Nonspecific Tests Research Articles

Evaluation of the Diesse Cube 30 touch erythrocyte sedimentation method in comparison with Alifax test 1 and the manual Westergren gold standard method

The erythrocyte sedimentation rate (ESR) is a traditional nonspecific laboratory test used for the assessment of inflammation. Even if its usefulness is nowadays being largely debated, it is still considered a valuable laboratory test in selected clinical conditions, such as rheumatoid diseases, orthopedic infections and Hodgkin’s lymphoma, and it can be used for the infectious, inflammatory, malignancies, and autoimmune diseases follow-up. The introduction of new methodologies on semi-automated and automated analyzers started about four decades ago and opened a new era of ESR analysis characterized by shorter assay time, use of (EDTA) undiluted blood, that increases sample stability and allows using a single sample for also other hematologic tests, and greater safety for laboratory personnel. In this context, the aim of this study was to evaluate the performances of new device Diesse Cube 30 touch, comparing it with Alifax Test 1 and with the gold standard Westergren method. The new Diesse Cube 30 touch for determination of the ESR shows a good correlation with the manual Westergren gold standard method in a shorter time, and in a standardized way, since all the phases of the test are automatized. The Diesse Cube 30 touch respect the manual gold standard method, displayed a small bias to confirm that the new automated test system tended to have a small bias for ESR values (mean positive bias +0.2 mm/h). The findings of the present study show that the Diesse Cube 30 touch Westergren-based method can be a valid alternative in laboratory analysis for the determination of ESR.

Non-specific blood tests as proxies for COVID-19 hospitalisation: are there plausible associations after excluding noisy predictors?

This study applied causal criteria in directed acyclic graphs for handling covariates in associations for prognosis of severe coronavirus disease 2019 (COVID-19) cases. To identify non-specific blood tests and risk factors as predictors of hospitalisation due to COVID-19, one has to exclude noisy predictors by comparing the concordance statistics (area under the curve - AUC) for positive and negative cases of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Predictors with significant AUC at negative stratum should be either controlled for their confounders or eliminated (when confounders are unavailable). Models were classified according to the difference of AUC between strata. The framework was applied to an open database with 5644 patients from Hospital Israelita Albert Einstein in Brazil with SARS-CoV-2 reverse transcription - polymerase chain reaction (RT-PCR) exam. C-reactive protein (CRP) was a noisy predictor: hospitalisation could have happened due to causes other than COVID-19 even when SARS-CoV-2 RT-PCR is positive and CRP is reactive, as most cases are asymptomatic to mild. Candidates of characteristic response from moderate-to-severe inflammation of COVID-19 were: combinations of eosinophils, monocytes and neutrophils, with age as risk factor; and creatinine, as risk factor, sharpens the odds ratio of the model with monocytes, neutrophils and age.

Unexplained recurrent pericardial effusion in a young adult male: Think beyond tuberculosis

Pericardial effusion is usually caused by infection, fluid overload states, connective tissue disorders, heart surgery, aortic dissection, and malignancy. When a patient presents with recurrent isolated pericardial effusion accompanied by a nonspecific history and negative laboratory tests, it can pose a diagnostic dilemma to the clinician. Primary malignant tumors of the pericardium are sporadic, and most primary malignant pericardial tumors are mesotheliomas. We report the case of a young adult male with recurrent pericardial effusion and no specific clinical clues enabling an early diagnosis, which later turned out to be caused by a primary angiosarcoma of the pericardium.

Pharmacognostic Study and Antioxidant Activity of Mundar (Garcinia forbesii King.) leaves from Banua Botanical Gardens of South Kalimantan

