Essential Diagnostic Test Research Articles

Do different positions during a non-stress test affect the maternofetal physiological parameters and comfort in pregnant women?

A non-stress test (NST) is an essential diagnostic test performed during pregnancy to assess fetal well-being. It is a recording of fetal movements besides fetal heart rate, indicating fetal biophysiological well-being. As maternal physiology is altered in various positions, apt positioning during the NST is essential for accurate results while ensuring maternal comfort. This study aims to evaluate the effect of different maternal positions, left lateral and semi-fowler's, on NST reactivity, maternal blood pressure, heart rate, and comfort in pregnant women while performing the NST. This crossover study evaluated 50 healthy pregnant women between 32 and 40 weeks of gestation with no obstetric complications for the effect of maternal positions on maternofetal physiological parameters and comfort. The NST was performed for 20 min in each position with a washout period of 10 min. The maternofetal physiological parameters were recorded by a calibrated sphygmomanometer and the electrocardiograph interpretations. The maternal comfort was assessed using a maternal comfort rating scale (MCRS) for each position after the NST. Relevant descriptive and inferential statistics are applied to compute the results. Statistically, there was a significant difference in the mean maternal blood pressure and heart rate between the left lateral and semi-fowler's positions at 0 and 20 min (P = 0.001), whereas within the groups, in the same position at 0 and 20 min, no significant difference was found. There was no significant difference in NST reactivity (P = 0.79) in different positions. There was no significant difference between the MCR scores of women in either of the positions (Z = -1.64, df = 49, P = 0.100). Semi-fowler's position demonstrated favorable maternal blood pressure and heart rate during the NST in the third trimester of pregnancy, though it was clinically not significant. There was no significant difference in the comfort of women in both positions. Hence, either of the positions can be implemented in practice as an alternative position while performing the NST, based on the women's preference.

Performance of rapid rk39 tests for the diagnosis of visceral leishmaniasis in Ethiopia: a systematic review and meta-analysis

BackgroundVisceral Leishmaniasis (VL) is a severely neglected disease affecting millions of people with high mortality if left untreated. In Ethiopia, the primary laboratory diagnosis of VL is by using an antigen from a 39-amino acid sequence repeat of a kinesin-related (rK39) of leishmania donovani complex (L. donovani), rapid diagnostic tests (RDT). Different rk39 RDT brands are available with very variable performance and studies from Ethiopia showed a very wide range of sensitivity and specificity. Therefore, a systematic review and meta-analysis were conducted to determine the pooled sensitivity and specificity of rk39 RDT in Ethiopia.MethodPUBMED, EMBASE, and other sources were searched using predefined search terms to retrieve all relevant articles from 2007 to 2020. Heterogeneity was assessed by visually inspecting summary receiver operating curves (SROC), Spearman correlation coefficient (rs), Cochran Q test statistics, inconsistency square (I2) and subgroup analysis. The presence and statistical significance of publication bias were assessed by Egger's test at p < 0.05, and all the measurements showed the presence of considerable heterogeneity. Quality assessment of diagnostic accuracy studies (QUADAS-2) checklists was used to check the qualities of the study.ResultsA total of 664 articles were retrieved, and of this 12 articles were included in the meta-analysis. Overall pooled sensitivity and specificity of the rk39 RDT to diagnose VL in Ethiopia were 88.0% (95% CI 86.0% to 89.0%) and 84.0% (95% CI 82.0% to 86.0%), respectively. The sensitivity and specificity of the rk39 RDT commercial test kits were DiaMed: 86.9% (95% CI 84.3% to 89.1%) and 82.2% (95% CI 79.3% to 85.0%), and InBios: 80.0% (95% CI 77.0% to 82.8%) and 97.4% (95% CI 95.0% to 98.8%), respectively.ConclusionReferring to our result, rk39 RDT considered an essential rapid diagnostic test for VL diagnosis. Besides to the diagnostic accuracy, the features such as easy to perform, quick (10–20 min), cheap, equipment-free, electric and cold chain free, and result reproducibility, rk39 RDT is advisable to remains in practice as a diagnostic test at least in the remote VL endemic localities till a better test will come.

