Laboratory evaluation of anti-phospholipid syndrome: a preliminary prospective study of phosphatidylserine/prothrombin antibodies in an at-risk patient cohort.

Immunoglobulin (Ig)G/IgM autoantibodies to phosphatidylserine/prothrombin (aPS/PT) were evaluated individually and in combination with criteria anti-phospholipid (aPL) tests in a prospectively ascertained cohort of patients at risk for anti-phospholipid syndrome (APS). One hundred and sixty (160) consecutive requests for lupus anti-coagulant (LAC) from the University of Utah Health Sciences Center were identified during 8 weeks. Of these, 104 unique patients had additional requests for cardiolipin (aCL) and/or beta2 glycoprotein I (aß2 GPI) IgG and/or IgM; samples were retained and analysed for aPS/PT, aCL and/or aß2 GPI IgG and IgM antibodies. Following testing, a comprehensive chart review was performed and patients categorized according to their clinical diagnosis. Individual and combined sensitivities, specificities, odd ratios (OR), diagnostic accuracy for specific tests or combinations by receiver operating characteristic (ROC), area under the curve (AUC) analyses and correlations between test results were determined. The sensitivities of aPS/PT IgG/IgM (54·6/45·5%) were lower than LAC (81·8%) but higher relative to aCL IgG/IgM (27·3/0%) or aß2 GPI IgG/IgM (27·3/0%). The best correlation between LAC and any aPL test was observed with aPS/PT (P = 0·002). There was no significant difference in the diagnostic accuracies for any panel with LAC: LAC/aß2 GPI IgG/aCL IgG [AUC 0·979, OR 475·4, 95% confidence interval (CI) 23·1-9056·5, P = 0·0001 and LAC/aß2 GPI IgG/aPS/PT IgG or LAC/aPS/PT IgG/aCL IgG (AUC 0·962, OR 265·3, 14·2-4958·2, P = 0·0001). The high correlation between LAC and aPS/PT IgG/IgM in this preliminary study suggest that this marker may be useful in the evaluation of APS. More studies to determine the optimal aPL antibody tests combination are needed.

The distribution of total and specific serum IgE in the European Community Respiratory Health Survey.

BACKGROUND: Variations in the prevalence of atopy could provide important clues to the etiology of atopy and asthma. Although estimates of prevalence are available from different studies, a lack of standardization makes comparisons difficult. OBJECTIVE: This study was conducted to estimate the variation of geometric mean levels of serum IgE and the prevalence of specific IgE to common allergens between populations as part of the European Community Respiratory Health Survey (ECRHS), a multicenter survey of asthma and risk factors for asthma. METHODS: Random samples of subjects living in 37 centers in 16 countries who had answered a questionnaire about their respiratory symptoms were invited for further assessment including total serum IgE and the presence of specific IgE against house dust mite (Dermatophagoides pteronyssinus), timothy grass, cat, Cladosporium herbarum, and a local allergen. Sera were tested from 13,883 persons. RESULTS: The estimated prevalence of atopy, defined as the presence of at least one positive specific IgE, ranged from 16% in Albacete (Spain) to 45% in Christchurch (New Zealand). The geometric mean total serum IgE varied from 13 kU/L in Reykjavik (Iceland) to 62 kU/L in Bordeaux (France). There was no relation between the geometric mean total serum IgE in a center and the prevalence of atopy. CONCLUSIONS: There are substantial variations in the prevalence of atopy and the level of serum IgE. These variations are independent of each other and likely to be largely environmental in origin.

Microorganisms on toothbrushes at day-care centers.

