Comparison of different sets of immunological tests to identify treatable immunodeficiencies in adult bronchiectasis patients

BackgroundReported prevalence of immunodeficiencies in bronchiectasis patients is variable depending on the frequency and extent of immunological tests performed. ERS Guidelines recommend a minimum bundle of tests. Broadening the spectrum of immunological tests could increase the number of patients diagnosed with an immunodeficiency and those who could receive specific therapy. The primary objective of the present study was to assess the performance of different sets of immunological tests in diagnosing any, primary, secondary, or treatable immunodeficiencies in adults with bronchiectasis.MethodsAn observational, cross-sectional study was conducted at the Bronchiectasis Program of the Policlinico University Hospital in Milan, Italy, from September 2016 to June 2019. Adult outpatients with a clinical and radiological diagnosis of bronchiectasis underwent the same immunological screening during the first visit when clinically stable consisting of: complete blood count, IgA, IgG, IgM, IgG subclasses, total IgE, lymphocyte subsets, and HIV antibodies. The primary endpoint was the prevalence of patients with any immunodeficiencies using five different sets of immunological tests.ResultsA total of 401 bronchiectasis patients underwent the immunological screening. A significantly different prevalence of bronchiectasis patients diagnosed with any, primary, or secondary immunodeficiencies was found across different bundles. 44.6% bronchiectasis patients had a diagnosis of immunodeficiency using when IgG subclasses and lymphocyte subset are added to the minimum bundle suggested by the guidelines.ConclusionA 4-fold increase in the diagnosis of immunodeficiencies can be found in adults with bronchiectasis when IgG subclasses and lymphocyte subsets are added to the bundle of tests recommended by guidelines.

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Igg Subclasses in Capd Patients

Peritoneal Dialysis International ◽

10.1177/089686089601600310 ◽

1996 ◽

Vol 16 (3) ◽

pp. 288-294 ◽

Cited By ~ 9

Author(s):

Raymond T. Krediet ◽

Ger C.M. Koomen ◽

Arjen Vlug ◽

Dirk G. Struijk ◽

Barbara Buis ◽

...

Keyword(s):

Healthy Volunteers ◽

Interleukin 2 ◽

Hemodialysis Patients ◽

Igg Subclasses ◽

University Hospital ◽

Synthesis Rate ◽

Renal Unit ◽

Cross Sectional ◽

Transport Studies ◽

Peritoneal Transport

Objective To make a comparison of serum levels of immunoglobulin G (lgG) subclasses in adult continuous ambulatory peritoneal dialysis (CAPD) patients with those in age-and sex-matched hemodialysis patients and healthy volunteers, and to analyze the contribution of removal of these proteins in peritoneal effluent to their plasma values. Design A cross-sectional study. Setting A renal unit of a university hospital. Patients Twenty-three CAPD patients, 21 hemodialysis patients, and 21 healthy volunteers. Peritoneal transport studies were done in 8 of the 23 CAPD patients. Methods IgG subclasses were measured in serum by nephelometry. For the peritoneal transport studies an ELISA method on ethylenediamine tetracetic acid plasma was used. The same method was used in seven-to ten-fold concentrated peritoneal dialysate. Results CAPD patients had lower IgG2 and IgG4 1evels than hemodialysis patients and healthy volunteers (p < 0.01). lgG2 values below 1.5 glL were present in 43% of the CAPD patients (p < 0.001 compared to healthy volunteers). Peritonitis incidence was not different between CAPD patients with low or normal IgG2 plasma levels. Peritoneal clearance of IgG3 was lower than that of the other subclasses. Evidence was obtained for a depressed synthesis of IgG2 and IgG4 in CAPD patients. The hypothesis that interleukin-2 may be involved in the low synthesis rate of IgG2 is discussed. Conclusion Low serum IgG2 and IgG4 1evels are present in stable, adult CAPD patients. These were not caused by increased peritonealloss, but by decreased synthesis.

