Concurrent gonococcal and chlamydial infections among men attending a sexually transmitted diseases clinic

The aim of this retrospective study was to determine the prevalence of Chlamydia trachomatis co-infection in men with gonorrhoea attending a sexually transmitted diseases clinic in Edinburgh, Scotland. During the study period, there were 660 cases of culture-proven gonorrhoea. Chlamydial DNA was detected in the urethra in 79 (31%; 95% confidence interval [CI], 25–37%) heterosexual men who have sex with women (MSW); the median age was significantly lower than those with gonorrhoea alone (24.0 versus 30.0; P < 0.0005). The prevalence of urethral chlamydial infection among MSW was significantly higher than among men who have sex with men (MSM) (32 [12%; 95% CI, 8–16%] of 268 MSM) (χ2 = 27.21; P < 0.001). Sixteen (24%; 95% CI, 14–34%) of 68 MSM with rectal gonorrhoea had concurrent rectal chlamydial infection. The high prevalence of concurrent gonorrhoea and chlamydiae therefore warrants empirical treatment and/or testing for chlamydia in all men with urethral gonorrhoea.

The sensitivity of syphilis assays in detecting different stages of early syphilis

Our aim was to determine the sensitivity of the Murex ICE enzyme immunoassay (EIA) as a screening test for early syphilis and to determine how many additional cases of infection were detected by performing additional tests when requested on clinical grounds.

This was an observational study on consecutive patients diagnosed with syphilis in the Department of Genitourinary Medicine, Edinburgh between January 1st 2004 and April 1st 2005. Additional tests were performed on sera that gave a positive or equivocal EIA on screening as well as by clinical request on sera from contacts of syphilis, and those with clinical signs of syphilis. Additional tests included a Venereal Diseases Research Laboratory (VDRL) carbon antigen test, a Treponema pallidum particle agglutination (TPPA) test, INNO-LIA line immunoblot assay, and an EIA specific for anti-treponemal IgM.

A total of 105 patients were diagnosed with syphilis: primary (50), secondary (26), early latent (8), and of unknown duration (21). The TPPA was the most sensitive test in primary syphilis and had a sensitivity of 96% (48/50), which was significantly higher ( P <0.05) than the sensitivity of 84% (42/50) for the screening EIA: seven of the EIA negatives were detected by EIA–IgM, six by TPPA, five by immunoblot, and two by VDRL. EIA–IgM was negative in six primaries; all were positive by TPPA and immunoblot.

We conclude that, in order to maximize the serological detection of primary syphilis a specific EIA–IgM test and a TPPA test should be performed whenever there is a clinical suspicion of primary infection. This is particularly important when an EIA such as Murex ICE is used as a single screening test as it is less sensitive than the TPPA in primary infection.

Evaluation of the Serodia Treponema pallidum particle agglutination, the Murex Syphilis ICE and the Enzywell TP tests for serodiagnosis of syphilis

We evaluated the Treponema pallidum haemagglutination assay (TPHA), a treponemal test, with three other treponemal tests, the Serodia T. pallidum particle agglutination assay, the Murex Syphilis ICE IgG + IgM enzyme immunoassay (EIA) and the Enzywell TP IgG + M EIA (a new rapid EIA) for use in conjunction with the rapid plasma reagin test (RPR), a non-treponemal test, for serodiagnosis of syphilis. In all, 124 serum samples were found reactive with RPR and/or TPHA after testing by the routine laboratory protocol. Twenty-three (18.5%) of them were positive only by RPR test and were evaluated as biologically false-positive, 16 were positive only by the TPHA and 84 by both the RPR and TPHA tests; one sample was non-specific (heterophile reaction) in the TPHA.

Agreements of the TPHA with the Serodia TPPA, the Murex Syphilis ICE and the Enzywell TP tests were 96.7%, 100% and 99.1%, respectively.

We conclude that each one of the tests, the Serodia TPPA, the Murex Syphilis ICE and the Enzywell TP, is an appropriate substitute for screening for serodiagnosis of syphilis.

