What Are the Indications for Chlamydia Infection Test of Cure at 4 Weeks Instead of 12 Weeks?

CDC recommendations to retest all patients with documented chlamydial infection for C. trachomatis three months after treatment. Test of cure means diagnostic testing to assess whether the administered antibiotic regimen eradicated the pathogen. Test of cure is not routinely warranted except in certain situations when there is a risk of suboptimal microbiologic cure rates:

• Pregnancy, regardless of treatment administered
• Persistent symptoms
• Concern for nonadherence to the regimen
• Use of a regimen with inferior cure rates, such as erythromycinor amoxicillin
• Azithromycintreatment of patients with or at high risk for rectal infection

In these situations, a test of cure should be performed no sooner than four weeks after treatment is completed. This is especially important when NAATs are used because C. trachomatis nucleic acid may still be detectable several weeks after treatment despite an absence of viable organisms.

Source: UpToDate

What Are Risk Stratification Scores Used in Settings Without Troponin Testing?

The Marburg Heart Score and the HEAR Score can help to identify low-risk cardiac pain in settings without access to troponin testing.  The Marburg Heart Score awards 1 point for each determinant found. Scores of 3 to 5 points were treated as positive predictors for CAD, while scores of ≤2 points were treated as negative. The score had a sensitivity of 86.4%, with a NPV of 97.3% and a false negative rate of 2.7%.

The HEAR score is a modification of the HEART Score that omits the troponin level. Initial research on the validity and specificity of the score for identifying low-risk cardiac pain has been supportive.

Source: Evidence Based Urgent Care

Are Score Systems Reliable in Diagnosing or Ruling Out Appendicitis?

The most commonly used scoring systems are the Alvarado score and the Appendicitis Inflammatory Response (AIR) score.   The Alvarado score system has a 99% sensitivity but is only 43% specific. This is because of the setting of the threshold. If the threshold is increased from 5 to 7, the specificity increases to 81% at the cost of a lower sensitivity, down to 82%. That is why the Alvarado score system is most useful for ruling out appendicitis, rather than diagnosing it. The AIR score has a sensitivity of 92% and a specificity 63%.

The use of a scoring system alone for the diagnosis of acute appendicitis is not recommended by the World Society of Emergency Surgery (WSES), which prefers a stepwise diagnostic approach pathway depending on age, sex, and clinical signs and symptoms of the patient.

Source: JUCM

Email your clinical questions to the Editors:

Tracey Davidoff, MD, FCUCM tdavidoff@coucm.org

Cesar Mora Jaramillo, MD, FAAFP,FCUCM cmjaramillo@coucm.org

Disclaimer: This material is for educational purposes only. Medical practice and knowledge are constantly evolving and changing. This information is peer-reviewed but should not be your only source. Providers of care should use discretion when applying knowledge to any individual patient.