Objectives: To investigate potential predictors of treatment response in primary Sjögren's syndrome (pSS) patients with severe immune thrombocytopenia (ITP), with a focus on bone marrow megakaryocyte (MK) count. Methods:This case-control study included patients with pSS and severe ITP who were admitted to Peking Union Medical College Hospital and met the 2002 AECG or 2016 American College of Rheumatology / European League Against Rheumatism criteria for SS. Patients who had overlap other connective tissue diseases and with thrombocytopenia that could be explained by other causes were excluded. Severe ITP was defined as platelet count <20 × 10 9 /L. Response was evaluated at 3 months after treatment.Results: Sixty-eight eligible patients were included: 34 (50%) achieved complete remission (CR), 18 (26%) partial remission (PR) and 16 (24%) were non-responders (NRs).Fewer infections were found in the CR group (24%) than in the PR (50%) and NR (56%) groups (P = 0.04). The MK count (CR 32 vs PR 36 vs NR 4 per slide, P < 0.001) in the NR group was significantly lower than in the other groups. MK count >6.5 per slide predicted good treatment response, with 85.7% sensitivity, 88.1% specificity and 0.866 area under the curve. Logistic regression indicated that patients with more MKs were more likely to respond to immunotherapy (crude odds ratio [OR] 1.45, 95% CI 1.2-2.0, adjusted OR 1.68, 95% CI 1.2-2.7).Conclusions: MK count predicted response to immunosuppressive treatment in pSS patients with severe ITP. These patients are recommended to have bone marrow aspiration before treatment initiation. Clinicians should be aware of screening for infections during clinical practice.
Introduction Psittacosis can cause severe community-acquired pneumonia (CAP). The clinical manifestations of psittacosis range from subclinical to fulminant psittacosis with multi-organ failure. It is essential to summarize the clinical characteristic of patients with severe psittacosis accompanied by acute hypoxic respiratory failure (AHRF). Methods This retrospective study included patients with severe psittacosis caused CAP accompanied by AHRF from 19 tertiary hospitals of China. We recorded the clinical data, antimicrobial therapy, respiratory support, complications, and outcomes. Chlamydia psittaci was detected on the basis of metagenomic next-generation sequencing performed on bronchoalveolar lavage fluid samples. Patient outcomes were compared between the treatment methods. Results This study included 45 patients with severe CAP and AHRF caused by psittacosis from April 2018 to May 2021. The highest incidence of these infections was between September and April. There was a history of poultry contact in 64.4% of the patients. The median PaO2/FiO2 of the patients was 119.8 (interquartile range, 73.2 to 183.6) mmHg. Four of 45 patients (8.9%) died in the ICU, and the median ICU duration was 12 days (interquartile range, 8 to 21) days. There were no significant differences between patients treated with fluoroquinolone initially and continued after the diagnosis, fluoroquinolone initially followed by tetracycline, and fluoroquinolone combined with tetracycline. Conclusion Psittacosis caused severe CAP seems not rare, especially in the patients with the history of exposure to poultry or birds. Empirical treatment that covers atypical pathogens may benefit such patients, which fluoroquinolones might be considered as an alternative.
Background: The relationship of spicy food intake with hyperuricemia remains unknown. The objective of this study was to examine the association between spicy food intake and hyperuricemia, and whether this association was mediated by body mass index (BMI) in Chinese rural population.Methods: 38, 027 adults aged 18–79 years were recruited from the Henan Rural Cohort Study. Information on spicy food intake was obtained using a validated questionnaire survey. Multivariable logistic regression model was used to estimate the association between spicy food intake and hyperuricemia, multiple linear regression model was performed to estimate the relationships between spicy food intake, BMI and serum urate level. BMI was used as a mediator to evaluate the mediation effect.Results: After adjusting for potential confounders, compared with no spicy food flavor, the odds ratio (OR) and 95% confidence interval (CI) of mild, middle, and heavy flavor for hyperuricemia were 1.09 (1.00-1.19), 1.10 (0.97-1.24), and 1.21 (1.10-1.46), respectively (Ptrend=0.017). Similarly, compared with those without intake in spicy food, the multivariable adjusted OR (95% CI) of 1-2days/week, 3-5 days/week, and 6-7 days/week were 1.15 (1.01-1.31), 1.14 (1.01-1.30) and 1.15 (1.05-1.26), respectively (Ptrend=0.007). However, when we further controlling for BMI, the associations were substantially attenuated. Furthermore, mediation analysis showed that BMI play a full mediating role in the relationship of spicy food intake with hyperuricemia.Conclusion: Spicy food flavor and intake frequency are positively related with hyperuricemia in Chinese rural population. BMI may play a full mediating role in the relationship.
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