Are CSF neopterin levels a marker of disease activity in multiple sclerosis?

The study aimed to evaluate neopterin levels in cerebro-spinal fluid (CSF) as a marker of disease activation and progression of multiple sclerosis (MS). Neopterin, a substance known to be released from macrophages and monocytes at increased rates in cellular immune reactions, was investigated by radioimmunoassay, in the CSF of 19 patients with MS during exacerbations of the disease, in 34 patients with other neurological diseases (OND) and in 20 normal subjects used as controls. Poser's criteria were used for the diagnosis of MS. Although elevated neopterin levels in the CSF of patients with MS during exacerbations have been reported by other investigators, we found such elevation in only 4 out of 19 patients with MS (21%), in 5 out of 34 patients with OND (14.7%), and in none of the control group. Student's t-test was used for statistical analysis. There was no significant difference in the CSF values of the MS patients, the patients with OND (p > 0.05) or the controls. These results indicate that neopterin levels in CSF may not be considered a marker of disease activity in MS

Diagnostic accuracy of point-of-care testing for acute coronary syndromes, heart failure and thromboembolic events in primary care: a cluster-randomised controlled trial

Background: Evidence of the clinical benefit of 3-in-1 point-of-care testing (POCT) for cardiac troponin T (cTnT), N-terminal pro-brain natriuretic peptide (NT-proBNP) and D-dimer in cardiovascular risk stratification at primary care level for diagnosing acute coronary syndromes (ACS), heart failure (HF) and thromboembolic events (TE) is very limited. The aim of this study is to analyse the diagnostic accuracy of POCT in primary care. Methods: Prospective multicentre controlled trial cluster-randomised to POCT-assisted diagnosis and conventional diagnosis (controls). Men and women presenting in 68 primary care practices in Zurich County (Switzerland) with chest pain or symptoms of dyspnoea or TE were consecutively included after baseline consultation and working diagnosis. A follow-up visit including confirmed diagnosis was performed to determine the accuracy of the working diagnosis, and comparison of working diagnosis accuracy between the two groups. Results: The 218 POCT patients and 151 conventional diagnosis controls were mostly similar in characteristics, symptoms and pre-existing diagnoses, but differed in working diagnosis frequencies. However, the follow-up visit showed no statistical intergroup difference in confirmed diagnosis frequencies. Working diagnoses overall were significantly more correct in the POCT group (75.7% vs 59.6%, p = 0.002), as were the working diagnoses of ACS/HF/TE (69.8% vs 45.2%, p = 0.002). All three biomarker tests showed good sensitivity and specificity. Conclusion: POCT confers substantial benefit in primary care by correctly diagnosing significantly more patients