scholarly journals Aspergillus fumigatus Antigen Detection in Sera from Patients at Risk for Invasive Aspergillosis

2000 ◽  
Vol 38 (1) ◽  
pp. 438-443
Author(s):  
Bernabé F. F. Chumpitazi ◽  
Claudine Pinel ◽  
Bernadette Lebeau ◽  
Pierre Ambroise-Thomas ◽  
Renee Grillot
Keyword(s):  
At Risk ◽  
Invasive Aspergillosis ◽  
Aspergillus Fumigatus ◽  
Polyclonal Antibodies ◽  
Latex Agglutination ◽  
Control Group ◽  
Molecular Weights ◽  
Circulating Antigens ◽  
Patients At Risk ◽  
Sensitivity Specificity

ABSTRACT We have developed an inhibition enzyme immunoassay (inhibition-EIA) to monitor for the occurrence of invasive aspergillosis (IA) in sera from 45 immunocompromised (IC) patients. The test uses rabbit polyclonal antibodies and a mixture of components from Aspergillus fumigatus , containing three predominant antigens with molecular weights of 18,000, 33,000, and 56,000. Circulating antigens were found in five of seven proven cases of IA due to A. fumigatus . In two of the five positive cases, antigenemia was detected with inhibition-EIA earlier than with X ray or other biological methods. No antigens were detected in the sera from two patients with proven IA due to Aspergillus flavus and Aspergillus terreus nor in the sera from four patients with probable IA. Circulating antigens were not detected in the control group, composed of 30 healthy adult blood donors. Four of the 32 at-risk patients examined, though they displayed no definite evidence of IA, gave a positive result in this test. The sensitivity, specificity, and positive predictive value of inhibition-EIA were 71.4, 94.4, and 71.2%, respectively. The data were compared with those obtained by a latex agglutination assay of galactomannan (GM) that was positive in only one patient with probable IA. The higher sensitivity obtained by inhibition-EIA may well be due to its ability to detect circulating antigens other than GM in the sera of IC patients with IA. Detecting these antigens may improve the diagnosis of IA, as they may serve as markers of this infection.

scholarly journals The importance of NT proBNP in hypertensive patients management for preventing heart failure

2021 ◽  
Vol 68 (1) ◽  
pp. 71-76
Author(s):  
Irina Cuciureanu ◽  
◽  
Anamaria-Georgiana Avram ◽  
Maria Suzana Guberna ◽  
Cătălina Liliana Andrei ◽  
...  
Keyword(s):  
Heart Failure ◽  
At Risk ◽  
Diastolic Dysfunction ◽  
Medical Management ◽  
Systolic Dysfunction ◽  
Intervention Group ◽  
Control Group ◽  
Cardiovascular Pathology ◽  
Hypertensive Patients ◽  
Patients At Risk

Purpose. NT proBNP is routinely used in the diagnosis and prognosis of HF. The study aimed to determine whether the value of NT proBNP can be used in hypertensive patients to detect patients at risk of developing HF and whether in these patients medical management guided by NT proBNP can prevent the development of HF. Material and methods. We included 275 hypertensive patients who presented to the Bagdasar-Arseni Emergency Hospital for cardiological consultation for a period of 3 years. Patients diagnosed with heart failure or left ventricular systolic dysfunction and patients with symptoms of heart failure at enrollment were excluded. We divided the patients into 2 groups, a control group and an intervention group. Patients in the intervention group were managed according to the NT proBNP value, and patients in the control group received standard treatment. Results. The objectives pursued at 3 years were: diagnosis of heart failure, systolic or diastolic dysfunction of the left ventricle and hospitalization for cardiovascular pathology. After 3 years, in the control group there were 34 patients (25.4%) who developed HF, compared to 24 patients (17.0%) in the intervention group. In the control group, 51 patients (38.1%) were diagnosed with LV systolic dysfunction compared to 37 patients (26.2%) in the intervention group. Regarding diastolic LV dysfunction, in the control group there were 83 patients (61.9%), and in the intervention group there were 73 patients (51.8%). Also, the rate of hospitalizations for cardiovascular pathology was higher in the control group 47 patients (35.1%) compared to 27 patients (19.1%) in the intervention group. Discussions. Hypertensive patients in the intervention group, who were managed according to the NT proBNP value, had a lower incidence rate of heart failure, LV systolic or diastolic dysfunction, or hospitalizations for cardiovascular events than in the control group. Conclusions. The value of NT proBNP may be useful for detecting hypertensive patients at risk of developing HF, and NT proBNP-guided medical management may prevent or delay the onset of HF.

