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PubMed2004

Comparison of the semisolid agar antifungal susceptibility test with the NCCLS M38-P broth microdilution test for screening of filamentous fungi.

Antifungal susceptibility testing of pathogenic molds is being developed. A simple screening semisolid agar antifungal susceptibility (SAAS) test accurately measures susceptibilities of yeasts. The performance of the SAAS screening test for filamentous fungi was assessed by comparing MICs of four antifungals (amphotericin B [AMB], AMB lipid complex [ABEL], itraconazole [ITZ], and posaconazole [POS]) for 54 clinical mold isolates with the results of the National Committee for Clinical Laboratory Standards (NCCLS) proposed broth microdilution method (M38-P). The SAAS test utilized inocula stabbed into tubes of 0.5% semisolid heart infusion agar. In both tests MICs were read after incubation at 35 degrees C for 48 h. The isolates tested were Aspergillus fumigatus, Aspergillus niger, Aspergillus flavus, other Aspergillus spp., Fusarium spp., Penicillium sp., Mucor sp., Scedosporium prolificans, Trichophyton sp., and an unidentified dematiaceous mold. Concordance of test results was determined as the percent agreement of MICs +/- 1 dilution. The overall agreement between the tests for each drug was as follows: AMB, 94%; ABEL, 83%; ITZ, 94%; POS, 94%. For the Aspergillus spp., all but one were susceptible to ITZ by SAAS test; all were susceptible to POS (MIC range, 0.25 to 4 micro g/ml). Three of six non-Aspergillus molds that were resistant to AMB and ABEL by SAAS (MIC >/= 2 micro g/ml) were also resistant by the NCCLS test. The SAAS test compared favorably to the NCCLS broth microdilution test for molds, and most of the clinical isolates tested were susceptible to all four drugs.

Agar↗

PubMed1997

A citric acid solution is an optimal test drink in the 13C-urea breath test for the diagnosis of Helicobacter pylori infection.

BACKGROUND: The 13C-urea breath test (13C-UBT) is a simple, non-invasive and reliable test for the diagnosis of Helicobacter pylori infection. The duration of the test, the timing of breath sampling, and the accuracy of the method vary according to the test meal used. AIM: To identify the optimal test meal or drink for rapid and accurate performance of the 13C-UBT for the detection of H pylori infection. PATIENTS: Eighty patients with dyspeptic symptoms were included. Of these, 48 patients had a positive H pylori status and 32 a negative one according to the results of the rapid urease test, histological examination, and culture. METHODS: A 13C-UBT was performed after an overnight fast, on three consecutive days. On each study day a different test meal or drink was given (0.1 N citric acid solution, a standard semiliquid meal, or a semiliquid fatty meal) 10 minutes before giving 75 mg 13C-urea. Breath samples were collected at 0, 15, 30, 45, and 60 minutes, and analysed by isotype ratio mass spectrometry. Results were expressed as delta (delta) and considered as positive for H pylori if the highest delta (peak) was greater than 4.0. RESULTS: The delta peak obtained with the citric acid drink in H pylori positive subjects (24.1 (SEM 1.5)) was significantly higher than that obtained with any of the semiliquid meals (13.3 (SEM 1.1) and 17.1 (SEM 1.0) respectively, p < 0.001). Furthermore, this delta peak was obtained earlier with the citric acid drink (30 (SEM 2) minutes) than with the other two meals tests (53 (SEM 2) min and 45 (SEM 2) min, p < 0.001). The sensitivity of the 13C-UBT for the diagnosis of H pylori infection was 96-100% with all three test meals. This high sensitivity was, however, obtained from 15 minutes by giving citric acid as the test drink, from 45 minutes by giving a semiliquid fatty meal, and at 60 minutes by giving the semiliquid standard meal. The specificity was 100% for all test meals. Citric acid is inexpensive and palatable to patients. CONCLUSIONS: The 13C-UBT procedure with citric acid as the test drink is superior to the previously proposed semiliquid test meals in terms of 13CO2 recovery, time requirement, and cost. In routine clinical sampling, collection at times 0 and 30 minutes seems to be optimal and gives a high diagnostic accuracy.

