Long-term use of prescription opioids for non-cancer pain and mortality: a population-based, propensity-weighted cohort study.

OBJECTIVE: The objective of this study was to identify factors associated with long-term opioid use and to assess the association between long-term use and death. STUDY DESIGN: Retrospective cohort study combining several population-wide databases and covering a population of five million inhabitants, including all adults who were initiated on opioid treatment from 2014 to 2018 for non-cancer pain. METHODS: We used logistic regression models to identify factors associated with chronic opioid use and carried out survival analyses using multivariable Cox regression modelling for all-cause mortality during follow-up using inverse probability of treatment weighting (IPTW) and propensity scores based on the probability of using opioids chronically. RESULTS: Among 760,006 patients, 82,423 (10.85%) used opioids for 90 days or more after initiation. Initial therapy characteristics associated with higher risk for long-term use were initiating with long- and short-acting opioids (when compared to tramadol, odds ratio [OR]: 2.63, 95% confidence interval [CI]: 2.57, 2.69 and OR: 1.60, 95%CI: 1.46, 1.76, respectively), using higher daily doses (when compared to 50 morphine milligramme equivalent [MME] or less, prescribing 50 to 89 daily MME, OR: 1.76, 95%CI: 1.65, 1.87; 90 to 119 daily MME, OR: 2.44, 95%CI: 1.99, 3.01; and more than 120 daily MME, OR: 1.77, 95%CI: 1.64, 1.91), and overlapping with gabapentinoids (OR: 2.26, 95%CI: 2.20, 2.32), benzodiazepines (OR: 1.32, 95%CI: 1.30, 1.35), and antipsychotics (OR: 1.21, 95%CI: 1.16, 1.26). After IPTW, chronic opioid use was associated with higher risk of all-cause mortality when compared to short-term use (Hazard Ratio (HR): 1.37, 95%CI: 1.32, 1.42). Sensitivity analyses provided similar results. CONCLUSION: These findings may help healthcare managers to identify and address patients at higher risk of long-term use and riskier prescription patterns.

Worldwide use of HPV self-sampling for cervical cancer screening.

An increasing body of evidence supports the validity of self-sampling as an alternative to clinician collection for primary Human Papillomavirus (HPV) screening. Self-sampling effectively reaches underscreened women and can be a powerful strategy in low- and high-resource settings for all target ages. This work aims to summarize the current use of HPV self-sampling worldwide. It is part of a larger project that describes cervical cancer screening programmes and produces standardized coverage estimates worldwide. A systematic review of the literature and official documents supplemented with a formal World Health Organisation country consultation was conducted. Findings show that the global use of HPV self-sampling is still limited. Only 17 (12%) of countries with identified screening programs recommend its use, nine as the primary collection method, and eight to reach underscreened populations. We identified 10 pilots evaluating the switch to self-sampling in well-established screening programs. The global use of self-sampling is likely to increase in the coming years. COVID-19's pandemic has prompted efforts to accelerate HPV self-sampling introduction globally, and it is now considered a key element in scaling up screening coverage. The information generated by the early experiences can be beneficial for decision-making in both new and existing programs.

Doramectin efficacy against Psoroptes ovis in sheep: Evaluation of pharmacological strategies.

The aims of this study were to evaluate the efficacy of two injectable formulations of doramectin (DRM) against Psoroptes ovis in sheep infested under controlled experimental conditions and to characterize the DRM plasma disposition kinetics in the infested animals. To this end, sheep were experimentally infested with a P. ovis strain from a farm with a history of treatment failure, and then treated either with DRM 1% (traditional preparation) on days 0 and 7 or with DRM 3.15% (long-acting formulation) on day 0. The efficacy of each treatment was calculated by counting live mites in skin scrapings. Plasma samples were obtained from each animal and DRM concentrations were measured by HPLC. After the two doses of DRM 1%, the maximum efficacy (98.8%) was reached on day 28, whereas after the single dose of DRM 3.15%, the maximum efficacy (100%) was reached on day 35 and ratified on day 42. The long-acting formulation allowed obtaining higher exposure and more sustained concentrations of DRM than the traditional preparation. Although both DRM formulations studied were effective according to international protocols, they did not reach 100% effectiveness in the time required for approved pharmaceutical products against sheep scab, according to Argentine regulations.