scholarly journals Efficacy and Pharmacodynamics of Flucytosine Monotherapy in a Nonneutropenic Murine Model of Invasive Aspergillosis

2005 ◽  
Vol 49 (10) ◽  
pp. 4220-4226 ◽  
Author(s):  
D. T. A. te Dorsthorst ◽  
P. E. Verweij ◽  
J. F. G. M. Meis ◽  
J. W. Mouton
Keyword(s):  
Invasive Aspergillosis ◽  
Aspergillus Fumigatus ◽  
Survival Rates ◽  
Standard Condition ◽  
Dose Fractionation ◽  
Total Daily Dose ◽  
Control Group ◽  
Infection Model ◽  
Time Curve ◽  
Dosing Regimens

ABSTRACT The therapeutic efficacy of flucytosine (5FC) monotherapy and the pharmacodynamic index predictive of efficacy were evaluated in a nonneutropenic mouse model of acute invasive aspergillosis. Mice were infected intravenously with an Aspergillus fumigatus isolate (the median MICs of 5FC were 128 μg/ml under the standard condition, 0.5 μg/ml at pH 6.0, and 0.031 μg/ml at pH 5.0) 2 h prior to the start of therapy and were treated for 7 days with different 5FC dosing regimens. The total doses ranged from 50 to 800 mg/kg of body weight/day and were administered at 6-, 12-, and 24-h intervals. The efficacy was assessed by means of survival. The survival rates of the treatment groups ranged from 40 to 90%, while the survival rate of the control group was 20%. The efficacy found depended primarily on the total daily dose. However, the power of our sample size may have been too low to exclude an effect of dose fractionation. The pharmacodynamic index that most strongly correlated with the efficacy was the area under the serum concentration-time curve and MIC ratio (R 2 = 0.86). We conclude that 5FC monotherapy is efficacious in a murine Aspergillus fumigatus infection model.

A Biochemical Marker of Preeclampsia - Hypertriglyceridemia - and the Impact of Secondary Prevention Therapy

2018 ◽  
Vol 69 (10) ◽  
pp. 2740-2743
Author(s):  
Corina Grigoriu ◽  
Florentina Furtunescu ◽  
Laura Elena Gaman ◽  
Alice Lavinia Balaceanu ◽  
Ramona Buzatu ◽  
...  
Keyword(s):  
At Risk ◽  
Pregnant Women ◽  
Secondary Prophylaxis ◽  
Control Group ◽  
Maternal Complications ◽  
Prevention Therapy ◽  
Severe Hypertriglyceridemia ◽  
Patients At Risk ◽  
Anticoagulant Prophylaxis ◽  
The Impact

Changes in lipid metabolism from pregnancies with preeclampsia (PE) are a challenge for the obstetrician, because they contribute to the pathological chain and to some specific severe complications (severe hypertriglyceridemia of pregnancy, acute pancreatitis etc). Patients at risk for PE have higher levels of triglycerides, total and LDL cholesterol, compared to normotensive pregnant women. We searched the link between lipidic changes in pregnancies with PE and the way secondary prophylactic treatments with acetylsalicilic acid or low molecular weight heparin (LMWH) can influence the evolution of pregnancy, avoiding the severe complications of this disease. We identified patients at risk of developing PE and then applied a secondary prophylaxis with either a platelet antiaggregant (acetylsalycilic acid - a group of 36 patients) or an anticoagulant prophylaxis with LMWH � enoxaparin (a second group of 37 patients), aiming a decrease of severe complications of PIH/PE. The control group consisted of 33 pregnant women with risk factors for PE, without any secondary prophylaxis, according to actual guidelines. We periodically determined (at 14, 16-20 and 34 weeks of pregnancy) several biochemical parameters: triglycerides, uric acid, free fatty acids, total cholesterol and albuminemia. In the present paper we present the evolution of triglyceridemia in the studied groups, considering hypertriglyceridemia as an important prognostic factor for maternal complications in pregnancy. The most important result of our study is the statistically significant extremely low rate of complications in the treatment groups.

