David Burt

Diagnosis of Multiple Enteric Protozoan Infections by Enzyme-Linked Immunosorbent Assay in the Guatemalan Highlands

We tested a prototype stool enzyme-linked immunosorbent assay (ELISA) (TRI-COMBO) that is simultaneously diagnostic for Giardia lamblia, Cryptosporidium parvum, and Entamoeba histolytica in a rural pediatric clinic in Guatemala. We compared its results to those of three individual ELISAs for these parasites, assessed the prevalence of these parasites, and compared our findings to those found by stool microscopy. We tested 620 non-diarrheal stools. The TRI-COMBO diagnosed 57 positive samples and 52 (91%) had a correlating positive result in an individual assay, giving a kappa coefficient of 0.90. Giardia spp., E. histolytica, and Cryptosporidium spp. were detected in 52 (8.4%), 2 (0.3%), and 3 (0.5%) samples, respectively. Twenty-three (40%) samples positive by ELISA for Giardia spp. were identified by microscopy. This study is the first to test the TRI-COMBO in this setting and, to our knowledge, represents the first assessment of these parasites in Guatemala by stool ELISA.

Risk screening for cardiovascular disease and diabetes in Latino migrant farmworkers: a role for the community health worker.

Abstract Diabetes and heart disease are two of the leading causes of death for Hispanics living in the United States (American Heart Association [AHA] in Circulation 123:e18–e209. doi:10.1161/CIR.0b013e3182009701, 2010). As the Hispanic population continues to grow, the need for low-cost, non-invasive methods to detect at risk populations for such diseases becomes more important. Once at risk individuals are detected, prevention strategies can be implemented. Studies have shown that Latino community health workers (CHWs) are effective educators, patient advocates and health promotion motivators for patients with known heart disease or diabetes. This pilot study examined the accuracy with which Latino CHWs could determine migrant farmworkers at risk for diabetes or cardiovascular disease (CVD) in rural Virginia. This quasi-experimental study supports the hypothesis that Latino CHWs can use non-invasive diabetes and CVD screening tools with similar accuracy as a registered nurse. The screening tools used were the American Diabetes Association’s diabetes risk calculator and a non-laboratory screening tool for CVD risk designed by Gaziano et al. (Lancet 371:923–931, 2008). The terms Latino and Hispanic will be used interchangeably.

Field testing of a smartphone application for the pre-hospital transmission of electrocardiogram images

Heart attacks are a significant cause of death in the United States. In the case of an S-T segment-elevation myocardial infarction (STEMI), there is a direct correlation between time to treatment and patient outcome; earlier treatment is superior. The transmission of pre-hospital ECG images allows earlier activation of the STEMI treatment process as a doctor can diagnosis a STEMI by examining the electrocardiogram (ECG) image before the patient is actually present at the treatment facility. Currently, EMS personnel use expensive proprietary systems to transmit the ECG images from EMS to the accepting center, but this is a costly solution. This paper describes the optimization and testing of an iPhone application (app) that transmits the ECG image via technology that is significantly less expensive than existing commercial systems. To date, testing has revealed that the current version of the app outperforms image transmission compared to emailed (large file size) photos. The next step is comparative testing against commercially available systems. The results from this comparative testing will provide quantitative evidence of the efficacy and reliability of this low cost innovation compared to a much more expensive proprietary system.