Isolation and molecular characterization of Clostridium perfringens from healthy Merino lambs in Patagonia region, Argentina.

The presence and molecular characterization of Clostridium perfringens in healthy Merino lambs over a six-month period was investigated in this study. Overall, a high prevalence of C. perfringens was detected, even in day-old lambs. Even though the majority of the isolates were characterized as being of type A, types C and D were also isolated. Furthermore, a high genetic diversity was observed by PFGE among the type A isolates.

Occupational exposure to endocrine disruptors and lymphoma risk in a multi-centric European study.

BACKGROUND: Incidence rates of lymphoma are usually higher in men than in women, and oestrogens may protect against lymphoma. METHODS: We evaluated occupational exposure to endocrine disrupting chemicals (EDCs) among 2457 controls and 2178 incident lymphoma cases and subtypes from the European Epilymph study. RESULTS: Over 30 years of exposure to EDCs compared to no exposure was associated with a 24% increased risk of mature B-cell neoplasms (P-trend=0.02). Associations were observed among men, but not women. CONCLUSIONS: Prolonged occupational exposure to endocrine disruptors seems to be moderately associated with some lymphoma subtypes.

A multicentric study regarding the use of hormone therapy during female mid-age (REDLINC VI).

BACKGROUND: Menopausal hormone therapy (HT) has shown benefits for women; however, associated drawbacks (i.e. risks, costs, fears) have currently determined its low use. OBJECTIVE: To determine the prevalence of current HT use among mid-aged women and describe the characteristics of those who have never used, have abandoned or are currently using HT. In addition, reasons for not using HT were analyzed. METHOD: This was a cross-sectional study that analyzed a total of 6731 otherwise healthy women (45-59 years old) of 15 cities in 11 Latin American countries. Participants were requested to fill out the Menopause Rating Scale (MRS) and a questionnaire containing sociodemographic data and items regarding the menopause and HT use. RESULTS: The prevalence of current HT use was 12.5%. Oral HT (43.7%) was the most frequently used type of HT, followed by transdermal types (17.7%). The main factors related to the current use of HT included: positive perceptions regarding HT (odds ratio (OR) 11.53, 95% confidence interval (CI) 9.41-14.13), being postmenopausal (OR 3.47, 95% CI 2.75-4.36) and having a better socioeconomic level. A total of 48.8% of surveyed women had used HT in the past, but abandoned it due to symptom improvement or being unconcerned; fear of cancer or any other secondary effects were also reported but in less than 10%. Among women who had never used HT, 28% reported the lack of medical prescription as the main reason, followed by the absence of symptoms (27.8%). Among those reporting lack of prescription as the main reason for not using HT, 30.6% currently had severe menopausal symptoms (total MRS score > 16); 19.5% of women were using alternative 'natural' therapies, with 35.1% of them displaying severe menopausal symptoms as compared to a 22.5% observed among current HT users. CONCLUSION: The use of HT has not regained the rates observed a decade ago. Positive perceptions regarding HT were related to a higher use. Lack of medical prescription was the main reason for not using HT among non-users, many of whom were currently displaying severe menopausal symptoms.

Pine needle abortions in cattle due to consumption of Pinus ponderosa in Argentina: Case reports.

