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It is hypothesized that the shape of the glucose curve during an oral glucose tolerance test is an early indicator of the risk for developing type 2 diabetes mellitus. In this study, we aimed to examine the shape of plasma glucose response curves and study their relationship with insulin sensitivity, insulin secretion and components of the metabolic syndrome in end-pubertal obese girls. Eighty-one end-pubertal obese girls [median (range) age: 14.4 (11.2-18.0) years; BMI: 34.6 (25.4-50.8) kg/m(²)] who underwent a 2-h oral glucose tolerance test were classified according to the shape of the glucose curve. Four shape types of the plasma glucose response curve were observed: 28 (34.6%) monophasic, 30 (37.0%) biphasic, 14 (17.3%) triphasic, and 9 (11.1%) unclassified. Patients with a monophasic shape had a higher area under the curve for glucose (p = 0.008), a lower early-phase insulin secretion (p = 0.005), and a poorer beta cell function relative to insulin sensitivity as reflected by the oral disposition index (p = 0.022) compared to the bi- and triphasic shape types. In addition, the triglyceride level and TG/HDL-C ratio was higher in patients with a monophasic shape compared to those with a biphasic shape (p = 0.040 and p = 0.048, respectively). In conclusion, end-pubertal obese girls with a monophasic plasma glucose curve are at increased risk for insulin resistance, which can contribute to the development of type 2 diabetes mellitus and cardiovascular diseases.

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Autoantibodies to nuclear antigens, i.e. antinuclear antibodies (ANA), antibodies to double-stranded DNA (dsDNA) and extractable nuclear antigens (ENA), are useful as diagnostic markers for a variety of autoimmune diseases. In March 2010, the Belgian national External Quality Assessment Scheme sent a questionnaire on ANA, anti-dsDNA and anti-ENA antibody testing designed by the Dutch EASI (European Autoimmunity Standardization Initiative) team, to all clinical laboratories performing ANA testing. Virtually all laboratories completed the questionnaire (97·7%, 127/130). This paper discusses the results of this questionnaire and provides valuable information on the state-of-the-art of ANA, anti-dsDNA and anti-ENA antibody testing as practiced in the Belgian laboratories. In addition, this work presents practical recommendations developed by the members of the advisory board of the scheme as a result of the outcome of this study.

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BACKGROUND: Celiac Disease (CD) has a high prevalence worldwide. Because the disease may be underdiagnosed in Belgium, we wanted to evaluate the seroprevalence of CD in children and adolescents. PATIENTS AND METHODS: Serum samples from 1159 apparently healthy children and adolescents aged between 1-19 years, were prospectively collected in 2006 by 15 Belgian diagnostic laboratories. In September 2009, all samples were analyzed for human tissue transglutaminase IgA antibodies (IgA tTG) and total IgA levels by, respectively a commercial ELISA and immunonephelometry. Sera, found positive, were assessed by immunofluorescence for the presence of IgA and IgG antiendomysium antibodies (IgA/IgG EMA). In patients with IgA deficiency IgG antibodies against deamidated gliadin peptides (IgG DGP) and IgG antiendomysium antibodies (IgG EMA) were determined. RESULTS: Ten of the 1159 individuals (0.86%) tested positive for IgA tTG. A further 0.86% showed borderline IgA tTG results. In almost two percent (198%) of the analyzed samples total IgA levels below the lower limit of normal were observed. Four out of eight positive IgA tTG samples tested positive for IgA EMA. All samples with borderline IgA tTG results were negative for IgA EMA. Twenty-six percent (6/23) of the IgA deficient samples showed positive IgG DGP antibodies, but none of those tested positive for IgG EMA. CONCLUSION: The seroprevalence of IgA tTG in this non-IgA deficient population (n = 1136) in Belgium is 1:114. The combined seroprevalence of IgA tTG and IgA EMA in that same population is 1:284. The seroprevalence based on positive IgA tTG or DPG IgG in, respectively, non-IgA deficient and IgA deficient subjects is 1:72 (n = 1159). These seroprevalences are similar to those found in neighbouring countries.

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The antistreptolysin O antibody (ASLO) test is often requested in a clinical setting with limited evidence for its usefulness. For this reason, the diagnostic scenario in which ASLO plays an evidence-based role and the analytical performance of the test are critically appraised, taking into account the clinical need and the direct medical cost. Little or no scientific evidence was found for the use of ASLO in patients with pharyngitis, post-streptococcal glomerulonephritis and in adults with rheumatoid arthritis. The clinical relevance of ASLO is restricted to paediatrics, where it contributes to fulfil the diagnosis of acute rheumatic fever (ARF) as per Jones criteria. The standardization of current automated ASLO-latex assays is limited. Attention should be paid to inaccurate reference values and many circumstances causing false positive and false negative results. Because of a low prevalence of ARF in the Western world, a high negative predictive value is obtained for the ASLO test (> 99%). In clinical practice, the result of the test is not urgent. To reduce overconsumption, the clinical laboratory should drive the request behaviour of physicians by a strategic lay-out of the application form. The health insurance/government also contributed by introducing a diagnostic rule for reimbursement.

