Standard Blood Tests Research Articles

Adjusting CA19-9 values to predict malignancy in obstructive jaundice: Influence of bilirubin and C-reactive protein

To find a possible relationship between inflammation and CA19-9 tumor marker by analyzing data from patients with benign jaundice (BJ) and malignant jaundice (MJ). All patients admitted for obstructive jaundice, in the period 2005-2009, were prospectively enrolled in the study, obtaining a total of 102 patients. On admission, all patients underwent complete standard blood test examinations including C-reactive protein (CRP), bilirubin, CA19-9. Patients were considered eligible for the study when they presented obstructive jaundice confirmed by instrumental examinations and increased serum bilirubin levels (total bilirubin > 2.0 mg/dL). The standard cut-off level for CA19-9 was 32 U/mL, whereas for CRP this was 1.5 mg/L. The CA19-9 level was adjusted by dividing it by the value of serum bilirubin or by the CRP value. The patients were divided into 2 groups, MJ and BJ, and after the adjustment a comparison between the 2 groups of patients was performed. Sensitivity, specificity and positive predictive values were calculated before and after the adjustment. Of the 102 patients, 51 were affected by BJ and 51 by MJ. Pathologic CA19-9 levels were found in 71.7% of the patients. In the group of 51 BJ patients there were 29 (56.9%) males and 22 (43.1%) females with a median age of 66 years (range 24-96 years), whereas in the MJ group there were 24 (47%) males and 27 (53%) females, with a mean age of 70 years (range 30-92 years). Pathologic CA19-9 serum level was found in 82.3% of MJ. CRP levels were pathologic in 66.6% of the patients with BJ and in 49% with MJ. Bilirubin and CA19-9 average levels were significantly higher in MJ compared with BJ (P = 0.000 and P = 0.02), while the CRP level was significantly higher in BJ (P = 0.000). Considering a CA19-9 cut-off level of 32 U/mL, 82.3% in the MJ group and 54.9% in the BJ group were positive for CA19-9 (P = 0.002). A CA19-9 cut-off of 100 U/mL increases the difference between the two groups: 35.3% in BJ and 68.6% in MJ (P = 0.0007). Adjusting the CA19-9 value by dividing it by serum bilirubin level meant that 21.5% in the BJ and 49% in the MJ group remained with a positive CA19-9 value (P = 0.003), while adjusting the CA19-9 value by dividing it by serum CRP value meant that 31.4% in the BJ group and 76.5% in the MJ group still had a positive CA19-9 value (P = 0.000004). Sensitivity, specificity, positive predictive values of CA19-9 > 32 U/mL were 82.3%, 45% and 59.1%; when the cut-off was CA19-9 > 100 U/mL they were, respectively, 68.6%, 64.7% and 66%. When the CA19-9 value was adjusted by dividing it by the bilirubin or CRP values, these became 49%, 78.4%, 69.4% and 76.5%, 68.6%, 70.9%, respectively. The present study proposes CRP as a new and useful correction factor to improve the diagnostic value of the CA19-9 tumor marker in patients with cholestatic jaundice.

Validating the CANRISK prognostic model for assessing diabetes risk in Canada’s multi-ethnic population

Introduction Despite high rates of undiagnosed diabetes and prediabetes, suitable risk assessment tools for estimating personal diabetes risk in Canada are currently lacking. Methods We conducted a cross-sectional screening study that evaluated the accuracy and discrimination of the new Canadian Diabetes Risk Assessment Questionnaire (CANRISK) for detecting diabetes and prediabetes (dysglycemia) in 6223 adults of various ethnicities. All participants had their glycemic status confirmed with the oral glucose tolerance test (OGTT). We developed electronic and paper-based CANRISK scores using logistic regression, and then validated them against reference standard blood tests using test-set methods. We used area under the curve (AUC) summary statistics from receiver operating characteristic (ROC) analyses to compare CANRISK with other alternative risk-scoring models in terms of their ability to discern true dysglycemia. Results The AUC for electronic and paper-based CANRISK scores were 0.75 (95% CI: 0.73–0.78) and 0.75 (95% CI: 0.73–0.78) respectively, as compared with 0.66 (95% CI: 0.63–0.69) for the Finnish FINDRISC score and 0.69 (95% CI: 0.66–0.72) for a simple Obesity model that included age, BMI, waist circumference and sex. Conclusion CANRISK is a statistically valid tool that may be suitable for assessing diabetes risk in Canada’s multi-ethnic population. CANRISK was significantly more accurate than both the FINDRISC score and the simple Obesity model.

