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Painful joints. Clues to early diagnosis.

Many cases of joint pain may be diagnosed from clinical findings alone. A careful history and physical examination are essential. Of all diagnostic laboratory tests for joint disease, none is completely specific. Results of latex fixation tests, antinuclear antibody (ANA) tests, and uric acid tests are all strongly suggestive when positive but do not rule out disease when negative. The most valuable laboratory procedure is examination of the synovial fluid. X-ray examination seldom is helpful in differentiation of early joint disease but may be very helpful in later stages.

Antibodies, Antinuclear↗

Evaluation of kits for measurement of the soluble transferrin receptor.

Three commercially available kits for determination of the soluble serum transferrin receptor (sTfR), R&D Systems, UK, Ramco Laboratories, USA and Orion, Finland were compared with respect to practicability, comparability and ability to discriminate between iron deficient and non-iron deficient subjects. Serum samples representing different concentrations of sTfR were tested. The three kits involved virtually the same laboratory procedures except for a predilution step for Ramco. Both the absolute amounts and the units (mg/L and nmol/L) differed among the kits, emphasizing the need for internationally accepted reference material and comparable units. The correlation coefficients were 0.974 (Ramco and R&D), 0.769 (R&D and Orion) and 0.759 (Ramco and Orion), indicating a lower comparability for Orion compared to the other two kits. The differences between the kits may be attributed to uncertainties in the reference intervals and to variations in kit format. This may have implications for studies of the usefulness of sTfR as a marker of iron deficiency.

Calibration↗

Simultaneous determination of 4-hydroxy-2-alkenals, lipid peroxidation toxic products.

Lipid peroxidation has been associated with cell injury and possible carcinogenecity, for the products can damage cellular membrane and DNA. Among the products formed from lipid peroxidation, 4-hydroxy-2-alkenals are the major components and have been suggested to play a role in cellular toxicity. However, the difficulties of the quantification due to their strong reactivity during laboratory procedures hinder the exposure measurement of the compounds. A novel detection method based on the conversion of 4-hydroxy-2-alkenals to stable diols and to subsequent ortho-esters has been developed. Simultaneous detection in a sensitive single-ion monitoring mode by GC/MS was carried out, monitoring m/z 129, which was the common fragment ion for the ortho-esters derived from 4-hydroxy-2-alkenals. The proposed method was used to quantify 4-hydroxy-2-nonenal in oils and in oxidized arachidonic acid.

Aldehydes↗

Endemic canine and feline histoplasmosis in El Paso, Texas.

Seventeen cases of histoplasmosis involving 2 dogs and 15 cats have occurred in the Upper Rio Grande Valley of El Paso since 1978. The diagnosis, based on clinical signs and radiographic findings, was confirmed by one or more of the following laboratory procedures: demonstration of intracellular Histoplasma capsulatum yeast cells in tissue, positive serology, or isolation of H. capsulatum from various organs of necropsied animals. H. capsulatum was isolated also from a bat cave and soil in the vicinity of some of the houses where the affected animals had resided. Skin-tests of 97 persons for histoplasmosis indicated a 14% positive prevalance in this locale.

Animals↗

Evaluation of the neutralising capacity of bactec medium for some antibiotics.

Bactec medium 9240 (Becton Dickinson, MD, USA) is a blood culture medium used routinely at Sultan Qaboos University Hospital (SQUH). The medium is said to contain substances that can neutralise antibiotics and destroy leucocytes in blood samples. In this study, the ability of the medium to neutralise the effect of some antibiotics and to destroy leucocytes is investigated. Vancomycin, amoxicillin, chloramphenicol, penicillin, gentamicin, fungizone and amikacin at various concentrations were added to separate bottles of Bactec medium 9240. Escherichia coli (NCTC 10418), Pseudomonas aeruginosa (NCTC 10662), Staphylococcus aureus (NCTC 6571) and Candida albicans (ATCC 10231), each at 1 x 10(4) colony-forming units (CFU)/mL were added separately, depending on the type of antibiotic. The blood samples were incubated at 37 degrees C for seven days under manual and automated blood culture systems. Subcultures were made from the manual system and routine laboratory procedures for detection of positive cultures were followed for the automated system. The Bactec medium was found to neutralise all antibiotics up to a concentration of 100 microg/mL by the automated method but showed some variation in results by the manual system. Leucocytes were destroyed within 24 hours.

Amikacin↗

Stabilization/solidification of salt from a waste incinerator.

A laboratory procedure was developed and verified for stabilizing salt produced by an industrial waste incinerator. This procedure is based on salt stabilization by means of an asphalt binder. Conductivity values and relevant anion contents in leachates of stabilized waste with an asphalt coating were near zero. The pH value of these leachates equaled the pH value of the water used, so that the stabilized waste salt represented inert material, posing no environmental hazard. An unusually significant reduction in the volume of processed salt occurred during stabilization. After compacting under 10.4 MPa pressure, the volume of test specimens was almost 55% smaller than the initial salt volume. In practice, this would mean more than a doubling of landfill waste capacity. Volume reduction was successfully explained by means of a mathematical model.