Administration, Oral↗

PubMed2006

How much does pre-trial testing influence complex intervention trials and would more testing make any difference? An email survey.

BACKGROUND: The UK Medical Research Council has proposed that complex interventions should be tested in exploratory trials prior to a full-scale trial so as to better define the intervention and test the feasibility of components such as recruitment. It is not clear to what extent this is being done. This study aimed to determine to what extent complex interventions are tested prior to a full-scale trial and whether more or different testing would have led to a different intervention being used in the trial. METHODS: Email survey of the authors of complex intervention trials published in seven major journals in 2004. RESULTS: 72% (50/69) of eligible authors replied. Eight authors did not consider their interventions to be complex. The majority of respondents' complex interventions were tested (34/42): some extensively. Conversely, only 17 of the 34 published reports describing these trials mention testing. Two-thirds (22/34) of those testing their interventions did not believe that more or different testing would have produced a more effective intervention. 31% (13/42) of all authors did believe further testing would have led to improvements. Five respondents mentioned a lack of funding as a reason for not doing more testing. CONCLUSION: Complex interventions are generally tested prior to their evaluation in a full-scale trial, although the amount of testing varies. Testing is often not described in trial reports, which makes it hard to judge whether a trial result could be improved with a better intervention, or whether further work with a different intervention is required.

Attitude of Health Personnel↗

PubMed1994

A comparison of the standard high dose dexamethasone suppression test and the overnight 8-mg dexamethasone suppression test for the differential diagnosis of adrenocorticotropin-dependent Cushing's syndrome.

To improve the overnight 8-mg dexamethasone (DEX) suppression test (DST) for differential diagnosis of Cushing's syndrome and to develop optimal criteria for its interpretation, we increased the number of blood samples and measured the suppression of both plasma ACTH and cortisol. Forty-one patients who were subsequently proven at surgery to have Cushing's syndrome were studied (34 Cushing's disease and 7 ectopic ACTH secretion). DEX (8 mg, orally) was administered at 2300 h. Blood samples for ACTH and cortisol measurements were obtained at 0800, 0830, and 0900 h on the day before and at 0700, 0800, 0900, and 1000 h on the morning after DEX treatment. The conventional 6-day DST was also performed, with measurement of both urinary free cortisol and urinary 17-hydroxysteroids as indices of suppression. Optimal criteria for the diagnosis of Cushing's disease were developed for both the overnight 8-mg and the 6-day tests using receiver operating characteristic curves. The results were compared with those using the previously published criteria for diagnosis of Cushing's disease by the overnight 8-mg test (> 50% suppression of plasma cortisol at 0700-0800 h). In our patients, the previously published criterion for the overnight 8-mg test yielded high sensitivity (88%), but low specificity (57%), in making the diagnosis of Cushing's disease. When the time of cortisol measurement and the diagnostic criteria for Cushing's disease were revised to achieve 100% specificity, the sensitivity of the overnight 8-mg test was 71%, which was not significantly different from that of the 6-day test (79%; P = NS). Addition of plasma ACTH levels to the test did not improve diagnostic accuracy compared to that with measurement of plasma cortisol levels alone. When the revised 8-mg overnight dexamethasone suppression test was combined with the 6-day dexamethasone suppression test, sensitivity increased to 91%, with a specificity of 100%, which was significantly better than that of the overnight 8-mg test alone (P < 0.002). We conclude that the overnight 8-mg DST has low specificity for the diagnosis of Cushing's disease when performed as originally described. However, with revised sampling times and diagnostic criteria, the overnight test has sensitivity and specificity similar to those of the conventional 6-day DST. The diagnostic performance of a criterion that combines the results of both tests is better than the diagnostic performance of either test alone.

Administration, Oral↗

PubMed2000

Evaluation of E test for susceptibility testing of Mycobacterium tuberculosis to primary anti tubercular drugs.

