scholarly journals Whole Blood Stimulation Assay as a Treatment Outcome Monitoring Tool for VL Patients in Ethiopia: A Pilot Evaluation

2020 ◽  
Vol 2020 ◽  
pp. 1-12
Author(s):  
Yetemwork Aleka ◽  
Ana Victoria Ibarra-Meneses ◽  
Meseret Workineh ◽  
Fitsumbrhan Tajebe ◽  
Amare Kiflie ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Whole Blood ◽  
Treatment Efficacy ◽  
Fold Increase ◽  
Cell Mediated Immunity ◽  
Early Assessment ◽  
Cross Sectional ◽  
End Of Treatment ◽  
Outcome Monitoring ◽  
Whole Blood Stimulation

Visceral leishmaniasis (VL) is a lethal disease if left untreated. Current treatments produce variable rates of treatment failure and toxicity without sterile cure, rendering treatment efficacy monitoring essential. To avoid repeated invasive tissue aspirates as well as empirical treatment, there is a need for new tools that allow a less-invasive and early assessment of treatment efficacy in the field. Cross-sectional studies have suggested levels of cytokines/chemokines after whole blood stimulation as good markers of cure, but longitudinal studies are lacking. In this study, we followed 13 active VL cases in an endemic area in Ethiopia by measuring the production of IFN-γ, TNF-α, IP-10, IL-2, IL-10, MCP-1, and MIG before, during, and at the end of treatment. After 24 hours of stimulation of whole blood with soluble Leishmania antigen, we observed an early, robust, and incremental increase of IFN-γ, TNF-α, and IP-10 levels in all patients during treatment. Moreover, based on the IFN-γ levels that showed an average 13-fold increase from the time of diagnosis until the end of treatment, we could almost perfectly discriminate active from cured status. Similar concentrations and patterns were found in stimulation assays with the two main Leishmania species. The levels of IFN-γ, IP-10, or TNF-α also seemed to be inversely associated with the parasite load at baseline. Despite a 1/10 drop in concentrations, similar patterns were observed in IFN-γ and IP-10 levels when dried plasma spots were stored at 4°C for an average of 225 days. All the above evidence suggests a detectable restoration of cell-mediated immunity in VL and its association with parasite clearance. With a potential application in rural settings by means of dried plasma spots, we recommend to further explore the early diagnostic value of such assays for treatment efficacy monitoring in large cohort studies including treatment failure cases.

Monitoring Anticoagulant Therapy by Activated Partial Thromboplastin Time: Hirudin Assessment

1994 ◽  
Vol 72 (05) ◽  
pp. 685-692 ◽  
Author(s):  
Michael T Nurmohamed ◽  
René J Berckmans ◽  
Willy M Morriën-Salomons ◽  
Fenny Berends ◽  
Daan W Hommes ◽  
...  
Keyword(s):  
Whole Blood ◽  
Partial Thromboplastin Time ◽  
Ex Vivo ◽  
Fold Increase ◽  
Heparin Therapy ◽  
Activated Partial Thromboplastin Time ◽  
Recombinant Hirudin ◽  
Interindividual Differences ◽  
The Relationship

SummaryBackground. Recombinant hirudin (RH) is a new anticoagulant for prophylaxis and treatment of venous and arterial thrombosis. To which extent the activated partial thromboplastin time (APTT) is suitable for monitoring of RH has not been properly evaluated. Recently, a capillary whole blood device was developed for bed-side monitoring of the APTT and it was demonstrated that this device was suitable to monitor heparin therapy. However, monitoring of RH was not evaluated.Study Objectives. To evaluate in vitro and ex vivo the responsiveness and reproducibility for hirudin monitoring of the whole blood monitor and of plasma APTT assays, which were performed with several reagents and two conventional coagulometers.Results. Large interindividual differences in hirudin responsiveness were noted in both the in vitro and the ex vivo experiments. The relationship between the APTT, expressed as clotting time or ratio of initial and prolonged APTT, and the hirudin concentration was nonlinear. A 1.5-fold increase of the clotting times was obtained at 150-200 ng/ml plasma. However, only a 2-fold increase was obtained at hirudin levels varying from 300 ng to more than 750 ng RH/ml plasma regardless of the assays. The relationship linearized upon logarithmic conversion of the ratio and the hirudin concentration. Disregarding the interindividual differences, and presuming full linearity of the relationship, all combinations were equally responsive to hirudin.Conclusions. All assays were equally responsive to hirudin. Levels up to 300 ng/ml plasma can be reliably estimated with each assay. The manual device may be preferable in situations where rapid availability of test results is necessary.