Mundar (Garcinia forbesii King.) is a plant from South Kalimantan. This plant has chemical contents that have potential as medicine. The purpose of this study is to provide a pharmacognostic picture of a specific, nonspecific and determine the antioxidant activity of G. forbesii leaves. Specific parameters include organoleptic, microscopic testing, thin-layer chromatography profiles, and phytochemical screening. Nonspecific parameters include total ash content, acid insoluble ash content, drying loss, water-soluble extract content, and ethanol-soluble extract content. Antioxidant activity was determined by the DPPH method based on IC50 values. Specific parameter test results are green powder, characteristic odor, and sour taste. Microscopic tests showed stomata, upper epidermis, lower epidermis, cell walls, xylem, phloem, palisade tissue, spongy tissue, and cuticles. Garcinia forbesii leaves contain alkaloids, flavonoids, phenols, tannins, and steroids. The TLC profile showed good separation of polar eluents, and yellow spots appeared after spraying DPPH reagents. The non-specific parameter test is the total ash content of 6.52�0.1%; acid insoluble ash content 1.06�0.08%; drying shrinkage 6.43�0.38%; water-soluble extracts 34.3�0.3%; and ethanol-soluble extracts 23.47�0.35%. Ethanol extract of G. forbesii leaves has antioxidant activity with IC50 of 65.7 ppm. Pharmacognostic study fulfills the requirements, and G. forbesii leaves extract has strong antioxidant activity.

Reliability of Throwing Velocity during Non-specific and Specific Handball Throwing Tests.

Throwing velocity is one of the most important factors for scoring goals in handball. This study aimed to identify the type of throw and procedure for selecting the final test outcome that provide throwing velocity with the greatest reliability. Fifteen experienced handball players and 33 non-experienced participants were tested in two sessions. Each session consisted of 4 trials of 3 different throwing tests (unspecific, 7-meters, and 3-steps). The maximum value of 4 trials, average value of 4 trials, and average value of the 3 best trials were considered. Throwing velocity was highly reliable (coefficient of variation [CV]≤3.3%, intraclass correlation coefficient≥0.89) with the exception of the unspecific throw for the non-experienced group (CV≥5.9%, intraclass correlation coefficient≤0.56). The 3-steps throw (CV=1.7%) was more reliable than the 7-meters throw (CV=2.1%) (CVratio=1.19) and unspecific throw (CV = 3.8%) (CVratio=2.18), the 3 procedures provided a comparable reliability (CV range=2.4-2.6%; CVratio≤1.07), and the experienced group (CV=1.0%) presented a higher reliability than the non-experienced group (CV=4.0%) (CVratio=3.83). These results support the 3-steps throw to maximise the reliability of throwing velocity performance.

Coagulation Testing in Acute Ischemic Stroke Patients Taking Non-Vitamin K Antagonist Oral Anticoagulants

Abstract Introduction/Objective In patients who present with acute ischemic stroke while on treatment with non-vitamin K antagonist oral anticoagulants (NOACs), coagulation testing is necessary to confirm the eligibility for thrombolytic therapy. We evaluated the current use of coagulation testing in routine clinical practice in patients who were on NOAC treatment at the time of acute ischemic stroke. Methods Prospective multicenter observational RASUNOA registry (Registry of Acute Stroke Under New Oral Anticoagulants). Results of locally performed nonspecific (international normalized ratio, activated partial thromboplastin time, and thrombin time) and specific (antifactor Xa tests, hemoclot assay) coagulation tests were documented. The implications of test results for thrombolysis decision-making were explored. Results In the 290 patients enrolled, nonspecific coagulation tests were performed in ≥95% and specific coagulation tests in 26.9% of patients. Normal values of activated partial thromboplastin time and international normalized ratio did not reliably rule out peak drug levels at the time of the diagnostic tests (false-negative rates 11%-44% [95% confidence interval 1%-69%]). Twelve percent of patients apparently failed to take the prescribed NOAC prior to the acute event. Only 5.7% (9/159) of patients in the 4.5-hour time window received thrombolysis, and NOAC treatment was documented as main reason for not administering thrombolysis in 52.7% (79/150) of patients. Conclusion NOAC treatment currently poses a significant barrier to thrombolysis in ischemic stroke. Because nonspecific coagulation test results within normal range have a high false-negative rate for detection of relevant drug concentrations, rapid drug-specific tests for thrombolysis decision-making should be established.

