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Journal of Thrombosis and Haemostasis :... Dec 2023Triple positivity for all 3 criteria antiphospholipid antibodies confers high risk of symptom development in carriers, and recurrence in antiphospholipid syndrome (APS)....
BACKGROUND
Triple positivity for all 3 criteria antiphospholipid antibodies confers high risk of symptom development in carriers, and recurrence in antiphospholipid syndrome (APS). Most triple-positivity studies report lupus anticoagulant (LA) testing as positive without distinguishing between positivity with dilute Russell's viper venom time (dRVVT) and activated partial thromboplastin time (APTT) and single-assay positivity or only perform dRVVT. Single LA assay repertoires remain in use in some centers, which risks missing some triple positives. Positivity with both assays may identify higher risk.
OBJECTIVES
The aim of this study is to investigate the frequency of single LA assay positivity in triple-positive patients.
METHODS
Three hundred forty-two triple-positive profiles from nonanticoagulated patients (237 APS, 45 systemic lupus erythematosus without APS symptoms, and 60 nonclinical criteria) were identified from laboratory databases and assessed for LA positivity by dRVVT and/or APTT.
RESULTS
Seventy-three of 237 (30.8%) APS samples were LA-positive with 1 assay, 40/237 (16.9%) by dRVVT only, and 33/237 (13.9%) with APTT only. Nineteen of 45 (42.2%) were LA-positive with 1 assay in the systemic lupus erythematosus cohort; 12/45 (26.7%) with dRVVT only and 7/45 (15.5%) with APTT only. Thirty-three of 60 (55.0%) were LA-positive with 1 assay in the nonclinical criteria cohort; 24/60 (40.0%) with dRVVT only and 9/60 (15.0%) with APTT only. The most common solid-phase assay profile was elevated immunoglobulin G aCL and aβ2GPI.
CONCLUSION
Up to 55.0% of triple-positive samples were positive in 1 LA assay, representing significant potential for misdiagnosis and inappropriate management via single LA assay repertoires.
Topics: Humans; Antiphospholipid Syndrome; Lupus Coagulation Inhibitor; Blood Coagulation Tests; Antibodies, Antiphospholipid; Prothrombin Time; Partial Thromboplastin Time; Lupus Erythematosus, Systemic
PubMed: 37597725
DOI: 10.1016/j.jtha.2023.08.009 -
Hospital Pediatrics Oct 2022Caregivers are often at the bedside of hospitalized children posing an additional risk for coronavirus disease 2019 (COVID-19) transmission. We describe the...
BACKGROUND
Caregivers are often at the bedside of hospitalized children posing an additional risk for coronavirus disease 2019 (COVID-19) transmission. We describe the implementation of caregiver COVID-19 testing before inpatient pediatric admissions and the effect on patient cohorting and bed capacity.
METHODS
We implemented an ordering pathway to facilitate COVID-19 testing of caregivers of patients admitted to the inpatient units from the pediatric emergency department, elective procedural admissions, or direct admissions at a tertiary children's hospital in the Northeastern United States in August 2021. Testing was expedited by the clinical laboratory, and caregiver results were used to inform cohorting, infection prevention, and bed management decisions.
RESULTS
From August 2021 to January 2022, 2558 caregiver tests were ordered through this pathway, and 83 (3.2%) were positive. Of the positive tests, 72 (86.7%) occurred after December 18, 2021, coinciding with the local Omicron variant wave. Among positives, 67 caregiver or child pairs were identified, and 36 positive caregivers had a COVID-19 negative child leading to use of isolation precautions. Reintroduction of patient cohorting increased overall bed capacity from 74% to 100% of available beds.
CONCLUSIONS
The overall incidence of COVID-19 among caregivers before admission correlated well with rates of COVID-19 positivity among asymptomatic adults in the community during the study period. Implementation of caregiver testing increased bed capacity by reintroducing cohorting of patients and identified patients needing isolation that would have been missed by patient testing alone. More research is necessary to determine the extent that routine caregiver testing mitigates the risk of nosocomial severe acute respiratory syndrome coronavirus 2 transmission.
