Usefulness of the QuantiFERON test for the diagnosis of tubercular uveitis and the predictions of response to antituberculosis treatment

2021 ◽  
pp. bjophthalmol-2021-318868
Author(s):  
William Danjou ◽  
Pierre Pradat ◽  
Yvan Jamilloux ◽  
Mathieu Gerfaud-Valentin ◽  
Laurent Kodjikian ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Diagnostic Criteria ◽  
Response Prediction ◽  
Trial Registration ◽  
Single Centre ◽  
Predictive Values ◽  
Ocular Tuberculosis ◽  
Antituberculosis Treatment ◽  
Registration Number ◽  
Quantiferon Test

AimsFew studies have evaluated the contribution of QuantiFERON test for the diagnosis of tubercular uveitis in non-endemic countries for tuberculosis (TB). The objective of the present study was to evaluate the value of the QuantiFERON test in a large cohort of patients with uveitis for both the diagnosis of tubercular uveitis and antituberculosis treatment (ATT) response prediction.MethodsA single-centre retrospective study including consecutive adult patients with uveitis who were prescribed a QuantiFERON test between January 2003 and December 2019 was performed. Adjusted ORs (aORs) were calculated between patients with uveitis responding and not responding to ATT according to the Collaborative Ocular Tuberculosis Study (COTS) group diagnostic criteria. Sensitivity (SE), specificity (Sp), and positive and negative predictive values of the QuantiFERON test were calculated.ResultsA total of 1075 patients were included in the study; 178 (16.5%) were found positive using the QuantiFERON test. Among the 178 positive patients, 62 (35%) had a diagnosis of tubercular uveitis according to the updated COTS classification; all received ATT for 6 months; and 44/62 (71%) responded to ATT. A QuantiFERON test value of >2 IU/mL was associated with a greater chance of responding to ATT (aOR=36.7, 95% CI 7.2 to 185.9, p<0.001). The optimal threshold to maximise both Sp and SE for diagnosis of TB uveitis was 4 IU/mL.ConclusionOne-sixth of the patients diagnosed with uveitis had a positive QuantiFERON test. The QuantiFERON threshold with the optimal SE and Sp for the diagnosis of tubercular uveitis was 4 IU/mL.Trial registration numberNCT03863782.

scholarly journals Systemic Inflammation and Clinical Outcomes in COVID-19: a retrospective study

2020 ◽  
Author(s):  
Meijia Wang ◽  
Zhenli Huang ◽  
Kun Tang ◽  
Pengfei Gao ◽  
Yanjiao Lu ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Clinical Outcomes ◽  
Systemic Inflammation ◽  
Trial Registration ◽  
Inflammatory Factors ◽  
Reactive Protein ◽  
Tnf Α ◽  
Registration Number ◽  
Factor Α

Abstract Background：COVID-19 causes epidemics and pandemics worldwide, but the role of pathophysiological parameters particularly systemic inflammation in COVID-19 has not been understood. We aimed to investigate clinical outcomes in view of systemic inflammation in COVID-19.Methods：In this retrospective study, the demographic and clinical data of 225 confirmed COVID-19 cases on admission at Tongji Hospital from January 28 to February 15, 2020, were extracted and analyzed. These patients were categorized by inflammation state on the basis of the expression of inflammatory factors or classified as severe and non-severe according to 2019 American Thoracic Society / Infectious Disease Society of America guidelines.Results: Among 225 patients with confirmed COVID-19, 155 patients (68.9%) categorized into hyperinflammation group and 70 (31.1%) were non- hyperinflammation group. Compared to non-hyperinflammation group, hyperinflammation group more frequently had chest tightness/dyspnea and lymphopenia, aberrant multiple indexes of organ function including the heart, liver, kidney, and coagulation, with higher level of C-reactive protein (hsCRP) as well as interleukin (IL)-6, IL-8, tumour necrosis factor α (TNF-α), etc. Hyperinflammation group were more likely to admit to intensive care unit (ICU) (52.3% vs 5.7%), receive ventilation (84.5% vs 10.0%) and be with higher mortality (44.5% vs 5.7%) than non-hyperinflammation group. The mortality of severe patients with hyperinflammation (60/99, 60.6%) was significantly higher than without hyperinflammation (2/20, 10.0%). Non-severe patients with hyperinflammation even tended to have higher mortality (9/56, 16.1%) than those in severe cases without hyperinflammation (2/20, 10%).Conclusion: Excessive systemic inflammation was correlated highly with poor clinical outcomes in COVID-19, particularly in severe cases. Non-severe patients with hyperinflammation even tended to have higher mortality than those in severe cases without hyperinflammation.Trial registration: This is a retrospective observational study without a trial registration number.

scholarly journals Perioperative use of serum creatinine and postoperative acute kidney injury: a single-centre, observational retrospective study to explore physicians’ perception and practice

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Gianluca Villa ◽  
Silvia De Rosa ◽  
Caterina Scirè Calabrisotto ◽  
Alessandro Nerini ◽  
Thomas Saitta ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Retrospective Study ◽  
High Risk ◽  
Abdominal Surgery ◽  
Serum Creatinine ◽  
Malignant Disease ◽  
Kidney Injury ◽  
Major Surgery ◽  
Single Centre

