Screening Asymptomatic Patients Research Articles

Lowering the limit: reducing the CD4 T-cell threshold for ophthalmic screening in patients with HIV in an ethnically diverse UK population.

BackgroundBefore highly active antiretroviral therapy, cytomegalovirus (CMV) retinitis was a major threat to vision in individuals with HIV. We investigate whether ophthalmic screening of asymptomatic HIV patients still has value in the highly active antiretroviral therapy era and consider CD4 thresholds in line with the world literature and UK experience.MethodsA retrospective chart review was conducted of all patients seen by the HIV Ophthalmic Service of a UK university hospital both before (2007–2008) and after (2011–2012) introduction of a threshold of CD4 lower than 100 cells/mm3. Data collected included CMV and HIV RNA load, CD4 cell counts and CD4 percentage, CMV-immunoglobulin G status, ocular symptoms, and evidence of HIV-related ocular disease.ResultsIn total, 54 patients were referred to the HIV ophthalmic service. Three patients failed to attend, resulting in complete data for 51 patients (n=24 for 2007–2008; n=27 for 2011–2012). Seven patients had ophthalmic manifestations of their HIV; these cases had lower CD4 counts than those with normal examinations (median [interquartile range], 9 [7–80] versus 175 [44–394]; P=0.0039; Mann–Whitney test). Six cases had HIV retinopathy without sight loss; one case had sight-threatening CMV retinitis associated with a CD4 count of 6 cells/mm3.ConclusionBefore 2008, our practice was to screen all asymptomatic patients with CD4 counts lower than 200 cells/mm3. Screening asymptomatic patients with CD4 counts below 100 cells/mm3 was not associated with any missed or late-presenting cases of CMV retinitis in our HIV population.

PO-0773 Lung Ultrasound Findings In Congenital Lung Malformations

Background and aims Congenital cystic adenomatoid malformation (CCAM) is a group of rare congenital malformations of the lung and airways, with varying clinical pictures. Lung ultrasound (LUS) is a quick, easy and cheap imaging technique that is increasingly used in critical care settings. Specific LUS findings have been described for some types of neonatal lung injury, but no formal data exist on pulmonary malformations. We here describe ultrasound findings in CCAM. Methods Three patients with a prenatal diagnosis of CCAM and presenting with neonatal respiratory distress were examined by LUS, during the first week of life, using a linear 12–18 MHz, or a microconvex 7,5 MHz probe. Chest CT-scans were used as reference. Results LUS findings were variable and corresponded well with CT-scan images (LUS dynamic video recordings will be showarn). One patient had a single large hypoechogenic cystic lesion. Two patients had several hypoechogenic lesions, of various size and form, surrounded by consolidated lung tissue. All patients showed normal lung patterns in the areas adjacent to the CCAM. LUS did not permit the exact localization of lung lesions. Conclusions We provide the first formal description of LUS findings in neonates with CCAM. Further studies are necessary to define the place of LUS in the management of CCAM. LUS could be a useful tool in screening asymptomatic patients and determining optimal timing for CT-scan and surgery, thereby limiting radiation exposure.

Progression to Overt or Silent CAD in Asymptomatic Patients With Diabetes Mellitus at High Coronary Risk: Main Findings of the Prospective Multicenter BARDOT Trial With a Pilot Randomized Treatment Substudy

ObjectivesThe purpose of this study was to evaluate prevalence, progression, treatment, and outcome of silent coronary artery disease (CAD) in asymptomatic patients with diabetes (DM) at high coronary risk. BackgroundDespite the close association of diabetes and CAD, general CAD screening in asymptomatic patients with DM is discouraged even though outcome data in patients at high coronary risk are lacking. MethodsProspective multicenter outcome study—with a pilot randomized treatment substudy. The study comprised 400 asymptomatic patients with DM (type 2) without history or symptoms of CAD at high CAD risk. They underwent clinical evaluation and myocardial perfusion single-photon emission computed tomography (MPS) at baseline and after 2 years. Patients with normal MPS received usual care; those with abnormal MPS received medical or combined invasive and medical management. ResultsAn abnormal MPS was found in 87 of 400 patients (22%). In patients with normal MPS, MACE occurred in 2.9% and ischemia or new scar in 3.2%. Patients with abnormal MPS had more MACE (9.8%; hazard ratio: 3.44; 95% confidence interval [CI]: 1.32 to 8.95; p = 0.011) and ischemia or new scar (34.2%; odds ratio: 15.91; 95% CI: 7.24 to 38.03; p < 0.001) despite therapy, resulting in “overt or silent CAD progression” of 35.6% versus 4.6% (odds ratio: 11.53; 95% CI: 5.63 to 24.70; p < 0.001). Patients with abnormal MPS randomized to medical versus invasive-medical strategies had similar event rates (p = 0.215), but more ischemic or new scar findings (54.3% vs. 15.8%; p < 0.001). ConclusionsHigh-risk asymptomatic patients with DM and normal MPS (78%) have a low rate of first manifestations of CAD. Patients with abnormal MPS at baseline (22%) have a 7-fold higher rate of progression to “overt or silent CAD,” despite therapy. Randomized patients’ outcomes suggest that a combined invasive and medical strategy for silent CAD may reduce scintigraphic but not symptomatic CAD progression versus medical therapy alone. (Trial of Invasive versus Medical therapy of Early coronary artery disease in Diabetes Mellitus ISRCTN87953632).

