Rapid Bedside Test Research Articles

Study for the Significance of Ascetic Fluid Lactoferrin in Diagnosis of Spontaneous Bacterial Peritonitis in Decompensated Liver Cirrhosis

Abstract Background Cirrhosis represents the inal common histological pathway for a wide variety of chronic liver diseases. Occurrence of ascites is the most common presentation of liver cirrhosis. Spontaneous bacterial peritonitis (SBP) is observed in 15–26% of patients hospitalized with ascites. SBP is deined as the infection of AF in the absence of a contiguous source of infection and/or an intra-abdominal inlammatory focus. An AF-polymorphonuclear (PMN) leukocyte count more than or equal to 250/mm irrespective of the AF culture result is universally accepted nowadays as the best surrogate marker for diagnosing SBP. Frequently, the results of the manual or automated PMN count do not reach the hands of the responsible medical personnel in a timely manner. Aim of the Work to use AF lactoferrin for the diagnosis of SBP and to identify a clinically useful marker that can be used for future development of an important clinical, economic, and time saving rapid bedside test for the diagnosis of SBP in cirrhotic ascites. Patients and Methods This study was conducted on 60 patients with decompensated chronic liver disease and ascites with and without spontaneous bacterial peritonitis admitted to Gastroenterology and Hepatology department inpatient and outpatient clinics at Ain Shams University Hospitals and labs, from April 2023 to September 2023. Results Females were affected more than males by SBP, SBP has higher incidence in elderly compared to control group No significant difference between studied groups regards to risk factors and Child class (p > 0.05). HCV infection was the main etiology of liver cirrhosis in both groups while HBV infection was much less common with no significant difference between studied groups (p > 0.05). Patients in SBP group showed positive reaction to CRP compared to control group with significant difference between them (p < 0.05). No statistical significant differences between studied groups regards to abdominal ultrasonographic indings (p > 0.05). Liver enzymes (ALT and AST) were higher in SBP patients compared to non SBP patients with signiicant difference between them (P < 0.05). SBP patients have higher TLC and lower MCV and platelets count compared to non SBP patients with signiicant difference between them (P < 0.05). No statistical signiicant difference between studied groups regards to INR, Hb and MCH values (p > 0.05). Conclusion Outcomes of our study provide evidence of the clinical usefulness of AF lactoferrin levels in patients with cirrhosis to differentiate those with and without SBP. It is important to note that the correlation of lactoferrin levels and inlammatory markers in blood samples and AF could be inluenced by lysis of PMN cells during transport to the laboratory, which could lead to a false negative result. Moreover, manual measurement of the AF and PMN count is operator dependent, which makes quality control difficult. Commercially available kits for the measurement ascetic luid lactoferrin could be used in a future development of qualitative bedside assay.

IPad-Based Neurocognitive Testing (ImPACT-QT) in Acute Adult Mild Traumatic Brain Injury/Concussion: Study on Practicality and Bedside Cognitive Scores in a Level-1 Trauma Center.

There lacks rapid standardized bedside testing to screen cognitive deficits following mild traumatic brain injury (mTBI). Immediate Post-Concussion Assessment & Cognitive Testing-Quick Test (ImPACT-QT) is an abbreviated-iPad form of computerized cognitive testing. The aim of this study is to test ImPACT-QT utility in inpatient settings. We hypothesize ImPACT-QT is feasible in the acute trauma setting. Trauma patients ages 12-70 were administered ImPACT-QT (09/2022-09/2023). Encephalopathic/medically unstable patients were excluded. Mild traumatic brain injury was defined as documented-head trauma with loss-of-consciousness <30 minutes and arrival Glasgow Coma Scale 13-15. Patients answered Likert-scale surveys. Bivariate analyses compared demographics, attention, motor speed, and memory scores between mTBI and non-TBI controls. Multivariable logistic regression assessed memory score as a predictor of mTBI diagnosis. Of 233 patients evaluated (36 years [IQR 23-50], 71% [166/233] female), 179 (76%) were mTBI patients. For all patients, mean test-time was 9.3 ± 2 minutes with 93% (73/76) finding the test "easy to understand." Mild traumatic brain injury patients than non-TBI control had lower memory scores (25 [IQR 7-100] vs 43 [26-100], P = .001) while attention (5 [1-23] vs 11 [1-32]) and motor score (14 [3-28] vs 13 [4-32]) showed no significant differences. Multivariable-regression (adjustment: age, sex, race, education level, ISS, and time to test) demonstrated memory score predicted mTBI positive status (OR .96, CI .94-.98, P = .004). Immediate Post-Concussion Assessment & Cognitive Testing-Quick Test is feasible in trauma patients. Preliminary findings suggest acute mTBIs have lower memory but not attention/motor scores vs non-TBI trauma controls.

