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Alternative diagnostic method for streptococcal pharyngitis: Breese scoring system.

This study was performed to determine the effectiveness of the Breese scoring system for the diagnosis of streptococcal pharyngitis with respect to different age groups. Two hundred and two children aged three years and younger (Group 1), and 514 children over three years old (Group 2) with complaints of acute pharyngitis were evaluated by Breese scoring and throat-swab cultures. In Group 1, no significant difference was detected in Breese scoring between subjects who had positive and negative culture for group A beta-hemolytic streptococci (GABHS). However, in Group 2 the mean value of the Breese scores was found to be higher in subjects who had positive GABHS. The diagnostic value of Breese scoring was examined for each group. Its sensitivity, and positive and negative predictive values were higher in Group 2 than in Group 1. In conclusion, Breese scoring was determined to be helpful in the diagnosis of streptococcal pharyngitis in children over three years of age.

Adolescent↗

Comparison of diagnostic methods for detection of active infection with Tritrichomonas foetus in beef heifers.

OBJECTIVE: To compare sensitivity of a generic trypticase-yeast extract-maltose (TYM) medium versus a commercial nutrient medium in the diagnosis of Tritrichomonas foetus infection in heifers and to assess sensitivity when incubation of samples inoculated into commercial medium pouches is delayed overnight. DESIGN: Prospective study. ANIMALS: 30 virgin beef heifers. PROCEDURES: 20 heifers vaccinated with a trichomonad antigen and 10 unvaccinated control heifers were exposed at synchronized estrus by intravaginal instillation of 10(6) T foetus organisms. Cervicovaginal mucus samples were collected every other week for 10 weeks from controls and once (10 weeks after exposure) from vaccinated heifers. Samples were inoculated into both media and immediately incubated at 37 C (98.6 F). A duplicate inoculation from controls was made into commercial medium, and the pouch was shipped overnight to a diagnostic laboratory without prior incubation. RESULTS: For 40 of 50 samples from control heifers, there was agreement on diagnoses between media. There was agreement on a positive diagnosis for 3 of 20 samples from vaccinated heifers and on a negative diagnosis for 15 of these 20 samples. For samples shipped overnight before incubation, there were 10% fewer positive diagnoses, compared with samples incubated immediately in commercial medium and 10% more positive diagnoses, compared with samples immediately incubated in TYM. CLINICAL IMPLICATIONS: Use of the commercial medium is a more sensitive indicator of current infection in heifers than use of generic TYM medium. In herds where infection prevalence is high, this method is likely to identify more infected females, an important consideration when control programs include culling of infected cows.

Animals↗

Cutaneous leishmaniasis in Guatemala: comparison of diagnostic methods.

A comparison was made of methods used to diagnose suspected cutaneous leishmaniasis in Guatemala. The most sensitive method was a combination of thin smears made from superficial scrapings of the ulcers and inoculation of culture medium with either aspirates or scrapings. The diagnosis was confirmed in 252 (70%) of 362 patients. Ability to cultivate Leishmania was correlated with the concentration of amastigotes seen on thin smears. Leishmania were cultured in 42 (27%) of 153 patients with no amastigotes found in 400 oil-immersion fields and in 174 (83%) of 209 patients with at least 1 amastigote. No difference in diagnostic outcome was found when we compared smears or cultures taken from the center or the border of the ulcer or from an incision made tangential from the ulcer. We found no difference when we compared smears obtained with scalpels, capillary tubes, or dental broaches. The use of scrub brushes soaked in iodine neither decreased the rate of culturing parasites nor decreased contamination rates.

Animals↗

Detection of bovine coronavirus and type A rotavirus in neonatal calf diarrhea and winter dysentery of cattle in Quebec: evaluation of three diagnostic methods.

