Performance evaluation of different strategies based on microscopy techniques, rapid diagnostic test and molecular loop-mediated isothermal amplification assay for the diagnosis of imported malaria.

OBJECTIVES: Malaria is one of most common tropical diseases encountered in travellers and migrants. It requires an urgent and reliable diagnosis considering its potential severity. In this study, performance of five diagnostic assays were evaluated in a nonendemic region and compared prospectively to quantitative PCR (qPCR). METHODS: A prospective study was conducted at Toulouse Hospital from August 2017 to January 2018 and included all patients with initial Plasmodium screening. Thin and thick blood smears (TnS, TkS), quantitative buffy coat (QBC), rapid diagnostic tests (RDTs) and commercial loop-mediated isothermal amplification (LAMP) were independently performed on each blood sample and compared to our qPCR reference standard. RESULTS: The study encompassed 331 patients, mainly returning from Africa. qPCR detected 73 Plasmodium-positive samples (including 58 falciparum). Individually, LAMP had a 97.3% (71/73) sensitivity, far ahead of TnS (84.9%, 62/73), TkS (86.3%, 63/73), QBC (86.3%, 63/73) and RDT (86.3%, 63/73). RDT demonstrated a high sensitivity for falciparum (98.3%, 57/58) but missed all ovale, malariae and knowlesi infections. Specificity was excellent for all techniques (99.6-100%). The most sensitive diagnosis strategies were TnS + RDT (95.9%, 70/73), TnS + LAMP (97.3%, 71/73) and TnS + RDT + LAMP (100%, 73/73), about 10% higher than strategies using exclusively microscopy, TkS + TnS (87.7%, 64/73) or QBC + TnS (87.7%, 64/73). TnS remains necessary for Plasmodium species identification and quantification. Adding sequentially TnS only on LAMP-positive samples did not decrease TnS + LAMP strategy sensitivity. CONCLUSIONS: In nonendemic countries, the currently recommended microscopy-based strategies seem unsatisfactory for malaria diagnosis considering RDT and LAMP performance, two rapid and sensitive assays that require limited training.

Should we abandon standard microscopy when screening for urinary tract infections in young children?

Dipstick analysis is a screening test for urinary tract infection (UTI) in office practice. Standard urine microscopy is available offsite. We evaluated the usefulness of these tests on consecutive urine samples obtained by bladder catheterization in young children with a possible UTI. Thirty of 230 children had positive cultures. Dipstick analysis was specific (98%) but not sensitive (70%). Standard microscopy was not specific. Dipstick analysis and urine culture are useful tests for the diagnosis of UTI.

[Epidemiology of children's intestinal parasitism in the Guadalquivir Valley, Spain]. / Epidemiología del parasitismo intestinal infantil en el Valle del Guadalquivir, España.

BACKGROUND: Intestinal parasitism represents a public health problem that should be periodically assessed in each region. In the present paper, a study about prevalence of intestinal parasites, has been carried out in children from the natural region of the Guadalquivir Valley. METHODS: During the period 1994-1996, 1,917 children without symptoms, aging between 6 and 10, were studied by means of coprological analysis and Graham method, all of them living in 20 villages in the Guadalquivir valley. RESULTS: The overall prevalence of intestinal parasitism have been of 27.12%. The reported parasites and their prevalence are as follows: Enterobius vermicularis (20.44%), Giardia lamblia (5.05%), Entamoeba coli (2.45%), Endolimax nana (1.61%), Entamoeba histolytica (0.31%), Entamoeba hartmanni (0.05%), Iodamoeba bütschlii (0.05%). CONCLUSIONS: The overall prevalence of intestinal parasites is similar to that found in other spanish region, if only a little bit more favourable probably due to the long lasting drought and the improvements in health resources, no geohelminths have been detected unlike other protozoan infections, giardiasis maintains a relatively high prevalence.

Wnt signaling and hepatocarcinogenesis: the hepatoblastoma model.

The Wnt/ß-catenin pathway plays a key role in liver development, regeneration and tumorigenesis. Among human cancers tightly linked to abnormal Wnt/ß-catenin signaling, hepatoblastoma (HB) presents with the highest rate (50-90%) of ß-catenin mutations. HB is the most common malignant tumor of the liver in childhood. This embryonic tumor differs from hepatocellular carcinoma by the absence of viral etiology and underlying liver disease, and by distinctive morphological patterns evoking hepatoblasts, the bipotent precursors of hepatocytes and cholangiocytes. Recent studies of the molecular pathogenesis of hepatoblastoma have led to identify two major tumor subclasses resembling early and late phases of prenatal liver development and presenting distinctive chromosomal alterations. It has been shown that the molecular signature of Wnt/ß-catenin signaling in hepatoblastoma is mainly imposed by liver context, but differs according to developmental stage. Finally, the differentiation stage of tumor cells strongly influences their invasive and metastatic properties, therefore affecting clinical behavior.

Acute oxygen deprivation: neuropsychological profiles and implications for rehabilitation.

OBJECTIVE: To investigate areas of neuropsychological functioning in severe anoxia survivors that have received little prior attention but that have significant implications for rehabilitation. DESIGN: Residents of a long-term neurobehavioural rehabilitation facility were administered comprehensive neuropsychological protocols. Areas assessed were arousal and attention, executive abilities, reasoning, language, visuospatial abilities, motor, praxis, memory, affective regulation, and insight into deficits. RESULTS: Subjects were impaired in all areas except in performing automatized tasks. Areas of dysfunction not previously emphasized included praxis, affective regulation, and verbal fluency. CONCLUSION: Areas of compromise not previously emphasized were identified. Their routine assessment can assist rehabilitation professionals in better serving anoxic encephalopathy survivors, particularly those with profound behavioural dysregulation.

