Metabolic and Toxic Myelopathies

2021 ◽  
Author(s):  
Michaël C. C. Slama ◽  
Aaron L. Berkowitz
Keyword(s):  
Decompression Sickness ◽  
Diagnostic Testing ◽  
Intrathecal Chemotherapy ◽  
Rapid Identification ◽  
Nutritional Deficiencies ◽  
Toxic Substances ◽  
Toxic Exposure ◽  
Heroin Use ◽  
Temporal Course ◽  
Chronic Myelopathy

AbstractMetabolic and toxic causes of myelopathy form a heterogeneous group of disorders. In this review, we discuss the causes of metabolic and toxic myelopathies with respect to clinical presentation, pathophysiology, diagnostic testing, treatment, and prognosis. This review is organized by temporal course (hyperacute, acute, subacute, and chronic) and etiology (e.g., nutritional deficiency, toxic exposure). Broadly, the myelopathies associated with dietary toxins (neurolathyrism, konzo) and decompression sickness present suddenly (hyperacute). The myelopathies associated with heroin use and electrical injury present over hours to days (acutely). Most nutritional deficiencies (cobalamin, folate, copper) and toxic substances (nitrous oxide, zinc, organophosphates, clioquinol) cause a myelopathy of subacute onset. Vitamin E deficiency and hepatic myelopathy cause a chronic myelopathy. Radiation- and intrathecal chemotherapy-induced myelopathy can cause a transient and/or a progressive syndrome. For many metabolic and toxic causes of myelopathy, clinical deficits may stabilize or improve with rapid identification and treatment. Familiarity with these disorders is therefore essential.

scholarly journals Multicenter Evaluation of the Xpert Norovirus Assay for Detection of Norovirus Genogroups I and II in Fecal Specimens

2015 ◽  
Vol 54 (1) ◽  
pp. 142-147 ◽  
Author(s):  
Mark D. Gonzalez ◽  
L. Claire Langley ◽  
Blake W. Buchan ◽  
Matthew L. Faron ◽  
Melanie Maier ◽  
...  
Keyword(s):  
Gold Standard ◽  
Infection Prevention ◽  
Diagnostic Testing ◽  
Reference Method ◽  
Rapid Identification ◽  
Prevention Measures ◽  
Predictive Values ◽  
Common Cause ◽  
Percent Agreement ◽  
Control And Prevention

Norovirus is the most common cause of sporadic gastroenteritis and outbreaks worldwide. The rapid identification of norovirus has important implications for infection prevention measures and may reduce the need for additional diagnostic testing. The Xpert Norovirus assay recently received FDA clearance for the detection and differentiation of norovirus genogroups I and II (GI and GII), which account for the vast majority of infections. In this study, we evaluated the performance of the Xpert Norovirus assay with both fresh, prospectively collected (n= 914) and frozen, archived (n= 489) fecal specimens. A Centers for Disease Control and Prevention (CDC) composite reference method was used as the gold standard for comparison. For both prospective and frozen specimens, the Xpert Norovirus assay showed positive percent agreement (PPA) and negative percent agreement (NPA) values of 98.3% and 98.1% for GI and of 99.4% and 98.2% for GII, respectively. Norovirus prevalence in the prospective specimens (collected from March to May of 2014) was 9.9% (n= 90), with the majority of positives caused by genogroup II (82%,n= 74). The positive predictive value (PPV) of the Xpert Norovirus assay was 75% for GI-positive specimens, whereas it was 86.5% for GII-positive specimens. The negative predictive values (NPV) for GI and GII were 100% and 99.9%, respectively.

Hormesis: public health policy, organizational safety and risk communication

2003 ◽  
Vol 22 (1) ◽  
pp. 39-41 ◽  
Author(s):  
Marc Poumadére
Keyword(s):  
Public Health ◽  
Risk Communication ◽  
Public Health Issue ◽  
Toxic Substances ◽  
Toxic Exposure ◽  
Positive Health ◽  
Organizational Safety ◽  
The Public ◽  
Regulatory Issue ◽  
The Impact

Thirty years of research suggests low doses of toxic substances may have positive health effects. If confirmed, hormesis will imply radical changes in risk assessment and management of existing industrial toxic sources (chemical and nuclear). Renn analyses risk communication issues and positions hormesis–largely unknown to the public today–as a hypothetical risk object in society. Our comments stress the necessity to consider hormesis first as a public health issue (versus an industrial regulatory issue), to consider the impact of managerial changes upon organizational safety culture, and to assess effects on public health from the ‘bad news’ of toxic exposure.

scholarly journals Implementation of an efficient SARS-CoV-2 specimen pooling strategy for high throughput diagnostic testing

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Lavanya Singh ◽  
Ugochukwu J. Anyaneji ◽  
Wilfred Ndifon ◽  
Neil Turok ◽  
Stacey A. Mattison ◽  
...  
Keyword(s):  
Diagnostic Testing ◽  
Professional Sports ◽  
Rapid Identification ◽  
Rt Pcr ◽  
Assay Sensitivity ◽  
Sports Team ◽  
Sample Pooling ◽  
Pooling Strategies ◽  
Frequent Testing ◽  
Liquid Handling Robot