Diagnostic Validation Study. Relationship Between Optical Spectroscopy and Ankle Brachial Index Tests for Peripheral Artery Disease.

Ankle brachial index (ABI)is an essentialdiagnostic test for peripheral artery disease. It has some important limitationsso it can´t always be performed.In those cases, tissue oximetry based on near-infrared spectrum could overcome these limitations. Assessment ofthe relationship between ABI and tissue oximetry tests and the ability of the oximetry to detect postoperative improvement. Prospective observational study. Several measures were made by both, ankle pressure and tissue oximetry tests, in lower limbs. Absolute values were collected at foot level (anterior and posterior tibial arteries) and the indexes were calculated in relation to a control (upper limbs for ABI and left infraclavicular region for tissue oximetry). In order to evaluate the correlation between ankle pressure and tissue oximetry values, Pearson correlation coefficient and linear regression analyses were applied. T-Student and ROC curve analysis were made to evaluate thepostoperative improvement detected by bothankle pressureandtissue oximetry tests. 60 patients with peripheral artery disease were included. Ankle pressure and tissue oximetry were measured in 70 lower limbs, in 45 of them before and after revascularization. Compared to ankle pressure, tissue oximetry was able to detect improvement in absolute values and indexes after revascularization. This indexes improvement was parallel (P=0.234 for anterior tibial artery and P=0.356 for posterior tibial artery). We weren´t able to determine a cutoff point between both tests (ROC curve analysis).We observed a significative positive correlation in absolute values of both tests (Pearson correlation coefficient, r=0,281; P < 0.001). Tissue oximetry is able to detect improvement after revascularization of lower limbs.

Blood Culture Utilization at Six Southeastern US Hospitals

Group Name: Duke Center for Antimicrobial Stewardship and Infection PreventionBackground: Blood cultures are an essential diagnostic test, but over- and underutilization may cause harm. Methods: We analyzed blood culture utilization at 6 hospitals in the southeastern United States including 1 academic hospital (A) and 5 community hospitals (B–F) from May 2019 to April 2020. We measured blood culture utilization rate (BCUR) per 1,000 patient days and blood cultures per encounter. We counted blood cultures by laboratory accession number and measured utilization per 1,000 patient days and encounter. A likely contaminant was defined as 1 of 2 blood cultures collected in the same calendar day positive for a common skin commensal (CSC), as defined by the NHSN, and not identified from subsequent cultures. A likely pathogen was defined as a culture with a pathogen not on the CSC list or a CSC not meeting the contaminant definition. Hospital-level BCUR included samples for culture collected in the emergency department (ED) and inpatient areas divided by inpatient days. Results: The analysis included 117,897 blood cultures and 662,723 patient days with a median BCUR of 209.7 per hospital and median blood culture per encounter of 2 (Table 1). One community hospital (C) demonstrated a substantially higher BCUR than others. Cultures were frequently collected in the ED (54%; range, 36%–78%); most encounters with cultures in the ED were subsequently admitted to an inpatient unit (84%; range, 73%–89%). Higher BCURs were observed in intensive care and oncology units. The proportion of first blood cultures drawn after initiation of antibiotics was 6% (range, 3%–9%. Mondays had higher BCURs than other days of the week (Figure 1). The average BCUR by month was 176.1 (range, 164.3–181.4) with no seasonal patterns observed. Overall, 7.7% (range, 4.5%–9.1%) of blood cultures identified a likely pathogen and 2.1% (range, 1.3%–3.2%) identified a likely contaminant. The 3 hospitals with BCURs &gt;200 also had contaminant rates &gt;2% and &gt;60% ED cultures. Conclusions: Blood culture utilization varied by hospital, unit, and day of the week. We observed higher rates of likely contaminants among hospitals with higher BCURs and ED culture rates. Comparisons may assist in identifying opportunities to optimize practice around blood-culture ordering and collection.Funding: NoDisclosures: None

Point-of-care haemoglobin testing in African hospitals: a neglected essential diagnostic test.

