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  • 1
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  GMS Zeitschrift zur Förderung der Qualitätssicherung in medizinischen Laboratorien; VOL: 1; DOC04 /20091020/
    Publication Date: 2009-10-21
    Description: The present investigation analyzes and describes the results of the German proficiency testing trials in bacteriologic infection serology in 2006. Target values and important findings of external quality control are summarized and commented. Syphilis- and borrelia-serology as well as C. trachomatis -antigen detection methods and molecular diagnostic tests showed good to excellent performance. Determination of protective immunity for tetanus and diphtheria and quantitative determination of ASL, ADNase, and rheumatoid factor turned out more reliable as many other quantitative ELISAs and conventional titer tests for the detection of specific antibodies. Nevertheless, problems in the quantification and standardization of such tests became obvious despite the availability of international standard preparations. Our study indicates that major difficulties persevere in the quality and performance of helicobacter-, pertussis- and chlamydia-serology clearly impairing the diagnostic reliability of such tests in the routine diagnostic laboratories.
    Description: Die vorliegende Arbeit beschreibt und bewertet in standardisierter Form die Ergebnisse der Ringversuche in der bakteriologischen Infektionsserologie aus dem Jahr 2006. Die Zielwerte und Ergebnisse sowie spezielle, für die Qualitätssicherung besonders bedeutsame Befunde werden zusammenfassend dargestellt und kommentiert. Für infektionsserologische Klassiker wie die Lues- und Borrelien-Diagnostik zeigte sich ebenso wie für die geprüften Direktnachweisverfahren (C. trachomatis -Antigennachweise und PCR-Verfahren) eine zufriedenstellende bis gute Ergebnisqualität. Für die Impftiterbestimmung im Rahmen der Tetanus- und Diphtherietoxoid-Antikörperdiagnostik oder für die ASL-, ADNase- und Rheumafaktorbestimmung fand sich eine bessere Vergleichbarkeit quantitativer Ergebnisse als für klassische Titertests und quantiative ELISA-Verfahren. Diese Verfahren unterliegen jedoch trotz der Verfügbarkeit von internationalen Referenzpräparationen weiterhin erheblichen methoden- und herstellerabhängigen Schwankungen. Offensichtlich problematisch bleiben die Helicobacter-, Pertussis- und Chlamydien-Serologie mit bislang relativ niedrigem Standardisierungsgrad und entsprechend eingeschränkter diagnostischer Aussagekraft unter Routinebedingungen.
    Keywords: testing ; external quality control ; bacteriologic infection serology ; microbiology ; Ringversuche ; externe Qualitätskontrolle ; bakteriologische Infektionsserologie ; Mikrobiologie ; ddc: 610
    Language: German
    Type: article
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  • 2
    Publication Date: 2010-09-13
    Description: Participation in external quality assessment schemes (EQUAS) is gaining increasing importance for quality control and surveillance of medical laboratories. The present work analyzes the results of the 2007 EQUAS for bacteriologic infection serology performed by INSTAND Germany. Data reported from participating laboratories were collected and analyzed in order to evaluate the quality and diagnostic capacities of the part〈TextGroup〉 ic 〈/TextGroup〉ipants.Results mainly confirm the observations and trends of the preceding years: the performance of assays highly depended on standardization of the respective analyte and the individual quality of existing commercial or in-house reagents. Especially the ongoing diagnostic problems of Chlamydia spp.- and Salmonella spp.-serology should eventually lead to changes in diagnostic recommendations issued by the appropriate scientific societies.
    Description: Eine regelmäßige Teilnahme an Ringversuchen hat gerade im Hinblick auf die neue Richtlinie der Bundesärztekammer und die Akkreditierung vieler Laboratorien eine wachsende Bedeutung für die Qualitätskontrolle und Überwachung der medizinischen Labordiagnostik erhalten. Diese Arbeit analysiert die Ergebnisse der INSTAND-Ringversuche für bakteriologische Infektionsserologie aus dem Jahr 2007 in Deutschland.Die Ergebnisse bestätigen zumeist die Erfahrungen und Trends aus den letzten Jahren: die Bestehensquoten sind wesentlich von der Standardisierung und Güte der untersuchten Parameter und der zur Verfügung stehenden Reagenzien abhängig. Vor allem die fortbestehenden Probleme in der Chlamydien- und Salmonellen-Serologie sollten sich zukünftig in Änderungen der diagnostischen Leitlinien der zuständigen Fachgesellschaften niederschlagen.