Screening Asymptomatic Patients for Carotid Artery Stenosis

Sponsoring Organization: U.S. Preventive Services Task Force (USPSTF)Target Audience: Primary care cliniciansBackground and ObjectiveMortality from

Early effect of hydroxychloroquine therapy: relationship between cumulative dose and retinal thickness

Background: Hydroxychloroquine (HCQ) is widely used for long-term treatment of autoimmune diseases such as rheumatoid arthritis. However, its long-term use is known to be associated with visual changes due to retinal damage. Retinal damage associated with long-term HCQ therapy is preventable if the drug is discontinued early when the patients are still asymptomatic. In view of contrasting reports from previous studies, we investigated the association of prolonged HCQ therapy with retinal thickness in macular area.Methods: This study included 48 patients on long-term HCQ therapy and 38 healthy controls. All subjects underwent examination for corrected visual acuity, fundus photography, visual fields and SD-OCT for retinal thickness.Results: Visual acuity, visual fields, fundus photography and SD-OCT did not reveal changes consistent with diagnosis of established HCQ retinopathy in any of the subjects from HCQ group. Retinal thickness in central, parafoveal and perifoveal areas did not show significant differences between HCQ and control groups. However, we observed negative correlation between cumulative dose and retinal thickness in the parafoveal (p = 0.003) and perifoveal areas (p = 0.019) but not in the central area.Conclusions: Correlation of cumulative dose with retinal thickness in parafoveal and perifoveal areas and not the central area is in accordance with the late appearance of HCQ-induced bull's eye retinopathy. Hence screening of asymptomatic patients using OCT seems to be of great importance for early detection of retinal changes.

Risk Stratification of Hypertensive Patients Referred for Renal Transplant.

Cardiovascular disease is the leading cause of morbidity and mortality in patients with end-stage renal disease. The 2012 AHA/ACCF guidelines gave only Class 2b recommendations for screening asymptomatic patients for renal transplant listing. In 2007, we adopted an invasive-only approach for assessment of coronary artery disease (CAD, ≥70% stenosis in a major epicardial vessel) in non-diabetics >50 years old on dialysis (n=159) referred for renal transplant. Prevalence of CAD and risk factors were identified. METHODS: Patients underwent coronary angiography after dialysis initiation and prior to transplant. Noninvasive stress testing was not performed routinely. Binary logistic regression was used to identify predictors of CAD. The initial model was fit and respecified by removal of nonsignificant interaction items. RESULTS: Patients were 50.3% male and 64.2% African-American. Mean age was 57 years. Smoking was present in 47.8%, hypertension (HTN) in 98.7%, hyperlipidemia in 47.2%. CAD was found in 20.1% (10.7% 1 vessel, 5.0% 2 vessel, 4.4% 3 vessel). Significant (p<0.05) bivariate predictors of CAD were history of CAD (Odds Ratio (OR)=18.303), history of MI (OR=7.067), hyperlipidemia (OR=3.109) and history of revascularization by PCI or bypass (OR=37.289). With each additional risk factor, odds of a finding CAD increased by 2.017 times (p<0.001). Patients with LVH were less likely to have CAD (OR=0.389). Patients without history of MI, CHF, stroke or CAD were 3.95 times more likely to have no CAD (p<0.001). Among traditional risk factors for CAD (HTN, hyperlipidemia, smoking), only hyperlipidemia was a significant predictor of CAD. Patients with hyperlipidemia were 3.101 times more likely to demonstrate CAD (p=0.008). The predicted probability of CAD in non-diabetics without risk factors other than HTN was 9%. Probability of CAD with one risk factor was 23%; 2 risk factors 47%; 3 risk factors 73% and all 4 risk factors 89%. CONCLUSIONS: In the absence of risk factors, the likelihood of identifying CAD at cardiac cath was very small. Routine cath in hypertensive patients >50 years old being considered for renal transplant without other risk factors for CAD is not warranted. Noninvasive testing should be adequate for most patients with HTN referred for renal transplant, including those > 50 years old.

