Contribution of real-time PCR to Plasmodium species identification and to clinical decisions: a nationwide study in a non-endemic setting

Treatment choice for patients with malaria in Israeli hospitals is based on microscopy and rapid diagnostic tests (RDTs). Here, we demonstrate the cumulative value of real-time polymerase chain reaction (PCR) in optimizing the treatment of malaria. Between January 2009 and December 2015, 451 samples from 357 patients were tested in our laboratory using a real-time PCR assay. Hospital laboratory results (without real-time PCR) were compared to those obtained in our laboratory. A total of 307 patients had a malaria-positive laboratory finding in the hospital. Out of those, 288 were confirmed positive and 19 negative using real-time PCR. Two negative hospital results were found to be positive by real-time PCR. More specifically, of 153 cases positive for Plasmodium falciparum by real-time PCR, only 138 (90%) had been correctly identified at the hospitals. Similarly, 66 (67%) of 99 cases positive for P. vivax, 2 (11%) of 18 cases positive for P. ovale, and 3 (30%) of 10 cases positive for P. malariae had been correctly identified. Of 10 cases of mixed infection, only one had been identified as such at the hospital. Thus, real-time PCR was required for correct identification in 81 (28%) out of 290 positive cases. In 52 (18%) of those, there was an erroneous categorization of relapsing versus non-relapsing parasites. In a nationwide study, we found that the use of real-time PCR is definitely beneficial and may change the decision regarding the choice of treatment.

The perils of complementary alternative medicine

More than 11,000 articles lauding alternative medicine appear in the PubMed database, but there are only a few articles describing the complications of such care. Two patients suffering from complications of alternative medicine were treated in our hospital: one patient developed necrotizing fasciitis after acupuncture, and the second developed an epidural hematoma after chiropractic manipulation. These complications serve as a clarion call to the Israeli Health Ministry, as well as to health ministries around the world, to include complementary medicine under its inspection and legislative authority.

Socioeconomic Status, Health Inequalities, and Solidarity Trends in a Mass Vaccination Campaign

Background

In July 2013, Israel was swept with fear of a polio outbreak. In response to the importation of wild polio virus, the Ministry decided to take preventive action by administering oral poliovirus vaccine (OPV) to all children born after 1 January 2004 who had received at least one dose of inactivated poliovirus vaccine (IPV) in the past. This study analyzes the vaccination uptake rates resulting from the mass polio vaccination campaign on the basis of health inequality parameters of socioeconomic status (SES), principles of solidarity, and the Gini inequality index. The research explores understanding the value of the Gini inequality index within the context of SES and solidarity.

Methods

The study is based on data gathered from the Israeli Ministry of Health’s administrative records from mother-and-child clinics across Israel. The research population is comprised of resident infants and children whom the Ministry of Health defined as eligible for the OPV between August and December 2013.

Results

The higher the SES level of the area where the mother-and-child clinic is located, the lower the OPV vaccination uptake is. The greater the income inequality is in the municipality where the mother-and-child clinic is situated, the lower the vaccination uptake. As time passed in the vaccination campaign, vaccination uptake increased regardless of the location of the mother-and-child clinics. The highest vaccination uptake rate was found among populations of low SES and low Gini inequality index. The lowest vaccination uptake rate was found among populations of high SES/high Gini inequality index.

Conclusions

Public health professionals promoting vaccine programs need to make specially-designed efforts both in localities with high average income and in localities with a high level of income diversity/inequality. Such practice will better utilize funds, resources, and manpower dedicated to increasing vaccination uptake across varying populations and communities.

Key messages

The higher the SES in municipalities with mother-and-child clinics, the less likely children were to be vaccinated. The lower the Gini inequality index, there is a higher polio vaccination uptake among of children.

A Pilot Study of Percutaneous Cholecystoenteric Anastomosis: A New Option for High-Risk Patients with Symptomatic Gallstones

PURPOSE

To evaluate the safety and effectiveness of percutaneous cholecystoenteric anastomosis (PCEA) creation in patients with indwelling cholecystostomy tubes who are high-risk surgical candidates.

MATERIALS AND METHODS

Fourteen (male, 10; female, 4) patients with a mean age of 79 years (range, 53-92 years) with previously inserted cholecystostomy tubes underwent PCEA with the adjacent duodenum using a lumen-apposing metal stent (LAMS) between January 2015 and October 2022. Intraprocedural adverse events and postprocedural safety and effectiveness outcomes were evaluated. Nine procedures were performed under sedation and 5 under general anesthesia.

RESULTS

Technical success was achieved in 100% of the patients. In 12 patients (86%), the existing cholecystostomy tube was removed after the insertion of the LAMS. Three patients (21%) had a pre-existing cholecystoduodenal fistula, in which the stent was placed, and 11 (79%) underwent creation of a de novo anastomosis. The mean procedure time was 1.5 hours (range, 1-2 hours). The mean length of stay after the procedure was 2.4 days (range, 1-10 days). There were no intraprocedural adverse events. One patient with severe pre-existing cardiac comorbidities died during his postprocedural stay despite a technically successful procedure. One patient had delayed closure of the long-standing cholecystocutaneous tract.

CONCLUSIONS

Early clinical experience with PCEA using an LAMS suggests that it is a safe and effective option for the creation of internal gallbladder drainage in patients who are not candidates for surgical cholecystectomy.

The relationship between a common catechol-O-methyltransferase (COMT) polymorphism val(158) met and fibromyalgia

OBJECTIVES

Fibromyalgia syndrome (FM) is an idiopathic chronic pain syndrome characterised by widespread nonarticular musculoskeletal pain, generalised tender points, in the absence of inflammatory or structural musculoskeletal abnormalities, accompanied by a constellation of symptoms that include fatigue and disturbances of sleep and mood. Catechol-O-methyltransferase (COMT) is the major catecholamine-clearing pathway and involved in the mediation of pain perception in humans, and the hypothesized role of pain perception in FM. The association between Val/Met polymorphism at the COMT gene was evaluated in FM disorder.

