Use of chick embryo in screening for toxin-producing fungi

The toxinogenicity of 720 fungal isolates was evaluated using the Chisk Embryotoxicity Screening Test (CHEST, phase 1). Three hundred and sixteen (43.9%) isolates produced some of the 23 identified mycotoxins, unidentified toxic metabolites were produced by 170 (23.6%), and 234 (32.5%) isolates showed no signs of toxinogenicity. The 24 h lasting chick embryo assay proved very suitable for detecting fungal products with general cytotoxic potential where it yielded results consistent with those obtained with cell cultures and higher organisms. Simplicity, rapidity, and modest laboratory equipment belong to the advantages of this reliable and non expensive screening procedure.     

Genetic screening for glucocorticoid-remediable aldosteronism (GRA): experience of three clinical centres in Poland

Glucocorticoid-remediable aldosteronism (GRA), also known as familial hyperaldosteronism type I (FH-I, OMIM 103900), is a monogenic form of inherited hypertension caused by the presence of a chimaeric gene originating from an unequal cross-over between the CYP11B1 (11beta-hydroxylase) and CYP11B2 (aldosterone synthase) genes. The hybrid gene has the CYP11B1 sequence at the 5' end, including the promoter, and the CYP11B2 sequence at the 3' end. The aim of our study was to evaluate the prevalence of GRA in a Polish population of 129 patients with primary hyperaldosteronism (PHA) and 132 patients with essential hypertension (EH), through the use of a PCR-based test revealing the chimaeric gene. None of our PHA or EH patients was positive for the CYP11B1/CYP11B2 chimaeric gene. These data suggest that GRA is unlikely to be a common cause of hypertension in Polish subjects. However, the real prevalence of GRA in Poland, both in the high-risk group of individuals with primary hyperaldosteronism and in the general population, remains to be established.     

Use of hexamethonium in arterial hypertension

Hexamethonium is a potent anti-hypertensive agent. Its use is associated with prominent and unpleasant side effects, and sometimes with circulatory complications from excessive depressor action. It is suitable for relatively few hypertensive patients, and often fails when renal insufficiency is present. The degree of care required to obtain satisfactory effectiveness is such that the program of treatment becomes too unwieldy for general use.     

Evaluation of screening for hypertension in general practice with an automatic machine.

An automatic device for measuring blood pressure was used to screen all patients aged 30 to 65 years registered at a health centre. Of those who were eligible, 55% attended. Patients with previously recognised hypertension were more common among the attenders than among the non-attenders. High readings obtained on the automatic device possibly deterred some patients from reattending for follow up measurements of blood pressure. Although the device is quick and easy to use, the logistic challenge of formal blood pressure screening is considerable. Hypertension was discovered in 52 patients (mean diastolic pressure greater than 100 mm Hg). Retrospective analysis of their medical records showed that a third had had an abnormal blood pressure reading noted during the past 10 years and no further action had been taken, and almost three quarters had attended their practitioner during the previous year without having a blood pressure measurement recorded. One year after the screening procedure two fifths of the newly discovered hypertensive patients had defaulted from follow up and treatment. Automatic devices are not a short cut to the discovery of occult hypertension. Case finding by routine measurement of blood pressure at surgery visits is more efficient.     

Finger systolic pressure: its use in screening for hypertension and monitoring.

A finger sphygmomanometer was compared with a mercury column sphygmomanometer for its ability to screen for hypertension. A total of 881 patients used each machine, both in initial screening and then for monitoring. The finger sphygmomanometer had a specificity of 98.5% in routine screening as compared with 97.6% for the mercury column device. Sensitivity of the finger device was 98.2%. These findings suggest that the finger sphygmomanometer using finger systolic pressure alone is adequate for screening and monitoring blood pressure.     

Long-term follow-up of a hypertension screening program.

Of 185 people found to be hypertensive in a shopping centre screening program who went to their physician and had medication prescribed, then were contacted 18 months later, 33 had discontinued the medication at their physician''s request. But of 152 who were to continue taking medication 139 (91.4%) had complied. Blood pressure had decreased to less than 160 mm Hg systolic or less than 95 mm Hg diastolic, or both, in 65.1% of the 152; was 160 to 169 mm Hg systolic or 95 to 99 mm Hg diastolic, or both, in 13.8%; was mildly or moderately decreased but still above 169 mm Hg systolic or 99 mmHg diastolic, or both, in 8.6%; and was higher than before the onset of treatment in 3.9%. Adequacy of blood pressure control was not related to age, sex, initial blood pressure values, awareness before the screening of having hypertension, or treatment for hypertension before the screening. Diuretics had been prescribed for 93.5% of the 139 patients, most often as single-pill combinations with other antihypertensive agents.     

Use of risk-based cervical screening programs in resource-limited settings

Cervical cancer screening and management in the U.S. has adopted a risk-based approach. However, the majority of cervical cancer cases and deaths occur in resource-limited settings, where screening and management are not widely available. We describe a conceptual model that optimizes cervical cancer screening and management in resource-limited settings by utilizing a risk-based approach. The principles of risk-based screening and management in resource limited settings include (1) ensure that the screening method effectively separates low-risk from high-risk patients; (2) directing resources to populations at the highest cancer risk; (3) screen using HPV testing via self-sampling; (4) utilize HPV genotyping to improve risk stratification and better determine who will benefit from treatment, and (5) automated visual evaluation with artificial intelligence may further improve risk stratification. Risk-based screening and management in resource limited settings can optimize prevention by focusing triage and treatment resources on the highest risk patients while minimizing interventions in lower risk patients.     

