Routine Testing Of Patients Research Articles

Should routine testing in patients undergoing cataract surgery be avoided?

Grzybowski, Andrzej MD, PhD, MBA; Kanclerz, Piotr MD, PhD; Tuuminen, Raimo MD, PhD, FEBO Author Information

Limonene Hydroperoxides.

Limonene is a fragrance widely used in cosmetics and household products. Until recently, contact allergy to limonene was considered rare because positive patch tests to it were infrequently observed. In recent years, however, it has been demonstrated that exposure of limonene to oxygen (air) results in the formation of a number of oxidation products, of which the hydroperoxides have a far stronger sensitizing potency than the pure compound. By routine testing of patients suspected of contact dermatitis with hydroperoxides of limonene, high frequencies of positive reactions were found, indicating that these chemicals are important fragrance allergens. It should be realized, however, that a number of "positive" reactions may well be false-positive, irritant responses.

Linalool Hydroperoxides.

Linalool is a fragrance widely used in cosmetics and household products. Until recently, contact allergy to linalool was considered rare because positive patch tests to it were infrequently observed. In recent years, however, it has been demonstrated that exposure of linalool to oxygen (air) results in formation of a number of oxidation products, of which the hydroperoxides have a far stronger sensitizing potency than the pure compound. By routine testing of patients suspected of having contact dermatitis with hydroperoxides of linalool, high frequencies of positive reactions were found, indicating these chemicals are important fragrance allergens. It should be realized, however, that a number of "positive" reactions may well be false-positive, irritant responses.

Whole Genome Trio Sequencing as a Standard Routine Test in Patients With Rare Diseases - "GENOME FIRST APPROACH"

Whole Genome Trio Sequencing as a Standard Routine Test in Patients With Rare Diseases - "GENOME FIRST APPROACH"

The clinical value of a thorough diagnostic evaluation for neurotologic complaints

PurposeDetermine the clinical efficacy of comprehensive neurotologic testing in patients presenting with complaints of hearing loss, tinnitus and/or dizziness. MethodsThis is a retrospective analysis of 1170 consecutive charts of patients who presented between 1980 and 2013 with neurotologic complaints. Demographic data, chief complaint, diagnostic imaging, audiograms, and blood tests were evaluated. ResultsRetrospective analysis of 1170 patient charts was performed. 762/1170 (65%) patients presented with subjective hearing loss, 575/1170 (49%) with dizziness, and 657/1170 (56%) with tinnitus. Audiometric testing revealed hearing loss in 1059/1169 (91%) patients. 536/1120 (48%) patients had abnormalities on Magnetic Resonance Imaging, and 343/1087 (32%) on Computed Tomography imaging. Endocrine and immunologic testing revealed 108/1135 (9.5%) patients were hyperglycemic; 125/1124 (11%) patients had elevated TSH; 149/1141 (13%) patients had a positive ANA; and 82/1133 (7.2%) patients were positive for RF. 198/1083 (18%) of patients were positive for HLA-B35, 246/1083 (23%) for HLA-Cw4, 454/1083 (42%) for HLA-Cw7, and 747/1060 (70%) of patients had absent HLA-DR4. 112/1085 (10%) of patients were positive for anti-68kD antibodies and 154/936 (17%) for protein 0. Many patients were diagnosed with previously unrecognized medical conditions. ConclusionComprehensive neurotological workup results in diagnoses that would go unrecognized otherwise, allowing patients to receive prompt treatment for medically important conditions, some of which may be causally related to their neurotologic complaints. However, the value of each study for routine testing of patients with neurotologic complaints remains controversial; and the evidence presented herein should help practitioners determine what studies should be included in their patient assessments.

An Initiative to Reduce Routine Viral Diagnostic Testing in Pediatric Patients Admitted with Bronchiolitis

Bronchiolitis is a viral lower respiratory tract infection that causes significant morbidity and mortality in the pediatric population. Viral diagnostic testing (VDT) has been used to identify specific viral pathogens. However, current guidelines suggest that routine use of this testing is not advisable. For children admitted to a children's hospital from the pediatric emergency department (PED), the rate of VDT was 63%, which was higher than the national rate. A quality improvement project was conducted to reduce the use of routine VDT. Key drivers of VDT were identified, and interventions, which included staff education about the cost and use of VDT and dissemination of a simplified cohorting policy aimed to eliminate VDT without medical necessity, were implemented through the PED and inpatient unit settings. Between January 2017 and April 2017, VDT use in all non-ICU patients admitted from the PED with bronchiolitis decreased from 63% to 12%. In the same time period, patients with VDT sent from the PED fell from 53% to 14%. A reduction in VDT for patients admitted with asthma exacerbation was also observed-from 24% to 0%-demonstrating early spread of these effects. Cost savings of approximately $8,584 per year in direct supply costs alone was documented. Using simple, low-cost interventions, including education and guideline refinement, the rate of VDT use for bronchiolitis was significantly reduced. Further directions for this project include the reduction of routine testing for patients with bronchiolitis who are admitted to the ICU or discharged for outpatient care.