Upper tract urothelial carcinomas in patients with chronic kidney disease: relationship with diagnostic challenge.

Chronic kidney disease and upper tract urothelial carcinomas display a bidirectional relationship. Review of the literature indicates that early diagnosis and correct localization of upper tract urothelial carcinomas in dialysis patients and kidney transplant recipients are important but problematic. Urine cytology and cystoscopy have limited sensitivity for the diagnosis of upper tract urothelial carcinomas in dialysis patients. Enhanced computed tomography and magnetic resonance imaging could prove useful for the detection and staging of upper tract urothelial carcinomas in dialysis patients. Renal ultrasound can detect hydronephrosis caused by upper tract urothelial carcinomas in kidney transplant recipients but cannot visualize the carcinomas themselves. High detection rates for upper tract urothelial carcinomas in kidney transplant recipients have recently been demonstrated using computed tomography urography, which appears to be a promising tool. To detect carcinomas in dialysis patients and kidney transplant recipients as early as possible, regular screening in asymptomatic patients and diagnostic work-up in symptomatic patients should be performed using a combination of urological and imaging methods. Careful assessment of subsequent recurrence within the contralateral upper urinary tract and the urinary bladder is necessary for dialysis patients and kidney transplant recipients with upper tract urothelial carcinomas.

Pial synangiosis for moyamoya syndrome in children with sickle cell anemia: a comprehensive review of reported cases

Pediatric patients with sickle cell anemia (SCA) carry a significant risk of developing moyamoya syndrome (MMS) and brain ischemia. The authors sought to review the safety and efficacy of pial synangiosis in the treatment of MMS in children with SCA by performing a comprehensive review of all previously reported cases in the literature. The authors retrospectively reviewed the clinical and radiographic records in 17 pediatric patients with SCA treated at the Morgan Stanley Children's Hospital of New York (MSCHONY) who developed radiological evidence of MMS and underwent pial synangiosis between 1996 and 2012. The authors then added any additional reported cases of pial synangiosis for this population in the literature for a combined analysis of clinical and radiographic outcomes. The combined data consisted of 48 pial synangiosis procedures performed in 30 patients. Of these, 27 patients (90%) presented with seizure, stroke, or transient ischemic attack, whereas 3 (10%) were referred after transcranial Doppler screening. At the time of surgery, the median age was 12 years. Thirteen patients (43%) suffered an ischemic stroke while on chronic transfusion therapy. Long-term follow-up imaging (MR angiography or catheter angiography) at a mean of 25 months postoperatively was available in 39 (81%) treated hemispheres. In 34 (87%) of those hemispheres there were demonstrable collateral vessels on imaging. There were 4 neurological events in 1590 cumulative months of follow-up, or 1 event per 33 patient-years. In the patients in whom complete data were available (MSCHONY series, n = 17), the postoperative stroke rate was reduced more than 6-fold from the preoperative rate (p = 0.0003). Pial synangiosis in patients with SCA, MMS, and brain ischemia appears to be a safe and effective treatment option. Transcranial Doppler and/or MRI screening in asymptomatic patients with SCA is recommended for the diagnosis of MMS.

Mesenteric Lymph Node Cavitation Syndrome: An Unusual Presentation of a Common Disease