    Keywords: external quality assessment ; bacteriologic infection serology ; microbiology ; Ringversuch ; externe Qualitätskontrolle ; bakteriologische Infektionsserologie ; Mikrobiologie ; ddc: 610
    Language: German
    Type: article
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Cellular and molecular life sciences 27 (1971), S. 1338-1339 
    ISSN: 1420-9071
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology , Medicine
    Notes: Zusammenfassung Durch Behandlung mit Glutardialdehyd wirdNaja-naja-Gift weitgehend entgiftet. Einzeldosen bis zu 20 mg pro Kaninchen können ohne Nebenwirkungen injiziert werden. Durch Immunisierung von Kaninchen wird eine gute Antikörperbildung gegenNajanaja-Gift — und vor allem auch gegen die niedermolekularen Toxine — erzielt.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 0044-281X
    Keywords: Schlüsselwörter Epidemiologie – Resistenz – Bakterielle Infektionen – Geriatrie –¶Kalkulierte Antibiotikatherapie ; Key words Epidemiolgy –¶resistance – infection – elderly – empiric antimicrobial therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary As the elderly segment of our population expands, there is an increase of therapeutic problems considering this age group. The elderly patient is generally susceptible to infections because of the decline in host defense mechanisms that occurs with aging, and the underlying chronic diseases of these patients. Increasing numbers of elderly people are being treated in hospitals and are additionally at particular risk of acquiring nosocomial infections with antibiotic-resistant organisms. This article focuses on the epidemiological considerations, risk factors, types of infections that occur in elderly patients, and the guidelines for empiric therapy. The most common infections of the elderly are respiratory tract infection, urinary tract infection, and skin and soft tissue infection. Empirical therapy should be broader in spectrum for elderly patients since the variety of infecting bacteria tends to be greater and the choice of antimicrobial therapy must be based on risk stratification (age, medical illnesses, and severity of presentation). Many additional aspects, e.g., route of administration, drug pharmacokinetics and pharmacodynamics, drug toxicity and drug-drug interactions, compliance, and multiple underlying diseases (e.g., renal failure) must be considered in the rational selection of antibiotic regimen.
    Notes: Zusammenfassung Da der Anteil älterer Personen in unserer Bevölkerung stetig zunimmt, wächst das Interesse an therapeutischen Problemen in der Geriatrie. Die Abnahme der körpereigenen Abwehr und die häufig zugrundeliegende Multimorbidität machen den älteren Menschen grundsätzlich anfälliger für Infektionen. Da immer mehr ältere Menschen in Krankenhäusern behandelt werden, steigt auch das Risiko der Aquirierung nosokomialer Infektionen mit multiresistenten Keimen in dieser Patientenpopulation. Der vorliegende Bericht befasst sich mit der Epidemiologie und Therapie von häufig vorkommenden Infektionen im Alter, namentlich respiratorische Infektionen, Harnwegsinfektionen und Haut- und Weichteilinfektionen. Bei der empirischen Initialtherapie ist in der Regel ein breiteres Keimspektrum und die Schwere der Erkrankung zu berücksichtigen. Weiterhin müssen bei der Wahl eines geeigneten Antibiotikums die Applikationsart, Pharmakokinetik, Pharmakodynamik, Toxizität, Arzneimittelinteraktionen, die Compliance sowie die zugrundeliegenden Begleiterkrankungen (z.B. Niereninsuffizienz) mitberücksichtigt werden.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1439-0973
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1439-0973
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Wir berichten über ein achtjähriges Mädchen, das sechs Wochen nach zwei Zeckenstichen an einer akuten Fazialisparese begleitet von Kopfschmerzen, Müdigkeit, Arthralgien und Myalgien erkrankte. Die körperliche Untersuchung ergab außer der linksseitigen Fazialisparese keine weiteren Auffälligkeiten. Die Entzündungsparameter in Blutbild, BKS und CRP waren im Normbereich. Die Lumbalpunktion ergab einen Eiweißgehalt von 63 mg/dl, Glukose 45 mg/dl und keine Zellen. Die IFT-Titer gegenBorrelia burgdorferi waren im Serum und Liquor signifikant erhöht. Eine positive Westernblot-Untersuchung unterstützte die Diagnose. Die Behandlung wurde mit Ceftriaxon i.v. über 14 Tage durchgeführt. Innerhalb von fünf Tagen konnte eine deutliche Befundbesserung registriert werden. Die Liquoruntersuchung kann bei Patienten mit Fazialisparese durch parallele Bestimmung von IFT- Titern gegenBorrelia burgdorferi in Serum und Liquor zur Diagnosestellung „Lyme-Borreliose“ beitragen, auch wenn der Liquorstatus keine oder nur geringe Entzündungszeichen ergibt.