The use of direct electron microscopy, enzyme-linked immunosorbent assay, and protein A-gold immunoelectron microscopy for the identification of bovine coronavirus and type A rotavirus were examined. Two hundred and forty-nine samples from diarrheic calves and winter dysenteric cattle from seven geographic areas in Quebec were examined for the presence of viruses by direct electron microscopy of negatively stained preparations. In addition, all the samples were analyzed by enzyme-linked immunosorbent assay, and a random selection of 47 samples were also analyzed by protein A-gold immunoelectron microscopy. Thirty-nine percent of samples examined by direct electron microscopy contained viral particles; bovine coronavirus and type A rotavirus were the most common viruses involved. Overall agreement between any two of the methods used compared favorably with results obtained by others using similar methods. The presence of coronavirus and rotavirus in fecal samples obtained from neonatal calves and the presence of coronavirus in samples from winter dysenteric adult cattle suggested their etiological roles in the respective diseases. Furthermore, results from protein A-gold immunoelectron microscopy of coronavirus-like particles implied that a different coronavirus or some other viruses might be involved in these diseases. Finally, the efficiency of direct electron microscopy, enzyme-linked immunosorbent assay and protein A-gold immunoelectron microscopy as diagnostic tools is discussed.

Animals↗

[New diagnostic methods--ultrasound and clinico-chemical procedures in diagnosis of ischemia].

Stress-echocardiography represents a new non-invasive, alternative approach in the assessment of patients with coronary artery disease. By means of dynamic or pharmacological stress or by atrial pacing regional wall motion abnormalities can be induced, which can be identified by 2D-echocardiography. Beyond the indirect detection of ischemia this approach allows a better quantification of the amount of ischemia and of global LV function, which is advantageous compared to stress ECG recording or myocardial scintigraphy. Disadvantageous is however, the subjective reading of the echo itself. In experienced hands stress-echocardiography has proven to be as sensitive and specific as myocardial scintigraphy. Recently, in addition the diagnostic potential of myocardial cell injury has been improved by the detection of specific antibodies versus Troponin T. In comparison with conventional biochemical markers of myocardial cell necrosis Troponin T analysis has been proven to be superior in postoperative or traumatic cardiac damage or in the setting of acute myocardial infarction. In this situation the time window is improved by an earlier rise compared to CK and a longer detection rate compared to lactate dehydrogenase.

Adenosine↗

[Diagnostic methods in allergic asthma].

Analysis of the allergic component in asthma results in a critical comparison of the data provided by the interview, skin tests, possibly completed by carefully selected immunological tests and/or bronchial or nasal stimulation tests. For some allergens, it is also possible to study the allergenic environment of these patients. The skin tests allow an easy analysis of the skin mastocytes carrying specific IgE and degranulating after the allergenic extract has been introduced. Among the in vitro tests, phadiatop represents a screening test of respiratory allergies which is more reliable than total IgE assays. Specific serum IgE assays should be reserved for difficult or conflicting cases. Bronchial allergen stimulation tests confirm the etiopathogenic role of an allergen. A few examples of diagnostic strategies are presented.

Antibody Specificity↗

Amoebiasis in a non-endemic country. Epidemiology, presenting symptoms and diagnostic methods.

392 patients with amoebiasis, diagnosed at Roslagstull Hospital, Stockholm during 10 yr, are reviewed. The disease is increasing in frequency, due both to increased travelling by Swedish citizens and immigration from non-European countries. The risk for an ordinary charter tourist is, however, rather low. Two-thirds of the patients were symptomatic and one-third were regarded as asymptomatic cyst carriers. The importance of repeated examination of stool samples and examinations using different techniques, especially direct microscopy of fresh faeces, is pointed out. The latter technique is in our laboratory shown to be as efficient in cases with no diarrhoea as in those with diarrhoea, with trophozoites demonstrated in the same frequency in both groups. Sigmoidoscopy with scrapings was seldom of diagnostic value.

Adolescent↗

Diagnostic methods for differentiation of Entamoeba histolytica and Entamoeba dispar in carriers: performance and clinical implications in a non-endemic setting.

