Portable Pocket colposcopy performs comparably to standard-of-care clinical colposcopy using acetic acid and Lugol's iodine as contrast mediators: an investigational study in Peru.

OBJECTIVE: Our goal was to develop a tele-colposcopy platform for primary-care clinics to improve screening sensitivity and access. Specifically, we developed a low-cost, portable Pocket colposcope and evaluated its performance in a tertiary healthcare centre in Peru. DESIGN AND SETTING: Images of the cervix were captured with a standard-of-care and Pocket colposcope at la Liga Contra el Cáncer in Lima, Peru. POPULATION: Two hundred Peruvian women with abnormal cytology and/or human papillomavirus positivity were enrolled. METHODS: Images were collected using acetic acid and Lugol's iodine as contrast agents. Biopsies were taken as per standard-of-care procedures. MAIN OUTCOME MEASURES: After passing quality review, images from 129 women were sent to four physicians who provided a diagnosis for each image. RESULTS: Physician interpretation of images from the two colposcopes agreed 83.1% of the time. The average sensitivity and specificity of physician interpretation compared with pathology was similar for the Pocket (sensitivity = 71.2%, specificity = 57.5%) and standard-of-care (sensitivity = 79.8%, specificity = 56.6%) colposcopes. When compared with a previous study where only acetic acid was applied to the cervix, results indicated that adding Lugol's iodine as a secondary contrast agent improved the percent agreement between colposcopes for all pathological categories by up to 8.9% and the sensitivity and specificity of physician interpretation compared with pathology by over 6.0 and 9.0%, respectively. CONCLUSIONS: The Pocket colposcope performance was similar to that of a standard-of-care colposcope when used to identify precancerous and cancerous lesions using acetic acid and Lugol's iodine during colposcopy examinations in Peru. TWEETABLE ABSTRACT: The Pocket colposcope performance was similar to that of a standard-of-care colposcope when identifying cervical lesions.

In-screw cement augmentation for iliosacral screw fixation in posterior ring pathologies with insufficient bone stock.

BACKGROUND: Minimal invasive screw fixation is common for treating posterior pelvic ring pathologies, but lack of bone quality may cause anchorage problems. The aim of this study was to report in detail a new technique combining iliosacral screw fixation with in-screw cement augmentation (ISFICA). DESCRIPTION OF TECHNIQUE: The patient was put under general anesthesia and placed in the supine position. A K-wire was inserted under inlet-outlet view to guide the fully threaded screw. The screw placement followed in adequate position. Cement was applied through a bone filler device, inserted at the screwdriver. The immediate control of cement distribution, accurate screw placement and potential leakage were obtained via intraoperative CT scan. PATIENTS AND METHODS: Twenty consecutive patients treated with ISFICA were included in this study. The mean age was 74.4 years (range 48-98). Screw placement, possible cement leakage and screw positioning were evaluated via intraoperative CT scan. Postoperative neurologic deficits, pain reduction and immediate postoperative mobilization were clinically evaluated. RESULTS: Twenty-six screws were implanted. All patients were postoperatively, instantly mobilized with reduced pain. No neurologic deficits were apparent postoperatively. No cement leakage occurred. One breach of the iliac cortical bone was noted due to severe osteoporosis. One screw migration was seen after 1 year and two patients showed iliosacral joint arthropathy, which led to screw removal. CONCLUSION: ISFICA is a very promising technique in terms of safety, precision and initial postoperative outcome. Long-term outcomes such as lasting mechanical stability or pain reduction and screw loosening despite cement augmentation should be investigated in further studies with larger patient numbers.

Direct fluorescent antibody testing for endocervical Chlamydia trachomatis: factors affecting accuracy.

Endocervical swabbings obtained after two previous cleansing swabs from 202 women with indications for testing for genital chlamydial infection were evaluated for the presence of Chlamydia trachomatis by culture and two direct fluorescent monoclonal antibody tests. In comparison with culture, the two direct fluorescent antibody tests showed sensitivities of 37.5 and 56.5% and specificities of 97.0 and 99.4% when read by experienced microbiology technologists recently trained in chlamydia direct fluorescent antibody interpretation and blinded to culture results. Overall sensitivities of 69.6 and 78.3% for the direct fluorescent antibody tests were obtained by an expert interpreter during discrepancy analysis. When only direct fluorescent antibody test specimens from the first swab after endocervical cleansing were considered, recently trained interpreters obtained sensitivities of 53.8 and 69.2%, and both direct fluorescent antibody tests were 100% sensitive for the expert interpreter. These data emphasize the critical importance of observer expertise and swab order to the accuracy of chlamydia direct fluorescent antibody tests. Previous studies of these tests are examined to determine how these factors and others may have influenced the outcome.

Clinical significance of cerebrospinal fluid tests for neurosyphilis.

