scholarly journals When Non-Whiteness Becomes a Condition

Blood ◽  
2020 ◽  
Author(s):  
Lauren E Merz ◽  
Maureen Achebe
Keyword(s):  
Predominantly White ◽  
American Medical ◽  
African Ancestry ◽  
Medical System ◽  
Risk Of Infection ◽  
Systemic Racism ◽  
European Descent ◽  
White American ◽  
Increased Risk ◽  
Sub Saharan

The term "benign ethnic neutropenia" describes the phenotype of having an ANC less than 1500 cells/uL with no increased risk of infection. This is most commonly seen in those of African ancestry. In addition, ANC ranges from countries in Africa emphasize that ANC levels below 1500 cell/uL are common and harmless. The lower ANC levels are driven by the Duffy null [Fy(a-b-)] phenotype which is protective against malaria and seen in 80-100% of those of Sub-Saharan African ancestry and <1% of those of Caucasian descent. Benign ethnic neutropenia is clinically insignificant, but the average ANC values differ from what is typically seen in those of European descent. Thus, the predominantly white American medical system has described this as a condition. This labelling implicitly indicates that common phenotypes in non-white populations are abnormal or wrong. We feel that it is important to examine and rectify practices in hematology that contribute to systemic racism.

scholarly journals The Duffy-null genotype and risk of infection

2020 ◽  
Vol 29 (20) ◽  
pp. 3341-3349
Author(s):  
Sophie E Legge ◽  
Rune H Christensen ◽  
Liselotte Petersen ◽  
Antonio F Pardiñas ◽  
Matthew Bracher-Smith ◽  
...  
Keyword(s):  
Blood Cells ◽  
Middle Eastern ◽  
African Ancestry ◽  
Strong Association ◽  
White Blood Cells ◽  
Population Based ◽  
Risk Of Infection ◽  
Cell Counts ◽  
Increased Risk ◽  
The Uk

Abstract Many medical treatments, from oncology to psychiatry, can lower white blood cell counts and thus access to these treatments can be restricted to individuals with normal levels of white blood cells, principally in order to minimize risk of serious infection. This adversely affects individuals of African or Middle Eastern ancestries who have on average a reduced number of circulating white blood cells, because of the Duffy-null (CC) genotype at rs2814778 in the ACKR1 gene. Here, we investigate whether the Duffy-null genotype is associated with the risk of infection using the UK Biobank sample and the iPSYCH Danish case-cohort study, two population-based samples from different countries and age ranges. We found that a high proportion of those with the Duffy-null genotype (21%) had a neutrophil count below the threshold often used as a cut-off for access to relevant treatments, compared with 1% of those with the TC/TT genotype. In addition we found that despite its strong association with lower average neutrophil counts, the Duffy-null genotype was not associated with an increased risk of infection, viral or bacterial. These results have widespread implications for the clinical treatment of individuals of African ancestry and indicate that neutrophil thresholds to access treatments could be lowered in individuals with the Duffy-null genotype without an increased risk of infection.

Prostate Cancer

2018 ◽  
Author(s):  
Kathryn M. Wilson ◽  
Lorelei Mucci
Keyword(s):  
Prostate Cancer ◽  
Risk Factors ◽  
Family History ◽  
Prostate Specific Antigen ◽  
Advanced Prostate Cancer ◽  
Advanced Disease ◽  
African Ancestry ◽  
Specific Antigen ◽  
Dietary Factors ◽  
Increased Risk

Prostate cancer is among the most commonly diagnosed cancers among men, ranking second in cancer globally and first in Western countries. There are marked variations in incidence globally, and its incidence must be interpreted in the context of diagnostic intensity and screening. The uptake of prostate-specific antigen screening since the 1990s has led to dramatic increases in incidence in many countries, resulting in an increased proportion of indolent cancers that would never have come to light clinically in the absence of screening. Risk factors differ when studying prostate cancer overall versus advanced disease. Older age, African ancestry, and family history are established risk factors for prostate cancer. Obesity and smoking are not associated with risk overall, but are associated with increased risk of advanced prostate cancer. Several additional lifestyle factors, medications, and dietary factors are now emerging as risk factors for advanced disease.

