Few studies have evaluated the utility of Aspergillus fumigatus-specific IgG in allergic bronchopulmonary aspergillosis (ABPA). Herein, we evaluate the role of specific IgG in diagnosis and monitoring treatment response in ABPA. Forty-eight control subjects with A. fumigatus-associated asthma underwent A. fumigatus-specific IgG measurements at baseline, while specific IgG was assayed in 102 treatment-naïve subjects of ABPA at baseline, after eight weeks of glucocorticoid therapy, and during exacerbations. For determining the cut-off of A. fumigatus-specific IgG, we randomly classified two-thirds of the study subjects (cases and controls) as the derivation cohort, while the remaining one-thirds were labelled as the validation cohort. The best cut-off value of A. fumigatus-specific IgG in the derivation cohort was 26.9 mg /L (sensitivity: 88%; specificity: 100%). Using this limit, the sensitivity and specificity of A. fumigatus-specific IgG in diagnosis of ABPA was 89% and 100%, respectively, in the validation cohort. In contrast, the sensitivity of Aspergillus precipitins was only 27.4%. Following treatment, the A. fumigatus-specific IgG increased in 38 (37.2%) subjects, while it decreased in three (23.1%) of the 13 subjects experiencing an exacerbation. The A. fumigatus-specific IgG was found to be an extremely useful test in the diagnosis and differential diagnosis of ABPA but is unreliable in monitoring treatment response in this disorder.
There has been a lot of recent excitement regarding elevated serum uric acid as it has been correlated with not just the traditional disorders associated with it, like gout and nephrolithiasis, but also with numerous other chronic diseases like chronic kidney disease, metabolic syndrome, hypertension, coronary artery disease etc which have emerged as the new epidemic of the twenty first century. Although numerous studies have explored the correlation of gout with these lifestyle disorders, none has as yet managed to elucidate the role, if any; hyperuricemia plays in the causation of these. The fact that the rise in mean serum uric acid levels parallels the increase in consumption of certain dietary products has also received a lot of attention. In recent times, light has been shed onto the exact mechanism of renal handling of uric acid, the transporters involved in the tubular excretion and reabsorption, which maintain uric acid homeostasis in our body. We know now that a slight disturbance can overwhelm this machinery and contribute greatly towards the development of hyperuricemia in a given individual. The purpose of this review is to provide a basic understanding into what position this molecule holds in the current clinical scenario and more importantly, how we got here.
Introduction: The COVID-19 pandemic is a global crisis, the number of cases and deaths are on a steep incline. This article reviews the possible immunological mechanisms which underlie the disease pathogenesis by looking at the behaviour of previous coronaviruses not only in humans but also other mammals which possibly act as reservoir hosts. Observations: A key aspect of this coronavirus as well as the previous SARS CoV seems to be the importance of host immune response in the pathology and clinical severity of illness caused by them. A hyperactive innate immune state in combination with an exhausted adaptive immune response are possible determinants of severe illness. Conclusion: There is a possibility that the current SARS CoV 2 has immune evasive tactics similar to SARS CoV in its repertoire, since they share a 76% homology. These might have been learnt behaviour from long periods of persistence in their reservoir hosts and they may be the reason behind the dysregulated immune response evoked in humans. That in turn is highly likely to be one of the factors which govern disease severity. With this in mind we want to bring the medical community’s attention to a ‘hit early, hit hard’ intervention as a possible strategy to modify the course of the disease and bring down the numbers of severe sufferers.