METHODS

209 FM female patients were compared with 152 of their non-affected relatives. DNA was obtained from all family members and extracted. We used the logistic based variant of the transmission disequilibrium test to assess association (and linkage) without confounding effect of population stratification.

RESULTS

We observed an association between FM and the COMT val(158) met polymorphism in a dose response effect of the COMT genotype and the number of pressure points reported. We also observed that non-affected relatives of FM patients had a reduced percentage of the COMT met allele.

CONCLUSIONS

Our results are consistent with carriers of the COMT met/met genotype showing increased sensitivity to pain as one mechanism for the role of this gene in conferring risk for FM. We suggest that the reduced frequency of the met allele in the non-affected relatives acts as a 'protective' allele in this group and prevents the development of clinical FM.

Self-expanding metallic stent insertion for malignant bowel obstruction secondary to gynecologic malignancies: a retrospective analysis : SEMS for gynecological MBO is efficient

BACKGROUND

Malignant bowel obstruction (MBO) is a common complication in advanced and recurrent gynecologic malignancies, with limited treatment options and poor prognosis. Self-expanding metallic stent (SEMS) insertion has emerged as an alternative palliative measure, yet data specific to gynecologic malignancies remains scarce.

METHODS

A retrospective analysis was conducted on 61 patients with gynecologic malignancies and malignant large bowel obstruction who underwent colorectal stenting between January 2002 and December 2023. Data, including demographics, procedural details, clinical outcomes, and complications, were collected from electronic medical records.

RESULTS

The mean age of patients was 65.7 years, with ovarian cancer being the most common malignancy (77%). "Technical success" of SEMS insertion was achieved in 91.4% of cases, with a "clinical success" rate of 76.7%. Major complications occurred in 2% and 5% of patients at 30- and 90 days post-procedure, respectively. Overall mortality rates were 4% at 30 days and 28% at 90 days.

CONCLUSION

SEMS for managing MBO is a promising alternative to surgery in patients with advanced or recurrent gynecologic malignancies. It offers high technical and clinical success rates with acceptable complication rates. Further research is needed to delineate optimal patient selection criteria and refine procedural techniques to maximize outcomes in this challenging population.

Are psychological distress symptoms different in fibromyalgia patients compared to relatives with and without fibromyalgia?

OBJECTIVES

Investigating psychological distress symptoms in the context of fibromyalgia (FM) is important due to their role in pain perception, and in the development of pain related disability. Although The Symptom Check-List-90-Revised (SCL-90-R) (1) questionnaire was used to evaluate psychological distress symptoms in FM patients, it was not applied in a familial context in families of FM patients. Our aim was to identify possible differences between FM patients and their relatives with and without FM regarding psychological distress symptoms.

METHODS

The participants of the current investigation included 127 diagnosed female patients with FM, and 57 of their first degree relatives, 27 of whom had previously undiagnosed FM. Psychological distress was measured using The Symptom Check-List-90-Revised (SCL-90-R), a self report symptom inventory that addresses 9 distress dimensions reflecting various types of psychopathology.

RESULTS

FM patients reported significantly higher severity in 6 of the 9 distress symptoms compared to relatives without FM: somatisation, obsessive-compulsive, interpersonal sensitivity, depression, anxiety and psychoticism. Similar results were observed among relatives with FM, compared to the healthy group, except for anxiety. No differences were observed between FM patients and relatives with FM in the report of psychological distress.

CONCLUSIONS

FM patients and relatives with FM expressed similar symptoms of psychological distress compared to the healthy group.

Differences in the personality profile of fibromyalgia patients and their relatives with and without fibromyalgia

OBJECTIVES

To investigate whether Fibromyalgia (FM) patients differ from their first-degree relatives with and without FM regarding the four personality traits, based on Cloninger's TPQ questionnaire (1).

METHODS

The study population was obtained from a genetic study from 2003-2007 and included 129 female FM patients, 27 female relatives with undiagnosed FM and 30 female relatives without FM. All participants completed a socio-demographic questionnaire and the Tridimensional Personality Questionnaire (TPQ) (1) that refers to four personality dimensions: 'novelty seeking', 'harm avoidance', 'reward dependence' and 'persistence'. Non-articular tenderness was evaluated by tender point count and by dolorimetry.

RESULTS

FM patients and their relatives with FM had higher scores on 'harm avoidance' than relatives without FM (p<0.001, p=0.017 respectively). Furthermore, the mean point counts of FM patients were significantly higher and their tenderness thresholds were significantly lower than that of their relatives in the other two groups (p<0.001; p<0.001, respectively).

CONCLUSIONS

The findings suggest that relatives with FM display personality resemblance to FM patients especially in the personality trait harm avoidance. It appears that there are factors in this personality trait that are hereditary and that may contribute to the development of FM. However, the results could not differentiate between factors from a genetic or a non-genetic origin, due to the study design. In addition, FM's place as an independent component among genetic disorders such as pain, depression and anxiety is still unclear.

Serial two-dimensional echocardiography in infective endocarditis of the pulmonic valve

Infective endocarditis was diagnosed in a 15-yr-old patient following closure of a patent ductus arteriosus several weeks previously. Pulmonic valve vegetations were detected by both M-mode and two-dimensional echocardiograms. The serial echocardiographic examinations revealed the emergence of a vegetation on the pulmonic valve, a marked decrease in its size subsequent to pulmonary embolism, reemergence of a vegetation upon relapse of the disease and its resolution 4 mo later. The echocardiographic findings and their correlation to the various stages of the disease are described.