A multimodal support group with Hispanic traumatic brain injury survivors.

OBJECTIVES: (a) To design and pilot a culturally sensitive and neuropsychologically informed support group addressing barriers to emotional, social, and vocational adjustment among high-level functioning Hispanic/Latino TBI survivors. (b) To determine efficacy through outcome measures. INTERVENTION: Ten-week multimodal, culturally sensitive support group focusing on TBI sequelae education, relaxation techniques, coping skills development, behavioral goal setting and monitoring, and family participation. PARTICIPANTS: Six Spanish-speaking high-level functioning TBI survivors aged 20-42. SETTING: Outpatient neuropsychological assessment and treatment center. OUTCOME MEASURES: Beck Hopelessness Scale; Purpose in Life Test; Perceived Self-Regulatory Ability Inventory. RESULTS: Participants' sense of personal destiny and feelings of hopelessness improved, as evidenced by objective measures and self-report. A telephone interview a year later indicated that gains had been maintained, and most participants were vocationally active. CONCLUSIONS: Results underscore the importance of considering linguistic and ethnic factors in developing support groups.

[Xanthogranulomatous pyelonephritis. Our theory and discussion on the development of such an entity. Report of 9 cases]. / Pielonefritis xantogranulomatosa. Nuestra teoria y discusión sobre el desarrollo de tal entidad. Presentación de nueve casos.

The authors present 9 cases of xanthogranulomatous pyelonephritis observed in the "Juan XXIII" Hospital in Tarragona. They emphasize the relationship between lithiasis, chronic urinary infection and antigenic stimulation for the development of this entity, the progressive result of a lesion in the kidney tissue with immobilized infectious calcareous deposits. In the granulomatous lesion they find cells called antigen-antibody quartets, with foamy-type histiocytes, the nodular collections of which constitute the key to X.P. The formation of lymphocytic germinal centres is another antigenic stimulus in some parts of the kidney tissue. These structures are due to the storing of antibodies and therefore the immunoglobulins would not be released towards the blood stream, which would explain changes in the immunoglobulins in these patients' serum.

Cat-scratch disease encephalopathy: a cause of status epilepticus in school-aged children.

We describe 6 school-aged patients who presented with status epilepticus (SE) secondary to cat-scratch disease (CSD) encephalopathy to alert clinicians to this distinctive clinical entity. The hospital database for admissions during 1 year was reviewed for patients presenting with SE; 4 of 5 previously healthy school-aged children with SE had CSD encephalopathy based on elevated indirect fluorescent antibody titers to Bartonella henselae. CSD encephalopathy should be included in the differential diagnosis of school-aged children presenting with SE.

[Determinants of the use of pediatric consultations: study of child morbidity and maternal variables]. / Determinantes del uso de las consultas de pediatría: estudio de morbilidad infantil y variables maternas.

OBJECTIVE: To know the relations of the frequency of the pediatrics consultations with the maternal use of the consultations of family medicine, the maternal perception of his son's health, the events happened previously in the family, the infantile morbidity and socioeconomic condition. DESIGN: Prospective and observational study, duration 12 months. EMPLACEMENT: Primary care. PATIENTS: 261 children from 0 to 12 years old selected by systematic randomized pattern. The mother was required to have history in the center. MEASUREMENTS AND RESULTS: The dependent variable was the frequentation to the pediatric clinics, and the independent variables were the mother frequentation to the medical clinics; perception of its son's health, measured by health questionnaire; inventory of previous events according to Holmes and Rahe's questionnaire; sociodemographic variables and children morbidity registered in the medical files. The mean of infantile frequentation proved to be 10.18 visits per year (7.9 DS). 12% of children were high users and they accounted for 42% of all contacts. The variables associated to the frequentation were: age smaller than the boy, infantile morbidity and maternal frequent to the medical services, p < 0.001 for each one the variables. Those variables explained 40.8% of the variance in volume of care. CONCLUSIONS: The maternal use exercises an independent influence in the use of the pediatric services. Educative performances directed to the mother could improve this behaviour. The age is a predisposing factors of frequentation to the infantile services. The conditions of health are a potent predictor of frequentation, those children require more cares to attend their needs. Educational strategies which improve the level of maternal cares to the child in situation of illness could diminish the cares which are offered in pediatrics.

[Maternal anxiety, family dysfunction, morbidity and attendance at pediatric consultations]. / Ansiedad materna, disfunción familiar, morbilidad y frecuentación a las consultas de pediatría.

OBJECTIVE: To know the use of the pediatric offices and their connection with the family dysfunction, the maternal anxiety and children's morbidity. DESIGN: Observational prospective study the children that attended during a period, of one year. SETTING: EAP Virgen de la Fuensanta. PATIENTS: Children aged 0-12 years old, since 1st. October 1994 to 31st. September 1995, 649 children, except children that suffered chronic disease. MEASURES: Consultation and its diagnoses were registered in the health history, according WONCA classification, completing socioeconomical questionnaire, family APGAR test, and anxiety scale stai/trait (STAI). Groups were compared according attendees, consulting/year average plus one standard deviation, or no attendees. We used statistics techniques squared-Chi, simple regression and logistic regression. RESULTS: To be attendee was significantly associated with minor age of child and morbidity. Significant differences were not found with family dysfunction, neither with maternal anxiety state or trait, nor with socioeconomical variables. CONCLUSIONS: The high use of pediatric consulting may be not, seeing that hyperusers in account of their age and morbidity have bigger hardships.