routine assessment
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Author(s):  
Osama Alzoubi ◽  
Asim Khanfar

The neutrophil to lymphocyte ratio (NLR)is an emerging biomarker used in the prognosis of many conditions. We aimed to conduct a meta-analysis to assess the prognostic accuracy of the NLR in determining mortality in patients with Community acquired pneumonia (CAP). The Pubmed, EBSCO, and Scopus databases were searched to find all relevant articles. 10 articles with 5220 patients were included. The pooled area under the curve (AUC) of NLR admission levels to predict 30-Day mortality of CAP patients was 0.706; 95% CI (0.631 to 0.781), while the pooled AUC of NLR levels taken at 3-5 days was 0.882; 95% CI (0.818 to 0.945). Meta analysis also showed a significant difference in the NLR between the Survivors and 30-Day non-survivors. This difference was greater when NLR levels were taken at 3-5 days; Standardized mean difference (SMD) = 1.646; 95% CI (0.451 to 2.840) compared to NLR levels at admission SMD = 1.139; 95% CI (0.514 to 1.764). These results show that the NLR has potential to be incorporated in the routine assessment and stratification of CAP patients, especially in the early-stage evolution (3-5 days), keeping in mind the availability and cost effectiveness of this test.


2021 ◽  
Author(s):  
Philippa K Bird ◽  
Zoe Hindson ◽  
Abigail Dunn ◽  
Anna Cronin de Chavez ◽  
Josie Dickerson ◽  
...  

A secure parent-infant relationship lays the foundations for childrens development, however there are currently no measurement tools recommended for clinical practice. We evaluate the clinical utility of a structured assessment of the parent-infant relationship (the Maternal Postnatal Attachment Scale, MPAS) in a deprived, multi-ethnic urban community in England. This paper answers the question: what are health visitors views on the parent-infant relationship, and experiences of piloting the MPAS? It explores the barriers and facilitators to implementation, and complements the paper on psychometric properties and representativeness reported in Dunn et al (submitted). Semi-structured interviews were conducted with 11 health visitors and data were analysed using thematic analysis. Health visitors stressed the importance of the parent-infant relationship and reported benefits of the MPAS, including opening conversation, and identifying and reporting concerns. Challenges included timing, workload, the appropriateness and understanding of the questions and the length of the tool. Suggestions for improvements to the tool were identified. Our findings help to explain results in Dunn et al, and challenges identified would hinder routine assessment of the parent-infant relationship. Further work with health professionals and parents has been undertaken to co-produce an acceptable, feasible and reliable tool for clinical practice.


2021 ◽  
Vol 17 ◽  
Author(s):  
Consuelo Romero-Sánchez ◽  
Sebastián Giraldo ◽  
Ana María Heredia-P ◽  
Juliette De Avila ◽  
Lorena Chila-Moreno ◽  
...  

Background: The aim of this study was to assess DKK-1 levels, in Gingival Crevicular Fluid (GCF) and serum, as a biomarker for bone loss and disease activity in periodontitis and early RA (eRA). Methods: In this cross-sectional study, we obtained serum and GCF from 10 interproximal sites (Distal Buccal I/S, Mesio Buccal I/S, Distal Palatal/Lingual, Mesio Palatal/Lingual) according to the highest degree of inflammation by a patient for 240 sites from eRA patients. Patients received a periodontal assessment, a radiographic evaluation, tomography of interproximal sites, and DKK1 levels were determined by ELISA. Comparisons were performed by the Mann–Whitney U test and analysis by Chi2 test, and a logistic regression model was applied. Results: The mean age was 46.33 ± 12.0 years, the Disease Activity Score (DAS-28-ESR) was 4.08 ± 1.4. Periodontitis was present in 65.2% of the patients, and 59.6% of these patients had bone loss in interproximal sites. Higher GCF-DKK1 levels were associated with serum-DKK1 (OR:2.41 IC95% 1.14–5.09, p=0.021) and were related with DAS28-ESR (p=0.001), Routine Assessment of Patient Index Data 3 (RAPID 3) (p=0.001), and tender joints (p=0.040). Foot bone erosion and juxta-articular osteopenia were associated with high levels of serum-DKK1 (p=0.009 and 0.001, respectively). Serum-DKK1 were associated with SDAI (OR: 2.38 IC95% 1.03–5.52, p=0.043), RAPID 3 (p=0.001), and rheumatoid factor (p=0.018). The GCF-DKK1 levels were associated with periodontal bone loss (p=0.011), periodontitis (p=0.070) and its severity (OR: 2.58 IC95% 2.28–7.28, p=0.001). Bone loss was more frequent in buccal sites (73.5%) and was associated with increased levels of DKK1 (p=0.033). Conclusion: In the early stages of the eRA disease, serum and GCF-DKK1 could be a biomarker for clinical disease activity and periodontal and articular bone erosion.