scholarly journals 1095. Investigation of Risk Factors Associated with Serious Bacterial, Viral and Invasive Fungal Infections in Hematologic Patients on Ibrutinib

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S576-S577
Author(s):  
Thomas Holowka ◽  
Harry Cheung ◽  
Maricar F Malinis ◽  
Sarah Perreault ◽  
Iris Isufi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Fungal Infections ◽  
Antimicrobial Prophylaxis ◽  
Hematologic Malignancy ◽  
Invasive Fungal Infections ◽  
Risk Of Infection ◽  
Factors Associated ◽  
Serious Infection ◽  
Increased Risk ◽  
Serious Infections

Abstract Background Ibrutinib is a tyrosine kinase inhibitor used to treat hematologic malignancies that may increase the risk of serious infection including invasive fungal infections (IFI). In a study of 378 patients with hematologic malignancy on ibrutinib, serious infection and IFI occurred in 11% and 4% respectively (Varughese et al. Clin Infect Dis). The primary aims of our study were to determine the incidence of serious infection and associated risk factors in patients on ibrutinib. Methods We performed a retrospective analysis of patients with hematologic malignancy prescribed ibrutinib for ≥ 1 week at Yale New Haven Hospital from 2014 to 2019 to identify serious infections defined as those requiring inpatient management. We collected demographic, clinical and oncologic data. Chi-squared tests were used to determine factors associated with an increased risk of infection. Results A total of 254 patients received ibrutinib including 156 with CLL, 89 with NHL and 9 with other leukemias. Among these, 21 underwent HSCT, 9 complicated by GVHD. There were 51 (20%) patients with serious infections including 45 (17.7%) bacterial, 9 (3.5%) viral and 5 (2%) IFI (1 pulmonary cryptococcosis, 4 pulmonary aspergillosis). Anti-mold prophylaxis was prescribed to 7 (2.8%) patients, none of whom developed IFI. Risk factors associated with serious infection included ECOG score ≥ 2 (OR 4.6, p < 0.001), concurrent steroid use (≥ 10 mg prednisone daily for ≥ 2 weeks; OR 3.0, p < 0.001), neutropenia (OR 3.6, p < 0.01), lymphopenia (OR 2.4, p < 0.05) and maximum ibrutinib dose of 560 mg (OR 2, p < 0.05). There was a dose dependent increase in infections based on number of chemotherapy regimens prior to ibrutinib initiation: 14.3% with 0, 19.7% with 1-2 and 28.7% with ≥ 3 prior treatments. Conclusion The incidence of serious infection in hematologic patients on ibrutinib was higher than previously reported (20% versus 11%) but the rate of IFI was lower (2% versus 4%). High ECOG score, leukopenia, steroids, and higher ibrutinib doses were associated with an increased risk for serious infection. Targeted antimicrobial prophylaxis should be considered for patients on ibrutinib with these risk factors. Improving functional status may also reduce the risk of infection in patients on ibrutinib. Disclosures All Authors: No reported disclosures

scholarly journals A novel box for aerosol and droplet guarding and evacuation in respiratory infection (BADGER) for COVID-19 and future outbreaks

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hau D. Le ◽  
Gordon A. Novak ◽  
Kevin C. Janek ◽  
Jesse Wang ◽  
Khang N. Huynh ◽  
...  
Keyword(s):  
Respiratory Infection ◽  
Healthcare Providers ◽  
Airborne Particles ◽  
Risk Of Infection ◽  
Indirect Contact ◽  
Vacuum Suction ◽  
Qualitative And Quantitative ◽  
Additional Layer ◽  
Increased Risk ◽  
Design Construction

