Full Screening Research Articles

CO2 -dependent metabolic modulation in red blood cells stored under anaerobic conditions.

Anaerobic red blood cell (RBC) storage reduces oxidative damage, maintains adenosine triphosphate (ATP) and 2,3-diphosphoglycerate (DPG) levels, and has superior 24-hour recovery at 6 weeks compared to standard storage. This study will determine if removal of CO2 during O2 depletion by gas exchange may affect RBCs during anaerobic storage. This is a matched three-arm study (n = 14): control, O2 and CO2 depleted with Ar (AN), and O2 depleted with 95%Ar/5%CO2 (AN[CO2 ]). RBCs in additives AS-3 or OFAS-3 were evenly divided into three bags, and anaerobic conditions were established by gas exchange. Bags were stored at 1 to 6°C in closed chambers under anaerobic conditions or ambient air, sampled weekly for up to 9 weeks for a panel of in vitro tests. A full metabolomics screening was conducted for the first 4 weeks of storage. Purging with Ar (AN) results in alkalization of the RBC and increased glucose consumption. The addition of 5% CO2 to the purging gas prevented CO2 loss with an equivalent starting and final pH and lactate to control bags (p > 0.5, Days 0-21). ATP levels are higher in AN[CO2 ] (p < 0.0001). DPG was maintained beyond 2 weeks in the AN arm (p < 0.0001). Surprisingly, DPG was lost at the same rate in both control and AN[CO2 ] arms (p = 0.6). Maintenance of ATP in the AN[CO2 ] arm demonstrates that ATP production is not solely a function of the pH effect on glycolysis. CO2 in anaerobic storage prevented the maintenance of DPG, and DPG production appears to be pH dependent. CO2 as well as O2 depletion provides metabolic advantage for stored RBCs.

Optimization and design of an ibuprofen-loaded nanostructured lipid carrier with a 23 full factorial design

With the aim of the development an ibuprofen (IBU)-loaded NLC with a 23 full factorial design, lipid screening and contact angle measurements were applied to choose the most suitable excipients for the formulation of the system. The results of DSC, XRD and FT-IR studies demonstrated the compatibility between the drug and the components. The factorial design was utilized to investigate the effects of the excipients on the zeta potential (ZP) and the mean particle size. The addition of a liquid lipid to the solid lipid decreased both the melting point and the crystallinity index, which also occurred after the dissolution of IBU in the lipid mixture. The XRD diffractograms confirmed the reduction in the crystallinity of the components, but despite this decrease they still retained a crystalline structure. FT-IR did not reveal any interaction between the drug and the excipients. The particle sizes were 129–160nm, the PDIs ranged between 0.065 and 0.237, and their ZPs varied from −15.40 to −7.54mV. Random samples (picked out from the design space) were also prepared. Analysis of their particle sizes and ZPs led to an optimum equation which demonstrated the appropriateness of the analysis and allowed the shortening of further experimental planning.

Early audiological diagnostic in newborn and infant

Congenital hearing loss is a frequently met congenital condition, invisible, with extremely severe consequences upon child and his family. Late detection of this sensorial handicap, deafness, and absence of an appropriate treatment leads to double handicap - children become deaf and mute. Newborn hearing screening can be performed since day 2 or 3 of life, by automatic methods which do not imply audiology trained personnel. Otoacoustic emission and brainstem auditory evoked response are fast, non-invasive tests which can be performed in baby’s natural sleep. The utility of newborn hearing screening is obvious and demonstrated by medical reports. This led to international available specific testing protocols and also an ideal scheme of testing in order to assure hearing aid provider and speech therapy from 6 month of age. In Romania, the National Program of newborn hearing screening started in 2006, at the Institute of Phono-Audiology and Functional Surgery’s initiative, but not until no full national cover, law-driven screening and rigorous follow-up of REFER babies was obtained.

