Diagnostic value of early secreted antigenic target-6 for the diagnosis of tuberculous meningitis patients.

BACKGROUND: The early diagnosis of tuberculous meningitis (TBM) is very crucial, since delayed diagnosis can lead to various neurological manifestations. We have previously developed an in-house indirect enzyme-linked immunosorbent assay (ELISA) for TBM diagnosis using the Antigen 85 (Ag 85) complex. It has been suggested that the Ag 85 complex might give false-positive reactions for individuals vaccinated with Bacillus Calmette-Guérin (BCG). OBJECTIVES: In the present study, we describe a prospective evaluation demonstrating that early secreted antigenic target- 6 (ESAT-6), which is absent in Mycobacterium bovis BCG strains, is in the cerebrospinal fluid (CSF) of TBM patients. METHODS: We used an indirect ELISA to detect ESAT-6 antigens in the CSF of TBM patients using polyclonal antibodies against ESAT-6. RESULTS: Using the indirect ELISA method, we demonstrated a sensitivity and specificity of 80% and 94%, respectively, for the diagnosis of TBM. CONCLUSION: The detection of ESAT-6 in the CSF of TBM patients by indirect ELISA is a promising method and can be used to develop an immunodiagnostic assay with increased sensitivity and specificity.

Transcutaneous electrical nerve stimulation for relief of parturition pain. A clinical report.

The purpose of this clinical report is to share procedures and results using transcutaneous electrical nerve stimulation (TENS) in the management of pain associated with labor and delivery. Although favorable reports of the use of TENS during labor have been published in Europe, its application in the United States to the labor and delivery process has received little attention and is relatively unknown. We decided to use US equipment in the obstetric department of a US community hospital to verify the European studies. Fifteen patients selected by two obstetricians evaluated the effectiveness of a 3M TENS unit Model 6240. The criteria for inclusion were willingness to try TENS and ability to understand the procedure. The patients served as their own control and turned the unit off for several contractions during the middle and late periods of the first stage of labor to judge the effectiveness of TENS. Twenty-four hours after delivery, a physical therapist recorded the subjective response of patients and obstetricians separately on a questionnaire, which gave a rating scale of poor, moderate, or excellent for relief. We found TENS provided some form of relief to 87 percent of the participants, and 20 percent reported excellent relief. Most participants expressed a willingness to use TENS if they gave birth again.