Clinical impact of rapid molecular detection of respiratory pathogens in patients with acute respiratory infection

•

Diagnosis with FilmArray-RP was associated with changes in medical management.

•

Accurate and rapid diagnosis decreased antibiotic use and complementary studies, and improved oseltamivir use.

•

The multiplex PCR respiratory panel permitted a high viral detection rate not only in children but in adults.

Background

Acute respiratory infections (ARI) are a leading cause of morbidity and mortality worldwide. There is a need to demonstrate the clinical impact of using the new, rapid and sensitive molecular assays in prospectively designed studies.

Objectives

To study the impact on medical management of a rapid molecular assay in patients with respiratory infections.

Study design

A prospective, randomized, non-blinded study was performed in patients presenting to the Emergency Department during two respiratory seasons (2016–2017). Diagnosis was performed by FilmArray Respiratory Panel (FilmArray-RP) or by immunofluorescence assay (IFA).

Results

A total of 432 patients (156 children and 276 adults) were analyzed. Diagnosis with FilmArray-RP was associated with significant changes in medical management including withholding antibiotic prescriptions (OR:15.52, 95%CI:1.99–120.83 in adults and OR:12.23, 95%CI:1.56–96.09 in children), and reduction in complementary studies in children (OR:9.64, 95%CI:2.13–43.63) compared to IFA. Decrease in oseltamivir prescriptions was significantly higher in adults in the FilmArray-RP group (p = 0.042; OR:1.19, 95%CI:0.51-2.79) compared to adults managed with IFA. Diagnostic yield was significantly higher by FilmArray-RP (81%) than by IFA (31%)(p < 0.001). The median time from sample collection to reporting was 1 h 52 min by FilmArray-RP and 26 h by IFA (p < 0.001).

Conclusions

The high respiratory viruses’ detection rate and availability of results within two hours when using FilmArray-RP were associated with decreases in antibiotic prescriptions and complementary studies and more accurate use of oseltamivir.

Solar oxidation and removal of arsenic--Key parameters for continuous flow applications

Solar oxidation to remove arsenic from water has previously been investigated as a batch process. This research has investigated the kinetic parameters for the design of a continuous flow solar reactor to remove arsenic from contaminated groundwater supplies. Continuous flow recirculated batch experiments were carried out under artificial UV light to investigate the effect of different parameters on arsenic removal efficiency. Inlet water arsenic concentrations of up to 1000 μg/L were reduced to below 10 μg/L requiring 12 mg/L iron after receiving 12 kJUV/L radiation. Citrate however was somewhat surprisingly found to promote a detrimental effect on the removal process in the continuous flow reactor studies which is contrary to results found in batch scale tests. The impact of other typical water groundwater quality parameters (phosphate and silica) on the process due to their competition with arsenic for photooxidation products revealed a much higher sensitivity to phosphate ions compared to silicate. Other results showed no benefit from the addition of TiO2 photocatalyst but enhanced arsenic removal at higher temperatures up to 40 °C. Overall, these results have indicated the kinetic envelope from which a continuous flow SORAS single pass system could be more confidently designed for a full-scale community groundwater application at a village level.

Liquid-based cytology improves productivity in cervical cytology screening

OBJECTIVES

The ThinPrep test was introduced into our institution on a phased basis over 3 years between January 2002 and December 2004. This study set out to assess its effect on productivity (as measured by output of cases per medical scientist per day) during the changeover period. Numbers of high and low-grade lesions and of unsatisfactory slides were also monitored.

METHODS

The percentage conversion from conventional preparation to liquid-based cytology (LBC) and output of cases per medical scientist per day were calculated from our database at 6-month intervals. The average backlog, average number of cases received per month and percentage of unsatisfactory and abnormal cases were calculated similarly.

RESULTS

Over the study period 92 084 cases were received. The percentage of cases using ThinPrep increased: from 9% in January 2002 to 73% in December 2004. During the study there was an increase in output from 17.0 to 22.3 cases per medical scientist per day, representing a 31% improvement at 73% conversion. Numbers of unsatisfactory cases decreased substantially and the numbers of low and high-grade diagnoses were relatively constant.

CONCLUSIONS

The change to ThinPrep has improved productivity and decreased the number of unsatisfactory cases. There was no adverse effect on quality during the changeover.

Transfected synphilin-1 forms cytoplasmic inclusions in HEK293 cells

The discovery of mutations in the gene for alpha-synuclein in familial Parkinson's disease (PD) has led to an increased interest in this pre-synaptic protein. Synphilin-1, a potential synuclein-binding protein, was cloned using yeast two-hybrid assays. The function of synphilin-1 is currently unknown, although it has been reported to be present along with alpha-synuclein in Lewy bodies in PD. In the present study, we monitored synphilin-1 aggregation directly using fusion proteins of synphilin-1 and green fluorescent protein (EGFP). Transfection of synphilin-EGFP fusion proteins formed cytoplasmic inclusions in HEK293 cells. Although these inclusions overlapped with the distribution of alpha-synuclein, they were unlike Lewy bodies in that they were not eosinophilic, and instead were membrane-bound, lipid-rich cytoplasmic inclusions.

Hyperhomocysteinaemia: a risk factor for extracranial carotid artery atherosclerosis

Hyperhomocysteinemia arising from impaired methionine metabolism, and usually due to a deficiency of cystathionine beta-synthase is a significant and independent risk factor for symptomatic vascular disease. It is not known if hyperhomocysteinemia in apparently healthy asymptomatic subjects is associated with atherosclerosis and whether such a relationship is independent of conventional risk factors. The prevalence of asymptomatic extracranial carotid artery atherosclerosis was determined by duplex ultrasound examination in 25 obligate heterozygotes with respect for cystathionine beta-synthase deficiency (whose children were known to be homozygous for this genetic defect) and in 21 controls. Hyperhomocysteinemia was determined by a standard methionine-loading test and conventional risk factors were also recorded. Twelve of 25 obligate heterozygotes and 8 of 21 normal controls had evidence of extracranial carotid artery atherosclerosis. Hyperhomocysteinemia as a genetic trait was not a significant risk marker, but the actual homocysteine level was associated with an increased risk of carotid disease. After adjustment for the effects of other significant risk factors, the odds ratio of hyperhomocysteinemia for carotid disease was 1.038 per unit increase in homocysteine level (P = 0.03). Hyperhomocysteinemia is a weak risk factor for asymptomatic extracranial carotid atherosclerosis and the relative risk associated with this genetic trait is less than that observed in a study of patients presenting with clinical manifestations of vascular disease.