BACKGROUND & OBJECTIVES: Antimicrobial susceptibility tests for tuberculosis take weeks and delayed therapy can lead to an increase in disease incidence. The E test is a new concept for minimum inhibitory concentrations (MIC) determinations for antimicrobial agents that is based on a predefined antibiotic gradient on a plastic strip calibrated with a continuous logarithmic MIC scale covering 15 two-fold dilutions. The present study was undertaken to evaluate E test strips for susceptibility testing of Mycobacterium tuberculosis. METHODS: Twenty five clinical isolates of M. tuberculosis were tested for the four first line antitubercular drugs by E test and were compared with standard proportion method. The inoculum turbidity was adjusted to McFarland 3.0 standard and agar plates (Middle brook 7H11 agar) were inoculated and preincubated (37 degrees C in 7-10% CO2) for 24 h after which time, the E test strips were placed on the agar surface which were incubated under same conditions. The MIC was interpreted as the point at which the ellipse intersected the 'E test' strip as described in E test technical guide. RESULTS: Of the 25 strains, susceptibility as determined by both methods for isoniazid (INH), rifampin, ethambutol and streptomycin was found in 22 (88%), 20 (80%), 24 (96%) and 18 (72%) strains respectively. Agreement between E test and proportion method was 96 per cent for INH, 92 per cent for rifampin and 100 per cent for ethambutol and streptomycin each. However, sensitivity could be predicted after 7-10 days by E test and exact MIC could also be determined. INTERPRETATION & CONCLUSIONS: E test method was found to be rapid, accurate, reliable and easy to perform. It can be employed for routine susceptibility testing for antitubercular drugs.

Antitubercular Agents↗

PubMed2000

Comparison of human papillomavirus DNA testing and repeat Papanicolaou test in women with low-grade cervical cytologic abnormalities: a randomized trial. HPV Effectiveness in Lowgrade Paps (HELP) Study No. 1 Group.

BACKGROUND: Results of cervical cytology screening showing atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesions (LSIL) indicate risk for high-grade cervical intraepithelial neoplasia (CIN 2 or 3). In a community-based randomized trial we compared the test performance of human papillomavirus (HPV) DNA testing with that of 6-month repeat Papanicolaou (Pap) test in detecting histologically confirmed CIN 2 or 3. METHODS: We randomly assigned 212 women aged 16-50 years with ASCUS or LSIL on cervical cytology screening to undergo either immediate HPV DNA testing or a repeat Pap test in 6 months. Cervical swabs for the HPV DNA testing and the Pap smears were obtained by their family physicians. We tested the swabs for oncogenic HPV using the Hybrid Capture II assay (Digene Corp., Beltsville, Md.). Community-based pathologists examined the Pap smears. All women were referred for colposcopy by their family physicians. Two gynecological pathologists assessed the histology findings. We calculated test performance in women who completed the trial using CIN 2 or 3 as the reference standard. RESULTS: A total of 159 women completed the study. Compared with HPV DNA testing, which detected 87.5% (7/8) of the cases of CIN 2 or 3, repeat Pap smear showing high-grade intraepithelial neoplasia (HSIL) detected 11.1% (1/9) of cases (p = 0.004), and repeat Pap smear showing ASCUS, LSIL or HSIL detected 55.6% (5/9) (p = 0.16). Corresponding specificities were 50.6%, 95.2% (p = 0.002) and 55.6% (p = 0.61). Loss to follow-up was 17.1% in the HPV test group and 32.7% in the repeat Pap group (p = 0.009). Given the 7 cases of CIN 2 or 3 detected by HPV testing and the 5 cases detected by the repeat Pap smear, the incremental cost of HPV testing was calculated to be $3003 per additional case of CIN identified. INTERPRETATION: HPV DNA testing was more costly but was associated with significantly less loss to follow-up. It may detect more cases of CIN 2 or 3 in women with low-grade cytologic abnormalities.

Adolescent↗

PubMed2002

Abnormal glucose screening test followed by normal glucose tolerance test and pregnancy outcome.

