Quality assurance of malaria rapid diagnostic tests used for routine patient care in rural Tanzania: microscopy versus real-time polymerase chain reaction.

BACKGROUND: The World Health Organization (WHO) recommends parasitologic confirmation of suspected malaria cases before treatment. Due to the limited availability of quality microscopy services, this recommendation has become scalable following increased use of antigen-detecting malaria rapid diagnostic tests (RDTs) in many malaria-endemic countries. This study was carried out to monitor quality of RDT performance in selected health facilities using two quality assurance (QA) methods: reference microscopy and detection of parasite DNA by real-time quantitative polymerase chain reaction (qPCR) on dried blood spots (DBS). METHODS: Blood samples for QA were collected from patients undergoing RDT for diagnostic confirmation of malaria during two to three consecutive days per month in 12 health facilities in rural Tanzania. Stained blood smears (BS) were first examined at the district hospitals (BS1) and then at a reference laboratory (BS2). Discordant BS1 and BS2 results prompted a third examination. Molecular analysis was carried out at the Ifakara Health Institute laboratory in Bagamoyo. RESULTS: Malaria RDTs had a higher positivity rate (6.5%) than qPCR (4.2%) or microscopy (2.9% for BS1 and 2.5% for BS2). Poor correlation was observed between RDT and BS results: BS1 (K = 0.5), BS2 (K = 0.43) and qPCR (K = 0.45), challenging the utility of these tests for RDT QA. In addition, many challenges related to qPCR processing were recorded and long delays in obtaining QA test results for both microscopy and qPCR. CONCLUSIONS: Overall there was limited agreement among the three diagnostic approaches and neither microscopy nor qPCR appear to be good QA options for RDTs under field conditions.

Acid-base balance during social interactions in rainbow trout (Oncorhynchus mykiss).

Socially subordinate rainbow trout (Oncorhynchus mykiss) experience chronic stress that impacts upon a variety of physiological functions, including Na(+) regulation. Owing to the tight coupling between Na(+) and Cl(-) uptake and, respectively, H(+) and HCO(3)(-) loss at the gill, ionoregulatory changes associated with social status may affect acid-base regulation. The present study assessed the responses of dominant, subordinate and control trout to hypercapnia (1% CO(2)) to test this hypothesis. Social status appeared to impact net acid excretion (J(net)H(+)) as subordinate individuals failed to increase net acid flux in response to hypercapnia. However, blood acid-base status was found to be unaffected by social status before or during hypercapnic exposure, indicating that subordinate fish were as effective as dominant or control trout in achieving compensation for the acid-base disturbance induced by hypercapnic exposure. Compensation in all groups involved decreasing Cl(-) uptake in response to hypercapnia. The branchial activities of both Na(+),K(+)-ATPase (NKA) and V-type H(+)-ATPase were affected by social interactions and/or exposure to hypercapnia. Branchial NKA activity was higher but V-ATPase activity was lower in control fish than in dominant or subordinate trout. In addition, control and subordinate but not dominant trout exposed to 24h of hypercapnia exhibited significantly higher branchial V-ATPase activity than fish maintained in normocapnia. Collectively, the data suggest that subordinate trout are able to regulate blood pH during a respiratory acidosis.

Lymph-nodal ratio in gastric cancer staging system.

AIM: Many studies have indicated that lymph node metastases and the depth of invasion of the primary tumor are the most reliable prognostic factors for patients with radically resected gastric cancer. Recently the ratio between metastatic and examined lymph nodes (n ratio) has been proposed as a new prognostic indicator. The aim of this study was to evaluate the prognostic value of n ratio in patients with gastric cancer. METHODS: We retrospectively reviewed the data of 399 patients who had undergone radical resection for gastric carcinoma. RESULTS: N ratio was significantly greater in patients with large and undifferentiated tumors. Moreover, it was significantly related to both the number and location of lymph node metastases. Survival curves showed that n ratio was strictly related to patients' survival. Multivariate analysis confirmed that it was an important independent prognostic indicator. CONCLUSION: N ratio is useful to better evaluate the status of lymph node metastases in patients with gastric cancer submitted to radical surgery. Moreover it is a very important independent prognostic factor for gastric cancer.

Herba Artemisiae annuae tea preparation compared to sulfadoxine-pyrimethamine in the treatment of uncomplicated falciparum malaria in adults: a randomized double-blind clinical trial.

Tea preparations from the herb Artemisia annua L. (Aa) which is used in traditional Chinese medicine might offer an inexpensive way of producing artemisinin drugs locally. We compared Aa with sulfadoxine-pyrimethamine (SP) in the treatment of uncomplicated falciparum malaria in semi-immune adults. After seven days, the cure rate was 7/10 for the Aa compared to 7/9 for SP; this dropped to 4/10 for Aa and 4/9 for SP at day 14 and to 1/9 for Aa and 3/8 for SP at day 28.

Maturity-Onset Diabetes of the Young: An Overview with Focus on the Middle East.