Antibiotics Susceptibility Profile of Wounds Isolates

Background: Wounds infection occurs due to contamination of wounds with microbes. Wounds infection can lead to serious complications as a result of localize or hematogenous spread of their causative pathogens. Objective: This study aimed to evaluate the susceptibility of Enterobacteriaceae isolates to commonly use antibiotics for wounds infections. Materials and Methods: This is a cross sectional, hospital and laboratory based study, carried out during period from October 2016 to August 2017. Wound swab was collected from each participant and cultured directly on blood and MacConkey agar; then incubated at 37°C aerobically for 24 hours. Each isolate was identified base on culture characters, Gram stain and manual biochemical tests. All isolates (hindered) which presumptively identified as a member of Enterobacteriaceae were further subjected to antimicrobial susceptibility testing (AST). Statistical analysis was performed using statistical package for social sciences (SPSS) software version 16. Results: Antimicrobial susceptibility testing showed an emerge in antimicrobial resistant, among wounds isolates and there is significant difference in the susceptibility of this isolates to antibiotics. Most isolates were sensitive to IPM, and all were resistant to CTR 100%. Conclusions: Antimicrobial susceptibility testing will be performed as a routine test for patients with wounds infections. Further studies must focus on other highly active and cheaper alternative therapies.

Video-Head impulse test with little diagnostic impact in vertigo-patients

Video-head impulse test (V-HIT) is more and more becoming a routine test in patients with vertigo, contributing information about the vestibulo-ocular reflex (VOR). According to Ewald's second law, the unilateral pathological test points to this side's peripheral organ as being diseased. The value in clinical routine is still unclear. 171 consecutive patients with vertigo that had received a V-HIT and caloric testing at presentation in an academic ENT-department were included. By chart-review, they were categorized in different groups with unilateral peripheral, central and other etiology of vertigo, irrespective of their V-HIT result. Then the latter was analyzed within the different groups with respect to Gain, Gain-Asymmetry (GA) and Catch-up Saccades (CS). Canal Paresis (CP) from caloric testing was compared to GA. In patients with unilateral peripheral disease, 31 % showed a pathological gain (< 0.8), the mean GA was 4.53 % (± 16.72 %) and 60 % had CSs. In patients with presumed or assured central etiology, these data were 28 %, -1,56 % (± 17,89 %) and 45 %. Isolated CS occurred only sporadically. CP was not correlated with GA in all groups (p = 0,114). In this study V-HIT showed little diagnostic use, especially in separating peripheral from central disease. The lacking correlation between asymmetry in caloric testing and asymmetry of V-HIT gain challenges current pathophysiological concepts of impaired VOR.

Detección de inhibidores de factor viii y ix en pacientes que reciben factores de coagulación liofilizados como profilaxis o tratamiento

Al paciente con hemofilia se le administra como profilaxis o tratamiento el FVIII o FIX liofilizado; en ocasiones, el organismo lo reconoce como extraño y crea anticuerpos que neutralizan su efectividad. Son inhibidores dependientes del tiempo y su aparición se ve influenciado por predisposición genética. El objetivo de esta investigación fue determinar la frecuencia de los inhibidores de FVIII y FIX en 104 pacientes, de 1 a 59 años, que recibieron factores liofilizados comerciales. Se valoraron 34,6 % pacientes con hemofilia “A” moderada; 23,08 % severa y 13,4 % leve; 2,88 % hemofilia “B” moderada. Adicionalmente se incluyeron seis pacientes (5,77 %) con Enfermedad de Von Willebrand que recibieron FVIII, en los que es probable que la efectividad del tratamiento con desmopresina no fue la ideal. El 20,19 % recibió factor VIII pero no conocía el nombre de su patología. El 40,8 % de los resultados fue positivo para la prueba Bethesda y cinco pacientes presentaron valores mayores a cinco unidades Bethesda, es decir “altos respondedores”. Se evidenció la necesidad de practicar esta prueba como prueba de rutina, en los pacientes que reciben seguido plasmas con factores liofilizados.

