Improvement in early diagnosis of Japanese spotted fever by using a novel Rick PCR system

Rickettsia diseases, including Japanese spotted fever (JSF), are serious infections. Delayed diagnosis occasionally results in life‐threatening liver disorders and disseminated intravascular coagulation (DIC). Because of the shortness of the latent period, serological diagnosis is not preferable for early diagnosis of JSF. Until now, a polymerase chain reaction (PCR)‐based diagnosis method has been used for early diagnosis, and the sensitivity reaches as high as 90% using skin biopsy samples as we previously reported. On the other hand, the sensitivity of the same PCR method using blood samples is limited at less than 50%. In the present study, using peripheral blood samples, we developed a novel diagnostic method for JSF using a Rick PCR system with original PCR primers, showing improved sensitivity compared with the conventional nested PCR. It may constitute a preferable diagnostic tool for early and sensitive diagnosis of Rickettsia infection.     

母婴血型不合导致新生儿溶血病的实验室诊断技术分析

目的：探讨临床母婴血型不合引发新生儿溶血病（HDN）的血型分布，分析其诊断技术对临床的价值。方法选取本院2014年4月～2015年4月送检的420例疑似HDN患儿血液样本作为研究对象，对其进行ABO和Rh血型鉴定，检测其直接抗人球蛋白、游离液抗体及放散液抗体的水平。结果采用血型的血清学检测检测出由于血型不合而引发新生儿溶血病的有242例，阳性率为57.6%，其中ABO-HDN的有240例（57.1%），而Rh-HDN的有2例（0.47%）。在71例O型血患儿中，采用直接抗球蛋白和不规则抗体检测时均为阴性。已证实为ABO-HDN的240例患儿中，A型的为104例（43.3%）， B型的为136例（56.7%）。结论本次研究的由于血型不合而导致新生儿溶血病中，ABO-HDN较为常见，而其中以母亲为O型血的B型血新生儿较多见。通过对新生儿溶血病的血型相符度进行检测，对新生儿溶血病的诊断及治疗具有重要的临床意义。     

Time to diagnosis of retinoblastoma in Latin America: A systematic review

Retinoblastoma (RB) is the most common intraocular tumor of childhood. In low income countries, Time to diagnosis (TTD: interval between first symptom and diagnosis) has been associated with extraocular disease, metastasis and mortality. However, the relationship between TTD and prognosis is complex and not simply a linear correlation, particularly if TTD is <6?months. This systematic review aims to identify studies reporting TTD of retinoblastoma in Latin America, highlighting factors affecting TTD, alongside proposals and initiatives to obtain shorter intervals. The review also aims to discuss the methodology linked to cancer pathways studies. The study respected PRISMA recommendations, was registered on Prospero, an international database for systematic review registries under number CRD42017076777. MEDLINE/PUBMED, LILACS and SCIELO databases were searched. Studies from Latin America and the Caribbean, published between 1997 and 2017, reporting TTD and age at diagnosis of patients with retinoblastoma were selected. Nine studies were selected, concerning 1560 patients from Argentina, Brazil, Chile, Honduras, Mexico and Peru. The median TTD ranged from 3 to 5?months and the median age at diagnosis ranged from 16.5 to 22.2?months. A prolonged TTD was observed and was associated to damaging results on retinoblastoma outcomes, particularly increasing extraocular disease, and mortality rates. Methodological heterogeneity was observed and reiterates the importance of standardization of TTD studies, allowing more reliable comparisons and greater knowledge about retinoblastoma pathways before diagnosis. Reports on successful initiatives against delayed diagnosis were scarce, emphasizing a need for further studies.     