Topics: Adult; COVID-19; COVID-19 Testing; Caregivers; Child; Humans; SARS-CoV-2
PubMed: 36047308
DOI: 10.1542/hpeds.2022-006715 -
Frontiers in Endocrinology 2023To explore the impact of diabetes itself and glycemic control status on tuberculosis (TB).
OBJECTIVES
To explore the impact of diabetes itself and glycemic control status on tuberculosis (TB).
METHODS
A total of 3393 patients with TB and diabetes mellitus (DM) who were hospitalized in the Public Health Clinical Center of Chengdu from January 1, 2019, to December 31, 2021, were retrospectively included and divided into three groups according to baseline glycemic control status: two groups according to glycemic status at discharge, two groups according to cavity occurrence, three groups according to sputum results, and three groups according to lesion location. The influencing factors and the differences in cavity occurrence, sputum positivity and lesion location among different glycemic control groups or between different glycemic status groups were analyzed.
RESULTS
In this TB with DM cohort, most of the subjects were male, with a male to female ratio of 4.54:1, most of them were 45-59 years old, with an average age of 57.44 ± 13.22 years old. Among them, 16.8% (569/3393) had cavities, 52.2% (1770/3393) were sputum positive, 30.4% (1030/3393) had simple intrapulmonary lesions, 68.1% (2311/3393) had both intra and extrapulmonary lesions, only 15.8% (537/3393) had good glycemic control,16.0% (542/3393) and 68.2% (2314/3393) had fair and poor glycemic control, respectively. Compared with the non-cavity group, the sputum-negative group and the extrapulmonary lesion group, the cavity group, sputum-positive group, intrapulmonary lesion group and the intra and extrapulmonary lesion group all had higher fasting plasma glucose (FPG) and glycosylated hemoglobin A 1c (HbA1c) and lower good glycemic control rates at admission (all <0.001). Another aspect, compared with the good glycemic control group, the poor glycemic control group had a higher cavity occurrence rate, sputum positive rate, and greater proportion of intrapulmonary lesions. Moreover, FPG and HbA1c levels and poor glycemic control were significantly positively correlated with cavity occurrence, sputum positivity, and intrapulmonary lesions and were the main risk factors for TB disease progression. On the other hand, cavity occurrence, sputum positivity, and intrapulmonary lesions were also main risk factors for hyperglycemia and poor glycemic control.
CONCLUSION
Diabetes itself and glycemic control status could impact TB disease. Good glycemic control throughout the whole process is necessary for patients with TB and DM to reduce cavity occurrence and promote sputum negative conversion and lesion absorption.
Topics: Humans; Male; Female; Adult; Middle Aged; Aged; Glycated Hemoglobin; Retrospective Studies; Tuberculosis, Pulmonary; Glycemic Control; Diabetes Mellitus; Tuberculosis; Hyperglycemia
PubMed: 38027218
DOI: 10.3389/fendo.2023.1250001 -
PLoS Neglected Tropical Diseases Feb 2022Lymphatic filariasis (LF) has been targeted for global elimination as a public health problem since 1997. The primary strategy to interrupt transmission is annual mass...
BACKGROUND
Lymphatic filariasis (LF) has been targeted for global elimination as a public health problem since 1997. The primary strategy to interrupt transmission is annual mass drug administration (MDA) for ≥5 years. The transmission assessment survey (TAS) was developed as a decision-making tool to measure LF antigenemia in children to determine when MDA in a region can be stopped. The objective of this study was to investigate potential sampling strategies for follow-up of LF-positive children identified in TAS to detect evidence of ongoing transmission.
METHODOLOGY/PRINCIPLE FINDINGS
Nippes Department in Haiti passed TAS 1 with 2 positive cases and stopped MDA in 2015; however, 8 positive children were found during TAS 2 in 2017, which prompted a more thorough assessment of ongoing transmission. Purposive sampling was used to select the closest 50 households to each index case household, and systematic random sampling was used to select 20 households from each index case census enumeration area. All consenting household members aged ≥2 years were surveyed and tested for circulating filarial antigen (CFA) using the rapid filarial test strip and for Wb123-specific antibodies using the Filaria Detect IgG4 ELISA. Among 1,927 participants, 1.5% were CFA-positive and 4.5% were seropositive. CFA-positive individuals were identified for 6 of 8 index cases. Positivity ranged from 0.4-2.4%, with highest positivity in the urban commune Miragoane. Purposive sampling found the highest number of CFA-positives (17 vs. 9), and random sampling found a higher percent positive (2.4% vs. 1.4%).