SummaryOwing to the rapid turnaround time in the assessment of haemoglobin level by point-of-care tests (POC Hb), these have grown in popularity and scope in large parts of the world. However, whilst POC testing for malaria and HIV remains has been integrated into patient management in Africa, the use of POC haemoglobin testing remains neglected by health services. The main users of transfusions (paediatric, maternity and trauma services) present largely as emergencies. Ward-based POC Hb could result in more rapid and accurate diagnosis of anaemia, contributing to saving of lives and at the same time reduce unnecessary transfusions which deplete the limited supplies of donated blood in Africa. Severe anaemia requiring transfusion is a major cause of paediatric admission in Africa. At a dissemination meeting to discuss the results of a large phase III paediatric transfusion trial and steps to implementation of the findings participants strongly recommended that one of the most pressing actions required was to prioritise the use of POC haemoglobin testing. This would facilitate implementation of the new transfusion algorithm, developed at the meeting, which refines patient management including blood transfusions. We present the rationale for the strongly recommended prioritisation of POC Hb, using paediatric transfusion as an exemplar.

Incidence of Thyroid Cancer in Thyroid Swelling, Study of 200 Cases

Objective: The incidence of thyroid cancer has rapidly increased in the United States (US) and other developed countries over the past 30 years but there is no study to find out the true incidence of thyroid cancer in Bangladesh. The aim of this study is to compare FNAC with histopathology reports and to find out the true incidence of thyroid malignancy in thyroidectomy patients presenting with thyroid swelling. Methods: This is a prospective study of 200 thyroid swelling patients underwent thyroid surgery done at Shaheed Suhrawardy Medical College Hospital, a tertiary Care Hospital in Dhaka from July 2017 to December 2020. FNAC and histopathology reports were studied to find out the incidence of benign and thyroid malignancy among the thyroid swelling. Results: The age of the patients ranged from 8 to 75 years. The mean age was 37.2 years. There were 156 female and 44 male patients with female male ratio 3.54:1. Diagnostic categorization of 200 thyroid swelling underwent surgery, FNAC based on Bathesda classification showed that 163 (81.5%) cases were cytologically benign, 37 (18.5%) cases were malignant category. Out of 200 cases histopathology showed134 cases(67.0%) are benign and 66(33.0%) are malignant thyroid swelling. Among the benign lesions96.31% are colloid goiter and among the malignant lesions 93.4% are papillary thyroid carcinoma. Conclusion: Although FNAC is an essential diagnostic test to rule out thyroid malignancy but histopathological examination is the only way to give true incidence of thyroid malignancy among the thyroid swelling and it is observed that there is high incidence of thyroid malignancy(33.0%) among the thyroid swelling patient underwent thyroid surgery. Bangladesh J Otorhinolaryngol; April 2021; 27(1): 12-16

Elimination Effect of Cross Excitation Artifacts using the Changes of Flip Angle in 3.0 T MRI

Magnetic resonance imaging (MRI) shows high contrast and resolution on the soft tissues and nervous tissues without radiation hazard, which is used as an essential diagnostic test in the radiology. Cross excitation means to show artifacts upon the signal loss from overlapped radio frequency (RF) in some anatomical locations during the image acquisition process with RF pulse. To lower cross excitation artifacts, their images were analyzed by the changes of flip angle, TR, and TE. Ingenia 3.0T CX MRI by Philips was used for image acquisition. Self-developed water phantom used for quality control of MRI was used. SNR values at 40 degree of flip angle were 1,354 ±7.12 and 214 ± 2.10; those at 70 degree were 1,375 ± 7.31 and 305 ± 2.12; and those at 90 degree were 1,413 ± 7.93 and 357 ± 2.33, for water and artifact, respectively. CNR values were 1,140 ± 7.01, 1,070 ± 7.18, and 1,056 ± 7.12 at 40, 70 and 90 degree of flip angle, respectively (P 0.05). As f lip angle was lowered more, artifact was decreased more. In case of 90 degree of flip angle, artifact was decreased more as TR was longer. These results are anticipated to be used as the fundamental data to acquire more valued medical images in terms of diagnostics with MRI to diagnose various diseases.

