Evaluation of the accuracy of a multi-infection screening test based on a multiplex immunoassay targeting imported diseases common in migrant populations.

BACKGROUND: We aimed to evaluate the performance of a novel multiplex serological assay, able to simultaneously detect IgG of six infections, as a screening tool for imported diseases in migrants. METHODS: Six panels of 40 (n = 240) anonymized serum samples with confirmed infections were used as positive controls to assess the multiplex assay's sensitivity. One panel of 40 sera from non-infected subjects was used to estimate the seropositivity cutoffs, and 32 non-infected sera were used as negative controls to estimate each serology's sensitivity and specificity. The multi-infection screening test was validated in a prospective cohort of 48 migrants from endemic areas. The sensitivity of the Luminex assay was calculated as the proportion of positive results over all positive samples identified by reference tests. The specificity was calculated using 32 negative samples. Uncertainty was quantified with 95 % confidence intervals using receiver operating characteristic analyses. RESULTS: The sensitivity/specificity were 100 %/100 % for HIV (gp41 antigen), 97.5 %/100 % for Hepatitis B virus (HBV-core antigen), 100 %/100 % for Hepatitis C virus (HCV-core antigen), 92.5 %/90.6 % for strongyloidiasis [31-kDa recombinant antigen (NIE)], 97.5 %/100 % for schistosomiasis (combined serpin Schistosoma mansoni and S.haematobium antigens) and 95 %/90.6 % for Chagas disease [combined Trypanosoma cruzi kinetoplastid membrane protein-11 (KMP11) and paraflagellar rod proteins 2 (PFR2) antigens]. In the migrant cohort, antibody response to the combination of the T.cruzi antigens correctly identified 100 % individuals, whereas HBV-core antigen correctly identified 91.7 % and Strongyloides-NIE antigen 86.4 %. CONCLUSIONS: We developed a new, robust and accurate 8-plex Luminex assay that could facilitate the implementation of screening programmes targeting migrant populations.

Isolated clinical hypertension diagnosis: self-home BP, ambulatory BP monitoring, or both simultaneously?

UNLABELLED: Self-blood pressure (BP) measurement (SBPM) and ambulatory BP measurement (ABPM) are suitable for the isolated clinical hypertension (ICH) or 'white-coat' hypertension diagnosis. However, patients with ICH have a different cardiovascular risk according to the measurement technique used for the diagnosis. OBJECTIVE: To describe baseline cardiovascular risk of patients with hypertension and with ICH according to SBPM and daytime ABPM. METHODS: Six hundred and sixty-four newly diagnosed and never treated patients with hypertension and with an average age of 59.3 years (standard deviation=12.0) were included (52% men) in this study. Clinical data, analytical data with urinary albumin excretion rate, estimated glomerular filtration rate, retinography, SBPM, and ABPM were performed. Cardiovascular risk was estimated from the European Society of Hypertension and Systemic Coronary Risk Evaluation tables. RESULTS: ICH prevalence varies according to the ambulatory measurement technique used: SBPM=24.2%, daytime ABPM=8.1, and 5.2% if criteria are required from both techniques. In the 403 patients with hypertension and who had SBPM and ABPM, the percentage of patients with high or very high baseline cardiovascular risk, falls progressively from 31.2% of patients with sustained hypertension to 20.0% of patients with ICH measured using SBPM, to 15.1% of patients with ICH measured using ABPM-day and to 9.5% of patients who present ICH using both techniques (P<0.005 for trend). CONCLUSION: The baseline results show that patients with hypertension and with ICH using SBPM and daytime ABPM are those who have a lower baseline cardiovascular risk and allow ICH to be defined on the basis of normal ambulatory readings using both techniques.