Introduction: Classic celiac disease is characterized by malabsorption of nutrients secondary to villous atrophy of the small intestinal mucosa after ingestion of wheat gluten or related proteins. Prompt clinical and histologic improvement usually follows strict adherence to a gluten-free diet. More often, patients present with atypical or silent variants, manifested by extra-intestinal symptoms or diagnosed after screening in asymptomatic patients. Some patients present with refractory disease that does not respond to a six month trial of gluten free diet. Case report: We present a case of a 70-year-old woman who was evaluated for anemia, chronic diarrhea, weight loss, and fatigue. She had a history of diabetes mellitus, hypothyroidism, and colon cancer. Medications included iron, vitamin B12, and levothyroxine. A comprehensive physical exam was unremarkable. Laboratory results revealed a white blood cell count of 3.1 K/uL, hematocrit 27.6%, and platelet count of 58 K/uL; peripheral blood smear revealed the presence of Howell-Jolly bodies. A basic metabolic profile was normal. She had mild elevations in the aminotransferases and alkaline phosphatase. Her albumin and INR were 3.1 g/dL and 1.2, respectively, and a thyroid stimulation hormone was 7.651 uIU/mL. The tissue transglutaminase IgA was positive. Other hematological and infectious work up was negative. An upper endoscopy revealed a severely atrophic mucosa of the duodenum with villous blunting, fissuring, and scalloping. A computerized tomography of the abdomen revealed multiple, 2-5cm hypodense mesenteric lymph nodes with thin enhancing rims. Histopathology evaluation of duodenal biopsies revealed complete villous blunting with lamina propria expansion by chronic inflammation and markedly increased intraepithelial lymphocytes. Fine needle aspirate of a mesenteric lymph node showed central necrosis with surrounding fibrosis and scattered lymphoplasmacytic aggregates. Special stains were negative for organisms. A full hematopathology work-up was performed and there was no evidence of lymphoma. The patient was started on a gluten-free diet but her symptoms and her laboratory tests (complete blood count), albumin, INR failed to improve after a 6 week trial. Conclusion: Mesenteric lymph node cavitation syndrome is a rare and poorly understood complication of celiac disease. It is characterized by small bowel mucosal atrophy, splenic atrophy and/or hypofunction, cavitation of mesenteric lymph nodes, and refractory symptoms even after a strict gluten-free diet. Complications include cachexia, infections (usually pneumonia), and lymphoma. Overall, prognosis tends to be poor despite treatment with gluten-free diet and steroids.

Shock-induced failure of a Riata lead with normal electrical lead parameters and a normal fluoroscopic appearance: A case report

An 81-year-old man was scheduled for an elective implantable cardioverter defibrillator (ICD) generator exchange because of battery depletion. The Atlas™+ DR ICD (St. Jude Medical, Sylmar, CA) had been implanted in February 2007 for primary prevention. The ICD lead (Riata 1570, St. Jude Medical, Sylmar, CA) had been positioned via the left cephalic vein at the right ventricular apex. Prior to the ICD generator exchange, which took place 70 months after the initial implantation, all routine device interrogations revealed normal electrical lead parameters, and cine-fluoroscopy of the lead showed normal appearance without any apparent fracture. We attempted to conduct high-voltage shock testing, as there was concern about the possibility of silent lead malfunction. Following delivery of the first high-voltage shock, the device declared “possibility of output circuit damage.” Subsequent shocks could not be delivered. Nonetheless, other lead parameters remained stable, and high-voltage lead impedance was <20Ω. The following day, the failed generator was replaced with a new ICD generator and connected with a new ICD lead. We then tested the new device by inducing ventricular fibrillation, which was defibrillated successfully. Although electric screening in asymptomatic patients with the Riata ICD lead remains controversial, it should be remembered that there are patients with or without detected cable externalization in whom only high-voltage shock testing can disclose lead malfunction. Issues with Riata leads have not yet been elucidated in full detail.

BOWEL CANCER SCREENING–ARE THE PATIENTS TRULY ASYMPTOMATIC?

IntroductionBowel Cancer Screening (BCS) was launched in 2010 in Northern Ireland, with screening colonoscopy lists starting in the Northern Trust in May 2010. Screening is offered every two years to...

Perinatally HIV-infected youth presenting with acute stroke: Progression/evolution of ischemic disease on neuroimaging

