scholarly journals Dynamics of antimalarial antibodies in non-immune patients during and after a first and unique P. falciparum malaria episode

2020 ◽  
Author(s):  
Zeno Bisoffi ◽  
Marco Bertoldi ◽  
Ronaldo Silva ◽  
Giulia Bertoli ◽  
Tamara Ursini ◽  
...  
Keyword(s):  
Blood Donors ◽  
Travel Medicine ◽  
Antibody Test ◽  
Malaria Episode ◽  
Full Blood Count ◽  
Case Report Form ◽  
Retrospective Diagnosis ◽  
Laboratory Test Results ◽  
High Level

Abstract BackgroundMalaria is a major travel medicine issue. Retrospective confirmation of a malaria episode diagnosed in an endemic area can have relevant implications in trasfusional medicine in Europe, where blood donors are excluded from donation on the basis of positive malaria serology. However, there is scarce evidence on the dynamics of antimalarial antibodies after a first malaria episode in non immune individuals. First aim of this study was to describe the dynamics of antimalarial antibodies in a first malaria episode in non immune travellers. Secondary objectives were to assess the sensitivity of serology for a retrospective diagnosis in non immune travellers diagnosed while abroad and to discuss the implications in transfusional medicine.MethodsRetrospective analysis of the results of an indirect fluorescence antibody test (IFAT) for malaria available for patients with a first malaria episode by Plasmodium falciparum and admitted at the IRCCS Sacro Cuore Don Calabria hospital in a 14-year period. The antibody titres were collected at baseline and during further follow up visits. Epidemiological, demographic and laboratory test results (including full blood count and malaria parasite density) were anonymously recorded in a study specific electronic Case Report Form created with OpenClinica software. Statistical analysis was performed with SAS software version 9.4. ResultsThirty-six patients were included. Among them, all but two were Europeans (one African and one American). Median length of fever before diagnosis was two days (IQR 1-3). Thirty-five patients had seroconversion between day 1 and day 4 from admission, and the titre showed a sharply rising titre, often to a very high level in a few days. Only a single patient remained negative in the first 5 days from admission, after which he was no more tested. Six patients were followed up for at least two months, and they all showed a decline in IFAT titre, tending to seroreversion (confirmed in one patient with the longest follow up, almost four years). ConclusionsSerology demonstrated reliable for retrospective diagnosis in non immune travellers. The decline in the antimalarial titre might be included in the screening algorithms of blood donors, but further studies are needed.

scholarly journals Dynamics of antimalarial antibodies in non-immune patients during and after a first and unique P. falciparum malaria episode.

2020 ◽  
Author(s):  
Zeno Bisoffi ◽  
Marco Bertoldi ◽  
Ronaldo Silva ◽  
Giulia Bertoli ◽  
Tamara Ursini ◽  
...  
Keyword(s):  
Blood Donors ◽  
Travel Medicine ◽  
Antibody Test ◽  
Malaria Episode ◽  
Full Blood Count ◽  
Case Report Form ◽  
Retrospective Diagnosis ◽  
Laboratory Test Results ◽  
High Level

Abstract Background Malaria is a major travel medicine issue. Retrospective confirmation of a malaria episode diagnosed in an endemic area can have relevant implications in trasfusional medicine in Europe, where blood donors are excluded from donation on the basis of positive malaria serology. However, there is scarce evidence on the dynamics of antimalarial antibodies after a first malaria episode in non immune individuals. First aim of this study was to describe the dynamics of antimalarial antibodies in a first malaria episode in non immune travellers. Secondary objectives were to assess the sensitivity of serology for a retrospective diagnosis in non immune travellers diagnosed while abroad and to discuss the implications in transfusional medicine. Methods Retrospective analysis of the results of an indirect fluorescence antibody test (IFAT) for malaria available for patients with a first malaria episode by Plasmodium falciparum and admitted at the IRCCS Sacro Cuore Don Calabria hospital in a 14-year period. The antibody titres were collected at baseline and during further follow up visits. Epidemiological, demographic and laboratory test results (including full blood count and malaria parasite density) were anonymously recorded in a study specific electronic Case Report Form created with OpenClinica software. Statistical analysis was performed with SAS software version 9.4. Results Thirty-six patients were included. Among them, all but two were Europeans (one African and one American). Median length of fever before diagnosis was two days (IQR 1-3). Thirty-five patients had seroconversion between day 1 and day 4 from admission, and the titre showed a sharply rising titre, often to a very high level in a few days. Only a single patient remained negative in the first 5 days from admission, after which he was no more tested. Six patients were followed up for at least two months, and they all showed a decline in IFAT titre, tending to seroreversion (confirmed in one patient with the longest follow up, almost four years). Conclusions Serology demonstrated reliable for retrospective diagnosis in non immune travellers. The decline in the antimalarial titre might be included in the screening algorithms of blood donors, but further studies are needed.