Diagnostics ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. 1916
Author(s):  
Filippo Fraggetta ◽  
Alessandro Caputo ◽  
Rosa Guglielmino ◽  
Maria Giovanna Pellegrino ◽  
Giampaolo Runza ◽  
...  

Digital pathology for the routine assessment of cases for primary diagnosis has been implemented by few laboratories worldwide. The Gravina Hospital in Caltagirone (Sicily, Italy), which collects cases from 7 different hospitals distributed in the Catania area, converted the entire workflow to digital starting from 2019. Before the transition, the Caltagirone pathology laboratory was characterized by a non-tracked workflow, based on paper requests, hand-written blocks and slides, as well as manual assembling and delivering of the cases and glass slides to the pathologists. Moreover, the arrangement of the spaces and offices in the department was illogical and under-productive for the linearity of the workflow. For these reasons, an adequate 2D barcode system for tracking purposes, the redistribution of the spaces inside the laboratory and the implementation of the whole-slide imaging (WSI) technology based on a laboratory information system (LIS)-centric approach were adopted as a needed prerequisite to switch to a digital workflow. The adoption of a dedicated connection for transfer of clinical and administrative data between different software and interfaces using an internationally recognised standard (Health Level 7, HL7) in the pathology department further facilitated the transition, helping in the integration of the LIS with WSI scanners. As per previous reports, the components and devices chosen for the pathologists’ workstations did not significantly impact on the WSI-based reporting phase in primary histological diagnosis. An analysis of all the steps of this transition has been made retrospectively to provide a useful “handy” guide to lead the digital transition of “analog”, non-tracked pathology laboratories following the experience of the Caltagirone pathology department. Following the step-by-step instructions, the implementation of a paperless routine with more standardized and safe processes, the possibility to manage the priority of the cases and to implement artificial intelligence (AI) tools are no more an utopia for every “analog” pathology department.


2021 ◽  
pp. jrheum.210992
Author(s):  
Joel M. Kremer ◽  
George Reed ◽  
Dimitrios A. Pappas ◽  
Kevin Kane ◽  
Vivi L. Feathers ◽  
...  

Drs. Pincus, Bergman, and Yazici have raised some concerns about our published article comparing the Clinical Disease Activity Index (CDAI) with simultaneous measures of the Routine Assessment of Patient Index Data 3 (RAPID3).1 We believe our publication has clearly established that the validated CDAI scores provide a fundamentally different evaluation of disease status compared with the RAPID3.


2021 ◽  
pp. jrheum.210953
Author(s):  
Theodore Pincus ◽  
Martin J. Bergman ◽  
Yusuf Yazici

We agree strongly with Kremer et al that "metrics are essential for evaluating disease activity in patients with rheumatoid arthritis (RA)."1 Nonetheless, data reported from the Corrona and the Brigham and Women's Rheumatoid Arthritis Sequential Study (BRASS) registries for Clinical Disease Activity Index (CDAI) and Routine Assessment of Patient Index Data 3 (RAPID3) are quite similar to those reported in the initial 2008 RAPID3 report.2


2021 ◽  
Vol 41 (1) ◽  
pp. 22-26
Author(s):  
Thomas Ferenc ◽  
Anna Mrzljak ◽  
Irena Tabain ◽  
Tatjana Vilibić-Čavlek

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 ( SARS-CoV-2). It usually presents with mild common cold-like symptoms. However, it can lead to series of complications with some of them being fatal. One of the rare and potentially neglected manifestations of COVID-19 is subacute thyroiditis (SAT). Viral causes of SAT documented so far include several viruses, but according to the newest reports, SARS-CoV-2 should also be added to the list. The median time between COVID-19 diagnosis and the onset of SAT symptoms is reported to be 29 days. Patients mostly present with triphasic course of symptoms - thyrotoxicosis, followed by hypothyroidism and euthyroidism. Although limited number of SAT cases after SARS-CoV-2 infection are reported, physicians should consider SAT as a differential diagnosis in COVID-19 patients. The routine assessment of thyroid function in patients with clinical suspicion of SAT or with the suspicion of any other thyroid dysfunction is advised.


Cancers ◽  
2021 ◽  
Vol 13 (19) ◽  
pp. 4924
Author(s):  
Noemí Puig ◽  
Juan Flores-Montero ◽  
Leire Burgos ◽  
María-Teresa Cedena ◽  
Lourdes Cordón ◽  
...  

