Background
An elevated blood eosinophil count when asthma is stable predicts exacerbations and therapeutic response to corticosteroids or biologics targeting eosinophils. Few studies have examined the prognostic value of blood eosinophils measured at exacerbation.
Aim
To elucidate the relationship between a spot blood eosinophil count–measured at the onset of a life‐threatening asthma exacerbation–with indices of exacerbation severity and risk of subsequent exacerbations.
Methods
Real‐world, retrospective review of all life‐threatening asthma cases admitted at 4 public hospitals in Singapore between 2011‐2015. We assessed the trends and correlations between blood eosinophil count on admission with arterial blood gas values, duration of mechanical ventilation, and risk of death, hypoxic ischemic encephalopathy or respiratory arrest. Risk of future exacerbations among survivors was modelled using Cox regression and survival curves.
Results
There were 376 index life‐threatening exacerbations with median blood eosinophil count (5‐95th percentiles) of 0.270 × 109/L (0‐1.410 × 109/L). Arterial pH decreased and PCO2 increased with increasing eosinophil count. Duration of mechanical ventilation and risk of death, hypoxic ischaemic encephalopathy or respiratory arrest did not vary with eosinophils. Among 329 survivors who were followed‐up over a median of 52 months, blood eosinophils ≥1.200 × 109/L was associated with an increased hazard of emergency visits and/or admissions for asthma (hazard ratio 1.8, 95% confidence interval 1.1‐2.9, P = .02).
Conclusion
In this study of life‐threatening asthma, we found that a spot blood eosinophil count correlates with severity of respiratory failure and predicts risk of subsequent exacerbations.
The long-term outcomes of osseointegration for digital amputations are not well established, and it is not known whether osseointegration can achieve similar function and patient satisfaction to conventional surgical options such as replantation and microsurgical toe transfer. We compared the long-term outcomes after digital osseointegration and replantation. Six patients treated by osseointegration and seven patients treated by replantation were included, with median follow-ups of 8 years and 4.6 years, respectively. Outcomes were assessed using the Michigan Hand Outcomes Questionnaire, grip and pinch strength, range of motion, two-point discrimination, Semmes-Weinstein tests, Jebsen-Taylor Hand Function Test and clinical photography. Osseointegration was associated with poorer sensibility and range of motion than replantation; no other differences reached statistical significance. Long-term osseointegration is a safe and effective reconstructive option that can deliver excellent outcomes in appropriately selected patients. Level of evidence: IV
Community partnerships and active learning community-based interventions may be effective in increasing the commitment, but not intentions to donate. However, the overall risk of bias for was high, and this may have led to overestimation of the relative treatment effects of these interventions.
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