Background-Shedding of endothelial cells from damaged endothelium into the blood occurs in a variety of vascular disorders. The purpose of this study was to evaluate the utility of circulating endothelial cell (CEC) count as a diagnostic marker of non-ST-elevation acute coronary syndromes (ACSs). Methods and Results-CEC counts were determined immediately (H0), 4 hours (H4), and 8 hours (H8) after admission in 60 patients with documented non-ST-elevation ACS and 40 control patients with no evidence of coronary artery disease. A total of 32 patients in the ACS group had elevated CEC counts (Ͼ3 cells/mL) in relation to early admission and single-episode chest pain. Patients from the control group had normal CEC counts. The interval between the chest pain episode and elevation was significantly shorter for CEC than troponin I. No correlation was found between the 2 markers. Interestingly, a subgroup of ACS patients with initially normal troponin I levels had high CEC counts, thus allowing early diagnosis in 30% more cases. At H0, the mean area under the receiver operating characteristic curve was significantly higher with the CEC count than with the troponin I level. At H4 and H8, the combined use of CEC and troponin was significantly better as a marker of ACS than CEC alone or troponin I alone. Conclusions-This study demonstrates that CEC count can be used as an early, specific, independent diagnostic marker for non-ST-elevation ACS. A combined strategy using CEC count and troponin I level could provide an effective diagnostic tool.

Implemented as one arm of the malaria control program in French Guiana in the early 1990s, our laboratory has since established in vitro profiles for parasite drug susceptibility to a panel of eight antimalarials for more than 1,000 Plasmodium falciparum isolates from infected patients. The quinine-doxycycline combination was introduced in 1995 as the first-line drug treatment against uncomplicated P. falciparum malaria, replacing chloroquine, and the first-line drug combination was changed to the artemether-lumefantrine combination in 2002. Resistance to chloroquine declined 5 years after it was dropped in 1995 as the first-line drug, but unlike similar situations in Africa, there was a rapid halt to this decline. Doxycycline susceptibility substantially decreased from 2002 to 2005, suggesting parasite selection under quinine-doxycycline drug pressure. Susceptibility to mefloquine decreased from 1997 onward. Throughout the period from 1994 to 2005, most isolates were sensitive in vitro to quinine, amodiaquine, and atovaquone. Susceptibility to amodiaquine was strongly correlated with that to chloroquine and to a lesser extent with that to mefloquine and halofantrine. Susceptibilities to mefloquine and to halofantrine were also strongly correlated. The Guyana Shield currently has the highest malaria rates in South America and is the only geographical area in the Americas where Plasmodium falciparum infection is diagnosed more frequently than P. vivax infection. In French Guiana, P. falciparum accounts for 60 to 70% of the 3,000 to 5,000 malaria cases reported every year (3). Malaria occurs in isolated geographical foci situated along the rivers in the Amazonian forest, and the population has little specific immunity. Malarial control involves spraying insecticides over the coastal region, where approximately 80% of the population resides, and using bed nets, an evidence-based drug policy, and deploying health services in remote endemic areas to provide prompt treatment by public primary health centers and/or private practitioners.As in the neighboring countries of the Amazon basin (36), P. falciparum is multidrug resistant, with failures documented for chloroquine (18), the amodiaquine/sulfadoxine-pyrimethamine combination (22), halofantrine (9, 19), chloroquine-proguanil (19), and even quinine (6). In the last decade, the drug policy in French Guiana has been based on both an in vivo assessment of therapeutic efficacy and longitudinal monitoring of in vitro drug susceptibility. In 1995, the quinine-doxycycline combination was recommended as the first-line treatment. It was replaced by the artemether-lumefantrine combination in 2002.Monitoring drug resistance is particularly important in this region, where illegal gold-mining activities in the malaria endemicity areas are associated with erratic consumption of antimalarials and frequently with self-medication, unclear compliance to recommended regimens, and the formulation and use of illegally imported molecules of unknown quality, which contribute to the select...

BackgroundDengue has emerged as the most important vector-borne viral disease in tropical areas. Evaluations of the burden and severity of dengue disease have been hindered by the frequent lack of laboratory confirmation and strong selection bias toward more severe cases.MethodologyA multinational, prospective clinical study was carried out in South-East Asia (SEA) and Latin America (LA), to ascertain the proportion of inapparent dengue infections in households of febrile dengue cases, and to compare clinical data and biological markers from subjects with various dengue disease patterns. Dengue infection was laboratory-confirmed during the acute phase, by virus isolation and detection of the genome. The four participating reference laboratories used standardized methods.Principal FindingsAmong 215 febrile dengue subjects—114 in SEA and 101 in LA—28 (13.0%) were diagnosed with severe dengue (from SEA only) using the WHO definition. Household investigations were carried out for 177 febrile subjects. Among household members at the time of the first home visit, 39 acute dengue infections were detected of which 29 were inapparent. A further 62 dengue cases were classified at early convalescent phase. Therefore, 101 dengue infections were found among the 408 household members. Adding these together with the 177 Dengue Index Cases, the overall proportion of dengue infections among the study participants was estimated at 47.5% (278/585; 95% CI 43.5–51.6). Lymphocyte counts and detection of the NS1 antigen differed significantly between inapparent and symptomatic dengue subjects; among inapparent cases lymphocyte counts were normal and only 20% were positive for NS1 antigen. Primary dengue infection and a specific dengue virus serotype were not associated with symptomatic dengue infection.ConclusionHousehold investigation demonstrated a high proportion of household members positive for dengue infection, including a number of inapparent cases, the frequency of which was higher in SEA than in LA.

The sophisticated technical design of 2SE FAG has resulted in a system which is able to carry out its role as an early warning system. Efforts must be concentrated on increasing its acceptance and use by people who have to enter data and decreasing the occurrence of the frequency of technical problems.