Evaluation of a commercial latex agglutination assay for serological diagnosis of leptospirosis.

Leptospirosis is a febrile zoonosis of worldwide distribution. A latex agglutination assay was evaluated in two studies, the first using a panel of well-characterized sera from patients with leptospirosis and from patients with other disease states and the second, a prospective hospital-based study, evaluating sera from 186 consecutive patients admitted to hospital with acute febrile illness. The confirmed leptospirosis serum panel included paired acute- and convalescent-phase specimens from 40 cases, of which 34 gave positive latex tests (case sensitivity, 85%; 95% confidence interval [95% CI], 70 to 94%). The other diseases represented in the panel of 112 specimens from nonleptospirosis patients included autoimmune diseases, brucellosis, dengue, melioidosis, malaria, syphilis, toxoplasmosis, viral hepatitis, and a number of other viral infections. The specificity of latex agglutination using this panel was 81% (95% CI, 73 to 87%). Among the patients with acute febrile illness, there were 25 cases of leptospirosis and 161 patients with other diagnoses. The sensitivity and specificity of latex agglutination in this group were 88% (95% CI, 72 to 97%) and 98% (95% CI, 95 to 100%), respectively. In this evaluation, the two distinct groups of specimens gave similar results for sensitivity, but specificity was different in each study. The sensitivity and specificity observed for the hospital study were similar to those obtained in evaluations of other rapid tests in the same population. The results of this study suggest that multiple evaluations of new diagnostic assays should be performed, because performance characteristics may vary in different populations.

Right hemisphere dysfunction: therapeutic intervention from acute care to home health.

This article discusses clinical practice variances in speech-language treatment of patients with right hemisphere dysfunction by therapeutic milieu. With an eye toward enhanced cost effectiveness, a model of intervention is presented that takes a patient from acute care management through rehabilitation. Issues discussed include assessment, family training, goal setting, and documentation. A right hemisphere screening tool is included in an appendix for use in acute and transitional care settings where in-depth testing might be inappropriate because of time constraints or the acute or transitory nature of the patient's symptoms.

Opportunities for pregnant and parenting teenagers: a school-based and school-linked intervention program.

Three hundred and ninety (390) pregnant and parenting teens participated in a school-based and school-linked federally funded program at 10 high-risk schools. The program was designed to (1) increase the use of referred services and attendance at these services without students' missing school, (2) increase academic skills, and (3) increase health and well-being of the students and their infants. The program provided 18 services coordinated at the school or provided on site. The end-of-year evaluations indicated 88% to 95% of teens attended services that were recommended, and 69% did not miss school to receive these services. The teens' rate of passing their grade level increased at the end of the program year. Additionally, 78% used birth control, and over 90% of the infants received timely health care. The qualitative data provided by students indicated pregnant and parenting teens wanted to remain in school despite the struggles they encountered. The process evaluation provided by the coordinators at each school indicated that communication and cooperation between program staff and school nurses were the key elements in enabling teens to receive the targeted services.

Glycated serum albumin induces chemokine gene expression in human retinal pigment epithelial cells.

Chronic hyperglycemia is thought to be important in the development of diabetic neovascularization but the mechanisms involved remain poorly understood. Interleukin-8 (IL-8) is a leukocyte chemokine and activating agent with angiogenic properties that is present in diabetic vitreous and may play a role in diabetic vasculopathy. We studied IL-8 and monocyte chemotactic protein-1 (MCP-1) production by human retinal pigment epithelial (hRPE) cells exposed to glycated human serum albumin (GHSA). Enzyme-linked immunoassay GHSA (500 micrograms/mL)-treated hRPE cells secreted levels of IL-8 and MCP-1 detectable within 4 h and reached 26.0 +/- 1.3 and 42.2 0.4 ng/10(6) cells/mL after 24 h, respectively. Induction of IL-8 and MCP-1 by GHSA at concentrations ranging from 62.5 to 3,000 micrograms/mL exhibited dose-dependent kinetics. The GHSA-induced chemokine secretion by hRPE was almost completely inhibited by actinomycin D and cycloheximide, suggesting that de novo mRNA and protein synthesis are necessary for the GHSA-induced IL-8 and MCP-1 production. Northern blot analysis of GHSA-induced hRPE IL-8 and MCP-1 mRNA expression corresponded to the time- and dose-dependent increases measured by enzyme-linked immunosorbent assay. High concentrations of glucose (20 mM; 360 mg/dl) increased GHSA-induced hRPE IL-8 and MCP-1 secretion, whereas added insulin (0.5 ng/mL) inhibited IL-8 but not MCP-1 protein secretion and mRNA expression. GHSA also induced hRPE to secrete GRO-alpha, RANTES, and NAP-2 chemokines. GHSA induction of hRPE chemokines further suggests a role for the hRPE in leukocyte infiltration, vascular injury, and neovascularization.