PULMONARY MUCORMYCOSIS: A RARE CAUSE OF HYDROPNEUMOTHORAX

SESSION TITLE: Medical Student/Resident Chest Infections Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Mucormycosis is a rare but often fatal fungal infection. These fungi are ubiquitous in nature and most commonly cause rhino-orbital-cerebral infections. Patients who are immunocompromised are at higher risk (1). CASE PRESENTATION: A 76 year-old never-smoker with a medical history significant for type 2 diabetes (HbA1c 5.8%) and Coombs negative hemolytic anemia was admitted with 3 months of progressive dyspnea. She had an associated nonproductive cough for 10 days. She denied fevers, night sweats, chest pain or hemoptysis. Two months prior to presentation, she started prednisone 60 mg daily for hemolytic anemia. Prednisone was slowly tapered to 30 mg daily at the time of presentation. She received one dose of Rituximab due to persistent anemia. Evaluation 2 weeks prior to presentation revealed a right upper lobe, 5 cm cavitary lesion on chest CT. On arrival she was tachycardic (heart rate 110) and tachypneic (respiratory rate 32) without hypoxemia. Labs were notable for a hemoglobin of 9.5 g/dl, WBC of 13.6, and creatinine of 1.85 mg/dl. Chest x-ray showed a loculated right hydropneumothorax. Chest CT showed the right hydropneumothorax with progression of the right upper lobe cavitary lesion. A 14 French pigtail catheter was placed at bedside via ultrasound guidance. Pleural studies demonstrated exudative fluid with negative cytology and cultures. She underwent CT-guided biopsy of the cavitary lesion, which revealed inflammation, necrosis, and numerous broad-ribbon-like, pauci-septate hyphae favoring mucormycosis. IV liposomal amphotericin and posaconazole were initiated. Thoracic surgery declined operative intervention due to her age and comorbidities. She developed respiratory and renal failure and passed away 1 month after presentation. DISCUSSION: This patient developed pulmonary mucormycosis in the setting of glucocorticoid and Rituximab therapy. The diagnosis of mucormycosis can be difficult due to nonspecific symptoms (1) and lack of serologic tests. Commonly used fungal antigen tests such as 1,3-beta-D-glucan are traditionally negative (2). Chest CT findings are nonspecific with the classic halo or reversed halo sign present in only a minority of cases (1). A definitive diagnosis is made with histopathology (1). Successful treatment requires early diagnosis, reversal of predisposing factors, surgical debridement, and prompt initiation of antifungal therapy (3). Liposomal amphotericin is first-line pharmacologic therapy (1); however, antifungal therapy without surgical debridement is unlikely to be successful. CONCLUSIONS: Our patient presented with an unusual case of pulmonary mucormycosis; a high suspicion and histopathology are required to make the diagnosis. CT findings are non-specific and common fungal antigen tests can be negative. Early diagnosis and prompt initiation of antifungal therapy with surgical debridement improves the chance for survival. Reference #1: Farmakiotis D, Kontoyiannis DP. Mucormycoses. Infect Dis Clin North Am 2016; 30:143. Reference #2: Ostrosky-Zeichner L, Alexander BD, Kett DH, et al. Multicenter clinical evaluation of the (1-->3) beta-D-glucan assay as an aid to diagnosis of fungal infections in humans. Clin Infect Dis 2005; 41:654. Reference #3: Spellberg B, Walsh TJ, Kontoyiannis DP, et al. Recent advances in the management of mucormycosis: from bench to bedside. Clin Infect Dis 2009; 48:1743. DISCLOSURES: No relevant relationships by Meghan Hill, source=Web Response author/editior relationship with UpToDate Please note: $5001 - $20000 Added 04/01/2020 by David Midthun, source=Web Response, value=Royalty No relevant relationships by Kelly Pennington, source=Web Response

The effect of tranexamic acid on the values of activated clotting time in patients undergoing cardiac surgery: A PRISMA-compliant systematic review and meta-analysis