Abstract Background Postoperative acute kidney injury (PO-AKI) is a leading cause of short- and long-term morbidity and mortality, as well as progression to chronic kidney disease (CKD). The aim of this study was to explore the physicians’ attitude toward the use of perioperative serum creatinine (sCr) for the identification of patients at risk for PO-AKI and long-term CKD. We also evaluated the incidence and risk factors associated with PO-AKI and renal function deterioration in patients undergoing major surgery for malignant disease. Methods Adult oncological patients who underwent major abdominal surgery from November 2016 to February 2017 were considered for this single-centre, observational retrospective study. Routinely available sCr values were used to define AKI in the first three postoperative days. Long-term kidney dysfunction (LT-KDys) was defined as a reduction in the estimated glomerular filtration rate by more than 10 ml/min/m2 at 12 months postoperatively. A questionnaire was administered to 125 physicians caring for the enrolled patients to collect information on local attitudes regarding the use of sCr perioperatively and its relationship with PO-AKI. Results A total of 423 patients were observed. sCr was not available in 59 patients (13.9%); the remaining 364 (86.1%) had at least one sCr value measured to allow for detection of postoperative kidney impairment. Among these, PO-AKI was diagnosed in 8.2% of cases. Of the 334 patients who had a sCr result available at 12-month follow-up, 56 (16.8%) developed LT-KDys. Data on long-term kidney function were not available for 21% of patients. Interestingly, 33 of 423 patients (7.8%) did not have a sCr result available in the immediate postoperative period or long term. All the physicians who participated in the survey (83 out of 125) recognised that postoperative assessment of sCr is required after major oncological abdominal surgery, particularly in those patients at high risk for PO-AKI and LT-KDys. Conclusion PO-AKI after major surgery for malignant disease is common, but clinical practice of measuring sCr is variable. As a result, the exact incidence of PO-AKI and long-term renal prognosis are unclear, including in high-risk patients. Trial registration ClinicalTrials.gov, NCT04341974.

scholarly journals Efficacy of pediatric integrative manual therapy in positional plagiocephaly: a randomized controlled trial

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Iñaki Pastor-Pons ◽  
María Orosia Lucha-López ◽  
Marta Barrau-Lalmolda ◽  
Iñaki Rodes-Pastor ◽  
Ángel Luis Rodríguez-Fernández ◽  
...  
Keyword(s):  
Manual Therapy ◽  
Education Program ◽  
Controlled Trial ◽  
Asymmetry Index ◽  
Trial Registration ◽  
Control Group ◽  
Parental Perception ◽  
Positional Plagiocephaly ◽  
Caregiver Education ◽  
Registration Number

Abstract Background Positional plagiocephaly frequently affects healthy babies. It is hypothesized that manual therapy tailored to pediatrics is more effective in improving plagiocephalic cranial asymmetry than just repositioning and sensory and motor stimulation. Methods Thirty-four neurologically healthy subjects aged less than 28 weeks old with a difference of at least 5 mm between cranial diagonal diameters were randomly distributed into 2 groups. For 10 weeks, the pediatric integrative manual therapy (PIMT) group received manual therapy plus a caregiver education program, while the controls received the same education program exclusively. Cranial shape was evaluated using anthropometry; cranial index (CI) and cranial vault asymmetry index (CVAI) were calculated. Parental perception of change was assessed using a visual analogue scale (− 10 cm to + 10 cm). Results CVAI presented a greater decrease in PIMT group: 3.72 ± 1.40% compared with 0.34 ± 1.72% in the control group (p = 0.000). CI did not present significant differences between groups. Manual therapy led to a more positive parental perception of cranial changes (manual therapy: 6.66 ± 2.07 cm; control: 4.25 ± 2.31 cm; p = 0.004). Conclusion Manual therapy plus a caregiver education program improved CVAI and led to parental satisfaction more effectively than solely a caregiver education program. Trial registration Trial registration number: NCT03659032; registration date: September 1, 2018. Retrospectively registered.

scholarly journals A single-centre, retrospective study of the incidence of invasive fungal infections during 85 years of autopsy service in Brazil

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kátia Cristina Dantas ◽  
Thais Mauad ◽  
Carmen D. Saldiva de André ◽  
Ana Luiza Bierrenbach ◽  
Paulo Hilário Nascimento Saldiva
Keyword(s):  
Retrospective Study ◽  
Essential Role ◽  
Fungal Infections ◽  
Invasive Fungal Infections ◽  
Single Centre ◽  
Historical Trends ◽  
Aids Pandemic ◽  
History Of ◽  
Frequent Infection ◽  
Over Time

AbstractAutopsy continues to play an essential role in monitoring opportunistic fungal infections. However, few studies have analysed the historical trends of fungal infections in autopsies. Here, we analyse available data on fungal infections obtained from autopsy reports during 85 years of autopsies performed by the largest autopsy service in Brazil. All invasive fungal infections presented in autopsy reports between 1930 and 2015 were included. Of the 158,404 autopsy reports analysed, 1096 involved invasive fungal infections. In general, paracoccidioidomycosis (24%) was the most frequent infection, followed by candidiasis (18%), pneumocystosis (11.7%), cryptococcosis (11%), aspergillosis (11%) and histoplasmosis (3.8%). Paracoccidioidomycosis decreased after the 1950s, whereas opportunistic fungal infections increased steadily after the 1980s during the peak of the AIDS pandemic. The lung was the most frequently affected organ (73%). Disseminated infection was present in 64.5% of cases. In 26% of the 513 cases for which clinical charts were available for review, the diagnosis of opportunistic fungal infections was performed only at autopsy. Our unique 85-year history of autopsies showed a transition from endemic to opportunistic fungal infections in São Paulo, Brazil, reflecting increased urbanization, the appearance of novel diseases, such as AIDS in the 1980s, and advances in medical care over time.

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