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Increasing Trends in Opioid Use From 2010 to 2018 in the Region of Valencia, Spain: A Real-World, Population-Based Study

Frontiers in Pharmacology ◽

10.3389/fphar.2020.612556 ◽

2020 ◽

Vol 11 ◽

Author(s):

Isabel Hurtado ◽

Aníbal García-Sempere ◽

Salvador Peiró ◽

Gabriel Sanfélix-Gimeno

Keyword(s):

Health And Safety ◽

Fold Increase ◽

The United States ◽

Population Based ◽

Annual Number ◽

World Population ◽

Opioid Use ◽

Cross Sectional ◽

Opioid Prescription ◽

Number Of Patients

Background: The opioid epidemic has been extensively documented in the United States and Canada, but fewer data are available for Europe.Aim: To describe the trends in opioid use—volume of prescriptions, dosage and number of patients treated—in a Spanish population with more than 4.2 million inhabitants aged 18 years and older.Patients and Methods: Population-based cross-sectional analysis of opioid prescription in adults (≥18 years) from January 1, 2010 to December 31, 2018 in the region of Valencia, Spain. Outcomes were estimated on an annual basis: number of prescriptions, prescription rate per 100 inhabitants, dosage per capita (morphine mg equivalents, MME/c) and volume of patients treated (overall and by drug).Results: Over the study period, 2,107,756 unique patients were prescribed more than 35 million total treatments. The yearly number of treatments doubled, and total MME/c showed almost a threefold increase. Fentanyl MME/c more than tripled, accounting for 34.4% of the total MME/c in 2018. Oxycodone MME/c showed a 10-fold increase, while tapentadol, launched in 2011, showed the highest growth rates. The annual number of patients receiving at least one opioid prescription more than doubled, from 335,379 in 2010 to 722,838 in 2018.Conclusions: Even if proportions still seem far from epidemic, urgent research is warranted on the observed patterns of use, their appropriateness and their association with health and safety outcomes, especially for high-use and high-strength drugs.

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Diagnoses from lung specimen collected through flexible bronchoscopy from patients in a tertiary hospital in Dar es Salaam Tanzania: a retrospective cross-sectional study

BMC Pulmonary Medicine ◽

10.1186/s12890-019-0972-x ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Deus A. Ndilanha ◽

Grace A. Shayo ◽

Ramadhan Hassan ◽

Moses Byomuganyizi ◽

Leonard E. K. Lema

Keyword(s):

Fold Increase ◽

Tertiary Hospital ◽

Cross Sectional Study ◽

Tracheobronchial Tree ◽

Flexible Bronchoscopy ◽

Sectional Study ◽

Cross Sectional ◽

Number Of Patients ◽

Common Diagnosis ◽

Lung Biopsies

Abstract Background Flexible bronchoscopy enables visualization of the respiratory airway mucosa from the oropharynx to third generation branching of the tracheobronchial tree. Bronchoscopic diagnoses vary from one locality to the other in accordance to the locality specific risk factors for lung diseases. This study aimed at describing diagnoses of all specimen of patients who underwent flexible bronchoscopy at Muhimbili National Hospital from January 2013 to November 2017. Methods A retrospective hospital-based cross sectional study was conducted among 451 patients. Data was collected from archives and included both demographic and clinical variables. Descriptive statistics were used to summarize the study findings. Results There was a 3 fold increase in the number of patients who underwent flexible bronchoscopy from 57 cases in 2013 to 180 cases in 2017. About 39% (174/451) of patients underwent lung biopsies while 64.5% (291/451) underwent bronchioalveolar lavage, bronchial washings or brush cytology, alone or in combination with biopsy. Generally, 64.4% (112/174) of all lung biopsies were malignant. Adenocarcinoma was the most common diagnosis seen in 33.9% (59/174). Of 76 cytological samples which were sent for bacterial culture and sensitivity, 11/76 (11.8%) were culture positive. A total of 6 (10.7%) out of 56 samples which were sent for GeneXpert MTB/RIF tested positive for M.tuberculosis. Conclusion Adenocarcinoma was the most common diagnosis. Bacterial and mycobacterial infections were among the most reported findings in cytological samples. Suspicious tuberculosis lesions during bronchoscopy made it possible to diagnose tuberculosis which was hard to diagnose before patients were sent for bronchoscopy.

