Role of plasma ammonia level in detecting intra-abdominal hemorrhage following blunt abdominal trauma.

BACKGROUND: Blunt abdominal injury is a leading cause of death in trauma patients. A reliable test predicting intra-abdominal hemorrhage would be a novel method. The study objective was to assess the diagnostic accuracy of plasma ammonia in detection of intra-abdominal bleeding in patients with blunt abdominal trauma (BAT). MATERIALS AND METHODS: In this observational study, all patients suffering from BAT, referred to our university teaching hospital included. The levels of ammonia were measured at the time of emergency department admission and 1 h after initial treatment. Demographic data, vital signs, and venous blood gas reports were recorded. Findings of contrast-enhanced abdominopelvic computed tomography scan and laparotomy were assumed as a gold standard for abdominal injuries. RESULTS: A total of 104 patients was enrolled in the study. 15 patients (14.4%) had intra-abdominal hemorrhage and the mean plasma ammonia level in this group was significantly higher than the other patients on admission time (101.73 ± 5.41 µg/dL vs. 47.36 ± 26.31 µg/dL, P < 0.001). On receiver-operator characteristic curve analysis, in cutoff point of 89 µg/dL, the sensitivity, specificity, positive and negative likelihood ratios were 100% (95% confidence interval [CI], 79.6-100), 93.26% (95% CI, 86-96.8), 14.83 (95% CI, 6.84-32.12), and 0, respectively. CONCLUSION: The study findings suggest the measurement of ammonia level at the time of admission in the patients with BAT would be a useful test predicting intra-abdominal hemorrhage. Furthermore, decrease in the ammonia level could be a useful marker for monitoring response to treatment in these patients.

Comparative evaluation of the Bio-Rad Geenius HIV-1/2 Confirmatory Assay and the Bio-Rad Multispot HIV-1/2 Rapid Test as an alternative differentiation assay for CLSI M53 algorithm-I.

INTRODUCTION: The CLSI-M53-A, Criteria for Laboratory Testing and Diagnosis of Human Immunodeficiency Virus (HIV) Infection; Approved Guideline includes an algorithm in which samples that are reactive on a 4th generation EIA screen proceed to a supplemental assay that is able to confirm and differentiate between antibodies to HIV-1 and HIV-2. The recently CE-marked Bio-Rad Geenius HIV-1/2 Confirmatory Assay was evaluated as an alternative to the FDA-approved Bio-Rad Multispot HIV-1/HIV-2 Rapid Test which has been previously validated for use in this new algorithm. METHODS: This study used reference samples submitted to the Canadian - NLHRS and samples from commercial sources. Data was tabulated in 2×2 tables for statistical analysis; sensitivity, specificity, predictive values, kappa and likelihood ratios. RESULTS: The overall performance of the Geenius and Multispot was very high; sensitivity (100%, 100%), specificity (96.3%, 99.1%), positive (45.3, 181) and negative (0, 0) likelihood ratios respectively, high kappa (0.96) and low bias index (0.0068). The ability to differentiate HIV-1 (99.2%, 100%) and HIV-2 (98.1%, 98.1%) Ab was also very high. CONCLUSION: The Bio-Rad Geenius HIV-1/2 Confirmatory Assay is a suitable alternative to the validated Multispot for use in the second stage of CLSI M53 algorithm-I. The Geenius has additional features including traceability and sample and cassette barcoding that improve the quality management/assurance of HIV testing. It is anticipated that the CLSI M53 guideline and assays such as the Geenius will reduce the number of indeterminate test results previously associated with the HIV-1 WB and improve the ability to differentiate HIV-2 infections.

Análise probabilística de parâmetros de qualidade da água para suporte ao processo de enquadramento de cursos d'água / Probabilistic water quality parameters analysis for supporting Brazilian watercourses use classes definition processes

RESUMO O presente trabalho teve como objetivo geral estudar o emprego de curvas de probabilidade da qualidade da água como subsídio para o enquadramento legal dos corpos d'água. Para a avaliação da utilização das referidas curvas foram reunidas informações sobre qualidade da água do Rio Jucu, principal manancial de abastecimento da Região Metropolitana da Grande Vitória, Espírito Santo. A partir da função de distribuição acumulada, foram construídas curvas de probabilidade de ocorrência para diferentes parâmetros físicos, químicos e bacteriológicos de qualidade de água, e avaliadas frequências de incompatibilidade com padrões estabelecidos pela Resolução CONAMA nº 357/2005 para diferentes classes de uso. A avaliação de incompatibilidade considerou duas perspectivas: (1) enquadramento único para o curso d'água, perspectiva na qual as curvas de probabilidade foram construídas com a reunião de todos os registros de qualidade dos diferentes pontos de monitoramento; e (2) enquadramento diferenciado ao longo do curso d'água. Avaliou-se, adicionalmente, a influência da sazonalidade do regime hidrológico sobre as respostas oferecidas pelas curvas de probabilidade. Os resultados indicaram que os parâmetros fósforo total e coliformes termotolerantes apresentaram elevados percentuais de incompatibilidade, independentemente da classe de uso, da perspectiva de enquadramento (único ou diferenciado ao longo do rio) e do período do ano hidrológico (seco ou úmido). A avaliação sazonal demonstrou que apenas o parâmetro de turbidez, quando considerada a perspectiva de enquadramento na classe 1, apresentou diferença entre as frequências de incompatibilidade observadas para os períodos seco e úmido do ano hidrológico.

ABSTRACT The present work aims to study the use of water quality probability curves for technical support of legal watercourse reaches water uses class definition. For the evaluation of the use of such curves, we used data from the Jucu River water quality. This is the main water source of the metropolitan region of Vitória, Espírito Santo, Brazil. From the accumulated distribution function, different physical, chemical and bacteriological water quality parameters probability curves were fitted to the monitoring data in order to evaluate frequencies of incompatibility with established legal standards corresponding to different Brazilian National Council CONAMA 357/2005 Resolution watercourse use classes. The incompatibility evaluation considered two different conditions: (1) unique, by aggregating all water quality parameters values for all different monitoring points; and (2) different water use classes along the Jucu River. Additionally, the influence of the hydrological regime seasonality on the probability curves was evaluated. The results indicated that total phosphorus and coliforms parameters presented high incompatibility frequencies, regardless of water use class (unique or different along the river) and season (dry or wet). The seasonal assessment showed that only the turbidity parameter presented significant differences among incompatibility frequencies, considering wet and dry periods of the hydrological year, and only for the CONAMA Resolution water use class 1.