AbstractThe rapid identification and isolation of infected individuals remains a key strategy for controlling the spread of SARS-CoV-2. Frequent testing of populations to detect infection early in asymptomatic or presymptomatic individuals can be a powerful tool for intercepting transmission, especially when the viral prevalence is low. However, RT-PCR testing—the gold standard of SARS-CoV-2 diagnosis—is expensive, making regular testing of every individual unfeasible. Sample pooling is one approach to lowering costs. By combining samples and testing them in groups the number of tests required is reduced, substantially lowering costs. Here we report on the implementation of pooling strategies using 3-d and 4-d hypercubes to test a professional sports team in South Africa. We have shown that infected samples can be reliably detected in groups of 27 and 81, with minimal loss of assay sensitivity for samples with individual Ct values of up to 32. We report on the automation of sample pooling, using a liquid-handling robot and an automated web interface to identify positive samples. We conclude that hypercube pooling allows for the reliable RT-PCR detection of SARS-CoV-2 infection, at significantly lower costs than lateral flow antigen (LFA) tests.

Influence de l'exercice physique pendant et après la plongée sur le risque d’accident de décompression

2008 ◽  
Vol 33 (4) ◽  
pp. 666-670
Author(s):  
Emmanuel Gempp ◽  
Jean-Éric Blatteau
Keyword(s):  
Decompression Sickness ◽  
Temporal Course ◽  
Decompression Procedure ◽  
Risque D’Accident

Exercise at depth and during decompression is a commonly accepted factor that affects the risk of decompression sickness in divers and aviators, but data documenting these effects are limited and conflicting. The mechanisms may be complex and influenced by several factors, such as the type and nature of exercise, the temporal course of the exercise in relation to the decompression procedure, and the diving profile. This paper reviews previous studies in this field of research, and discusses current concepts in diving activities.

Camphor Revisited: Focus on Toxicity

PEDIATRICS ◽  
1994 ◽  
Vol 94 (1) ◽  
pp. 127-128 ◽  
Author(s):  
Keyword(s):  
Adverse Reactions ◽  
Rapid Onset ◽  
The Body ◽  
Poison Control ◽  
Toxic Substances ◽  
Toxic Exposure ◽  
Poison Centers ◽  
Rate Of Absorption ◽  
Life Threatening ◽  
Level Of Concern

This commentary updates a previous AAP statement developed by the Committee on Drugs concerning camphor.1 The original commentary reflected the level of concern among pediatric practitioners and poison centers about the toxicity of camphor. Since the original statement, the Food and Drug Administration (FDA) has recognized camphor as a safe and effective topical antitussive, analgesic, anesthetic, and antipruritic agent.2 Following the approval process in 1983, the FDA required that the concentration of camphor in products not exceed 11%.2 Higher concentrations were not more effective and could cause more serious adverse reactions if accidentally ingested. Most reported camphor-related fatalities involved agents containing a concentration greater than 11%. Ingestion of potentially toxic substances by children is related to the availability of a product in their environment. Camphor remains widely available (Table). The toxicity of camphor when inappropriately used is well documented.3-6 Ingestion is the most common route of potentially toxic exposure, with rapid onset of toxic effects. The risk of toxicity relates to both the concentration of camphor in the ingested product and the rate of absorption of camphor into the body. From 1985 through 1989, 32 362 human exposures to camphor were reported to the American Association of Poison Control Centers.7-11 From 1985 through 1989, life-threatening toxicity occurred in 33 children as the result of camphor ingestion. During this period, there were no Childhood deaths as the result of camphor ingestion. In 5 cases, the products ingested contained more than 11% camphor even though they had been discontinued in 1983. In 14 cases, the products contained between 10% and 11% camphor.

scholarly journals Implementation of an efficient SARS-CoV-2 specimen pooling strategy for high throughput diagnostic testing

2021 ◽  
Author(s):  
Lavanya Singh ◽  
Ugochukwu J. Anyaneji ◽  
Wilfred Ndifon ◽  
Neil Turok ◽  
Stacey A. Mattison ◽  
...  
Keyword(s):  
Diagnostic Testing ◽  
Professional Sports ◽  
Rapid Identification ◽  
Rt Pcr ◽  
Assay Sensitivity ◽  
Sports Team ◽  
Sample Pooling ◽  
Pooling Strategies ◽  
Frequent Testing ◽  
Liquid Handling Robot

Abstract The rapid identification and isolation of infected individuals remains a key strategy for controlling the spread of SARS-CoV-2. Frequent testing of populations to detect infection early in asymptomatic or presymptomatic individuals can be a powerful tool for intercepting transmission, especially when the viral prevalence is low. However, RT-PCR testing – the gold standard of SARS-CoV-2 diagnosis – is expensive, making regular testing of every individual unfeasible. Sample pooling is one approach to lowering costs. By combining samples and testing them in groups the number of tests required is reduced, substantially lowering costs. Here we report on the implementation of pooling strategies using 3-d and 4-d hypercubes to test a professional sports team in South Africa. We have shown that infected samples can be reliably detected in groups of 27 and 81, with minimal loss of assay sensitivity for samples with individual Ct values up to 32. We report on automation of sample pooling, using a liquid-handling robot and an automated web interface to identify positive samples. We conclude that hypercube pooling allows for the reliable RT-PCR detection of SARS-CoV-2 infection, at significantly lower cost than lateral flow antigen (LFA) tests.