A-377 The Selection and Implementation of POC Illicit Drug Toxicology Testing in Hamad Medical Corporation - Doha, Qatar

Abstract Background In 2013, Qatar launched the National Mental Health Strategy which is further supported by National Health Strategy 2018–2022 and Qatar National Vision 2030, where the mental health has been identified as a priority area of development. In doing so, the Ministry of Public Health worked closely with the Ministry of Interior in providing the appropriate treatment rehabilitation. With all considerable advantages of point-of-care testing (POCT) in rapid diagnosis, POC toxicological test has been implemented and used in screening of patients for drugs of abuse. In this study, we highlighted the challenges in selection and implementation process of POC toxicological test in Hamad Medical Corporation (HMC). Methods Due to unavailability of all required drug panels, it had to be customized and tested for the verification purpose before starting the evaluation process. Maintaining HMC procurements regulations and Clinical Laboratory Improvement Amendments (CLIA) and College of American Pathologist (CAP) standards for POC toxicology tests, two POC illicit drug toxicology screening tests has been evaluated, comparison study has been performed against the HMC central laboratory. POCT team conducted training session ensuring the appropriate practice in place. The Extendable Laboratory Information System (LIS) functionality has been utilized for seamless data management and reporting for the automated analyzer. Results QUIDEL triage meter pro is an automated drug testing analyzer which detects Amphetamines, Barbiturates, Benzodiazepines, Cannabinoids, Methadone Metabolite, Methamphetamine, Opiates, Tricyclic and Cocaine Metabolites, while the customized manual testing kit FASTEP detects Tramadol (TRA), Methylenedioxymeth-amphetamine (MDMA), Phencyclidine (PCP), Buprenorphine (BUP), Oxycodone (OXY), Fentanyl (FYL), Ethyl Glucuronide (EtG), Cotinine (COT), Pregabalin (PGB) and Gamma Hydroxybutyrate (GHB). Both analytical performances were verified. Rapid bedside testing performed for more than 100 patients in last 8 months during admission, observation, and pre- discharge process. There is An Obvious improvement observed in testing turnaround time compared to the laboratory, easy results interpretation and reporting as well as cost-effective. Conclusion The implementation of POC illicit drug toxicology testing in HMC aligned with core pillars of the Qatar vision 2030 to deliver the right treatment at the right time and place. Its enhancing patient outcomes and overall Satellite health care sector in Qatar.

A Bedside Test to Detect the Presence of Embryonic or Fetal Tissue in Vaginal Blood.

To evaluate a rapid bedside test that detects alpha-fetoprotein (AFP) and insulin-like growth factor-binding protein 1 (IGFBP-1) to identify the presence of embryonic or fetal tissue in vaginal blood. This was a prospective cohort study. Reproductive-aged individuals were recruited into three groups: a negative control group consisting of nonpregnant individuals undergoing dilation and curettage (D&C) or experiencing vaginal bleeding; a positive control group of individuals with confirmed intrauterine pregnancy undergoing D&C; and the study group of pregnant individuals with first-trimester bleeding. Lateral flow immunoassay strips capable of detecting both AFP and IGFBP-1 were used to test vaginal blood for the presence of embryonic or fetal tissue. Ninety individuals were recruited: 31 in the positive control group, 23 in the negative control group, and 36 in the study group, including 12 individuals with ectopic pregnancies, 16 with active miscarriages, four with threatened miscarriages, and four with complete miscarriages. Vaginal blood from 14 of the 16 individuals with active miscarriages was correctly positive for embryonic or fetal tissue. Vaginal blood from all individuals with ectopic pregnancies, threatened miscarriages, and complete miscarriages was negative for embryonic or fetal tissue. Overall, 45 of 47 individuals with confirmed embryonic or fetal tissue in vaginal blood correctly tested positive using the test strips, a test sensitivity of 95.7% (95% CI 85.5-99.5%). Of the 43 individuals with confirmed absence of embryonic or fetal tissue in their vaginal blood, 42 were correctly negative, a test specificity of 97.7% (95% CI 87.7-99.9%). A rapid test strip detecting both AFP and IGFBP-1 can accurately identify the presence of embryonic or fetal tissue in vaginal blood. When positive, this could aid in diagnosing miscarriage and ruling out ectopic pregnancy at the bedside.