From 1978 to 1987, 1,665 cerebrospinal fluid (CSF) fluorescent treponemal antibody absorption (CSF-FTA-ABS) tests were performed as the screening procedure for neurosyphilis. The CSF samples from 48 patients were reactive, and the medical history and results of the CSF-Venereal Disease Research Laboratory test (CSF-VDRL) for syphilis for 38 of these patients were reviewed. Likely active neurosyphilis was diagnosed if the patient had a reactive CSF-FTA-ABS test, recent onset of neurological signs consistent with neurosyphilis, abnormal CSF, and no other recognized cause for the neurological illness. Fifteen patients were so classified. Four had a reactive CSF-VDRL test. The specificity of the CSF-VDRL in diagnosing likely active neurosyphilis was 100%, but the sensitivity was only 27%. The insensitivity of the CSF-VDRL test limits its usefulness as a screening test for neurosyphilis. The CSF-FTA-ABS test appears more sensitive for screening but is less specific than the CSF-VDRL test in distinguishing currently active neurosyphilis from past syphilis. These findings imply that clinical judgment is still essential in establishing the diagnosis of active neurosyphilis.

Inhibition of protein synthesis also inhibits synthesis of lipid-linked oligosaccharides.

Studies were initiated to determine whether the formation of lipid-linked oligosaccharides was coupled to the synthesis of protein. Canine kidney cells were grown with [2-3H]mannose or [3H]leucine in the presence of cycloheximide or puromycin and the effect of these inhibitors on the synthesis of proteins and lipid-linked oligosaccharides was measured. In all cases, the inhibition of protein synthesis resulted in a substantial inhibition in the incorporation of mannose into the lipid-linked oligosaccharides, although the synthesis of mannosyl-phosphoryl-dolichol was only slightly inhibited. Cycloheximide had no effect on the in vitro incorporation of mannose into lipid-linked oligosaccharides when GDP-[14C]mannose was incubated with aorta microsomal preparations. The inhibition of lipid-linked oligosaccharides was apparently not due to a decrease in the amount of glycosyltransferases as a result of protein degradation in the absence of protein synthesis, nor was it the result of a more rapid degradation of lipid-linked oligosaccharides. The inhibition also did not appear to be due to limitations in the available dolichyl-phosphate. The results suggest that the formation of lipid-linked oligosaccharides may be regulated by end product inhibition.

Subinhibitory concentrations of antimicrobial agents reduce the uptake of Legionella pneumophila into Acanthamoeba castellanii and U937 cells by altering the expression of virulence-associated antigens.

We determined the MICs of ampicillin, ciprofloxacin, erythromycin, imipenem, and rifampin for two clinical isolates of Legionella pneumophila serogroup 1 by 3-(4,5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) reduction assay and by quantitative culture. To test the influence of subinhibitory concentrations (sub-MICs) of antimicrobial agents on Legionella uptake into Acanthamoeba castellanii and U937 macrophage-like cells, both strains were pretreated with 0.25 MICs of the antibiotics for 24 h. In comparison to that for the untreated control, subinhibitory concentrations of antibiotics significantly reduced Legionella uptake into the host cells. Measurement of the binding of monoclonal antibodies against several Legionella antigens by enzyme-linked immunoassays indicated that sub-MIC antibiotic treatment reduced the expression of the macrophage infectivity potentiator protein (Mip), the Hsp 60 protein, the outer membrane protein (OmpM), an as-yet-uncharacterized protein of 55 kDa, and a few lipopolysaccharide (LPS) epitopes. In contrast, the expression of some LPS epitopes recognized by monoclonal antibodies 8/5 and 30/4 as well as a 45-kDa protein, a 58-kDa protein, and the major outer membrane protein (OmpS) remained unaffected.

Adherence of bacteria to mammalian cells: inhibition by tunicamycin and streptovirudin.

Group B streptococci were labeled either by growing the cells in [14C]fructose or by using the surface label 4,4'-[3H]diisothiocyano-1,2-diphenylethane-2,2'-disulfonic acid, which reacts with amino groups. A quantitative assay was developed by using these labeled bacteria to study the adherence of streptococci to canine kidney epithelial cells. The bacteria adhered to kidney cells that had been infected with influenza A virus, but did not adhere to uninfected cells. The binding of 3H-labeled group B streptococci was proportional to the number of bacteria added and showed saturation kinetics. The binding was blocked by the addition of unlabeled group B streptococci but was not affected by addition of streptococci from other groups. It was also blocked by mixing the 3H-labeled streptococci with influenza A virus before adding the bacteria to the kidney cells. When the kidney cells were infected with influenza virus in the presence of either tunicamycin or streptovirudin, these antibiotics inhibited the appearance of viral hemagglutinin in the kidney cells and also prevented the release of mature virus. In these experiments, the adherence of 3h-labeled streptococci was also inhibited. Tunicamycin was shown to block the incorporation of [14C]mannose into lipid-linked oligosaccharides and glycoprotein in both normal and virus-infected kidney cells. These data give strong support to the notion that adherence of streptococci to mammalian cells involves recognition of viral hemagglutinin, a glycoprotein whose synthesis is blocked by certain antibiotics.