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The presentation of older people with vertebral fragility fractures to a university hospital: a cross-sectional analysis

Current Rheumatology Reviews ◽

10.2174/1573397116999200820170559 ◽

2020 ◽

Vol 16 ◽

Cited By ~ 1

Author(s):

Terence Ong ◽

Syed Ajmal bin Syed Ali ◽

Opinder Sahota

Keyword(s):

Fragility Fracture ◽

Geriatric Medicine ◽

Health Assessment ◽

Fragility Fractures ◽

University Hospital ◽

Hospital Services ◽

Cross Sectional ◽

Number Of Patients ◽

Thoracolumbar Region ◽

Vertebral Fragility Fracture

Introduction: There is a lack of robust data on hospitalised acute vertebral fragility fractures. This analysis aimed to report on the number of hospitalised vertebral fragility fractures treated in a large UK teaching hospital. This information would support better design of hospital services and resource allocation to manage this group of patients. Method: Patients aged 50 years and over hospitalised with a vertebral fragility fracture from 1/2/2016 to 31/1/2017 were identified from radiology and hospital records. Patients sustaining vertebral fractures due to either major trauma or malignancy were excluded. Data was collected on patient demographics, fracture details, hospitalisation details and health outcomes. Results: 208 patients with acute vertebral fragility fractures were hospitalised over a 12 month period. The mean(SD) age was 80.5(11) years, of which 68% were female. 94% presented to the Emergency Department (ED) as their first point of contact of which 70% were subsequently hospitalised. Two-thirds presented with a single level vertebral fracture predominantly around the thoracolumbar region. The majority (87%) were non-operatively managed by general physicians of which most were under Geriatric Medicine. The median length of stay was 12 (IQR 6-20) days and in-patient mortality was 3%. 52% of patients went on to have a bone health assessment. Conclusion: We have reported on the number of patients presenting to hospital with an acute vertebral fragility fracture over 12 months. This helps identify resources needed to design hospital services to manage them adequately.

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Self-reported burden in patients with localized prostate cancer treated with stereotactic body radiation therapy (SBRT).

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.6_suppl.51 ◽

2018 ◽

Vol 36 (6_suppl) ◽

pp. 51-51

Author(s):

Abigail Pepin ◽

Nima Aghdam ◽

Colin Johnson ◽

Malika Danner ◽

Marilyn Ayoob ◽

...

Keyword(s):

Quality Of Life ◽

Prostate Cancer ◽

Cross Sectional Study ◽

University Hospital ◽

Localized Prostate Cancer ◽

Cross Sectional ◽

Validated Questionnaire ◽

Number Of Patients ◽

Over Time

51 Background: Retaining quality of life in patients treated with SBRT for prostate cancer remains paramount. As such, balancing the benefits of treatment against the effects of therapy on patients is essential. The quality of life is influenced by the disease and treatment related burden. The EORTC QLQ-ELD14 (ELD14) is a validated questionnaire that can assess burden. This study reports burden trends in patients with prostate cancer treated with SBRT. Methods: All patients with localized prostate cancer treated with SBRT at Georgetown University Hospital from 2007 to 2016 were eligible for inclusion in this cross-sectional cohort. The ELD14 questionnaire was used to assess self-reported patient quality of life at time points before and following treatment. Initially, 267 patients (Median age of 70) responded to the ELD14 questionnaire. Approximately 30% received ADT. The specific questions reviewed for this study were focused on burden of disease and treatment. The responses to these questions were grouped into three clinically relevant categories (not at all, a little and quite a bit to very much). Results: Number of patients reporting quite a bit or very much burden from prostate cancer declined over time from 13% prior to treatment to 8% at 36 months post-SBRT. This was highest at one month post-SBRT (15%) and resolved to baseline by 6 months. Treatment burden similarly decreased over time from 10% to 3%. Patients treated with androgen deprivation therapy (ADT) experienced greater burden than others. At initial consult, 19% of patients on ADT reported quite a bit or very much burden from their illness. At one month post-SBRT, this had increased to 27% and subsequently decreased to 16% at 36 months. Of those not receiving ADT, 12% reported having quite a bit or very much burden from illness initially, 9% at one month and 6% at 36 months. Conclusions: This cross-sectional study suggests that the burden of clinically localized prostate and its treatment with SBRT improves over time. Increased burden was noted in patients receiving ADT. These findings can inform decision making in improving quality of life for patients with prostate cancer treated with SBRT.

