Oesophageal biopsy from a patient with diagnosis of eosinophilic oesophagitis. The mucosa has greater than 20 eosinophis per hpf. Haematoxylin & eosin stain, (400×magnification)
interesting medical information
A flu test influences the choice of treatment
A recent study found that patients tested for and diagnosed with influenza with a rapid test were more likely to receive appropriate treatment than those diagnosed with the flu without testing.
Investigators at the University of Utah (Salt Lake City, USA) reviewed data from the National Hospital Ambulatory Medical Care Survey, a nationally representative sample of emergency room visits in the US. From this database they identified children and adults who had been diagnosed with influenza across three flu seasons (2007-2009).
Analysis of the data showed that at least 23% of patients diagnosed with influenza without rapid testing received a prescription for antibiotics, which are not effective in treating influenza.
Prescriptions for antiviral drugs (e.g. Tamiflu®), which can be effective in treating influenza when used early and appropriately, were ordered for 56% of patients diagnosed with influenza using a rapid test, compared to orders for prescriptions for antiviral drugs for only 19% of influenza patients diagnosed without testing.
Overall, the data showed that influenza diagnoses made in association with a laboratory assay resulted in fewer additional tests, antibiotic prescriptions, and more frequent use of antiviral drugs.
The study was published in the November 13, 2013, online edition of the Journal of the Pediatric Infectious Diseases Society.
The sperm fertility index (SFI)
The sperm fertility index (SFI) is used by Medical Diagnostic Laboratories IDEA for assessing the ability of semen to fertilize.
For the numerical calculation of SFI has been designed software that takes into account various parameters typically identified in semen analysis (sperm count, morphology and motility, biochemical tests, presence of antisperm antibodies).
According to this classification completely normal semen has a SFI larger than 160 AU. SFI values between 80 and 160 AU indicate moderate quality semen. Finally SFI values less than 80 AU have been found in problematic semen with extremely low capacity for fertilization.
in patients with asthma
Asthma is a common disease that affects 8-10% of adults. On the other hand eosinophilic oesophagitis is a relatively “new” disease, which occurs in up to 0.4% of the population. The epidemiological finding linking the two diseases is the fact that approximately 50% of patients with eosinophilic oesophagitis simultaneously suffering from asthma.
Thus some patients with asthma will experience sometime eosinophilic oesophagitis. The question is whether oesophagitis due to asthma or cause of asthma or treatment for asthma
A recent (2013) research study conducted at the Mayo Clinic by pulmonologists and gastroenterologists concluded that allergic asthma, allergic rhinitis and peripheral eosinophilia (especially active eosinophils) are associated with the appearance of eosinophilic oesophagitis. Steroid inhalers appear to have a protective effect against eosinophilic oesophagitis.
The results of this research show that eosinophilic oesophagitis should be viewed as part of a generalized allergic disease rather than isolated oesophageal disease.
Medically significant fungi
and superficial mycoses
Fungi are eukaryotic microorganisms. Only about 15 genera and 100 species of the thousands of species are involved in human disease. Most of the medically important fungi are ubiquitous in nature.
Superficial mycoses involve the keratin-containing structures of the body (epidermis, hair, nails). The infections generally are considered cosmetic problems and are not life threatening. The disease processes very rarely spread to other tissues and, then, only in extremely immunocompromised individuals. Children are more susceptible than adults, and infections are more common in warm, moist climates.
The major causes of superficial mycoses are Trichophyton species, Microsporum species, and a single species of Epidermophyton, which collectively are referred to as dermatophytes. Other fungi involved in superficial mycoses include Pityrosporum species and Candida species.
Clinical manifestations may include scaling of skin, hair loss, pruritus, and erythema or other discoloration. The symptomatology is characteristic, but it is not diagnostic, so an accurate diagnosis relies on laboratory tests.
(Photos have reprinted from the book U. Spyrakou: Basic Medical Mycology, 2nd ed., Athens, 2000.)
UMMA : A superior assay for the detection of vitamin B12 deficiency
Vitamin B12 is important in DNA synthesis, erythropoiesis, and development and maintenance of the myelin sheath of nerves. Deficiency of the vitamin B12 can cause pernicious anaemia, neurological damage, e.g. spinal cord degeneration and mental changes. If left untreated, it is estimated that 80 - 90% of deficient individuals will develop disorders of the nervous system such as fatigue, muscle aches, decreased visual acuity, depression, confusion, loss of memory or dementia similar to Alzheimer’s disease and leg paralysis. Similarly, recent research indicates that B12 deficiency can be a cause of heart attack or stroke.
Different laboratory methods have been used to screen selected individuals such as serum vitamin B12 measurement, Schilling test and plasma homocysteine, but all these tests often give falsely positive and falsely negative values.
Elevated urinary methylmalonic acid (UMMA) levels indicate tissue/cellular B12 deficiency since they are directly related to a B12 dependent pathway:
Methylmalonic acid ———————→Succinic acid
Vitamin B12 deficiency impedes this pathway causing urine excretion of methylmalonic acid to increase.
Normal UMMA is less than 3,8 μg / mg creatinine.
Many researchers have showed that UMMA assay is much more reliable than all other tests in early diagnosis of vitamin B12 deficiency as well as in monitoring improvement after therapy.
IAST® : A valuable test for respiratory allergy
Two out of ten are allergic. Allergy often presents with an unclear, confusing picture, making the correct diagnosis difficult. Allergy is therefore to a large extent an underdiagnosed condition.
A recent solution to this situation is IAST® (Inhalation Allergy Screen Test). IAST is a simple blood test, which confirms or excludes atopic allergy in patients with symptoms of the eyes, ears and the upper and lower respiratory tract.
IAST® is a laboratory test based on the allergosorbent principle. It utilizes two discs, which carry balanced mixtures of relevant allergens causing common inhalant allergy. A blood sample of 0.50 ml is sufficient to perform the assay. The results are reported in AU/L (Allergy Units). Normal value is 0-35 AU/L. Recent clinical studies in IDEA Medical Labs show over 95% agreement with the more complex and expensive conventional diagnostic methods (skin tests and RAST).