Study objectiveActivated clotting time (ACT) is a non-specific test to evaluate the adequacy of systemic heparinization whose value could be influenced by many factors. Tranexamic acid (TXA) is a widely used antifibrinolytic agent worldwide and whether TXA influences ACT value in cardiac surgical patients remains unknown. Current study was performed to address this question. DesignSystematic review and meta-analysis. PUBMED, Cochrane Library, EMBASE, OVID and Chinese BioMedical Literature & Retrieval System were searched using search terms “tranexamic acid”, “activated clotting time”, “cardiac surgery”, “randomized controlled trial” till May 7th, 2020, to identify all relevant randomized controlled trials (RCTs). SettingOperating room. PatientsCardiac surgical patients. InterventionsTXA or placebo. MeasurementsPrimary outcomes of interest included peri-operative ACT values. Secondary outcomes of interest include heparin dosage, protamine dosage, postoperative bleeding and blood transfusion. Main resultsSearch yielded 13 studies including 1168 patients, and 619 patients were allocated into Group TXA and 549 into Group Control (placebo). Meta-analysis suggested that, ACT values after heparinization [(WMD = −1.45; 95%CI: −12.52 to 15.43; P = 0.84)] and after protamine [(WMD = −1.18; 95%CI: −2.81 to 0.46; P = 0.16)] were comparable between Group TXA and Group Control, and that TXA did not influence heparin dose in adult patients [(WMD = 0.38; 95%CI: 0.30 to 0.46; P<0.00001) with no heterogeneity (I2 = 4%, P = 0.35)] and protamine dose for heparin reversal [(WMD = 5.23; 95%CI: −0.33 to 10.80; P = 0.07) with no heterogeneity (I2 = 0, P = 0.58)]. Meta-analysis also demonstrated that, TXA administration significantly reduced post-operative bleeding volume [(WMD = −126.33; 95%CI: −177.46 to −75.19; P < 0.0001), post-operative red blood cell (RBC) transfusion volume [(WMD = −71.86; 95% CI: −88.22 to −55.50; P < 0.00001), fresh frozen plasma (FFP) transfusion volume [(WMD = −13.83; 95% CI: −23.67 to −4.00; P = 0.006) and platelet concentrate (PC) transfusion volume [(WMD = −0.20; 95% CI: −0.29 to −0.10; P < 0.0001). ConclusionThis meta-analysis suggested that, TXA administration did not influence ACT value, heparin and protamine doses, but significantly reduced post-operative blood loss and transfusion requirement in cardiac surgical patients.

Growth hormone and periarticular new bone formation--a causal relationship? A preliminary communication

In an attempt to examine the relationship between growth hormone (GH) and periarticular new bone formation (PNBF), we studied eight patients with brain lesions of different origins who were in a prolonged comatose state for 164 to 1320 days. Five of them developed PNBF. The latter reacted to both the specific L-Dopa test and to the non-specific TRH test with an increase in GH serum concentration. Those patients who did not develop PNBF, failed to react significantly to either tests. The difference in GH values between the two groups is statistically significant at the 95% level of confidence. We hypothesize that there may be a causal relationship between high concentrations of GH in serum and PNBF.

Horses for courses? Assessing the potential value of a surrogate, point-of-care test for SARS-CoV-2 epidemic control.

Point‐of‐care tests (POCTs) offer considerable potential for improving clinical and public health management of COVID‐19 by providing timely information to guide decision‐making, but data on real‐world performance are in short supply. Besides SARS‐CoV‐2‐specific tests, there is growing interest in the role of surrogate (non‐specific) tests such as FebriDx, a biochemical POCT which can be used to distinguish viral from bacterial infection in patients with influenza‐like illnesses. This short report assesses what is currently known about FebriDx performance across settings and populations by comparison with some of the more intensively evaluated SARS‐CoV‐2‐specific POCTs. While FebriDx shows some potential in supporting triage for early‐stage infection in acute care settings, this is dependent on SARS‐CoV‐2 being the most likely cause for influenza‐like illnesses, with reduction in discriminatory power when COVID‐19 case numbers are low, and when co‐circulating viral respiratory infections become more prevalent during the autumn and winter. Too little is currently known about its performance in primary care and the community to support use in these contexts, and further evaluation is needed. Reliable SARS CoV2‐specific POCTs—when they become available—are likely to rapidly overtake surrogates as the preferred option given the greater specificity they provide.