The microflora on 44 toothbrushes at 4 day-care centers in the city of Göteborg have been investigated as a presumptive risk factor for transmission of microorganisms by children. Non-supervised toothbrushing without the use of toothpaste was performed at the day-care centers twice a day. Streptococci, predominantly S. salivarius, S. sanguis, and S. mitis, were the most frequently recorded group of microorganisms and generally constituted the greatest part of the flora (on average, 50%). Beta-hemolytic streptococci were not found in any sample. Haemophilus species were noted in 82% of the samples. H. parainfluenzae being the most frequent, and H. influenzae being identified in only one sample. Anaerobes constituted on average a third of the microflora. Staphylococci were identified in 86% of the samples, S. epidermidis dominating. Fungi including molds were found in 50% of the samples, and from one day-care center large numbers of enteric organisms were identified. Thus this study shows that unsupervised toothbrushing at day-care centers can be questioned, more from a general hygienic point of view than from the risk of transmitting serious pathogens.

Diagnostic capabilities of penicillin-based structures as tools in the in vitro diagnosis of penicillin allergy.

Various penicillin-based structures attached to paper disks were used in the radioallergosorbent test (RAST) to measure concentrations of circulating specific IgE antibodies in sera from subjects suspected of having penicillin allergy. The structures used were penicilloyl, penicillanyl, penicoyl and penicanyl groups prepared from benzylpenicillin (PG), phenoxymethylpenicillin (PV), amoxicillin (AX) and 6-amino-penicillanic acid (6-APA). The efficacy of these structures was evaluated using serum samples from 53 subjects who, on clinical grounds, were considered to have had adverse reactions to penicillins. The results showed the presence of IgE antibodies specific to the penicillin side-chain in certain patients, whereas others had IgE antibodies specific to the penicilloyl or penicillin basic structure (penicillin nucleus), which led to clinical cross-reactions between penicillins. The results showed that the use of several penicillin-based structures in a new test system increased the positive rate observed to 54.7% from 37.7% utilizing penicilloyl G, penicilloyl V and amoxicilloyl Phadebas RAST. Thus, the prepared species improve the capabilities of the in vitro diagnosis of penicillin allergy.

Ligature wires and elastomeric rings: two methods of ligation, and their association with microbial colonization of Streptococcus mutans and lactobacilli.

Twelve orthodontic patients undergoing treatment with fixed appliances took part in the present study. In all patients elastomeric rings were used for ligation on one side of the dental arch midline, whereas steel wires were used on the opposite side. The number of micro-organisms in samples of plaque, taken from the labial surface of the upper lateral incisors, was recorded on five occasions during treatment. In samples of saliva, the numbers of Streptococcus mutans and lactobacilli were recorded on the same occasions. This registration was also made on two occasions before insertion of the fixed appliance, and 6 weeks after the period of active treatment. The results showed that, in the majority of patients, the incisor which was attached to the arch-wire with an elastomeric ring, exhibited a greater number of micro-organisms in the plaque than the incisor ligated with steel wire. Following insertion of fixed appliances the number of S. mutans and lactobacilli in saliva increased significantly. Variations in the number of micro-organisms in the saliva during active treatment were not reflected in any relative increase or decrease in microbial colonization on either steel ligatures or elastomeric rings. The use of retainers after active treatment was not associated with increased numbers of micro-organisms in the saliva.

Clinical and immunological characteristics of Brazil nut allergy.

Twelve cases of allergy to Brazil nut have been recorded in the last 8 years. The reaction is usually IgE mediated and most patients have other atopic diseases. There appear to be several proteins with potent antigenic components in Brazil nut.

Fluorine uptake in bovine enamel from various treatment agents.

Bovine tooth enamel with a low and uniform fluorine content was used for the study of fluorine uptake by the Micro-Acid-Drop enamel biopsy technique from different treatment agents commonly used in Sweden. The fluorine concentration in the enamel was also measured after an exposure of the treated test surfaces in artificial saliva for 90 minutes. Sodium fluoride 0.2% and 2%, ferric aluminum fluoride solution and Duraphat varnish showed a high uptake of fluorine in the enamel with the highest concentration in the surface layer. Fluor Protector and the toothpastes showed a considerably lower fluorine uptake. After immersion in artificial saliva of the specimens, the concentration of fluorine in the enamel decreased.