The diagnosis of infection in chronic leg ulcers: A narrative review on clinical practice

This literature review aimed to provide a narrative review of evidence on validity of clinical and microbial indicators of infection and to gain insights into the diagnosis of infection in chronic leg ulcers (CLUs). A search was conducted in Cinahl, Medline, the Cochrane Library databases, Embase, Web of Science, ScienceDirect, Pubmed, PsycINFO, ProQuest dissertations, and Google Scholar from January 1990 to July 2017. The inclusion criteria were original studies, systematic reviews, and consensus documents focused on “infection” in CLUs, English language, clinical and community settings, and human. The reviewed studies were inconsistent in criteria for infection between investigated wound types and lack of specificity regarding wound types. There were few studies investigating the criteria for diagnosis of infection in leg ulcers. The identification of leg ulcer infection still remains problematic and relies on out‐of‐date and not uniform evidence. Literature in this area was mostly limited to level III and IV evidence based on The Australian National Health and Medical Research Council Levels of Evidence, or expert opinion. This literature review showed seven clinical signs and symptoms that could be diagnostic for infection in CLUs, including: new, increased, or altered ulcer pain; malodour; increased ulcer area; wound breakdown, delayed or non‐healing; and erythema and increased local temperature, whilst the microbial indicators used to diagnose infected leg ulcers were varied and regarded as less important.     

(i) Clinical assessment of the shoulder

Clinical assessment of the shoulder involves an interview with the patient during which a history is taken relevant not only to the presenting complaint, but also to factors that might impact on treatment such as a past history of similar complaints and a review of the medical history of the patient which may impact on the management plan. This is followed by clinical examination which refines the differential diagnosis suggested by the history and is used to direct the choice of subsequent investigations. This article considers the salient components of the history and clinical examination of a patient presenting with shoulder problems. Subsequent articles in the mini-symposium will look at the imaging of shoulder problems as well as the capabilities of shoulder arthroscopy, which started as a technology to supplement available imaging modalities but now presents increasingly exciting prospects for minimally invasive treatment of many of the conditions detected by our clinical assessment.     

Diagnóstico microbiológico de las infecciones virales respiratorias en el paciente adulto

Conventional techniques for the diagnosis of respiratory viruses are still being used, although molecular methods are now considered as a gold standard in this field. Molecular techniques have a great number of advantages such as an excellent sensitivity, specificity, adaptability to emerging viruses, capability for multiplex and for automation. With all the available repertoire of techniques for microbiological diagnosis, the knowledge relative to respiratory viruses is growing up not only for new aetiological agents but also for its epidemiology. The advances in molecular and non-molecular fast diagnostic methods for one or more respiratory viruses allow quick decisions in the management of the patient. However, there are also disadvantages. The great sensitivity of molecular techniques has meant a significant increase in the rate of multiple detections of respiratory viruses, whose clinical involvement is difficult to interpret. Finally, it remains to show whether the use of new techniques, of high cost, in the microbiological routine diagnosis of acute respiratory viral infections in the hospitalized patient, is cost effective.     

慢性鼻窦侵袭性真菌病并发颞下窝真菌感染2例

颞下窝真菌感染属于侵袭性真菌感染，临床少见，多发生于糖尿病、恶性肿瘤、烧伤或长期糖皮质激素治疗的患者，其病原菌源于鼻窦真菌[1-2]。近年来侵袭性真菌性鼻一鼻窦炎（invasive fungalrhino-sinusitis，IFRS）及其并发症在国内外的发病率明显上升，其主要并发症是眶内、翼腭窝、颞下窝及颅内真菌感染。其中，颞下窝真菌感染较侵袭到眶内或颅内的真菌感染更为少见[3-4]。现将我科诊治的2例颞下窝真菌感染患者的资料报告如下。     

Hcy与IMA在AMI诊断中的应用价值

目的探讨血清同型半胱氨酸(Hcy)、缺血修饰清蛋白(IMA)联合检测在急性心肌梗死(AMI)诊断中的意义。方法对80例AMI患者、60例不定型心绞痛患者和40例健康体检者(对照组)的血清Hcy、IMA进行检测,并对结果进行统计分析。结果 AMI患者Hcy、IMA水平显著高于对照组,差异有统计学意义(P0.05);Hcy、IMA联合诊断的灵敏度较单一项目诊断高;Hcy与IMA呈正相关(P0.05)。结论联合检测血清Hcy、IMA水平对AMI早期诊断、监测疗效效果较好,值得推广使用。