Occupational allergy to methacrylates: a deadly risk in workplace

Allergic contact dermatitis (ACD) caused by (meth) acrylates (MA) is common in exposed persons. Moreover, Exposure to MA may rise the predisposition to rhinitis and asthma. However, the occurrence of both asthma and ACD due to MA in the same patient seems to be exceptional. Aim: Report a case of a complex allergy to MA in workplace and stress the difficulty of professional reclassification. A 36-year-old female worker in an electric factory presented to the department of occupational medicine for rhino conjunctivitis, asthma and ACD. Symptoms of weezing dyspnea, rhino conjunctivitis and ACD appeared a few months after recruitment and followed a professional rythmicity (improved during vacation time and aggravated when return to work). The patient’s occupational history revealed that she used a glue containing Hydroxy ethyl methacrylates. Asthma was diagnosed by spirometry, a reversibility test was positive (the FEV1 went up by 12% and 250 ml), nonspecific inhalation challenge test to methacholin was not performed because of a recent history of inadequately controlled asthma. Exhaled NO revealed bronchial inflammation and eosinophilia. The skin-prick test reactions to common environmental allergens and MA were negative. On patch testing, positive reactions were found to several MA including dimethacrylates ethyglycol (++) and mainly the 2-hydroxyethylmethacrylate (2-HEMA) (++). Diagnosis of occupational asthma, rhino conjunctivitis, and ACD to MA was retained. A professional reclassification prohibiting handling all products containing MA was indicated. While resumption of work, the patient presented two episodes of severe acute asthma with hospitalization in intensive care unit and use of endotracheal intubation. Investigation concluded that effective avoidance of use and exposure to glue was not insured imposing a long work stoppage (3 years). Yet, the patient has suffered from a non-controlled severe asthma. To the best of the authors' knowledge, nowadays, there is only one previous reported case of a dentist with both occupational skin and respiratory hypersensitivity from MAs. The case we reported revealed a serious case of occupational asthma, rhino conjunctivitis and ACD caused by MA and threatening the patient's life. Patients with allergy to MA should stop handling it but in practice, professional reclassification finds its limit in severe immediate hypersensitivity forms.

Prognostic value of endogenous and exogenous metabolites in liver transplantation.

Liver transplantation has been widely accepted as an effective intervention for end-stage liver diseases and early hepatocellular carcinomas. However, a variety of postoperative complications and adverse reactions have baffled medical staff and patients. Currently, transplantation monitoring relies primarily on nonspecific biochemical tests, whereas diagnosis of multiple complications depends on invasive pathological examination. Therefore, a noninvasive monitoring method with high selectivity and specificity is desperately needed. This review summarized the potential of endogenous small-molecule metabolites as biomarkers for assessing graft function, ischemia-reperfusion injury and liver rejection. Exogenous metabolites, mainly those immunosuppressive agents with high intra- and inter-individual variability, were also discussed for transplantation monitoring.

Multiplex Tests for Respiratory Tract Infections: The Direct Utility of the FilmArray Respiratory Panel in Emergency Department.

Background The FilmArray Respiratory Panel with multiplex targets for respiratory pathogens has been widely used and verified in clinical trials in special test settings. However, it is necessary to evaluate the panel's performance at the point of care directly, in nonspecific test settings. Methods Patients with respiratory tract infections were enrolled from among emergency department visitors, and all steps, including the collection of specimens and testing, were performed by our clinicians. Results Among 270 patients, 196 (72.6%) patients were found to have one or more pathogens. For signal pathogen detection, influenza A virus had the highest rate of detection; 45 (16.7%) of the patients had two or more respiratory pathogens codetected, and most of the multiplex pathogens were rhinovirus/enterovirus codetected with Bordetella pertussis (17.8%). The information provided by the FilmArray had an impact on the prescription of antimicrobials, and there were differences in the rates of antibiotic prescriptions and anti-influenza prescriptions among patients. Conclusions Use of the FilmArray by clinical staff was successfully implemented in the emergency department for the first time in China. The FilmArray has the potential for point-of-care testing in nonspecific settings.