Reduction of intrapartum antibiotic prophylaxis by combining risk factor assessment with a rapid bedside intrapartum polymerase chain reaction testing for group B streptococci

ObjectiveTo investigate the impact of administering Intrapartum Antibiotic Prophylaxis (IAP) to laboring women with one or more risk factors for Early Onset Group B Streptococcal neonatal infection (EOGBS) based on the result of a rapid bedside test for Group B Streptococci (GBS). Study designQuality assessment study. MethodsThree-hundred-sixty-six laboring women admitted to our maternity ward, with one or more risk factors for EOGBS, were prospectively included. Rectovaginal swab-samples were examined bedside by the GenomEra® GBS Polymerase Chain Reaction (PCR) assay upon admission. Time from administration of IAP to delivery was registered. According to national guidelines, one-hundred-two women mandatorily received IAP independent of the PCR test result fulfilling one of the following three risk factors: prior infant with EOGBS, preterm labor before 35 gestational week, temperature ≥ 38 °C during labor. Women with GBS bacteriuria during current pregnancy, rupture of membranes ≥ 18 h IAP, and preterm labor between 35 and 37 gestational week, received IAP solely if the PCR test was positive. Predictive values were calculated for each risk factor. ResultsPrevious GBS bacteriuria was strongly associated (PPV = 71%) with a positive GBS PCR test, whilst the corresponding positive percent of ROM > 18 h and of GA 35–37 was only PPV = 16% and 22%, respectively. Seventy-four women, 74/251 (31%), received IAP because they were GBS PCR positive. IAP was thus reduced by about two-thirds compared to the risk-based strategy of offering IAP to all women with one or more risk factors for EOGBS. Two women, 2/254 (0.8%), received inferior care, as they did not receive IAP within the recommended 4 h prior to delivery due to the extra time spend on the test procedure. ConclusionBedside intrapartum PCR testing of women with risk factors for EOGBS effectively diminishes use of IAP during labor compared to the present risk factor-based strategy alone. In this project, the extra time spend on the PCR test procedure did not lead to noticeable delay in IAP.

Usefulness of AF Lactoferrin Levels in Patients with Liver Cirrhosis to Diagnose Spontaneous Bacterial Peritonitis

Abstract Background Cirrhosis represents the final common histological pathway for a wide variety of chronic liver diseases. Occurrence of ascites is the most common presentation of liver cirrhosis. Spontaneous bacterial peritonitis (SBP) is observed in 15–26% of patients hospitalized with ascites. Objectives The aims of this study was to evaluate the usefulness of AF lactoferrin for the diagnosis of SBP and to identify a clinically useful cut-off level that can be used for future development of an important clinical, economic and time saving rapid bedside test for the diagnosis of SBP in cirrhotic ascites. Patients and Methods This study was conducted on 40 patients with decompensated chronic liver disease and ascites with and without spontaneous bacterial peritonitis admitted to Nasser institute for researches and treatment Hospital and Internal Medicine department, Faculty of Medicine, Ain Shams University from November 2017 to April 2018. Results Females were affected more than males by SBP, SBP has higher incidence in elderly compared to control group, no significant difference between studied groups regards to risk factors and Child class, HCV infection was the main etiology of liver cirrhosis in both groups while HBV infection was much less common with no significant difference between studied groups. Patients in SBP group showed positive reaction to CRP compared to control group with significant difference between them. No statistical significant differences between studied groups regards to abdominal ultrasonographic findings. Liver enzymes (ALT) and ALP were higher in SBP patients compared to non SBP patients with significant difference between them. SBP patients have higher TLC and lower MCV and platelets count compared to non SBP patients with significant difference between them. No statistical significant difference between studied groups regards to INR, Hb and MCH values. Conclusion Outcomes of our study provide evidence of the clinical usefulness of AF lactoferrin levels in patients with cirrhosis to differentiate those with and without SBP.

'Geno-to-pheno' SARS-CoV-2 genome-COVID-19 association studies

'Geno-to-pheno' SARS-CoV-2 genome-COVID-19 association studies

Macrophage Inflammatory Protein Type 1 Beta as a Novel Diagnostic Marker for Diagnosis of Spontaneous Bacterial Peritonitis

Background: Spontaneous bacterial peritonitis (SBP) is a severe complication of cirrhotic ascites. SBP diagnosis is based on the count of ascitic fluid neutrophils (>250/mm3). This procedure is an invasive maneuver with many complications. This study aimed to find a sensitive diagnostic tool for SBP by examining ascitic fluid Macrophage Inflammatory Protein type 1 beta(MIP-1β) as a rapid bedside test for diagnosis of SBP. Materials and methods: The study included 53 cirrhotic ascitic patients (33 with and 20 without SBP). Patients were subjected to thorough medical history taking, clinical examination, and laboratory investigation. Two ascitic fluid samples were taken, the first at admission time for cell count and culture, and the second sample was taken 48 hours after treatment in patients with SBP. Ascitic MIP-1β was measured using ELISA technique at admission in both groups and 48 hours after treatment in the SBP group. Results: Ascitic MIP-1β and CRP levels were significantly higher in the SBP group versus non-SBP patients. There was a significant positive correlation between ascitic fluid MIP-1β and WBCs and serum CRP. Ascitic fluid MIP-1β at a cut-off value ≥ of 31.95 pg/ml had 79% sensitivity and 75% specificity for the diagnosis of SBP. Combined ascetic fluid MIP-1β at the cut-off value ≥31.95 pg/ml and CRP in serum at a cut-off value ≥of 36 mg/L had 61% sensitivity and 100% specificity. There was a significant decrease of both, ascitic MIP-1β and ascetic fluid PMN after treatment of SBP. Conclusions: Ascitic fluid MIP-1β is highly sensitive and specific in the diagnosis of SBP- especially when combined with CRP.