AbstractThe coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has infected millions and killed more than 1.7 million people worldwide as of December 2020. Healthcare providers are at increased risk of infection when caring for patients with COVID-19. The mechanism of transmission of SARS-CoV-2 is beginning to emerge as airborne spread in addition to direct droplet and indirect contact as main routes of transmission. Here, we report on the design, construction, and testing of the BADGER (Box for Aerosol and Droplet Guarding and Evacuation in Respiratory Infection), an affordable, scalable device that contains droplets and aerosol particles, thus minimizing the risk of infection to healthcare providers. A semi-sealed environment is created inside the BADGER, which is placed over the head of the patient and maintains at least 12-air changes per hour using in-wall vacuum suction. Multiple hand-ports enable healthcare providers to perform essential tasks on a patient’s airway and head. Overall, the BADGER has the potential to contain large droplets and small airborne particles as demonstrated by simulated qualitative and quantitative assessments to provide an additional layer of protection for healthcare providers treating COVID-19 and future respiratory contagions.

scholarly journals Risk of infection associated with targeted therapies for solid organ and hematological malignancies

2021 ◽  
Vol 8 ◽  
pp. 204993612198954
Author(s):  
Isabel Ruiz-Camps ◽  
Juan Aguilar-Company
Keyword(s):  
Hematological Malignancies ◽  
Opportunistic Infections ◽  
Respiratory Infections ◽  
Fungal Infections ◽  
Checkpoint Inhibitors ◽  
Janus Kinase ◽  
Prolonged Treatment ◽  
Solid Organ ◽  
Risk Of Infection ◽  
Increased Risk

Higher risks of infection are associated with some targeted drugs used to treat solid organ and hematological malignancies, and an individual patient’s risk of infection is strongly influenced by underlying diseases and concomitant or prior treatments. This review focuses on risk levels and specific suggestions for management, analyzing groups of agents associated with a significant effect on the risk of infection. Due to limited clinical experience and ongoing advances in these therapies, recommendations may be revised in the near future. Bruton tyrosine kinase (BTK) inhibitors are associated with a higher rate of infections, including invasive fungal infection, especially in the first months of treatment and in patients with advanced, pretreated disease. Phosphatidylinositol 3-kinase (PI3K) inhibitors are associated with an increased risk of Pneumocystis pneumonia and cytomegalovirus (CMV) reactivation. Venetoclax is associated with cytopenias, respiratory infections, and fever and neutropenia. Janus kinase (JAK) inhibitors may predispose patients to opportunistic and fungal infections; need for prophylaxis should be assessed on an individual basis. Mammalian target of rapamycin (mTOR) inhibitors have been linked to a higher risk of general and opportunistic infections. Breakpoint cluster region-Abelson (BCR-ABL) inhibitors are associated with neutropenia, especially over the first months of treatment. Anti-CD20 agents may cause defects in the adaptative immune response, hypogammaglobulinemia, neutropenia, and hepatitis B reactivation. Alemtuzumab is associated with profound and long-lasting immunosuppression; screening is recommended for latent infections and prevention strategies against CMV, herpesvirus, and Pneumocystis infections. Checkpoint inhibitors (CIs) may cause immune-related adverse events for which prolonged treatment with corticosteroids is needed: prophylaxis against Pneumocystis is recommended.

scholarly journals Ethnic disparities in COVID-19: increased risk of infection or severe disease?

The Lancet ◽  
2021 ◽  
Vol 398 (10298) ◽  
pp. 389-390
Author(s):  
Daniel Pan ◽  
Christopher A Martin ◽  
Joshua Nazareth ◽  
Clareece R Nevill ◽  
Jatinder S Minhas ◽  
...  
Keyword(s):  
Severe Disease ◽  
Ethnic Disparities ◽  
Risk Of Infection ◽  
Increased Risk

scholarly journals Migrant status and risk of compulsory admission at first diagnosis of psychotic disorder: a population-based cohort study in Sweden

2020 ◽  
pp. 1-10
Author(s):  
J. Terhune ◽  
J. Dykxhoorn ◽  
E. Mackay ◽  
A.-C. Hollander ◽  
J. B. Kirkbride ◽  
...  
Keyword(s):  
Psychotic Disorder ◽  
Middle Eastern ◽  
Population Based ◽  
Compulsory Admission ◽  
Migrant Status ◽  
Region Of Origin ◽  
Increased Risk ◽  
National Register Data ◽  
Sub Saharan ◽  
First Diagnosis

