Detection of group a Streptococcus in pharyngitis by two rapid tests: comparison of the BD Veritor™ and the QuikRead go® Strep A.

We compared the performance of two rapid antigen tests-QuikRead go® Strep A test (Orion Diagnostica, Espoo, Finland) and BD Veritor™ system (Becton, Dickinson and Company, Sparks, MD) with throat culture. Our aim was to evaluate each assay's performance and agreement compared to throat culture in order to choose one of the assays as a point-of-care test in the emergency room. One hundred throat samples were collected in triplicates from patients with suspected pharyngitis admitted to the emergency room. One throat swab was seeded for a throat culture. The other two throat swabs from each patient were analyzed at the emergency room by the QuikRead go® Strep A test, and by the BD Veritor™ system, according to each manufacturer's instructions. Agreement level between BD Veritor™ test and throat culture was 79%; sensitivity and specificity of this test were 80% and 78.7%, respectively. QuikRead go® Strep A test had an agreement level of 75% with throat culture; sensitivity and specificity of this test were 80% and 73.3%, respectively. Both tests have a good diagnostic performance. Other characteristics such as costs, size of instrument, and ease of implementation should be taken into consideration when choosing a point-of-care test.

Combined approach sialendoscopy for management of submandibular gland sialolithiasis.

PURPOSE: Sialolithiasis is the primary cause of obstructive sialadenitis, affecting the submandibular gland in 80-90% of cases. Sialendoscopy has dramatically changed the diagnosis and management of salivary gland diseases. However, in cases in which endoluminal removal via sialendoscopy is not successful, a combined approach using a limited intraoral incision under guidance of sialendoscopy can facilitate stone removal. We reviewed our institution's experience with combined approach sialendoscopy and evaluated its role in managing sialolithiasis of the submandibular gland. MATERIALS AND METHODS: Retrospective study of the treatment of sialolithiasis in the submandibular gland via combined approach sialendoscopy from January 2010 through March 2014. Demographics, clinical data, intraoperative findings and post-operative course were reviewed. RESULTS: Most sialoliths (56.5%) were over 10 mm in size and were in the hilus of the gland (56%). The success rate of the combined approach was 87%. No significant complications were documented. Symptoms resolved in 75.7% of patients; however, this did not correlate with placement of an intraductal stent (p=0.7) or steroid irrigation (p=0.1). An overall gland preservation rate of 94.9% was achieved. CONCLUSIONS: Combined approach sialendoscopy offers a minimally invasive technique for treating refractory sialolithiasis not amenable to removal via sialendoscopy alone. The procedure is well-tolerated, performed under local anesthesia with low morbidity and a high success rate.

Genetic elucidation of human hyperosmia to isovaleric acid.

The genetic basis of odorant-specific variations in human olfactory thresholds, and in particular of enhanced odorant sensitivity (hyperosmia), remains largely unknown. Olfactory receptor (OR) segregating pseudogenes, displaying both functional and nonfunctional alleles in humans, are excellent candidates to underlie these differences in olfactory sensitivity. To explore this hypothesis, we examined the association between olfactory detection threshold phenotypes of four odorants and segregating pseudogene genotypes of 43 ORs genome-wide. A strong association signal was observed between the single nucleotide polymorphism variants in OR11H7P and sensitivity to the odorant isovaleric acid. This association was largely due to the low frequency of homozygous pseudogenized genotype in individuals with specific hyperosmia to this odorant, implying a possible functional role of OR11H7P in isovaleric acid detection. This predicted receptor-ligand functional relationship was further verified using the Xenopus oocyte expression system, whereby the intact allele of OR11H7P exhibited a response to isovaleric acid. Notably, we also uncovered another mechanism affecting general olfactory acuity that manifested as a significant inter-odorant threshold concordance, resulting in an overrepresentation of individuals who were hyperosmic to several odorants. An involvement of polymorphisms in other downstream transduction genes is one possible explanation for this observation. Thus, human hyperosmia to isovaleric acid is a complex trait, contributed to by both receptor and other mechanisms in the olfactory signaling pathway.

Mutations in olfactory signal transduction genes are not a major cause of human congenital general anosmia.

Anosmia affects the western world population, mostly the elderly, reaching to 5% in subjects over the age of 45 years and strongly lowering their quality of life. A smaller minority (about 0.01%) is born without a sense of smell, afflicted with congenital general anosmia (CGA). No causative genes for human CGA have been identified yet, except for some syndromic cases such as Kallman syndrome. In mice, however, deletion of any of the 3 main olfactory transduction components (guanidine triphosphate binding protein, adenylyl cyclase, and the cyclic adenosine monophosphate-gated channel) causes profound reduction of physiological responses to odorants. In an attempt to identify human CGA-related mutations, we performed whole-genome linkage analysis in affected families, but no significant linkage signals were observed, probably due to the small size of families analyzed. We further carried out direct mutation screening in the 3 main olfactory transduction genes in 64 unrelated anosmic individuals. No potentially causative mutations were identified, indicating that transduction gene variations underlie human CGA rarely and that mutations in other genes have to be identified. The screened genes were found to be under purifying selection, suggesting that they play a crucial functional role not only in olfaction but also potentially in additional pathways.

Antibiotic treatment in acute otitis media: 'in vivo' demonstration of antibacterial activity.

The ultimate goal in antibiotic treatment of acute otitis media (AOM) is eradication of the pathogens from the middle ear fluid (MEF). To test the ability of an antibiotic to achieve this goal, the best available method is to obtain MEF by aspiration before initiating antibiotics and to repeat this procedure during treatment, a method which was termed the 'in vivo sensitivity test'. This advantageous method is difficult to perform and thus only a few groups were able to conduct such large-scale studies. The available information is discussed in the present manuscript, as well as some preliminary results suggesting that oral beta-lactam antibiotics may not be the ideal drugs to date, due to the emergence of resistant pneumococci.