PENGARUH STRES TERHADAP FUNGSI MEMORI PADA PASIEN DIABETES MELITUS DI KOTA DEPOK

2018 ◽  
Vol 2 (2) ◽  
pp. 124
Author(s):  
Fathiya Hanisya ◽  
Dikha Ayu Kurnia
Keyword(s):  
Diabetes Mellitus ◽  
Chronic Disease ◽  
Digit Span ◽  
Memory Function ◽  
Early Assessment ◽  
Depression Anxiety Stress Scale ◽  
Cross Sectional ◽  
Spearman Rank ◽  
Stress Scale ◽  
Diabetes Melitus

Diabetes melitus merupakan penyakit kronis yang dapat mempengaruhi sisi psikologi penderitanya. Stres merupakan salah satu akibat dari penyakit kronis. Stres memiliki dampak negatif pada penderita diabetes melitus karena menyebabkan keadaan hiperglikemia. Hiperglikemia merupakan awal mula dari kerusakan fungsi kognitif, salah satunya kerusakan pada fungsi memori. Penelitian ini bertujuan mengetahui hubungan antara stres dengan fungsi memori. Desain penelitian ini adalah analitik korelatif dengan pendekatan cross sectional, menggunakan 85 responden penderita diabetes melitus di Kecamatan Sawangan Depok. Stres dinilai menggunakan Depression, Anxiety, Stress scale 42 khususnya pada subscale stres sebanyak 14 pernyataan. Sedangkan fungsi memori dinilai menggunakan digit span forward and backward. Uji analisis bivariat menggunakan uji Spearman Rank menyatakan bahwa terdapat hubungan yang bermakna antara stres dan fungsi memori pada penderita diabetes melitus di Kota Depok (p<0,05). Penelitian ini merekomendasikan kepada praktisi kesehatan untuk menekankan manajemen stres dalam tatalaksana diabetes melitus dan penilaian awal tingkat stres sebelum dilakukan pendidikan kesehatan pada penderita diabetes melitus. Kata kunci: stres, fungsi memori, diabetes melitus, depok AbstractDiabetes mellitus is a chronic disease that affect psychological side of individual with diabetes. Stress is one of the result of chronic disease. Stress has a negative impact on people with diabetes melitus because it causes a state of hyperglycemia. Hyperglycaemia is the beginning of cognitive function impairment, one of which is damage to memory function. This study aims was to determine the relationship between stress and memory function. The design of this study was correlative analytic with cross sectional approach, using 85 respondents with diabetes mellitus in Kecamatan Sawangan Depok. Stress was assessed using Depression, Anxiety, Stress scale 42 (DASS 42), especially on stress subscales consists of 14 statements. While the memory function was assessed using the forward and backward digit span. Bivariate analysis test using Spearman Rank test stated that there was a significant relationship between stress and memory function in people with diabetes mellitus in Depok City (p <0,05). This study recommends to health practitioners to emphasize stress management in the management of diabetes mellitus and early assessment of stress levels prior to health education in people with diabetes mellitus. Keywords: stress, memory function, diabetes mellitus, depok

The Worrying Trend of Diabetes Mellitus in Saudi Arabia: An Urgent Call to Action

2020 ◽  
Vol 16 (3) ◽  
pp. 204-210 ◽  
Author(s):  
Asirvatham A. Robert ◽  
Mohamed A. Al Dawish
Keyword(s):  
Diabetes Mellitus ◽  
Saudi Arabia ◽  
Present Report ◽  
Adult Population ◽  
Current Trend ◽  
Fold Increase ◽  
Developed Countries ◽  
Evidence Base ◽  
Small Sample ◽  
Cross Sectional

From last few years, the pervasiveness of diabetes mellitus (DM), in Saudi Arabia, is growing at a frightening rate. Overall, one-fourth of the adult population is affected by DM, which is further predicted to rise to more than double by the year 2030. The most alarming is possibly the escalation propensity of diabetes, in recent years, where a nearly ten-fold increase has been witnessed over the past thirty years in Saudi Arabia. However, the number of research arbitrations on the prevalence and incidence of DM is woefully inadequate, as compared to developed countries. Apart from this, most of the existing research data carried out in Saudi Arabia is cross-sectional, with small sample sizes, which most often involve only certain parts of the country. Consequently, the present scenario demands more multidimensional and multisectoral research to strengthen the evidence base and to accumulate greater knowledge as a basis for measures and programmes to confront diabetes and its complications. Thus, the present report makes an attempt to depict the current trend of diabetes as well as intends to put forward essential measures for controlling diabetes in Saudi Arabia.

scholarly journals Analysis of blood transfusion request and utilization pattern at teaching hospital in Eastern Nepal

