Enzyme-linked immunosorbent assays for IgM antirubella were carried out on 1,546 sera, using an IgM capture method with a F (ab')2 conjugate (ACCA). Under the conditions described, sera containing IgM antirubella bound up to 15 times as much enzyme activity as negative specimens. Paired serum specimens from 27 patients, serial serum specimens from 6 patients, and single serum specimens from 15 patients who had had recent rubella were examined by the haemagglutination inhibition test (HAI) in the presence and absence of 2-mercaptoethanol following sucrose density gradient centrifugation (SDGC). ACCA confirmed all the results found with HAI following SDGC. Specimens were examined from ten patients with congenital rubella; ACCA confirmed the results found with both immunofluorescence following SDGC and radioimmunoassay. Pre- and post-vaccination specimens from 123 patients who had been vaccinated against rubella were examined. An IgM response could only be demonstrated in the 57 cases when IgG was absent in the first specimen. The specificity of the assay was confirmed by testing 31 serum specimens from rubella immune patients that also contained rheumatoid factor, 163 serum specimens from patients with acute infections other than rubella, and 12 serum specimens from infants with miscellaneous neonatal abnormalities other than congenital rubella. The ACCA proved a simple, sensitive, and specific test for IgM antirubella and the results compared favourably with those obtained by the SDGC technique.
IntroductionA study was performed to assess the cost of a rapid molecular assay (PCR) for diagnosis of Clostridium difficile infection (CDI) and the impact of its routine use on patient length of stay (LOS) in comparison with cell culture cytotoxin neutralization assay (CCNA).MethodsFrom March 2011 to September 2011, Xpert®C. difficile (Cepheid, Sunnyvale, CA, USA) PCR was used on patients with suspicion of CDI in two acute care hospitals in Abertawe Bro Morgannwg University Health Board, Swansea, Wales, UK. Test results were used for patient management. LOS and time to reportable result were compared for negative and positive prospective patients tested by PCR and historic control patients tested by CCNA during March 2010 to September 2010. Tests were priced using micro-costing and a cost comparison analysis was undertaken.ResultsIn total, 506 patients were included. Time to reportable result for PCR samples was 1.53 h compared to 46.54 h for CCNA negatives and 22.45 h for CCNA positives. Patients tested by CCNA stayed 4.88 days longer in hospital compared to PCR patients if they tested positive and 7.03 days if tests were negative. The mean reduction in LOS observed in our study has the potential to generate cost savings of up to £2,292.62 for every patient with suspected CDI, if samples were to be tested routinely with PCR instead of CCNA.ConclusionA rapid molecular test for C. difficile in an acute hospital setting produced quick results that led to a decrease in LOS compared to historic CCNA control patients. This could result in considerable savings through reduced excess inpatient days.Electronic supplementary materialThe online version of this article (doi:10.1007/s40121-014-0034-x) contains supplementary material, which is available to authorized users.
SUMMARY Sera from 180 patients with suspected toxoplasmic lymphadenopathy were examined for antitoxoplasma IgM by an enzyme-linked immunosorbent assay (ELISA), using antibody class capture (ACCA). Of 82 positive ACCA results, 78 were confirmed by testing the IgM fractions of the sera, obtained by sucrose density gradient centrifugation (SDGC). The four positive results which could not be confirmed were all from patients with at least a year's history of lymphadenopathy. Sera from 10 patients with low Sabin Feldman dye test (DT) titres gave positive ACCA results and subsequent specimens from them showed a rise in antibody concentration, confirming the diagnosis of acute toxoplasmosis.The antitoxoplasma IgM immunofluorescent antibody test (IgM-IFA) on whole serum was relatively insensitive and gave false-positive results with sera containing rheumatoid factor (RF) and antinuclear factor (ANF). There were no false-positive ACCA results with such sera, probably because the conjugates were prepared from F(ab')2 fragments of antitoxoplasma serum.The ACCA proved to be sensitive, specific and easily automated enabling examination of large numbers of specimens. followed by serological tests in the presence and absence of 2-mercaptoethanol (2-ME) as has been described for the detection of antirubella 1gM.6These fractionation techniques are time-consuming, require expensive apparatus and are not practicable for large numbers of specimens.An enzyme-linked immunosorbent assay
was collected retrospectively from patient case notes, endoscopy reporting system and emergency theatre records. Results 77 cases of AUGIB were identified with gender distribution of 56% males and 44% females. The median age of presentation was 67 years (range 20-93 years). Most cases of AUGIB (71%) were acute admissions with the rest occurring among in-patients.A major improvement in the service is that all patients had at least one endoscopy during their presentation with most endoscopies (67%) performed within 24 hours or less and a further (26%) carried out 2-7 days. Endoscopies were performed by gastroenterologist (66%), surgeons (20%) and specialist registrar (14%). About a third (27%) had out of hours (OOH) emergency endoscopies and the remaining procedures were carried out in the dedicated inpatient lists. Majority (62%) of the OOH procedures were done at the weekends.A notable shortcoming was poor risk assessment (18%) at presentation although retrospective risk scoring revealed a median Rockall Score of 3 (range 1-5). At presentation only 8% of patients were admitted to the dedicated gastroenterology ward before the first endoscopy while the majority (52%) were managed initially on the acute medical wards and discharged or subsequently admitted to the gastroenterology ward. Conclusion The introduction of a dedicated service has improved the management of AUGIB in our hospital serving a population of 325,000 particularly during the OOH. The findings of this retrospective audit showed an AUGIB service collaborating medical gastroenterologists and surgeons is workable and sustainable in the setting of a district general hospital.To further improve the service a dedicated AUGIB clerking proforma incorporating Rockall risk score assessment is being considered.
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