Lynch syndrome mutations in Poland and the Baltic States

Lynch syndrome is a hereditary cancer syndrome that accounts for up to 15% of all colorectal cancers diagnosed at a young age. The disease is caused by germinal mutations in mismatch repair genes. To date, hundreds of small pathogenic and possibly pathogenic DNA variants (small insertions, deletions and substitutions) have been described for Lynch syndrome worldwide. Because of the variety of small changes in mismatch repair genes only full screening (exon by exon) by DHPLC/sequencing or HRM/sequencing seems to be the appropriate screening option. However, full screening is still too expensive and time consuming. A solution that uses the opportunity to reduce costs and improve diagnosis is the detection of recurrent mutations. This approach has been successfully applied as a pre-screening method. We have compared all identified changes in MMR genes detected to date from populations emanating from Estonia, Latvia, Lithuania and Poland to ascertain if there are any similarities in the mutation spectra that can be used in designing a rapid diagnostic test for recurrent mutations characteristic for the Eastern Baltic Sea region.

Pap smears with glandular cell abnormalities: Are they detected by rapid prescreening?

Rapid prescreening (RPS) is one of the quality assurance (QA) methods used in gynecologic cytology. The efficacy of RPS has been previously studied but mostly with respect to squamous lesions; in fact, there has been no study so far specifically looking at the sensitivity of RPS for detecting glandular cell abnormalities. A total of 80,565 Papanicolaou (Pap) smears underwent RPS during a 25-month period. A sample was designated as "review for abnormality" (R) if any abnormal cells (at the threshold of atypical squamous cells of undetermined significance/atypical glandular cells [AGC]) were thought to be present or was designated as negative (N) if none were detected. Each sample then underwent full screening (FS) and was designated as either R or N and also given a cytologic interpretation. The final cytologic interpretation was a glandular cell abnormality (≥AGC) in 107 samples (0.13%); 39 of these (36.4%) were flagged as R on RPS. Twenty-four patients (33.8%) out of 71 who had histologic follow-up were found to harbor a high-grade squamous intraepithelial lesion or carcinoma; 13 of those 24 Pap smears (54.2%) had been flagged as R on RPS. Notably, 11 AGC cases were picked up by RPS only and not by FS and represented false-negative cases; 2 of these showed endometrial adenocarcinoma on histologic follow-up. Pap smears with glandular cell abnormalities are often flagged as abnormal by RPS, and this results in a sensitivity of 36.4% (at the AGC threshold). Most importantly, some cases of AGC are detected on Pap smears by RPS only, and this demonstrates that RPS is a valuable QA method.

The role of fiber supplementation in the treatment of irritable bowel syndrome: a systematic review and meta-analysis.

Irritable bowel syndrome (IBS) is a functional bowel disorder associated with a wide variety of clinical symptoms. The use of fiber in treatment of IBS is well established, but recent reviews have shown conflicting evidence. The aim of our review was to study the effects of fiber (soluble and insoluble) on the symptoms of IBS. Medline, EMBASE, Cochrane Central, CINAHL, LILACS, and ClinicalTrials.gov were searched for appropriate studies. Two reviewers screened the title/abstract and full text against the inclusion criterion - that is, randomized control trials/crossover studies that compare fiber with placebo for its effect on IBS in an outpatient setting. Independent double data extraction was performed across multiple fields. An assessment of the risk of bias and tests for heterogeneity were carried out, along with a meta-analysis of the outcomes of interest. The search yielded 4199 unique records: 121 were selected after title/abstract screening and 22 after full screening. There was moderate clinical, methodological, and statistical heterogeneity across studies, with a moderate risk of bias. Overall, there was a significant improvement in global assessment of symptoms among those randomized to fiber [risk ratio: 1.27; 95% confidence interval (CI): 1.05-1.54]. Soluble fiber improved assessment of symptoms (risk ratio 1.49; 95% CI: 1.09-2.03), as well as the abdominal pain score (mean difference: -1.84; 95% CI: -2.72 to -0.97), with insoluble fiber not showing improvement in any outcome. Soluble fiber appears to improve symptoms of IBS, whereas there is no evidence for recommending insoluble fiber for IBS.

