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To the Editor: In 2001, a Klebsiella pneumoniae isolate from a patient in Turkey was found to harbor a novel class D carbapenem-hydrolyzing oxacillinase, OXA-48 (1). Although this enzyme hydrolyzes [...]

Investigates the presynaptic dopamine function in neuroleptic and mood-stabilizer-naive nonpsychotic manic patients in the U.S. Treatment with divalproex sodium; Use of graphical analysis; Comparison between healthy subjects and manic patients.

The article deals with the new guidelines issued by the Public Health Agency of Canada for the management of Neisseria gonorrhoea. The two principles underlying the revised guidelines are higher doses and co-treatment with another antibiotic class. It cites circumstances wherein cultures and susceptibility testing of Neisseria gonorrhoea should be used. It points out a need for comprehensive prevention and control measures amid diminishing treatment options for the disease.

The objective of the study was to ascertain an optimal Helicobacter pylori diagnostic strategy using population-level laboratory data comparing the performance of serology against urea breath test (UBT). H. pylori diagnostic test results for serology and UBT from two laboratories over a 12-year period (2006-20017) were extracted, linked, and analyzed. A subset of this population underwent both methods of testing within days of each other, enabling a direct comparison of the two methods. The average prevalence of H. pylor i positivity was 21.3% by serology and 17.5% by UBT. There were 2,612 individuals who had serology performed first, followed by UBT within 14 days. For this subset, the sensitivity of serology compared with UBT was 96.5% with a specificity of 79.2%. The negative predictive value for serology was 98.4%. Contrary to various recent clinical guidelines, the data show that serology still has utility as a sensitive enough test to be used as an initial H. pylori screening test in a lower prevalence population. Negative serology can be used with confidence to rule out active infection, whereas a positive serology could be followed up with a UBT or a similar performing test such as stool antigen to differentiate active from past infection. For population-based diagnostic recommendations, such a strategy may be ideal since serology generally costs less than UBT and may be combined with a blood draw being done for other diagnostic tests. Continuing to offer serology increases options for patients and may provide economic benefits for single-payer health care systems or health maintenance organizations., Importance: This study compares the performance of serology with urea breath test in the diagnosis of Helicobacter pylori in a population-level data set and mimics a head-to-head direct comparison as the study population had both tests performed within 2 weeks of each other. This provides new information supporting the use of serology in a diagnostic algorithm. There are several instances where serology could be preferable to patients to rule out disease, despite some guidelines suggesting serology should not be used.

The following abstracts are compiled from Check Sample exercises published in 2008. These peer-reviewed case studies assist laboratory professionals with continuing medical education and are developed in the areas of clinical chemistry, cytopathology, forensic pathology, hematology, microbiology, surgical pathology, and transfusion medicine. Abstracts for all exercises published in the program will appear annually in AJCP.