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Rapid rule out

Andrew McDowell, Neeraj Raizada, Sunil D Khaparde, Raghuram Rao, Sanjay Sarin, Aakshi Kalra, Virender Singh Salhotra, Sreenivas Achuthan Nair, Catharina Boehme, Claudia M Denkinger
BACKGROUND: Diagnosing tuberculosis (TB) in children presents considerable challenges. Upfront testing on Xpert® MTB/RIF ('Xpert')-a rapid molecular assay with high sensitivity and specificity-for pediatric presumptive TB patients, as recommended by India's Revised National Tuberculosis Control Program (RNTCP), can pave the way for early TB diagnosis. As part of an ongoing project implemented by Foundation for Innovative New Diagnostics (FIND) dedicated to providing upfront free-of-cost (FOC) Xpert testing to children seeking care in the public and private sectors, a qualitative assessment was designed to understand how national guidelines on TB diagnosis and Xpert technology have been integrated into the pediatric TB care practices of different health providers...
2018: PloS One
James B Wood, Lauren S Jones, Nicole R Soper, Meng Xu, Victor J Torres, C Buddy Creech, Isaac P Thomsen
Background: Staphylococcus aureus is among the most commonly identified causes of invasive bacterial infection in children; however, reliable results from cultures of sterile-site samples often cannot be obtained, which necessitates prescription of a broad empiric antimicrobial agent(s). Children with invasive S aureus infection rapidly generate high antibody titers to the cytotoxin LukAB; therefore, the aim of this study was to assess the diagnostic utility of an anti-LukAB antibody assay for children with musculoskeletal infection (MSKI)...
March 10, 2018: Journal of the Pediatric Infectious Diseases Society
Leonardo Iula, Irene A Keitelman, Florencia Sabbione, Federico Fuentes, Mauricio Guzman, Jeremías Gastón Galletti, Pehuén Pereyra Gerber, Matías Ostrowski, Jorge R Geffner, Carolina C Jancic, Analía S Trevani
Interleukin-1β (IL-1β), a major pro-inflammatory cytokine, is a leaderless cytosolic protein whose secretion does not follow the classical endoplasmic reticulum-to-Golgi pathway, and for which a canonical mechanism of secretion remains to be established. Neutrophils are essential players against bacterial and fungi infections. These cells are rapidly and massively recruited from the circulation into infected tissues and, beyond of displaying an impressive arsenal of toxic weapons effective to kill pathogens, are also an important source of IL-1β in infectious conditions...
2018: Frontiers in Immunology
Sarifuddin, Prashanta Kumar Mandal
Angioplasty with drug-coated balloons (DCBs) using excipients as drug carriers is emerging as a potentially viable strategy demonstrating clinical efficacy and proposing additional compliance for the treatment of obstructive vascular diseases. An attempt is made to develop an improved computational model where attention has been paid to the effect of interstitial flow, that is, plasma convection and internalization of bound drug. The present model is capable of capturing the phenomena of the transport of free drug and its retention, and also the internalization of drug in the process of endocytosis to atherosclerotic vessel of heterogeneous tissue composition comprising of healthy tissue, as well as regions of fibrous cap, fibro-fatty, calcified and necrotic core lesions...
March 5, 2018: Cardiovascular Engineering and Technology
Mark Archie, Meena Archie, Jessica O'Connell, Brian DeRubertis
INTRODUCTION: Catheter-directed thrombolysis (CDT) has been shown to be a safe and effective treatment for the management of acute iliofemoral DVT. The potential benefits of this therapy include more rapid resolution of symptoms and possible reduction in the long-term sequelae. Many patients diagnosed with DVT in the inpatient setting have contraindications to lytic therapy, but less is known regarding the suitability of thrombolysis for outpatients diagnosed with acute DVT. We sought to determine the proportion of patients who were candidates for thrombolytic therapy and were referred to a vascular specialist for evaluation...
February 27, 2018: Annals of Vascular Surgery
Jessica Mak, Ayman Al Habeeb, Mona Al Kalabi, Afsaneh Alavi
Blastomyces dermatitidis is typically contracted through inhalation of the dimorphic conidia, resulting in pulmonary infection as well as extrapulmonary disease through hematogenous spread. Blastomycosis is considered one of the great mimickers in medicine, with verrucous cutaneous blastomycosis resembling skin malignancy and B dermatitidis pulmonary infections often confused with lung cancer. Cutaneous blastomycosis can also often mimic pyoderma gangrenosum and should be considered in the differential diagnosis in any suspected case...