Algorithms↗

Effect of the inoculum size on susceptibility tests performed on sessily growing bacteria.

It has been clearly established that the inoculum size greatly affects the results of antibiotic susceptibility tests performed in both liquid and solid media in standard laboratory growth conditions (i.e. planktonic). Recently methods were developed to perform antibiotic susceptibility tests on bacteria growing in sessile conditions. The present study investigates the effect of the inoculum size on results obtained by these methods. Results show that the inoculum size does not affect tests performed in sessile conditions. A simple and reliable method is proposed to be applied to routine microbiological laboratory procedures.

Anti-Bacterial Agents↗

A new whole-body vapor exposure chamber for protection performance research on chemical protective ensembles.

A chemical vapor exposure chamber was designed to permit the study of whole-body vapor exposure of individuals wearing full protective clothing and equipment systems. A methodology also was developed to quantify the vapor protection performance of chemical protective ensembles (CPE) under safe and validated laboratory procedures. The principal research objectives were to (1) provide a methodology to accurately assess the performance of CPE and equipment under different environmental and chemical vapor challenge conditions; (2) quantify the vapor protection on a per body region basis; (3) have a systems level tool to aid in the research and development of more effective CPE for use in chemical biological environments; and (4) have a safe and reliable means of qualifying new CPE on the basis of vapor protection. Although designed for the evaluation of military-style protective equipment, the procedures apply equally to other styles of CPE used by civilian agencies such as firefighters, police, and hazmat units. The chamber and methodology were specifically designed to examine the vapor protection performance of clothing ensembles, including the details of protection variation over the body. A variety of exposure conditions appropriate to indoor and outdoor scenarios are possible, including the effects of wind, temperature, and relative humidity. Protection performance results from a number of individuals wearing typical military-style CPE are presented. These results demonstrate that there is no such thing as a unique protection performance level obtained for a given CPE. Rather, the individual and the ensemble interact differently in each situation, resulting in a protection performance distribution for individuals, and for groups of wearers, even under a standardized set of exposure conditions.

Administration, Inhalation↗

Nephrotoxicity in isoxazolylpenicillin prophylaxis in hip surgery.

In 789 courses of antibiotic prophylaxis in hip arthroplasty surgery, either dicloxacillin (Diclocil) or cloxacillin (Ekvacillin) was used during two different time periods. The surgical methods, anesthesia, preoperative and postoperative care of the patients, and laboratory procedures were the same all the time. Changes in creatinine values were used as a method for evaluating the impact on renal function. When using dicloxacillin, a pathologic increase of creatinine was noted in 12 and 13 percent by two different calculation methods. Sixteen patients (4.2 percent) had a severe creatinine increase during the first postoperative week after dicloxacillin prophylaxis, requiring dialysis in 2 patients. Cloxacillin had only a marginal impact on renal function. Patients above aged 70 years were more vulnerable as regards renal function than younger persons, and the impairment was slightly dose related in all ages. In the dicloxacillin group, preoperative use of antiphlogistic drugs was correlated with reduced postoperative renal function.

Adult↗

Pneumonia outbreak associated with group a Streptococcus species at a military training facility.

BACKGROUND: Although group A streptococci (GAS) infections are a major cause of morbidity and mortality, outbreaks of associated pneumonia are rare. We report an outbreak of GAS pneumonia that occurred at a US military training camp. METHODS: Standard epidemiologic and laboratory procedures were used to characterize the outbreak and causative organism(s). A case-control study and determination of the prevalence of GAS infection among camp personnel were also performed. RESULTS: A total of 162 of 4500 Marine Corps personnel were hospitalized for respiratory symptoms during the period of 1 November and 20 December 2002, and 127 (78%) had radiographically confirmed pneumonia. The attack rate was 1.6 cases per 100 person-months. Thirty-four (27%) of 127 patients with pneumonitis had definite or probable GAS pneumonia; an additional 22 (17.3%) were coinfected with GAS and another pathogen. Pathogens, in addition to GAS, included Chlamydia pneumoniae (27 patients), Mycoplasma pneumoniae (19), adenovirus (5), and Streptococcus pneumoniae (2). A survey revealed that the pharyngeal carriage rate of GAS among camp personnel was 16%. Molecular characterization of the GAS isolates found emm type 3, multilocus sequence type 15. The epidemic ended after administration of additional prophylaxis with a single dose of intramuscular benzathine penicillin (1.2 million U) or azithromycin (1 g orally). Because the number of days from the last penicillin injection was correlated with a positive throat culture result and the occurrence of pneumonia, the dosing interval of benzathine penicillin was shortened from every 28-35 days to every 21 days. CONCLUSIONS: This is the largest outbreak of GAS pneumonia reported in >30 years. This outbreak emphasizes the potential for GAS to cause epidemics of severe infection and demonstrates the need for surveillance and consideration of appropriate antibiotic prophylaxis among particularly high-risk populations.