Two outbreaks of pine needle abortions in cattle are here reported for the first time in Argentina. The cases occurred in Chubut and Neuquén provinces in the Patagonia region, causing 29.6% and 9% of abortions in each herd respectively. In both outbreaks, the dams were in the last third of gestation, and, due to a period of cold, snow and lack of available forage, they gained access to Pinus ponderosa and Pinus contorta forests. No pathological lesions, serological, molecular, or microbiological evidence of infectious causes were observed in any of the six fetuses analyzed. Microhistological analysis of feces confirmed higher presence of fragments of Pinus spp. needles in the diet of affected dams than in that of non-affected ones (12.2 vs 3.0%). Moreover, toxicological analysis showed higher tetrahydroagathic acid in the sera of affected dams than in that of non-affected ones (10.05 vs 2.81 ppm). In addition, this acid was detected in different fetal fluids (3.6-8.1 ppm) of the six fetuses analyzed. Interestingly, isocupressic acid was detected only in needles of P. ponderosa, and its content was lower than that found in other areas of the world (0.31 and 0.5% in Chubut and Neuquén respectively). These results confirm that the consumption of P. ponderosa by dams could have been the cause of these abortion outbreaks, a fact that should be considered as differential diagnosis in abortions of cattle, especially in silvopastoral systems of Argentina.

Historical and projected changes in hydrological and sediment connectivity under climate change in a tropical catchment of Mexico.

Hydrological and erosion dynamics are prone to change due to natural factors, human activities, or climate change. These changes are mainly related to modifications of land use and cover and can be assessed through the concept of connectivity, which analyzes how the spatial distribution of the elements facilitates runoff and sediment transport. The objective of this study was to evaluate changes in hydrological and sediment connectivity over 42 years and projected under a climate change scenario in the tropical Santa Cruz catchment in Aquismón, S.L.P., Mexico. The index of connectivity (IC) was computed using SedInConnect version 2.3 and the ArcSWAT model to estimate runoff. Hydrological connectivity and runoff were projected for 2027 using the MPI ECHAM 5 in the A2 climate change scenario. The results indicated that spatio-temporal changes in land use/cover, in conjunction with geomorphological features and expected climate change, would modify hydrological and sediment connectivity, especially in flat areas, where conversion of natural vegetation to cropland was steadily increasing over the years. Under future conditions, runoff and sediment transport are likely to increase, which will impact soil erosion and vulnerability to flooding but will not necessarily be negative. The study shows how spatial-temporal integration of runoff, sediments, landforms, land use cover and change, and connectivity can improve our understanding of catchment dynamics and the importance of analyses that characterize their evolution. The results can subsequently be applied and replicated in other catchments for management and restoration purposes.

[Sensitivity and specificity of three complementary methods in the diagnosis of carpal tunnel syndrome]. / Sensibilidad y especificidad de tres métodos complementarios para el diagnóstico de síndrome de túnel carpiano.

INTRODUCTION: Currently there is no universally accepted standard of reference for the diagnosis of carpal tunnel syndrome so it is considered a «latent class¼ pathology, that is, it lacks any diagnostic tests that absolutely certain the presence of disease. METHODS: Prospective, observational and analytical study evaluating the three diagnostic methods used for carpal tunnel syndrome (clinical examination, ultrasound and electromyography). Normality values were set for each diagnostic method. RESULTS: 50 people (14 men and 36 women) were evaluated. The clinical examination showed a positive and significant correlation with the diameter of the affected median nerve (ecography) (R = 0.694, p = 0.032). The values of the under the curve area (UCA) for median nerve conduction speed (MNCS), cubital nerve conduction speed (CNCS), and distal latency (DL) by electromyography were 0.60, 0.519 and less than 0.50 respectively. This states that the diagnostic value of electromyography characteristics is bad. CONCLUSION: Our work establishes clinical examination as a good quality tool being the most sensitive method for diagnosing carpal tunnel syndrome. If there was a need for diagnostic confirmation, the ultrasound proved to be a highly satisfactory study generating less stress, pain and invasion to the patient, decreasing health expenditure and speeding up the process.