February 1, 2018: Journal of Cutaneous Medicine and Surgery
Susanna S Ng, Fernando Souza-Fonseca-Guimaraes, Fabian de Labastida Rivera, Fiona H Amante, Rajiv Kumar, Yulong Gao, Meru Sheel, Lynette Beattie, Marcela Montes de Oca, Camille Guillerey, Chelsea L Edwards, Rebecca J Faleiro, Teija Frame, Patrick T Bunn, Eric Vivier, Dale I Godfrey, Daniel G Pellicci, J Alejandro Lopez, Katherine T Andrews, Nicholas D Huntington, Mark J Smyth, James McCarthy, Christian R Engwerda
Objectives: Innate lymphoid cells (ILCs) share many characteristics with CD4+ T cells, and group 1 ILCs share a requirement for T-bet and the ability to produce IFNγ with T helper 1 (Th1) cells. Given this similarity, and the importance of Th1 cells for protection against intracellular protozoan parasites, we aimed to characterise the role of group 1 ILCs during Plasmodium infection. Methods: We quantified group 1 ILCs in peripheral blood collected from subjects infected with with Plasmodium falciparum 3D7 as part of a controlled human malaria infection study, and in the liver and spleens of Pc AS-infected mice...
2018: Clinical & Translational Immunology
Beat Roth, Ioannis Giannakis, Meret Elisabeth Ricklin, George Niklaus Thalmann, Aristomenis Konstantinos Exadaktylos
Objectives: We sought to identify a simplified approach for the rapid differential diagnosis of patients presenting with acute scrotum. Methods: A total of 440 patients referred to the emergency department of the University Hospital of Bern, Switzerland, with acute scrotum between 2003 and 2013 were retrospectively analyzed. Simple and multiple binary logistic regression analyses were used to evaluate clinical and laboratory parameters that may help to distinguish between genital/paragenital infection and acute testicular torsion...
January 2018: Oman Medical Journal
Doniparthi Venkata Seshagiri, Arun Sasidharan, Gulshan Kumar, Pramod Kumar Pal, Sanjeev Jain, Bindu M Kutty, Ravi Yadav
OBJECTIVES: Spinocerebellar ataxias are progressive neurodegenerative disorders characterized by progressive cerebellar features with additional neuro-axis involvement. Oculomotor abnormality is one of the most frequent manifestations. This study was done to assess the polysomnographic abnormalities in patients with Spinocerebellar ataxia (SCA1, SCA2 and SCA3) and also to evaluate whether oculomotor abnormalities interfere with sleep stage R scoring. METHODS: The study was carried out using 36 genetically positive SCA patients...
February 2018: Sleep Medicine
Katie Pettit, Julie L Welch
No abstract text is available yet for this article.
February 13, 2018: Annals of Emergency Medicine
Stacey J Howell, Jonathan Bui, Balasingam Thevakumar, Ezra A Amsterdam
There are few data on the utility of physician selection of cardiac tests, including no-test, in a chest pain unit (CPU) to rule out acute coronary syndrome in low-risk patients without a history of coronary artery disease. We analyzed consecutive low-risk patients admitted to our CPU between 2012 and 2014 and determined the proportion of patients selected for testing, the type of initial cardiac test selected, and the incidence of major adverse cardiac events (MACEs) at 30 days and 6 months. The study group comprised 619 patients: mean age 57 years (27 to 92), 332 women (54%), and 360 (58%) with multiple cardiac risk factors...
January 10, 2018: American Journal of Cardiology
István Dávid, István Ráth, Dániel Varró
Streaming model transformations represent a novel class of transformations to manipulate models whose elements are continuously produced or modified in high volume and with rapid rate of change. Executing streaming transformations requires efficient techniques to recognize activated transformation rules over a live model and a potentially infinite stream of events. In this paper, we propose foundations of streaming model transformations by innovatively integrating incremental model query, complex event processing (CEP) and reactive (event-driven) transformation techniques...
2018: Software and Systems Modeling
Djuna Z de Back, Richard Vlaar, Boukje Beuger, Brunette Daal, Johan Lagerberg, Alexander P J Vlaar, Dirk de Korte, Marian van Kraaij, Robin van Bruggen
BACKGROUND: Several circumstances require the accurate measurement of red blood cell (RBC) survival and clearance, such as determination of posttransfusion recovery of stored RBCs to investigate the effect of new additive solutions. To this end, biotin as a marker of RBCs to track donor RBCs in the blood of the recipient has been used in many studies. However, so far only experimental, nonvalidated, biotin-labeled red cell concentrates (RCCs) are transfused. The goal of this study was to produce a standardized biotin-labeled RCC product in a fast, simple, and sterile manner that can be used for clinical research and for the evaluation of new blood products according to Good Practice Guidelines (GPG) for blood establishments...
