(i) The proportion of patients attaining an SVR in Scottish routine practice is marginally lower than in RCTs and (ii) other than genotype, γ-glutamyl transferase emerges as a valuable predictor of an SVR in routine practice. Further, we demonstrate an approach to more clearly discern the predictive value of response predictors.

Cell cultures have been important historically for the development of virology. However, I will argue that they are no longer essential for a diagnostic laboratory and should be replaced with nucleic acid detection methods. This change of technology should be cost-neutral once the full costs to the laboratory of cell cultures, including staff time, are calculated. Molecular methods are more sensitive than cell cultures and provide answers much more rapidly, especially for negative samples. Since negative results are frequently as important to our clinical colleagues as positive results, we should change now to routine diagnostic services based upon nucleic acid detection.

Enteric fever is a major public health concern in endemic areas, particularly in infrastructure-limited countries where Salmonella Paratyphi A has emerged in increasing proportion of cases. We aimed to evaluate a method to detect Salmonella Typhi (S. Typhi) and Salmonella Paratyphi A (S. Paratyphi A) in febrile patients in Bangladesh. We conducted a prospective study enrolling patients with fever > 38°C admitted to two large urban hospitals and two outpatient clinics located in Dhaka, Bangladesh. We developed and evaluated a method combining short culture with a new molecular assay to simultaneously detect and differentiate S. Typhi and S. Paratyphi A from other Salmonella directly from 2 to 4 mL of whole blood in febrile patients (n = 680). A total of 680 cases were enrolled from the four participating sites. An increase in the detection rate (+38.8%) in S. Typhi and S. Paratyphi A was observed with a multiplex polymerase chain reaction (PCR) assay, and absence of non-typhoidal Salmonella detection was reported. All 45 healthy controls were culture and PCR negative, generating an estimated 92.9% of specificity on clinical samples. When clinical performance was assessed in the absence of blood volume prioritization for testing, a latent class model estimates clinical performance ³ 95% in sensitivity and specificity with likelihood ratio (LR) LR+ > 10 and LR− < 0.1 for the multiplex PCR assay. The alternative method to blood culture we developed may be useful alone or in combination with culture or serological tests for epidemiological studies in high disease burden settings and should be considered as secondary endpoint test for future vaccine trials.

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accordance with National recommendations for children, 2003. Exposure assessment was based on the levels of scalp hair elements and lead in blood. The analysis was done using ICP-MS and AAS methods. Blood lead samples were analysed using the Lead Care instrument. Multiple logistic regression analysis was done with the adjustment for confounders. Results Concentrations of studied elements were in subtoxic range, average levels were significantly higher in Gus, then in Moscow. In Gus were revealed strong positive associations of BP, especially diastolic, with the tertile rank of blood Lead (in the range 4.4 mg/dl and higher) and hair cerium (in the range 0.7 mkg/g and higher). OR for elevated diastolic BP due to Lead was 3.0; 95% CI 0.59 to 15.76; p<0.186); due to Cerium -3.9; 95% CI 1.23 to 12.53; p<0.021). In Moscow BP was significantly correlated with the tertile rank of hair nickel (in the range 0.2 mk/g and higher). OR for elevated systolic BP due to nickel was 2.5 (95% CI 1.1 to 5.7, p<0.026); for diastolic BP -5,6; 95% CI 2.2 to 14.6; p<0.001).Conclusions The blood Lead, hair Nickel and Cerium levels, even in the low range of concentrations, positively associates with the risk of elevated blood pressure in children. Introduction It is not clear what proportion of HCV (hepatitis C virus) patients attain a sustained viral response (SVR) when treated with pegylated interferon and ribavirin combination therapy outside randomised clinical trials (RCTs). Secondly, pre-treatment factors available in routine clinical settings that are predictive of SVR (the optimal treatment outcome) are not known. Methods HCV clinical databases from nine Scottish treatment clinics were used to derive a retrospective cohort of 934 patients initiated on HCV treatment during 2000e2007. Results In our cohort, 39% (123/315, 95% CI 34% to 45%) of genotype (GT) 1, and 70% (414/594, 95% CI 66% to 73%) of genotype 2/3 (GT2/3) patients achieved a SVR; this compares with pooled estimates of 47% for GT1 (95% CI 41% to 52%), and 80% for GT2/3 (95% CI 75% to 85%) patients from RCTs. Pre-treatment factors significantly associated with SVR were: gamma glutamyl transferase (GGT) $55 IU/l (adjusted OR: 0.46, 95% CI 0.33 to 0.65), platelet count $150310 P2-122 RESPONSE AND PREDICTORS OF RESPONSE, TO PEGYLATED INTERFERON AND RIBAVIRIN FOR CHRONIC HEPATITIS C PATIENTS IN SCOTLAND: ALANINE AMINOTRANSFERASE (ALT) AND GAMMA GLUTAMYL TRANSFERASE (GGT) ARE VALUABLE PRE-TREATMENT MARKERS OF AN SVR IN ROUTINE CLINICAL PRACTICE