The Value of Partnerships: Patient Care Isn't Something We Should Leave to Chance

The case report by Lyon et al. (1) in this issue of JALM highlights the importance of investigating unusual findings discovered during routine patient testing. In this particular case, extreme levels of serum protein caused …

IL6-174 G/C Gene Polymorphism in Children with Septicemia: Single Center Study

Background: Sepsis represents the main cause of mortality at intensive care units, with mortality rates from 30–50%. Elderly, pediatric, and immune-compromised patients show atypical clinical manifestations of bacterial infection. Several studies showed that Cytokines are involved in the pathogenesis of sepsis. We conducted this study to investigate the association of IL6-174 G/C gene polymorphism with sepsis outcome in critically ill children admitted to pediatric intensive care units. Patients and methods: Sixty children were included, thirty cases with sepsis and septic shock admitted to pediatric ICU in children’s hospital Cairo University. Their ages ranged from 2 months to 24 months (2 years), with 18 (60%) males and 12 (40%) females in comparison to 30 healthy controls. Blood samples (5 ml) were collected (2 ml. on EDTA for DNA extraction and RFLP of IL-6 gene at locus 174. The rest was used for separation of serum for determination of IL-6 protein by ELISA technique. Results: IL6 serum levels were significantly elevated in those children with septicemia and septic shock (114 pg/ml) compared to healthy matched controls (2.60 pg/ml), p <0.001. Regarding the IL6-174 genotype; G/C, G/G and CC represents 53.3%, 36.7% and 10%, respectively. Comparing the genotypes with mortality rates for those children with sepsis and septic shock, IL6-174, GC, GG and CC were 46.7%, 66.3%, and 100% respectively. Conclusion: IL6 serum levels are elevated in patients with sepsis, supporting its role in the pathogenesis of sepsis. IL6-174 G/C gene polymorphism may contribute to the prognosis and outcome of sepsis. Recommendation: Further large-scale studies are needed to clarify the role of IL6-174 genotypes in association with critical illnesses in children. Using IL-6 polymorphisms as a routine test in patients admitted to PICU may help us predict the prognosis of critically ill children, and allow for better treatment options for those who are at risk.

Call for routine testing for patients with high risk of HIV infection

Call for routine testing for patients with high risk of HIV infection

Hypertension is strongly associated with false-positive bicycle exercise stress echocardiography testing results

Introduction: Exercise echocardiography is a reliable routine test in patients with known or suspected coronary artery disease. However, in ∼15% of all patients, stress echocardiography leads to false-positive stress echocardiography results. We aimed to investigate the impact of hypertension on stress echocardiographic results.Methods: We performed a retrospective study of patients with suspected or known stable coronary artery disease who underwent a bicycle exercise stress echocardiography. Patients with false-positive stress results were compared with those with appropriate results.Results: 126 patients with suspected or known coronary artery disease were included in this retrospective study. 23 patients showed false-positive stress echocardiography results. Beside comparable age, gender distribution and coronary artery status, hypertension was more prevalent in patients with false-positive stress results (95.7% vs. 67.0%, p = 0.0410). Exercise peak load revealed a borderline-significance with lower loads in patients with false-positive results (100.0 (IQR 75.0/137.5) vs. 125.0 (100.0/150.0) W, p = 0.0601). Patients with false-positive stress results showed higher systolic (2.05 ± 0.69 vs. 1.67 ± 0.39 mmHg/W, p = 0.0193) and diastolic (1.03 ± 0.38 vs. 0.80 ± 0.28 mmHg/W, p = 0.0165) peak blood pressure (BP) per wattage. In a multivariate logistic regression test, hypertension (OR 17.6 [CI 95% 1.9–162.2], p = 0.0115), and systolic (OR 4.12 [1.56–10.89], p = 0.00430) and diastolic (OR 13.74 [2.46–76.83], p = 0.00285) peak BP per wattage, were associated with false-positive exercise results. ROC analysis for systolic and diastolic peak BP levels per wattage showed optimal cut-off values of 1.935mmHg/W and 0.823mmHg/W, indicating false-positive exercise echocardiographic results with AUCs of 0.660 and 0.664, respectively.Conclusions: Hypertension is a risk factor for false-positive stress exercise echocardiographic results in patients with known or suspected coronary artery disease. Presence of hypertension was associated with 17.6-fold elevated risk of false-positive results.

Issue Highlights

Issue Highlights

High Total Cholesterol in Peripheral Blood Correlates with Poorer Hearing Recovery in Idiopathic Sudden Sensorineural Hearing Loss.

