Toxocariasis is a helminth zoonosis caused by infection with the larvae of Toxocara spp. ascarid worms. Only two species, Toxocara canis and Toxocara cati, are recognised as causative agents of human disease. The best choice for serodiagnosis of the generalised forms of toxocariasis, visceral larva migrans (VLM) or covert toxocariasis, relies upon the initial use of TES-ELISA, after which any positive result should subsequently be tested by Western blotting (WB). Covert toxocariasis is mostly a benign infection, so a large majority of infected subjects are asymptomatic or have very few symptoms and therefore go undiagnosed. In this form, this helminthosis is often self-limiting, leaving residual specific antibodies. A positive serodiagnosis caused by residual antibodies that do not have any diagnostic significance can be associated with any infectious or non-infectious disease. If separated from the ongoing clinical and laboratory context, such a positive result has no diagnostic value and should be only taken into account after the possible etiologies of any observed syndromes have been ruled out. Unlike the methods used for the immunodiagnosis of bacterial, viral or protozoal (toxoplasmosis) infections, it is not possible with toxocariasis to assess the age of the presence of specific IgG using the levels of specific IgM because IgM antibodies can be found throughout the course of helminthiasis. The detection of other classes of immunoglobulins, namely IgE and IgA, the subclasses, namely IgG4 or circulating Ag was proven to be unable to discriminate between active and self-cured generalised toxocaral infections. Currently, the diagnosis of an active covert toxocariasis relies upon indirect arguments, e.g., the presence of otherwise unexplained symptoms along with blood eosinophilia and/or elevated levels of eosinophil cationic protein (ECP). This situation is far from ideal and more research should be carried out to solve this difficult problem.

Pneumocystis pneumonia (PCP) in solid organ transplant (SOT) recipients becomes rare in the immediate posttransplantation period thanks to generalized prophylaxis. We aimed to identify the predictive factors for PCP in the era of universal prophylaxis and to propose a strategy for preventing PCP beyond the first year after transplantation. In a retrospective case–control study, 33 SOT cases with PCP diagnosed between 2004 and 2010 were matched with two controls each to identify risk factors for PCP by uni‐ and multivariate analysis. All the patients benefited from 6 months of posttransplantation trimethoprim–sulfamethoxazole prophylaxis. Most PCP in SOT patients occurred during the second year posttransplantation (33%). By univariate analysis, age, nonuse of tacrolimus, total and CD4 lymphocyte counts, gamma‐globulin concentration and cytomegalovirus (CMV) infection appeared to be PCP risk factors. In the final multivariate analysis, age (adjusted odds ratio [OR] 3.7, 95% confidence interval [CI]: 1.3–10.4), CMV infection (OR: 5.2, 95% CI: 1.8–14.7) and total lymphocyte count (OR: 3.9, 95% CI: 1.4–10.7) were found to be independently associated with PCP. The second year posttransplantation appeared to be the new period of highest risk of PCP. Age, CMV viremia and lymphocytes were the most pertinent predictive criteria to evaluate the risk of PCP in clinical practice.

Purpose. To analyse the impact of computer-based patient record systems (CBPRS) on medical practice, quality of care, and user and patient satisfaction. Data sources. Manual and electronic search of the Medline, Cochrane, and Embase databases. Study selection. Selected articles were published from 2000 to March 2003. CBPRS was defined as computer software designed to be used by clinicians as a direct aid in clinical decision making. To be included, the systems should have recorded patient characteristics and offered online advice, or information or reminders specific to clinicians during the consultation. Data extraction. Keywords used for the search were: electronic record, informatic record, electronic medical record, electronic patient record, patient order entry, computer-based patient system, clinical decision support systems, and evaluation. Results. Twenty-six articles were selected. Use of a CBPRS was perceived favourably by physicians, with studies of satisfaction being mainly positive. A positive impact of CBPRS on preventive care was observed in all three studies where this criterion was examined. The 12 studies evaluating the impact on medical practice and guidelines compliance showed that positive experiences were as frequent as experiences showing no benefit. None of the six studies analysing the impact of CBPRS on patient outcomes reported any benefit. Conclusions. CBPRS increased user and patient satisfaction, which might lead to significant improvements in medical care practices. However, the studies on the impact of CBPRS on patient outcomes and quality of care were not conclusive. Alternative approaches considering social, cultural, and organizational factors may be needed to evaluate the usefulness of CBPRS.

Background: Muscle strength (MS) may be impaired in obese persons, and this impairment may be a consequence of both obesity and low physical fitness. Objective: We investigated whether MS differed between obese [body mass index (BMI; in kg/m²) > 29], normal-weight (BMI = 24–29), and lean (BMI < 24) elderly subjects and compared the MS of sedentary and active subjects according to their BMI group. Design: The study included 215 obese [x̄ (± SD) age: 80.0 ± 3.5 y; BMI: 31.9 ± 2.6], 630 normal-weight (age: 80.2 ± 3.7 y; BMI: 26.3 ± 1.4), and 598 lean (age: 80.7 ± 3.5 y; BMI: 21.6 ± 1.8) women with good functional ability. A cross-sectional design was used. Anthropometric measures (weight, height); measures of appendicular skeletal muscle mass (by dual-energy X-ray absorptiometry), isometric knee and elbow extension (by statergometer), and isometric handgrip strength (by dynamometer); and data on health status and self-reported recreational physical activity (RPA: walking, gymnastics, cycling, swimming, gardening) were collected. Results: Absolute (unadjusted) MS was higher in obese than in lean women (P < 0.01), except for handgrip strength (P > 0.05). When adjusted for age, height, RPA, pain, depression, and appendicular skeletal muscle mass, MS did not differ significantly between obese, normal-weight, and lean subjects, except for knee extension (significant interaction effect with RPA; P = 0.01). With increasing BMI, lower limb strength did not change in the sedentary women but increased in active (≥ 1 h/wk in ≥ 1 RPA for ≥ 1 mo) women. All adjusted MS measures in active participants were significantly higher (P < 0.001) than those in their sedentary peers. Conclusion: The adjusted MS of elderly women is not associated with obesity but is higher in active subjects than in sedentary ones, especially in the lower limbs of obese subjects.