CONCLUSIONS/SIGNIFICANCE
Overall, both purposive and random sampling methods were reasonable and achievable methods of TAS follow-up in resource-limited settings. Both methods identified additional CFA-positives in close geographic proximity to LF-positive children found by TAS, and both identified strong signs of ongoing transmission in the large urban commune of Miragoane. These findings will help inform standardized guidelines for post-TAS surveillance.
Topics: Animals; Antigens, Helminth; Child; Elephantiasis, Filarial; Filaricides; Follow-Up Studies; Haiti; Humans; Mass Drug Administration; Prevalence; Wuchereria bancrofti
PubMed: 35213537
DOI: 10.1371/journal.pntd.0010231 -
American Journal of Clinical Pathology Nov 2019Multiple practice guidelines discourage indiscriminate use of broad panels of allergen-specific IgE (sIgE) tests due to increased risk of false positives and...
OBJECTIVES
Multiple practice guidelines discourage indiscriminate use of broad panels of allergen-specific IgE (sIgE) tests due to increased risk of false positives and misinterpretation of results. We provide an analytical framework to identify specialty-specific differences in ordering patterns and effectiveness, which can be used to improve test utilization.
METHODS
Test results from a tertiary pediatric hospital were analyzed by ordering specialty to evaluate size of allergen workups. Positivity rates were analyzed to determine effectiveness in selecting tests with high positive pretest probabilities. Laboratory test menu components were also evaluated.
RESULTS
Our findings demonstrate 29% of sIgE tests are ordered as part of broad workups (>20 sIgE tests/date of service) contrary to the recommended testing approach. Detailed descriptions of ordering patterns and positivity rates are provided.
CONCLUSIONS
This study provides a framework for using a cross-sectional analytical approach to assess test utilization patterns and evaluate components of laboratory testing menus.
Topics: Allergy and Immunology; Child; Cross-Sectional Studies; Dermatology; Female; Gastroenterology; Guideline Adherence; Humans; Hypersensitivity; Immunoglobulin E; Male; Naturopathy; Pediatrics; Practice Patterns, Physicians'; Pulmonary Medicine
PubMed: 31332424
DOI: 10.1093/ajcp/aqz097 -
International Journal of Cancer Mar 2022How to manage human papillomavirus (HPV)-positive women in cervical cancer screening remains debated. Our study compared different strategies to triage HPV positivity in...
How to manage human papillomavirus (HPV)-positive women in cervical cancer screening remains debated. Our study compared different strategies to triage HPV positivity in a large cohort of women participating in a population HPV-based screening program. Women were tested for HPV (Cobas 4800; Roche), and those positive were triaged with cytology; cytology-positives were referred to colposcopy, while negatives were referred to 1-year HPV retesting. All HPV-positive women were also evaluated with p16/ki67 dual staining (Roche). All lesions found within 24 months of follow-up were included in the analyses. Of the 70 146 women tested, 4757 (6.8%) were HPV-positive. Of these, 1090 were cytology-positive and were referred to colposcopy. Of the 2958 HPV-positive/cytology-negative women who presented at 1-year retesting, 1752 (59.9%) still tested positive. Cumulatively, 532 CIN2+ (including 294 CIN3+) were found. The sensitivity of cytology, HPV16/18 and p16/ki67 as triage test for CIN3+ was 67.9%, 56.0% and 85.0%, respectively. The positive predictive value (PPV) for immediate colposcopy referral was 21.0%, 15.8% and 22.9%, respectively. Combining cytology with typing increased sensitivity to 83.9% and lowered PPV to 14.8%, while combining p16/ki67 and typing increased sensitivity to 91.1%, lowering the PPV to 15.9%. Women negative to p16/ki67 triage presented a cumulative 1-year CIN3+ risk of about 1%. In conclusion, when triaging HPV positivity, p16/ki67 performed better than cytology with or without HPV16/18 genotyping. The strategies that included dual staining achieved sensitivity and low 1-year risk for CIN3+ sufficiently high enough to permit considering extending the surveillance interval to 2 to 3 years for HPV-positive/triage-negative women.
