BackgroundThe Leishmania OligoC-TesT and NASBA-Oligochromatography (OC) were recently developed for simplified and standardised molecular detection of Leishmania parasites in clinical specimens. We here present the phase II evaluation of both tests for diagnosis of visceral leishmaniasis (VL), cutaneous leishmaniasis (CL) and post kala-azar dermal leishmaniasis (PKDL) in Sudan.MethodologyThe diagnostic accuracy of the tests was evaluated on 90 confirmed and 90 suspected VL cases, 7 confirmed and 8 suspected CL cases, 2 confirmed PKDL cases and 50 healthy endemic controls from Gedarif state and Khartoum state in Sudan.Principal FindingsThe OligoC-TesT as well as the NASBA-OC showed a sensitivity of 96.8% (95% CI: 83.8%–99.4%) on lymph node aspirates and of 96.2% (95% CI: 89.4%–98.7%) on blood from the confirmed VL cases. The sensitivity on bone marrow was 96.9% (95% CI: 89.3%–99.1%) and 95.3% (95% CI: 87.1%–98.4%) for the OligoC-TesT and NASBA-OC, respectively. All confirmed CL and PKDL cases were positive with both tests. On the suspected VL cases, we observed a positive OligoC-TesT and NASBA-OC result in 37.1% (95% CI: 23.2%–53.7%) and 34.3% (95% CI: 20.8%–50.9%) on lymph, in 72.7% (95% CI: 55.8%–84.9%) and 63.6% (95% CI: 46.6%–77.8%) on bone marrow and in 76.9% (95% CI: 49.7%–91.8%) and 69.2% (95% CI: 42.4%–87.3%) on blood. Seven out of 8 CL suspected cases were positive with both tests. The specificity on the healthy endemic controls was 90% (95% CI: 78.6%–95.7%) for the OligoC-TesT and 100% (95% CI: 92.9%–100.0%) for the NASBA-OC test.ConclusionsBoth tests showed high sensitivity on lymph, blood and tissue scrapings for diagnosis of VL, CL and PKDL in Sudan, but the specificity for clinical VL was significantly higher with NASBA-OC.

Previous reports showed that surgery is the only method of treating liver hydatid cysts that have ruptured into the biliary system. We report a case of obstructive jaundice due to spontaneous rupture of a liver hydatid cyst into the biliary system, which was treated non-surgically by endoscopic papillotomy and extraction of daughter cysts from the biliary system, insertion of a nasobiliary tube for drainage and injection of scolicidal hypertonic saline, into the biliary system. Clear resolution of the obstruction, disappearance of daughter cysts and a decrease in the size of the hepatic cyst was shown by ERCP, ultrasound and CT scan. We believe that this new method is safe, effective and has a lower incidence of mortality, morbidity and recurrence than surgery, which it should replace whenever possible.

Purpose To conduct a systematic review of outcomes following primary arthroscopic repair of chronic massive rotator cuff tears (RCTs) and to assess clinical outcomes and rates of repair failure. The authors' preferred treatment algorithm is also provided. Methods Medline, Embase and PubMed were searched identifying articles pertaining to primary arthroscopic repair of chronic massive RCTs without the use of augmentation. Primary outcomes were patient-reported outcomes and the secondary outcome was the rate of repair failure. Outcome data were pooled and presented as well as assessment of study methodological quality. Data from studies reporting similar outcome measures were pooled when possible, and mean differences alongside confidence intervals and p values were reported, where appropriate. Results Twenty-six studies (1405 participants) were included, with mean age of 62 years (range 52-69). The mean duration of symptoms pre-operatively was 31 months (range 6-40), and the mean follow-up time was 39 months (range 12-111). Complete repair was performed in 78% of patients and partial repair was performed in 22%. Both complete and partial repairs resulted in significant improvements with respect to pain, range of motion and functional outcome scores. The rate of repair failure for the total cohort was 36% at a mean follow-up of 31 months, and for the complete and partial repair subgroups the failure rate was 35% and 40%, respectively. Conclusions Arthroscopic repairs of chronic, massive RCTs, whether complete or partial, are associated with significant improvements in pain, function and objective outcome scores. The rate of repair failure is lower than previously reported, however, still high at 36%. The present paper finds that arthroscopic repair is still a viable treatment option for massive RCTs. Level of evidence IV.

Introduction The relationship between cannabis use and hypertension is not clear based on prior epidemiological studies. Thus, we examined this relationship over a 3‐year follow‐up period using a large population‐based sample from the USA. Methods Self‐reported longitudinal data were obtained from the National Epidemiologic Survey on Alcohol and Related Conditions Wave 1 (2001/2002) and Wave 2 (2004/2005). The sample was restricted to participants who did not report hypertension at baseline (n = 26 844; 51% 40 years and older, 51% female, 71% white). χ2‐tests were used to examine the distributions of confounders stratified by the incidence of hypertension. Thereafter, multiple logistic regression analyses were conducted to quantify the relationships between lifetime cannabis use, 12‐month cannabis use and 12‐month cannabis use frequency and incidence of hypertension while adjusting for confounders. Results Cannabis use was associated with a decreased incidence of hypertension in the unadjusted analyses. However, the relationships were confounded by age. After adjustment for all confounders, neither lifetime cannabis use (odds ratio, 95% confidence interval 0.89, 0.77 to 1.02), 12‐month cannabis use (0.78, 0.56 to 1.09) nor 12‐month cannabis use frequency [at least monthly use (0.85, 0.57 to 1.28) and less than monthly use (0.67, 0.40 to 1.11)] were associated above chance with the incidence of hypertension. Discussion and Conclusions Lifetime cannabis use, 12‐month cannabis use and 12‐month cannabis use frequency were not associated with the incidence of hypertension.