Routine biomarkers are strong predictors of short term mortality

Methods A prospective observational cohort study of 6,279 consecutive patients admitted from the Emergency Department of Hillerod University Hospital. All triaged patients with a full biochemical screening (albumin, creatinine, CRP, haemoglobin, Lactate dehydrogenase, leukocytes, potassium, and sodium) were included. Vital status was collected from the Danish Central Office of Civil Registration. The primary endpoint was 30-day mortality. Secondary endpoints were admission to intensive care unit (ICU) and readmission. Univariate logistic regression splines were made for all eight biomarkers with cuts defined after internationally accepted reference intervals. These models were used to create a multivariate logistic regression spline including all eight biomarkers, and discriminative ability was evaluated with receiver operation characteristics and area under the curve (AUC). Ultimately predicted risks of mortality based on the biomarkers were calculated for all patients, and they were divided into four groups: Green 25%.

Morphologic analysis of false negative SurePath® slides using Focalpoint™ GS computer-assisted cervical screening technology: An Australian experience.

The trial results of BD FocalPoint™ GS computer assisted screening(FP) of BD SurePath(®) liquid based cervical cytology slides (SP) were published in Diagnostic Cytopathology in 2012.(1) METHOD: The FP-reviewed SP slides were compared to conventional cervical Pap smears (CON) in a split sample of 2198 routine specimens. In all 47 confirmed high grade (HG) cases, FP either selected fields of view (FOV) containing cells suspicious or diagnostic of HG (46/47), or prompted full screening of the slide (1/47) leading to detection of the HG lesion. In this study for the HG cases which were reported initially as negative (NEG) or low grade (LG), the original slides were reviewed to determine the reasons for the false negative reporting and to identify features characteristic of a HG pattern. Indicators of a high risk pattern for HG Squamous Intraepithelial lesions (HSIL) included the recognition of pale abnormal immature metaplastic cells. Indicators of a high risk pattern for HG Glandular Intraepithelial lesion (AIS) were single columnar cells with the nucleus occupying the widest area of the cell. Pavemented sheets of glandular cells and isolated mitoses were additional clues to the diagnosis. In endocervical and endometrial adenocarcinomas tumour diathesis tends to be absent in SurePath slides. Single cells with ingested neutrophils and obscured eccentric nuclei were another clue to the detection of endometrial adenocarcinoma. These morphological features are illustrated to help identify HSIL and HG glandular lesions when viewing the FOV presented by the FocalPoint(TM) GS technology.

Rapeseed straw as a renewable source of hemicelluloses: Extraction, characterization and film formation

Polymeric hemicelluloses were extracted by autohydrolysis and alkali from a biomass feed consisting of the stems of rapeseed straw according to a full statistical factorial screening design. Water extraction yielded fractions rich in galactoglucomannan, while alkaline extraction yielded primarily xylan. The extracted galactoglucomannan and xylans had similar molecular weights, while the yield of xylan was higher than the yield of galactoglucomannan. The extracted hemicellulose fractions also contained some lignin (7–15%) and traces of Ca, K, Na, and Si. Free-standing films were prepared from the hemicellulose fractions with different xylan:galactoglucomannan ratios. The rapeseed xylan films showed strain-to-break values >60% without any added plasticizers.

High-throughput and full automatic DBC-module screening tester for high power IGBT

We developed a high-throughput screening tester for DBC-module of IGBT. The tester realizes a new screening test with current distribution in addition to a conventional switching test. It consists of a power circuit, a replaceable test head, sensor array module and digitizer with LabVIEW program. Therefore, all kinds of DBC-modules can be screened by switching the test head. The tester acquires magnetic field signals and displays GO/NOGO judgment automatically after digital calibration and signal processing in 10s. It is expected to be applied for screening in a production line and analysis in order to prevent the failure of power modules.