The role of the veterinary diagnostic lab in the management of BRD.

Veterinary diagnostic labs (VDLs) are important service agencies providing essential diagnostic testing for a wide variety of domestic animal species as well as wildlife. They serve key roles in disease monitoring and diagnosis as well as surveillance for diseases of consequence. Of the many roles VDLs serve, one is being a member of the larger team of professionals dealing with the management of the bovine respiratory disease (BRD) complex. VDLs provide a number of services related to the management of BRD. These include disease outbreak investigation, abnormal morbidity characterization, routine monitoring, and biosecurity screening for a variety of infectious agents via methods such as necropsy and histopathology, bacterial culture, antimicrobial sensitivity testing, virus isolation, and serological assays. VDLs continue to look for better methods and assays as instrumentation technology also grows and improves. This is reflected in the growing proliferation of molecular-based assays that provide a high degree of sensitivity and specificity. Professional staff in VDLs work in collaboration with those in academia and private industry to conduct basic research focusing on a different aspect of the BRD complex. VDLs remain a primary source of the varied field-origin infectious agents associated with BRD that are used for research purposes.

Liquid biopsy in ovarian cancer

Ovarian cancer is typically diagnosed at an advanced stage and poses a significant challenge to treatment and recovery. Relapsed ovarian cancer and chemoresistance of ovarian tumor cells are other clinical challenges. Liquid biopsy is an essential non-invasive diagnostic test that evaluates circulating tumor cells and tumor DNA, as well as other blood markers that may be useful in guiding precision medicine. Although liquid biopsy is not a routinely used diagnostic test, the potential applications in the diagnosis and prognosis in ovarian cancer are rapidly growing. This review explores recent studies examining the clinical potential of circulating tumor cells, cell-free microRNA, exosomes, tumor DNA, and other analytes as a source of liquid biopsy biomarkers in ovarian cancer diagnosis, prognosis and response to treatment.

Mycetoma and Chromoblastomycosis: Perspective for Diagnosis Improvement Using Biomarkers.

Background: Mycetoma and chromoblastomycosis are both chronic subcutaneous infectious diseases that pose an obstacle to socioeconomic development. Besides the therapeutic issue, the diagnosis of most neglected tropical diseases (NTD) is challenging. Confirmation using direct microscopy and culture, recognized as WHO essential diagnostic tests, are limited to specialized facilities. In this context, there is a need for simple user-friendly diagnostic tests to be used in endemic villages. Methods: This review discuss the available biomarkers that could help to improve the diagnostic capacity for mycetoma and chromoblastomycosis in a theoretical and practical perspective. Results: A lack of research in this area has to be deplored, mainly for mycetoma. Biomarkers based on the immune response (pattern of leucocytes, antibody detection), the dermal involvement (extracellular matrix monitoring, protein expression), and the presence of the infectious agent (protein detection) are potential candidates for the detection or follow-up of infection. Conclusion: Confirmatory diagnosis based on specific diagnostic biomarkers will be the basis for the optimal treatment of mycetoma and chromoblastomycosis. It will be part of the global management of NTDs under the umbrella of stewardship activities.

Essential in-vitro laboratory diagnostic services provision in accordance with the WHO standards in Guragae zone primary health care unit level, South Ethiopia