OBJECTIVE: To study the pregnancy outcome of patients with abnormal glucose screening test followed by normal glucose tolerance test. METHODS: In Sultan Qaboos University Hospital, Sultanate of Oman, a study was made to compare the complication of pregnancy, infant weight, placental weight and neonatal morbidity in women with and without abnormal glucose screening test, it was performed between July 1999 and June 2000. Hundred postnatal files form each group was analyzed. The Chi square test, and test for comparison of proportion were the statistical tests used. RESULTS: Although women with abnormal glucose screening test were older, there was no evidence in this study that increasing parity is a risk factor for abnormal glucose screening test. Candidiasis and polyhydramnios was significantly more frequent in the group with abnormal glucose screening test. The women with abnormal glucose screening test were at higher risk for elective cesarean section, whereas the number of emergency cesarean sections and instrumental deliveries was not significantly different. The mean birth weight of infants in the abnormal glucose screening test group was higher and also, macrosomia was significantly more frequent in this group. The mean weight of placenta from women with abnormal glucose screening test was higher than that of placenta from women with normal glucose screening test. CONCLUSION: The results of this study are consistent with the previous reports that minor abnormalities of glucose metabolism without gestational diabetes are a significant risk factor for fetal overgrowth and its attendant problems.

Adult↗

PubMedDate not supplied

[Comparison of faecal lipase test and faecal elastase-1 test in the assessment of exocrine pancreatic function in cystic fibrosis].

OBJECTIVE: In pediatric patients, indirect tests are preferred because of their less invasive character. Among those, faecal elastase-1 test has so far been shown been shown to have the highest sensitivity and specificity. However, the role of the faecal lipase test in the diagnostic work up for pancreatic insufficiency in cystic fibrosis (CF) patients has not been defined. Therefore, the aim of the present study was to compare the sensitivity and the specificity of faecal lipase test to the faecal elastase-1 test in the assessment of exocrine pancreatic function. MATERIAL AND METHODS: 63 CF patients and 95 healthy subjects (HS) were evaluated. In all subjects, faecal elastase-1 concentration (ELISA) and lipase activity (ELISA) were measured. In 50 HS, sample-to-sample (n=3) variation from the same stool and day-to-day variation from three consecutive stools were determined twice. The presence of pancreatic insufficiency patients was documented in 55 pancreatic insufficient CF patients by the determination of faecal fat excretion and in 12 pancreatic sufficient patients by the direct test. The sensitivity and specificity of the faecal elastase-1 test and faecal lipase test were compared. RESULTS: The sample-to-sample variation (mean + SEM: 13.2+1.2% vs. 23.4+2.2%) and day-to-day variation (mean + SEM: 16.3+1.2% vs. 32.5+2.6%) were significantly lower (p<0.0001) for elastase-1 determinations than for lipase measurements. With the cut-off levels giving the same specificity for both tests (95.8%), the sensitivity of faecal elastase-1 test (87.3%) was significantly higher (p<0.04) than that of faecal lipase test (77.8%). IN CONCLUSION: Faecal lipase test is less useful in the assessment of exocrine pancreatic function sensitive than faecal elastase-1 test.

Adolescent↗

PubMed2004

[Comparison of the results of in vitro antifungal susceptibility testing using the Fungitest kit and the disc diffusion test].

