المؤلفون: Arthur Marx, Matthias Egger, Christoph Hatz, Reto Nüesch, Heiner C. Bucher, Daniel Pewsner, Peter Jüni, Blaise Genton

المصدر: Annals of Internal Medicine. 142:836

مصطلحات موضوعية: medicine.medical_specialty, Endemic Diseases, Program activities, Sensitivity and Specificity, THICK SMEAR, parasitic diseases, Internal Medicine, medicine, Humans, False Positive Reactions, Malaria, Falciparum, Aldehyde-Lyases, Likelihood Functions, Travel, Hematologic tests, L-Lactate Dehydrogenase, biology, business.industry, Proteins, Diagnostic test, Plasmodium falciparum, General Medicine, Gold standard (test), biology.organism_classification, medicine.disease, United States, Malaria, Surgery, Meta-analysis, Emergency medicine, Parasitology, Reagent Kits, Diagnostic, business

الوصف: Microscopic diagnosis of malaria is unreliable outside specialized centers. Rapid tests have become available in recent years, but their accuracy has not been assessed systematically.To determine the accuracy of rapid diagnostic tests for ruling out malaria in nonimmune travelers returning from malaria-endemic areas.The authors searched MEDLINE, EMBASE, CAB Health, and CINAHL (1988 to September 2004); hand-searched conference proceedings; checked reference lists; and contacted experts and manufacturers.Diagnostic accuracy studies in nonimmune individuals with suspected malaria were included if they compared rapid tests with expert microscopic examination or polymerase chain reaction tests.Data on study and patient characteristics and results were extracted in duplicate. The main outcome was the likelihood ratio for a negative test result (negative likelihood ratio) for Plasmodium falciparum malaria. Likelihood ratios were combined by using random-effects meta-analysis, stratified by the antigen targeted (histidine-rich protein-2 [HRP-2] or parasite lactate dehydrogenase [LDH]) and by test generation. Nomograms of post-test probabilities were constructed.The authors included 21 studies and 5747 individuals. For P. falciparum, HRP-2-based tests were more accurate than parasite LDH-based tests: Negative likelihood ratios were 0.08 and 0.13, respectively (P = 0.019 for difference). Three-band HRP-2 tests had similar negative likelihood ratios but higher positive likelihood ratios compared with 2-band tests (34.7 vs. 98.5; P = 0.003). For P. vivax, negative likelihood ratios tended to be closer to 1.0 for HRP-2-based tests than for parasite LDH-based tests (0.24 vs. 0.13; P = 0.22), but analyses were based on a few heterogeneous studies. Negative likelihood ratios for the diagnosis of P. malariae or P. ovale were close to 1.0 for both types of tests. In febrile travelers returning from sub-Saharan Africa, the typical probability of P. falciparum malaria is estimated at 1.1% (95% CI, 0.6% to 1.9%) after a negative 3-band HRP-2 test result and 97% (CI, 92% to 99%) after a positive test result.Few studies evaluated 3-band HRP-2 tests. The evidence is also limited for species other than P. falciparum because of the few available studies and their more heterogeneous results. Further studies are needed to determine whether the use of rapid diagnostic tests improves outcomes in returning travelers with suspected malaria.Rapid malaria tests may be a useful diagnostic adjunct to microscopy in centers without major expertise in tropical medicine. Initial decisions on treatment initiation and choice of antimalarial drugs can be based on travel history and post-test probabilities after rapid testing. Expert microscopy is still required for species identification and confirmation.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::b3ce31a47b8f1323e06cbfd84644cbf7Test
https://doi.org/10.7326/0003-4819-142-10-200505170-00009Test

المؤلفون: Jak Yiu Lai, Kam Cheong Lee, Kin Wing Choi, William Wai-lung Lam, Wing Lok Tong, Sik To Lai, Eugene Tso, Ming Chee Chiu, Tai Nin Chau, Po Oi Lee, Wai Fu Ng, Owen Tsang, Tak Keung Ng, Wai Cho Yu