February 15, 2018: Transfusion
Neil Saez, Giriraj K Sharma, Christian H Barnes, Yuxin Lu, Frank P Hsu, Kevin C Huoh, Hamid R Djalilian, Harrison W Lin
OBJECTIVES: Aneurysmal bone cysts (ABC) are benign, rapidly growing osteolytic lesions. Solid variant of ABC (SVABC) is a rare subtype of ABC that has not been reported in the temporal bone. METHODS: We report the case of a 6-year-old boy presenting with a slowly enlarging bony protuberance over the right zygomatic/malar eminence region. Computed tomography and magnetic resonance imaging demonstrated a 2.6 × 5.8 × 5.1 cm temporal bone mass involving the right mastoid, petrous, and temporal squamosal calvarium, with extradural intracranial extension to the middle cranial fossa...
February 1, 2018: Annals of Otology, Rhinology, and Laryngology
Ryota Hikiami, Hodaka Yamakado, Shinsui Tatsumi, Takashi Ayaki, Yuichiro Hashi, Hirofumi Yamashita, Nobukatsu Sawamoto, Teruyuki Tsuji, Makoto Urushitani, Ryosuke Takahashi
We herein report a 15-year-old girl who developed rapid progressive muscle weakness soon after the third injection of a bivalent human papilloma virus (HPV) vaccine. Although immunotherapies were performed for possible vaccine-related disorders, she died of respiratory failure 14 months after the onset of the disease. A genetic analysis identified a heterozygous p.P525L mutation of the fused in sarcoma (FUS) gene, and a histopathological analysis was also consistent with FUS-associated amyotrophic lateral sclerosis (ALS) without any evidence of neuroinflammation...
February 9, 2018: Internal Medicine
Arjun K Venkatesh, Charles D Scales, Marta E Heilbrun
Over the past twenty years, the Emergency Department (ED) has transformed from a location that managed patients with acute life-threatening illness or injury to an acute diagnostic center. The advent of rapid and accurate imaging, novel biomarkers, and other innovations concurrent with effects from financial and social forces has supported the development of an acute care system focused on "ruling out" low-frequency, high-mortality events such as acute myocardial infarction, stroke, pulmonary embolism, and aortic dissection...
February 10, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Gonzalo Labarca, Iván Caviedes, Erik Folch, Adnan Majid, Sebastián Fernández-Bussy
In the last years, several techniques have been developed to obtain a prompt diagnosis or rule out lung cancer. Endobronchial ultrasound- guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive procedure with a high diagnostic yield for mediastinal and central pulmonary lesions. This procedure is especially useful for lung cancer diagnosis and mediastinal staging. Two different types of EBUS are currently available: Radial EBUS and lineal EBUS. Each one has technical differences together with a range of clinical indications...
September 2017: Revista Médica de Chile
R Feldmann, S Wahl, A Steiner
Glucagonoma is an extremely rare tumor of the pancreatic alpha-cells. Its estimated annual incidence is 1 case per 20 million individuals. Necrolytic migratory erythema (NME) is the hallmark clinical sign. We report a patient with normoglycemic glucagonoma and NME. A 44-year-old male patient presented with a 4-year history of unexplained exanthema and unintentional weight loss. Skin examination revealed a mildly pruritic rash on the trunc, the extremities and the face (fig 1). One found erythematous polycyclic migratory lesions with scaling and crusting margins and central resolution...
February 8, 2018: Journal of the European Academy of Dermatology and Venereology: JEADV
Jaimi Greenslade, Elizabeth Cho, Christopher Van Hise, Tracey Hawkins, William Parsonage, Jacobus Ungerer, Jillian Tate, Carel Pretorius, Martin Than, Louise Cullen
BACKGROUND: Low concentrations of cardiac troponin (cTn) have been recommended for rapid rule-out of acute myocardial infarction (AMI). We examined the Beckman Coulter Access high-sensitivity cardiac troponin I (hs-cTnI) assay to identify a single test threshold that can safely rule out AMI. METHODS: This analysis used stored samples collected in 2 prospective observational studies. In all, 1871 patients presenting to a tertiary emergency department with symptoms of acute coronary syndrome had blood taken for measurement of cTnI on presentation...
February 1, 2018: Clinical Chemistry
James E Andruchow, Peter A Kavsak, Andrew D McRae
This article synthesizes current best evidence for the evaluation of patients with suspected acute coronary syndrome (ACS) using high-sensitivity troponin assays, enabling physicians to effectively incorporate them into practice. Unlike conventional assays, high-sensitivity assays can precisely measure blood cardiac troponin concentrations in the vast majority of healthy individuals, facilitating the creation of rapid diagnostic algorithms. Very low troponin concentrations on presentation accurately rule out acute myocardial infarction (AMI) and enable the discharge of approximately 20% of patients after a single test, whereas an additional 30%-40% of patients can be safely discharged after short-interval serial sampling in as little as 1 or 2 hours...
February 2018: Canadian Journal of Cardiology
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