Today, there are more than 32 million patients with diabetes in the Middle East (ME), the number is expected to double by 2040. In contrast to Europe and North America and despite the high prevalence of diabetes in ME, epidemiological data about incident and types of diabetes in the region is very limited. Maturity-onset diabetes of the young (MODY) is a subtype of monogenic diabetes representing 2-5% of all diabetes patients. The disease is autosomal dominant mode of inheritance characterized by ß-cell malfunction below the age of 35 years. To date, there are 15 different MODY forms that have been identified; each has a distinct genetic etiology. It is very common that MODY is misdiagnosed between with type 1 or type 2 diabetes. Hence, accurate genetic diagnosis is crucial to individualize the treatment and to improve glycaemia control. New technologies such as next-generation sequencing (NGS) offer an excellent alternative to screen and identify causative MODY mutations. In this review, we summarize the main clinical and genetic characteristics for each MODY form. In addition, we shed light on MODY studies that have been executed in the ME region.

Surgical treatment for incisional hernias.

BACKGROUND: A great variety of surgical techniques have been proposed to repair large abdominal incisional hernias, but the best results are achieved using synthetic grafts as in the Rives' or Ramirez' procedure. METHODS: During the period September 1993-May 2001, a total of 145 patients, 54 males and 91 females, mean age 52 (range 16-88) with large incisional hernia were observed. Ninety-two hernias were bigger than 10 cm. The average follow-up was 3 years (1-72 months). All successfully underwent surgery using the following techniques: 19 (13.1%) simple fascial sutures, 68 (46.9%) implants of retromuscolar polypropylene grafts (Rives' or Ramirez' technique), 24 (16.5%) subcutaneous meshes, 17 (11.7%) preperitoneal meshes (14 polypropylene, 2 glycolic acid, 1 Goretex), 4 (2.75%) intraperitoneal implants of polypropylene meshes, 13 (9.05%) intraperitoneal glycolic acid grafts plus retromuscular polypropylene graft. RESULTS: One patient died in postoperative for heart failure. Morbidity was 8 subcutaneous hemorrhagic suffusions, 10 seromas which were resolved by repeated percutaneous drainage, 4 suppurating wounds that did not require graft removal, 2 little recurrences treated by a new mesh repair under local anaesthesia, 2 sinus for mesh intollerance and 1 fistula requiring a new intervention. CONCLUSIONS: In this report we discuss the tolerability and reliability of mesh repair, especially in Rives' and Ramirez' technique.

The sentinel node in anal carcinoma.

AIMS AND BACKGROUND: Anal cancer is a rare condition. The inguinal lymph nodes are the most common site of metastasis in this neoplasm. The inguinal lymph node status is an important prognostic indicator and the presence of metastases is an independent prognostic factor for local failure and overall mortality. Depending on the primary tumor size and histological differentiation, metastasis to superficial inguinal lymph nodes occurs in 15-25% of cases. METHODS AND STUDY DESIGN: To evaluate the inguinal lymph node status we performed a search for the sentinel node in a female patient affected by squamous and carcinoma. RESULTS: Identification and examination of the sentinel node was positive and postoperative histology showed the presence of bilateral lymph node metastases. CONCLUSIONS: We suggest that examination of the sentinel node in anal cancer could be an efficient way to establish the inguinal lymph node status, which would help the clinician to plan and perform adequate treatment.

[Indications for the use of somatostatin and octreotide in digestive pathology]. / Indicazioni all'uso della somatostatina e dell'octreotide in patologia digestiva.

The authors report their experience about the use of somatostatin (SST-14) (47 cases) and its analog octreotide (15 cases) in gastrointestinal diseases. On the basis of own clinical data and literature review, at present they think useful SST-14 employ in the upper gastrointestinal tract bleeding and acute pancreatitis. Out of the emergency, they consider favourable the use of octreotide, above all because of the easy subcutaneous administration's route.

[Day Surgery. An opportunity for postgraduate surgeons' training]. / Formazione dei giovani chirurghi agli interventi in regime di Day Surgery.

BACKGROUND: It is widely acknowledged that day surgical procedures must be performed by expert personnel or carried out under their supervision. Recent regulations introduced by Schools of Postgraduate Surgery oblige postgraduate surgeons to carry out a number of minor and medium-sized operations. The characteristics of day surgery make it an appropriate organisational model for complying with the requirements of these directives. Interventional research has shown that adequate training permits education to be coupled with good results. METHODS: The postgraduate surgeons are trained to perform hernioplasty using Trabucco's method through surgical training based on an initial phase of at least 20 operated patients during which they act as the second surgeon, and a phase of 10 patients during which they are the first surgeon working alongside a tutor with proven experience. Five doctors are completing their training, having acted as first surgeon assisted by a tutor during the period 01/11/1999 - 31/10/00 in 60 hernioplasty operations using Trabucco's method out of a total of 143 carried out in the same period, with an average of 12 operations each. Specific informed consent was obtained from all patients. All operations were performed under local anesthesia. RESULTS: There was no need to convert to general anesthesia. Complications were comparable to those occurring during surgery performed by experienced colleagues. No recurrences were reported. The mean follow-up was 10 months. CONCLUSIONS: An evaluation of these data confirms the real possibility of dedicating a number of ambulatory surgical procedures to training postgraduate surgeons. This would not lead to a reduced efficacy of treatment and does not increase the percentage of complications.

