Targeting of blood safety measures to affected areas with ongoing local transmission of malaria.

An outbreak of locally acquired Plasmodium vivax malaria in Greece started in 2009 and peaked in 2011. Targeting of blood safety measures to affected areas with ongoing transmission of malaria raised questions of how to define spatial boundaries of such an area and when to trigger any specific blood safety measures, including whether and which blood donation screening strategy to apply. To provide scientific advice the European Centre for Disease Prevention and Control (ECDC) organised expert meetings in 2013. The outcomes of these consultations are expert opinions covering spatial targeting of blood safety measures to affected areas with ongoing local transmission of malaria and blood donation screening strategy for evidence of malaria infection in these areas. Opinions could help EU national blood safety authorities in developing a preventive strategy during malaria outbreaks.

Primary central nervous system vasculitis: A diagnostic and therapeutic challenge. A series of 7 patients.

INTRODUCTION: Primary central nervous system vasculitis (PCNSV) is a rare disease affecting medium- and small-calibre blood vessels of the central nervous system. OBJECTIVE: The aim of this study was to analyse clinical findings and diagnostic aspects, with special attention to histopathological findings, as well as the treatments used and treatment response in patients diagnosed with PCNSV at our hospital. PATIENTS AND METHODS: We conducted a retrospective descriptive analysis of patients with a diagnosis of PCNSV at discharge from our centre and meeting the 1988 Calabrese criteria. To this end, we analysed the hospital discharge records of Hospital General Universitario de Castellón between January 2000 and May 2020. RESULTS: We analysed a series of 7 patients who were admitted with transient focal alterations and other less specific symptoms such as headache or dizziness; diagnosis was based on histological findings in 5 cases and on suggestive arteriographic findings in the remaining 2. Neuroimaging results were pathological in all cases, and CSF analysis detected alterations in 3 of the 5 patients who underwent lumbar puncture. All patients received initial treatment with megadoses of corticosteroids followed by immunosuppressive treatment. Progression was unfavourable in 6 cases, with fatal outcomes in 4. CONCLUSIONS: Despite the diagnostic challenge of PCNSV, it is essential to attempt to reach a definitive diagnosis using such tools as histopathology and/or arteriography studies, in order to promptly establish appropriate treatment and thus reduce the morbidity and mortality of this condition.

Clinical performance evaluation of Elecsys HIV Duo, Anti-HCV II, HBsAg II, Anti-HBc II, and Syphilis assays for routine screening of first-time blood donor samples at a French blood donation center.

OBJECTIVES: Implementing fully automated analyzers has become a crucial safety step in blood donation centers. The Elecsys® assays were evaluated on the cobas e 801 module (Roche Diagnostics) for routine first-time blood donor screening. MATERIALS & METHODS: Five Elecsys infectious disease assays were tested on the cobas e 801 module at Etablissement Français du Sang, Montpellier, France (March-April 2018). The performance of Elecsys HIV Duo, Anti-HCV II, HBsAg II, Anti-HBc II, and Syphilis assays was compared with PRISM HIV O Plus, HCV, HBsAg, HBcore, and newbio pk TPHA assays (specificity analyses)/ARCHITECT Syphilis TP (sensitivity analyses), respectively. Specificity was determined in residual fresh serum samples from unselected first-time blood donors (n≥5195 per parameter). Elecsys assay sensitivity was tested using 30 preselected, positively characterized samples per assay and compared with archived routine testing data for comparator assays. RESULTS: Across all parameters, specificities for repeatedly reactive samples ranged from 99.81-100.00% for Elecsys assays and 99.71-99.98% for comparator assays. Sensitivities of Elecsys and comparator assays were the same for hepatitis C (85.19%), hepatitis B surface antigen (70.00%), hepatitis B core antigen antibodies (100.00%), and syphilis (100.00%). The sensitivity of the Elecsys HIV Duo assay was higher than the comparator assay (83.33% vs. 76.67%), but the difference was not statistically significant. CONCLUSIONS: Elecsys infectious disease assays on the cobas e 801 module demonstrated high specificity and sensitivity for screening first-time blood donor samples, and were comparable with other commercially available assays. The Elecsys assays are reliable tests for screening blood donations.

[Visual episodes in non-ketonic hyperglycemia: contribution of 1 case with alteration in diffusion magnetic resonance imaging]. / Crisis visuales en hiperglucemia no cetónica: aportación de un caso con alteración en resonancia magnética de difusión.

