Geographic variation in end-stage renal disease incidence and access to deceased donor kidney transplantation.

The effect of demand for kidney transplantation, measured by end-stage renal disease (ESRD) incidence, on access to transplantation is unknown. Using data from the U.S. Census Bureau, Centers for Medicare & Medicaid Services (CMS) and the Organ Procurement and Transplantation Network/Scientific Registry of Transplant Recipients (OPTN/SRTR) from 2000 to 2008, we performed donation service area (DSA) and patient-level regression analyses to assess the effect of ESRD incidence on access to the kidney waiting list and deceased donor kidney transplantation. In DSAs, ESRD incidence increased with greater density of high ESRD incidence racial groups (African Americans and Native Americans). Wait-list and transplant rates were relatively lower in high ESRD incidence DSAs, but wait-list rates were not drastically affected by ESRD incidence at the patient level. Compared to low ESRD areas, high ESRD areas were associated with lower adjusted transplant rates among all ESRD patients (RR 0.68, 95% CI 0.66-0.70). Patients living in medium and high ESRD areas had lower transplant rates from the waiting list compared to those in low ESRD areas (medium: RR 0.68, 95% CI 0.66-0.69; high: RR 0.63, 95% CI 0.61-0.65). Geographic variation in access to kidney transplant is in part mediated by local ESRD incidence, which has implications for allocation policy development.

A note on the use of immunofluorescent methods for the detection of Pseudomonas aeruginosa in bronchitic sputum.

By immunofluorescent microscopy of sputum from 67 cases of bronchitis Pseudomonas aeruginosa was detectable in 14 as compared with nine by cultural methods.

Laboratory diagnosis of cryptosporidiosis.

Cryptosporidium spp is now widely accepted as a cause of gastroenteritis. Various methods have been applied to detect oocysts in faeces, but the difficulties of discriminating between non-cryptosporidial bodies, acid fast bodies like cryptosporidia, and cryptosporidia remain. A simple examination in two stages, suitable for routine use is described, using auramine phenol and carbol fuchsine for screening and a modified Ziehl-Neelsen staining method for confirmation. A further method, using Jenner and Giemsa stains, is of value for confirmation of identity, especially where fluorescence microscopy is unavailable. A modification of the formol-ether method of concentration is also described. Immunofluorescence and thin section electron microscopy provide definitive identification. Vomiting can be an important clinical feature of gastroenteritis, and the first description of oocysts in vomit is reported. Preliminary findings, after more than two years of study show that Cryptosporidium is an important pathogenic agent in gastroenteritis, confirm the increased incidence in children, and suggest a possible seasonal trend.

Cryptosporidium species a "new" human pathogen.

Publications describing aspects of the coccidian protozoan parasite Cryptosporidium, increased greatly during 1983 and 1984 as a result of not only increasing veterinary interest but also in the role of the parasite in the newly recognised acquired immune deficiency syndrome (AIDS). The reports reflected widespread collaboration, not only between clinicians, microbiologists, and histopathologists, but also between veterinary and human health care workers. Cryptosporidium was first described in mice in 1907 and subsequently in various other species; it was not described in man until 1976. Several likely putative species have been described, but there is probably little host specificity. Experimental and clinical studies have greatly increased the knowledge about the organism's biology. The parasite undergoes its complete life cycle within the intestine, although it may occasionally occur in other sites. The main symptom produced is a non-inflammatory diarrhoea, which, in patients with AIDS and children in Third World countries, may be life threatening: even in immunocompetent subjects this symptom is usually protracted. Attempts to find effective chemotherapeutic agents have been unsuccessful. Epidemiologically the infection was thought to be zoonotic in origin, but there is increasing evidence of person to person transmission. Diagnosis has depended upon histological examination, but simple methods of detection have now been described: more invasive methods need no longer be used. The parasite, which is found more commonly in children, occurs in about 2% of faecal specimens examined and seems to be closely associated with production of symptoms. A serological response has been shown. Much remains to be learned about its epidemiology and pathogenic mechanisms, while the expected increase in incidence of AIDS makes an effective form of treatment essential.