Wako β-D-glucan assay can be used to measure serum β-D-glucan in Sudanese patients to aid with diagnosis of eumycetoma caused by Madurella mycetomatis

BACKGROUND

Eumycetoma is a neglected tropical infection of the subcutaneous tissue commonly caused by the fungus Madurella mycetomatis. Previously, we demonstrated that β-D-glucan was present in the serum of eumycetoma patients.

OBJECTIVE

To compare the performance of the recently approved easy-to-use Wako β-D-glucan assay to that of the Fungitell assay in eumycetoma patients.

METHODS

Using sera obtained from 41 eumycetoma, 12 actinomycetoma and 29 healthy endemic controls, we measured the β-glucan serum concentrations using the Wako assay and compared the performance to that of the Fungitell assay.

RESULTS

With the Fungitell assay, median β-glucan serum concentrations of 208, 70 and 27 pg/ml were obtained for the 41 eumycetoma patients, the 12 actinomycetoma patients and the 29 healthy endemic controls, respectively. With the Wako assay these concentrations were 14.45, 11.57 and 2.5 pg/ml, respectively. We demonstrated that when using the optimized cut-off value (5.5 pg/ml) for the Wako assay, the Wako and Fungitell assays had comparable performance in terms of sensitivity and specificity.

CONCLUSION

The Wako assay is comparable to the Fungitell assay for measurement of serum β-glucan in mycetoma patients and hence can be used in combination with current diagnostic tools. However, this test should be used in combination with other tests to differentiate actinomycetoma from eumycetoma.

P445 Clinical evaluation of the performance of the most commonly used eumycetoma diagnostic tests using sequencing of the internally transcribed spacer region as the golden standard

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM

 

Objective

Mycetoma is a neglected tropical skin disease, caused by 70 different causative agents. For most of the causative agents, molecular identification is the only reliable method to identify the species level. In practice, ultrasound, histopathology, culturing, and species-specific PCRs are most commonly used for species identification. However, the performance of these different tests was not validated using molecular identification by sequencing barcoding genes.

Methods

In this study, we validated the performance of the most commonly used diagnostic tools including culture, histopathology, Ultrasound and two species-specific PCR for Madurella mycetomatis on 222 patients suspected of fungal mycetoma by M. mycetomatis; the sensitivity, specificity, and accuracy of each method was calculated.

Results

From the 222 patients, 154 (69.3%) were correctly identified by ultrasound, histology, culture, and both species-specific PCRs. For five patients all tests were negative and for three only the ultrasound was indicative of mycetoma. For the other 60 patients, at least one of the assays was negative for M. mycetomatis. The two species-specific PCRs were the most sensitive and specific, followed by culture and histology. Ultrasound was the least specific as it only allows to differentiate between actinomycetoma and eumycetoma. However, with ultrasound, an identification could be obtained in 9.38 min. PCR took 3.76 h, histology 8.5 days, and culturing 21 days.

Conclusion

We concluded that PCR directly on DNA isolated from grains is the most rapid and reliable diagnostic tool to identify M. mycetomatis from eumycetoma grains to use species-specific PCRs. In order to shorten the time to identification of other causative agents, the focus should be on developing more molecular assays for those species.

Vulnerability and revictimization: Victim characteristics in a Dutch assault center

Sexual and family violence are highly prevalent problems with numerous negative health consequences. Assault centres, such as the Centre for Sexual and Family Violence (CSFV) in the Netherlands, have been set up to provide optimal care to victims. We wanted to gain insight into characteristics of the population that presented to the Centre in order to customize care to their needs. File analysis was conducted of victims who attended the CSFV between 2013 and 2016. Data were analyzed in SPSS. A total of 121 victims entered the Centre, 93% of them being female. Forty-two per cent were adult victims of sexual violence, 28% minor victims of sexual violence and 30% adult victims of family violence. One-third of sexual and two-third of family violence victims had experienced prior abuse. Current use of psychosocial services and psychiatric medication was high, and a cognitive disability was present in 18% of the sexual violence victims. Half the victims reported, but when the perpetrator was a recent contact, e.g., someone met at a party, reporting rates went down. Sexual and family violence victims share characteristics that indicate vulnerability, suggesting that care for both groups might best be combined in one single assault centre. In this way, victims can make use of the same services and knowledge of gender-based violence. One of the major aims of assault centres is to provide psychosocial follow-up care and facilities for reporting. The victims' needs in these matters deserve further research.