AIM OF STUDY: Substantial progress has been achieved in the field of in vitro antifungal susceptibility testing, including the interpretation of the test results towards the clinical practice. Reference methods for antifungal testing of yeasts (M27-A) and filamentous fungi (M38-P) are available now. There are several alternatives to these standard protocols as the potential candidates for a routine laboratory testing of antifungal drugs. The aim of the study is to compare the results of antifungal susceptibility testing obtained by Fungitest and disk diffusion method. MATERIALS AND METHODS: From 1997 to 2000, 134 strains of 16 yeast species from the patients with suspected or proven mycosis were evaluated in the mycology laboratory of the Department of Clinical Microbiology, Teaching Hospital in Hradec Krlové. All these strains were tested by both disc test on Sabouraud agar (pH = 5.6) and Fungitest. The agreement of the results of the both methods was determined for all antimycotics and fungal species tested in terms of the categories susceptible, intermediate and resistant strain. RESULTS: Overall, there was only 60.3 % agreement between these methods for all antifungal drugs with the best results for flucytosine (71.4 % agreement), further for ketoconazole (66.2 %), amphotericin B (60.2 %), fluconazole (57.9 %), itraconazole (52.6 %), and miconazole (50.5 %). The best overall agreement between the results for individual species was found with C. lusitaniae (73.9 %), C. pelliculosa (73.5 %), C. parapsilosis (71.7 %), and partly with C. albicans (67.5 %). The poorest results were associated with fluconazole-resistant yeasts Saccharomyces cerevisiae (30.0 %), C. krusei (32.5 %) and C. glabrata (47.7 %). Regressive analysis revealed a relative close relationship between the results of these methods for miconazole (R = 0.49, P < 0.001), fluconazole (R = 0.45, P < 0.001), itraconazole (R = 0.42, P < 0.001) and flucytosine (R= 0.37, P < 0.001), but not for amphotericin B (R = 0.10) and ketoconazole (R = 0.16). CONCLUSION: The comparison of the results of the disk test and Fungitest showed some discrepancies which were dependent on an antifungal drug, a yeast species and the test conditions. Sabouraud agar and the criteria for interpretation of the results of the disk test seemed to be main sources of the disagreement. A modified Mueller-Hinton agar (2 % glucose, methylene blue) as a recommended test medium in a proposed agar diffusion method M44-P is the way to the improvement of standardization and reproducibility of the test.

Antifungal Agents↗

PubMed2005

Screening of dementia in Chinese elderly adults by the clock drawing test and the time and change test.

OBJECTIVES: To assess the usefulness, relative ease of administration, and patient acceptance of the clock drawing test as well as the time and change test for detecting dementia in Chinese elderly adults. DESIGN: Prospective case-controlled study. SETTING: Memory clinic and geriatric clinic of a district hospital, Hong Kong. PARTICIPANTS: A convenient sample of 85 subjects aged 65 years or older attending the two clinics during the period from September 2002 to June 2003. MAIN OUTCOME MEASURES: The clock drawing test scored according to Lam's method; the time and change test with modification to the making change task; and the Chinese version of the Mini-Mental State Examination. RESULTS: Demented subjects were matched with non-demented ones with respect to age, sex, educational level, and co-morbidity status. The clock drawing test had a comparable sensitivity (89.4%) but a lower specificity (47.1%) when compared with that of the Chinese version of the Mini-Mental State Examination (96.0 and 76.5%, respectively). In contrast, the time and change test had a lower sensitivity (62.7%) but higher specificity (94.1%). Both tests took significantly less time to complete than the Chinese version of the Mini-Mental State Examination. All except four subjects completed the clock drawing test while all subjects accepted the time and change test well. CONCLUSIONS: The Chinese version of the Mini-Mental State Examination is still the best among the three tests despite the longer time to completion. The clock drawing test may be a good alternative to the Mini-Mental State Examination as an effective screening test for dementia when time does not permit. The time and change test, although time-saving, is not suitable to be used alone because of its low sensitivity.

Aged↗

PubMedDate not supplied

HBsAg and HCV: increasing test requests and decreasing frequency of positive tests at clinical laboratory of Ayub Teaching Hospital, Abbottabad.

BACKGROUND: This audit was carried out to assess the frequency of positive results out of the total test requests made for HBsAg and HCV at our laboratory. The frequencies for three years were compared for significance. We have reported monthly total test requests and frequency of positive tests for each of these years in this article. METHODS: This study is an audit of all HBsAg and HCV test requests received at clinical laboratory of Ayub Teaching Hospital, Abbottabad during a three year period from 2002 - 2004. Both the tests were made using Rapid device (immunochromatographic kits) method. Frequencies of positive results were calculated from the total test requests for each month of these three years. Cumulative frequencies were compared for statistical significance of difference. RESULTS: Total HBsAg tests requested for years 2002, 2003 and 2004 were 2058, 2563 and 5207 respectively. The frequencies of HBsAg positive cases out of these were 5.53%, 4.36% and 2.68% respectively. The number of test requests for HBsAg increased significantly from 2002 to 2003 and 2004, while the frequency of positive tests decreased significantly (p < .001) during this period. Total HCV requests for years 2002, 2003 and 2004 were 1261, 1671 and 4638 respectively. The frequencies of HCV positive cases out of these were 14.19%, 8.79% and 5.84% respectively. Just like HBsAg, number of test requests for HCV increased significantly from 2002 to 2003 and 2004, while the frequency of positive tests decreased significantly (p < .001) during this period. CONCLUSIONS: The test requests have considerably increased in the last few years, probably as a result of increasing awareness of clinicians and public. However most of these tests are negative. In view of high prevalence of both HBsAg and HCV in Pakistan, this overcautious attitude of clinicians is understandable although this is a burden on the pocket of patients and hospital resources.