المصدر: Annals of Internal Medicine. 139:715

مصطلحات موضوعية: Male, medicine.medical_specialty, macromolecular substances, Severe Acute Respiratory Syndrome, Cohort Studies, Risk Factors, Internal medicine, Outcome Assessment, Health Care, Epidemiology, Internal Medicine, medicine, Humans, Respiratory system, Intensive care medicine, Aged, Retrospective Studies, Aged, 80 and over, Lung, L-Lactate Dehydrogenase, business.industry, Respiratory disease, Age Factors, Retrospective cohort study, General Medicine, Middle Aged, Prognosis, medicine.disease, Coronavirus, Pneumonia, medicine.anatomical_structure, Respiratory failure, Hong Kong, Female, business, Follow-Up Studies, Cohort study

الوصف: Severe acute respiratory syndrome (SARS) has become a global public health emergency.To evaluate the characteristics and outcomes of patients with SARS in Hong Kong and to identify predictors of mortality.Retrospective cohort study.Quarantine hospital for patients with SARS in Hong Kong.267 consecutive patients hospitalized from 26 February to 31 March 2003 for probable or confirmed SARS.Clinical, laboratory, and radiographic measures; 3-month mortality rate.According to our case definition, there were 227 cases of confirmed SARS and 40 cases of probable SARS. Common presenting symptoms were fever (99% of patients), chills (74%), malaise (63%), and myalgia (50%). Laboratory findings included lymphopenia (73%), thrombocytopenia (50%), hyponatremia (60%), and elevated levels of lactate dehydrogenase (47%) and C-reactive protein (75%). During hospitalization, incidence of diarrhea (53%), anemia (53%), and acute renal failure (6%) increased. Sixty-nine patients (26%) required intensive care because of respiratory failure. The 3-month mortality rate was 12% (95% CI, 8% to 16%). Factors contributing to mortality were respiratory failure, acute renal failure, and nosocomial sepsis. On multivariate Cox regression, age older than 60 years (relative risk, 5.10 [CI, 2.30 to 11.31]; P0.001) and lactate dehydrogenase level greater than 3.8 micro kat/L at presentation (relative risk, 2.20 [CI, 1.03 to 4.71]; P = 0.04) were independent predictors of mortality.Because of the longer follow-up period in our cohort, the mortality rate in these patients is higher than rates reported in previous studies. Advanced age and high lactate dehydrogenase level at presentation predict mortality. *For members of the Princess Margaret Hospital SARS Study Group, see the Appendix.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::a5a83744870ec0b2aedc823b9d07c8c7Test
https://doi.org/10.7326/0003-4819-139-9-200311040-00005Test

المؤلفون: Bart Barlogie, Terry L. Smith, Meletios A. Dimopoulos, Raymond Alexanian

المصدر: Annals of Internal Medicine. 115:931

مصطلحات موضوعية: medicine.medical_specialty, Time Factors, medicine.medical_treatment, Drug Resistance, Drug resistance, chemistry.chemical_compound, Internal medicine, Lactate dehydrogenase, Antineoplastic Combined Chemotherapy Protocols, Internal Medicine, medicine, Humans, Short survival, Survival analysis, Multiple myeloma, Proportional Hazards Models, chemistry.chemical_classification, Chemotherapy, Ploidies, L-Lactate Dehydrogenase, Proportional hazards model, business.industry, General Medicine, Middle Aged, Prognosis, medicine.disease, Survival Analysis, Endocrinology, Enzyme, chemistry, Karyotyping, Multiple Myeloma, business, Biomarkers