Neuropsychological functioning related to specific characteristics of nocturnal enuresis

There is a high comorbidity demonstrated in the literature between nocturnal enuresis and several neuropsychological dysfunctions, with special emphasis on attention deficit hyperactivity disorder (ADHD). However, the majority of the psychological studies did not include full non-invasive screening and failed to differentiate between monosymptomatic nocturnal enuresis (MNE) and non-MNE patients. The present study primarily aimed to investigate the association between nocturnal enuresis and (neuro)psychological functioning in a selective homogeneous patient group, namely: children with MNE and associated nocturnal polyuria (NP). Secondly, the study investigated the association between specific characteristics of nocturnal enuresis (maximum voided volume, number of wet nights and number of nights with NP) and ADHD-inattentive symptoms, executive functioning and quality of life. The psychological measurements were multi-informant (parents, children and teachers) and multi-method (questionnaires, clinical interviews and neuropsychological testing). Thirty children aged 6-16 years (mean 10.43 years, SD 3.08) were included. Of them, 80% had at least one psychological, motor or neurological difficulty. The comorbid diagnosis of ADHD, especially the predominantly inattentive presentation, was most common. According to the teachers, a low maximum voided volume (corrected for age) was associated with more attention problems, and a high number of nights with NP was associated with more behaviour-regulation problems. No significant correlations were found between specific characteristics of enuresis and quality of life. Details are demonstrated in Table. The children were recruited from a tertiary referral centre, which resulted in selection bias. Moreover, NP was defined as a urine output exceeding 100% of the expected bladder capacity for age (EBC), and not according to the expert-opinion-based International Children's Continence Society norm of 130% of EBC. The definition for NP of a urine output exceeding 100% of the EBC is more in line with the recent findings of the Aarhus group. For children with MNE and associated NP, a high comorbidity with the predominantly inattentive presentation of ADHD was demonstrated. Children experienced problems with daytime functioning in relation to their wetting problem at night. According to the teachers, a low maximum voided volume was associated with more attention problems, and a high number of nights with NP was associated with more behaviour-regulation problems. Although comorbidity is still the appropriate word to use, the observation favours a more complex pathogenesis of enuresis with a common pathway in the central nervous system, including: neurotransmitters, influencing neuropsychological functioning as well as sleep, circadian rhythm of diuresis and bladder function control.

Performance-related-pay in the UK public sector

Purpose – The purpose of this paper is to provide an up-to-date, comprehensive, independent and credible assessment of relevant academic and other literature since 2007, on the effectiveness and value for money of performance-related-pay (PRP) in the public sector. Design/methodology/approach – PRP was studied using both economics-based literature and literature from the organisational and management field (including human resources, management sociology and psychology). An initial search of databases identified 7,401 documents regarding PRP in the public sector, which was reduced to 57 final papers included in the study (27 in the health sector, 16 in the education sector and 16 in the civil service) after abstract and full paper screening. Findings – The review found some evidence that PRP schemes can be effective across the three domains of the public sector for which there was evidence available (health, education and the civil service), but findings within and between the sectors are mixed, with scheme effectiveness often dependent on scheme design and organisational context. Research limitations/implications – The research highlights the importance of considering both economics-based and organisational literature when discussing PRP in the public sector, and the implications for motivation and PRP design. Practical implications – The results indicated that the design of PRP schemes could influence their effectiveness and outcomes, and the research suggests how the challenges of designing and implementing PRP schemes can be overcome in the public sector. Social implications – The review highlights that when implementing PRP schemes there may be gender differences in their overall effectiveness (especially in education) and there must be consideration for how fairly the PRP scheme is perceived. Originality/value – The paper uses literature from economics and behavioural sciences when looking at the motivational implications for PRP in the public sector.

P210 Uptake and acceptance of combined HIV poct and STI screening for MSM in community settings during national HIV testing week