Topics: Cyclin-Dependent Kinase Inhibitor p16; Female; Genotype; Human Papillomavirus DNA Tests; Human papillomavirus 16; Human papillomavirus 18; Humans; Ki-67 Antigen; Triage; Uterine Cervical Neoplasms; Uterine Cervical Dysplasia
PubMed: 34706093
DOI: 10.1002/ijc.33858 -
Frontiers in Neurology 2023In this study, we aim to evaluate the treatment responses and prognostic characteristics of Myasthenia Gravis (MG) patients followed in a tertiary neuromuscular diseases...
INTRODUCTION
In this study, we aim to evaluate the treatment responses and prognostic characteristics of Myasthenia Gravis (MG) patients followed in a tertiary neuromuscular diseases center in Turkey.
METHODS
One hundred seventy four MG patients (between years 2011 and 2022) in Antalya, Turkey were diagnosed, and evaluated on a classification of MG was based on Myasthenia. Gravis Foundation of America (MGFA) clinical classification. Exclusion of other possible diseases in the differential diagnosis and support by beneficial response to treatment with acetylcholinesterase inhibitors were also taken into consideration.
RESULTS
Mean age of participants was 54.86 (SD = 14.856; min-max = 22-84). Ninety (51.7%) were female. MG was more common in women under the age of 65 (58%) and in men over the age of 65 (64%). Generalized MG was seen in 75.3% of the patients. Anti-AChR positivities were detected in 52.3%, Anti-MuSK positivity in 4.6%, and seronegativity in 22.4%. Thymoma was detected in nearly 9.8% and thymectomy was performed in 28.7 percent. Most of the patients (57.5%) were using corticosteroids. Azathioprine was used by 39% and mycophenolate mofetil by 10.3% of patients. Mortality was higher and disease was more severe in late-onset (>50 years) MG patients (especially in the COVID-19 pandemic). Eight patients (four women, four men, mean age 75.5 years) died during follow-up. None of them died due to myasthenic worsening, two died due to malignancy and two due to infection. During the COVID pandemic, 16 patients (9.2%) had COVID infection. Four patients died due to COVID-19 infection, these four patients had serious comorbidities, and three of them were elderly (>75 years).
CONCLUSION
In conclusion, MG is more common in women between the ages of 20-40 and in men over the age of 65. The use of corticosteroids was more common under the age of 50, and the use of non-steroidal immunosuppressant agents was more common over the age of 50. Thymectomy is still an important supportive treatment approach in anti-AChR positive and seronegative generalized patients under 50 years of age. IVIG and plasmapheresis are effective treatments during acute exacerbations and bridging periods of treatments. Specific treatments are needed especially for resistant group of patients.
PubMed: 37602241
DOI: 10.3389/fneur.2023.1176636 -
PloS One 2021In Western societies, the stereotype prevails that pink is for girls and blue is for boys. A third possible gendered colour is red. While liked by women, it represents...
In Western societies, the stereotype prevails that pink is for girls and blue is for boys. A third possible gendered colour is red. While liked by women, it represents power, stereotypically a masculine characteristic. Empirical studies confirmed such gendered connotations when testing colour-emotion associations or colour preferences in males and females. Furthermore, empirical studies demonstrated that pink is a positive colour, blue is mainly a positive colour, and red is both a positive and a negative colour. Here, we assessed if the same valence and gender connotations appear in widely available written texts (Wikipedia and newswire articles). Using a word embedding method (GloVe), we extracted gender and valence biases for blue, pink, and red, as well as for the remaining basic colour terms from a large English-language corpus containing six billion words. We found and confirmed that pink was biased towards femininity and positivity, and blue was biased towards positivity. We found no strong gender bias for blue, and no strong gender or valence biases for red. For the remaining colour terms, we only found that green, white, and brown were positively biased. Our finding on pink shows that writers of widely available English texts use this colour term to convey femininity. This gendered communication reinforces the notion that results from research studies find their analogue in real word phenomena. Other findings were either consistent or inconsistent with results from research studies. We argue that widely available written texts have biases on their own, because they have been filtered according to context, time, and what is appropriate to be reported.