Diagnostic study and meta‐analysis of C‐reactive protein as a predictor of postoperative inflammatory complications after pancreatic surgery

Although C-reactive protein (CRP) can be measured by a standard blood test, its diagnostic value for distinguishing patients with inflammatory complications after pancreatic surgery from patients with normal postoperative inflammatory responses has not been adequately investigated. This study aimed to assess the diagnostic accuracy of CRP levels for the occurrence of postoperative inflammatory complications after pancreatic surgery. Clinical data and CRP levels measured in 280 patients after pancreatic surgeries (performed between 1998 and 2010) until postoperative day 10 (POD 10) were retrospectively analyzed. Using the receiver operating characteristic method, diagnostic accuracy was evaluated by an area under the curve (AUC) analysis. Furthermore, the results of the present study were compared to previously published reports by applying diagnostic meta-analysis techniques. The 30-day mortality rate was 3.9% (95% CI 2.1-7.0%). Inflammatory complications occurred in 153 of 280 patients (54.6%; 95% CI 48.8-60.4%). On POD 4, the AUC was 0.67 (95% CI 0.58-0.76). The highest diagnostic accuracy was observed on POD 7 (AUC 0.77; 95% CI 0.68-0.85). In a diagnostic meta-analysis that included two additional studies, the diagnostic sensitivity on POD 4 was 0.63 (95% CI 0.50-0.76), and the specificity was 0.79 (95% CI 0.71-0.88). The highest sensitivity occurred on POD 6 (0.75; 95% CI 0.68-0.82). Considerable statistical heterogeneity was observed in the analysis of PODs 3, 4 and 5. According to this limited evidence, CRP levels had a low to moderate diagnostic accuracy. Large, blinded studies are warranted for a more precise estimation of CRP's diagnostic value.

The value of pre-operative magnetic resonance spectroscopy in the assessment of steatohepatitis in patients with colorectal liver metastasis

Neoadjuvant chemotherapy prior to liver surgery for colorectal metastases can cause marked steatosis (≥ 33%) and steatohepatitis defined by non-alcoholic fatty liver disease activity score (NAS) as adverse effects on liver parenchyma. The aim of this study was to evaluate the steatosis level prior to liver resection using proton magnetic resonance spectroscopy ((1)H MRS) and to compare it with digital quantification of steatosis (DQS) and "classical" histopathology. (1)H MRS at 3T evaluated steatosis in 35 patients with colorectal liver metastasis, planned for liver resection. Non-tumorous liver parenchyma samples were obtained after surgery for classical histopathology and DQS utilising automated software for quantification of histopathological slides using image processing. Classical histopathology defined marked steatosis in nine patients. Histopathology was less reliable than DQS (interclass correlation coefficient - ICC 0.771) or (1)H MRS (ICC 0.722) in steatosis estimation. (1)H MRS showed very similar steatosis levels and high reliability compared to DQS (ICC 0.955). Steatohepatitis was observed in seven patients (NAS ≥ 4) and (1)H MRS was able to predict it with 100% sensitivity and 89% specificity at threshold 10.9%, without knowing lobular inflammation or hepatocyte ballooning. BMI was significantly higher in the groups with marked steatosis and steatohepatitis. Standard blood tests or chemotherapy had no predictive value. (1)H MRS is a reliable non-invasive tool for steatosis assessment, and interestingly, it was able to predict steatohepatitis defined by NAS ≥ 4 in patients planned for liver resection of colorectal metastases after neoadjuvant chemotherapy.