Validation of Serum Aspergillus Galactomannan Index as a Surrogate Endpoint for Outcome of Invasive Aspergillosis: Clinical and Research Implications.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 2861-2861 ◽  
Author(s):  
Gail Woods ◽  
Marisa Miceli ◽  
Monica Grazziutti ◽  
Somashekar Krishna ◽  
Nayyar Syed ◽  
...  
Keyword(s):  
At Risk ◽  
Clinical Outcome ◽  
Invasive Aspergillosis ◽  
Composite Endpoint ◽  
Surrogate Endpoint ◽  
Laboratory Findings ◽  
Hematological Cancer ◽  
Non Invasive ◽  
Patients At Risk ◽  
Neutropenic Patients

Abstract Background: Assessing clinical outcome of aspergillosis with conventional clinical and laboratory criteria is difficult. A composite “global outcome response” (clinical, radiologic, pathologic and microbiologic criteria) is frequently used but suffers from poor sensitivity and specificity, and has not been standardized or validated. A reliable, quantitative, non-invasive, and easy to measure laboratory test than can substitute for this composite endpoint, i.e. serve as a surrogate endpoint for aspergillosis outcome is highly desirable. Galactomannan (GM) is an Aspergillus-specific polysaccharide released during aspergillosis and detected by the serum GM test. The test which is reported as an index of optical density (OD) is an accepted diagnostic marker for aspergillosis and preliminary data suggest a correlation between GM index (GMI) and outcome. Purpose: To evaluate serum GMI as a surrogate endpoint for outcome of invasive aspergillosis in patients with hematological cancer. Patients and Methods: patients at risk for aspergillosis (11/03-2/06) underwent GMI screening during periods at risk. The clinical and laboratory findings of patients with ≥ 2 (+) GMI (OD ≥ 0.5) were reviewed. To validate GMI as a surrogate endpoint for aspergillosis, a k correlation concordance coefficient test between GMI and an objective clinical outcome of aspergillosis (death) was applied. The correlation is considered perfect when k is 1.0; excellent when ≥ 0.75. Results: 30 patients had GMI (+) aspergillosis of the respiratory tract [myeloma 92%; median age: 59 years (27–75); 15 males]. Aspergillosis developed following stem cell transplantation [autologous (11), allogeneic (1)], or after conventional chemotherapy (18). Among 25 neutropenic patients (<1000/ml), persistent GMI elevation was associated with death (5/5 patients) while return to negative values predicted survival (20/20 patients). Among 5 non-neutropenic patients, 1 with persistently elevated GMI died compared to no death among the remaining 4 whose GMI became negative. Overall, the GMI correlated with clinical outcome in all 30 patients with a perfect 1.0 k correlation concordance coefficient. Conclusion: we have validated GMI as an excellent surrogate endpoint for the outcome of invasive aspergillosis among patients with hematological cancer. This FDA-approved test is reproducible, quantitative, non-invasive, easy to measure and widely available. These findings have important implications for patient care and for the design of clinical trials of mould-active antifungal agents.

scholarly journals Reduction in acute kidney injury post cardiac surgery using balanced forced diuresis: a randomized, controlled trial

2020 ◽  
Author(s):  
Heyman Luckraz ◽  
Ramesh Giri ◽  
Benjamin Wrigley ◽  
Kumaresan Nagarajan ◽  
Eshan Senanayake ◽  
...  
Keyword(s):  
At Risk ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Confidence Interval ◽  
Kidney Injury ◽  
Control Group ◽  
Binary Logistic Regression Analysis ◽  
Number Needed To Treat ◽  
Forced Diuresis ◽  
Patients At Risk