Non-chlamydial non-gonococcal urethritis or undiagnosed chlamydial urethritis?

The aim of this study is to investigate the prevalence of sexually transmitted infections (STI) in the partners of men with non-chlamydial, non-gonococcal urethritis (NCNGU).

Observational study of the sexual partners of men with NCNGU diagnosed in the Department of Genitourinary Medicine, Edinburgh between 1 June 2002 and 31 December 2003. The diagnosis of chlamydial infection was based on ligase chain reaction (LCx) between June 2002 and March 2003, and on polymerase chain reaction (PCR) thereafter. Gonococcal infection was diagnosed with culture method.

Sexual partners of 99 (25%) of the 403 heterosexual men diagnosed with NCNGU were screened. Chlamydial infection was detected in 19 (19%) of the female sexual partners. Higher proportion of female partners of symptomatic men (15/51) had chlamydial infection compared with that of partners of asymptomatic men (4/48) ( P < 0.005).

NCNGU may be related to false-negative results of chlamydial diagnostic tests. Screening and treatment of sexual partners of men with NCNGU is therefore necessary.

Intravenous fluid bolus therapy: a bi-national survey of critical care nurses' self-reported practice

Knowledge of critical care nurses' intravenous fluid bolus therapy (FBT) practice remains underexplored. Using a multi-choice online survey conducted between September and October 2014, we sought to describe the self-reported practice of critical care nurses located in Australia and New Zealand. Two hundred and ninety-five critical care nurses responded to the survey with most practising in adult ICUs. Overall, 0.9% saline solution was the preferred solution for FBT. However, more Australian than New Zealand respondents preferred 'albumin 4%' (31% versus 3.6%, P <0.01) for FBT. In contrast, more New Zealand respondents preferred 'Plasma-Lyte®' (33.3% versus 6.4%, P <0.01). Half of the respondents defined FBT as 250 ml administered as quickly as possible. However, FBT volumes ranged from 100 ml to >1000 ml and administration duration from as quickly as possible to 60 minutes. In response to FBT, almost half of the respondents expected an increase in mean arterial pressure of between 11 to 20 mmHg. Similarly, >40% expected a central venous pressure increase >3 mmHg, >70% expected a urinary output increase of 0.5 to 1.0 ml/kg/hr, and >60% expected a decrease in heart rate of >11 /min. Overall, 0.9% saline remains the most common solution for FBT, but there are significant national differences in the preference for albumin and Plasma-Lyte. A volume of 250 ml defines a fluid bolus, with a range from 100 ml to >1000 ml, and speed of delivery from stat to 60 minutes. Most nurses expect substantial physiological effects with FBT.

We should be using nonlinear indices when relating heart-rate dynamics to cognition and mood

Both heart rate (HR) and brain functioning involve the integrated output of a multitude of regulatory mechanisms, that are not quantified adequately by linear approximations such as means and standard deviations. It was therefore considered whether non-linear measures of HR complexity are more strongly associated with cognition and mood. Whilst resting, the inter-beat (R-R) time series of twenty-one males and twenty-four females were measured for five minutes. The data were summarised using time, frequency and nonlinear complexity measures. Attention, memory, reaction times, mood and cortisol levels were assessed. Nonlinear HR indices captured additional information, enabling a greater percentage of the variance in behaviour to be explained. On occasions non-linear indices were related to aspects for behaviour, for example focused attention and cortisol production, when time or frequency indices were not. These effects were sexually dimorphic with HR complexity being more strongly associated with the behaviour of females. It was concluded that nonlinear rather than linear methods of summarizing the HR times series offers a novel way of relating brain functioning and behaviour. It should be considered whether non-linear measures of HR complexity can be used as a biomarker of the integrated functioning of the brain.

Urinary neutrophil gelatinase-associated lipocalin to hepcidin ratio as a biomarker of acute kidney injury in intensive care unit patients

BACKGROUND

Labile iron is important in the pathogenesis of acute kidney injury (AKI). Neutrophil gelatinase-associated lipocalin (NGAL) and hepcidin control iron metabolism and are upregulated during renal stress. However, higher levels of urinary NGAL are associated with AKI severity whereas higher urinary hepcidin levels are associated with absence of AKI. We aimed to investigate the value of combining both biomarkers to estimate the severity and progression of AKI in intensive care unit (ICU) patients.