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The Aspergillus galactomannan test is a valuable tool in the diagnosis of invasive aspergillosis. We hereby report a high rate of false-positive results by the Platelia Aspergillus galactomannan antigen test (Bio-Rad Laboratories) for patients treated with amoxicillin-clavulanate.

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The Osiris and Sirscan 2000 systems are two semiautomated systems that can be used to read and interpret the results on disk diffusion agar plates. They are both used for determination of susceptibility to antimicrobial agents. The present study compared both systems versus the NCCLS standard method of visual reading with a ruler. Both inpatient and outpatient samples with a total of 315 nonfastidious gram-negative strains were obtained. In total, 3724 organism-antimicrobial agent combinations that fulfilled the NCCLS guidelines for disk diffusion susceptibility testing were evaluated prospectively. The results obtained with both systems in comparison with those obtained by the classical nonautomated means of interpretation were excellent, with correlation coefficients of 0.96 for both systems. The overall agreements for susceptibility interpretation were 96.56 and 96.24% with the Osiris and Sirscan systems, respectively. Very major errors were obtained for 8 (1.07%) and 10 (1.34%) organism-antimicrobial agent combinations with the Osiris and Sirscan systems, respectively. In addition, major errors were obtained for 2 (0.07%) and 6 (0.21%) combinations with the Osiris and Sirscan systems, respectively. Minor errors were obtained for 118 and 124 organism-antimicrobial agent combinations with the Osiris and Sirscan systems, respectively. Overall, both the Osiris system and the Sirscan system are comparable and reliable systems for determination of interpretative categories from the zone diameters of standard disk diffusion test plates.

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Rothia dentocariosa is a rare cause of endocarditis. It occurs most frequently in patients with prior heart conditions. Although the clinical course is typically subacute, it has a high rate of complications. In particular, the reported incidence of mycotic aneurysms is as high as 25%. Penicillin is the treatment of choice, but additional complications may necessitate prompt surgical intervention. As far as we know, this paper reports the first case of repeated subarachnoid hemorrhages due to R. dentocariosa endocarditis.

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Presented here is the case of a 63-year-old patient with a Streptococcus pneumoniae-infected aneurysm extending from a persistent lobar pneumonia of the left lung into the thoracic aorta. The patient was successfully treated with surgery and high-dose penicillin, and he remained well at 6-month follow-up. A review of the English-language literature over the past 25 years revealed 22 cases of mycotic or infected aortic aneurysms due to Streptococcus pneumoniae; however, none of these cases resulted in a positive outcome for the patient. The characteristics of these cases are discussed.

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We describe a 74-year-old woman with the diagnosis of natural killer (NK)-cell leukaemia and autoimmune pathology. Four years previously, a diffuse large B cell non-Hodgkin's lymphoma had been diagnosed and treated effectively. Although NK-cell leukaemia has been thought to be a distinct highly aggressive clinicopathological entity, our case shows no further evolution at the present time. As far as we know, this association has not been previously described in the literature.

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We evaluated indirect immunofluorescence (IF) using HEp-2000 slides, which are transfected with SS-A cDNA, for screening for anti-SS-A antibodies, by comparing it with counterimmunoelectrophoresis (CIE). A total of 2427 specimens were screened for IF reactivity and for SS-A precipitins, of which 1033 (43%) were negative on both IF and CIE. There were 1271 SS-A precipitin-negative specimens (52%) which were IF-positive but lacked the distinctive SS-A staining pattern. One precipitin-negative serum was IF-positive with the distinctive SS-A pattern in the HEp-2000 system. One hundred and twenty-two specimens (5%) were positive for anti-SS-A precipitins on CIE, 107 showed the distinctive SS-A fluorescence staining pattern, whereas 15 of these precipitin-positive samples (12%) were IF-positive but did not display the distinctive SS-A pattern on the transfected cells. Fourteen of the 15 samples in which the distinctive SS-A pattern was not observed displayed other significant antinuclear antibody (titre equal or >1:320) patterns. In conclusion, the presence of the typical 'distinctive' SS-A pattern on IF using the HEp-2000 slides is highly specific for the presence of autoantibodies to SS-A and has a sensitivity of 88% for detecting these antibodies.

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