Role of erythrocyte sedimentation rate and C-reactive protein as a predictor of severity of cellulitis and necrotising fasciitis

Background: Skin infections are major cause of morbidity and mortality worldwide, affecting more than one person/1000 person/year. Sepsis has a worldwide incidence of more than 20 million cases a year, with mortality due to septic shock reaching up to 50% even in industrialized countries. Acute phase reactants like erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) have been used traditionally as markers for inflammation and are readily available in most centres. Aim was to study the correlation between the values of ESR and CRP with severity of cellulitis and necrotising fasciitis (in term of hospital stay and disease outcome).Methods: This was a prospective observational study conducted at Department of Surgery, GMC and Hamidia Hospital, Bhopal from a period of March 2016 to August 2018.Results: Skin and soft tissue infections are most commonly affects male, diabetes mellitus most common co-morbid condition. Mean value of ESR and CRP in patients who could not survived was 64.44 and 145.92 respectively and value more than 54.95 and 93.41 requires longer hospital stay.Conclusions: ESR and CRP are non-specific test but they are good predictors of severity of cellulitis and necrotising fasciitis not only in planning of management of these cases but also predicting outcome of the disease.

Diagnostic Accuracy of Physical Examination Tests in Core Muscle Injury

Background: Core muscle injury (CMI), often referred to as a sports hernia, is a common cause of groin pain in athletes characterized by concomitant injury to the insertion of the adductor longus and the rectus abdominis muscles. Currently, the literature on CMI is sparse with no standardized physical examination tests used in the diagnosis of this type of injury. Purpose: To determine the diagnostic accuracy of various physical examination tests in the diagnosis of CMI. Study Design: Cohort study (Diagnosis); Level of evidence, 3. Methods: A consecutive series of patients evaluated by the senior author with symptoms consistent with CMI were included. Four physical examination tests were routinely performed in these patients by the senior author and were noted in each patient’s chart as positive or negative: (1) pain with resisted cross-body sit-up in figure-of-4 position, (2) pain with straight-leg sit-up, (3) pain with resisted hip flexion in external rotation (external rotation Stinchfield test), and (4) the presence of an adductor contracture. CMI was independently diagnosed by a reference standard (magnetic resonance imaging [MRI]). All MRI scans were read by a musculoskeletal fellowship-trained radiologist. The sensitivity and specificity of each physical examination test alone and in combination were calculated based on this reference standard. Results: A total of 81 patients were included in this study. MRI was positive for a CMI in 39 patients (48%) overall. Both the cross-body sit-up test and the presence of an adductor contracture were found to have a sensitivity of 100% (specificity, 3% for both). The external rotation Stinchfield test was found to have the highest specificity of 60% (sensitivity, 15%). The sensitivity of all 4 physical examination tests in combination was found to be 100% (specificity, 0%). Conclusion: Certain physical examination maneuvers can be used to assist in the diagnosis of a CMI. The cross-body sit-up test and the presence of an adductor contracture are highly sensitive but nonspecific tests for CMI and therefore should be used in conjunction with diagnostic imaging before deciding on an appropriate treatment course.

Rickettsial Infections: A Clinician’s Diagnostic Dilemma

Rickettsial diseases are arthropod borne zoonotic infections that are being increasingly recognized as one of the causes of pyrexia of unknown origin (PUO). These pathogens are gram-negative bacteria causing fever and rash, usually transmitted to humans by tick or flea bite. These infections must be differentiated from other febrile illnesses such as enteric fever, malaria, dengue, leptospirosis, and infectious mononucleosis. The common clinical presentation includes fever with chills and rigor, headache, vomiting, cough, conjunctival congestion and eschar. Presenting with varied and non-specific symptoms, ignorance, and low index of suspicion, they are often under-diagnosed due to the unavailability of the reliable diagnostic test. Weil- Felix test (WFT) is a non-specific heterophile tube agglutination test in which antibodies against rickettsiae are detected. If timely treatment with doxycycline is instituted the adverse consequences can be well averted.

