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Dementia
Published in Henry J. Woodford, Essential Geriatrics, 2022
There are no laboratory tests to diagnose the common forms of dementia. Investigations may help to exclude potentially reversible causes. The standard ‘dementia screen' bloods: ESR, vitamin B12 and TSH should be performed (to exclude vasculitis [see page 431], combined degeneration and hypothyroidism). Syphilis serological testing (venereal disease research laboratory test [VDRL]) may be considered – see Box 6.1. Although, none of these is likely to be the cause.
DRCOG OSCE for Circuit A Answers
Published in Una F. Coales, DRCOG: Practice MCQs and OSCEs: How to Pass First Time three Complete MCQ Practice Exams (180 MCQs) Three Complete OSCE Practice Papers (60 Questions) Detailed Answers and Tips, 2020
The three serologic tests for syphilis are venereal disease research laboratories (VDRL), fluorescent treponemal antibody (FTA) and Treponema pallidum haemagglutination (TPHA). VDRL is a low-cost test based on the fact that the particles of the lipid antigen remain dispersed with normal serum but form clumps when combined with reagin. The test reverts to negative in 6-18 months after treatment. FTA uses indirect immunofluorescence (killed T. pallidum + patient's serum + labelled antihuman γ-globulin) and has excellent sensitivity and specificity for syphilis antibodies. It is the first test to become positive in early syphilis but remains positive for many years following treatment. TPHA uses red blood cells treated to adsorb treponemes on their surface. The cells clump, if mixed with serum containing antitreponemal antibodies. It is similar in sensitivity and specificity to the FTA test but only becomes positive later in the course of syphilis.
“Primary” Anti-Phospholipid Syndrome
Published in E. Nigel Harris, Thomas Exner, Graham R. V. Hughes, Ronald A. Asherson, Phospholipid-Binding Antibodies, 2020
The largest series documented was from Asherson et al. comprising 70 patients and the frequency of clinical and serological abnormalities are shown in the accompanying tables (Tables 1 and 2); 54% suffered from episodes of deep venous thrombosis (DVT). These were accompanied by pulmonary thromboembolism in one third. Two patients suffered from pulmonary hypertension (PHT); one had developed this complication following repeated pulmonary thromboembolism; in two others it resembled the “primary” nonthromboembolic variety. IVC thrombosis and a Budd Chiari syndrome were present in two patients. Arterial occlusions were present in 44%, strokes and TIAs being most frequently encountered (50%). Multi-infarct dementia had followed in four. Myocardial infarctions were seen in five patients; occlusion of the aorta in one, multiple visceral arterial occlusions in one, renal infarction in one and renal artery stenosis in one. Subclavian occlusions were present in two and gangrene of the toes occurred in two. Recurrent fetal loss was present in 34%; 46% were ANA positive and antibodies to mitochondria (type MS) were present in 11 of 40 tested. Thirty-two patients had been thrombocytopenic at some stage of their illness. Menorrhagia was encountered in one patient only in whom the platelet count had fallen to 5.10 x 109/1. A false-positive VDRL was present in 17 of 51 patients tested. Coombs positivity occurred in 10, but hemolytic anemia had developed in only three. Six patients demonstrated cryoglobulinemia.
Ocular Syphilis: Experience over 11 Years at a German Ophthalmology Reference Centre
Published in Ocular Immunology and Inflammation, 2023
R. Yaici, A. Balasiu, C.R. MacKenzie, M. Roth, K. Beseoglu, C. Holtmann, G. Geerling, R. Guthoff
The serology results were obtained from the Institute of Medical Microbiology and Hospital Hygiene, Heinrich-Heine University, Duesseldorf. The standard testing for syphilis included non-treponemal and treponemal tests and the so-called reverse sequence syphilis-screening algorithm was employed. Initial screening, a treponemal test, was done by means of chemiluminescence immunoassay (CLIA) (DiaSorin, Sallugia, Italy). A positive screening test was confirmed by a Treponema pallidum particle agglutination assay (TPPA) (Fujirebio, Gent, Belgium) and fluorescent treponemal antibody absorption (FTA-ABS) (Mast Diagnostica, Reinfeld, Germany). Thereafter, an anti-lipoidal antibody test (Venereal Disease Research Laboratory [VDRL] or rapid plasma reagin [RPR] [Biokit, Barcelona, Spain]) was used to determine disease activity and therapy effectiveness. IgM and IgG immunoblot assays (Viramed Biotech, Planegg, Germany) were performed additionally in some cases.
Extended-release tofacitinib improves refractory Takayasu’s arteritis
Published in Scandinavian Journal of Rheumatology, 2022
C-R Wang, Y-S Tsai, Y-W Liu, Y-H Li
A 21-year-old male was transferred from a local hospital to our medical centre owing to a sudden attack of massive haematemesis. Fresh blood and clots in the oesophagus and stomach were identified by emergency endoscopy. Progressive pain over the chest and back had been noted before this haematemesis episode. He had no history of orogenital ulcers, skin rash, or ear pain. Echocardiography demonstrated aortic regurgitation (Figure 1A) and pulmonary hypertension. Computed tomography and magnetic resonance angiographic examinations revealed enhanced and thickened walls of bilateral common carotid artery, right brachiocephalic (innominate) artery, left subclavian artery, ascending aorta, aortic arch, descending thoracic aorta, and right main pulmonary artery, with dilated aortic root and ascending aorta (Figure 1B–F). Laboratory tests showed elevated erythrocyte sedimentation rate (ESR; 54 mm/h) with unremarkable platelet counts, coagulation profiles, and liver/kidney functions. Anti-nuclear and anti-neutrophil cytoplasmic antibodies and rheumatoid factor were absent, and immunoglobulin G4 levels were normal. The Venereal Disease Research Laboratories (VDRL) test was non-reactive, and a microbiological survey failed to identify pathogens. A diagnosis of TAK with non-infectious LVV was made in this young patient on 6 June 2018. His massive haematemesis may be related to abnormal esophagogastric submucosal arteries (Dieulafoy’s lesions), an unusual complication of TAK (8).
High risk and low HIV prevention behaviours in a new generation of young trans women in Brazil
Published in AIDS Care, 2021
Erin C. Wilson, Emilia M. Jalil, Ronaldo I. Moreira, Luciane Velasque, Cristiane V. Castro, Laylla Monteiro, Valdilea G. Veloso, Beatriz Grinsztejn
This is a secondary analysis using data from “Transcender”, which was a respondent driven sampling study (RDS) of trans women in Rio de Janeiro, Brazil, conducted from August 2015 to January 2016. Study methods, including survey measures are described in detail elsewhere (Grinsztejn et al., 2017; Jalil et al., 2018). Briefly, the study was conducted using RDS to obtain a robust and diverse sample of trans women. A total of 345 trans women were recruited to participate in the study. Incentives for study participation consisted of snacks, sexual health materials, make-up, a medical visit, and transportation reimbursement. STI testing included Venereal Disease Research Laboratory tests (VDRL) for syphilis screening (confirmed positive results with a microhaemagglutination assay for Treponema pallidum), HIV rapid test, and rectal Chlamydia and gonorrhea detection by molecular biology. We defined active syphilis as a VDRL equals or higher than 1:8 plus a positive treponemal test. All participants with identified STI were provided treatment either onsite or through referrals within Oswaldo Cruz Foundation (Fiocruz). The Evandro Chagas National Institute of Infectious Diseases (INI)-Fiocruz Institutional Review Board provided ethical approval for this project. All participants consented with their participation before any study procedure was performed.