INTRODUCTION: Non-ketonic hyperglycemia (NKH) is recognized both as a direct cause of a precipitating factor of many types of epileptic seizures-partial motor, including partial motor status, complex partial, as well as reflex motor seizures and hemichorea-hemibalism syndrome. Less known is its association with isolated visual alterations. We present a clinical case with visual episodes and diffusion restriction. MATERIAL AND METHODS: Clinical description together with the results of complementary tests: magnetic resonance imaging (MRI) brain sequences: T1W, T2W, FLAIR, DP, diffusion; and magnetic resonance angio-imaging, electroencephalogram (EEG), visual campimetry, carotid echodoppler. CLINICAL CASE: 51 year old male with visual complaints manifested as bright light in left lower quadrant with progressive increase in frequency until it becomes constant. Polyuria, polydipsia and weight loss are associated. No personal background of diabetes mellitus, epilepsy or migraine. Among the laboratory tests, non-ketonic hyperglycemia of 569 mg/dl stands out. The visual campimetry showed left lower quadrantanopsia, the intercritical EEG was reported as normal and the brain MRI showed alteration in right cortical-subcortical occipital diffusion sequence. Interpreted as simple partial seizure in the occipital region secondary to hyperglycemia, it was corrected, and the subject was asymptomatic at one month of discharge. DISCUSSION: We stress that isolated visual episodes may be the initial manifestation of NKH. The rareness of the alteration in the diffussion MRI (interpretable as artifact) orients to a possible mechanism of simple partial status. A high index of suspicion of this entity is important since adequate hypoglycemic treatment permits a perfect control of the seizure.

Crisis visuales en hiperglucemia no cetónica: aportación de un caso con alteración en resonancia magnética de difusión / Visual episodes in non-ketonic hyperglycemia: contribution of 1 case with alteration in diffusion magnetic resonance imaging

Introducción. La hiperglucemia no cetónica (HNC) se reconoce tanto como una causa directa como un factor desencadenante de numerosos tipos de crisis epilépticas: parciales motoras incluyendo estatus parcial motor, parciales complejas, así como de crisis motoras reflejas y del síndrome hemicorea-hemibalismo. Menos conocida es su asociación con alteraciones visuales aisladas. Presentamos un caso clínico con crisis visuales y restricción en la difusión. Material y métodos. Descripción clínica junto a los resultados de pruebas complementarias: resonancia magnética (RM) cerebral secuencias: T1W, T2W, FLAIR, DP, difusión; así como angiorresonancia magnética, electroencefalograma (EEG), campimetría visual y eco-doppler carotídeo. Caso clínico. Varón de 51 años con quejas visuales manifestadas como luz brillante en cuadrante inferior izquierdo, con aumento progresivo en frecuencia hasta que se hace constante. Se asocia a poliuria, polidipsia y pérdida de peso. Sin antecedentes personales de diabetes mellitus, epilepsia o migraña. Entre las pruebas de laboratorio destaca una hiperglucemia de 569 mg/dl, no cetónica. La campimetría visual demostró cuadrantanopsia inferior izquierda, el EEG intercrítico se informó como normal y la RM cerebral demostró alteración en secuencia de difusión corticosubcortical occipital derecha. Interpretado como crisis epiléptica parcial simple occipital secundaria a hiperglucemia, se corrigió ésta hallándose asintomático al mes del alta. Discusión. Destacamos que las crisis visuales aisladas pueden ser la manifestación inicial de una HNC. Lo excepcional de la alteración en RM difusión (no interpretable como artefacto) orienta a posible mecanismo de estatus parcial simple. Es importante un alto índice de sospecha de esta entidad ya que un tratamiento hipoglucemiante adecuado permite un perfecto control de las crisis