A new rapid bedside test to diagnose and monitor intraamniotic inflammation in preterm PROM using transcervically collected fluid

Microbial invasion of the amniotic cavity, a clinical condition present in approximately 50% of patients with preterm prelabor rupture of membranes, is often associated with intraamniotic inflammation, a risk factor for a short admission-to-delivery interval, early preterm delivery, and neonatal complications. We previously developed a transcervical amniotic fluid collector, the device that allows the collection of fluid noninvasively from the cervical canal when membrane rupture occurs. This study was designed to determine whether rapid analysis of an interleukin-8 concentration in fluid obtained noninvasively by the transcervical amniotic fluid collector can be used to assess the risk of intraamniotic inflammation. We also compared the diagnostic performance of this point-of-care test for interleukin-8 in transcervically obtained fluid to that of a white blood cell count determined in amniotic fluid retrieved by transabdominal amniocentesis. This prospective cohort study was conducted between October 2011 and April 2017. Fluid was retrieved through both transabdominal amniocentesis and the use of a transcervical amniotic fluid collector within 24 hours of amniocentesis in patients with a singleton pregnancy and preterm prelabor rupture of the membranes (16-35 weeks of gestation). Amniotic fluid obtained via amniocentesis was cultured for aerobic and anaerobic bacteria and genital mycoplasmas; a white blood cell count was also measured in amniotic fluid. Intraamniotic infection was diagnosed when microorganisms were identified by the cultivation of amniotic fluid. Intraamniotic inflammation was defined as an elevated amniotic fluid matrix metalloproteinase-8 concentration (>23 ng/mL) assayed by enzyme-linked immunosorbent assay. Interleukin-8 in cervical fluid obtained by the collector was measured by the point-of-care test that used a test strip and scanner based on the fluorescence immunochromatographic analysis in 2019. The diagnostic indices, predictive values, and likelihood ratios of the 2 different tests were calculated. First, interleukin-8 concentration ≥9.5 ng/mL in cervical fluid, determined by the point-of-care test, was at the knee of the receiver operating characteristic curve analysis and had a sensitivity of 98% (56/57; 95% confidence interval, 91-99.96%), specificity of 74% (40/54; 95% confidence interval, 60-85%), positive predictive value of 80% (56/70; 95% confidence interval, 72-86%), negative predictive value of 98% (40/41; 95% confidence interval, 85-99.6%), positive likelihood ratio of 3.79 (95% confidence interval, 2.41-5.96), and negative likelihood ratio of 0.02 (95% confidence interval, 0.003-0.17) in the identification of intraamniotic inflammation; a concentration of matrix metalloproteinase-8 >23 ng/mL by enzyme-linked immunosorbent assay had a prevalence of 51% (57/111). Second, a cervical fluid interleukin-8 concentration ≥9.5 ng/mL had significantly higher sensitivity than a transabdominally obtained amniotic fluid white blood cell count (≥19 cells/mm3) in the identification of intraamniotic inflammation (sensitivity: 98% [95% confidence interval, 91-99.96%] vs 84% [95% confidence interval, 72-93%]; P<.05; specificity: 74% [95% confidence interval, 60-85%] vs 76% [95% confidence interval, 62-87%); positive and negative predictive values: 80% [95% confidence interval, 72-86%] and 98% [95% confidence interval, 85-99.6%] vs 79% [95% confidence interval, 69-86%] and 82% [95% confidence interval, 71-89%]) and in the identification of intraamniotic inflammation/infection (gold standard: positive culture for bacteria or a matrix metalloproteinase-8 >23 ng/mL; sensitivity: 91% [95% confidence interval, 82-97%] vs 75% [95% confidence interval, 63-85%]; P<.05). The point-of-care test was predictive of intraamniotic inflammation, based on the determination of interleukin-8 in fluid retrieved by a transcervical amniotic fluid collector. Therefore, the analysis of cervically obtained fluid by such point-of-care test may be used to noninvasively monitor intraamniotic inflammation in patients with preterm prelabor rupture of membranes.

