Amplification of the six major human herpesviruses from cerebrospinal fluid by a single PCR.
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We used a novel type of primer system, a system that uses stair primers, in which the primer sequences are based on consensus sequences in the DNA polymerase gene of herpesvirus to detect herpesviruses by PCR. A single PCR in a single tube detected the six major herpesviruses that infect the central nervous system: herpes simplex virus type 1 (HSV-1), and type 2 (HSV-2), cytomegalovirus (CMV), Epstein-Barr virus (EBV), varicella-zoster virus (VZV), and human herpesvirus 6 (HHV-6). We used the technique to analyze 142 cerebrospinal fluid (CSF) samples that had been stored at -80 degrees C and compared the results with those obtained previously for the same samples by standard, targeted PCR. Four hundred one targeted PCR tests had been run with the 142 samples to detect HSV-1, HSV-2, CMV, and VZV; screening for EBV and HHV-6 was not prescribed when the samples were initially taken. Eighteen CSF samples tested positive by classic targeted PCR. The herpesvirus consensus PCR detected herpesviruses in 37 samples, including 3 samples with coinfections and 17 viral isolates which were not targeted. Two samples identified as infected by the targeted PCR tested negative by the consensus PCR, and eight samples that tested positive by the consensus PCR were negative by the targeted PCR. One hundred three samples scored negative by both the targeted and the consensus PCRs. This preliminary study demonstrates the value of testing for six different herpesviruses simultaneously by a sensitive and straightforward technique rather than screening only for those viruses that are causing infections as suggested by clinical signs. (+info)
Non-epileptic attack disorder (NEAD): a comprehensive review.
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Non-epileptic attack disorder (NEAD) represents a well-recognized clinical problem with a reported incidence among individuals with a diagnosis of intractable epilepsy as high as 36%. A failure to identify this disorder may lead to certain risks for the patient including polypharmacy, anticonvulsant toxicity, hazardous intervention, social and economic demands and a lack of recognition or neglect of any underlying psychological distress. This review provides a description of NEAD in an historic and societal context and discusses the variety of terminology which has been applied to this psychophysiological phenomenon. Epidemiology and associated methodological limitations; and diagnostic and classification issues related to NEAD in comparison to epilepsy are considered. The problems of failure to recognize NEAD in comparison to epilepsy are considered. The problems of failure to recognize NEAD are outlined, and theoretical and empirical aetiological issues are discussed. (+info)
Transrectal ultrasonography in the assessment of congenital vaginal canalization defects.
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Our aim was to evaluate the reliability of transrectal ultrasonography in the preoperative assessment of congenital vaginal canalization defects. We studied nine patients, six with suspected Rokitansky syndrome and three with suspected complete transverse septum. Before corrective surgery all the patients underwent pelvic examination, transabdominal and transrectal ultrasonography. The ultrasonographic findings were compared with the surgical ones. Transrectal ultrasonography provided an accurate map of the pelvic organs showing the precise distances between the urethra and bladder anteriorly, rectum posteriorly, retrohymenal fovea caudally, and pelvic peritoneum cranially. Transrectal ultrasonography produced a picture that corresponded perfectly with the real anatomical situation. Conversely, abdominal ultrasonography provided inadequate images in six of our nine patients, and magnetic resonance imaging was responsible for a mistaken diagnosis in one patient with suspected transverse vaginal septum. In conclusion, if our results are confirmed in larger series, transrectal ultrasonography could be considered as a diagnostic procedure of choice in the assessment of vaginal canalization defects. (+info)
Geometric features of coronary artery lesions favoring acute occlusion and myocardial infarction: a quantitative angiographic study.
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OBJECTIVES: We sought to identify the angiographic predictors of a future infarction, to study their interaction with time to infarction, patient risk factors and medications, and to evaluate their clinical utility for risk stratification. BACKGROUND: Identification of coronary lesions at risk of acute occlusion remains challenging. Stenosis severity is poorly predictive but other stenosis descriptors might be better predictors. METHODS: Eighty-four patients with an acute myocardial infarction and a coronary angiogram performed within the preceding 36 months (baseline angiogram), and after infarction were selected. All coronary stenoses (from 10% to 95% lumen diameter reduction) at baseline angiogram were analyzed by computer-assisted quantification. Each of the 84 lesions responsible for the infarction (culprit) was compared with the nonculprit stenoses (controls) in the same patient. RESULTS: Culprit lesions were more symmetrical (symmetry index +15%; p < 0.001), had steeper outflow angles (maximal angle +4 degrees; p < 0.001), were more severe (percent stenosis +5%; p = 0.001) and longer (+ 1.5 mm, p = 0.01) than controls. The symmetry index and the outflow angles were the two independent predictors of infarction at three-year follow-up. Stenosis severity predicted only infarctions occurring within 1 year after angiography. In moderately severe stenoses (40% to 70% stenosis), stratification using the symmetry index and outflow angles accurately predicted lesions remaining free of occlusion and infarction at three-year follow-up. CONCLUSIONS: Better characterization of stenosis geometry might help to understand the pathophysiologic mechanisms triggering coronary occlusion and to stratify patients for improved care. (+info)
Clinical evaluation of the enhanced Gen-Probe Amplified Mycobacterium Tuberculosis Direct Test for rapid diagnosis of tuberculosis in prison inmates.