Idiopathic sudden sensorineural hearing loss (ISSHL) is a common otologic emergency whose cause is still unclear. The importance of blood lipids in the pathogenesis of ISSHL is widely reported in literature. In fact elevated levels of low density lipoprotein cholesterol (LDL), total cholesterol (TC) and apolipoprotein B (Apo-B) have been proposed as risk factors for this pathology. No correlation has been described between serum lipid parameters and the prognosis of ISSHL. Aim of the present study was to identify prognostic factors associated with hearing recovery in a group of patients affected by ISSHL. Ninety-four patients with the diagnosis of ISSHL hospitalized between March 2013 and October 2014 were included in this study. Patients’ blood sampling and hearing assessments were carried out. Patients were divided into two groups as “recovered” and “unrecovered”, according to their response to the treatment. We found a statistically significant higher level of total cholesterol in the unrecovered group compared to the recovered one (p = 0.03). None of the other routine laboratory parameters have shown a statistically significant difference between the patients successfully treated and patients with poor outcomes. Total cholesterol concentrations may be a prognostic factor for recovery in ISSHL and should be assessed together with routine tests in patients with this condition. The other routine laboratory parameters seem to have no effect on the development and prognosis of this pathology.

Evidence Against Routine Testing of Patients With Functional Gastrointestinal Disorders for Celiac Disease: A Population-based Study

Celiac disease has been linked to irritable bowel syndrome (IBS)-like symptoms in outpatient clinics. Guidelines recommend that all patients with IBS-like symptoms undergo serologic testing for celiac disease, but there is controversy over whether celiac disease is more prevalent in populations with IBS-like symptoms. We aimed to determine whether positive results from serologic tests for celiac disease are associated with IBS and other functional gastrointestinal disorders (FGIDs) in a large U.S. white population. Validated, self-report bowel disease questionnaires (BDQs) were sent to randomly selected cohorts of Olmsted County, Minnesota residents. In separate protocols, serum samples were collected from more than 47,000 Olmsted County residents without a prior diagnosis of celiac disease; we performed serologic tests for celiac disease on stored serum samples from residents who completed the BDQ. Logistic regression was used to test for the association between serologic markers of celiac disease (positive vs negative) and individual FGIDs. A total of 3202 subjects completed the BDQ and had serum available for testing. IBS was identified in 13.6% of these subjects (95% confidence interval [CI], 12.4%-14.8%), and any gastrointestinal symptom occurred in 55.2% (95% CI, 53.5%-56.9%). The prevalence of celiac disease on the basis of serologic markers was 1.0% (95% CI, 0.7%-1.4%). IBS was less prevalent in patients with celiac disease (3%) than patients without celiac disease (14%), although the difference was not statistically significant (odds ratio, 0.2; 95% CI, 0.03-1.5). Abdominal pain, constipation, weight loss, and dyspepsia were the most frequent symptom groups in subjects who were seropositive for celiac disease, but none of the gastrointestinal symptoms or disorders were significantly associated with celiac disease serology. Symptoms indicative of FGIDs and seropositive celiac disease are relatively common in a U.S. white community. Testing for celiac disease in patients with IBS in the community may not have a significantly increased yield over population-based screening in the United States.

Cost-effectiveness of screening for HLA-A*31:01 prior to initiation of carbamazepine in epilepsy.

Carbamazepine causes severe cutaneous adverse drug reactions that may be predicted by the presence of the HLA-A*31:01 allele in northern European populations. There is uncertainty as to whether routine testing of patients with epilepsy is cost-effective. We conducted an economic evaluation of HLA-A*31:01 testing from the perspective of the National Health Service (NHS) in the United Kingdom. A short-term, decision analytic model was developed to estimate the outcomes and costs associated with a policy of routine testing (with lamotrigine prescribed for patients who test positive) versus the current standard of care, which is carbamazepine prescribed without testing. A Markov model was used to estimate total costs and quality-adjusted life-years (QALYs) over a lifetime to account for differences in drug effectiveness and the long-term consequences of adverse drug reactions. Testing reduced the expected rate of cutaneous adverse drug reactions from 780 to 700 per 10,000 patients. The incremental cost-effectiveness ratio for pharmacogenetic testing versus standard care was £12,808 per QALY gained. The probability of testing being cost-effective at a threshold of £20,000 per QALY was 0.80, but the results were sensitive to estimated remission rates for alternative antiepileptic drugs (AEDs). Routine testing for HLA-A*31:01 in order to reduce the incidence of cutaneous adverse drug reactions in patients being prescribed carbamazepine for epilepsy is likely to represent a cost-effective use of health care resources.