IntroductionLaboratory services are crucial parts of the health system having a great contribution to disease prevention and management. The importance of accurate and reliable laboratory test results is less recognized in developing countries like Ethiopia where most medical decisions are based on clinical judgment. It is time for countries like Ethiopia to not only increase health care coverage but also improve access to essential diagnostic tests. Hence, this proposed study aims to assess essential in-vitro laboratory service provision in accordance with the WHO standards in Guragae Zone primary health care unit level, South Ethiopia.MethodsHealth institution-based cross-sectional study was carried out. 30% randomly selected primary health care units were recruited. Each facility was visited with a WHO checklist by a trained data collector to assess the availability of essential diagnostics service provision. The proportion of available in-vitro diagnostics services was calculated. Results were presented as percentages in tables and figures.ResultTwenty-one primary health care facilities located in Guragae Zone were assessed between May and July 2019. All surveyed facilities had major gaps in essential test availability. Among essential diagnostic tests listed with WHO like C-reactive protein, lipid profile, Amylase and Lipase, TroponinT/I, hepatitis B e-antigen, IgM-specific antibodies to hepatitis B core antigen, Glucose-6-phosphate dehydrogenase activity, and anti-HIV/p24 rapid test were not provided in any facilities. However, essential diagnostic services like urine dipstick testing, random blood sugar, smear microscopy, and few serological tests were provided at all primary health care units. All surveyed facilities had limited major laboratory equipment and consumables.Conclusion and recommendationThe present study shows limited access to essential laboratory tests at the primary health care level. Hence, the responsible body should invest to make essential tests accessible at the primary care unit level within the framework of universal health coverage in the study area. The fact that access to essential diagnostic tests is the first key step in improving quality of care; such study has its own efforts to enable the implementation of essential diagnostic lists, and improve access to diagnostics in the country.

Consensus Report on Diagnosis, Treatment and Prevention of Infective Endocarditis by Turkish Society of Cardiovascular Surgery (TSCVS), Turkish Society of Clinical Microbiology and Infectious Diseases (KLIMIK), Turkish Society of Cardiology (TSC), Turkish Society of Nuclear Medicine (TSNM), Turkish Society of Radiology (TSR), Turkish Dental Association (TDA) and Federation of Turkish Pathology Societies (TURKPATH) Cardiovascular System Study Group

Infective endocarditis (IE) is rare, but associated with significant morbidity and mortality rates. Estimates of the incidence of IE in Turkey are compromised by the absence of population-based prospective studies. Due to the frequent presence of predisposing cardiac conditions and higher rates of nosocomial bacteremia in highrisk groups, the incidence of IE is expected to be higher in Turkey. Additionally, while IE generally affects older people in developed countries, it still affects young people in Turkey. In order to reduce the mortality and morbidity, it is critical to diagnose the IE to determine the causative agent and to start treatment rapidly. However, most of the patients cannot be diagnosed in their first visits, about half of them can be diagnosed after three months, and the disease often goes unnoticed. In patients diagnosed with IE, the rate of identification of causative organisms is significantly lower in Turkey than in developed countries. Furthermore, most of the centers do not perform some essential microbiological diagnostic tests as a routine practice. Some antimicrobials that are recommended as the first-line of treatment for IE, particularly antistaphylococcal penicillins, are not available in Turkey. These problems necessitate reviewing the epidemiological, laboratory, and clinical characteristics of IE in our country, as well as the current information about its diagnosis, treatment, and prevention together with local data. Physicians can follow patients with IE in many specialties. Diagnosis and treatment processes of IE should be standardized at every stage so that management of IE, a setting in which many physicians are involved, can always be in line with current recommendations. Study Group for Infective Endocarditis and Other Cardiovascular Infections of the Turkish Society of Clinical Microbiology and Infectious Diseases has called for collaboration of the relevant specialist organizations to establish a consensus report on the diagnosis, treatment, and prevention of IE in the light of current information and local data in Turkey.

Cartridge-based nucleic acid amplification test (Xpert Mycobacterium tuberculosis/Rifampicin Assay): An essential molecular diagnostic test for early diagnosis and initiation of treatment in childhood tuberculous meningitis and primary multidrug-resistant cases