Phase 1 Clinical Trial of Prion-Filtered Red Cell Concentrates (pfRCC) in Patients Requiring Allogeneic Blood Transfusion.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 994-994
Author(s):  
Tracy Murphy ◽  
Mary R Cahill ◽  
Jim Fagan ◽  
Croxon Harry ◽  
Mohammed Khan ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Blood Donors ◽  
Phase 1 ◽  
Autologous Blood ◽  
Safety Data ◽  
Full Blood Count ◽  
Red Cell ◽  
Serious Adverse Events ◽  
Degree Of Protection

Abstract Background; Transmission of vCJD by blood transfusion from pre-symptomatic blood donors has occurred in 4 reported cases to date. Screening blood donors for infectivity is unlikely to be feasible for several years. Removing infectivity from blood using selective filtration may provide a useful degree of protection from transfusion transmission of the disease. A filter that may remove infectivity from red cell concentrates has been developed and trialed in volunteers receiving autologous blood. No studies have been carried out to date of pfRCC in allogeneic transfusions in the clinical setting. Aims; To establish safety and tolerability of transfusion of prion filtered red cell concentrates. Methods; Twenty patients scheduled to receive transfusion were recruited following ethical approval and with informed consent. Prion filtered units were prepared by the Irish Blood Transfusion Service. A mean loss of 9 gm of haemoglobin per unit of RCC occurred during the filtration process. Each patient received one unit of pfRCC, and a median of 2 units overall (range 1 to 4 units) per transfusion episode. A cross-match sample, full blood count (FBC), renal and liver profile was taken from each patient prior to transfusion. Patients were observed for adverse reactions. After 24 hours, FBC, renal and liver profile were repeated. Six weeks after the transfusion a further sample was tested for red cell antibodies. Six of these patients have consented to undergo re-transfusion with pfRCC. Two re-infusions have taken place uneventfully six months after the first exposure to pfRCC and 4 more are planned. Results No serious adverse events were encountered during the study, or at 24 hour and 6 week follow up after the initial transfusion episode. Mean haemoglobin increment per unit transfused was 0.68g (SD 0.45g; range −0.5 to 1.35g ). Recruitment and follow-up is ongoing in patients exposed to repeat transfusion challenge. Summary The first clinical transfusions of pfRCC were well tolerated. Two patients were rechallenged with transfusions of pfRCC without adverse effect. Further studies with transfusions of prion filtered red cells are now warranted to extend the safety data and to determine whether efficacy is comparable to standard transfusions in adult and paediatric populations.

Dynamics ofLegionellaantibody levels during 1 year in a healthy population

2008 ◽  
Vol 137 (7) ◽  
pp. 1013-1018 ◽  
Author(s):  
M. RUDBECK ◽  
K. MØLBAK ◽  
S. A. ULDUM
Keyword(s):  
Blood Donors ◽  
Antibody Test ◽  
Severe Illness ◽  
Healthy Population ◽  
Antibody Titres ◽  
History Of ◽  
Absence From Work ◽  
Immunofluorescence Antibody Test ◽  
Immunofluorescence Antibody

