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According to a report published in the July issue of the European Heart Journal, serial mass CK-MB measurements can be used to determine within 7 hours of chest pain onset whether or not a patient has experienced acute myocardial infarction. A retrospective study of 470 patients admitted to a hospital chest pain unit within 5 hours of the emergence of symptoms showed that a CK-MB level greater than 7.0 mcg/L at any of the three time points, or as an increase greater than 2.0 mcg/L between the first two samples was a clear marker for MI.
Researchers at the Helsinki University Central Hospital in Finland have found that serum C-reactive protein (CRP) levels reliably distinguish between Gram stain-negative bacterial meningitis and viral meningitis in children. In a study of 55 children with Gram-negative, culture-positive bacterial meningitis and 182 children with presumed or proven viral meningitis the children were tested for cerebrospinal fluid glucose, protein, and leukocyte counts; peripheral leukocyte count; and CRP. The study suggests that in 93% of viral meningitis patients the CRP value was within the normal range (<20 mg/L) and only two children with Gram-negative bacterial meningitis had CRP levels <20 mg/L. Based on these findings and on the test's rapid turnaround time, the researchers recommended that CRP measurement be added to the armamentarium for distinguishing viral from bacterial meningitis.
Source: Journal of Pediatrics June 1999;134:724-729.
Nucleic acid testing performed at the Washington University School of Medicine in St. Louis, Missouri has identified Ehrlichia ewingii, previously associated with infection in dogs, as the cause of human granulocytic ehrlichiosis in four patients from Missouri. The findings suggest that in areas where Ehrlichia is endemic, like Missouri, physicians need to add ehrlichiosis to their differential diagnosis of flulike symptoms in the setting of tick exposure and treat appropriate patients with doxycycline.
Source: New England Journal of Medicine, July 15, 1999;341:148-155,195-197.
A study reported in Blood has discovered that people who carry the PIA2 polymorphic allele of platelet glycoprotein IIIa are at risk of a myocardial infarction before 45 years of age. According to a multicenter trial conducted in Italy, individuals who carried this allele had an increased risk of myocardial infarction, with an odds ratio of 1.84 compared with individuals who carried the PIA1 allele.
Source: Blood, July 1, 1999;94:46-51.
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