The COVID-19 pandemic has brought an unprecedented challenge to public health. Numerous scientific publications are published daily on COVID-19 to understand the unexplored facets of the disease. The sheer volume of these publications makes it daunting for researchers to quickly find information and evaluate data related to specific COVID-19 queries. Natural Language Processing (NLP), a form of artificial intelligence, assists in churning these huge piles of data with a sophisticated algorithmic approach. The purpose of this study is to investigate key a COVID-19 question by using NLP on scientific publications. Using the T5 (Text-To-Text Transfer Transformer) model, we analyzed 740,000 journal abstracts for specific answers an important COVID-19 question. We performed qualitative observations, T-Tests (p-values and inferences), and accuracy metrics (Precision, Recall, and F1 score) to evaluate the models in this study. As the number of scientific publications increases, our proposed methodology provides an efficient mechanism for performing specific information retrieval for emerging questions, diseases, and related conditions, especially for underrepresented populations.
In this study, a combination of clinical and hematological information, collected on day of presentation to the hospital with pneumonia, was evaluated for its ability to predict severity and mortality outcomes in COVID-19. Ours is a retrospective, observational study of 203 hospitalized COVID-19 patients. All of them were confirmed RT-PCR positive cases. We used simple hematological parameters (total leukocyte count, absolute neutrophil count, absolute lymphocyte count, neutrophil to lymphocyte ration and platelet to lymphocyte ratio); and a severity classification of pneumonia (mild, moderate and severe) based on a single clinical parameter, the percentage saturation of oxygen at room air, to predict the outcome in these cases. The results show that a high absolute neutrophil count on day of onset of pneumonia symptoms correlated strongly with both severity and survival in COVID-19. In addition, it was the primary driver of an initial high neutrophil-to-lymphocyte ratio (NLR) observed in patients with severe disease. The effect of low lymphocyte count was not found to be very significant in our cohort. Multivariate logistic regression was done using Python 3.7 to assess whether these parameters can adequately predict survival. We found that clinical severity and a high neutrophil count on day of presentation of pneumonia symptoms could predict the outcome with 86% precision. This model is undergoing further evaluation at our centre for validation using data collected during the second wave of COVID-19. We present the relevance of an elevated neutrophil count in COVID-19 pneumonia and review the advances in research which focus on neutrophils as an important effector cell of COVID-19 inflammation.
Objectives To identify factors that drive high biologic usage in a real-world clinical setting. Methods We collected retrospective data from all patients with axial spondyloarthritis who had received biologic therapy for their disease in our designated specialised clinic in a tertiary centre. Our outcome measure was ‘high biologic usage’ (defined as the use ≥ 3 biologic drugs/tsDMARDs and/or ≥ 2 biologic pathways targeted for therapy. We analysed patient age, sex, BMI, the concomitant presence of chronic widespread pain (CWP), HLA-B27 positivity, radiographic-SpA, extra-articular manifestations, time to initiate biologic therapy from diagnosis and disease activity measures (BASDAI, pain VAS and CRP) to identify predictors. Results Out of a total of 227 patients in our axSpA cohort, 166 (71% male, mean age 48 years) had received biologic therapy. Of these, 62 (27%) met the definition of high biologic usage. Our analysis identified four factors that were significantly associated with our outcome: HLA-B27 positivity (positive correlation), time to start biologic from diagnosis (negative correlation), concomitant chronic widespread pain (negative correlation) and aggregate BASDAI burden while on biologics (positive correlation). Conclusion There was a significant cohort of axial spondyloarthritis patients who met our criteria of ‘high biologic usage’. HLA-B27 positivity, the early requirement of biologics in the disease course and higher aggregate BASDAI burden were associated with greater biologic usage. A concomitant diagnosis of chronic widespread pain has the confounding effect of being associated with a higher BASDAI though lower biologic usage, exemplifying the impact this diagnosis has on clinical decision making. Key messages: Patients with axSpA receiving high-cost therapies form distinct clusters based on response to treatment, and the presence or absence of CWP. Concurrent CWP in axSpA can introduce cognitive bias when deciding on the need for change in therapy, especially given the subjective nature of assessments including BASDAI. AxSpA patients with CWP are likely to represent a distinct subtype of disease who display worse clinical outcomes and are likely to require alternative management strategies.
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