Detecting hypertension: screening versus case finding in Norway.

OBJECTIVE--Evaluation of detection of hypertension in adults in the county of Nord-Trøndelag, Norway. DESIGN--Cross sectional survey with clinical follow up examinations. SETTING--Health survey by screening teams from the national health screening service, and examinations by all 106 general practitioners in the county. SUBJECTS--During 1984-6, 74,977 persons (88.1% of those aged 20 years and over) participated in the health survey. MAIN OUTCOME MEASURES--Hypertension (when assessed by standardised recording and by questionnaires on drug treatment for hypertension) according to the blood pressure thresholds used in the Norwegian treatment programme. Subjects positive on screening were grouped after clinical examination into treatment groups. RESULTS--In all, 2399 subjects were positive for hypertension. Before screening 6210 (8.3%) patients reported taking antihypertensive drugs and another 3849 (5.1%) had their blood pressure monitored regularly. All who screened positive were referred to their general practitioner and evaluated according to a standard programme. As a result, drug treatment was started in 406 (0.5%) participants screened and blood pressure monitoring in another 1007 (1.3%). Of all patients taking antihypertensive drugs after the screening, 6399 (94.0%) had been diagnosed before screening, and of those whose blood pressure was monitored after the screening, 79.3% had been diagnosed before screening. CONCLUSIONS--At the blood pressure screening thresholds used, and when hypertension is defined by an overall clinical diagnosis, the results indicate that general practitioners can find and diagnose hypertensive patients with the case finding strategy.     

Use of radiothermometry in the screening of nonpalpable breast neoplasms

As compared with other types of malignancies, breast cancer is one of the commonest causes of female death. Mammography used for screening is associated with radiation exposure and it is of low informative value in women less than 35 years of age. Breast ultrasonography (USG) cannot be used for screening of women less than 35 years of age in whom a glandular component is prevalent in the breast structure as it takes much time and should be performed by a qualified specialist. The purpose of our study was to estimate the diagnostic capacities of microwave radiothermometry (RTM) and to determine its place in the early diagnosis of nonpalpable breast neoplasms in medical practice. An integrated study, including RTM, USG, and mammography, was conducted in women at the District Mammology Department, Diagnostic Center Five, and at Branch One of the Female Health Clinic Diagnostic Center in March 2003 to October 2006. The study covered 200 women aged 35 to 71 years who had neither complaints nor clinical signs of a breast nodule and had been found to have neoplasms after undergoing the above diagnostic studies. The studies performed showed that the sensitivity of RMT diagnosis, USG, and mammography was 86.7, 75.8, and 88.3%, respectively. The precision of these techniques was 75.2, 80.0, and 83%.     

Use of mobile screening unit for diabetic retinopathy in rural and urban areas.

OBJECTIVES--To compare the effectiveness of a mobile screening unit with a non-mydriatic polaroid camera in detecting diabetic retinopathy in rural and urban areas. To estimate the cost of the service. DESIGN--Prospective data collection over two years of screening for diabetic retinopathy throughout Tayside. SETTING--Tayside region, population 390,000, area 7770 km2. SUBJECTS--961 patients in rural areas and 1225 in urban areas who presented for screening. MAIN OUTCOME MEASURES--Presence of diabetic retinopathy, need for laser photocoagulation, age, duration of diabetes, and diabetic treatment. RESULTS--Compared with diabetic patients in urban areas, those in rural areas were less likely to attend a hospital based diabetic clinic (46% (442) v 86% (1054), p < 0.001); less likely to be receiving insulin (260 (27%) v 416 (34%), p < 0.001 and also after correction for differences in age distribution); more likely to have advanced (maculopathy or proliferative retinopathy) diabetic retinopathy (13% (122) v 7% (89), p < 0.001); and more likely to require urgent laser photocoagulation for previously unrecognised retinopathy (1.4% (13) v 0.5% (6), p < 0.02). The screening programme cost 10 pounds per patient screened and 1000 pounds per patient requiring laser treatment. CONCLUSION--The mobile diabetic eye screening programme detected a greater prevalence of advanced retinopathy in diabetic patients living in rural areas. Patients in rural areas were also more likely to need urgent laser photocoagulation. Present screening procedures seem to be less effective in rural areas and rural patients may benefit more from mobile screening units than urban patients.     

Use of delta-(alpha-aminoadipoyl) chromogenic amides in screening for aminoadipoyl amidohydrolases.

The synthesis of delta-(alpha-aminoadipoyl) aromatic amides and their use in screening for enzymes able to cleave delta-(alpha-aminoadipoyl) residues off the synthetic amides and cephalosporin C are described. A number of commercially available proteases and peptidases were not active with delta-(alpha-aminoadipoyl) chromogenic amides. Also, most tested microbial strains known to produce acylases did not hydrolyze these compounds. Only one microbial strain, Xanthomonas maltophila, had an appreciable activity toward the racemic form of chromogenic substrates. Activity measured in crude extracts from Xanthomonas cells indicated that this bacterium produces predominantly L-specific aminoadipoyl amidohydrolase and gamma-glutamyl hydrolase. A low level of cephalosporin C and glutaryl-cephalosporin acylase activities was also found.