METHODS

Urinary NGAL and hepcidin were quantified within 48 hours of ICU admission in patients with the systemic inflammatory response syndrome and early kidney dysfunction (oliguria for ≥ 2 hours and/or a 25 µmol/L creatinine rise from baseline). Diagnostic and prognostic characteristics were assessed by logistic regression and receiver operating characteristics (ROC) analysis.

RESULTS

Of 102 patients, 26 had mild AKI and 28 patients had severe AKI on admission. Sepsis (21%), cardiac surgery (17%) and liver failure (9%) were primary admission diagnoses. NGAL increased (P=0.03) whereas hepcidin decreased (P=0.01) with increasing AKI severity. The value of NGAL/hepcidin ratio to detect severe AKI was higher than when NGAL and hepcidin were used individually and persisted after adjusting for potential confounders (adjusted OR 2.40, 95% CI 1.20-4.78). The ROC areas for predicting worsening AKI were 0.50, 0.52 and 0.48 for NGAL, 1/hepcidin and the NGAL/hepcidin ratio.

CONCLUSION

The NGAL/hepcidin ratio is more strongly associated with severe AKI than the single biomarkers alone. NGAL and hepcidin, alone or combined as a ratio, were unable to predict progressive AKI in this selected ICU cohort.

Can daytime measures of lung function predict respiratory failure in children with neuromuscular disease?

Neuromuscular disorders in children are a heterogeneous group of conditions with a variable age of presentation and overlapping clinical manifestations, many of which have progressive respiratory morbidity. Respiratory insufficiency occurs as a consequence of an imbalance between demands on the respiratory system and respiratory muscle capacity. Daytime measures of pulmonary function are used routinely in these children to assess respiratory status and monitor the consequences of the progression of muscle weakness. This review describes the current evidence for daytime pulmonary function tests and their ability to predict imminent respiratory morbidity.

Patient-reported outcome measures in psoriasis: the good, the bad and the missing!

As a long-term condition, psoriasis demands significant personal and professional input for optimal self-management. Low levels of well-being and high levels of psychological distress in patients with psoriasis are associated with reduced resources for self-care. Patient-reported outcome (PRO) measures can be used to assess physical, social and psychological functioning in order to guide treatment. In this article, we systematically reviewed the development and validation of existing PRO measures. PubMed (Medline), PsycINFO and CINAHL were searched systematically using predefined search terms. The search was limited to articles in the English language relating to human subjects. Articles were selected for full review through explicit inclusion/exclusion criteria. PRO measures were critically reviewed in accordance with the published guidelines and theory on the development and validation of PROs. The search identified 967 abstracts; 71 of these articles met the criteria for full review. In these 71 articles, 45 PRO measures were found: 16 were specific to psoriasis, 21 assessed other dermatological conditions and eight were developed for generic nondermatological health conditions. The review revealed several limitations of the existing measures, including: (i) a composite structure assessing multiple, poorly-defined concepts; (ii) a lack of evidence for face and content validity; (iii) a failure to include both patient and clinician perspectives and requirements and (iv) a lack of evidence regarding the feasibility and acceptability for patients and physicians. No single PRO measure with adequate evidence of validity, reliability and sensitivity to change captures patient well-being in psoriasis. A valid, sensitive, specific and acceptable PRO that assesses the full impact of psoriasis on well-being is needed for the comprehensive clinical management of psoriasis.

The effect of chicken extract on mood, cognition and heart rate variability

Chicken extract, which is rich in anserine and carnosine, has been widely taken in Asian countries as a traditional remedy with various aims, including attenuation of psychological fatigue. The effects of consuming BRAND’S Essence of Chicken (EOC) or a placebo on 46 young adults’ responses to a standard psychological “stressor” were considered. Heart rate variability (HRV), cortisol responses, mood and cognition were measured at baseline and after ten days supplementation. EOC resulted in feeling less anxious, depressed and confused and more agreeable and clearheaded. A decrease in HRV was observed after EOC but only in females. Cognition and cortisol levels were not influenced by EOC. Findings suggest that EOC may be a promising supplement to improve mood in a healthy population.