<h3>Background/introduction</h3> National HIV Testing Week (NHTW) aims to increase the earlier detection and treatment of HIV by increasing access to testing across community and statutory settings, with a focus on at risk populations including men who have sex with men (MSM). However there are increasing concerns about risky behaviour, including Chemsex, and an increase in other STIs in MSM. <h3>Aims/objectives</h3> To review the acceptance by MSM, of full sexually transmitted infection (STI) screening in a community setting, during NHTW. <h3>Methods</h3> We promoted NHTW using national and local material, shared across social media platforms aimed at MSM. In addition to HIV point of care testing (POCT) using a 4th generation test, we offered full STI screening (urine and self-taken pharyngeal/rectal swabs for chlamydia and gonorrhoea NAATs and syphilis POCT). Sexual histories were self-completed. <h3>Results</h3> 74 patients were screened; 56 identified as MSM; average age 33(17–75). Of these only 21(38%) reported consistent condom use for anal sex. 4(7%) reported Chemsex, with MCAT the commonest drug. 20(36%) had a past history of an STI. 42(75%) underwent full screening, 12(21%) POCT only (10 HIV and syphilis, 2 HIV), and 2(4%) for chlamydia and gonorrhoea only. There were 3 positive diagnoses: 1 HIV, 1 pharyngeal gonorrhoea and 1 rectal chlamydia. <h3>Discussion/conclusion</h3> NHTW has proven its effectiveness in increasing the uptake of HIV testing in at risk populations; we have shown that offering full sexual health screening as part of NHTW activity, using self-taken history and urine / non-invasive swabs, is acceptable and effective.

Clinical and molecular characterisation of 21 patients affected by quantitative fibrinogen deficiency.

Fibrinogen is a plasma glycoprotein mainly synthesised by hepatocytes and circulating as a 340-kDa hexamer consisting of two sets of three different polypeptide chains (Aα, Bβ, and γ, encoded by the FGA, FGB, and FGG gene, respectively). Congenital afibrinogenaemia and hypofibrinogenaemia are rare bleeding disorders characterised by abnormally low levels of functional and immunoreactive fibrinogen in plasma, associated with haemorrhagic manifestations of variable severity. While afibrinogenaemia is caused by mutations in the homozygous or compound heterozygous state in one of the three fibrinogen genes, hypofibrinogenaemia is generally due to heterozygous mutations, and is usually characterised by a milder phenotype. The mutational spectrum of these quantitative fibrinogen disorders includes large deletions, point mutations causing premature termination codons, and missense mutations often affecting fibrinogen assembly and/or secretion. Here we report the clinical and molecular characterisation of 13 unrelated afibrinogenaemic and eight hypofibrinogenaemic patients, leading to the identification of 17 different mutations (10 hitherto unknown). All the newly-identified missense and splicing mutations werein vitro expressed to verify their pathogenic role. Our data increase the number of mutations causing quantitative fibrinogen deficiencies by about 7 %. The high number of private mutations identified in the analysed probands indicates that the full mutational screening of the three fibrinogen genes is still required for molecular diagnosis.

P87 – 2840: Establishment of rare diagnoses is possible in countries with limited resources

Objective Globoid cell leukodystrophy is a rare autosomal recessive lysosomal storage disorder caused by the deficiency of galactocerebrosidase. Methods This report describes a case in which clinical and MRI picture lead to the direct diagnosis. Results 12 months old girl presented with loss of developmental milestones. Her development was not concerning until 4 months. Starting from that age she started to have difficulties in head control, lost emotional contact, later she started to have difficulties with swallowing and myoclonias. Examination revealed absence of head control, short fixation and eye tracking movements, spastic quadriparesis, startle myoclonic reflex to auditory stimuli, absence of TDRs from legs. NCS showed distal symmetrical demyelinating polyneuropathy. Brain MRI showed supratentorial and vermian atrophy, abnormal signal from PLIC, increased T2 signal from periventricular white matter (with sparing of subcortical U-fibers), enlargement of optic nerves and chiasm, bilateral areas of T2 hyperintensity in the dentate hilum and cerebellar white matter, hypointensity in the peridentate area. Brain CT scan was done for possible calcifications in basal ganglia (to exclude Aicardi-Goutieres syndrome), which surprisingly revealed communicating obstructive hydrocephalus. We went through the literature and found that the latter was also described in some cases of globoid cell leukodystrophy. Decreased galactocerebrosidase activity in leukocytes confirmed the diagnosis of Krabbe disease. Conclusion In developed countries this patient would undergo full metabolic screening to exclude most relevant possible diagnoses, but physicians in developing world are forced to put together clinical picture and other findings to reach to the most likely diagnosis, which is a very important step to narrow the list of differential diagnosis and costs of needed investigations.