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Establishment of Normal Reference Intervals for CD3+, CD4+, CD8+, and CD4+to CD8+Ratio of T Lymphocytes in HIV Negative Adults from University of Gondar Hospital, North West Ethiopia

AIDS Research and Treatment ◽

10.1155/2014/267450 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Addisu Gize ◽

Biniam Mathewos ◽

Beyene Moges ◽

Meseret Workineh ◽

Lealem Gedefaw

Keyword(s):

T Lymphocytes ◽

T Lymphocyte ◽

Lymphocyte Subsets ◽

Reference Interval ◽

Reference Intervals ◽

University Hospital ◽

T Lymphocyte Subsets ◽

Cross Sectional ◽

North West ◽

Normal Reference

Background.Reference values for the CD3+, CD4+, CD8+, and CD4+to CD8+ratio T lymphocyte subsets are adopted from textbooks. But for appropriate diagnosis, treatment, and follow-up of patients, correct interpretations of the laboratory results from normal reference interval are mandatory. This study was, therefore, planned to establish normal reference interval for T lymphocytes subset count and CD4+to CD8+ratio.Methods.A cross-sectional study was conducted on apparently healthy adult individuals who visited voluntary counseling and HIV testing clinic Gondar University Hospital from April to May, 2013. Whole blood was analyzed using fluorescence-activated cell sorting (BD FACS, San Jose, CA) machine to enumerate the T-cell subpopulations.Results.Out of the total 320 study participants, 161 (50.3%) were men and 159 (49.7%) were women. The normal reference intervals were (655–2,823 cells/μL), (321–1,389 cells/μL), and (220–1,664 cells/μL) for CD3+, CD4+, and CD8+T lymphocyte subsets, respectively, and CD4+to CD8+ratio was 0.5–2.5.Conclusion.The overall CD3+T lymphocytes reference interval in the current study was wide; low CD4+T lymphocytes, CD4 to CD8 ratio, and high CD8+T lymphocytes values were observed.

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Haematological profile of human immunodeficiency virus infected patients

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20190238 ◽

2019 ◽

Vol 5 (1) ◽

pp. 164

Author(s):

C. L. Chitra ◽

R. Manipriya ◽

K. Deepa

Keyword(s):

Human Immunodeficiency Virus ◽

Complete Blood Count ◽

Stage Iv ◽

Cd4 Count ◽

Stage I ◽

Cross Sectional ◽

Number Of Patients ◽

Increased Risk ◽

Haematological Profile ◽

Immunodeficiency Virus

Background: In India, approximately 6 million populations are affected by human immunodeficiency virus (HIV). Anemia and leukopenia, especially thrombocytopenia is seen commonly in HIV infections. Low CD4+ count and increased viral load are some of the factors associated with increased risk of thrombocytopenia. The aim of the study was to study the hematological changes that occur in HIV infected patients who attend the Institute of Venereology, before starting HAART.Methods: This cross-sectional study was conducted in the Institute of Venereology, Madras Medical College/Rajiv Gandhi Government General Hospital, Chennai in 100 treatment-naive HIV infected patients. Detailed history and clinical examination was done. Blood samples were collected. Complete blood count, CD4 count, prothrombin time, activated plasma thromboplastin time, peripheral smear etc., were done. Results were collected and analysed.Results: Out of 100 patients, 56% were males and 43% females and one transgender. Anaemia was detected in 72%patients. 73.5% males and 76.2% females with CD4 count <350/μl were anemic. The commonest anaemia was normochromic normocytic, seen in 65% patients. 7 male and 7 female patients had leukopenia. 81.25%patients with lymphocytopenia had CD4 count <350/μl. 12% males and 4% females had neutropenia. 17% had neutrophilia. Patients in WHO stage I did not have neutropenia. 23% patients had thrombocytopenia. 47% patients with thrombocytopenia were in stage IV. Maximum number of patients with normal platelet count was in stage I.Conclusions: Haematological abnormalities are a common occurrence during the course of HIV infection. Identifying and treating the haematological changes have great impact on both the morbidity and mortality of HIV infected patients.