Molecular epidemiology of norovirus in Edinburgh healthcare facilities, Scotland 2007–2011

2012 ◽  
Vol 140 (12) ◽  
pp. 2273-2281 ◽  
Author(s):  
G. McALLISTER ◽  
A. HOLMES ◽  
L. GARCIA ◽  
F. CAMERON ◽  
K. CLOY ◽  
...  
Keyword(s):  
Polymerase Chain Reaction ◽  
Surveillance System ◽  
Diagnostic Testing ◽  
Temporal Distribution ◽  
Rapid Identification ◽  
Rt Pcr ◽  
Chain Reaction ◽  
Predominant Genotype ◽  
Healthcare Facilities ◽  
Polymerase Chain

SUMMARYNorovirus (NoV) is a leading cause of outbreaks of gastroenteritis worldwide, and a major burden for healthcare facilities. This study investigated the NoV genotypes responsible for outbreaks in Edinburgh healthcare facilities between June 2008 and July 2011, and studied their temporal distribution to enable a better understanding of the epidemiology of the outbreaks. A total of 287 samples positive for NoV genogroup II (GII) RNA by reverse transcription–polymerase chain reaction (RT–PCR) during routine diagnostic testing were investigated. Nested RT–PCR (nRT–PCR) and sequencing was used to genotype the NoV strains. Overall, a total of 69 NoV strains belonging to six different genoclusters (GII.1, GII.2, GII.3, GII.4, GII.6, GII.13) were detected. The predominant genotype was GII.4 that included four variants, GII.4 2006a, GII.4 2006b, GII.4 2007 and GII.4 2010. Importantly, increases in NoV activity coincided with the emergence of new GII.4 strains, highlighting the need for an active surveillance system to allow the rapid identification of new strains.

scholarly journals Development and Validation of a Decision-Making Stratification Algorithm to Optimize the Use of Rapid Diagnostic Testing for Patients with Staphylococcus Bacteremia

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Thamer A. Almangour ◽  
Abdullah A. Alhifany ◽  
Deanne E. Tabb
Keyword(s):  
Positive Impact ◽  
Diagnostic Testing ◽  
Standard Of Care ◽  
Rapid Identification ◽  
Blood Cultures ◽  
Pharmacy Service ◽  
Rapid Diagnostic Testing ◽  
Expected Time ◽  
The Cost ◽  
Development And Validation

Purpose. To evaluate whether introducing rapid diagnostic testing in conjunction with implementing a stratification algorithm for testing eligibility would be an appropriate clinical and cost saving approach. Method. An internal concurrent 4-month observational study was performed. Positive blood cultures continued to be worked up in accordance with standard of care. An additional call to the infectious disease (ID) pharmacy service occurred for all positive blood cultures with Gram-positive cocci in clusters (GPCC). The ID pharmacy service investigated each case using a prespecified stratification algorithm to minimize unnecessary use of rapid identification testing. Results. 43 patients with GPCC were screened. Only nine patients met inclusion criteria for QuickFISH™ testing. The average expected time avoided to optimize antibiotic therapy is 35±16 hours. If the QuickFISH test had been indiscriminately implemented for all cases, the cost for performing this test would have been $5,590. However, using the prespecified algorithm, only 9 patients were tested for a projected cost of $1,170. Conclusion. Introducing rapid diagnostic testing in conjunction with implementing patient stratification algorithm for rapid identification of GPCC from blood cultures in addition to the ID pharmacy intervention will provide a positive impact on the clinical and economic outcomes in our health care setting.

Origin of Hepatic Nuclear Inclusion Bodies

1973 ◽  
Vol 31 ◽  
pp. 426-427
Author(s):  
F. G. Zaki ◽  
J. A. Greenlee ◽  
C. H. Keysser
Keyword(s):  
Inclusion Bodies ◽  
Storage Disease ◽  
Glycogen Storage ◽  
Nutritional Deficiencies ◽  
Nuclear Inclusion ◽  
Electron Microscopic ◽  
Human Liver Cells ◽  
Microscopic Studies ◽  
Per Se ◽  
Experimental Liver

Nuclear inclusion bodies seen in human liver cells may appear in light microscopy as deposits of fat or glycogen resulting from various diseases such as diabetes, hepatitis, cholestasis or glycogen storage disease. These deposits have been also encountered in experimental liver injury and in our animals subjected to nutritional deficiencies, drug intoxication and hepatocarcinogens. Sometimes these deposits fail to demonstrate the presence of fat or glycogen and show PAS negative reaction. Such deposits are considered as viral products.Electron microscopic studies of these nuclei revealed that such inclusion bodies were not products of the nucleus per se but were mere segments of endoplasmic reticulum trapped inside invaginating nuclei (Fig. 1-3).

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