The development of the predisposition to dehydration questionnaire

The role played by hydration in general health and well-being is an emerging public health issue, yet there are few tools available to monitor its status in large populations. The aim was therefore to develop a questionnaire that assesses individual differences in the tendency to lose body fluid in a warm environment and hence become dehydrated. Fifty-three subjects sat in a room at 30°C for four hours and changes in mood and measures of hydration were monitored. There were marked individual differences in the loss of body mass that differed from 0.24% to 2.39%. Females who reported habitually drinking a lot had more water in their diet and at baseline the osmolality of urine was lower. After being subject to heat, those who reported habitually drinking more produced more urine, had a lower urine osmolality at the end of the study, and overall more body mass was lost. Females who reported that they responded badly to heat were more confused, unsure and depressed after four hours at 30°C. In males those reporting that they habitually drank to a greater extent had more water in the diet, and also those who dealt badly with heat habitually drank more. It was concluded that particularly in females, questionnaire measures were able to predict changes in hydration that result from a warm environment.

The nature of the control of blood glucose in those with poorer glucose tolerance influences mood and cognition

The ability to control the levels of blood glucose was related to mood and cognition. 155 adults, aged 45-85 years, without a diagnosis of diabetes, were given an oral glucose tolerance test and cognitive tests. Participants were classified according to age (41-60/61-85 years), whether they had better or poorer glucose tolerance and whether blood glucose did or did not fall below baseline values. There were two main findings. Those with poorer glucose tolerance forgot more words and had slower decision times, but only if 61 years or older. Secondly as there are reports in animal studies that inducing low levels of blood glucose values benefited cognitive performance, for the first time in humans, individual differences in the tendency to develop low levels of blood glucose were considered. In those with poor glucose tolerance a tendency for blood glucose to fall below baseline values was associated with better mood and faster working memory.

Sex Pheromone Components in the New Zealand Brownheaded Leafroller. Ctenopseustis obliquana (Lepidoptera: Tortricidae)

The sex pheromone of Ctenopseustis obliquana was found to contain (Z)-8-tetradecenyl acetate and (Z)-5-tetradecenyl acetate in approximately 4:1 ratio. No A 11-tetradecenyl compound was detected in C. obliquana, in contrast with the pheromones thus far reported from species of the tribe Archipini elsewhere in the world.

The von Weizsäcker Coefficient in Density Functional Theoryt

For any given potential, linear response theory tells us the size that the von Weizsäcker coefficient must assume in order to obtain the correct energy in the weak coupling limit. With this necessarily imposed choice, the quality of results is investigated as the coupling is strengthened. From the study of a number of model problems (the harmonic oscillator, the Yukawa well and the Mathieu potential) it is concluded that good results can be maintained to high couplings.

A Sex Attractant for Sperchia in tractana Walker (Lepidoptera: Tortricidae) in New Zealand

Traps baited with approx. 2:1 mixtures of (E)-, and (Z)-11-tetradecenyl acetates caught male Sperchia intrac­tana Walker in the field. Analyses of extracts obtained from virgin female moths revealed the presence of these two compounds, which are presumably the major components of the sex pheromone.

Sex Pheromone Components in the New Zealand Greenheaded Leafroller. Planotortrix excessana (Lepidoptera: Tortricidae)

Planotortrix excessana was found to include moths of two distinct pheromone-types which were not mutually attractive. Tetradecyl acetate and (Z)-8-tetradecenyl acetate were identified as pheromone components in one, and two other tetradecenyl acetates, probably (Z)-5-and (Z)-7-tetradecenyl acetate, in the other. By contrast with other pheromones reported from the tribe Archipini,⊿11-tetradecenyl compounds were not found in either pheromone-type.