Deep Squat Score Predicts Functional Movement Screen Performance

The Functional Movement Screen (FMS) assesses movement dysfunctions during seven tests to predict musculoskeletal injury risk in a variety of populations. Despite the potential benefits of injury risk screening, time constraints may prevent clinicians from administering tools like the FMS. Identifying one FMS component that can determine which patients should undergo full screening may reduce time constraints and allow more clinicians to administer this tool to assess injury risk. PURPOSE: To determine if performance on the deep squat predicts performance on the Functional Movement Screen. METHODS: 66 NCAA Division I athletes (1.76±0.14 m, 73.86±14.70 kg) performed the Functional Movement Screen. The deep squat test and FMS composite score, excluding the deep squat score, were dichotomized into high-risk and low-risk categories for analysis. Scoring a 0 or 1 on the deep squat and below a 12 on the FMS were considered high-risk. A binomial logistic regression was used to determine the odds ratio between deep squat risk category and FMS risk category. Alpha level was set a-priori at p <0.05. RESULTS: Logistic regression revealed an odds ratio of 3.56 (95% CI: 1.24,10.23, p=0.018). CONCLUSIONS: Performance on the deep squat test may accurately predict performance on the Functional Movement Screen. Specifically, the odds of having a high-risk FMS composite score are 3.56 times higher for individuals with high-risk deep squat scores. These findings indicate that using deep squat performance to identify individuals who should undergo full screening may be a viable method for assessing injury risk while reducing time constraints.

Prevalence of gonococcal conjunctivitis in adults and neonates.

To report the prevalence of gonococcal conjunctivitis (GC) presenting to a tertiary referral maternity hospital (NMH) and a tertiary referral ophthalmic hospital (RVEEH) from 2011 to 2013 and describe the demographics, clinical presentation, and antibiotic susceptibility of Neisseria gonorrhoeae ocular infections. Demographic, clinical, and microbiological data were collected from patients with laboratory confirmed GC. There were 27 556 live births at NMH during the study period, and no case of neonatal GC was identified. Fourteen cases of GC were identified at RVEEH in this period, representing a prevalence of 0.19 cases per 1000 eye emergency attendees. Antibiotic susceptibility data were available on nine cases, of which, all were ceftriaxone- and ciprofloxacin sensitive. 64.3% of patients were male, with a mean age of 18 years. The mean duration of symptoms was 3 days. All patients presented with unilateral conjunctival injection and purulent discharge. Eight cases had visual impairment at presentation and their mean visual acuity was 6/15. Corneal involvement was present in 25% of patients. Uveitis was not detected. On receipt of positive culture and/or PCR results, treatment was altered in two thirds of patients. All patients were referred for full STI screening and all patients showed a full clinical recovery 1 week posttreatment. We observed that GC presented in young adults with a male predominance and was rare in neonates. In cases of unilateral purulent conjunctivitis, there should be a high clinical suspicion of GC, early swab for PCR and culture, and knowledge of current CDC-recommended antibiotic guidelines.

Reduced Haemodynamic Response in the Ageing Visual Cortex Measured by Absolute fNIRS.

The effect of healthy ageing on visual cortical activation is still to be fully explored. This study aimed to elucidate whether the haemodynamic response (HDR) of the visual cortex altered as a result of ageing. Visually normal (healthy) participants were presented with a simple visual stimulus (reversing checkerboard). Full optometric screening was implemented to identify two age groups: younger adults (n = 12, mean age 21) and older adults (n = 13, mean age 71). Frequency-domain Multi-distance (FD-MD) functional Near-Infrared Spectroscopy (fNIRS) was used to measure absolute changes in oxygenated [HbO] and deoxygenated [HbR] haemoglobin concentrations in the occipital cortices. Utilising a slow event-related design, subjects viewed a full field reversing checkerboard with contrast and check size manipulations (15 and 30 minutes of arc, 50% and 100% contrast). Both groups showed the characteristic response of increased [HbO] and decreased [HbR] during stimulus presentation. However, older adults produced a more varied HDR and often had comparable levels of [HbO] and [HbR] during both stimulus presentation and baseline resting state. Younger adults had significantly greater concentrations of both [HbO] and [HbR] in every investigation regardless of the type of stimulus displayed (p<0.05). The average variance associated with this age-related effect for [HbO] was 88% and [HbR] 91%. Passive viewing of a visual stimulus, without any cognitive input, showed a marked age-related decline in the cortical HDR. Moreover, regardless of stimulus parameters such as check size, the HDR was characterised by age. In concurrence with present neuroimaging literature, we conclude that the visual HDR decreases as healthy ageing proceeds.