INTRODUCCIÓN: Actualmente, no existe un estándar de referencia aceptado universalmente para el diagnóstico del síndrome de túnel carpiano, por lo que se le considera una patología de «clase latente¼, es decir, que carece de alguna prueba diagnóstica que dé certeza absoluta de la presencia de la enfermedad. MÉTODOS: Estudio prospectivo, observacional y analítico en el cual se evaluaron los tres métodos diagnósticos utilizados para el síndrome de túnel carpiano (examen clínico, ecografía y electromiografía). En él, se establecieron valores de normalidad para cada método diagnóstico. RESULTADOS: Se evaluó un total de 50 personas (14 hombres y 36 mujeres). El examen clínico presentó correlación positiva y significativa con el diámetro del nervio mediano afectado (ecografía) (R = 0.694 y p = 0.032). Los valores del área bajo la curva (AUC, por sus siglas en inglés) para la velocidad de conducción del nervio mediano (VCNM), velocidad de conducción de nervio cubital (VCNC) y latencia distal motora (LDM) por electromiografía fueron de 0.60, 0.519 y. CONCLUSIÓN: < 0.50, respectivamente, lo cual determinó que el valor diagnóstico de las características por electromiografía es malo. Nuestro trabajo establece al examen clínico como una herramienta de buena calidad, siendo el método más sensible para el diagnóstico de síndrome de túnel carpiano. Si existiera la necesidad de realizar una confirmación diagnóstica, la ecografía mostró ser un estudio altamente satisfactorio, el cual genera menos estrés, dolor e invasión al paciente, disminuyendo, a su vez, el gasto de salud y agilizando el proceso.

[Distal radius intraarticular fractures: fluoroscopy reduction versus arthroscopic assistance. Systematic review]. / Fracturas intraarticulares de radio distal: reducción bajo fluoroscopía versus asistencia artroscópica. Revisión sistemática.

INTRODUCTION: Intraarticular distal radius fractures are a therapeutic challenge for the orthopedist surgeon there are studies that support the use of fluoroscopy, and others promote arthroscopy, with this work we try to summarize the evidence, to determine whether arthroscopic assistance provides additional benefits to avoid joint incongruities compared to results obtained under fluoroscopic assistance. MATERIAL AND METHODS: Systematic search for prospective, retrospective, cohort, follow-up, clinical trials on PubMed, MEDLINE, Scopus, Scielo, Embase, Google Scholar and other national sources, including as keywords the terms: "intra-articular distal radius fracture", "wrist arthroscopy", "arthroscopy", "fluoroscopy". The average values and standard offsets for each characteristic, obtained from the selected works, were analyzed using descriptive statistics and illustrative graphs. RESULTS: 463 patients (256 women and 207 men) were evaluated, with an average age of 48.29 years and range from 39 to 64 years. The two treatments (A and F) were homogeneous in terms of the age of the patients reporting (p = 0.5820) and the average follow-up time (p = 0.9597). Only the ulnar deviation and DASH score, for which the arthroscopy group performed best, in the remaining variables the differences were not significant. CONCLUSION: The evidence available to date is conflicting, and does not allow recommendations to be made for or against these interventions, finding other factors that could influence decision-making.

INTRODUCCIÓN: Las fracturas intraarticulares de radio distal son un desafío terapéutico para el cirujano ortopedista. Hay estudios que avalan el uso de la fluoroscopía y otros promueven la artroscopia. Con este trabajo intentamos resumir la evidencia, para determinar si la asistencia artroscópica aporta beneficios adicionales para evitar incongruencias articulares en comparación con los resultados obtenidos bajo asistencia fluoroscópica. MATERIAL Y MÉTODOS: Búsqueda sistemática de estudios prospectivos, retrospectivos, de cohortes, seguimiento, ensayos clínicos en PubMed, MEDLINE, Scopus, Scielo, Embase, Google Scholar y otras fuentes nacionales, incluyendo como palabras clave los términos. RESULTADOS: intraarticular distal radius fracture, wrist arthroscopy, arthroscopy, fluoroscopy. Los valores medios y desvíos estándar para cada característica, obtenidos de los trabajos seleccionados fueron analizados usando estadística descriptiva y gráficos ilustrativos. Fueron evaluados 463 pacientes (256 mujeres y 207 hombres), con una edad promedio de 48.29 años y rango de 39 a 64 años. Los dos tratamientos (A y F) fueron homogéneos en cuanto a la edad de los pacientes que reportan (p = 0.5820) y el tiempo de seguimiento promedio (p = 0.9597). Sólo la desviación cubital y el DASH, para las cuales el grupo de artroscopía tuvo mejor desempeño, en las variables restantes las diferencias no fueron significativas. CONCLUSIÓN: La evidencia disponible hasta la fecha es controvertida y no permite hacer recomendaciones a favor o en contra de estas intervenciones, encontrando otros factores que podrían influir en la toma de decisiones.

