Clinical medicine & research
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Comparative Study Clinical Trial
Comparison of an in-house and a commercial RD1-based ELISPOT-IFN-gamma assay for the diagnosis of Mycobacterium tuberculosis infection.
To compare a RD1-based in-house ELISPOT-interferon-gamma (IFN-gamma) assay with a commercial (T-SPOT.TB) assay for the diagnosis of Mycobacterium tuberculosis (TB) infection and the efficacy of the tuberculin skin test (TST) and ELISPOT assay in detecting latent TB infection (LTBI). ⋯ Our in-house ELISPOT assay based on a restricted pool of highly selected peptides is equivalent to the commercial T-SPOT.TB assay, is cheaper and is probably not confounded, unlike the TST, by BCG vaccination in our setting.
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Intravenous and aerosolized polymyxins are being used increasingly, especially in the critical care setting, for treating patients with infections due to multidrug-resistant Gram-negative bacteria, mainly Acinetobacter baumannii and Pseudomonas aeruginosa. Recent literature suggests that intravenous colistin and polymyxin B have acceptable effectiveness for the treatment of patients with bacteremia, as well as infections of various systems and organs, including pneumonia, bacteremia, skin and soft tissue, and urinary tract infections. Although data from recent studies have suggested that the toxicity of intravenous polymyxins is probably less than reported in the older literature, caution should be taken to monitor the renal function of patients who receive these antibiotics.
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Diagnostic accuracy of the currently available serum markers of cardiac injury, such as myoglobin, creatine kinase and its myocardial isoform, are altered in patients with renal failure. It is shown that cardiac troponins have decreased diagnostic sensitivity and specificity in patients receiving renal replacement therapy. ⋯ We believe that cardiac troponin I should be the biomarker of choice for diagnosis of myocardial injury in these patients. However, further trials are required for conclusive results.
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Sepsis is a common cause of morbidity and mortality in intensive care units. Unfortunately, there is no gold standard for diagnosing sepsis as clinical and laboratory signs are neither sensitive enough nor specific enough, and microbiological studies often remain negative. ⋯ The triggering receptor expressed on myeloid cells-1 (TREM-1) is a member of the immunoglobulin superfamily, of which expression is upregulated on phagocytic cells in the presence of bacteria or fungi. Here we report on the potential usefulness of assessing the soluble form of TREM-1 (sTREM-1) in biological fluids for the diagnosis of microbial infection.
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In the United States, sports-related head injuries occur frequently. The Centers for Disease Control estimates more than 300,000 sports-related concussions occur each year in the United States. ⋯ In this article, we clarify some reasons for these misunderstandings and provide some of the possible causes for the increased susceptibility of the adolescent athlete, along with evidence-based assessment tools for assisting physicians in making return-to-play decisions. Finally, suggestions for a concussion safety program in the high school setting are also provided.