Although HIV infection is decreasing in infants and children, there is a steady cohort of perinatally HIV-infected (PHIV) children that are growing older. Increased risk of acute stroke has been reported in PHIV children. Our goal was to evaluate evolution/progression of neuroimaging findings in PHIV youth initially presenting with acute stroke. The medical records of PHIV pediatric patients (n = 179) from 1996 to 2010 were reviewed and patients with clinical documentation of acute stroke referred to the neuroradiology service were eligible for the study. Neuroimaging (brain CT, MRI, and MRA) and charts were evaluated; clinical and neuroimaging findings at the initial acute stroke and at the last presentation to the neuroradiology service were documented and analyzed. Eight PHIV patients with clinical findings of acute stroke referred to the neuroimaging were identified. CT and MRI findings of infarction were found in all (8/8) patients in their first and/or last neuroimaging study; including basal ganglia-thalami (BGT) infarction (7/8), focal cortical infarction (4/8), and internal capsule infarction (4/8). Imaging depicted cortical atrophy (5/8), BGT calcification (3/8), and posterior reversible encephalopathy syndrome, wallerian degeneration, and periventricular white matter hyperintense T2 signal each in one patient. No tumors or infectious masses, cysts or abscesses were identified. Subsequent available neuroimaging revealed progression of the cerebrovascular disease in seven patients, 5/7 in the absence of new clinical signs or symptoms. Segmental occlusion, narrowing or narrowing/dilatation in the circle of Willis was found in 6/6 patients who underwent MR angiography and fusiform aneurysms were detected in three of them, a saccular aneurysm in one patient. Asymptomatic progression of cerebrovascular disease was found in PHIV adolescents with prior stroke. These findings may have implications for long-term risk and outcomes for this patient population. There should be a low threshold to evaluate for CNS pathology even with minor symptoms in this population. More studies are necessary to determine if there is a benefit from screening of asymptomatic patients.

Screening – benefits or harms?

Screening asymptomatic patients is now an established part of medical practice. We routinely measure blood pressure, test urine, and carry out a chest X-ray pre-operatively. Screening is also offered to those who haven't asked for medical intervention. Many medical aids advise women over 50 to have an annual mammogram and to have their bone mineral density (BMD) measured at various intervals. Some even reward these women in the form of 'points' in various schemes linked to medical cover. People are advised to have an annual health check that includes cholesterol measurement. Screening has become routine - but few stop and ask whether it is beneficial, and even fewer stop to look at potential harms.

Screening for prostate cancer: the debate continues.

Other than skin cancer, prostate cancer is the most frequently diagnosed cancer in men, and it is the second leading cause of cancer-related death for males in the United States. Screening for prostate cancer using prostate-specific antigen testing became widely used by the late 1980s, augmenting the digital rectal exam. This led to a decline in the percentage of prostate cancer cases that were metastatic at diagnosis and a decrease in prostate cancer mortality. But some argued it led to overtreatment of prostate cancers as well. Recently, the U.S. Preventive Services Task Force (USPSTF) issued recommendations against routine prostate cancer screening in asymptomatic patients. The recent recommendations have created much controversy among medical professionals, patient advocate groups, and the general public. Most prostate cancer screening recommendations from professional organizations agree that an informed discussion and review of each individual patient's clinical situation should drive the decision to screen or not to screen, but the current USPSTF recommendations largely remove patient and provider autonomy in this regard. They do not contribute toward personalized screening based on individualized patient risk profiles, characteristics, and preferences.

Brain Metastases as First Metastatic Site in HER2 Positive Breast Cancer – Evaluation from Single Institution Prospective Breast Cancer Brain Metastases Data Base

Breast cancer (BC) brain metastases (BM) are the most disturbing metastatic event, causing specific morbidity with various mental, cognitive and neurological disfunction, and despite treatment, limmited survival to few minths In metastatic BC, symptomatic BM are reported in 15-16% patients, but autopsy studies reported indcidence as high as 30%. Although BM can not be predicted, some predisposing factors, has been sugested, such as younger age, lungs metastases, estrogen receptor negativity, and most importantly, HER2 overexpression It seems that patients with metastatic HER2 3+BC, has the highest risk for BM, but seemingly, more often if treated with trastuzumab, either in metastatic or adjuvant setting. However, there are no recommendations for routine brain screening in asymptomatic patients, regardless of any clinical and pathological parameters, or BC stage. The aim of this paper is to evaluate the incidence of BM as a first metastatic site in patients with HER2 3+ BC. Better characterization of this patient`s subgroup, might define candidates for whom BM screening can be a reasonable option.

Transvaginal Ultrasound for Endometrial Carcinoma Screening - Current Evidence-based Data.

The value of transvaginal ultrasound in gynaecological examinations is beyond dispute. But it is of particular forensic importance that the validity of this type of imaging with regard to the reliable detection of early-stage malignancy is properly understood. Vaginal ultrasound screening in asymptomatic patients for the early detection of endometrial carcinoma is not useful from a medical point of view, nor is it cost-efficient. However, even though the validity of transvaginal ultrasound for screening has currently not been proven, the method should still be an integral part of gynaecological examinations.

Using Patient-Provided Information to Refine Sexually Transmitted Infection Screening Criteria Among Women Presenting in the Emergency Department

Emergency department patients are at increased risk for infection with chlamydia and gonorrhea, but routine screening of asymptomatic patients is problematic. Limiting screening to patients answering the affirmative to 2 questions would reduce the number of tests administered by 51.9%, increase the tested population prevalence to 15.7%, and still identify 82.8% of those infected.