Systematic review with meta-analysis: Nutritional screening and assessment tools in cirrhosis.

Disease-related malnutrition is common in cirrhosis. Multiple studies have evaluated nutritional screening tools (NSTs, rapid bedside tests targeting who needs assessment) and nutritional assessment tools (NATs, used in diagnosing malnutrition) as predictors of clinical outcome in this population. We performed a systematic review and meta-analysis of this literature with the aim of summarising the varying definitions of malnutrition across studies, the available evidence for NSTs and the ability of NSTs and NATs to predict clinical outcomes in cirrhosis. The primary outcome measures were pre- and post-transplant mortality with a range of secondary outcomes. Inclusion: cirrhosis over age 16. Exclusion: >25% with hepatocellular carcinoma, primarily laboratory test-based NATs or lack of screening, assessment or outcome criteria. Eight thousand eight hundred fifty patients were included across 47 studies. Only 3 studies assessed NSTs. Thirty-two definitions for malnutrition were utilised across studies. NATs predicted pre-transplant mortality in 69% of cases that were assessed with a risk ratio (RR) of 2.38 (95% CI 1.96-2.89). NATs were prognostic for post-transplant mortality only 28% of the times they were assessed, with a RR of 3.04 (95% CI 1.51-6.12). The cirrhosis literature includes limited data on nutrition screening and multiple definitions for what constitutes malnutrition using NATs. Despite this discordance, it is clear that malnutrition is a valuable predictor of pre-transplant mortality almost regardless of how it is defined. We require clinical and research consensus around the definition of malnutrition and the accepted processes and cut-points for nutrition screening and assessment in cirrhosis.

Increased Sensitivity of Focused Cardiac Ultrasound for Pulmonary Embolism in Emergency Department Patients With Abnormal Vital Signs

Focused cardiac ultrasound (FOCUS) is insensitive for pulmonary embolism (PE). Theoretically, when a clot is large enough to cause vital sign abnormalities, it is more likely to show signs of right ventricular dysfunction on FOCUS, although this has not been well quantified. A rapid bedside test that could quickly and reliably exclude PE in patients with abnormal vital signs could be of high utility in emergency department (ED) patients. We hypothesized that in patients with tachycardia or hypotension, the sensitivity of FOCUS for PE would increase substantially. We performed a prospective observational multicenter cohort study involving a convenience sample of patients from six urban academic EDs. Patients suspected to have PE with tachycardia (heart rate [HR] ≥ 100 beats/min) or hypotension (systolic blood pressure [sBP]<90 mmHg) underwent FOCUS before computed tomography angiography (CTA). FOCUS included assessment for right ventricular dilation, McConnell's sign, septal flattening, tricuspid regurgitation, and tricuspid annular plane systolic excursion. If any of these were abnormal, FOCUS was considered positive, while if all were normal, FOCUS was considered negative. We a priori planned a subgroup analysis of all patients with a HR ≥ 110 beats/min (regardless of their sBP). We then determined the diagnostic test characteristics of FOCUS for PE in the entire patient population and in the predefined subgroup, based on CTA as the criterion standard. Inter-rater reliability of FOCUS was determined by blinded review of images by an emergency physician with fellowship training in ultrasound. A total of 143 subjects were assessed for enrollment and 136 were enrolled; four were excluded because they were non-English-speaking and three because of inability to obtain any FOCUS windows. The mean (±SD) age of enrolled subjects was 56 (±7) years, mean (±SD) HR was 114 (±12) beats/min, and 37 (27.2%) subjects were diagnosed with PE on CTA. In all subjects, FOCUS was 92% (95% confidence interval [CI]= 78% to 98%) sensitive and 64% specific (95% CI= 53% to 73%) for PE. In the subgroup of 98 subjects with a HR ≥ 110 beats/min, FOCUS was 100% sensitive (95% CI= 88% to 100%) and 63% specific (95% CI= 51% to 74%) for PE. There was substantial interobserver agreement for FOCUS (κ =1.0, 95% CI= 0.31 to 1.0). A negative FOCUS examination may significantly lower the likelihood of the diagnosis of PE in most patients who are suspected of PE and have abnormal vital signs. This was especially true in those patients with a HR ≥ 110 beats/min. Our results suggest that FOCUS can be an important tool in the initial evaluation of ED patients with suspected PE and abnormal vital signs.

Time course and prognostic value of serum GFAP, pNFH, and S100β concentrations in dogs with complete spinal cord injury because of intervertebral disc extrusion.