SUMMARYA total of 522 Danish blood donors were followed during 2004–2005 to describe the seroepidemiology ofLegionellainfections in healthy individuals from a general population. Antibodies toLegionellaspp. were measured by indirect immunofluorescence antibody test. The prevalence ofLegionellaantibodies (titre ⩾1:128) was 26·8% and remained fairly constant during the year of follow-up. However, 6·9% of the blood donors developed a fourfold or greater rise in antibody titres. A history of visits to Danish summer cottages was associated with bothLegionellaseropositivity (OR 1·53, 95% CI 1·02–2·30) and seroconversion (OR 2·66, 95% CI 1·21–5·83). There were no consistent associations between either levels of antibody titres or seroconversion and self-reported health symptoms, absence from work due to illness, or to any risk factors. We conclude that community-acquiredLegionellainfections are frequent; however, they rarely result in severe illness.

scholarly journals Real-world data suggest antibody positivity to SARS-CoV-2 is associated with a decreased risk of future infection

2020 ◽  
Author(s):  
Raymond A. Harvey ◽  
Jeremy A. Rassen ◽  
Carly A. Kabelac ◽  
Wendy Turenne ◽  
Sandy Leonard ◽  
...  
Keyword(s):  
Real World ◽  
Antibody Test ◽  
The United States ◽  
Test Results ◽  
Real World Data ◽  
World Data ◽  
Positive Antibody ◽  
Laboratory Test Results ◽  
Over Time

AbstractImportanceThere is limited evidence regarding whether the presence of serum antibodies to SARS-CoV-2 is associated with a decreased risk of future infection. Understanding susceptibility to infection and the role of immune memory is important for identifying at-risk populations and could have implications for vaccine deployment.ObjectiveThe purpose of this study was to evaluate subsequent evidence of SARS-CoV-2 infection based on diagnostic nucleic acid amplification test (NAAT) among individuals who are antibody-positive compared with those who are antibody-negative, using real-world data.DesignThis was an observational descriptive cohort study.ParticipantsThe study utilized a national sample to create cohorts from a de-identified dataset composed of commercial laboratory test results, open and closed medical and pharmacy claims, electronic health records, hospital billing (chargemaster) data, and payer enrollment files from the United States. Patients were indexed as antibody-positive or antibody-negative according to their first SARS-CoV-2 antibody test recorded in the database. Patients with more than 1 antibody test on the index date where results were discordant were excluded.Main Outcomes/MeasuresPrimary endpoints were index antibody test results and post-index diagnostic NAAT results, with infection defined as a positive diagnostic test post-index, as measured in 30-day intervals (0-30, 31-60, 61-90, >90 days). Additional measures included demographic, geographic, and clinical characteristics at the time of the index antibody test, such as recorded signs and symptoms or prior evidence of COVID-19 (diagnoses or NAAT+) and recorded comorbidities.ResultsWe included 3,257,478 unique patients with an index antibody test. Of these, 2,876,773 (88.3%) had a negative index antibody result, 378,606 (11.6%) had a positive index antibody result, and 2,099 (0.1%) had an inconclusive index antibody result. Patients with a negative antibody test were somewhat older at index than those with a positive result (mean of 48 versus 44 years). A fraction (18.4%) of individuals who were initially seropositive converted to seronegative over the follow up period. During the follow-up periods, the ratio (CI) of positive NAAT results among individuals who had a positive antibody test at index versus those with a negative antibody test at index was 2.85 (2.73 - 2.97) at 0-30 days, 0.67 (0.6 - 0.74) at 31-60 days, 0.29 (0.24 - 0.35) at 61-90 days), and 0.10 (0.05 - 0.19) at >90 days.ConclusionsPatients who display positive antibody tests are initially more likely to have a positive NAAT, consistent with prolonged RNA shedding, but over time become markedly less likely to have a positive NAAT. This result suggests seropositivity using commercially available assays is associated with protection from infection. The duration of protection is unknown and may wane over time; this parameter will need to be addressed in a study with extended duration of follow up.Key PointsQuestionCan real-world data be used to evaluate the comparative risk of SARS-CoV-2 infection for individuals who are antibody-positive versus antibody-negative?FindingOf patients indexed on a positive antibody test, 10 of 3,226 with a NAAT (0.3%) had evidence of a positive NAAT > 90 days after index, compared with 491 of 16,157 (3.0%) indexed on a negative antibody test.MeaningIndividuals who are seropositive for SARS-CoV-2 based on commercial assays may be at decreased future risk of SARS-CoV-2 infection.