High cortisol levels are associated with low quality food choice in type 2 diabetes

Hypothalamic-pituitary-adrenal (HPA) axis control may be impaired in type 2 diabetes (T2DM). Glucocorticoids increase consumption of low quality foods high in calories, sugar, and fat. We explored the relationship between cortisol levels, poor blood glucose control, and food quality choice in T2DM. Twenty-seven healthy controls were age-, gender- and education-matched to 27 T2DM participants. Standard clinical blood tests and cortisol values were measured from fasting blood samples. Participants recorded all consumed food and drink items in a consecutive 3-day food diary. Diaries were analyzed for "high quality" and "low quality" foods using a standardized method with high reliability (0.97 and 0.86, respectively). Controlling for education, body mass index (BMI) and hemoglobin A1C (HbA1C), log-transformed cortisol (LogC) predicted the percent of low quality foods (R (2) = 0.092, β = 0.360, P < 0.05), but not the percent of high quality foods chosen. Controlling for education, BMI, and LogC, HbA1C significantly predicted both the percent of low quality foods (ΔR (2) = 0.079, β = 0.348, P = 0.024) and high quality foods chosen (ΔR (2) = 0.085, β = -0.362, P = 0.022). The relationship between HbA1C and low quality food choice may be mediated by cortisol, controlling for BMI and education (P < 0.01). HbA1C displayed both an indirect (cortisol-mediated) effect (P < 0.05) and direct effect on low quality food choice (P < 0.05). The relationship between HbA1C and low quality food choice may be partially mediated by cortisol. Poor blood glucose control may cause HPA axis disruption, increased consumption of low quality foods.

Rapid Detection of HIV-1 and 2 Antibodies by using Oral Fluid: A Multicentric Pilot Study in India

Introduction: Detection of HIV antibodies is done by the standard blood tests. Rapid tests provide results in few minutes. The OraQuick rapid HIV1/2 antibody test using oral fluid has not been tried in resource-limited settings in India. The aim was to evaluate the efficacy of the OraQuick test kit using oral fluid for HIV antibody detection in patients attending the dental hospitals. Materials and methods: This multicentric pilot study was administered on 134 consenting subjects. Seventy subjects were randomly screened at Visakhapatnam and 64 at Davangere, by OraQuick test using oral fluid and other standard HIV screening tests. The subjects and the test administrators were enquired regarding the convenience of the oral fluid test and blood tests. The results were compared and conclusions were drawn. Results: Seventy subjects were positive with both oral fluid and blood tests. Sixty-four subjects were negative with both the tests demonstrating 100% sensitivity and specificity. The oral fluid test was well accepted by all patients and test administrators. Conclusion: Our study revealed that the OraQuick test using oral fluid was found to be highly accurate, noninvasive screening test which can be easily used in dental hospitals.

Posterior reversible encephalopathy syndrome in a patient following binge liquorice ingestion

Posterior reversible encephalopathy syndrome (PRES) is a rare clinicoradiographic entity manifesting as headache, confusion, seizure and/or visual disturbance with cerebral oedema demonstrated in the posterior portions of the cerebral hemispheres on computer tomography (CT)/magnetic resonance imaging (MRI) [1, 7]. It has been reported in association with a number of conditions including acute hypertension, eclampsia, immunosuppressive medication, infection and autoimmune disease [2, 9]. To our knowledge, only two cases of PRES have been previously reported following liquorice ingestion [3, 8]. A previously well 65-year-old woman presented with sudden onset confusion and disorientation. On questioning, she denied any history of neurological disease or taking prescription/recreational drugs. Physical examination revealed slurred speech but no focal neurological signs. Her blood pressure (BP) was 160 9 95 mmHg, pulse rate 88 bpm and temperature 36.4 C. Initial investigations including standard blood tests, toxicology screens, lumbar puncture, CT-head and EEG demonstrated no acute abnormalities. Four days after admission for observation the patient complained of severe occipital headache and loss of vision. She was noted to have reduced visual acuity and bilateral fine resting tremor in her upper limbs exacerbated by purposeful movements. Her systolic BP had risen to above 220 mmHg and repeat blood tests showed plasma sodium of 144 mmol/L, potassium of 3.5 mmol/L and creatinine of 284 lmol/L. A second CT-head revealed hypodensities in the cortical and subcortical regions of the occipital, parietal and posterior frontal lobes with no signs of intracranial haemorrhage or infarction (Fig. 1). An MRI-brain next demonstrated hyperintensities within the same distribution (Fig. 2). A diagnosis of PRES with severe hypertension was made. The patient was transferred to the intensive care unit (ICU) and treated with labetalol and supplementary metoprolol and amlodipine. An arterial blood gas in the ICU showed plasma sodium of 148 mmol/L, potassium of 2.6 mmol/L, bicarbonate of 40 mmol/L, and pH of 7.51. Evaluation for secondary causes of hypertension demonstrated recumbent plasma renin activity of less than 0.08 ng/L/s (normal 0.08–0.64 ng/L/s), recumbent plasma aldosterone activity of less than 70 pmol/L (normal 110–620 pmol/L) and renal artery stenosis following CT-angiography. Her serum cortisol, thyroid stimulating hormone and thyroxine levels were normal and urinary catecholamines unremarkable. The patient’s daughter subsequently revealed that the patient had binged on black liquorice in the immediate days prior to admission. After two further days in intensive care the patient became normotensive, her antihypertensive therapy was withdrawn, and, she developed a marked diuresis (urine output greater than 200 mL/h for 14 hours). The patient spent a further R. D. Morgan (&) Department of Medicine, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK e-mail: robert.morgan@doctors.org.uk