Hepatitis B Surface Antigens↗

PubMed2005

[Examination of gastric emptying rate by means of 13C-octanoic acid breath test. Methods of the test for adults and results of the investigation of healthy volunteers].

BACKGROUND: 13C-octanoic acid breath test (13C-OABT) is a simple, safe and non-invasive technique for measuring gastric emptying. However, the method has not been standardized yet. Aim of the study was to work up, introduce and evaluate our own method of the 13C-OABT for adults. METHODS AND RESULTS: Ten healthy volunteers entered the study (5 men, 5 women, mean age 32 years, 50 % Helicobacter pylori positive). Standard test meals (with 100 mg 13C-sodium octanoate) were used three times within 3 weeks. The same solid meal (1,178 kJ) for Tests 1 and 2 contained scrambled egg (+ 3 g oil), white bread (40 g), butter (10 g) and distilled water (200 ml). Semi-solid meal (1,020 kJ) for Test 3 contained milk pudding (200 g) and distilled water (200 ml). Duplicate breath samples were obtained before and every 15 minutes after eating the test meal during 255 minutes. Altogether 1,080 breath samples were analysed twice (isotope ratio mass spectrometry, AP2003 Analytical Precision, UK). To assess the half-life of elimination (t1/2 E), we modelled the process of elimination with the incomplete gamma-function, which has a convenient form for the empiric plotting of breath test data. Mean t1/2E was 136+/-10 minutes (Test 1), 134+/-14 (Test 2) and 123+/-16 minutes (Test 3). Clinical reproducibility of 13C-OABT in particular persons was 98.2% (18 breath samples series), 90.8 % (15 samples) and 87.1% (9 breath samples series). There was a significant correlation between Test 1 and Test 2 results (r=0.887, p<0.0001). Mean difference of duplicate breath sample analysis was 1.460 % (in 540 pairs), mean baseline one-day analysis difference was 0.0982 (99.9274% accuracy). In healthy volunteers, normal range of t1/2E is 110-160 minutes for solids and 91-155 minutes for semisolid test meal. Using our own computed mean time of intermediate metabolism of 13C-octanoic acid (76.5+/-7.5 minutes), gastric emptying half-time is 33.5-83.5 minutes for solids and 14.5-78.5 minutes for semisolid test meal in healthy volunteers. CONCLUSIONS: The 13C-OABT is accurate non-invasive method for gastric emptying measurement.

Adult↗

PubMed1988

The dexamethasone suppression test and depression. Approaches to the use of a laboratory test in psychiatry.

The dexamethasone suppression test has undergone unprecedented study among the biologic tests proposed for clinical use in psychiatry. Since the 1970s, its study has involved hundreds of reports and thousands of patients. Although important technical aspects of the test appear to be well accepted and validated, additional information is needed regarding the pharmacokinetics of dexamethasone. Marked interindividual differences in plasma dexamethasone suggest that performance of the test might be improved by factoring dexamethasone levels into test interpretations. There also may be advantages to the development of a modified test involving other exogenous and index steroids, such as monitoring corticosterone levels. Although it is too early to determine how ROC analysis will alter the clinical application of the test, some implications for methodology and data presentation are already clear. First, because the test is a diagnostic system with nonbinary outcomes, ROC analysis can augment traditional performance indices such as sensitivity, specificity, and positive predictive power. Second, ROC analysis will improve comparisons between the studies of different research groups and will help assess innovations in the application of the test. Third, ROC analytic techniques permit appropriate planning of sample size given estimates of the expected values of AUC that would be obtained from the studies. ROC theory thus promises to play an increasingly important role in the evaluation and future improvement of the dexamethasone suppression test and other biologic markers in clinical psychiatry. In conclusion, neither uncritical enthusiasm nor excessive skepticism is warranted about the use of the dexamethasone suppression test in clinical psychiatry. Evidence to date should encourage investigators to pursue refinement of the test or other tests of hypothalamic-pituitary-adrenal functioning to increase their accuracy and clinical utility.