The Use of a Virtual Reality Platform for the Assessment of the Memory Decline and the Hippocampal Neural Injury in Subjects with Mild Cognitive Impairment: The Validity of Smart Aging Serious Game (SASG).

Due to the lack of pharmacological treatment for dementia, timely detection of subjects at risk can be of seminal importance for preemptive rehabilitation interventions. The aim of the study was to determine the usability of the smart aging serious game (SASG), a virtual reality platform, in assessing the cognitive profile of an amnestic mild cognitive impairment (aMCI) population, its validity in discriminating aMCI from healthy controls (HC), and in detecting hippocampal degeneration, a biomarker of clinical progression towards dementia. Thirty-six aMCI and 107 HC subjects were recruited and administered the SASG together with a neuropsychological evaluation. All aMCI and 30 HC subjects performed also an MRI for hippocampal volume measurement. Results showed good usability of the SASG despite the low familiarity with technology in both groups. ROC curve analyses showed similar discriminating abilities for SASG and gold standard tests, and a greater discrimination ability compared to non-specific neuropsychological tests. Finally, linear regression analysis revealed that the SASG outperformed the Montreal cognitive assessment test (MoCA) in the ability to detect neuronal degeneration in the hippocampus on the right side. These data show that SASG is an ecological task, that can be considered a digital biomarker providing objective and clinically meaningful data about the cognitive profile of aMCI subjects.

A166 ANALYSIS OF SYMPTOMS, DIAGNOSTIC PATTERNS, AND CANADIAN PROVIDER PERSPECTIVE OF ACUTE HEPATIC PORPHYRIA

Abstract Background Acute hepatic porphyria (AHP) is a family of rare genetic diseases, the most common being acute intermittent porphyria (AIP). AHP results from enzyme deficiencies involved in haem synthesis, leading to accumulation of neurotoxic haem intermediates, aminolaevulinic acid (ALA) and porphobilinogen (PBG), causing potentially life-threatening attacks and chronic symptoms. Patients afflicted by AHP often remain without a proper diagnosis for up to 15 years due to lack of awareness and testing. First-line diagnostic biochemical tests include measuring spot urinary ALA and PBG as both are elevated in the majority of AHP patients. Aims The study aimed to describe physicians experience diagnosing AHP and characterize patients globally, including Canada. Methods Physicians (n=175) who actively managed AHP patients (with and without recurrent attacks) in the preceding year were recruited from 9/2017–10/2017 to complete an online survey collecting information on demographics, familiarity with AHP and diagnostic tests, perspective on symptoms important to diagnosis, referral patterns, and treatment preferences. Physicians also completed a chart review of 546 patients and reported anonymized data on demographics, medical history, attacks, and symptoms. Data was analysed using descriptive statistics. Results Canadian physicians (n=15) practiced a mean of 19.7 years, 67% worked in community settings, and 53% were gastroenterologists. Symptoms informing AHP diagnosis included fatigue (93%), sensory loss (87%), mental confusion (87%), Abdominal pain (80%), red/dark urine (80%), vomiting (73%). AHP diagnostic tests considered informative for diagnosis included urinary ALA (87%) and PBG (80%); however, several non-specific tests were also commonly considered informative of AHP. Chronic symptoms reported included fatigue (75%), nausea/vomiting (70%), weakness (66%), pain (58%), anxiety (54%), diarrhea (41%), constipation (40%). Canadian physicians reported a mean of 58% AHP patients they manage being initially misdiagnosed. Global patients (n=546) were aged 40 years (mean), female (52%), with AIP (83%). Canadian patients (n=38) were aged 41 years (mean), female (61%), with AIP (78%). Patients had mean of 3.4 attacks and 1.6 hospitalizations in the past year. Conclusions This study highlights the challenges diagnosing AHP due to non-specificity of symptoms and limited understanding of diagnostic procedures. Due to the frequent presentation of gastrointestinal symptoms, AHP should be included in gastroenterologists’ differential diagnosis of patients presenting with non-specific abdominal pain. Among patients diagnosed with AHP, both acute attacks and chronic symptoms were reported, implicating both in the disease. Funding Agencies Alnylam Pharmaceuticals