Improving care for victims: a study protocol of the evaluation of a centre for sexual and family violence

INTRODUCTION

Worldwide, sexual and family violence are highly prevalent problems. Victims of sexual and family violence often do not seek formal help in the acute phase. When they do seek help, they encounter a system of scattered care. For this reason, a centre for sexual and family violence was launched in Nijmegen, the Netherlands. The centre provides multidisciplinary care for victims of acute sexual and/or family violence. With the study described in this study protocol, we want to evaluate the implementation process and the reach of the Center for Sexual and Family Violence Nijmegen (CSFVN).

METHODS AND ANALYSIS

We will conduct a mixed-methods study including quantitative and qualitative methods of data collection and analysis. Data about the implementation process will be obtained via semistructured interviews and focus group discussions. Content analysis will be done in software program Atlas.ti. Analysis of file data will be undertaken to assess the reach of the CSFVN (patient characteristics and characteristics of the care they received). The data will be analysed in SPSS.

ETHICS AND DISSEMINATION

The Medical Ethics Committee of the Radboud University Nijmegen Medical Center approved the study protocol under file number 2012-1218. Dissemination will be done by submitting scientific articles to academic peer-reviewed journals. We will present the results at relevant international, national and local conferences and meetings. We will send press releases to relevant media. We will share the results with the network of assault centres in the Netherlands.

Similar risk of exercise-related hypoglycaemia for insulin degludec to that for insulin glargine in patients with type 1 diabetes: a randomized cross-over trial

We compared changes in blood glucose (BG) and risk of hypoglycaemia during and after exercise in 40 patients with type 1 diabetes (T1D) treated with insulin degludec (IDeg) or insulin glargine (IGlar) in a randomized, open-label, two-period, crossover trial. After individual titration and a steady-state period, patients performed 30 min of moderate-intensity cycle ergometer exercise (65% peak rate of oxygen uptake). BG, counter-regulatory hormones and hypoglycaemic episodes were measured frequently during and for 24 h after exercise. BG changes during exercise were similar with IDeg and IGlar [estimated treatment difference (ETD) for maximum BG decrease: 0.14 mmol/l; 95% confidence interval (CI) -0.15, 0.42; p = 0.34], as was mean BG (ETD -0.16 mmol/l; 95% CI -0.36, 0.05; p = 0.13). No hypoglycaemic episodes occurred during exercise. Post-exercise mean BG, counter-regulatory hormone response and number of hypoglycaemic episodes in 24 h after starting exercise were similar with IDeg (18 events in 13 patients) and IGlar (23 events in 15 patients). This clinical trial showed that, in patients with T1D treated with a basal-bolus regimen, the risk of hypoglycaemia induced by moderate-intensity exercise was low with IDeg and similar to that with IGlar.

Impact of injection speed and volume on perceived pain during subcutaneous injections into the abdomen and thigh: a single-centre, randomized controlled trial

AIM

The aim of this study was to assess pain associated with subcutaneous injection into the abdomen and thigh of different combinations of injection speeds and volumes.

METHODS

The study was a single-centre, one-visit, double-blinded, randomized controlled trial in 82 adults with type 1 or type 2 diabetes receiving daily injections of insulin or glucagon-like peptide-1 (GLP-1) agonists. Participants received 17 subcutaneous injections (12 in abdomen, 5 in thigh) of saline at different injection speeds (150, 300 and 450 µl/s), with different volumes (400, 800, 1200 and 1600 µl), and two needle insertions without any injection. Pain was evaluated on a 100-mm visual analogue scale (VAS) (0 mm no pain, 100 mm worst pain) and on a yes/no scale for pain acceptability.

RESULTS

Injection speed had no impact on injection pain (p = 0.833). Injection of larger volumes caused significantly more pain [VAS least square mean differences 1600 vs. 400 µl, 7 · 2 mm (95% confidence interval - CI; 4.6-9.7; p < 0.0001); 1600 vs. 800 µl, 7.2 mm (4.4-10.0; p < 0.0001); 1200 vs. 400 µl, 3.5 mm (0.4-6.6; p = 0.025) and 1200 vs. 800 µl, 3.6 mm (0.4-6.7; p = 0.027)]. Significantly more pain occurred in the thigh versus the abdomen [9.0 mm (6.7-11.3; p < 0.0001)].

CONCLUSIONS

Injection speed had no effect on injection pain, whereas higher injection volumes caused more pain. The results of this study may be of value for guiding patients to use the appropriate injection site and technique to reduce their injection pain. Furthermore, these findings may have important implications for the development of new injection devices and drug formulations for clinical practice.

Continuous glucose monitoring: quality of hypoglycaemia detection

AIMS

To evaluate the accuracy of a (widely used) continuous glucose monitoring (CGM)-system and its ability to detect hypoglycaemic events.

METHODS

A total of 18 patients with type 1 diabetes mellitus used continuous glucose monitoring (Guardian REAL-Time CGMS) during two 9-day in-house periods. A hypoglycaemic threshold alarm alerted patients to sensor readings <70 mg/dl. Continuous glucose monitoring sensor readings were compared to laboratory reference measurements taken every 4 h and in case of a hypoglycaemic alarm.

