown. Several studies of direct medical costs, both those associated with ophthalmic care and those associated with other care, have been conducted and have identified increased medical care associated with AMD. Direct non-medical costs include the cost for vision aids; while these costs may be substantial, they are difficult to quantify as no comprehensive sources track the distribution or use of vision aids. Because AMD is uncommon among people of working age, there is less concern regarding the impact of indirect (workplace) costs among AMD patients. However, indirect costs are incurred by caregivers who leave the workforce early or change their work patterns in order to provide assistance to AMD patients; the magnitude of caregiver-related costs is unknown. The cost effectiveness of some interventions for AMD has been explored. Supplementation with zinc and antioxidants for non-exudative (dry) AMD has been shown to result in an acceptable cost per QALY and is considered cost effective. Studies suggest that laser photocoagulation is cost effective but that photodynamic therapy with verteporfin appears to be cost effective only among patients with good visual acuity at baseline or when models extend longer than 5 years. Further research is needed to integrate the information on various components of AMD-related costs into a comprehensive burden of illness estimate and to evaluate basic utility assumptions in existing models.     

The cost-effectiveness of omega-3 supplements for prevention of secondary coronary events

PURPOSE: To project the clinical and economic benefits of omega-3 supplements for prevention of secondary (repeat) cardiovascular events in U.S. males. DESIGN: Decision-analytic model. METHODOLOGY: Model clinical probabilities (rates of fatal myocardial infarction [MI] and cardiovascular death) were based on published trials. Costs were derived from standard U.S. sources. Outcomes include deaths delayed, cost per death delayed, fatal MIs avoided, and cost per fatal MI avoided. Costs, outcomes, and cost-effectiveness were determined for the initial year and over a 42-month model period. Sensitivity analyses were conducted to evaluate the robustness of key model assumptions. PRINCIPAL FINDINGS: According to the model, the use of omega-3 supplements results in fewer fatal MIs and fewer cardiovascular deaths in the short-term (1 year) and longterm (42-month) analyses. When including only direct medical treatment costs for fatal MIs, omega-3 supplementation is cost-effective compared to no supplementation. In terms of total costs (medical costs and decreased productivity), supplementation is cost-saving, providing better outcomes and lower/fewer costs. Supplementation remained cost-effective in all sensitivity analyses. CONCLUSION: Under a variety of scenarios, omega-3 supplements are likely to improve health and lower total costs. Despite model limitations, omega-3 supplementation should be considered an important and cost-effective option for prevention of secondary cardiovascular events.     

Geoprocessing in health area

The map's usage and the concerns about geographic distribution related with diseases are not a recent issue. A classical example is the John Snow survey -maps were used to locate cholera's cases and related them with the water supplying. The spatial representation techniques are fewer used in health sectors due to troubles in managing such information. So, the aim of this survey was to establish the disease spatial distribution in Ribeir?o Preto, 2002. Secondary data were used to elaborate this study. The spatial distribution of cases was realized by using the MapInfo 7.8 software. Although many cases were concentrated in the northeast region in the city, which consists the quarters of low economical income. The results contribute to show the Tb spatial distribution in Ribeirao Preto, they also reinforce the space category as a methodological alternative to manage, to monitor and to evaluate the health actions by directing interventions to decrease the iniquities.     

Bifid mandibular condyle: archaeological case report of a rare anomaly

In this paper, an archaeological case of unilateral bifid mandibular condyle is presented. This uncommon anomaly is characterized by a division of the mandibular condylar head. In this case, the left condyle was divided into two articulating surfaces oriented mediolaterally; two articular facets on the anterior wall of the glenoid fossa for the double condyle were observed. The morphological and radiological analysis do not show any evidence of injuries or degenerative pathology. Taking into account the two main causes of bifid condyle suggested in the literature (traumatic and developmental), an embryopathy by teratogenic agents is proposed as a possible aetiology of the bifid condyle reported here.     

Practical applications of usability theory to electronic data collection for clinical trials

Pharmaceutical and device companies are more frequently considering and using electronic data collection (EDC) to collect patient-reported outcomes such as satisfaction and quality of life for clinical trials. The transition from paper-and-pencil data collection to EDC is not without risks. The unique context of clinical trials presents challenges that, if not addressed, can lead to expensive mistakes. The advantages inherent to EDC can easily be cancelled out without careful attention to the characteristics of the clinical setting. This paper provides an overview of EDC issues specific to clinical trials and health care settings. In particular, it evaluates usability issues associated with methods of EDC and suggests strategies to minimize potential problems. Lessons learned from usability testing in the unique setting of the clinical trial can be applied to other projects to decrease costs, enhance the quality of the data, and minimize time to analysis.     

Effect of GM-CSF on immune,inflammatory, and clinical responses to ragweed in a novel mouse model of mucosal sensitization

BACKGROUND: Conventional models of allergic airway inflammation involve intraperitoneal administration of ovalbumin in conjunction with a chemical adjuvant (generally aluminum hydroxide) to generate allergic airways inflammation. Here we have investigated the effect of respiratory mucosal exposure to a ragweed extract in the absence of chemical adjuvant on the generation of allergic responses. OBJECTIVES: We sought to develop a mouse model of ragweed-induced allergic airway inflammation through mucosal sensitization and to investigate the role of GM-CSF in this process. METHODS: Ragweed was delivered intranasally to an airway microenvironment enriched with GM-CSF, which was achieved by means of either multiple coadministrations of recombinant GM-CSF or a single delivery of an adenoviral vector carrying the GM-CSF transgene. RESULTS: Administration of a purified ragweed extract leads to T(H)2 sensitization (and not inhalation tolerance) accompanied by mild airway inflammation, modest clinical symptoms, and moderate production of T(H)2 cytokines by splenocytes on ragweed restimulation. The administration of anti-GM-CSF antibodies in conjunction with ragweed diminished T(H)2-associated cytokine production. These responses were amplified by enriching the airway microenvironment with GM-CSF. Under these conditions, all T(H)2-associated immune-inflammatory responses, as well as the clinical responses, were considerably enhanced. To investigate the mechanism underlying these effects, we examined lung mononuclear cells by means of flow cytometry and detected a substantial expansion of antigen-presenting cells, particularly dendritic cells, as well as a substantially increased activation of these antigen-presenting cells, as demonstrated by the expression of B7 molecules, particularly B7.2. CONCLUSION: GM-CSF plays an important role in the generation of allergic immune-inflammatory responses to ragweed.