Adrenocorticotropic Hormone↗

PubMed1994

The relationship of 1988 state HIV testing policies to previous and planned voluntary use of HIV testing.

This study analyzed whether state HIV testing policies were related to individuals' previous and planned voluntary use of HIV testing. Testing plays an important role in the prevention and treatment of HIV infection, yet little is known about how policies are related to testing use. Most states mandate the conditions under which testing is performed, but states vary widely in their policies. This cross-sectional study analyzed individual-level data from the 1988 AIDS Knowledge and Attitudes Survey, which was merged with state-level data on testing policies and incidence of AIDS cases. A multivariate regression model was used to assess the relationship of state policies to testing use, holding state AIDS incidence and individual characteristics (sociodemographics, AIDS knowledge, and risk status) constant. Individuals in states with policies protective of individual rights (i.e., early adoption of comprehensive antidiscrimination laws restricting screening by insurers and employers; provision of voluntary, anonymous testing) were significantly more likely to have been tested than individuals in comparison states (odds ratio = 1.5). Individual characteristics such as risk status, however, had the strongest relationships to testing use. No evidence was found that name-reporting requirements were related to previous or planned use of testing. Future research must address emerging testing issues such as policies covering the use of new testing technologies.

AIDS Serodiagnosis↗

PubMed1995

Diagnostic validation of specific IgE antibody concentrations, skin prick testing, and challenge tests in chemical workers with symptoms of sensitivity to different anhydrides.

BACKGROUND: The diagnostic possibilities of sensitization to various acid anhydrides are limited because of the lack of standardized allergens for the different test systems. This makes the diagnosis of IgE-mediated sensitization caused by occupational exposure difficult. METHODS: We prepared conjugates of human serum albumin with phthalic, maleic, trimellitic, and pyromellitic anhydrides to be used for IgE estimation by enzyme-allergosorbent test, skin prick tests, and nasal and bronchial challenge tests. Nine anhydride workers, who complained of various respiratory symptoms, were studied. RESULTS: Of the nine workers, four had immediate-type skin test responses to one or more conjugates. All four subjects had elevated IgE concentrations in addition to two other workers. Three of six nasal challenges and four of nine bronchial challenges resulted in positive responses. All but one of the positive nasal or bronchial test responses were associated with elevated IgE levels. The seven positive challenge test results included five positive skin test responses. On the other hand, in all but two of the subjects with negative challenge test results, no specific IgE could be detected. In these two subjects the negative results were associated with low levels of IgE, and in one, with the absence of asthma. None of the results of tests with unconjugated anhydrides were positive. CONCLUSIONS: Anhydrides investigated in this study can induce IgE-mediated hypersensitivity, which can be diagnosed by using the respective human serum albumin in estimation of specific IgE and in skin, nasal, and bronchial challenge tests. Estimation of IgE was demonstrated to be more sensitive than skin prick testing.

Anhydrides↗

PubMed1998

Comparison of helisal rapid blood test and 14C-urea breath test in determining Helicobacter pylori status and predicting ulcer disease in dyspeptic patients.