BackgroundA noninvasive biomarker is needed to predict recovery from severe spinal cord injury (SCI) because of thoracolumbar intervertebral disc extrusion (TL‐IVDE). Proteins released from neural and glial cells can be detected in the blood and show promise as prognostic tools, but their concentration is influenced by time after injury.Hypothesis/ObjectivesSerum concentrations of glial fibrillary acidic protein (GFAP), phosphorylated neurofilament heavy chain (pNFH), and S100β will follow different time courses; measurement of combinations of these proteins will predict outcome.AnimalsThirty‐one dogs with TL‐IVDE causing paralysis with no pain perception.MethodsProspective study. Serum samples were taken at presentation and intervals over 56 days and banked at −80°C. Glial fibrillary acidic protein, pNFH, and S100β concentrations were measured using ELISA tests and plotted against time from onset of nonambulatory status. Outcome was established at 6 months. The association between biomarker concentration and outcome was examined using logistic regression, receiver operator characteristics curve analysis, and model development.ResultsThirty‐one dogs participated, 3/31 (10%) developed progressive myelomalacia and 19/31 (62%) recovered ambulation. Glial fibrillary acidic protein and S100β concentrations rose for the first 1 to 3 days, and were undetectable by 14 and 28 days, respectively. Phosphorylated neurofilament heavy chain concentrations peaked at 14 days and were detectable at 56 days. Glial fibrillary acidic protein concentrations in the first 72 hours after onset of nonambulatory status predicted recovery with an accuracy of 76.7%‐89% depending on sample timing.Conclusions and Clinical ImportanceSerum GFAP concentrations can be used to predict outcome in clinically complete SCI. A rapid inexpensive bedside test is needed.

Fatal Acute Respiratory Distress Syndrome Due to Influenza A (H1N1) Infection in Patients After Kidney Transplantation: A Report of Five Cases

BackgroundIn the general population, swine influenza is a self-limited infection. Patients after kidney transplantation, however, are at increased risk for complications and mortality from influenza A (H1N1). Acute respiratory distress syndrome (ARDS) complicates up to 55% of influenza-related pneumonia in hospitalized patients and carries a mortality of 40–46%. We describe our experience in intensive care of kidney transplant patients with ARDS complicating influenza A (H1N1) pneumonia during a flu outbreak.Case ReportFive adult post kidney transplantation patients with progressive respiratory failure admitted to the ICU between February 2016 and April 2016 were included in this retrospectively analysis.All patients had influenza A (H1N1) viral pneumonia (confirmed with RT-PCR) complicated by ARDS and septic shock with multiple organ dysfunction syndrome. None of the patients received seasonal influenza vaccines. All patients had negative rapid influenza bedside tests, which resulted in delay of administration of antiviral therapy prior to admission to the ICU. All patients were managed with a lung protective ventilation strategy (average days of mechanical ventilation, 17.6±15.3). Three patients required additional therapies for refractory hypoxemia, including high positive end-expiratory pressure and prone positioning. Extracorporeal membrane oxygenation was not implemented. Treatment with oseltamivir was added to a broad-spectrum antibiotic on the first to the fifth day of intensive care. Despite these measures, all patients eventually died.ConclusionsDespite great progress in the management of ARDS, based mostly on advanced mechanical ventilation, early antiviral treatment of pneumonia caused by influenza A (H1N1) and annual vaccinations seem essential in prevention and management of influenza A (H1N1) infection among kidney transplant recipients.

Placental Alpha Microglobulin-1 Compared With Fetal Fibronectin to Predict Preterm Delivery in Symptomatic Women.

To compare the rapid bedside test for placental α microglobulin-1 with the instrumented fetal fibronectin test for prediction of imminent spontaneous preterm delivery among women with symptoms of preterm labor. We conducted a prospective observational study on pregnant women with signs or symptoms suggestive of preterm labor between 24 and 35 weeks of gestation with intact membranes and cervical dilatation less than 3 cm. Participants were prospectively enrolled at 15 U.S. academic and community centers. Placental α microglobulin-1 samples did not require a speculum examination. Health care providers were blinded to placental α microglobulin-1 results. Fetal fibronectin samples were collected through speculum examination per manufacturer requirements and sent to a certified laboratory for testing using a cutoff of 50 ng/mL. The coprimary endpoints were positive predictive value (PPV) superiority and negative predictive value (NPV) noninferiority of placental α microglobulin-1 compared with fetal fibronectin for the prediction of spontaneous preterm birth within 7 days and within 14 days. Of 796 women included in the study cohort, 711 (89.3%) had both placental α microglobulin-1 and fetal fibronectin results and valid delivery outcomes available for analysis. The overall rate of preterm birth was 2.4% (17/711) within 7 days of testing and 4.2% (30/711) within 14 days of testing with respective rates of spontaneous preterm birth of 1.3% (9/703) and 2.9% (20/701). Fetal fibronectin was detected in 15.5% (110/711), and placental α microglobulin-1 was detected in 2.4% (17/711). The PPVs for spontaneous preterm delivery within 7 days or less among singleton gestations (n=13) for placental α microglobulin-1 and fetal fibronectin were 23.1% (3/13) and 4.3% (4/94), respectively (P<.025 for superiority). The NPVs were 99.5% (619/622) and 99.6% (539/541) for placental α microglobulin-1 and fetal fibronectin, respectively (P<.001 for noninferiority). Although placental α microglobulin-1 performed the same as fetal fibronectin in ruling out spontaneous preterm delivery among symptomatic women, it demonstrated statistical superiority in predicting it.

