The AEIOU of essential diagnostics: align, expand, implement, oversee, and update

By Julia E von Oettingen, Ophira Ginsburg, Sandeep P Kishore, Sonak D Pastakia, Lee F Schroeder, Dan A Milner, et al.

The Lancet Global Health, June 1, 2019

 

Heart attack, diabetes, cancer: these common clinical diagnoses can (and should) be confirmed with a diagnostic test. However, in large parts of the world, up-to-date, cost-effective, and simple diagnostic tools remain unavailable.  Patients and health-care providers in such settings are often reliant on so-called syndromic medicine, whereby diagnoses are made on the basis of clinical judgment and treatment is administered empirically. This approach is less than ideal, because it carries the risk of misdiagnosis, unnecessary or harmful treatments, adverse sequelae, and even death.

 

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Bacterial and viral respiratory tract microbiota and host characteristics in children with lower respiratory tract infections: a matched case-control study

By Wing Ho Man, MD, Marlies A van Houten, MD, Marieke E Mérelle, MD, Arine M Vlieger, MD,Mei Ling J N Chu, BSc, Nicolaas J G Jansen, MD, et al.

The Lancet Respiratory Medicine, May 2019

 

Lower respiratory tract infections (LRTIs) are a leading cause of childhood morbidity and mortality. Potentially pathogenic organisms are present in the respiratory tract in both symptomatic and asymptomatic children, but their presence does not necessarily indicate disease. We aimed to assess the concordance between upper and lower respiratory tract microbiota during LRTIs and the use of nasopharyngeal microbiota to discriminate LRTIs from health.

 

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Introducing a New Algorithm for Classification of Etiology in Studies on Pediatric Pneumonia: Protocol for the Trial of Respiratory Infections in Children for Enhanced Diagnostics Study

By Rhedin SA,  Eklundh A, Ryd-Rinder M, Naucler P, Mårtensson A, Gantelius J, Zenk I, Andersson-Svahn H6, Nybond S, Rasti R, Lindh M, Andersson M, Peltola V, Waris M, Alfvén T

 

JMIR Research Protocols, April 2019

 

The overall aim of the Trial of Respiratory infections in children for ENhanced Diagnostics (TREND) study is to improve the differential diagnosis of bacterial and viral etiologies in children aged below 5 years with clinical CAP, by evaluating myxovirus resistance protein A (MxA) as a biomarker for viral CAP and by evaluating an existing (multianalyte point-of-care antigen detection test system [mariPOC respi] ArcDia International Oy Ltd.) and a potential future point-of-care test for respiratory pathogens.

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Atypical and Typical Bacteria in Children with Community Acquired Pneumonia

Jama-Kmiecik A, Frej-Mądrzak M, Sarowska J, Teryks-Wołyniec D, Skiba A, Choroszy-Król  

 

Part of the Advances in Experimental Medicine and Biology book series, April 2019

 

This seeks to determine the pathogens in respiratory specimens and blood serum obtained from children who present with community acquired pneumonia (CAP) diagnosed on the basis of clinical and radiological evidence. The study group consisted of 46 hospitalized children aged 1–11 years. The material for research consisted of pharyngeal swabs and samples of blood serum. One hundred and thirty eight pharyngeal swabs were examined for the presence of C. pneumoniae antigen, C. pneumoniae DNA, and for typical pathogens. C. pneumoniae DNA was detected in pharyngeal swabs with nested PCR. Classical microbiological culture was used for detection of typical bacteria. ELISA test were used for detection anti-C. pneumoniae and anti-M. pneumoniae antibodies in the serum. C. pneumoniae DNA was identified in 10.9% of children. Positive culture for typical pathogens was observed in 8.7% of children. Specific anti-C. pneumoniae IgM antibodies were found in 8.7% of children, and IgG and IgA antibodies in 1 child each. Specific anti-M. pneumoniae IgG antibodies were found in 13.1% of children and IgM antibodies in 1 child. We conclude that the underlying bacterial etiology of CAP is rather rarely conclusively confirmed in children. Nonetheless, determining the etiology of CAP is essential for the choice of treatment to optimize the use and effectiveness of antimicrobials and to avoid adverse effect. Due to considerable variations in the power of detection of the type of atypical bacteria causing CAP, the search for the optimum diagnostic methods continues.

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Mortality and cardiovascular and respiratory morbidity in individuals with impaired FEV1 (PURE): an international, community-based cohort study

by MyLinh Duong, MBBS; Shofiqul Islam, PhD; Sumathy Rangarajan, MSc; Darryl Leong, PhD; Om Kurmi, PhD; Prof Koon Teo, MB; et al.

To be published in The Lancet Global Health, May 2019.

 

 

The associations between the extent of forced expiratory volume in 1 s (FEV1) impairment and mortality, incident cardiovascular disease, and respiratory hospitalisations are unclear, and how these associations might vary across populations is unknown.

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