الوصف: To evaluate serum lactate dehydrogenase (LDH) as a prognostic factor in previously untreated patients with multiple myeloma.Study of 391 consecutive patients with uniformly treated multiple myeloma, followed until death in 63% of patients.Tertiary, referral cancer center.A total of 391 consecutive, previously untreated, symptomatic patients with various stages of multiple myeloma.Various chemotherapy regimens that included doxorubicin or glucocorticoids, or both, with a consistent response rate (53%).Outcomes included clinical response based on a 75% reduction of calculated tumor load and survival time from treatment. Univariate and multivariate analyses were used.Eleven percent of patients showed a high serum LDH level of more than 5.0 mukat/L (300 U/L). An elevated LDH level was seen more frequently with a rise in the tumor load; an increased level was present in 26% of patients with high tumor mass. A high LDH level was associated with plasma cell leukemia or lymphoma-like clinical features (43%) and with plasma cell hypodiploidy (17%). Only 20% of patients with elevated LDH levels responded to chemotherapy compared with a response rate of 57% for patients with low levels of LDH. Using multivariate analysis, LDH was a significant independent predictor of response (P = 0.001), with an odds ratio of 0.25 (95% Cl, 0.11 to 0.57). A high LDH level was associated with a short median survival (9 months) and showed the highest relative risk (2.63; Cl, 1.75 to 3.95; P = 0.001).Elevation of the LDH level suggests the presence of occult extraosseous disease and high tumor mass. The LDH level is a predictor of a poor prognosis in selected patients who should be considered for early intensive treatment.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::685554663b8020759307f22fb86fad1cTest
https://doi.org/10.7326/0003-4819-115-12-931Test

المؤلفون: Henry Stevenson, Thomas E. Walsh, Daniel C. Ihde, Ruby Phelps, H. K. Oie, James L. Mulshine, Robert W. Makuch, Adi F. Gazdar, Bimal C. Ghosh, R. Ilona Linnoila, Teresa O'Connor, Barnett S. Kramer, Edward L. Woods

المصدر: Annals of Internal Medicine. 113:764

مصطلحات موضوعية: Male, Oncology, medicine.medical_specialty, Prognostic factor, Lung Neoplasms, CD30, Cell Survival, Statistics as Topic, Tumor M2-PK, Tumor cells, Cohort Studies, Carcinoma, Non-Small-Cell Lung, Internal medicine, Tumor Cells, Cultured, Internal Medicine, medicine, Humans, Lung cancer, Analysis of Variance, L-Lactate Dehydrogenase, business.industry, Palliative Care, General Medicine, Middle Aged, Prognosis, medicine.disease, In vitro, Survival Rate, Lymphatic Metastasis, Female, Non small cell, business, Cohort study

الوصف: To determine the relation between in-vitro establishment of tumor cell lines and survival in patients with non-small-cell lung cancer.Cohort study.Single-institution tertiary care center.One hundred twenty-three consecutive patients with non-small-cell lung cancer from whom a viable tumor specimen could be obtained.Tumor tissue was removed at the time of entry into a therapeutic protocol. The tumor tissue was processed in the laboratory for attempted cell-line establishment. Patients classified as potentially curable (stages I, II, and IIIA) were treated with surgical resection, radiation therapy, or a combination. Patients suitable for palliative therapy only (stages IIIB and IV) were treated with radiation therapy with or without chemotherapy. Chemotherapy was based on in-vitro drug sensitivity when available. Cell-line establishment was correlated to clinical outcome.Univariate analysis of survival was done using the log-rank test; multivariate analysis was done by Cox modeling step-up and step-down techniques. Cell lines were established from the tumor specimens of 25 patients (20%). Those patients experienced a median survival of 7 months compared with 18 months in patients from whom cell lines could not be established (P less than 0.001). In the 61 patients with potentially curable disease, 8 patients (13%) with cell lines established had a median survival of 8 months compared with 32 months for those without cell lines established (P = 0.001). In the 62 palliative group patients, the median survival of the 17 patients (27%) from whom tumor cell lines were established was 5 months compared with 7 months for those without cell lines (P = 0.15). Multivariate analysis in both groups showed cell-line establishment to be a significant indicator of prognosis (P less than 0.0001 for curable group; P less than 0.01 for palliative group).In-vitro tumor growth is related to decreased patient survival, which in turn reflects the biologic aggressiveness of cancers giving rise to these tumor cell lines.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::a56ddffff85e6ffe3781eefad213e263Test
https://doi.org/10.7326/0003-4819-113-10-764Test

المؤلفون: Martin T. Schechter, Nirvair Levitt, Lindsay M. Lawson, Allan Belzberg, Julio S. G. Montaner, John Ruedy