The efficiency of sodC gene / N. meningitidis detection in comparison with the classical methods for the diagnosis of meningococcal infection / Evaluarea eficienţei Real Time PCR TaqMan utilizând gena sodC / N. meningitidis în comparaţie cu metodele clasice utilizate în diagnosticul infecţiei meningococice

AbstractMeningococcal infection requires a fast and accurate diagnostic method in order to correctly initiate the antibiotic therapy. The aim of our study was to assess the efficiency of Real Time PCR -Taq Man using sod C gene / N. meningitidis in comparison with the classical methods for the diagnosis of meningococcal infection - direct microscopy, cultivation, latex agglutination and blood culture. We have detected 24/44 (54.54%) patients with meningococcal infection. In both cases of patients with / without previous antibiotic therapy before admission, the AUC (area under curve) had the highest values for RT PCR in CSF and blood analysis. This sod C RT-PCR assay is a highly sensitive and specific method for detection of Neisseria meningitis and it would be useful to include this method like a multiplex in routine testing of patients with clinical meningococcal infection for other etiological agents also.

Cerebral SPECT under VEEG monitoring combined with semi-quantitative analysis in localization of epileptogenic zone

Objective To investigate the value of the cerebral blood flow SPECT used for localization of epileptogenic zone in patients with intractable epilepsy,which was performed under the videoelectroencephalogram (VEEG) monitoring combined with the semi-quantitative analysis.Methods Ccrcbral blood flow SPECT was performed under VEEG monitoring and seizures were captured either by sleep-deprived or by reducing dose or by withholding of antiepileptic drugs (AEDs).Neurogam analysis was used in the procedure of image interpretation.Results 19 inter-ictal combined with ictal images and 62 only inter-ictal images were obtained in this study.The detection rates of the pathological focus for SPECT,VEEG and MRI were 95％、98％ and 42％,respectively.There was no significant difference between SPECT and VEEG,but both methods were significant higher than MRI (x2 =52.913,P ＜ 0.001 ; x2 =59.247,P ＜ 0.001).The accordance rate of localization of pathological focus between SPECT and VEEG (69％) was significant higher than the accordance rate between SPECT and MRI (25％;x2 =26.905,P ＜0.001) and between VEEG and MRI (27％;x2 =26.905,P ＜0.001).The localization accuracy of SPECT,VEEG and MRI were 83％ 、74％ and 52％,rcspectively.Of the 14 patients who had an Engel class Ⅰ or Ⅱ outcome after surgery,there were 11 cases came from its coincidence between SPECT and VEEG.Conclusions The cerebral SPECT imaging method applied in this study was relatively simple and convenient and could play an important role in the localization of epileptogenic zone.It could be used as a routine test in patients with intractable epilepsy. Key words: Intractable epilepsy; Video electroencephalogram; Epileptogenic zone

PCN7 - Evolution of Molecular Diagnostic Test Usage in Solid Tumours in Western Europe: Ambition Study (Analysis of Molecular Biomarker Tests in Oncology)

The development of targeted therapies has changed the paradigm of cancer management necessitating the use of robust biomarkers to identify eligible patients. This study aims to evaluate trends in molecular diagnostic test (MDT) uptake across various solid tumors. This study used IMS Oncology Analyzer™, a patient database collected through a quarterly physician panel survey. This database provides comprehensive insight into cancer care. Selected patients were at advanced/metastatic stages and diagnosed with breast (BC), stomach (SC), non-small cell lung cancer (NSCLC) or colorectal cancer (CRC) and receiving chemotherapy. MDT uptake was analyzed from time 0 (year of the European Medicines Agency –EMA– approval of the associated targeted therapy) until 2012. The analysis was done on 5 EU countries (France, Germany, Italy, Spain and UK). Trastuzumab was approved in HER2+ BC by the EMA in 2000 and had a line extension in 2004. In metastatic BC, the proportion of HER2-tested patients in 2004 was 60% (787/1,320) versus 94% (1,351/1,430) in 2012. Following further approval in 2010 for use in HER2+ advanced SC, HER2-testing grew from 17% (176/1,015) to 50% (501/993) between 2010 and 2012 in this population. In the year that Gefitinib gained EMA approval in EGFR+ NSCLC (2009), 8% of advanced NSCLC patients (280/3,465) were EGFR-tested. This proportion increased to 56% (2,092/3,708) in 2012. Panitumumab and Cetuximab obtained EMA approval for KRAS-wild type CRC in 2007 and 2008 respectively. In 2009, 42% (1,183/2,843) of metastatic CRC patients were K-RAS-tested and 62% (1,782/2,873) in 2012. The use of MDTs has become increasingly important in oncology as more targeted therapies are launched. While consistent growth in testing is established, differences exist in the delay to achieving routine testing of patients. Further observation of MDT usage is required, considering national health guidelines, to better understand movement towards personalized cancer management.