Background: Tuberculosis (TB) still remains the major public health threat in India. Early diagnosis, so as to initiate early treatment is a priority as any delay, may complicate the prognosis further leading to the failure of an effective control. India accounts for 6% incidence of pediatric TB cases in a population that has 40% as estimated latent TB cases. Pediatric samples were considered as the key population in the study. TB remains the most common cause of childhood meningitis in high burden countries. India accounted for the highest number of TB deaths among children in the year 2015, followed by Nigeria and China. Of which, tuberculous meningitis (TBM) stands to be the most common cause of morbidity. Extrapulmonary TB accounts for 25% of the total TB cases reported among which the most severe form being TBM. Although severe and difficult to diagnose due to lack of specific tests to get confirmed, cartridge-based nucleic acid amplification test (CBNAAT) is the only solution for microbiological confirmation of the disease for early treatment initiation and reduction of morbidity and mortality. Previously, due to lower case detection rates owing to inadequate diagnostic facilities of higher analytical sensitivity, the mortality and morbidity continued to be in the higher range, and empirical treatment modality was the mainstay till the CBNAATs came into existence. The increase in the case detection for tuberculous meningitis at a manageable stage of the disease would help in decreasing the mortality rates. The study explores the increased case detection rates among pediatric population suffering from tuberculous meningitis from referral units to Intermediate Reference Laboratory (IRL), Kolkata. Cerebrospinal fluid (CSF) from the pediatric patients has not been very difficult procedure though invasive, especially in the pediatric age group, and can be practiced at peripheral unit having CBNAAT facility. Methods: CSF from pediatric patients showing obvious clinical signs of meningitis was collected from tertiary unit linked to IRL, Kolkata, and tested on CBNAAT by Xpert Mycobacterium tuberculosis/ rifampicin (RIF) (Cepheid) along with all the pulmonary and extrapulmonary samples based on the manufacturer's instruction. The data were captured in the Inbuilt software of the GeneXpert MTB/RIF (Xpert) and Genotype MTBDRplus (DRplus) (Cepheid , USA) of the cartridge based nucleic acid amplification test machines automatically during the tests and exported to the Microsoft Excel sheets for further analysis. A defined study design against each and every objective was setup to analyze the effective detection of tuberculous meningitis case and their resistance to RIF along with the other pulmonary and extrapulmonary samples. Results and Conclusions: The study concluded the confirmation of tuberculous meningitis cases by the help of CBNAAT. The detection of microbiologically confirmed TB by these specimens sent from the referral unit linked with IRL, Kolkata, for pulmonary and extrapulmonary cases along with tuberculous meningitis cases is significant and facilitates the early initiation of treatment for TB and more so to those who are newly detected as multidrug-resistant TB especially below the 6 months of age. About 5% prevalence and around 4.9% incidence are an alarming situation in the TB control scenario of West Bengal. The positive case detection among the CSF samples was found to be more in the 0.6–1-year group followed by the age group of 1–5 years. The percentage positivity of CSF is recorded as 2.38%, and the percentage of RIF resistance among positive cases from CSF was found to be 13.79% (n = 28).

Integrating HIV, syphilis, malaria and anaemia point-of-care testing (POCT) for antenatal care at dispensaries in western Kenya: discrete-event simulation modelling of operational impact

BackgroundDespite WHO advocating for an integrated approach to antenatal care (ANC), testing coverage for conditions other than HIV remains low and women are referred to distant laboratories for testing. Using point-of-care tests (POCTs) at peripheral dispensaries could improve access to testing and timely treatment. However, the effect of providing additional services on nurse workload and client wait times are unknown. We use discrete-event simulation (DES) modelling to understand the effect of providing four point-of-care tests for ANC on nurse utilization and wait times for women seeking maternal and child health (MCH) services.MethodsWe collected detailed time-motion data over 20 days from one high volume dispensary in western Kenya during the 8-month implementation period (2014–2015) of the intervention. We constructed a simulation model using empirical arrival distributions, activity durations and client pathways of women seeking MCH services. We removed the intervention from the model to obtain wait times, length-of-stay and nurse utilization rates for the baseline scenario where only HIV testing was offered for ANC. Additionally, we modelled a scenario where nurse consultations were set to have minimum durations for sufficient delivery of all WHO-recommended services.ResultsA total of 183 women visited the dispensary for MCH services and 14 of these women received point-of-care testing (POCT). The mean difference in total waiting time was 2 min (95%CI: < 1–4 min, p = 0.026) for MCH women when integrated POCT was given, and 9 min (95%CI: 4–14 min, p < 0.001) when integrated POCT with adequate ANC consult times was given compared to the baseline scenario. Mean length-of-stay increased by 2 min (95%CI: < 1–4 min, p = 0.015) with integrated POCT and by 16 min (95%CI: 10–21 min, p < 0.001) with integrated POCT and adequate consult times compared to the baseline scenario. The two nurses’ overall daily utilization in the scenario with sufficient minimum consult durations were 72 and 75%.ConclusionThe intervention had a modest overall impact on wait times and length-of-stay for women seeking MCH services while ensuring pregnant women received essential diagnostic testing. Nurse utilization rates fluctuated among days: nurses experienced spikes in workload on some days but were under-utilized on the majority of days. Overall, our model suggests there was sufficient time to deliver all WHO’s required ANC activities and offer integrated testing for ANC first and re-visits with the current number of healthcare staff. Further investigations on improving healthcare worker, availability, performance and quality of care are needed. Delivering four point-of-care tests together for ANC at dispensary level would be a low burden strategy to improve ANC.