[Tumor samples as a tool for large-scale monitoring of antigen-specific lymphocytes in gastric and colorectal neoplasms]. / L'utilizzo di campioni di tessuto tumorale come mezzo per il monitoraggio su larga scala dei linfociti antigene specifici nelle neoplasie gastriche e colorettali.

The characterization of tumor-associated antigens has enabled to direct the host immune response towards the autologous tumor through appropriate loading and presentation of the antigen. In vivo conditions that generate large numbers of tumor antigens would be an important step in vaccine strategies. In this study we have therefore tested the ability of freshly isolated gastric and colorectal cancer cells to induce a specific anti-tumor response in autologous T lymphocytes. Because dendritic cells (DC) are critically involved in both initiating and boosting host immune responses, they have been used to present apoptotic bodies generated by irradiated tumor cells. Results show that these native antigens stimulate T cytotoxic response against tumor, but not peritumor normal tissues. Induction of IFN-gamma secreting cell activity, which is a standard readout in current cancer vaccine protocols, was also demonstrated by Elispot single-cells assay. These data show the antigenicity of gastric and colorectal tumor cells and open new perspectives in immunotherapy.

[Lymphoscintigraphic localization of sentinel lymph nodes in colorectal carcinoma in early stage: results of a single center study and proposal of a multicenter protocol]. / Localizzazione linfoscintigrafica del linfonodo sentinella nel carcinoma del colon-retto in stadio precoce risultati di uno studio monocentrico e proposta di un protocollo multicentrico.

In colorectal cancer the sentinel node dissection may help to identify any unusual mesenteric lymphatic drainage pattern from the primary tumor site (ex/skip metastases); assuming that accurate pathological staging is critical for therapeutic decisions we are conducing a study to evaluate the feasibility of the sentinel node technique in colorectal neoplasms and its overall accuracy in predicting regional lymph nodes metastases for appropriate staging. From February 2001 to September 2004 we included in this study 30 patients with rectal lesions or degenerate colonic polyps not radically excised by endoscopy. Lymphatic mapping was performed with low molecular weight albumin colloid labelled with 500Mci of 99mTc in a 2 ml volume and injected submucosally by an endoscopic route at the four cardinal points around the tumor, the afternoon before the surgical procedure, both in case of colonic or rectal lesions. Scintigraphic images were obtained with a gamma camera fitted with a general purpose collimator. The day of the intervention, a hand held gamma detecting probe (Scintiprobe m100, Pol-Hi-Tech, Italy) was employed to detect the "hot" nodes, in vivo and ex vivo. These lymph nodes were tagged with a stitch in vivo; the specimen was removed by a standard resection and SLN were dissected ex vivo and sent separately for pathological examination. In case of rectal lesions, the sentinel nodes were searched ex vivo into mesorectal fat in case. All lymph nodes, including blue or hot ones, were embedded separately for preparation of paraffin sections and haematoxylin and eosin staining. Sentinel lymph node were submitted to multi-seriate sections in order to look for micrometastases. Using the radioactive tracer, sentinel lymph nodes were successfully identified in 27 out of 30 patients. Concordance between SLNs and nodal status was observed in 23 out of 27 cases (85%); two patients (7.4%) were upstaged, as SLN was the only site of metastases. In another two cases we observed no concordance between negative sentinel node and non sentinel nodes (false negative rate, 7.4%). Starting from this experience we are proposing a multicentric trial concerning the value of sentinel node technique in rectal cancer and in early colorectal cancers detected by screening programs.

Microwave oven for improved tissue fixation and decalcification.

The present study reports on our experience on microwave (MW) fixation and decalcification. A common kitchen microwave oven was used. Autoptical material and biopsies from different organs were immersed in 10% formalin and MW irradiated varying time and power. Bone biopsies were immersed in 5% formic acid and MW irradiated. The tissues were then routinely embedded in paraffin. The results, checked on routinely stained sections, indicate that MW irradiation speeds up both fixation and decalcification. Optimal treatment conditions are indicated.

Role of radioimmunolocalization in the staging of gastric carcinoma.

Intraoperative radioimmunolocalization is a potentially useful technique for staging gastric neoplasms without resorting to extensive surgical intervention. Before preoperative immunohistochemical typing for the presence or absence of tumor-associated glycoprotein (TAG) 72, we performed intraoperative radioimmunodetection on three patients presenting with gastric carcinoma using a whole monoclonal antibody (B72.3) marked with Indium-111 injected 1 week before operation. The results were calculated on the number of lymph node stations and yielded a high sensitivity due to a specificity of 72% and the absence of false negatives. Intraoperative radioimmunolocalization is a promising method for noninvasive staging of both early and advanced gastric carcinoma.