المصدر: Annals of Internal Medicine. 113:14

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Physical Exertion, Statistics as Topic, Anti-Infective Agents, Double-Blind Method, Acquired immunodeficiency syndrome (AIDS), Internal Medicine, medicine, Humans, In patient, Prospective Studies, Intensive care medicine, Randomized Controlled Trials as Topic, Acquired Immunodeficiency Syndrome, L-Lactate Dehydrogenase, business.industry, Pneumonia, Pneumocystis, fungi, food and beverages, General Medicine, medicine.disease, Oxygen, Clinical trial, Pneumonia, Pneumocystis carinii, Prednisone, Drug Therapy, Combination, Female, business

الوصف: To determine whether oral corticosteroids can prevent early deterioration in patients with acquired immunodeficiency syndrome (AIDS)-related Pneumocystis carinii pneumonia.Prospective, double-blind, placebo-controlled, randomized trial.Included patients were having their first P. carinii pneumonia episode, had no other known active pulmonary pathology, had no contraindications for corticosteroids, received no anti-P. carinii pneumonia medications for more than 48 hours, and had oxygen saturation by pulse oximetry of 85% or more and less than 90% at rest or a 5-percentage-point decrease in oxygen saturation with exercise while breathing room air. Consenting subjects were randomly assigned to prednisone, 60 mg/d for 7 days, followed by a progressive tapering over 14 days or to an identical placebo. Early deterioration, the endpoint of the trial, was defined as a 10% decrease in baseline oxygen saturation on day 3 or thereafter. The cases of patients developing early deterioration were considered to be failures of treatment; the code was then broken, and the patient's treatment was left to the judgment of the treating physician. Sequential analysis was done with the primary variable being development of early deterioration.The trial was terminated 5 April 1989 on the basis of the sequential analysis when a total of nine episodes of early deterioration had occurred in the first 37 patients at an overall significance level of P = 0.0136. A total of 8 of 19 placebo-treated patients (42.1%) developed early deterioration compared with only 1 of 18 patients (5.6%) treated with corticosteroids. Baseline characteristics were not statistically different between the two treatment groups. The adjusted odds ratio for the treatment effect was 5.87 (95% CI, 1.27 to 27.4). The adjusted point estimates for the probability of early deterioration in the placebo and corticosteroid groups were 43% and 12%, respectively. All 8 patients in the placebo group developing early deterioration recovered rapidly with addition of corticosteroid treatment. The single patient with early deterioration in the corticosteroid group died on day 6 from overwhelming P. carinii pneumonia, as documented at autopsy. The corticosteroid group had an increased exercise tolerance on day 7 that persisted at day 30.Oral corticosteroids prevent early deterioration and increase exercise tolerance in patients with moderately severe AIDS-related P. carinii pneumonia.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::645b51d89a883b6be7f2880052090ae0Test
https://doi.org/10.7326/0003-4819-113-1-14Test

المؤلفون: Elise Swenson, Steven W. Sanders, Jeffrey R. Saffle, John Russo, Thomas G. Burnakis, Glenn D. Warden, George E. Dukes

المصدر: Annals of internal medicine. 100(5)

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Adolescent, medicine.drug_class, Swine, medicine.medical_treatment, Aspartate transaminase, Transaminase, chemistry.chemical_compound, Random Allocation, Suidae, Lactate dehydrogenase, Internal medicine, Internal Medicine, Medicine, Animals, Humans, Aspartate Aminotransferases, Prospective Studies, Aged, Chemotherapy, biology, L-Lactate Dehydrogenase, business.industry, Heparin, Anticoagulant, Alanine Transaminase, General Medicine, Middle Aged, biology.organism_classification, Isoenzymes, Endocrinology, Alanine transaminase, chemistry, biology.protein, Cattle, Female, business, medicine.drug