Embolisation of prostate arteries in benign prostatic hyperplasia in non-surgical patients. / Embolización de arterias prostáticas en la hiperplasia benigna de la próstata en pacientes no quirúrgicos.

OBJECTIVE: To present the results of a multidisciplinary study of two tertiary hospitals, together with urology services, on 102 consecutive patients not candidates for surgery treated for more than 6 years, in whom prostatic arteries were embolised for the treatment of benign hyperplasia. MATERIAL AND METHODS: From December 2012 to February 2019, 102 patients with symptoms of benign prostatic hyperplasia (BPH) not candidates for surgery or who explicitly rejected surgery, with an average age of 73.9 years (range 47.5-94.5), underwent prostatic artery embolisation. The patients were followed up by questionnaires on urinary symptoms, sexual function and impact on quality of life, as well as measurement of prostate volume, uroflowmetry and prostate specific antigen (PSA) at one, 3 and 6 months and one year following the procedure. RESULTS: The technique was successful in 96% of patients (76.2% bilateral and 19.8% unilateral). The mean duration of the procedure was 92minutes and of the radioscopy 35.2minutes. Statistically significant changes were demonstrated (p <.05) in PSA, peak urinary flow, QoL (quality of life) questionnaire and the International Index of Erectile Function (IPSS). PSA had reduced by 58% from baseline at 3 months. Similarly, the Qmax had increased significantly by 63% in the third month following embolisation. A significant improvement in the QoL and IPSS tests was achieved, with a reduction of 3.7 points and a mean 13.5 points, respectively, at one year's follow-up. Prostate volume showed a non-statistically significant decrease at follow-up of one year following treatment. A series of minor complications was collected, no case of which required hospital admission. CONCLUSIONS: Prostatic embolisation for the treatment of BPH proved an effective and safe technique in patients who were not candidates for surgery.

Connectivity and hydrological efficiency dynamics at active volcanoes, Mexico.

Connectivity is an emergent property that describes how complex topography favors or impedes sediment transfer processes. In active volcanic areas, high connectivity may lead to extremely efficient processes, such as lahars. The aim of the present study is to examine the behavior (activation-deactivation) of sub-basins affected by volcanic and anthropogenic processes by studying the changes in connectivity and hydrological efficiency. Two volcanic zones in Mexico were selected: Volcán de Colima and Popocatépetl volcano, the two most active and dangerous volcanoes in the country. The joint index of connectivity (ICJ) and lateral hydrological efficiency index (LHEI) were calculated for both volcanic areas in basins recently affected by eruptive activity (Volcán de Colima) and co-seismic landslides (Popocatépetl). The analyses enabled the identification of eleven recently activated sub-basins (3.82 km2) at the Volcán de Colima and fifteen (3.77 km2) at the Popocatepetl volcano, as a consequence of natural processes and economic activities. Critical thresholds indicating the percentage area of land cover/use at which a sub-basin reaches high or very high LHEI values and the percentage of land cover/use change required for a sub-basin to modify its behavior (activation-deactivation) were identified using classification trees. The holistic capacity of the concepts of connectivity and hydrological efficiency permits analyzing the spatiotemporal variations of sediment transport based on the interactions between the hydrogeomorphological dynamics of volcanic processes and the territorial impact of socio-economical activities. Through this approach, new active areas have been identified in both volcanoes; the knowledge of the processes that occurred in these areas represents a key factor for hazard and risk assessment for the population in the near future.