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How ICU Patient Severity Affects Communicative Interactions Between Healthcare Professionals: A Study Utilizing Wearable Sociometric Badges

Frontiers in Medicine ◽

10.3389/fmed.2020.606987 ◽

2020 ◽

Vol 7 ◽

Author(s):

Eiji Kawamoto ◽

Asami Ito-Masui ◽

Ryo Esumi ◽

Hiroshi Imai ◽

Motomu Shimaoka

Keyword(s):

Healthcare Professionals ◽

Wearable Sensors ◽

University Hospital ◽

Cross Sectional ◽

Factors Affecting ◽

Face To Face ◽

Staff Members ◽

Number Of Patients ◽

Severity Scores ◽

The Face

Numerous factors affecting the interactions between healthcare professionals in the workplace demand a comprehensive understanding if the quality of patient healthcare is to be improved. Our previous cross-sectional analysis showed that patient severity scores [i.e., Acute Physiology and Chronic Health Evaluation (APACHE) II] in the 24 h following admission positively correlated with the length of the face-to-face interactions among ICU healthcare professionals. The present study aims to address how the relationships between patient severity and interaction lengths can change over a period of time during both admission and treatment in the ICU. We retrospectively analyzed data prospectively collected between 19 February to 17 March 2016 from an open ICU in a University Hospital in Japan. We used wearable sensors to collect a spatiotemporal distribution dataset documenting the face-to-face interactions between ICU healthcare professionals, which involved 76 ICU staff members, each of whom worked for 160 h, on average, during the 4-week period of data collection. We studied the longitudinal relationships among these interactions, which occurred at the patient bedside, vis-à-vis the severity of the patient's condition [i.e., the Sequential Organ Failure Assessment (SOFA) score] assessed every 24 h. On Day 1, during which a total of 117 patients stayed in the ICU, we found statistically significant positive associations between the interaction lengths and their SOFA scores, as shown by the Spearman's correlation coefficient value (R) of 0.447 (p < 0.01). During the course of our observation from Day 1 to Day 10, the number of patients (N) who stayed in the ICU gradually decreased (N = 117, Day1; N = 10, Day 10), as they either were discharged or died. The statistically significant positive associations of the interaction lengths with the SOFA scores disappeared from Days 2 to 6, but re-emerged on Day 7 (R = 0.620, p < 0.05) and Day 8 (R = 0.625, p < 0.05), then disappearing again on Days 9 and 10. Whereas all 6 SOFA sub-scores correlated well with the interaction lengths on Day 1, only a few of the sub-scores (coagulation, cardiovascular, and central nervous system scores) did so; specifically, those on Days 7 and 8. The results suggest that patient severity may play an important role in affecting the interactions between ICU healthcare professionals in a time-related manner on ICU Day 1 and on Days 7/8.