Incremental net benefit and acceptability of alternative health policies: a case study of mass screening for colorectal cancer

The incremental net benefit (INB) and the related acceptability curves for public health programs provide valuable tools for decision making. We proposed to apply them to the assessment of mass screening of colorectal cancer. The now standard guaiac fecal occult blood test (FOBT) is already implemented in several countries. We considered the innovative immunological FOBT and computed tomography colonography (CTC) as competing screening technologies. Using biennial guaiac FOBT as the reference strategy, we estimated the cost-effectiveness of the following alternatives: biennial immunological FOBT, CTC every 5 years (strategy CTC5), and CTC every 10 years (strategy CTC10). Over a 30-year horizon and from the perspective of a third-party payer, we developed a Markov model on a hypothetical cohort of 100,000 subjects at average risk of colorectal cancer. Close expected net benefits between immunological FOBT and CTC5 induced uncertainty in the choice of the optimal strategy. Probabilistic sensibility analysis then suggested that below a willingness to pay (WTP) per life-years gained (LYG) of 8,587 €/LYG, CTC10 was optimal, while CTC5 would be preferred beyond a WTP of 8,587 €/LYG.

Marked regional variations in the prevalence of sickle cell disease and β-thalassemia in Saudi Arabia: Findings from the premarital screening and genetic counseling program

BackgroundHemoglobinopathies represent a major public health problem in Saudi Arabia (SA). Reports suggest that their higher prevalence is not evenly distributed in SA. Regional differences were studied in sickle cell disease and β-thalassemia and their at-risk marriages using national data. MethodsThe carrier and case status of sickle cell disease and β-thalassemia were determined in couples approaching marriage between 2004 and 2009 using standard blood tests. Prevalence of both diseases and at-risk marriages in different SA administrative and geographical regions were calculated and compared. ResultsA total of 15,72,140 men and women were examined over 6years. This represented 0.06% of the entire population of Saudi Arabia. The prevalence of couples who tested positive for sickle cell was 45.1 (42.4 for carriers and 2.7 for cases) per 1000 persons examined. The prevalence was highest in the Eastern region (134.1 per 1000), followed by Southern and Western regions (55.6 and 28.5 per 1000, respectively) and lowest in Central and Northern regions (13.7 and 13.5 per 1000, respectively). The prevalence of couples testing positive for β-thalassemia was 18.5 (18.0 for carriers and 0.5 for cases) per 1000 persons examined. The prevalence was highest in the Eastern region (59.0), moderate in the Southern, Western and Central regions (14.2, 10.2, and 10.1 per 1000, respectively) and lowest in the Northern region (3.9). ConclusionVast regional differences in hemoglobinopathies among adult Saudis are being reported that may help policy makers better allocate resources of available preventive programs.

Magnetic resonance spectroscopy in the prediction of early conversion from amnestic mild cognitive impairment to dementia: a prospective cohort study

BackgroundMild cognitive impairment (MCI) of an amnestic type is a common condition in older people and highly predictive of Alzheimer's disease (AD). To date, there is no clear consensus regarding...