Unpreserved faecal samples, suspected to contain Entamoeba histolytica/Entamoeba dispar cysts or trophozoites on the basis of microscopic examination, and serum samples from 416 patients were collected in a prospective study to determine whether stool antigen assays and detection of antibodies in serum are reliable methods to distinguish between carriers of E. histolytica and E. dispar in comparison to the reference test: real-time PCR. In 283 patients (68%) DNA of E. histolytica or E. dispar was amplified by real-time PCR: 6 patients with amoebic colitis (2%), 19 carriers of E. histolytica (6.7%), and 258 carriers of E. dispar (91.2%). In 133 patients (31%) no DNA of E. histolytica or E. dispar could be amplified in the stool samples. This patient group was used as control for the evaluation of diagnostic tests. Using real-time PCR as a reference test, the sensitivity and specificity of (1) the Entamoeba test for the diagnosis of E. histolytica/E. dispar carrier were 59% and 98%, (2) E. histolytica II for the diagnosis of E. histolytica carrier was 71% and 100%, and (3) serology for the diagnosis of E. histolytica infection was 83.3% and 95.2%, respectively. Applied to carriers that did not originate from an endemic country the sensitivity of serology for E. histolytica infection was 90% and specificity was 98.8%. In comparison to real-time PCR the performances of Entamoeba test and E. histolytica II lacked sensitivity for a reliable diagnosis of E. histolytica/E. dispar infection in a non-endemic setting. In carriers of E. histolytica/E. dispar from non-endemic countries the high specificity of serology can be used to establish the diagnosis of E. histolytica infection if antibodies are present.

Adolescent↗

Assessment of various diagnostic methods of ureaplasma respiratory tract infections in newborns.

We compared three methods used microbial culturing for detection of ureaplasmas in endotracheal aspirate from 500 prematurely born neonates with respiratory disturbances: BioMerieux test, PCR and microbial culturing. Ureaplasmas were detected in respiratory tracts of 79 (16%) newborns. Correlation of the results of culture with those obtained with the BioMerieux kit, culture with PCR and BioMerieux kit with PCR was 97%, 89% and 90%, respectively. Sensitivity and specificity of PCR in comparison with culture was 86% and 98%, respectively, and of the BioMerieux kit 96% and 98%. PCR can be recommended in rapid diagnostics of respiratory infections in newborns suffering from respiratory disorders. It allows the detection of ureaplasmas in case of parallel infections and identification of their species.

DNA Primers↗

[Image fusion of bone SPECT and CT - a specific diagnostic method in oral and maxillofacial surgery].

OBJECTIVE: The aim of this study was to evaluate the benefit of image fusion of CT (computertomography) and bone SPECT (single photon emission computed tomography) in diagnosis of head and neck cancer. METHODS AND PATIENTS: Computer based image fusion has been applied in 39 patients with suspected cancer in the oromaxillofacial region following CT and SPECT without any further hazard for the patients. Afterwards image fusion was set in comparision to simultaneously evaluation of CT and SPECT and histological findings. RESULTS: In 5 out of 39 patients SPECT/CT image fusion obtained more precise anatomical findings in tumour expansion than simultaneously evaluation of CT and SPECT. CONCLUSION: For planning of surgical and radiation therapy of oral and maxillofacial cancer, image fusion of CT/SPECT provides efficient and plastical diagnostic imaging. Particularly in complex anatomical regions like maxilla or base of the skull image fusion could be an additional device, if simultaneous evaluation of CT and SPECT is not clear.

Adolescent↗

Diagnostic methods for African horsesickness virus using monoclonal antibodies to structural and non-structural proteins.