Evaluation of three different antigens in an indirect enzyme-linked immunoassay for the detection of antibodies against Brucella abortus SRB51 in vaccinated heifers.

The live attenuated Brucella abortus SRB51 (SRB51) is a partial O-chain-deprived mutant. The relative lack of the polysaccharide prevents it from inducing antibodies detectable by most of the serological tests used for the diagnosis of bovine brucellosis. The performance of three antigens used in an indirect enzyme-linked immunoassay test for detecting SRB51 antibodies were evaluated. A homogeneous group of twenty-five 10-month-old Hereford heifers was used. The animals were bled on day 0 and then subcutaneously vaccinated with 2 ml of a commercially available SRB51 vaccine (Schering-Plough) containing 1x10(7) to 3.4x10(7) viable cells. Blood samples without anticoagulant for sera obtaining were then collected at days 30, 90, 210 and 360 post-vaccination. To detect the SRB51 antibodies, Brucella ovis hot saline extract, B. ovis RLPS (RLPS), and SRB51-RLPS were used. The buffered antigen plate agglutination test and an indirect enzyme-linked immunoassay (I-ELISA) using the smooth LPS (SLPS) antigen from B. abortus were used as control tests. All the sera samples were negative in the BPA test and in the standard I-ELISA using the SLPS. The SRB51-RLPS and the B. ovis RLPS antigens performed better than the B. ovis hot saline extract antigen.

Alpine ski technique observation instrument: reliability and validity / Instrumento de observación de la técnica en esquí alpino: fiabilidad y validez

The aim of the study was to design an accurate and useful observational instrument for evaluating basic turn techniques in alpine skiing, and to determine its validity and reliability. A multi-step approach was used to design and validate the instrument: a literature revision; an expert meeting; a pilot test; the assessment of intra- and inter-observer reliability; a convergent validity test; and the responsiveness calculation with a pre- post-test. Results showed adequate values of intra-rater (P=0.80-0.83) and inter-rater reliability (P=0.86-0.97). For the convergent validity, a moderate statistically significant correlation for the speed and trajectory control dimensions were achieved (rho=0.58-0.65, p<0.001), but not for the balance position dimension (rho=0.24, p=0.166). The responsiveness was also acceptable (p<0.05, r=0.46-0.60). In conclusion, the Alpine Ski Technique Observation Instrument is a useful, reliable, valid, and responsive observational tool. (AU)

El objetivo del estudio fue diseñar un instrumento de observación preciso y útil para evaluar la técnica de cambios de dirección básicos en el esquí alpino, y determinar su validez y fiabilidad. Para diseñar y validar el instrumento se siguieron los siguientes pasos: revisión de la literatura, valoración por comité de expertos, prueba piloto, evaluación de la fiabilidad intra e inter-evaluador, prueba de validez convergente, y cálculo de sensibilidad con una prueba pre y post-intervención. Los resultados mostraron valores adecuados de fiabilidad intra-evaluador (P=0,80-0,83) e inter-evaluador (P=0,86-0,97). Respecto a la validez convergente se obtuvo una correlación moderada para las dimensiones de control de la velocidad y de la trayectoria (rho=0,58-0,65, p<0,001), pero no para la dimensión de posición de equilibrio (rho=0,24, p=0,166). La sensibilidad fue aceptable (p<0,05, r=0,46-0,60). En conclusión, el Instrumento de Observación de la Técnica en Esquí Alpino es una herramienta útil, fiable, válida y sensible. (AU)

Electrical bioimpedance spectroscopy as biosensor technique to identify cells lineages and cell differentiation process.

