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Introduction Anti-tumour necrosis factor (anti-TNF) agents are important treatments for a range of inflammatory conditions but are associated with a fivefold increase risk of tuberculosis (TB). Newer tests based on T cell interferon γ release (IGRA) may aid diagnosis of TB. Aim To assess the impact of IGRA testing on TB screening in patients awaiting anti-TNF therapy. Methods ‘Quantiferon’ (Celestis) IGRA blood testing was performed as part of TB screening prior to anti-TNF therapy. Results were reported as positive, indeterminate (and therefore repeated) and negative. Infectious Disease assessment was recommended for positive or 2 indeterminate Quantiferon results, CXR changes or other protocol-identified TB risk. Results 134 patients were screened (median age 47). Diagnoses: Inflammatory Bowel Diseases disease 51, Inflammatory arthropathy 63, Psoriasis 16, other 3. 91 were on immunomodulators (IM). 116 patients received anti-TNF agents. 124/134 had a Quantiferon test. 108 were negative; 8 were indeterminate (negative on repeat), of whom 7 were on IMs. 5 had 2 indeterminate results (4 on IMs). 3 had a positive test, 2 an abnormal CXR and 1 had no identified TB risk factors. Antituberculous therapy (anti-TBRx) was given to 6 patients prior to anti-TNF treatment: 3 with positive Quantiferon results, 2 negative (strong family history), 1 no test (abnormal CXR). 5 patients had CXR findings (Quantiferon negative 2; indeterminate followed by a negative 1; positive 1; not done 1). The latter 2 received anti TBRx. The screening proforma led to anti TBRx in 6 patients prior to anti-TNF therapy. In 1, the Quantiferon test was the only indicator of TB risk. After a median follow-up of 28 weeks, no patients had developed TB. Conclusion IGRA testing aids decision making in patients awaiting anti-TNF therapy as part of a screening protocol. 1 patient of 134, not identified by other screening methods, who required prior anti TBRx, was identified in this way. Clinical risk assessment is an independent reason for anti TBRx. Longer follow-up and costing of alternatives is needed to establish the validity of this strategy. [ABSTRACT FROM PUBLISHER]

Objectives: To evaluate the reproducibility with which microbiologists interpret Gram-stained sputa and examine the effect of the smear preparation method., Methods: Two hundred and ten coded slides prepared directly from a purulent portion of sputum (DS) and 140 slides prepared after homogenization of the same sputum (HS) were examined by three experienced microbiologists. A proportion of the slides prepared by each method were recorded and represented to the raters. Intraobserver and interobserver variation was assessed using the kappa statistic (kappa)., Results: Evaluation of the smear as being infected and predicting Streptococcus pneumoniae as the infecting organism showed the greatest intraobserver agreement (kappa=0.74-0.82) and interobserver agreement (kappa=0.50-0.82). The agreement concerning the number of cells and infection with Haemophilus influenzae was only fair to moderate. Differences in the interpretation of smears prepared by the two methods could be explained by the intrinsic disagreement that occurs when the same smear is examined twice. The positive predictive value of a positive S. pneumoniae smear for a positive culture ([10(6)/ml) was 81% with the DS and 97% with the HS., Conclusion: In this laboratory, a sputum Gram film interpretation suggesting infection with S. pneumoniae was reproducible and predictive of a significant positive culture., (Copyright 2000)

Approximately 50% of all adults in the United States have some form of gingivitis, and 80% have experienced some degree of periodontitis. Despite the use of fluoride, a critical element in the prevention of periodontal disease, many children and adults still suffer needlessly from this "silent" destroyer of the gum tissue and its underlying bone structures. This article highlights the prevalence, pathophysiology, classifications, health risk factors and clinical management of clients with periodontal diseases. Regardless of the health care setting, the advanced practice nurse plays a critical role in the prevention, early diagnosis and intervention of periodontal disease.

In single muscle fibers, small (1 percent) changes of length have a marked effect of both the calcium activation and the tension elicited by a constant current stimulus. The decrease in tension with shortening is accounted for almost entirely by a decrease in calcium release, rather than by changes in mechanical factors, such as filament geometry.