OBJECTIVE: Noninvasive tests for Helicobacter pylori are used increasingly. Our aim was to compare the Helisal Rapid Blood (HRB) test and 14C-urea breath test (UBT) for determining H. pylori status and predicting ulcer disease. METHODS: Three hundred fifty-one consecutive patients with dyspepsia (mean age 40 yr; range 16-77 yr) had an HRB test and UBT followed by endoscopy with biopsies of the antrum and body for histology and antral urease slide test (CLO test). Patients were excluded if they had previously confirmed ulcer disease, gastric surgery, or anti-H. pylori therapy or were taking nonsteroidal anti-inflammatory drugs. RESULTS: Sixty-three percent of the patients were "gold standard" H. pylori positive (positive CLO test, positive staining), 34% were gold standard negative (negative CLO test, negative staining), and 3% had conflicting CLO test and histology. The UBT was superior to HRB for determining H. pylori status (sensitivity 98% vs 92%, p = 0.04; specificity 100% vs 69%, p < 0.001). The specificity of the HRB decreased with increasing patient age (74% for age <46 yr; 57% for age > or =46 yr). A negative UBT was superior to a negative HRB test for predicting the absence of ulcer disease (47% vs 36 %; p < 0.01). A positive UBT was similar to a positive HRB in predicting the presence of ulcer disease (92% vs 84%; p = 0.23). CONCLUSIONS: The HRB test is inferior to the UBT for determining H. pylori status. The tests have a similar ability to predict the presence of ulcer disease when positive, but a negative UBT is a better predictor of the absence of ulcer disease.

Adolescent↗

PubMed1962

Diagnostic tests for thyroid antibodies: a comparison of the precipitin and latex-fixation (Hyland TAI) tests.

The clinical significance of thyroid antibodies is discussed and it is concluded that, of the antibody tests which have been extensively applied, the precipitin test is the most useful for diagnostic purposes. The recently introduced Hyland TA test is compared with the precipitin test. The TA test gives a rapid result and is slightly more sensitive, but it remains undecided whether a true positive result is always indicative of clinically important degrees of chronic thyroiditis. The TA test also gives occasional false positive results, not indicative of antibody to thyroglobulin. Furthermore, approximately 12% of precipitin-positive sera from patients with Hashimoto's disease give negative TA tests, and since these also have low titres, or are negative, in the tanned red cell haemagglutination test, the precipitin test is the only simple method of demonstrating the antibody concerned. In spite of these disadvantages, the TA test is regarded as a useful procedure, and there are advantages in using both the precipitin and TA tests together for routine diagnostic purposes. A modification is described whereby the TA test reagent may be used to titrate antibody to thyroglobulin.

Antibodies↗

PubMed1993

[Evaluation of usefulness of a new generation of tests for detection in humans of antibodies for 9,12 antigens of Salmonella. I. Occurrence and level of antibodies detected by DOT-ELISA, latex and passive hemagglutination tests].

The study was aimed at evaluation of usefulness of immunoenzymatic Dot-ELISA test and an own latex test (OL) for diagnosis of infections evoked by group D Salmonella in humans with application of passive hemagglutination test (OHS) as a relation test. Samples of blood donors, persons suspected of infection with group D Salmonella and of patients with acute gastroenteritis, were tested. In highest percentage of tested samples of serum derived from blood donors (84.5%), antibodies for 9, 12 antigen with Dot-ELISA were detected in immunoglobulin G class. In class IgM these antibodies were found in 46.5% of tested samples, whereas in IgA class only in 11.9% of samples. By application of passive hemagglutination, antibodies against 9, 12 antigen were detected in 56.8% of serum samples from blood donors and by application of a latex test in 8.7% of samples. Evaluation of antibody level of somatic antigen of group D Salmonella in healthy people formed a basis for determination for each of tests of a borderline serum titer accepted as diagnostically significant for specific antigenic stimulation. It permitted for analysis of variability of differences between the level of antibodies for 9, 12 antigen determined in blood donor serum and in patients from other two groups. By all three tests antibodies for 9, 12 antigen were detected significantly more frequently than in blood donors only in samples from patients suspected of Salmonella D infections. In highest percentage of samples (80.4%) these antibodies were detected by the Dot-ELISA test in IgM and IgG classes, slightly lower in OL (70.7% of samples) and in lowest in OHB (57.4% of samples). In samples of serum from patients with acute gastroenteritis, antibodies against 9, 12 antigen were found significantly more frequently than in blood donors only by the Dot-ELISA test in all classes of immunoglobulins (IgM-87.4%, IgA-56.2% and IgG-62.5% of serum samples).

Adult↗