Abstract OBJECTIVES Our goal was to investigate the efficacy of balanced forced diuresis in reducing the rate of acute kidney injury (AKI) in cardiac surgical patients requiring cardiopulmonary bypass (CPB), using the RenalGuard® (RG) system. METHODS Patients at risk of developing AKI (history of diabetes and/or anaemia; estimated glomerular filtration rate 20–60 ml/min/1.73 m2; anticipated CPB time &gt;120 min; log EuroSCORE &gt; 5) were randomized to the RG system group (n = 110) or managed according to current practice (control = 110). The primary end point was the development of AKI within the first 3 postoperative days as defined by the RIFLE (Risk, Injury, Failure, Loss of kidney function, End-stage renal disease) criteria. RESULTS There were no significant differences in preoperative and intraoperative characteristics between the 2 groups. Postoperative AKI rates were significantly lower in the RG system group compared to the control group [10% (11/110) vs 20.9% (23/110); P = 0.025]. This effect persisted even after controlling for a number of potential confounders (odds ratio 2.82, 95% confidence interval 1.20–6.60; P = 0.017) when assessed by binary logistic regression analysis. The mean volumes of urine produced during surgery and within the first 24 h postoperatively were significantly higher in the RG system group (P &lt; 0.001). There were no significant differences in the incidence of blood transfusions, atrial fibrillation and infections and in the median duration of intensive care unit stays between the groups. The number needed to treat with the RG system to prevent AKI was 9 patients (95% confidence interval 6.0–19.2). CONCLUSIONS In patients at risk for AKI who had cardiac surgery with CPB, the RS RG system significantly reduced the incidence of AKI and can be used safely and reproducibly. Larger studies are required to confirm cost benefits. Clinical trial registration number: NCT02974946

Elevated Faecal Calprotectin Levels are a Reliable Non-Invasive Screening Tool for Small Bowel Crohn’s Disease in Patients Undergoing Capsule Endoscopy

2018 ◽  
Vol 36 (3) ◽  
pp. 202-208 ◽  
Author(s):  
Hamid Yousuf ◽  
Umair Aleem ◽  
Roisin Egan ◽  
Pardeep Maheshwari ◽  
Jafaar Mohamad ◽  
...  
Keyword(s):  
At Risk ◽  
Crohn’S Disease ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Capsule Endoscopy ◽  
Characteristic Analysis ◽  
Faecal Calprotectin ◽  
Predictive Values ◽  
Patients At Risk ◽  
Sensitivity Specificity

Background: Approximately 10% of Crohn’s disease (CD) patients have this disease affecting the small bowel (SB) beyond the reach of Ileo-colonoscopy. Capsule endoscopy (SBCE) is the recommended investigation for SB disease. An accurate and inexpensive biomarker would help identify at-risk patients. Aim: To examine the efficacy of faecal calprotectin (FC) and C-reactive protein (CRP) as predictors of SBCE findings in suspected and known CD. Methods: A prospective observational study. Consecutive patients referred for SBCE gave FC and CRP samples. The diagnostic accuracy for SB CD based on SBCE result was calculated for both FC and CRP. Results: Of 100 invitees, FC and SBCE results were available in 64 cases. Correlation between FC >50 µg/g and SBCE result was poor К = 0.163; sensitivity, specificity, positive predictive value (PPV) and negative predictive values for ileitis were 60, 61, 32 and 83% respectively. PPV and specificity improved at FC >100 µg/g, 76 and 40%, correlation remained fair, К = 0.259. Receiver operating characteristic analysis had a sensitivity of 47% and specificity of 90% for FC >194 µg/g. CRP alone or in combination was an inaccurate predictor of ileitis. Conclusion: Our study suggests that FC level >194 µg/g may be a useful SBCE filter test, identifying patients at risk of SB CD.

scholarly journals Invasive Aspergillosis as an Under-recognized Superinfection in COVID-19

2020 ◽  
Vol 7 (7) ◽  
Author(s):  
George R Thompson III ◽  
Oliver A Cornely ◽  
Peter G Pappas ◽  
Thomas F Patterson ◽  
Martin Hoenigl ◽  
...  
Keyword(s):  
At Risk ◽  
Invasive Aspergillosis ◽  
Viral Infections ◽  
Pulmonary Aspergillosis ◽  
Large Numbers ◽  
Patients At Risk ◽  
Respiratory Viral Infections

Pulmonary aspergillosis has been increasingly reported following severe respiratory viral infections. Millions have been infected by SARS-CoV-2, placing large numbers of patients at-risk for COVID-19 associated pulmonary aspergillosis (CAPA). Prompt recognition of this syndrome and is paramount to improve outcomes.

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