STI screening in people living with HIV: are we getting the whole story?

People living with HIV are able to enjoy meaningful sexual relationships; there remains however the key responsibility of reducing transmission to others and within this the prevention and management of sexually transmitted infections (STIs). In 2008 and 2011 BHIVA published guidance on STI testing recommending annual STI screening in asymptomatic patients with consideration of more frequent screening dependent on risk. We conducted a retrospective case note review of 385 HIV‐positive patients presenting for routine HIV care in a large city teaching hospital HIV clinic during 2010. Data included demographics, HIV parameters, sexual history and STI screening were collected. 297 (77%) were male, 215 (56%) white British, 105 (27%) black African. 229 (56%) were MSM. Median age was 37 years (range 17–75) and the median year of diagnosis was 2005 (range 1998–2010). Median CD4 count was 467 cells/mm3 (range 1–1849) and undetectable viral load in 248 (64%). 296 (77%) were on HAART. 18 were co‐infected with HBV and 17 with HCV. 249 (65%) patients had at least one STI screen. 56 (15%) declined testing and 77 (20%) were not offered. 238 (62%) had regular partner(s) and of these 109 (46%) were known HIV‐positive and 128 (32%) reported casual partners. 11 (3%) had sex exclusively with HIV‐positive partners. 91 (69%) always used condoms for vaginal sex. With regards to anal sex, 16 (68%) always used condoms. 11% used condoms for oral sex. 25 patients (6.5%) had rectal chlamydia, 27 (7.0%) had rectal gonorrhoea, 8 had dual infection and 3 had LGV. 10 HSV, 12 syphilis and 6 acute HCV infections were diagnosed during this period. 172 patients reported monogamous relationship over 12 months 11 (6.4%) of these had STIs. 160 reported consistent condom use for anal sex; of these 24 (15%) had rectal STIs diagnosed. Routine STI screening is offered annually in our cohort with reasonable uptake rates. STIs are still being diagnosed in people living with HIV despite our repeated safe sex messages and self‐reported condom use. In our cohort this was almost exclusively in MSM. Sexual history and safe sex education should be included at each visit. STI screening should be offered annually even in those reporting monogamous relationships and more frequently dependent on sexual history.

A simple immune complex dissociation ELISA for leishmaniasis: Standardization of the assay in experimental models and preliminary results in canine and human samples

Visceral leishmaniasis, caused by Leishmania (Leishmania) chagasi, is a chronic parasitic disease of humans and dogs. Confirmation of the protozoal agent in bone marrow, lymph node or spleen aspirate is diagnostic, while specific-IgG serology is used mainly for epidemiology despite the general presence of high levels of serum immunoglobulin. Anecdotal reports of false-negative serology in active disease cases are known and are ascribed to the formation of immune complexes. Because dissociation of immune complexes can be accomplished by acid treatment, we devised a simple, routine enzyme immunoassay (ELISA) for the dissociation of immune complexes in serum samples using acid treatment in wells adsorbed with Leishmania antigen (dELISA). Confirmatory acid dot-blot was also developed for antigen detection by anti-Leishmania rabbit antiserum. In experimental L. chagasi hamster models, immune complexes interfered with ELISA mostly in the 30 and 60 days postinfection, according to both dELISA and antigen dot-blot results. In larger samples from endemic areas, dELISA was positive in 10% of seronegative dog samples (7/70) and 3.5% in negative human samples (3/88), showing that dELISA could be used in the serodiagnosis of visceral leishmaniasis. Moreover, dELISA could be used as an alternative approach to screening asymptomatic visceral leishmaniasis patients, instead of invasive confirmatory testing.

Coronary computed tomography angiography: a new wave of cardiac imaging

Coronary computed tomography angiography (CTA) is becoming a popular non-invasive imaging modality for coronary arteries. It has high sensitivity and specificity in the evaluation of coronary artery disease (CAD). Due to its high negative predictive value, the main clinical role of coronary CTA is in the exclusion of significant CAD in the low to intermediate pretest probability patients. In the emergency department, coronary CTA helps to fast-track the triage of acute chest pain patients. One of the major coronary CTA's limitations is its false positive findings in the presence of heavily calcified lesions. With the advance of CT technology, the radiation dose of coronary CTA has been reduced significantly. At present, coronary CTA is still not indicated for screening asymptomatic patients.