scholarly journals Diagnostic Challenge in a Patient Presenting with Ascites and Hypergammaglobulinemia

2021 ◽  
pp. 810-818
Author(s):  
Syifa Mustika ◽  
Mirza Zaka Pratama ◽  
Cosmas Rinaldi Adithya Lesmana
Keyword(s):  
Antibody Test ◽  
Diagnostic Challenge ◽  
Serum Globulin ◽  
Abdominal Ultrasonography ◽  
Salt Restriction ◽  
Conjugated Hyperbilirubinemia ◽  
M Spike ◽  
High Level ◽  
Abdominal Paracentesis

Ascites is defined as the accumulation of intra-peritoneal fluid that can be caused by several diseases. We described a 47-year-old female presenting with low serum-ascites albumin gradient (SAAG) and a markedly high level of serum globulin. Serum protein electrophoresis revealed an M spike in the gamma region. Other laboratory results showed a marked increase in aspartate aminotransferase and alanine aminotransferase and predominantly conjugated hyperbilirubinemia without a sign of dilatation of bile ducts from abdominal ultrasonography examination. Furthermore, the follow-up showed a positive result for the anti-nuclear antibody test. The patient was assessed with autoimmune hepatitis, and the cause of ascites was suggested from portal hypertension although the level of SAAG was low. The ascites condition got improved after salt restriction, diuretics treatment, and abdominal paracentesis. However, the patient passed away because of the intracranial hemorrhage as a result of prolonged INR and APTT due to liver failure.

Assessment of parental knowledge, attitude and practice towards antibiotic use in children

2020 ◽  
Vol 10 (2) ◽  
pp. 25-41
Author(s):  
Thejaswini Karanth ◽  
Someswar Deb ◽  
Lal Ruatpuii Zadeng ◽  
Rajeswari Ramasamy ◽  
Teena Nazeem ◽  
...  
Keyword(s):  
Parental Knowledge ◽  
Antibiotic Use ◽  
Case Report Form ◽  
Standard Case ◽  
Attitude And Practice ◽  
Validated Questionnaire ◽  
Antibiotics Use ◽  
The Impact ◽  
Knowledge Attitude And Practice

Objective to assess the impact of pharmacist assisted counselling in improving Parental Knowledge, Attitude and Practice [KAP] towards antibiotic use in children. A Prospective, Educational Interventional Study was conducted in 200 subjects, from the randomly chosen communities in Bangalore. The investigators did door to door visit. The primary demographics data of parents and their children were collected using standard Case Report Form (CRF), and the baseline towards antibiotic use in Children was obtained from parents using validated Questionnaire. In the presence of both parents, only one was supposed to answer the Questionnaire. Pharmacist assisted parent centred interventional counselling was provided with the help of Patient Information Leaflet1s (PIL). Follow-up and post interventional KAP assessment were done after two months from the baseline measurement. The changes in parental KAP towards antibiotics use in children were being assessed by comparing the Pretest and Posttest responses using statistical analysis. The knowledge of parents towards antibiotic use in children was medium to good in the baseline KAP assessment; however, in the majority of the participating parents it was not satisfactory in attitude and practice domains. A statistically significant improvement was seen in the KAP of parents towards antibiotic use in children after the pharmacist assisted interventional counselling. Thus, Investigators could bring excellent changes in the knowledge part; whereas the result for changes in the Attitude and Practice was good to medium respectively.