241 Iron deficiency in non-anemic heart failure patients

Functional improvement has recently been reported in anemic and non-anemic heart failure (HF) patients with biological iron deficiency who were treated by intravenous iron substitution. Our aim was to show whether the non-anemic patients with iron deficiency have poorer functional tests than non-deficient ones. We included 138 HF patients without anemia from our HF department at Toulouse University Hospital into 2 groups: 1/low ferritin rate group (LFG) with a serum ferritin of 100 μg/L and lower (n = 42), 2/normal ferritin rate group (NFG) with serum ferritin over 100 μg/L (n = 96). We measured standard blood tests and functional parameters including NYHA status, 6 minute walk test (6’WT), and peak oxygen consumption (VO2 max). Baseline patient characteristics showed a slight difference for hemoglobin in non-anemic patients (LFG, 13.9; NFG, 14.4; p = 0.04) who have no difference for ejection fraction (LFG, 27.5%; NFG 29.5%; p = NS) between groups. The iron deficient patients tend to be older (59 versus 63 yo, p = NS) and most of them were women (92% in LFG versus 67% in NFG (p<0.05)). Functional parameters showed i) NYHA status of 2.29 in LFG versus 2.35 in NFG (p = NS); ii) 6’WT of 307 m in LFG versus 361 m in NFG (p = 0.006); and, iii) VO2 max of 13.8 ml/min/kg in LFG versus 15.7 ml/min/kg for the NFG (p = 0.04). Moreover, the LFG had a higher creatinin rate of 145 μmol/l versus 107 μmol/l for the NFG (p = 0.02). Iron deficient patients have poorer functional tests and are more likely to have renal insufficiency. Risk factors for iron deficiency in HF are the age and the female sex. We put in light some risk factors for iron deficiency that may help the practitioner making out which non-anemic HF patients should have blood tests to look for iron deficiency.

Catheter-related atrial thrombosis in a patient with recent cerebral haemorrhage: to treat or not to treat?

We report on the case of a 43-year-old Indian man, brought to the emergency department (ED) because of traumatic brain injury due to a motorcycle crash. In the ED, the patient was awake, and haemodynamically stable. The neurological examination did not reveal any abnormality. All standard blood tests were normal. A brain computed tomography (CT scan) showed blood leakage on cortical insular and frontal furrows, temporo-parietal subdural haematoma, and a left occipital skull fracture. As the neurosurgeon suggested a conservative approach, the patient was transferred first to an ICU, then to our unit. Over the next few days, he became pyretic, and therefore the central venous catheter was removed. The catheter’s tip cultures eventually were positive for Staphylococcus epidermidis. A transthoracic echocardiogram (TTE) showed a right atrial mass (Fig. 1), which was determined to be an atrial thrombus on a transesophageal echocardiogram (TEE) and cardiac magnetic resonance imaging (MRI). Cautious anticoagulant therapy with low-molecular weight heparin was started, along with close clinical and radiological observation to detect any subtle haemorrhagic complications. After 20 days of effective anticoagulation, a TTE showed no evidence for atrial thrombi (Fig. 1). Discussion

Trace element quantification in high-resolution Rutherford backscattering spectrometry

The potential of high resolution Rutherford Backscattering (RBS) for identification and quantification of created elements in thin films was investigated. A beam of 250 keV d + ions from the AN700 van de Graaff accelerator in Linz was used to characterize the composition of an organic multi-element compound, i.e. a thin film of dried human blood on a carbon substrate. It was possible to identify more than 10 chemical elements with high accuracy, in the absence of any matrix effects. For instance, the Fe concentration was determined with a relative error <3% (400 ± 10 ppm), in perfect agreement with standard blood test values. The detection limit of heavy elements with atomic number higher than Fe was found to be below 50 ppm.

Screening patients with hypertrophic cardiomyopathy for Fabry disease using a filter-paper test: the FOCUS study

BackgroundPatients with Fabry disease (FD) show left ventricular hypertrophy (LVH) mimicking hypertrophic cardiomyopathy (HCM) of sarcomeric origin and might benefit, if detected early, from specific enzyme replacement therapy. The prevalence...