A panel of 32 hybridoma cell lines secreting monoclonal antibodies (MAbs) reactive with African horsesickness virus serotype 4 (AHSV-4) has been developed. Four of the MAbs recognized the major core antigen VP7, twenty recognized the outer capsid protein VP2 and eight reacted with the non-structural protein NS1. With the VP7-specific MAbs a rapid and sensitive double antibody sandwich immunoassay has been developed to detect viral antigen in infected Vero cells and in spleen tissue from AHSV-infected horses. The sensitivity of the assay is 10 ng viral antigen per 100 microliters. The NS1-specific MAbs allowed visualization by immunofluorescence of tubule-like structures in the cytoplasm of infected Vero cells. This can be very useful as a confirmatory diagnostic procedure. The antigenic map of the outer capsid VP2 protein with MAbs is also reported.

African Horse Sickness↗

HPV and pregnancy: diagnostic methods, transmission and evolution.

Pregnancy may foster the development of infections, in particular HPV infections. The aim of this study was to evaluate the entity of the relationship between HPV infection and pregnancy, with all the possible complications associated with this relationship. The pathology may be latent or manifest. Possible methods of diagnosis are clinical, namely gynecological examinations, PAP-tests, colposcopy or molecular, using viral DNA assay, Southern Blot, PCR, Hybrid Capture, etc. The prevalence of HPV infection in pregnancy varies between 5.4 and 68.8%. The population with the highest risk, also among pregnant women, are those under the age of 26. A number of different opinions emerge from the literature regarding the possibility of maternal-fetal virus transmission. None of the patients examined carried out treatment during pregnancy. The data reported in the literature on the relationship between HPV and pregnancy are highly discordant. This discrepancy depends on the diagnostic techniques used, the clinical history of the pregnant woman and the period of pregnancy when the sample is collected. Pregnancy enhances the development of the pathology which then often recedes in the postpartum. The possible maternal-fetal transmission of the virus is an important aspect: the letter is the main factor responsible for juvenile laryngeal papillomatosis. A number of Authors report an initial presence of HPV in newborns which often disappears within 6 months after birth.

Adolescent↗

[Failure of rapid serology for Helicobacter pylori as diagnostic method in primary care consultation].

OBJECTIVE: To evaluate the validity of a rapid serology test for diagnosing Helicobacter pylori infection in our area. DESIGN: Longitudinal, prospective study. SETTING: Urban primary care centre. MEASUREMENTS: As reference tests for defining the presence/absence of Helicobacter pylori, histology and the urease gastric mucous membrane test (Jatrox(R) test) were used. Both tests can be either positive or negative, without intermediate values. RESULTS: 47 consecutive patients were included. Histology (confirmed with the urease test) showed infection in 38 cases (80.85% prevalence). The results of rapid serology (95% CI) were: sensitivity 0.66 (0.51-0.81), specificity 1 (1-1), positive predictive value 1 (1-1), and negative predictive value 0.41 (0.2-0-61). CONCLUSIONS: In a population with high prevalence of infection, a positive in the rapid serology test confirms infection. However, a negative does not discount infection, which significantly reduces the test's overall diagnostic value. This confirms in the primary care context the findings of hospital-based studies.

Adult↗

Magnetic resonance imaging and contrast CT of the lumbar spine. Comparison of diagnostic methods and correlation with surgical findings.

Thirty-two patients with suspected lumbar disc herniation were studied with magnetic resonance imaging (MRI) and contrast computed tomography (CT). One hundred disc levels were evaluated. Twenty-five patients underwent surgery on 31 discs, allowing anatomic confirmation of the diagnosis. Surgical findings supported the MRI diagnosis at 28 of 31 levels (90.3% accuracy), whereas the CT diagnosis correctly reflected only 24 of 31 levels (77.4% accuracy). Discrepancy between MRI and CT interpretation occurred at ten levels that were surgically explored. Computed tomography (CT) was incorrect at seven levels, and MRI was in error at three levels. The sensitivity of MRI was 91.7%, compared with 83.3% for CT, and the MRI specificity of 100% was superior to 71.4% for CT. This study demonstrates the clinical superiority of surface coil MRI over contrast CT in the evaluation of lumbar disc herniation. Surface coil MRI can be used as the initial diagnostic procedure for a suspected herniated lumbar disc, using invasive contrast studies and CT, if required, to clarify an equivocal MRI finding.