Feline blood donation adverse reactions: classification and description of acute and delayed reactions in a donor population

2021 ◽  
pp. 1098612X2110202
Author(s):  
Tiago AM Abreu ◽  
Andreia ST Oliveira ◽  
Rui RF Ferreira ◽  
Sandrina MV Correia ◽  
Mafalda SSQ Morais ◽  
...  
Keyword(s):  
Blood Donors ◽  
Adverse Reactions ◽  
Blood Donation ◽  
Animal Blood ◽  
Veterinary Practitioner ◽  
Donor Programme ◽  
Donor Population ◽  
Delayed Reactions ◽  
Low Incidence ◽  
High Level

Objectives This article aims to analyse the safety of feline blood donation by describing the frequency and nature of any adverse reactions and their causes, as well as propose measures to decrease the incidence of adverse reactions. Methods In this prospective study, any blood donor adverse reactions detected by the clinical staff during and immediately after donation were recorded. The owners of the cats were also surveyed by a veterinary practitioner or veterinary nurse 5 days after donation, using a predefined questionnaire to assess for any clinical or behavioural changes. Data were collected between January 2019 and March 2020 from blood donors enrolled in an animal blood bank programme. Results Of 3690 blood donations from 1792 feline donors assessed, post-donation reactions were reported in 1.14% (n = 42): 0.22% (n = 8) were acute reactions, which included weakness, pallor, tachypnoea and open-mouth breathing; and 0.92% (n = 34) were delayed post-donation reactions, with 0.16% involving cutaneous (haematomas and skin rashes, n = 6), 0.68% involving behavioural (n = 25) and 0.08% involving digestive (emesis and inappetence, n = 3) signs. Conclusions and relevance The low incidence of post-donation reactions in this study is encouraging, suggesting that a well-established protocol and competent staff can help to ensure a high level of safety in a feline donor programme and, in turn, increase the confidence of cat owners.

scholarly journals Low dose oral ketamine treatment in chronic suicidality: An open-label pilot study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Adem T. Can ◽  
Daniel F. Hermens ◽  
Megan Dutton ◽  
Cyrana C. Gallay ◽  
Emma Jensen ◽  
...  
Keyword(s):  
Suicidal Ideation ◽  
Low Dose ◽  
Suicide Ideation ◽  
Well Being ◽  
Primary Outcome Measure ◽  
Open Label ◽  
Oral Ketamine ◽  
High Level ◽  
Chronic Suicidality

AbstractRecently, low-dose ketamine has been proposed as a rapid-acting treatment option for suicidality. The majority of studies to date have utilised intravenous (IV) ketamine, however, this route of administration has limitations. On the other hand, oral ketamine can be administered in a range of settings, which is important in treating suicidality, although studies as to safety and feasibility are lacking. n = 32 adults (aged 22–72 years; 53% female) with chronic suicidal thoughts participated in the Oral Ketamine Trial on Suicidality (OKTOS), an open-label trial of sub-anaesthetic doses of oral ketamine over 6 weeks. Participants commenced with 0.5 mg/kg of ketamine, which was titrated to a maximum 3.0 mg/kg. Follow-up assessments occurred at 4 weeks after the final dose. The primary outcome measure was the Beck Scale for Suicide Ideation (BSS) and secondary measures included scales for suicidality and depressive symptoms, and measures of functioning and well-being. Mean BSS scores significantly reduced from a high level of suicidal ideation at the pre-ketamine (week 0) timepoint to below the clinical threshold at the post-ketamine (week 6) timepoint. The proportion of participants that achieved clinical improvement within the first 6 weeks was 69%, whereas 50% achieved a significant improvement by the follow-up (week 10) timepoint. Six weeks of oral ketamine treatment in participants with chronic suicidality led to significant reduction in suicidal ideation. The response observed in this study is consistent with IV ketamine trials, suggesting that oral administration is a feasible and tolerable alternative treatment for chronic suicidality.

Lower perception of pharmacological treatment increases risk of non-adherence to medication

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
CB Graversen ◽  
JB Valentin ◽  
ML Larsen ◽  
S Riahi ◽  
T Holmberg ◽  
...  
Keyword(s):  
Pharmacological Treatment ◽  
Poisson Regression ◽  
Drug Class ◽  
Angiotensin Receptor Blockers ◽  
Adverse Outcomes ◽  
Adherence To Medication ◽  
Increased Risk ◽  
Patient Reported ◽  
High Level