Background: Whereas, in most patients with multiple myeloma (MM), achieving undetectable MRD anticipates a favorable outcome, some others relapse shortly afterwards. Although one obvious explanation for this inconsistency is the use of nonrepresentative marrow samples due to hemodilution, there is no guidance on how to evaluate this issue. Methods: Since B-cell precursors, mast cells and nucleated red blood cells are normally absent in peripheral blood, we analyzed them in 1404 bone marrow (BM) aspirates obtained in numerous disease settings and in 85 healthy adults (HA). Results: First, we confirmed the systematic detection of the three populations in HA, as well as the nonreduced numbers with aging. Pairwise comparisons between HA and MM patients grouped according to age and treatment showed significant variability, suggesting that hemodilution should be preferably evaluated with references obtained from patients treated with identical regimens. Leveraging the MRD results from 118 patients, we showed that a comparison with HA of similar age could also inform on potential hemodilution. Conclusions: Our study supports the routine assessment of BM cellularity to evaluate hemodilution, since reduced BM-specific cell types as compared to reference values (either treatment-specific or from HA if the former are unavailable) could indicate hemodilution and a false-negative MRD result.


2021 ◽  
Vol 10 (18) ◽  
pp. 4160
Author(s):  
César Picado ◽  
Iñaki Ortiz de Landazuri ◽  
Alexandru Vlagea ◽  
Irina Bobolea ◽  
Ebymar Arismendi ◽  
...  

Background: Selective IgE deficiency (SIgED) has been previously evaluated in selected patients from allergy units. This study investigates the effects of SIgED on the entire population in a hospital setting and sought to delineate in detail the clinical aspects of SIgED. Methods: A retrospective study of the data obtained from electronic medical records of 52 adult patients (56% female) with a mean age of 43 years and IgE levels of <2.0 kU/L with normal immunoglobulin (Ig) IgG, IgA, and IgM levels, seen at our hospital, without selection bias, from 2010 to 2019. Results: Recurrent upper respiratory infections were recorded in 18 (34.6%) patients, pneumonia was recorded in 16 (30.7%) patients, bronchiectasis was recorded in 16 (30.7%) patients, and asthma was recorded in 10 (19.2%) patients. Eighteen patients (34.6%) suffered autoimmune clinical manifestations either isolated (19%) or combining two or more diseases (15%), Hashimoto’s thyroiditis being the most frequent (19%), which was followed by arthritis (10%) and thrombocytopenia and/or neutropenia (5.7%). Other less frequent associations were Graves’ disease, primary sclerosing cholangitis, Sjögren’s syndrome, and autoimmune hepatitis. Eczematous dermatitis (15.3%), chronic spontaneous urticaria (17.3%), and symptoms of enteropathy (21%) were also highly prevalent. Thirty percent of patients developed malignancies, with non-Hodgkin lymphomas (13.4%) being the most prevalent. Conclusions: The clinical manifestations of SIgED encompass a variety of infectious, non-infectious complications, and malignancy. Since it cannot be ruled out that some type of selection bias occurred in the routine assessment of IgE serum Ievels, prospective studies are required to better characterize SIgED and to determine whether it should be added to the list of antibody deficiencies.


Author(s):  
Leah F. Moriarty ◽  
Papy Mandoko Nkoli ◽  
Joris Losimba Likwela ◽  
Patrick Mitashi Mulopo ◽  
Eric Mukomena Sompwe ◽  
...  

Routine assessment of the efficacy of artemisinin-based combination therapies (ACTs) is critical for the early detection of antimalarial resistance. We evaluated the efficacy of ACTs recommended for treatment of uncomplicated malaria in five sites in Democratic Republic of the Congo (DRC): artemether-lumefantrine (AL), artesunate-amodiaquine (ASAQ), and dihydroartemisinin-piperaquine (DP). Children aged 6–59 months with confirmed Plasmodium falciparum malaria were treated with one of the three ACTs and monitored. The primary endpoints were uncorrected and polymerase chain reaction (PCR)-corrected 28-day (AL and ASAQ) or 42-day (DP) cumulative efficacy. Molecular markers of resistance were investigated. Across the sites, uncorrected efficacy estimates ranged from 63% to 88% for AL, 73% to 100% for ASAQ, and 56% to 91% for DP. PCR-corrected efficacy estimates ranged from 86% to 98% for AL, 91% to 100% for ASAQ, and 84% to 100% for DP. No pfk13 mutations previously found to be associated with ACT resistance were observed. Statistically significant associations were found between certain pfmdr1 and pfcrt genotypes and treatment outcome. There is evidence of efficacy below the 90% cutoff recommended by WHO to consider a change in first-line treatment recommendations of two ACTs in one site not far from a monitoring site in Angola that has shown similar reduced efficacy for AL. Confirmation of these findings in future therapeutic efficacy monitoring in DRC is warranted.


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