Topics: Color; Female; Humans; Language; Male; Sexism; Young Adult
PubMed: 34061875
DOI: 10.1371/journal.pone.0251559 -
Biomedica : Revista Del Instituto... Mar 2019Direct visual inspection for cervical cancer screening remains controversial, whereas colposcopy-biopsy is considered the gold standard for diagnosis of preneoplastic... (Comparative Study)
Comparative Study
INTRODUCTION
Direct visual inspection for cervical cancer screening remains controversial, whereas colposcopy-biopsy is considered the gold standard for diagnosis of preneoplastic cervical lesions.
OBJECTIVES
To determine the rates of cervical intraepithelial neoplasia grade 2 or more and of false positives for colposcopy and direct visual inspection.
MATERIALS AND METHODS
Women aged 25-59 underwent direct visual inspection with acetic acid (VIA), Lugol's iodine (VIA-VILI), and colposcopy. Punch biopsies were obtained for all positive tests. Using histology as the gold standard, detection and false positive rates were compared for VIA, VIA-VILI, and colposcopy (two thresholds). Sensitivity and false positive ratios with the corresponding 95% confidence intervals were estimated.
RESULTS
We included 5,011 women in the analysis and we obtained 602 biopsies. Positivity rates for colposcopy high-grade and low-grade diagnosis were 1.6% and 10.8%. Positivity rates for VIA and VIA-VILI were 7.4% and 9.9%. VIA showed a significantly lower detection rate than colposcopy with low-grade diagnosis as the threshold (SR=0.72; 95% CI 0.57-0.91), and significantly lower false positive rate (FPR=0.70; 95% CI 0.65-0.76). No differences between VIA-VILI and colposcopy low-grade threshold were observed. VIA and VIA-VILI showed significantly higher detection and false positive rates than colposcopy high-grade threshold. Sensitivity rates for visual inspection decreased with age and false positive rates increased. For all age groups, false positive rates for VIA and VIA-VILI were significantly higher than colposcopy.
CONCLUSIONS
Detection rates for VIA-VILI similar to colposcopy low-grade threshold represent a chance to reduce cervical cancer mortality through see-and-treat approaches among women with limited access to health care. Lower detection rates suggest reviewing high-grade colposcopy findings as the threshold for biopsy in certain settings.
Topics: Acetic Acid; Adult; Biopsy; Colombia; Colposcopy; Early Detection of Cancer; False Positive Reactions; Female; Humans; Iodides; Middle Aged; Uterine Cervical Neoplasms; Uterine Cervical Dysplasia
PubMed: 31021548
DOI: 10.7705/biomedica.v39i1.4007 -
Neuropsychologia Oct 2019The current study investigated behavioral and electrophysiological (event-related potential; ERP) differences associated with task switching in a sample of young and...
The current study investigated behavioral and electrophysiological (event-related potential; ERP) differences associated with task switching in a sample of young and older monolingual and bilingual adults. ERPs associated with task preparation (switch and mixing positivity) and task execution processes (N2 and P3b) were investigated. Participants performed a cued letter-number task switching paradigm that included single task and mixed task blocks, while their electroencephalography was recorded. Behavioral results revealed smaller switch and mixing costs in bilinguals relative to monolinguals, in both young and older participants. There were no ERP differences in the effect size of the cue-locked mixing and switch positivities, nor the target-locked mixing and switch N2 and P3b components. However, overall larger target-locked N2 amplitudes were observed in bilinguals relative to monolinguals. In addition, bilingual older adults exhibited smaller P3b amplitudes than monolingual older adults. The smaller behavioral mixing and switch costs observed in bilinguals suggest that bilinguals exhibit superior sustained attention and faster task-set reconfiguration processes compared to monolinguals. The ERP measures provide evidence for differences in brain processes between monolinguals and bilinguals and a reliance on different processing strategies in bilingual compared to monolingual older adults.
Topics: Adult; Age Factors; Aged; Attention; Brain; Cerebral Cortex; Cues; Electroencephalography; Event-Related Potentials, P300; Evoked Potentials; Female; Humans; Male; Multilingualism; Reaction Time; Young Adult
PubMed: 31513809
DOI: 10.1016/j.neuropsychologia.2019.107186