The Diagnosis of Fungal Neglected Tropical Diseases (Fungal NTDs) and the Role of Investigation and Laboratory Tests: An Expert Consensus Report.

The diagnosis of fungal Neglected Tropical Diseases (NTD) is primarily based on initial visual recognition of a suspected case followed by confirmatory laboratory testing, which is often limited to specialized facilities. Although molecular and serodiagnostic tools have advanced, a substantial gap remains between the desirable and the practical in endemic settings. To explore this issue further, we conducted a survey of subject matter experts on the optimal diagnostic methods sufficient to initiate treatment in well-equipped versus basic healthcare settings, as well as optimal sampling methods, for three fungal NTDs: mycetoma, chromoblastomycosis, and sporotrichosis. A survey of 23 centres found consensus on the key role of semi-invasive sampling methods such as biopsy diagnosis as compared with swabs or impression smears, and on the importance of histopathology, direct microscopy, and culture for mycetoma and chromoblastomycosis confirmation in well-equipped laboratories. In basic healthcare settings, direct microscopy combined with clinical signs were reported to be the most useful diagnostic indicators to prompt referral for treatment. The survey identified that the diagnosis of sporotrichosis is the most problematic with poor sensitivity across the most widely available laboratory tests except fungal culture, highlighting the need to improve mycological diagnostic capacity and to develop innovative diagnostic solutions. Fungal microscopy and culture are now recognized as WHO essential diagnostic tests and better training in their application will help improve the situation. For mycetoma and sporotrichosis, in particular, advances in identifying specific marker antigens or genomic sequences may pave the way for new laboratory-based or point-of-care tests, although this is a formidable task given the large number of different organisms that can cause fungal NTDs.

Beyond biomarkers: How enhanced CT imaging can improve the diagnostic-driven management of invasive mould disease.

CT imaging remains an essential diagnostic test for identification, staging and management of invasive mould infection (IMI) in patients with hematological malignancies. Yet the limited specificity of standard CT imaging can drive excessive antifungal use in patients, especially when more definitive diagnosis cannot be established through microbiology or invasive diagnostic procedures. CT pulmonary angiography (CTPA) is a complimentary, non-invasive approach to standard CT that allows for direct visualization of pulmonary arteries inside infiltrates for signs of angioinvasion, vessel destruction and vessel occlusion. Experience from several centers that are using CTPA as part of a standard diagnostic protocol for IMI suggests that a positive vessel occlusion sign (VOS) is the most sensitive and a specific sign of IMI in both neutropenic and non-neutropenic patients. CTPA is particularly useful in patients who develop suspected breakthrough IMI during antifungal prophylaxis because, unlike serum and/or BAL galactomannan and polymerase chain reaction (PCR) testing, the sensitivity is not reduced by antifungal therapy. A negative VOS may also largely rule-out the presence of IMI, supporting earlier discontinuation of empirical therapy. Future imaging protocols for IMI in patients with hematological malignancies will likely replace standard chest X-rays in favor of early low radiation dose CT exams for screening, with characterization of the lesions by CTPA and routine follow-up using functional/metabolic imaging such as 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (FDG-PET/CT) to assess treatment response. Hence, enhanced CT imaging techniques can improve the diagnostic-driven management of IMI management in high-risk patients with hematological malignancies.

HIV Rapid Diagnostic Test Inventories in Zambézia Province, Mozambique: A Tale of 2 Test Kits.