الوصف: Eighty-six patients who required heparin therapy were randomly assigned to receive bovine or porcine heparin. Abnormal concentrations of alanine transaminase and aspartate transaminase developed during treatment in 59.3% and 26.7% of patients, respectively. Patient characteristics that significantly influenced the development of abnormal alanine transaminase concentrations were male sex and higher baseline enzyme values. Transaminase concentrations returned to normal in 80% of patients after heparin therapy was discontinued and in 20% during therapy. Analysis of transaminase concentrations in all 86 patients showed that 95% had some increase in enzymes during treatment. Mean maximal increase over baseline for all patients was 3.6 for alanine transaminase and 3.1 for aspartate transaminase (range, 1.0 to 15). Lactate dehydrogenase concentrations became abnormal in 35.7% of patients. Lactate dehydrogenase isoenzyme determinations in 6 patients showed elevated hepatic fractions. No clinical symptoms of hepatic dysfunction were seen.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::2660f6a9525ee8b429503f6f4b608700Test
https://pubmed.ncbi.nlm.nih.gov/6712030Test

المؤلفون: Lee Goldman, Thomas H. Lee

المصدر: Annals of internal medicine. 105(2)

مصطلحات موضوعية: medicine.medical_specialty, Myocardial Infarction, Serum enzymes, chemistry.chemical_compound, Lactate dehydrogenase, Internal medicine, Internal Medicine, medicine, Humans, Cardiac enzyme levels, False Positive Reactions, Myocardial infarction, Aspartate Aminotransferases, Creatine Kinase, False Negative Reactions, Probability, biology, L-Lactate Dehydrogenase, business.industry, General Medicine, Clinical Enzyme Tests, medicine.disease, Prognosis, Lactate dehydrogenase isoenzymes, Enzymes, Isoenzymes, chemistry, biology.protein, Cardiology, Creatine kinase, Myocardial infarction diagnosis, business, Quantitative analysis (chemistry)

الوصف: In the last 20 years, serum enzyme and isoenzyme levels have become the final arbiters by which acute myocardial infarction is diagnosed or excluded. We review the characteristics of these enzymes, the methods and limitations of commonly used assays, and data on diagnostic accuracy and clinical implications of enzyme levels in various settings and offer recommendations on their optimal use. Because of the poor sensitivity of single measurements of cardiac enzyme levels, these assays should not be used in the emergency room to exclude myocardial infarction. If myocardial infarction is suspected, levels of creatine kinase and its MB fraction should be measured at admission and about 12 and 24 hours later. If a myocardial infarction may have occurred more than 24 hours before evaluation, then lactate dehydrogenase isoenzyme measurements may increase diagnostic accuracy. Used properly, these assays are remarkably sensitive, but like all tests, optimal interpretation requires insight into technical pitfalls and other causes of misleading results.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::d5951c0b01bc0fe531be8ab18ba8a8a8Test
https://pubmed.ncbi.nlm.nih.gov/3524337Test

المؤلفون: Joseph W. Hess, Roderick MacDonald, Robert N. Jones, David Gross, Richard J. Frederick, Joann Neely

المصدر: Annals of internal medicine. 61

مصطلحات موضوعية: Anemia, Hemolytic, Hot Temperature, Adolescent, Anemia, Myocardial Infarction, Physiology, Hemolysis, Muscular Dystrophies, chemistry.chemical_compound, Lactate dehydrogenase, Neoplasms, Freezing, Internal Medicine, medicine, Humans, Myocardial infarction, Aspartate Aminotransferases, Muscular dystrophy, Muscle, Skeletal, Creatine Kinase, Myositis, Leukemia, biology, L-Lactate Dehydrogenase, business.industry, Liver Diseases, Skeletal muscle, General Medicine, Clinical Enzyme Tests, Hydrogen-Ion Concentration, medicine.disease, Pulmonary embolism, Cold Temperature, medicine.anatomical_structure, Blood, chemistry, Geriatrics, biology.protein, Creatine kinase, Kidney Diseases, Nervous System Diseases, business, Pulmonary Embolism

الوصف: Excerpt Serum enzyme determinations that are commonly available in hospital laboratories for aid in the diagnosis of diseases of the heart and skeletal muscle lack tissue specificity. Thus, it may ...