Chronic melioidosis causing an inguinal sinus in a Sri Lankan male

Introduction: Melioidosis is an emerging infection in South Asia. It has a spectrum of presentation causing many difficulties in early diagnosis and the control of infection. Here we report a rare case of melioidosis causing an inguinal sinus in a Sri Lankan male. Case presentation: This 54‐year‐old male had recurrent admissions to hospital with multiple acute infections including acute inguinal lymphadenitis, left lobar pneumonia and septic arthritis of the left knee joint. He was treated with short courses of antibiotics. Blood cultures revealed no bacterial growth. Ultrasound scan of the abdomen showed multiple loculated abscess formation typical of melioidosis. Repeat blood culture in selective Ashdown's medium was positive for the growth of Burkholderia pseudomallei. He was treated with ceftazidime and imipenem for 4 weeks but was lost to follow‐up before starting an eradication regimen. Later, he presented with a large left inguinal sinus and a draining sinus in the left thigh. Conclusion: Presence of multiple septic foci in this patient within a short span of time was due to discharge of bacilli into the bloodstream from the hidden infection in the spleen. This is a good example of an immune organ itself acting as a source of infection under suboptimal immune response. This case also highlights the importance of full screening and complete eradication of the infection at the initial diagnosis before establishment in relatively avascular tissues.

Protocol for a systematic review of screening tools for fear of recurrent illness in common life-threatening diseases.

BackgroundA myocardial infarction (MI) (‘heart attack’) can be intensely stressful, and the impact of this event can leave patients with clinically significant post-MI stress symptoms. Untreated stress can make heart disease worse. Few tools are available that screen for specific thoughts or beliefs that can trigger post-MI stress responses. In other life-threatening illnesses, fear of recurrence (FoR) of illness has been identified as a key stressor, and screening tools have been developed to identify this. The aim of this review is to identify FoR screening tools used in other common life-threatening diseases that report on the development of the tool, to assess if there are any that can be adapted for use in MI survivors so that those with high levels of FoR can be identified and helped.Methods/DesignThe review will evaluate full FoR screening tools and methods of measurement used in common life-threatening disease clinical populations. The Campbell and Cochrane Libraries, Cumulative Index of Nursing and Allied Health Literature (CINAHL), PsycINFO, MEDLINE, Embase, Applied Social Sciences Index and s (ASSIA), Published International Literature on Traumatic Stress (PILOTS), Social Services s, Sociological s, Web of Knowledge, Health and Psychosocial Instruments and SCOPUS databases will be searched for relevant studies published from database inception. Reference lists and published reviews/meta-analyses will also be searched. All titles and abstracts will be screened and relevant full-text versions retrieved by two reviewers, who will then extract all the data. Each will independently review all data extracted by the other. Selected studies will also be assessed by two independent researchers using the COnsensus-based standards for the Selection of health status measurement INstruments (COSMIN) checklist and other quality criteria. This will be done to evaluate the degree to which their measurement properties meet the standards for good methodological quality. Disagreement will be resolved through consensus.DiscussionUntreated post-MI stress has a considerable psychological and physical impact on MI survivors. Therefore, there is a critical need to develop a screening tool to identify fear of recurrent MI so that those affected can be identified and directed to appropriate support interventions. This proposed research will enable a tool to be developed and adapted for use in the MI survivor patient population.Systematic review registrationPROSPERO: CRD42014010500