THE PREDICTIVE VALUE OF SOME RECENT PARAMETERS FOR DIAGNOSIS OF SPONTANEOUS BACTERIAL PERITONITIS

Spontaneous Bacterial Peritonitis (SBP) is a frequent and severe complication in patient with cirrhosis and ascites due to CLD with high mortality rate (20%-40%). SBP causes an inflammatory reaction resulting in an increased number of PMNs in ascitic fluid. It was reported that diagnosis of SBP is established when the ascitic fluid PMN count is greater than 250 cells/mm3 Lysis of the PMNs during transport to the laboratory, may occur which may lead to false negative results. This study evaluated the*usefulness of some recent parameters for diagnosis of SBP that can be used for future development of a rapid bedside test. Identifying a sensitive marker that can be used for rapid diagnosis of SBP in cirrhotic patients will have important clinical and economic consequences for this group of patients and also for clinicians involved in their cares. This study was conducted on 100 patients with ascites admitted to Tropical Medicine department, Al-Azhar University.Hospitals in the period from January 2015 to August 2015. The results showed that there was a highly significant positive correlation between ascetic fluid LAF level and neutrophils in ascitic fluid in cases of SBP, Also there wasopositive correlation between ascetic fluid LAF and ascetic fluid LDH (p value<0.001).

Self-diagnosis of Vulvovaginal Candidiasis is Poor - A Comparison of Diagnostic Methods Introducing β-Glucan as a Complement

Aim: Self-diagnosis of Vulvovaginal Candidiasis (VVC) may result in misuse of over-the counter (OTC) antifungals. In this study the accuracy of self-diagnosis, clinical diagnosis, and laboratory diagnostic methods, including vaginal smear microscopy and a new method for the diagnosis of VVC (β-glucan), were compared using positive yeast culture as gold standard for diagnosis of VVC. Methods: Women with self-diagnosed VVC (n=88), intending to buy OTC antifungals, were recruited from pharmacies and health care providers. A clinical examination was performed including vaginal samples for quantitative culturing of yeast, for β-glucan determination and vaginal smear microscopy (VSM). Results: In all symptomatic women, 66% were culture-positive for yeast, 20% had bacterial vaginosis (BV) (12% concurrent with VVC), and 25% were not diagnosable. The sensitivity and specificity for diagnosis of VVC were similar for β-glucan (77% and 97%) and VSM (67% and 97%, respectively), while the sensitivity was low for clinical examination (40%). The sensitivity of VVC diagnosed by analysis of β-glucan was equal to gynecological examination combined with VSM. Conclusion: The accuracy of self-diagnosis of VVC is poor. To reduce misdiagnosis women should be offered complementary diagnostic methods. For correct diagnosis analysis of β-glucan or a combination of clinical examination and laboratory VSM is recommended. In cases of therapy resistance vaginal yeast cell culture is recommended. A future rapid bedside test of β-glucan would be useful avoiding misdiagnosis.

Comparison of rapid bedside tests for phosphorylated insulin-like growth factor-binding protein 1 and fetal fibronectin to predict preterm birth

ObjectiveTo compare the accuracy of rapid bedside tests for phosphorylated insulin-like growth factor-binding protein 1 (phIGFBP-1) and fetal fibronectin (fFN) to predict preterm delivery among women with threatened preterm labor. MethodsA prospective observational study was conducted among women with a singleton pregnancy of 28–36 weeks, intact membranes, and symptoms suggestive of preterm labor who attended a center in New Delhi, India, between April 1, 2011, and March 31, 2014. Rapid bedside tests were performed at presentation to measure the levels of phIGFBP-1 and fFN in cervicovaginal secretions. All patients were managed as per the standard hospital protocol and followed up until delivery. ResultsData were available for 468 participants. For delivery before 37 weeks, the phIGFBP-1 test exhibited a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 81.1%, 97.1%, 95.2% and 87.7%, respectively. The sensitivity, specificity, PPV, and NPV for the fFN test were 19.4%, 99.4%, 97.4%, and 63.2%, respectively. The phIGFBP-1 test displayed higher sensitivity and NPV than did the fFN test for delivery before 34 weeks and within 7 days of testing (P<0.05 for all). ConclusionThe rapid bedside test for phIGFBP-1 was more reliable in the prediction of preterm delivery than was the equivalent test for fFN.

