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Background Rapid diagnostic tests (RDTs) are effective tools to diagnose and inform the treatment of malaria in adults and children. The recent development of a highly sensitive rapid diagnostic test (HS-RDT) for Plasmodium falciparum has prompted questions over whether it could improve the diagnosis of malaria in pregnancy and pregnancy outcomes in malaria endemic areas. Methods This landscape review collates studies addressing the clinical performance of the HS-RDT. Thirteen studies were identified comparing the HS-RDT and conventional RDT (co-RDT) to molecular methods to detect malaria in pregnancy. Using data from five completed studies, the association of epidemiological and pregnancy-related factors on the sensitivity of HS-RDT, and comparisons with co-RDT were investigated. The studies were conducted in 4 countries over a range of transmission intensities in largely asymptomatic women. Results Sensitivity of both RDTs varied widely (HS-RDT range 19.6 to 85.7%, co-RDT range 22.8 to 82.8% compared to molecular testing) yet HS-RDT detected individuals with similar parasite densities across all the studies including different geographies and transmission areas [geometric mean parasitaemia around 100 parasites per µL (p/µL)]. HS-RDTs were capable of detecting low-density parasitaemias and in one study detected around 30% of infections with parasite densities of 0–2 p/µL compared to the co-RDT in the same study which detected around 15%. Conclusion The HS-RDT has a slightly higher analytical sensitivity to detect malaria infections in pregnancy than co-RDT but this mostly translates to only fractional and not statistically significant improvement in clinical performance by gravidity, trimester, geography or transmission intensity. The analysis presented here highlights the need for larger and more studies to evaluate incremental improvements in RDTs. The HS-RDT could be used in any situation where co-RDT are currently used for P. falciparum diagnosis, if storage conditions can be adhered to.

Objectives: This enquiry aimed to provide a snap-shot of availability, price and quality of malaria rapid diagnostic tests (RDTs) in private health facilities at selected sites in six malaria-endemic countries in Africa, South East Asia and South America. Methods: In each study site, data collectors surveyed private healthcare facilities which were selected based on accessibility from their home institution. Using a questionnaire, information was recorded about the facility itself and the malaria RDT(s) available. Where possible, a small number of RDTs were procured and quality control tested using a standardized procedure. Results: Of the 324 private healthcare facilities visited, 35 outlets (mainly private clinics and hospitals) were found to supply 10 different types of RDTs products. RDT prices across the six countries ranged from US$1.00 to $16.81. Five of the 14 malaria RDTs collected failed quality control testing. Conclusions: In the private outlets sampled, the availability of RDTs was limited. Some of the RDTs whose quality we tested demonstrated inadequate sensitivity. This presents a number of risks. Given the more widespread distribution of antimalarials currently planned for private sector facilities, parasite-based diagnosis in this sector will be essential to adhere to the WHO guidelines for effective case management of malaria. Considerable regulation and quality control are also necessary to assure the availability of accurate and reliable RDTs, as well as adequate case management and provider adherence to RDT results. Public sector engagement is likely to be essential in this process. Objetivos: Esta encuesta tenía por objetivo proveer una fotografía sobre la disponibilidad, el precio y la calidad de las pruebas de diagnóstico rápido (PDRs) de malaria en centros sanitarios privados de seis lugares seleccionados en seis países endémicos para malaria en África, el sudeste Asiático y Sudamérica. Métodos: En cada lugar de estudio, los recolectores de datos encuestaron centros sanitarios privados seleccionados basándose en la accesibilidad desde sus hogares. Utilizando un cuestionario, se obtuvo información sobre el centro sanitario así como sobre la disponibilidad de PDR(s). En donde era posible, se recogieron un pequeño número de PDRs y se realizaron pruebas de control de calidad utilizando un procedimiento estándar. Resultados: De los 324 centros sanitarios privados visitados, se hallaron 35 puntos de venta (principalmente clínicas privadas y hospitales) que proveían 10 tipos diferentes de PDRs. Los precios de las PDR en los seis países estaban entre US$1.00 y $16.81. Cinco de las 14 PDRs para malaria recolectadas no pasaron las pruebas de control de calidad. Conclusiones: En los puntos de venta privados muestreados, la disponibilidad de las PDRs era limitada. Algunas de las PDRs a las que se les realizó un control de calidad, demostraron tener una sensibilidad inadecuada. Esto presenta una serie de riesgos. Dada la mayor distribución de antipalúdicos actualmente planeada para los centros privados, el diagnóstico basado en el parásito en este sector sería esencial para adherirse a las guías de la OMS para realizar un manejo efectivo de casos de malaria. Es necesaria una regulación considerable y un control de calidad para asegurar la disponibilidad de PDRs precisas y fiables, al igual que un manejo adecuado de los casos y la adherencia del proveedor a los resultados de las PDRs. El compromiso del sector público será probablemente esencial en este proceso. Objectifs: Cette enquête visait à fournir une vue rapide sur la disponibilité, le prix et la qualité des tests de diagnostic rapide (TDR) du paludisme dans les établissements de santé privés dans des sites sélectionnés dans six pays endémiques pour le paludisme en Afrique, en Asie du sud-est et en Amérique du sud. Méthodes: Dans chaque site d’étude, les collecteurs de données ont enquêté sur les établissements de santé privés, choisis en fonction de l’accessibilitéà partir de leur institution d’origine. En utilisant un questionnaire, les informations ont été enregistrées sur l’installation elle-même et la disponibilité du TDR du paludisme. Lorsque possible, un petit nombre de TDR a été acquis et un contrôle de qualité a été effectué en utilisant une procédure standardisée. Résultats: Sur les 324 établissements de santé privés visités, 35 points (essentiellement des cliniques et hôpitaux privés) ont été trouvés, fournissant 10 différents types de produits TDR. Le prix des TDR dans les six pays variait de 1,00 $ US à 16,81 $ US. Cinq TDR du paludisme sur 14 collectés ont échoué au test de contrôle de qualité. Conclusions: Dans les points d’accès privés échantillonnés, la disponibilité des TDR était limitée. Certains TDR pour lesquels la qualité a été testée ont démontré une sensibilité inadéquate. Cela pose un certain nombre de risques. Compte tenu de la distribution plus étendue des antipaludiques prévue actuellement dans les établissements du secteur privé, le diagnostic parasitologique dans ce secteur devrait être essentiel afin de se conformer aux directives de l’OMS pour la prise en charge efficace des cas de paludisme. Une réglementation considérable et un contrôle de qualité sont également nécessaires pour assurer la disponibilité de TDR précis et fiables, ainsi qu’une prise en charge adéquate des cas et l’adhésion du prestataire aux résultats des TDR. L’engagement du secteur public est probablement essentiel dans ce processus.

Deep Vein Thrombosis (DVT) and pulmonary embolism are the dangerous and serious complications in patients undergoing surgery. It is known that prognosis is strictly linked to timely recognition of the pathogenetic-clinical phase of the thromboembolic disease and that prevention, therefore, plays the leading role in patients at risk. The most recent series show that, in absence of prophylaxis, the frequency of DVT, diagnosed by objective tests, is still significant in abdominal surgery. Modern diagnostic tools make possible to identify relatively silent clinical thrombosis, also with laboratory tests (i.e., D-dimer plasma levels). The Authors report a study on thromboembolic episodes in patients who underwent pneumoperitoneum with CO2 during laparoscopic abdominal surgery, compared to a control group submitted to open surgery. They underline the importance of a careful preoperative evaluation of the venous system, by Doppler study, in order to identify, patients at risk of DVT and establish a suitable anti-thrombotic prophylaxis.