Introduction. Non-ketonic hyperglycemia (NKH) is recognized both as a direct cause of a precipitating factor of many types of epileptic seizures-partial motor, including partial motor status, complex partial, as well as reflex motor seizures and hemichorea-hemibalism syndrome. Less known is its association with isolated visual alterations. We present a clinical case with visual episodes and diffusion restriction. Material and methods. Clinical description together with the results of complementary tests: magnetic resonance imaging (MRI) brain sequences: T1W, T2W, FLAIR, DP, diffusion; and magnetic resonance angio-imaging, electroencephalogram (EEG), visual campimetry, carotid echodoppler. Clinical case. 51 year old male with visual complaints manifested as bright light in left lower quadrant with progressive increase in frequency until it becomes constant. Polyuria, polydipsia and weight loss are associated. No personal background of diabetes mellitus, epilepsy or migraine. Among the laboratory tests, non-ketonic hyperglycemia of 569 mg/dl stands out. The visual campimetry showed left lower quadrantanopsia, the intercritical EEG was reported as normal and the brain MRI showed alteration in right cortical-subcortical occipital diffusion sequence. Interpreted as simple partial seizure in the occipital region secondary to hyperglycemia, it was corrected, and the subject was asymptomatic at one month of discharge. Discussion. We stress that isolated visual episodes may be the initial manifestation of NKH. The rareness of the alteration in the diffussion MRI (interpretable as arti- 89 fact) orients to a possible mechanism of simple partial status. A high index of suspicion of this entity is important since adequate hypoglycemic treatment permits a perfect control of the seizure

Enfermedad cerebrovascular como primera manifestación de arteritis de la temporal: presentación de tres casos y revisión de su patogénesis y tratamiento / Stroke as the first manifestation of temporal arteritis: three case reports and a review of its pathogenesis and treatment

Introducción. La arteritis de células gigantes (ACG) es la forma más común de vasculitis sistémica en adultos, y presenta predominio por el sexo femenino. La incidencia de la enfermedad aumenta con la edad, y es de aproximadamente 70,1 casos por 100.000 habitantes en los pacientes mayores de 80 años. El infarto cerebrovascular como primera manifestación de una ACG es una presentación inusual y con muy mal pronóstico asociado, especialmente a nivel vertebrobasilar. Casos clínicos. Presentamos tres casos clínicos de pacientes con edades comprendidas entre los 70 y los 82 años, en los cuales se llegó al diagnóstico de arteritis de la temporal tras el infarto cerebral. En todos ellos los síntomas más frecuentes de la enfermedad (cefalea, claudicación mandibular, síntomas constitucionales, fiebre, sudor nocturno, astenia, anorexia o pérdida de peso) pasaron desapercibidos hasta el ictus isquémico. En uno de los casos la evolución del infarto cerebral produjo la muerte en las primeras 24 horas, mientras que se pudo iniciar terapia corticoidea en los otros dos, y presentaron buena respuesta inicial. En los tres pacientes se llegó al diagnóstico final tras estudio anatomopatológico de la arteria temporal. La presencia de VSG normal en uno de los casos no fue contraindicación para la realización de biopsia temporal. Conclusiones. La arteritis de la temporal es causa infrecuente de ictus isquémico. No obstante, debido a su pronóstico ominoso, es importante identificar los signos principales de la enfermedad y considerar a esta entidad en el diagnóstico diferencial del ictus isquémico en el anciano (AU)

Introducción. La arteritis de células gigantes (ACG) es la forma más común de vasculitis sistémica en adultos, y presenta predominio por el sexo femenino. La incidencia de la enfermedad aumenta con la edad, y es de aproximadamente 70,1 casos por 100.000 habitantes en los pacientes mayores de 80 años. El infarto cerebrovascular como primera manifestación de una ACG es una presentación inusual y con muy mal pronóstico asociado, especialmente a nivel vertebrobasilar. Casos clínicos. Presentamos tres casos clínicos de pacientes con edades comprendidas entre los 70 y los 82 años, en los cuales se llegó al diagnóstico de arteritis de la temporal tras el infarto cerebral. En todos ellos los síntomas más frecuentes de la enfermedad (cefalea, claudicación mandibular, síntomas constitucionales, fiebre, sudor nocturno, astenia, anorexia o pérdida de peso) pasaron desapercibidos hasta el ictus isquémico. En uno de los casos la evolución del infarto cerebral produjo la muerte en las primeras 24 horas, mientras que se pudo iniciar terapia corticoidea en los otros dos, y presentaron buena respuesta inicial. En los tres pacientes se llegó al diagnóstico final tras estudio anatomopatológico de la arteria temporal. La presencia de VSG normal en uno de los casos no fue contraindicación para la realización de biopsia temporal. Conclusiones. La arteritis de la temporal es causa infrecuente de ictus isquémico. No obstante, debido a su pronóstico ominoso, es importante identificar los signos principales de la enfermedad y considerar a esta entidad en el diagnóstico diferencial del ictus isquémico en el anciano (AU)