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The reliability of the enhanced Amplified Mycobacterium Tuberculosis Direct Test (E-MTD; Gen-Probe, Inc., San Diego, Calif.) for rapid diagnosis of pulmonary tuberculosis (TB) was evaluated by testing 1, 004 respiratory specimens from 489 Texas prison inmates. Results were compared to those of mycobacterial culture (BACTEC TB 460 and Middlebrook 7H11 biplates), smear for acid-fast bacilli (AFB; auramine O), and clinical course. After chart review, three patients (nine specimens) who were on antituberculosis therapy before the study began were excluded from final analysis. Of the remaining 995 specimens, 21 were AFB smear positive: 13 grew Mycobacterium tuberculosis complex (MTBC), 6 grew nontuberculous mycobacteria, and 2 (from two patients diagnosed with TB and started on therapy after the study began) were culture negative. Twenty-eight specimens (20 patients) were positive for MTBC by culture and E-MTD. Seven specimens (seven patients) were positive by culture alone; three were from patients who had other E-MTD-positive specimens, two were false-positive cultures, and two were false-negative E-MTD results. Eight specimens were positive by E-MTD only; four specimens (four patients) were false-positive E-MTD results, and four specimens were from two patients with earlier E-MTD-positive specimens that grew MTBC. Thus, there were 22 patients with TB (10 smear positive and 12 smear negative). The sensitivity and specificity of the AFB smear for diagnosis of TB, by patient, were 45.5 and 98.9%, respectively. After resolving discrepancies, these same values for E-MTD were 90.9 and 99.1% overall, 100 and 100% for the smear-positive patients, and 83.3 and 99.1% for the smear-negative patients. Excluding the one smear-negative patient whose E-MTD-negative, MTBC culture-positive specimen contained inhibitory substances, the sensitivity of E-MTD was 95.2% overall and 90.9% in smear-negative patients. The specificity and positive predictive value of E-MTD can be improved, without altering other performance characteristics, by modifying the equivocal zone recommended by the manufacturer. These data suggest that E-MTD is a reliable method for rapid diagnosis of pulmonary TB, irrespective of the AFB smear result. Guidelines for the most appropriate use of E-MTD with smear-negative patients are needed. (+info)
The misdiagnosis of epilepsy and the management of refractory epilepsy in a specialist clinic.
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We assessed the frequency, causes and consequences of erroneous diagnosis of epilepsy, and the outcome of patients referred with 'refractory epilepsy', by retrospective analysis of the case records of 324 patients. The sample was divided into those exposed to anti-epileptic drugs (n = 184), of whom 92 were said to have refractory seizures, and those who had not received treatment (n = 140). The latter group is reported elsewhere. The overall misdiagnosis rate was 26.1% (46/184), with incomplete history-taking and misinterpretation of the EEG equally responsible. Side-effects were reported by 19/40, while unnecessary driving restrictions and employment difficulties were encountered by 12/33 and 5/33, respectively. Of those labelled 'refractory epilepsy', 12 did not have epilepsy. Sixteen were rendered seizure-free and 25 significantly improved by the optimal use of anti-epileptic drugs or surgery. Diagnostic and management services for patients with suspected and established epilepsy are suboptimal, with psychological and socio-economic consequences for individual patients. The resulting economic burden on the health and welfare services is probably substantial. (+info)
Current trends in trachoma in a previously hyperendemic area. The Trachoma Study Group.
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In response to reports of an excessive number of cases of trachoma at the end of 1995 from the western parts of the North Indian state of Uttar Pradesh, 837 children in the age-group 1-10 years were examined in three villages from where the maximum number of cases hailed. Clinically, the prevalence of trachoma was found to be 8.5% (71). The prevalence was significantly higher in males as compared to females (p < 0.05); and was observed to increase with age. 85.9% (61) of the clinically diagnosed children were active infective cases. 54.9% (39) of the clinically diagnosed cases showed the presence of antigen in the upper tarsal conjunctival scraping from the affected eye, using the Chlamydia trachomatis direct specimen kit (Syva MicroTrak, UK). It was concluded that ophthalmologists must be reoriented to the clinical diagnosis of trachoma to prevent overdiagnosis. (+info)
Multiple system atrophy.
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Multiple system atrophy is a neurological disorder that has gone unrecognized for too long due to its involvement across multiple regions of the central nervous system. This disorder is finally being unveiled through increased reporting in the scientific literature. Further research will enhance our understanding of this disease and lead to more effective treatment regimens as well as an improved quality of life for patients with MSA. (+info)