Abstract Background Minority ethnic and migrant groups face an elevated risk of compulsory admission for mental illness. There are overlapping cultural, socio-demographic, and structural explanations for this risk that require further investigation. Methods By linking Swedish national register data, we established a cohort of persons first diagnosed with a psychotic disorder between 2001 and 2016. We used multilevel mixed-effects logistic modelling to investigate variation in compulsory admission at first diagnosis of psychosis across migrant and Swedish-born groups with individual and neighbourhood-level covariates. Results Our cohort included 12 000 individuals, with 1298 (10.8%) admitted compulsorily. In an unadjusted model, being a migrant [odds ratio (OR) 1.48; 95% confidence interval (CI) 1.26–1.73] or child of a migrant (OR 1.27; 95% CI 1.10–1.47) increased risk of compulsory admission. However after multivariable modelling, region-of-origin provided a better fit to the data than migrant status; excess risk of compulsory admission was elevated for individuals from sub-Saharan African (OR 1.94; 95% CI 1.51–2.49), Middle Eastern and North African (OR 1.46; 95% CI 1.17–1.81), non-Nordic European (OR 1.27; 95% CI 1.01–1.61), and mixed Swedish-Nordic backgrounds (OR 1.33; 95% CI 1.03–1.72). Risk of compulsory admission was greater in more densely populated neighbourhoods [OR per standard deviation (s.d.) increase in the exposure: 1.12, 95% CI 1.06–1.18], an effect that appeared to be driven by own-region migrant density (OR per s.d. increase in exposure: 1.12; 95% CI 1.02–1.24). Conclusions Inequalities in the risk of compulsory admission by migrant status, region-of-origin, urban living and own-region migrant density highlight discernible factors which raise barriers to equitable care and provide potential targets for intervention.

scholarly journals Ethnic disparities in COVID-19: increased risk of infection or severe disease? – Authors' reply

The Lancet ◽  
2021 ◽  
Vol 398 (10298) ◽  
pp. 390
Author(s):  
Rohini Mathur ◽  
Christopher T Rentsch ◽  
Caroline E Morton ◽  
Rosalind M Eggo ◽  
Krishnan Bhaskaran ◽  
...  
Keyword(s):  
Severe Disease ◽  
Ethnic Disparities ◽  
Risk Of Infection ◽  
Increased Risk

757 Does Increased Sampling of Cerebrospinal Fluid from External Ventricular Drains Lead to Increased Rates of Infection?

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
B Edwards ◽  
A Zolnourian ◽  
D Bulters
Keyword(s):  
Research Study ◽  
Average Length ◽  
Risk Of Infection ◽  
Suspected Infection ◽  
Length Of Treatment ◽  
Increased Risk ◽  
Significant Difference ◽  
Daily Sampling ◽  
Frequent Sampling ◽  
Strict Protocol

Abstract Introduction External ventricular drains (EVDs) are commonly used in the management of acute hydrocephalus after subarachnoid haemorrhage (SAH). Infection is the most common complication. There remains controversy over whether frequent sampling is associated with increased risk of infection. Method Two cohorts of patients requiring EVD after SAH were retrospectively analysed for suspected and proven CSF infection. The first clinical cohort was of 50 consecutive patients with twice weekly sampling. The second group had alternate daily sampling as part of a prospective research study. Results Female to male ratio were (32:18) and (29:15) in clinical vs research group respectively. Average age of both groups was 59. Average length of treatment with EVD in both groups was 10 days. 16/50 (32%) patients had a suspected infection vs 13/44 (30%) and 8/50 (16%) had a proven infection compared to 6/44 (14%) in clinical and research groups, respectively. There was no statistically significant difference between the two groups (suspected infections p = 0.7 and proven infections p = 0.7) Conclusions Increased rates in CSF sampling in the research cohort did not result in higher rates of CSF infection. This suggests that rate of sampling, if done following a strict protocol, is not associated with increased risk of infection.

Sign in / Sign up

Export Citation Format

Share Document