Adult↗

[Comparative assessment of the diagnostic value of the laboratory diagnostic methods for trichomoniasis].

The authors compared the sensitivity and specificity of currently available methods for laboratory diagnosis of trichomoniasis, by examining 971 persons. The highest frequency of T. vaginalis was detected by studies of a stained smear (37.4%), culture tests (19.0%); polymerase chain reaction (PCR) (17.1%), immunofluorescence tests (12.7%), wet smear test (2.7%). Enzyme immunoassay yielded positive results in 36.2% of cases. The use of PCR and culture tests frequently provided similar results (92.0%). The authors have proposed an algorithm of a laboratory study including wet smear microscopy, PCR, and culture tests as basic methods. They have noted the higher detection rates of T. vaginalis when analyzing during draining physiotherapeutic procedures (endocervical vibratory massage with vacuum aspiration in females and pneumovibratory massage of the prostate with endourethral chemotrypsin electrophoresis in males).

Animals↗

[Pleural fibroma. Development of diagnostic methods and current anatomo-pathologic aspects. Apropos of 2 cases].

Pleural fibroma is a rare benign primary pleural tumour which has a favourable prognosis after surgical resection. Preoperatively, the diagnosis of the tumour of pleural origin can be made by means of modern imaging techniques, particularly computed tomography. However, there are no formal computed tomography or magnetic resonance imaging criteria allowing a precise characterisation of the tissues. The definitive diagnosis of pleural fibroma can only be based on histological examination of the entire surgical specimen.

Diagnosis, Differential↗

[Development of a new supplementary diagnostic method for endometrial cancer by flow cytometry employing anti-endometrial cancer antibody, MSN-1 and MSN-3].

In cytology, it is often difficult to make a definite diagnosis of endometrial cancer. In order to devise a new supplementary method, using flow cytometry we analyzed the reactivities of endometrial cells with two monoclonal antibodies (MSN-1 and MSN-3), both of which are strongly reactive to endometrial cancer cells. Employing either or both antibodies in flow cytometry, we investigated the usefulness of this analysis for distinguishing endometrial cancer cells from normal endometrial cells. Results revealed a low positive rate for normal endometrium: 9.2% with MSN-1 and 5.0% with MSN-3. In contrast, for endometrial cancer the positive rate was high: 81.2% with MSN-1 and 43.8% with MSN-3. Combined analysis with both antibodies increased the positive rate for endometrial cancer to 93.7%. These results suggest that analysis by flow cytometry employing MSN-1 and MSN-3 may have a diagnostic value for endometrial cancer. We are also investigating the usefulness of two-color analysis using these antibodies.

Antibodies, Monoclonal↗

[Pulmonary hypoplasia in adults: embryology, clinical presentation and diagnostic methods. Our experience and review of the literature].

We report five patients diagnosed of pulmonary hypoplasia (PH) in adulthood (age > 18 years, range 45 to 67 years). PH was left-sided in four cases. The malformations found were 2 cases of renal agenesis, 2 diaphragmatic hernias and 1 hiatal hernia. Lung function data were FEV1 0.88 +/- 0.32 L; FVC 1.30 +/- 0.52 L; FEV 1/FVC 68.5 +/- 5%. Arterial gases (with FiO2 0.21) were PaO2 63.6 +/- 24 and PaCO2 47.1 +/- 11.2 mmHg. Three cases were referred for monitoring of respiratory insufficiency (2 requiring home oxygen therapy) and two for radiographic study of chest disease. The diagnoses were made by computerized tomography (CT) of the chest. Congenital diseases due to underdeveloped lungs in the pseudoglandular phase are rarely diagnosed in adults (48 cases, including ours, have been found in the literature), and PH is rarely diagnosed, possibly because the anomalies observed are attributed to old infections. Clinical presentation is highly variable, depending in large measure on a history of smoking and repeated respiratory infections. Chest CT is at present the diagnostic tool of choice.

Aged↗