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation Background A large proportion of patients fail to reach optimal adherence to medication following incident ischemic heart disease (IHD) despite amble evidence of the beneficial effect of medication. Non-adherence to medication increases risk of disease-related adverse outcomes but none has explored how perception about pharmacological treatment detail on non-adherence using register-based follow-up data. Purpose To investigate the association between patients’ perception of pharmacological treatment and risk of non-initiation and non-adherence to medication in a population with incident IHD. Methods This cohort study followed 871 patients until 365 days after incident IHD. The study combined patient-reported survey data on perception about pharmacological treatment (categorised by ‘To a high level’, ‘To some level’, and ‘To a lesser level’) with register-based data on reimbursed prescription of cardiovascular medication (antithrombotics, statins, ACE-inhibitors/angiotensin receptor blockers, and β-blockers). Non-initiation was defined as no pick-up of medication in the first 180 days following incident IHD and analysed by Poisson regression. Two different measures evaluated non-adherence in patients initiating treatment: 1) proportion of days covered (PDC) analysed by Poisson regression, and 2) risk of discontinuation analysed by Cox proportional hazard regression. All analyses were adjusted for confounding variables (age, sex, ethnicity, income, educational level, civil status, occupation, charlson comorbidity index, supportive relatives, and individual consultation in medication) identified by directed acyclic graph and obtained from national registers and the survey. Item non-response was handled by multiple imputation and item consistency was evaluated by McDonalds omega. Results Lower perceptions about pharmacological treatment was associated with increased risk of non-initiation and non-adherence to medication irrespectively of drug class and adherence measure in the multiple adjusted analyses (please see figure illustrating results on antithrombotics). A dose-response relationship was observed both at 180- and 365-days of follow-up, but the steepest decline in adherence differed when comparing the two adherence measures (results not shown). Moderate internal consistency was found for the summed measure of perception (McDonalds omega = 0.67). Conclusion Lower perception of pharmacological treatment was associated with subsequent non-initiation and non-adherence to medication, irrespectively of measurement method and drug class. Abstract Figure. Figre: Multiple adjusted analyses

scholarly journals Decrease post-transplant relapse using donor-derived expanded NK-cells

Leukemia ◽  
2021 ◽  
Author(s):  
Stefan O. Ciurea ◽  
Piyanuch Kongtim ◽  
Doris Soebbing ◽  
Prashant Trikha ◽  
Gregory Behbehani ◽  
...  
Keyword(s):  
Nk Cells ◽  
Nk Cell ◽  
Ex Vivo ◽  
Disease Free Survival ◽  
Dependent Manner ◽  
Post Transplant ◽  
Haploidentical Transplantation ◽  
High Doses ◽  
High Level

AbstractIn this phase I/II clinical trial, we investigated the safety and efficacy of high doses of mb-IL21 ex vivo expanded donor-derived NK cells to decrease relapse in 25 patients with myeloid malignancies receiving haploidentical stem-cell transplantation (HSCT). Three doses of donor NK cells (1 × 105–1 × 108 cells/kg/dose) were administered on days −2, +7, and +28. Results were compared with an independent contemporaneously treated case-matched cohort of 160 patients from the CIBMTR database.After a median follow-up of 24 months, the 2-year relapse rate was 4% vs. 38% (p = 0.014), and disease-free survival (DFS) was 66% vs. 44% (p = 0.1) in the cases and controls, respectively. Only one relapse occurred in the study group, in a patient with the high level of donor-specific anti-HLA antibodies (DSA) presented before transplantation. The 2-year relapse and DFS in patients without DSA was 0% vs. 40% and 72% vs. 44%, respectively with HR for DFS in controls of 2.64 (p = 0.029). NK cells in recipient blood were increased at day +30 in a dose-dependent manner compared with historical controls, and had a proliferating, mature, highly cytotoxic, NKG2C+/KIR+ phenotype.Administration of donor-derived expanded NK cells after haploidentical transplantation was safe, associated with NK cell-dominant immune reconstitution early post-transplant, preserved T-cell reconstitution, and improved relapse and DFS. TRIAL REGISTRATION: NCT01904136 (https://clinicaltrials.gov/ct2/show/NCT01904136).

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