Background: The first pillar of the UNAIDS 90-90-90 goal seeks to accurately identify persons living with HIV (PLHIV), a process that is predicated on facilities having the necessary HIV tests available to perform the task. In many rural settings, the identification of PLHIV is accomplished through a two-step process involving the sequential use of 2 separate rapid diagnostic tests (RDTs). Inadequate inventory of either test has ramifications for the success of HIV-related programs. The purpose of this study was to evaluate the inventory levels of HIV RDT kits at specific healthcare facilities in Zambézia province, Mozambique. Methods: Using facility-level pharmacy stock surveillance data from October 2015 through September 2016, we assessed the inventory levels of HIV RDTs at 75 health facilities in 8 districts within Zambézia province, Mozambique. Using programmatically established categories (good, sufficient, threatened, or stockout), defined in conjunction with the provincial health authorities, descriptive statistics were performed to determine inventory control of HIV RDTs at the district and health facility levels. Monthly proportions of adequate (good + sufficient) inventory were calculated for each district to identify inventory trends over the evaluation period. To assess whether the proportion of inadequate stocks differed between RDT, a mixed-effects logistic regression was conducted, with inadequate inventory status as the outcome of interest. Results: When viewed as a whole, the inventory of each test kit was reported as being at adequate levels more than 89% of the time across the 75 facilities. However, disaggregated analysis revealed significant variability in the inventory levels of HIV RDTs at the district level. Specifically, the districts of Inhassunge, Namacurra, and Pebane reported inadequate inventory levels (threatened + stockout), of one or both test kits, for more than 10% of the study period. In addition, a disparity between inventory levels of each test kit was identified, with the odds of reporting inadequate inventory levels of the confirmatory test (Uni-Gold™) being approximately 1.8-fold greater than the initial test (Determine™) (odds ratio: 1.82, 95% CI: 1.40-2.38). Conclusion: As Test and Treat programs evolve, a significant emphasis should be placed on the "test" component of the strategy, beginning with assurances that health facilities have the adequate inventory of RDT necessary to meet the needs of their community. As national policy-makers rely predominantly on data from the upstream arm of the supply chain, it is unlikely the disparity between inventory levels of HIV RDTs identified at individual districts and specific health facilities would have been recognized. Moving forward, our findings point to a need for (1) renewed efforts reinforcing appropriate downstream forecasting of essential medicines and diagnostic tests in general and for Uni-Gold™ test kits specifically, and (2) simple metrics that may be routinely collected at all health facilities and which may then easily and quickly flow upstream so that policy-makers may optimally allocate resources.

ожирение (необходимые лабораторные методы диагностики). Методические рекомендации для врачей первичного звена

ожирение (необходимые лабораторные методы диагностики). Методические рекомендации для врачей первичного звена

MS06.1 Preparedness To Deliver Cardiovascular Care: Access To Essential Medicines and Diagnostic Tests In Nepal

MS06.1 Preparedness To Deliver Cardiovascular Care: Access To Essential Medicines and Diagnostic Tests In Nepal

Evaluation of sperm DNA fragmentation index, Zinc concentration and seminal parameters from infertile men with varicocele.

The aim of this study was to investigate the effect of varicocele on DNA fragmentation index (DFI), zinc concentration and seminal parameters in infertile patients. In this prospective study, 179 men with at least 1-year history of infertility and varicocele were examined for semen quality at Hanoi Medical University Hospital (HMUH), Hanoi, Vietnam. In addition, an inverse correlation between zinc concentration and the degree of sperm DNA fragmentation in patients with clinical varicocele was found. The difference in mean values of sperm DNA fragmentation index in patients with various grades of varicoceles can be neglected, whereas most patients with varicocele of grades II and III had DFI >30%. Varicocele is associated with high levels of DNA damage in spermatozoa and reduced zinc levels that correlate with different grades of disease. Therefore, DNA fragmentation index and zinc concentration can be used as essential additional diagnostic test for patients with clinical varicocele. A study should be conducted to evaluate the benefits of zinc supplementation to improve seminal parameters in patients with varicocele.