The identification and characterization of diverse cells types and cell differentiation process requires complex techniques as flow cytometry, immunocytochemistry and the exploration of molecular markers; such techniques require infrastructure and qualified personnel. The objective of this study was to analyze the use of Electrical Bioimpedance Spectroscopy (EBIS) measurements as a non-complex alternative technique to identify populations of undifferentiated mouse Pluripotent Stem Cells (mPSCs), Mouse Embryonic Fibroblasts (MEFs) and the differentiation process from preadipocytes (3T3-L1) to mature adipocytes. EBIS measurements were compared in populations of cells which were characterized previously using microscopy. The results indicate that EBIS technique has a potential sensitivity at certain frequency range to discriminate between both evaluated cell populations and some differentiation process. Additional studies with different concentrations to evaluate quantitatively the sensitivity and specificity of the proposed technique are recommended.

Low-dose cytarabine maintenance therapy vs observation after remission induction in advanced acute myeloid leukemia: an Eastern Cooperative Oncology Group Trial (E5483).

The Eastern Cooperative Oncology Group (ECOG) conducted a prospective phase III study in patients with relapsed/refractory acute myeloid leukemia (AML) to evaluate whether administration of repeated courses of low-dose cytarabine (LDAC) maintenance therapy after induction of complete remission in advanced AML would improve disease-free and overall survival. Patients with AML in second/later relapse or refractory disease were first treated with a combination of high-dose cytarabine and amsacrine. Those who achieved complete remission were then randomized to observation or to receive LDAC, 10 mg/m2 subcutaneously twice a day x2 21 days every 2 months until relapse occurred. Of 86 patients eligible for randomization, 41 patients were assigned to receive LDAC and 45 patients to observation. The median disease-free survival was 7.4 months for patients assigned to LDAC compared to 3.3 months for patients receiving no additional therapy, P= 0.084. The median survival from randomization was 10.9 months and 7.0 months for patients receiving LDAC maintenance chemotherapy and observation, respectively (P= 0.615). The data from this study suggest that LDAC maintenance therapy given to patients with advanced AML who achieve complete remission can increase disease-free survival compared to observation, but does not improve overall survival. Nevertheless, because of the ineffectiveness and toxicity of intensive post-remission chemotherapy in this circumstance, LDAC maintenance therapy, a tolerable outpatient regimen, offers the potential for improved quality of life.

Towards single screening tests for brucellosis.

This paper describes an indirect enzyme-linked immunosorbent assay (I-ELISA) and a fluorescence polarisation assay (FPA), each capable of detecting antibody in several species of hosts to smooth and rough members of the genus Brucella. The I-ELISA uses a mixture of smooth lipopolysaccharide (SLPS) and rough lipopolysaccharide (RLPS) as the antigen, and a recombinant protein A/G conjugated with horseradish peroxidase as the detection reagent. When using individually determined cutoff values, the SLPS/RLPS combined-antigen I-ELISA detected antibody in slightly more animals exposed to SLPS or to RLPS than did I-ELISA procedures using each individual antigen separately. Similarly, the assay using combined antigens detected antibody in slightly fewer animals not exposed to Brucella sp. When a universal cutoff of 10% positivity was used (relative to strongly positive control sera of each species), the overall performance index (percentage sensitivity plus percentage specificity) value decreased by 1.0 (from 199.4 to 198.4). In the FPA, it was not possible to use a universal cutoff without significant loss of performance. The overall sensitivity value for the FPA using the combined FPA antigen was 1.0% lower than using the O-polysaccharide (OPS) from SLPS and 9.1% higher than using the core antigen (CORE) from RLPS. When the combined antigen was used, the FPA specificity was slightly higher (1.2%) than from only the OPS, and considerably higher (12.6%) than the CORE. Overall, both the I-ELISA and the FPA with combined antigens were suitable as screening tests for all species of Brucella in the animal species tested.