Standardization of a Crude Drug Moringa oleifera Leaf from Africa, India and Local (Indonesian) which Cultivated in Bojonegoro Indonesia

Purpose: The research was to determine specific parameters (macroscopy and microscopy) and non-specific parameters (loss on drying, total ash content, acid insoluble ash content, water-soluble extractive matter, ethanol-soluble extractive matter), heavy metal contaminant (Pb, Hg, As, Cu) and microbial contaminant (Total Plate Count and Total Yeast Mold). Research also determined a total flavonoid of M. oleifera leaf. Methodology: The method carried out according to the procedure stated in the Materia Medika Indonesia 5 th edition. Methods to detection Contaminants were referred to WHO guidelines for assessing the quality of herbal medicines. The determination of total flavonoid was performed by spectroscopic method. Results: Crude drug of M. oleifera leaf meet the specific parameters (macroscopy and microscopy). Nonspecific parameters of Africa, India, Local M. oleifera leaf shows that loss on drying (8.06 ± 0.03; 8.89 ± 0.31; 7.56 ± 0.17) %, total ash content (8.64 ± 0.43; 10.64 ± 0.90; 15.31 ± 0.87) %, acid insoluble ash content (0.56 ± 0.08; 0.35 ± 0.01; 0.36 ± 0.06)%, water-soluble extractive matter (21.38 ± 1.39; 30.12 ± 2.06; 12.68 ± 1.12) %, ethanol-soluble extractive matter (39.37 ± 1.51; 27.74 ± 2.44; 27.09 ± 1.43)%, contaminant test including heavy metal contaminant shows that Pb, Cd, As and Hg were not to be detected. Microbial contaminant (Total Plate Count and Total Yeast Mold) under limits of WHO standart. Total flavonoid content of Africa, India, Local M. oleifera leaf were 8.12 ± 0.52 mg/ 100 mg QE; 10.69 ± 0.15 mg/ 100 mg QE dan 13.08 ± 0.08 mg/ 100 mg QE respectively. Conclusion: Moringa Leaves meet specific parameters (macroscopy and microscopy test). Non-specific parameter tests of Africa, India, Local Moringa Leaf shows that loss on drying, acid insoluble ash content, water-soluble extractive matter, ethanol-soluble extractive matter, contaminant test including heavy metal contaminant shows that (Pb, Cd, As and Hg) and microbial contaminant (Total Plate Count and Total Yeast Mold) meet the standard required, only total ash content did not meet the standard. Total Flavonoid content shows that the extract of M. oleifera from local (Indonesia) variety is higher than others. Keyword: M. oleifera leaf, Standardization, Crude Drug

Molecular confirmation & characterization of Rickettsia conorii in north India: A report of three cases.

Background & objectives:In India, spotted fever group rickettsiae (SFGR) are an underdiagnosed cause of acute febrile illness (AFI). The non-specific Weil-Felix test is the first diagnostic modality for the diagnosis of SFGR in many laboratories due to the lack of advanced diagnostic facilities in developing countries. The aim of this study was to detect SFGR using molecular methods in the patients, presenting with AFI in a tertiary care centre in north India.Methods:Consecutive patients (>14 yr of age) with AFI were enrolled over a six month period. Standard investigations for common pathogens causing AFI in India (malaria, dengue, scrub typhus, leptospirosis and enteric fever) were carried out. In patients who were negative for all of the above investigations, blood was subjected to polymerase chain reaction (PCR) targeting outer membrane protein A (ompA) gene of Rickettsia.Results:Of the 51 patients with an undiagnosed aetiology, three were positive by ompA PCR. Two of the PCR products produced good sequences and BLAST identification confirmed them as Rickettsia conorii. The sequences of R. conorii reported from south India clustered with two previously reported novel rickettsial genotypes. The study sequences clustered in a group different from that of Rickettsia spp. of the south Indian sequences reported earlier.Interpretation & conclusions:This study showed the existence of R. conorii in north India. Testing for SFGR may be included in the diagnostic workup of AFI for better disease management.