Adolescent↗

Ebola virus outbreak among wild chimpanzees living in a rain forest of Côte d'Ivoire.

An outbreak of Ebola in nature is described for the first time. During a few weeks in November 1994, approximately 25% of 43 members of a wild chimpanzee community disappeared or were found dead in the Taï National Park, Côte d'Ivoire. A retrospective cohort study was done on the chimpanzee community. Laboratory procedures included histology, immunohistochemistry, bacteriology, and serology. Ebola-specific immunohistochemical staining was positive for autopsy tissue sections from 1 chimpanzee. Demographic, epidemiologic, and ecologic investigations were compatible with a point-source epidemic. Contact activities associated with a case (e.g., touching dead bodies or grooming) did not constitute significant risk factors, whereas consumption of meat did. The relative risk of meat consumption was 5.2 (95% confidence interval, 1.3-21.1). A similar outbreak occurred in November 1992 among the same community. A high mortality rate among apes tends to indicate that they are not the reservoir for the disease causing the illness. These points will have to be investigated by additional studies.

Animals↗

Detection of an unusual combination of mutations in the HFE gene for hemochromatosis.

In the present paper, we describe an individual, found as part of a screening study, being homozygous for the C282Y mutation and at the same time heterozygous for the H63D mutation in the HFE gene. Identical results were obtained by three different methods, i.e., by PCR-RFLP, by sequencing, and by melting curve analysis. Thus, the common conception that the C282Y and the H63D mutations are mutually exclusive is not valid. Clinical symptoms and laboratory data on the individual were similar to hemochromatosis patients homozygous for the C282Y mutation. The implications of our finding for diagnostic analytical laboratory procedures are briefly discussed.

Adult↗

New monoclonal antibodies to non-glycosylated domains of the secreted mucins MUC5B and MUC7.

The separation and characterization of salivary mucins is not straightforward because of their large size, heterogeneity, and molecular interactions. The MUC5B and MUC7 mucins are major glycoprotein components of saliva that are thought to play a vital role in maintaining oral health. MUC5B is also a major component of respiratory mucus and is produced by the tracheal and bronchial glands, while MUC7 has a more limited pattern of expression in the bronchial tree. MUC5B is a gel-forming mucin and thus confers viscosity, whereas MUC7 is much smaller. MUC7 has anti-fungal activity, and both mucins interact with bacteria. The aim of this work was to produce new monoclonal antibodies that can be used to quantify and characterize these mucins by standard laboratory procedures. Peptide sequences in non-conserved and non-glycosylated regions were selected and monoclonal antibodies produced by an efficient immunization and cloning strategy, and screening against purified mucins. Three new antibodies-EU-MUC5Ba and EU-MUC5Bb (against MUC5B) and EU-MUC7a (against MUC7)-were isolated that do not show cross-reactivity with other gel-forming mucins. All work on immunohistochemistry can be used for semi-quantitative immunoblotting after agarose gel electrophoresis. These reagents are valuable tools to study changes in these mucins in oral and respiratory disease, and unlike other monoclonal antibodies to these mucins they recognize epitopes that are not affected by glycosylation.

Animals↗

Chronic effect of pneumoperitoneum on renal histology.

BACKGROUND AND OBJECTIVE: Transient intraoperative oliguria is a constant phenomenon during laparoscopic procedures. Laboratory studies have demonstrated that this effect is secondary to a decrease in renal blood flow caused by the pneumoperitoneum. With the advent of laparoscopic harvest of the kidney for renal transplantation, a concern is that increased intra-abdominal pressure may compound the effect of acute cold and warm renal ischemia during transplantation. Acute transient renal ischemia can produce chronic sclerosing histopathologic changes in native kidneys which are similar to those seen in chronic allograft rejection. The effect of positive-pressure abdominal pneumoperitoneum (15 mm Hg) on native kidneys was examined using a rodent model. The effects on renal function and histologic features were also studied. MATERIALS AND METHODS: Twenty-four Harlan Wistar-Furth rats were divided into four groups: controls, 1-hour pneumoperitoneum-91-day survival, 5-hour pneumoperitoneum-91-day survival, and 5-hour pneumoperitoneum-7-day survival. Control animals underwent placement of the Veress needle and anesthesia but no induction of pneumoperitoneum. At the time of sacrifice, blood was sampled for serum creatinine measurement. Both kidneys were harvested for frozen and permanent section and stained using hematoxylin and eosin. Specimens were graded for inflammatory and ischemic/sclerotic changes in the interstitium, tubules, glomeruli, and vasculature by a renal pathologist using a histologic score (0-3). RESULTS: In all groups, at a sacrifice interval of either 1 week or 3 months, there were no statistical differences in the histologic score, serum creatinine concentration, or renal weight. CONCLUSIONS: In a rodent model, no signs of chronic ischemic histologic changes were detected for a period of 3 months after up to 5 hours of pneumoperitoneum. As well, there was no change in the serum creatinine concentration.