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Usefulness of Defined Daily Dose and Days of Therapy in Pediatrics and Obstetrics-Gynecology: A Comparative Analysis of Antifungal Drugs (2000–2001, 2005–2006, and 2010–2011)

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-19.3.196 ◽

2014 ◽

Vol 19 (3) ◽

pp. 196-201

Author(s):

Justine Guillot ◽

Denis Lebel ◽

Hélène Roy ◽

Philippe Ovetchkine ◽

Jean-François Bussières

Keyword(s):

Fold Increase ◽

Daily Practice ◽

Antifungal Drugs ◽

University Hospital ◽

Defined Daily Dose ◽

Cross Sectional ◽

Defined Daily Doses ◽

Days Of Therapy ◽

Resistance Patterns ◽

The Mean

OBJECTIVES: The objective was to describe antifungal drug use by using the number of defined daily doses (DDD)/1000 patient-days per antifungal, the number of days of therapy (DOT)/1000 patient-days per antifungal, and the mean dose in mg/kg/day per antifungal during a 10-year period. METHODS: Retrospective, cross-sectional, descriptive study, in a mother-child university hospital center, with 400 pediatric beds and 100 obstetrics-gynecology beds. All inpatients who received 1 of the 7 authorized antifungals on the institution’s local formulary in 2000–2001, 2005–2006, or 2010–2011 were included. Prescriptions for emergency department and outpatient clinics were excluded. The data were extracted from the patients’ computerized medication profiles linked to patient admission, discharge, and transfer data. The DDD, DOT, and the mean dose in mg/kg/day were calculated for each antifungal and overall. RESULTS: There was a 2.97-fold increase in the overall number of DDD/1000 patient-days, from 14.8 in 2000–2001 to 37.5 in 2005–2006 and 43.9 in 2010–2011. There was a 2.97-fold increase in the overall number of DOT/1000 patient-days, from 22.8 in 2000–2001 to 50.3 in 2005–2006 and 67.8 in 2010–2011. CONCLUSIONS: It can be difficult to compare the use of antifungal drugs among institutions, owing to numerous factors, but it gives an idea about the consumption outside the studied center. Moreover, these ratios help to evaluate the use of antifungals within a same institution. These data could be correlated among others, with resistance patterns, in order to improve our daily practice concerning antifungal prescription.

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Frequency of cranio-autonomic symptoms in the patients of migraine presenting in an outpatient department of Dow University Hospital: A cross-sectional study

Romanian Journal of Neurology ◽

10.37897/rjn.2021.1.11 ◽

2021 ◽

Vol 20 (1) ◽

pp. 81-87

Author(s):

Meraj Fatima ◽

◽

Muhammad Sohaib Asghar ◽

Aijaz Ali ◽

Dileep Kumar ◽

...

Keyword(s):

Nasal Congestion ◽

Daily Practice ◽

Cross Sectional Study ◽

Primary Objective ◽

University Hospital ◽

Common Symptom ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Autonomic Symptoms ◽

The Mean

Objectives. Migraine is a prevalent debilitating neurological disorder manifested by frequent episodes of pounding headache. Cranial autonomic symptoms are frequently reported in patients of trigeminal autonomic cephalgias, but various studies also documented these cranio-autonomic symptoms in migraine patients as well. The primary objective of our study is to evaluate the prevalence of cranio-autonomic symptoms (CAS) amongst the patients suffering from migraines. Material and methods. This study was conducted as a descriptive, cross-sectional survey involving patients attending the neurology clinic at Dow University Hospital. 132 patients met the inclusion criteria (according to ICHDIII) and were assessed for the frequency of cranio-autonomic symptoms. Outcomes. The mean age recorded was 26.37 ± 6.31 years, while the mean duration of diagnosis was 23.54 ± 16.52 months. The frequency of cranio-autonomic symptoms was observed among 55% of the patients suffering from migraines in our study. The prominent symptom observed was lacrimation (56%), followed by nasal congestion (31%) and rhinorrhea (28%). The least prevalent symptom was ptosis (4%). Lacrimation was found more likely to be associated with the male gender (p = 0.096), while forehead/ facial sweating was found more prevalent in females (p = 0.162). The ciliary injection was frequent in conjunction with unilateral rather than a bilateral headache in the migraine patients (p= 0.055), while lacrimation was the most common symptom in the 21-30 years of age group followed by ciliary injection which was exclusively conspicuous in the same age category (p = 0.020). Conclusions. Cranio-autonomic symptoms were detected prevailing in our study population, and may present as a confounding factor in physician’s daily practice to diagnose migraine.

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