Biomarkers of fibrosis and impaired liver function in chronic hepatitis C: how well do they predict clinical outcomes?

To review the recent literature on the prognostic value of biomarkers of liver fibrosis and impaired liver function in patients with chronic hepatitis C with or without HIV coinfection. A combination of standard blood tests seems to be useful in identifying patients at risk of liver-related complications. Findings from studies investigating the validity of the Model for End-Stage Liver Disease (MELD) score in HIV-infected liver transplant candidates are conflicting. Two large studies of HIV/hepatitis C virus (HCV) coinfected patients have shown that plasma levels of the fibrosis marker hyaluronic acid are a strong predictor of clinical complications. A smaller study found hyaluronic acid and two other fibrosis tests, aspartate aminotransferase-to-platelet ratio index (APRI) and Fib-4, to be independent predictors of mortality when included in models with the MELD or the Child-Pugh-Turcotte scores. Although the data are still limited, recent findings from large studies of the prognostic ability of fibrosis markers in hepatitis C patients provides hope that fibrosis markers, together with other noninvasive methods, one day, will replace liver biopsy as the gold standard for the prognostic evaluation of liver disease. The MELD score, and other prognostic factors, need further evaluation in HIV/HCV coinfected patients with end-stage liver disease.

Prescribing Tai Chi for Fibromyalgia — Are We There Yet?

Fibromyalgia is a common and poorly understood pain disorder that afflicts an estimated 200 million or more people worldwide.1 The lack of objective abnormalities detected on physical examination and standard blood and imaging tests has led many physicians to question the existence of this disorder.2 However, for those experiencing the pain and other associated symptoms (including fatigue, stiffness, and nonrestorative sleep), there is little doubt that the condition is real — and so is the need for relief. Studies over the past decade suggest that fibromyalgia may be due, at least in part, to an alteration in pain sensitivity in . . .

Rapid Oral Fluid Testing for HIV in Veterans With Mental Health Diagnoses and Residing in Community-Assisted Living Facilities

Veterans with a history of mental health and substance abuse diagnoses, residing in assisted living facilities, are more likely to have an undiagnosed HIV infection related to high-risk behaviors. We determined (a) the cross-sectional prevalence of HIV infection among 65 veterans of unknown HIV serostatus with mental health diagnoses who resided in 11 community-assisted living facilities, and (b) whether patients who had not consented to standard physician-initiated blood testing in the previous 5 years would consent to rapid oral fluid HIV testing by nurses familiar to the subjects. We found an HIV prevalence of 3.1% in the subjects who agreed to be tested (n = 64, 98%). High test acceptance, especially in a group with little HIV screening experience, and the identified high prevalence of disease, suggest that this diagnostic method is effective. Patients' familiarity with the nurses who conducted the testing most likely supported the success of the procedure.

Knowledge and risk behaviors related to HIV/AIDS, and their association with information resource among men who have sex with men in Heilongjiang province, China

BackgroudIn Heilongjiang province, the HIV prevalence in men who have sex with men (MSM) is generally lower than other part of China. However, the official perception for their risk of HIV/AIDS infection has been increasing in the province over the years. Moreover, little information on HIV/AIDS was provided to the communities so that we have disadvantage of controlling HIV/AIDS epidemic in the region. The purpose of this study is to investigate the prevalence of HIV among MSM in Heilongjiang province, to assess their knowledge levels and risk behaviors related to HIV/AIDS, and to explore their associations with information resources.MethodsA cross-sectional study using a standardized questionnaire and blood test was administered in 2008 by local interviewers to a sample (1353) of MSM in four cities in Heilongjiang province.ResultsAmong 1353 MSM, 2.3% were identified with HIV infection. About 48.7% of the subjects had multiple male sexual partners and only 37.3% of the subjects had consistent condom use (use every time) in the past 6 months. Most had a fair level of knowledge on HIV/AIDS, with the highest mean knowledge score among the MSM from Jiamusi, those with income 2000-3000 RMB/month, those searching sexual partners via internet and those performed HIV testing over 1 year ago). However, some myths regarding viral transmission (e.g., via mosquito bites or sharing kitchen utensils) also existed. Resources of information from which knowledge and risk behaviors related to HIV/AIDS was most available were television (58.6%) among MSM, followed by sexual partner (51.6%), publicity material (51.0%) and internet (48.7%). Significantly statistical differences of mean knowledge score were revealed in favor of book (P = 0.0002), medical staff (P = 0.0007), publicity material (P = 0.005) and sexual partner (P = 0.02). Press (P = 0.04) and book (P = 0.0003) were contributory to the most frequent condom use (condom use every time), while medical staff (P = 0.005) and publicity material (P = 0.04) is associated with moderate rate of condom use (condom use often).ConclusionsAlthough the prevalence of HIV infection is low among MSM in Heilongjiang province, the situation that the risk behaviors were frequent in the population is alarming. The study suggests that some strategies like condom use and education intervention are practical approaches and need to be strengthened.