Animals↗

Cost analysis of surgical site infections.

BACKGROUND: Patients with surgical site infections (SSIs) require a longer time in the hospital, more nursing care, additional dressings, and, possibly, readmission to the hospital and further surgery. The combined direct and indirect costs of treating SSIs may be extremely high. METHODS: Review of current practice and guidelines. RESULTS: The direct costs of SSI include a longer hospital stay, readmission, outpatient and emergency visits, further surgery, and prolonged antibiotic treatment. Other direct costs arise from radiologic procedures, laboratory tests, home health visits and other ancillary services, drugs, and professional fees. Indirect costs, which are difficult to quantify, include lost productivity of the patient and family and a temporary or permanent decline in functional or mental capacity. The cost of SSIs increases with the depth of the infection. That is, the costs associated with superficial incisional SSIs are relatively low, but increase with deep SSI, and especially when organ or space infection is present. The estimated costs of managing SSI differ widely, from less than dollar 400 per case for superficial SSI to more than dollar 30,000 per case for serious organ or space infections. CONCLUSIONS: The need to treat SSIs places a severe financial strain on health care resources. It is possible that treating high-risk surgical patients medically will prove to be more cost-effective than repeated operations.

Costs and Cost Analysis↗

Transmission route efficacy and kinetics of Anaplasma phagocytophilum infection in white-footed mouse, Peromyscus leucopus.

Anaplasma phagocytophilum was used to infect Peromyscus leucopus mice by three routes of inoculation: infected tick infestation and intraperitoneal (IP) and subcutaneous (SQ) injection of infected tissue culture cells. A set of 12 mice were infected (four tick, four IP, and four SQ), and blood was drawn at 1, 3, 6, 9, 12, 15, 21, 28, 35, and 60 days post-infection and analyzed by use of a quantitative PCR assay to assess the level of infection. An additional set of 108 mice were infected (36 tick, 36 IP, 36 SQ) and euthanized at 1, 3, 6, 9, 12, 15, 21, 28, and 35 days post-infection (four mice/time point), and blood, spleen, bone marrow, and bladder tissue samples were analyzed. Tick infection generally produced the highest average levels of infection and peaked at 9 days post-infestation in blood, spleen, and bone marrow and at 6 days after infestation in the bladder. IP injection resulted in levels of infection that peaked on day 6 (spleen) or 12 (bladder, bone marrow, and blood). A. phagocytophilum injected SQ showed low levels of infection, and the day of peak infection varied. The average level of infection in the blood drawstressed mice was consistently higher and peaked earlier than infection in the non-stressed, euthanized mice. Xenodiagnosis was used to assay a third set of 12 mice (four tick, four IP, and four SQ) on days 7 and 14 post-infection and ticks fed on tick-infected mice showed the highest rate of PCR-positive test results at both time points (day 7, 22.2%; day 14, 17.3%). These data indicate that P. leucopus mice can be infected by tick infestation, IP injection, or SQ injection but that the kinetics and level of infection are quite variable among individual mice, may be influenced by the route of inoculation, and may be further altered by common laboratory procedures such as repeated collection of blood samples.

Anaplasma phagocytophilum↗

Diagnosis of human rabies by the cornea test.

The second death due to rabies encephalitis occurring among American servicemen stationed in the Republic of Vietnam is reported. The clinical diagnosis was confirmed by performing the direct fluorescent antibody test for rabies on smears of corneal epithelial cells obtained on the second day of hospitalization. The reliability of various laboratory procedures in confirming the diagnosis of human rabies early in the course of clinical illness is discussed. The cornea test is a useful and rapid method of diagnosing human rabies prior to the development of significant serum antibody titers.

Adult↗

A comparison of hard and soft glass blood-drawing tubes.

The authors examined both hard and soft glass evacuated blood-drawing tubes for possible effects on clinical chemistry measurements. Using routine laboratory procedures, no clinically or statistically significant difference could be detected in 34 analytes using 66 different methods. A special high-precision study utilizing an adaption of the NBS round-robin procedures for calcium, magnesium, sodium, and potassium detected no difference between paired sera when drawn or stored for 72 hours, or both, in the two types of glass. The authors conclude that the type of glass used in production of the evacuated blood-drawing tubes does not affect the clinical chemistry results obtained.

Blood Specimen Collection↗