Prediction of preterm labor by a rapid bedside test detecting phosphorylated insulin-like growth factor-binding protein 1 in cervical secretions

ObjectiveTo evaluate the utility of measuring phosphorylated insulin-like growth factor-binding protein 1 (phIGFBP-1) in cervical secretions to predict preterm birth among women with premature uterine contractions. MethodsA prospective study was conducted between September 27, 2013, and February 28, 2014, at a tertiary center in India. Participants with symptoms of preterm labor at 24–36weeks underwent testing for phIGFBP-1 in cervical secretions. Cervical length was measured by ultrasonography. ResultsCervical swab samples tested positive for phIGFBP-1 among 34 (57%) of the 60 participants. Mean cervical length was 2.15±0.63cm among the 46 (77%) women who delivered preterm and 2.54±0.47cm among the 14 (23%) women who delivered at term. Of the 46 preterm deliveries, 29 (63%) women tested positive for phIGFBP-1 and 17 (37%) tested negative. Mean length of pregnancy at delivery was 32.11±4.09weeks and 35.77±1.68weeks among women who tested positive and negative for phIGFBP-1, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of phIGFBP-1 to predict preterm birth were 86.96%, 35.29%, 64.52%, and 66.67%, respectively. ConclusionA rapid bedside test measuring phIGFBP-1 identified women at high risk of preterm delivery.

A Novel Rapid Bedside Test for Rupture of Membranes [25I

INTRODUCTION: Our objective was to evaluate the ability of a pad containing an immunoassay for alpha-fetoprotein (AFP) to detect amniotic fluid (AF) leakage to serve as a rapid and simple one-step bedside test. METHODS: A prospective cohort study. Pads containing a qualitative immunoassay for AFP (detection threshold of 20 ng/mL) were used. The study group was pads worn by 200 pregnant women with confirmed rupture of membranes. Three controls were evaluated: 1) Pads worn by 70 pregnant women with intact membranes who had no vaginal bleeding; 2) Additional pads instilled with urine specimens obtained from the 270 women described above (200 cases and the 70 women in group 1); 3) Pads instilled with semen collected from 40 men seen in an infertility clinic. RESULTS: All 200 pads that absorbed AF had positive results. Among the pads from the 70 women with intact membranes, only 36 absorbed a sufficient amount of normal vaginal discharge to activate the colorimetric reaction, and they all had negative results. The colorimetric reaction was either not activated or failed to complete in the remaining 34 pads. All 270 pads that absorbed urine, and all 40 pads with semen, had negative results. CONCLUSION: A qualitative immunoassay for AFP, embedded in a pad, appears to be a reliable bedside test for distinguishing amniotic fluid leakage from normal vaginal discharge, urine, or semen. This assay, based on the same principle as a home urine pregnancy test, has the potential to be a rapid and simple one-step bedside or home test for ROM.

Prevalence of Helicobacter pylori infection in patients with portal hypertensive gastropathy owing to liver cirrhosis in Upper Egypt

Background Gastrointestinal bleeding and anemia in patients with liver cirrhosis are common problems caused by various etiologies such as bleeding esophageal and gastric varices, bleeding peptic ulcer whether Helicobacter pylori or non-H. pylori related, portal hypertensive gastropathy (PHG), and other causes. Impairment of the gastric protective barriers and production of inflammatory cytokines such as tumor necrosis factor-α and interleukins, which occur because of colonization of gastric mucosa by H. pylori, may make the stomach more susceptible to the effects of portal hypertension. Aim of work The aim of this study was to investigate the prevalence of H. pylori infection and its association with PHG in patients with liver cirrhosis. Patients and methods Overall, 50 patients with liver cirrhosis and PHG (cases) and 50 patients with cirrhosis without PHG (controls) were enrolled in this study. H. pylori stool antigen rapid bedside test and upper endoscopy were done for patients in both groups to diagnose PHG and H. pylori infection. Results The prevalence of H. pylori infection among patients with PHG was higher than those without PHG (34 vs. 10%, respectively; P=0.031), and prevalence of H. pylori infection was 22% among the whole of the studied groups. There was no correlation between H. pylori infection and severity of PHG (P=0.381), Child score, Model for End-Stage Liver Disease score, or serum albumin level. However, our study showed a significant correlation between splenic size and portal vein diameter in patients with cirrhosis and PHG (P=0.002). Conclusion There is significant association between H. pylori infection and PHG, but there is no significant correlation between H. pylori infection and the severity of PHG or the severity of liver cirrhosis. Also, there is significant correlation between splenic size and portal vein diameter in patients with cirrhosis and PHG.