    Notes: Summary This is a report on an eight-year-old girl who presented with facial palsy, headache, fatigue, arthralgias and myalgias six weeks after two tick bites. Physical examination was unremarkable with the exception of a left-sided facial palsy. Laboratory investigation revealed normal complete blood count, ESR and CRP. The spinal tap showed a protein of 63 mg/dl, glucose 45 mg/dl and no cells. IFT titres toBorrelia burgdorferi in serum and CSF were significantly elevated. The diagnosis was supported by Western blot analysis. Treatment was started with ceftriaxone i.v. for a total of 14 days. Under this therapeutic regimen the patient improved substantially within five days. Investigation of CSF in patients with facial palsy may help to establish the diagnosis of Lyme disease by simultaneously measuring IFT toB. burgdorferi in serum and spinal fluid, even in cases where CSF shows little or no signs of inflammation.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 1439-0973
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Lyme arthritis (LA) may be confused with other rheumatic diseases, particularly in the absence of a history of erythema migrans (EM). We report the case of a 12-year-old patient who developed a large effusion of the tight knee joint. The titer for antinuclear antibodies was 1:80 and the test for rheumatoid factor was negative. – Investigations for antibody response to Borrelia burgdorferi demonstrated remarkable elevation of IgG antibody and no specific IgM response. These results were confirmed by immunoblotting reactivity with the bands p83/100, p58, p43, p41, p39, OspA, p30, OspC, p21, and p17. We subsequently learned that the child had suffered a tick bite followed by an EM 5 years earlier and had been treated with trimethoprim/sulfamethoxazole at that time. The patient now was given intravenous ceftriaxone, 2 g daily for 14 days. In the absence of clinical improvement 3 weeks later a knee joint aspiration was performed which resulted in a positive polymerase chain reaction (PCR) test for B. burgdorferi DNA (OspA) in the synovial fluid. The patient fully recovered 2 months later without further treatment. The case indicates that the latency period between EM and onset of LA may last up to 5 years. In addition to serologic test methods, analysis of synovial fluid using PCR may be decisive for making the final diagnosis of LA.
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  • 8
    ISSN: 1432-1831
    Keywords: Key words Borrelia burgdorferi ; Serum resistance ; Complement activation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Sixteen Borrelia burgdorferi strains, including all three species, were compared in a colorimetric bactericidal assay for their ability to escape the complement-dependent bacteriolysis on incubation in normal human serum free of specific antibodies (NHS). The species B. afzelii was found to be serum resistant (EB1, EB3, FEM1, FEM2, Pko), whereas strains of the species B. garinii were found to be serum sensitive (1/B29, G1, G2, PSth, PBr, PTrob). Six strains, mainly B. burgdorferi sensu stricto, were only partially sensitive (Z25, 297, B31, PKa-I, PBi). All strains activated the complement cascade in NHS, whereas only four strains (G1, G2, PBr, PSth) could activate complement in the presence of EGTA-Mg. After complement activation, covalently bound C3 fragments (C3b, iC3b) were detected on serum-sensitive as well as serum-resistant borrelial strains. Heterogeneity, however, was observed between serum-resistant and serum-sensitive strains with respect to deposition of C6 and C9. Whereas serum-sensitive strains were strongly positive for C6 and C9 and were, therefore, killed by the terminal complement complex (TCC), serum-resistant strains were devoid of C6 and C9 on their cell surface. The serum resistance may, therefore, be due to an absent or only transient formation of TCC on the bacterial surface.
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  • 9
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In order to evaluate a commercially available passive hemagglutination assay (PHA) as a screening test for the diagnosis of Lyme disease, 173 sera were tested by PHA and the results compared with those obtained by an indirect immunofluorescence assay (IFA) and a conventional immunoblot using whole cell antigen (IB). Identical results were found by PHA and IFA in 80 % of all cases. The sensitivity of the PHA was comparable to that of the IB (96 %). However, confirmation of positive PHA results was necessary due to lack of specificity. A commercially available recombinant immunoblot (RIB) was compared to a conventional IB for its efficiency as a confirmatory assay. The rate of agreement was 86 % of 64 sera tested positive or negative by IB. However, in order to obtain this high concordance of the RIB and IB, it was necessary to modify the RIB interpretation criteria of the manufacturer. Thus, screening of serum specimens by the PHA and confirmation of test results by the RIB appears to be a convenient test combination that allows the serological diagnosis of Lyme disease in most cases.
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In the present study 150Neisseria gonorrhoeae strains from prostitutes in Frankfurt, Germany, were investigated for their in vitro susceptibility to eight antimicrobial agents by the agar dilution test. While 21.3 % of gonococci were highly resistant to penicillin (MICs ≥ 2 mg/l), 49.4 % of the organisms were moderately sensitive (MICs=0.125–0.5 mg/l) and only 29.3 % of strains were fully susceptible to penicillin (MICs≤0.06 mg/l). No resistance to other antibiotics tested was observed, with the exception of doxycycline, to which overall resistance was 9.7 %. Genotypic analysis ofNeisseria gonorrhoeae by the restriction enzyme technique showed that most penicillin-resistant strains could be grouped into two main bacterial clones, whereas penicillinsusceptible isolates displayed a remarkable heterogeneity. This observation suggests that a restricted number of resistantNeisseria gonorrhoeae strains are likely to spread within the prostitute population of Frankfurt, Germany.
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