Frequency of Norovirus in stool samples from patients with gastrointestinal symptoms in Switzerland.

To determine the frequency of sporadic community-acquired Norovirus (NV) infection in the German-speaking part of Switzerland, an evaluation of gastroenteritis cases seen in physicians' practices between July 2001 and July 2003 was conducted. A total of 699 stool specimens documented to be free of common bacterial pathogens was screened for the presence of NV by RT-PCR. NV was detected in 125 (17.9%) of these specimens. In the seasonal analysis, the highest rate of NV-positive samples (38.3%) was found between January and March 2002. After July 2002, the study was expanded to additionally test for NV in stool samples containing a known bacterial pathogen. Among 132 such specimens, NV was detected in only one. This suggests that NV mixed-infections are playing a marginal role in Switzerland.

[Toxoplasmosis IgG avidity: what importance does it have in pregnancy?]. / Toxoplasmose-IgG-Avidität: Welchen Stellenwert hat sie in der Schwangerschaft?

Avidity describes the binding strength of specific antibody to antigen. It was found to be low in the first phase after primary infection but then to increase over time. In addition to classic serodiagnosis of toxoplasmosis, measurement of avidity provides information making it possible to distinguish between acute and chronic infection and is of particular interest in pregnant women. In 229 women we found IgG and IgM antibodies suggestive of acute infection. A total of 188 (82%) had an avidity index > 0.3, indicating that the infection had occurred at least four months earlier. Based on this additional information, repeated testing and unnecessary anxiety can be avoided.

[Importance of AFPplus-screening in daily practice. Evaluation of 2641 analyses]. / Welche Bedeutung hat ein AFPplus-Screening im Praxisalltag. Eine Auswertung von 2641 Analyses.

Since 1991 the measurement of 3 biochemical parameters for the risk assessment of trisomy 21 pregnancy (AFPplus, Alpha-check) is also offered by private laboratories in Switzerland. This work aimed at the proof of reliability of this risk analysis in the hands of practitioners and private laboratories. The investigated cohort included 2,641 pregnant women. An anonymous questionnaire on the outcome of pregnancy furnished informations in 97% of cases (2,561 cases). At a trisomy 21 risk cutoff of one to 380, 9% of the pregnant women had conspicuous AFPplus results (trisomy 21-risk > 1 to 380; age distribution at term: 17 to 45 years; median 29.4 years). Among the conspicuous cases were 8 with trisomy 21, 1 with trisomy 18, 5 spontaneous abortions and 3 special cases. Seven of a total of 9 trisomies were detected by the screening. From these data the following diagnostic parameters for AFPplus have been calculated: specificity 91.0%, sensitivity 77.8%, positive predictive value 99.9%, false positive rate 9.0%, false negative rate 22.2%. The use of AFPplus by a practitioner cooperating with a private laboratory thus reveals a detection rate comparable to that known from larger centers. AFPplus by a practitioner cooperating with a private laboratory thus reveals a detection rate comparable to that known from larger centers. AFPplus allows to individualize the statistical age-related risk of a pregnant women before age 35. Above age 35 AFPplus may support the indication for cases suitable for cytogenetic investigation. Thorough personal information of the patient before the 16th pregnancy week by the practitioner or by genetic counseling has without any doubt first priority.

[Which are the most frequent enteropathogenic parasites found in clinical practice?]. / Welches sind die häufigsten enteropathogenen Parasiten in der Praxis?

Infectious diarrhea is seen with increasing frequency in general practice. The main reason is growing tourism in countries with conditions of public health different from ours, where the incidence of enteropathogenic parasites is higher. To obtain an overview of these parasites, the results of 23,276 stool samples from patients in general practice throughout Switzerland were analyzed. Protozoa were found in 32% of samples (4.6% pathogenic protozoa, 24% facultative pathogenic protozoa and 3.4% apathogenic protozoa). Helminths were demonstrated in 2.9% of stool samples. The helminth spectrum covered 15 types, with Trichuris trichiuria predominating (one third). 8% of the Swiss population travel every year to areas with a higher diarrhea incidence. A proportion of these subjects constitute a health risk on their return to Switzerland. They chiefly consist of people working in, or living with someone working in, the food industry. Specific parasitologic diagnosis of diarrhea contributes significantly to reducing this risk.

[Which are the most frequently occurring enteropathogenic bacteria in clinical practice?]. / Welches sind die häufigsten enteropathogenen Bakterien in der Praxis?

Diarrhea is an increasingly frequent clinical finding in Swiss medical practice. One reason is the volume of tourism in countries with different climatic and social circumstances. To obtain an overview of the enteropathogenic bacteria spectrum as a cause of diarrhea, we analyzed 11,163 stool specimens from a representative group of patients throughout Switzerland. Enteropathogenic bacteria were found in 15.2% of all specimens; 50% were Campylobacter jejuni/coli, 35% Salmonella spp., 8% Aeromonas hydrophila group, 4% Shigella spp. and 3% Yersinia enterocolitica. This distribution is taken for all age groups and for both sexes. In the infant age there was a maximum evidence of enteropathogenic bacteria of the female sex. In childhood this maximum concerned to the male sex. Patients older than fifty had no positive stool specimens. As expected the most frequent positive stool specimens were in summer.

[Myeloperoxidase deficiency--blemish or disease? Evaluation of 60,337 differential blood pictures]. / Der Myeloperoxydase-Defekt--Schönheitsfehler oder Krankheit? Eine Auswertung von 60 337 Differentialblutbildern.

Leukocyte differential counting by flow cytochemistry (H 6000, Technicon) has shown 32 subjects with partial or complete leukocyte myeloperoxidase deficiency in a population of 60,337 patients screened at a reference laboratory over a one year period. Some of the patients were hospitalized, but most were outpatients. Partial (27 patients) or complete (5 patients) myeloperoxidase deficiency was confirmed by examination of cytochemical stains (Graham-Knoll method). None had hematologic malignancy. Eleven of these 32 patients had recurrent infections; 3 of these patients were found to have a hereditary disturbance which also involved other members of the family. The findings suggest that the incidence of myeloperoxidase deficiency is much higher than was previously suspected.

[To what extent do indications for or questioning of the 24-hour ECG in ambulatory practice correlate with established ECG findings?]. / Wie weit stimmen die Indikationen bzw. Fragestellungen in der ambulanten Praxis für das 24-Stunden-Ekg. mit den festgestellten Ekg.-Befunden überein?

In 1312 patients the Holter 24-h ECG method served to detect 3190 abnormalities of the cardiac rhythm (mean 2.43 different types of arrhythmia per patient), and were classified into 14 arrhythmia groups. The main groups of indications for Holter ECG were classified as follows: palpitation; syncopes, dizziness; life-threatening arrhythmias. The positivity of the test correlated extremely well with the severity of the clinical symptoms: if syncope or dizziness were the indications for Holter ECG, abnormalities were found in 57%; if life-threatening arrhythmias were suspected, abnormalities were found in 54.7% of the patients.