A clinical evaluation of the Amplicor polymerase chain reaction (PCR) assay for the detection of Chlamydia trachomatis in endocervical swabs (Roche Molecular Systems, Branchburg, N.J.) is described. This new clinical system used one-step sample preparation, amplification with biotinylated cryptic plasmid primer pairs (CP24-CP27), uracil-N-glycosylase (AmpErase), and a microtiter format for amplicon capture and detection. Culture with McCoy cells in duplicate 1-dram (3.697-ml) vials with fluorescent immunostaining was the reference system. Endocervical swab samples from 945 women provided 74 culture-positive specimens, of which PCR detected 71. The initial PCR result was positive for 12 additional specimens. Arbitration of the PCR-positive, culture-negative samples by PCR with major outer membrane protein primers, duplicate culture, elementary body direct fluorescent-antibody staining, and DNA extraction PCR showed that all 12 samples were positive for chlamydia, raising the number of truly positive samples from 74 to 86. After arbitration the true sensitivities of PCR and culture were 96.5 and 86%, respectively (P = 0.02). Specificities for both were 100%o. For PCR, the positive and negative predictive values were 100 and 99.7%, respectively. Total test efficiency was 99.7%. A high-test-volume (121 samples) timing study with all items included in the College of American Pathologists work load method indicated that this PCR format took approximately 3 min per sample. Because of the high sensitivity, specificity, and improved ease of handling, we found PCR to be a * Corresponding author. assay and compare it with the 1-dram (3.697-ml) vial McCoy cell culture as the reference method.
The temperature changes associated with total care nursing procedures were studied on 249 occasions during the first week of life in 25 preterm infants weighing less than 1500 g, 16 of whom weighed less than 1100 g. Large drops in both central and peripheral temperature occurred, with widening of the centralperipheral temperature gap. Recovery of the temperature after the total care procedure took up to two hours.These routine nursing procedures are carried out every four to six hours. during the handling of babies,'0 and showed that they were more pronounced when the incubator was used in a servo controlled temperature mode."1 The aim of the present study was to monitor the degree and importance of these temperature changes during handling.
SUMMARY We studied temperature stability in 22 infants of birthweight less than 1500 g in the first four days of life. Infants were nursed in incubators using either air mode control or skin temperature servo control. Data were collected continuously using a computer linked monitoring system. Skin temperature control resulted in a less stable thermal environment than air mode control. Increased thermal stability in the incubator on air mode control may well be beneficial, particularly to sick, very low birthweight infants.
Encephalitis is an inflammatory process of the brain that is most commonly related to infectious etiology; nonetheless, autoimmune encephalitis has been an increasingly identified entity that can cause it as well and should be considered. N-methyl-D-aspartate (NMDA) receptor encephalitis is a recently identified process but remains less recognized than autoimmune encephalitis. We report a case of an 18-year old female who initially presented with seizures and later developed behavioral symptoms of agitation, crying, screaming, and emotional lability. Ultimately, she was found to have NMDA receptor encephalitis related to ovarian paraneoplastic teratoma. The patient was treated with anti-epileptics and intravenous immunoglobulin and underwent oophorectomy that lead to her recovery. This case highlights the importance of early recognition of NMDA receptor encephalitis to facilitate appropriate investigations and management.
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