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::adae4b3e73eaa5a58a449fb5cb7c0045Test
https://pubmed.ncbi.nlm.nih.gov/14233823Test

المؤلفون: John S. Banas, Lewis Dexter, William Grossman, James E. Dalen, Harold L. Brooks, Steven G. Meister, Murrill M. Szucs

المصدر: Annals of internal medicine. 74(2)

مصطلحات موضوعية: Adult, Blood Platelets, Male, medicine.medical_specialty, L-Lactate dehydrogenase, Aspartate Aminotransferases, Iodine Radioisotopes, Electrocardiography, Leukocyte Count, Internal Medicine, medicine, Humans, Radionuclide imaging, False Positive Reactions, Sensitivity (control systems), Prospective Studies, Prospective cohort study, Radionuclide Imaging, False Negative Reactions, Aged, L-Lactate Dehydrogenase, business.industry, Obstetrics and Gynecology, Bilirubin, General Medicine, Middle Aged, medicine.disease, Pulmonary embolism, Blood Cell Count, Oxygen, Acute Disease, Female, Radiography, Thoracic, Radiology, business, Pulmonary Embolism

الوصف: Many different laboratory tests have been used to screen patients for pulmonary embolism. The sensitivity of certain laboratory tests was assessed in a prospective study of 50 patients wit...

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::3b60626d91a933d3a83cc0d8dc438cfdTest
https://pubmed.ncbi.nlm.nih.gov/5547543Test

المؤلفون: Donald E. Paglia, Kouichi R. Tanaka, William N. Valentine

المصدر: Annals of internal medicine. 103(2)

مصطلحات موضوعية: Anemia, Hemolytic, Erythrocytes, Adenosine Deaminase, Phosphofructokinase-1, Pyruvate Kinase, Pentose phosphate pathway, 5'-nucleotidase, Pentose Phosphate Pathway, chemistry.chemical_compound, Nucleotidases, Fructose-Bisphosphate Aldolase, Hexokinase, Internal Medicine, Bisphosphoglycerate Mutase, Medicine, Humans, Glycolysis, 5'-Nucleotidase, L-Lactate Dehydrogenase, business.industry, Nucleotides, Adenylate Kinase, General Medicine, Anemia, Hemolytic, Congenital Nonspherocytic, Phosphate, medicine.disease, Phosphoric Monoester Hydrolases, Hexokinase deficiency, Phosphoglycerate Kinase, Glucosephosphate Dehydrogenase Deficiency, chemistry, Biochemistry, Anaerobic glycolysis, business, Adenosine triphosphate, Pyruvate kinase deficiency, Triose-Phosphate Isomerase

الوصف: The human erythrocyte generates high-energy adenosine triphosphate by anaerobic glycolysis and cycles oxidized and reduced nicotinamide adenine dinucleotide phosphate by the aerobic pentose phosphate shunt pathway. Certain enzymopathies of the pentose phosphate shunt are associated with hemolysis resulting from oxidative denaturation of hemoglobin. Glucose-6-phosphate dehydrogenase deficiency, an X-chromosome-linked disorder, is the prototype of these diseases and is genetically and clinically polymorphic. Six enzymopathies of anaerobic glycolysis cause hemolytic anemia; lactate dehydrogenase deficiency does not. In 2,3-diphosphoglycerate mutase deficiency, 2,3-diphosphoglycerate is greatly reduced and asymptomatic polycythemia is noted. Pyrimidine-5'-nucleotidase deficiency, an enzymopathy of nucleotide metabolism, is characterized by intracellular accumulations of pyrimidine-containing nucleotides, marked basophilic stippling on the stained blood film, splenomegaly, and hemolysis. Lead inhibits the nucleotidase and an identical syndrome occurs during severe lead poisoning. Hemolysis also accompanies an unusual enzymopathy characterized by a 40- to 70-fold increase (not decrease) in adenosine deaminase activity.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::e6217fb756c0604ab5c449c0c8f53c46Test
https://pubmed.ncbi.nlm.nih.gov/2990276Test