Platelet function in brown bear (Ursus arctos) compared to man

BackgroundInformation on hemostasis and platelet function in brown bear (Ursus arctos) is of importance for understanding the physiological, protective changes during hibernation.ObjectiveThe study objective was to document platelet activity values in brown bears shortly after leaving the den and compare them to platelet function in healthy humans.MethodsBlood was drawn from immobilized wild brown bears 7-10 days after leaving the den in mid April. Blood samples from healthy human adults before and after clopidogrel and acetylsalicylic acid administration served as control. We analyzed blood samples by standard blood testing and platelet aggregation was quantified after stimulation with various agonists using multiple electrode aggregometry within 3 hours of sampling.ResultsBlood samples were collected from 6 bears (3 females) between 1 and 16 years old and from 10 healthy humans. Results of adenosine diphosphate, aspirin, and thrombin receptor activating peptide tests in bears were all half or less of those in humans. Platelet and white blood cell counts did not differ between species but brown bears had more and smaller red blood cells compared with humans.ConclusionUsing three different tests, we conclude that platelet function is lower in brown bears compared to humans. Our findings represent the first descriptive study on platelet function in brown bears and may contribute to explain how bears can endure denning without obvious thrombus building. However, the possibility that our findings reflect test-dependent and not true biological variations in platelet reactivity needs further studies.

Cerebellar infarction in vascular territory of arteria cerebelli superior

Cerebellar vascular diseases are focal cerebrovascular diseases in posterior circulation--vertebrobasilar system. The cerebellum is supplied by three main arteries arising from the vertebrobasilar system: arteria cerebelli inferior posterior, arteria cerebelli inferior anterior and arteria cerebelli superior. Cerebelar infarctions are rare but unpredictable disorders. The aim of this study was determination of main risk factors, clinical presentation and prognosis of the cerebellar infarctions in distal vascular teritorry of the arteria cerebelli superior. We evaluated 60 patients hospitalized after acute cerebellar infarction among other hospitalized patients in five year period. In 18 patients computerized tomography demonstrated infarction in distal vascular teritorry of the arteria cerebelli superior. All patients underwent clinical and other diagnostic investigations (computerized tomography, electrocardyography and standard blood tests) and were questioned by phone after finishing hospital treatment. Cerebellar infarcts in distal vascular teritorry of arteria cerebell superior was 30% of all cerebellar infarcts. The most frequent risk factor was hypertension (66.7%). Symptomatology and clinical signs were heterogenous but the most frequent were instability (77.8%), vertigo (72.2%) and vomiting (55.6%) followed by ataxia of the limbs (77.8%) and the body (61.1%), nystagmus (55.6%) and disarthria (33.3%) in clinical presentation. All patients had good recovery in hospital and one year afterwards. Infarctions in distribution of arteria cerebelli superior are rare and have multiple risk factors and various clinical features in majority of other studies as in this one. Mass effects are present in several studies but none in this one which reflects contraversions present in other published investigations. Cerebellar infarctions in vascular teritorry of arteria cerebelli superior have multiple risk factors, mostly heterogenous clinical presentations with predominance of instability, vertigo and vomiting with ataxia of the limbs and the body as well as nystagmus and disarthria in clinical presentation. The outcome and prognosis of disease is good despite the large amount of arteria cerebelli superior vascular teritorry.