RESULTS

A total of 2317 paired data points were evaluated. Overall, the mean absolute relative difference (MARD) was 16.7%. The percentage of data points in the clinically accurate or acceptable Clarke Error Grid zones A + B was 94.6%. In the hypoglycaemic range, accuracy worsened (MARD 38.8%) leading to a failure to detect more than half of the true hypoglycaemic events (sensitivity 37.5%). Furthermore, more than half of the alarms that warn patients for hypoglycaemia were false (false alert rate 53.3%). Above the low alert threshold, the sensor confirmed 2077 of 2182 reference values (specificity 95.2%).

CONCLUSIONS

Patients using continuous glucose monitoring should be aware of its limitation to accurately detect hypoglycaemia.

Paraphenylene diamine hair dye poisoning in an adolescent

A 14-year-old female was referred to the pediatric nephrology unit with a short history of progressive angio-oedema of the face requiring tracheostomy. She ingested an unusual substance which caused swollen tongue, cervical oedema and dark coloured brown urine. These clinical features with the laboratory tests confirmed the diagnosis of paraphenylene diamine (PPD) poisoning. Psychological assessment confirmed that the child had severe depression. The suicide attempt was just immediately after failure in the final qualifying examination to secondary school. She did not have any family support but she used to be punished in different ways. In Sudan PPD in its pure form is available in the local market and until recently there was no restrictions for its use or trade. Adolescents are well aware of its toxic effects and it is commonly used to attempt suicide. Legislation and laws should prevent its use in different hair dye formulations and look for another substitute. Clinical management is hampered by the lack of a rapid diagnostic test; no other treatment other than supportive measures can be offered.

Micronutrient supplements and mortality of HIV-infected adults with pulmonary TB: a controlled clinical trial

SETTING

Zomba and Blantyre, Malawi, Africa.

OBJECTIVES

To determine whether daily micronutrient supplementation reduces the mortality of human immunodeficiency virus (HIV) infected adults with pulmonary tuberculosis (TB).

DESIGN

A randomised, controlled clinical trial of micronutrient supplementation for HIV-positive and HIV-negative adults with pulmonary TB. Participants were enrolled at the commencement of chemotherapy for sputum smear-positive pulmonary TB and followed up for 24 months.

RESULTS

A total of 829 HIV-positive and 573 HIV-negative adults were enrolled. During follow-up, 328 HIV-positive and 17 HIV-negative participants died. The proportion of HIV-positive participants who died in the micronutrient and placebo groups was 38.7% and 40.4%, respectively (P = 0.49). Micronutrient supplementation did not reduce mortality (hazard ratio [HR] 0.93, 95%CI 0.75-1.15) among HIV-positive adults.

CONCLUSIONS

Micronutrient supplementation at the doses used in this study does not reduce mortality in HIV-positive adults with pulmonary TB in Malawi.

An epidemiological study on the occurrence of Staphylococcus aureus in superficial abscesses of patients presenting for surgery in a teaching hospital in Khartoum, Sudan

A group of patients (n=86) suffering from superficial abscesses was recruited in the Khartoum Teaching Hospital, Sudan. Detailed clinical and socio-economic data were collected. It appeared that 83% of all patients were younger than 40. Labourers were most prevalent (28%), followed by students (23%) and housewives (16%). The head and neck were most often affected (22%), with hands being second (19%). In 92% of all pus cultures a microbial agents was identified, the large majority being Staphylococcus aureus (69%). Among patients, 47% were nasal carriers of S. aureus, similar to the carriage rate measured among controls, suggesting that nasal carriage is no risk factor for abscess development. Multivariate logistic regression analysis revealed that a history of abscess, recent traditional medical treatment, poor hygiene and low socio-economic status were significantly and independently associated with the occurrence of superficial abscesses.

Post-kala-azar dermal leishmaniasis in the Sudan: peripheral neural involvement

Four patients developed post-kala-azar dermal leishmaniasis and neuritis (PKDL) 1 to 6 months following apparently successful treatment of kala-azar. The duration of the lesion varied between 1 month and nearly 5 years. The lesions were macules, papules, or nodules affecting the face, extremities, and trunk. The diagnosis was made by demonstration of the parasite in slit smear and biopsies and by a positive direct agglutination test (DAT). Histologically, the patients were found to have neuritis affecting the cutaneous nerves in the lesion only. The nerves showed a lymphohistiocytic infiltration and occasionally parasites. There was no impairment of sensation. Response to sodium stibogluconate was good. PKDL may simulate leprosy both clinically and pathologically.