2018 ◽  
Vol 8 (2) ◽  
pp. 1374-1377 ◽  
Author(s):  
Santosh Upadhyaya Kafle ◽  
Krishna Kumar Jha ◽  
Mrinalini Singh ◽  
Shilpi Shaukin
Keyword(s):  
Blood Transfusion ◽  
Blood Group ◽  
Teaching Hospital ◽  
Whole Blood ◽  
Age Group ◽  
Utilization Pattern ◽  
Total Blood ◽  
Cross Sectional ◽  
Male And Female ◽  
Gynecology And Obstetrics

Background: Blood transfusion unit collection, storage and dispatching on Birat Medical College and Teaching Hospital began from 19 June 2016 via blood bank. After which, many blood distribution were made accessible via this service. This study analyzes the blood transfusion request and utilization pattern and also to monitor for managing the bloodstocks meeting present and future demand in hospital. Materials and Methods: This is descriptive cross-sectional study conducted for all the requests of whole blood dispatched from 19th June, 2016 to 04th July, 2018. Whole blood requisitions from various departments were reviewed regarding the number of requisition, total blood unit replaced, blood group and socio-demographic profile of patients.Results: Of 648 transfusion units dispatched, 131 and 324 patients were male and female respectively, B positive blood group were most common, followed by A positive, O positive, AB positive, A negative, O negative and AB negative respectively. The largest numbers of requisitions were from Gynecology and Obstetric department in the hospital of 258 requisitions followed by internal medicine, surgery department, postoperative ward and orthopaedic department. Majority of the requisitions were for 20-29 years age group from the local district Morang. The total blood units replaced were 75, of which 29 and 46 of male and female respectively. Conclusions: B Positive was the predominant requested blood group with Gynecology and Obstetrics department making the most requests, among 20-29 years age group from Morang district. The total replaced blood units were less in number with some requisition forms even lacked essential details.

Abstract 3259: Leukocyte Subset Specific Gene Expression In Acute Stroke Patients

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Mateusz G Adamski ◽  
Yan Li ◽  
Hua Yu ◽  
Erin Wagner ◽  
Sareen Amarjeet ◽  
...  
Keyword(s):  
Gene Expression ◽  
Acute Stroke ◽  
Whole Blood ◽  
Peripheral Blood ◽  
Fold Increase ◽  
Specific Gene ◽  
Related Gene ◽  
Stroke Patients ◽  
Leukocyte Subset ◽  
Control Subjects

Background: Alterations in gene expression in the peripheral blood of patients with acute stroke have been demonstrated using microarray technology. Whole blood and peripheral blood mononuclear cells (PBMCs) were used in prior studies in which panels of genes diagnostic for stroke were developed. We aimed to determine the cellular sources of alterations in gene expression by studying individual leukocyte subsets. Methods: The expression of four genes previously found to be upregulated in ischemic and hemorrhagic stroke (IL1R2, S100A9, ETS2 and F5) was measured in four leukocyte subsets: CD14+ monocytes, CD4+ T cell lymphocytes, CD20+ B cell lymphocytes and PBMCs. These four genes had been reported in at least two of the previously published stroke-related gene panels. Peripheral blood was obtained from six acute stroke patients (all <48 hours from symptom onset) and 6 age, race and sex matched control subjects. Leukocytes were separated from whole blood using density gradient centrifugation and column magnetic bead cell sorting. The purity of separated leukocyte subsets exceeded 90% and was verified with flow cytometry. Messenger RNA was isolated from each leukocyte subset and analyzed by two step RT PCR and qPCR. The expression of the four stroke-related genes was compared to the expression of a housekeeping gene (GAPDH). The relative expression of individual genes and of the 4 gene panel within cellular subsets was compared between stroke patients and control subjects. Results: Individually, IL1R2 and S100A9 were significantly over-expressed in stroke patients with a 10 fold increase for IL1R2 in PBMCs (p<0.05) and a 3 fold increase for S100A9 in the CD4+ T and CD20+ B lymphocyte subsets (p<0.05). When analyzed as a panel of four genes the expression of IL1R2, S100A9, ETS2 and F5 was significantly higher in both the CD4+ T lymphocytes (p<0.05) and CD20+ B lymphocytes (p<0.05) of stroke patients but not in the monocytes or the PBMCs. Conclusion: These results show the potential diagnostic value of selected genes from panels previously found in microarray studies in stroke patients. They also emphasize the value of panel analysis over that of single gene expression and the potential cellular specificity of alterations in gene expression. Analysis of whole blood and PBMCs alone may not reflect important dynamic changes in stroke-related gene expression.

Evaluation of an Online System for Routine Outcome Monitoring: A Cross-Sectional Survey (Preprint)

2021 ◽  
Author(s):  
Deanna Wiebe ◽  
Pria Nippak ◽  
Julien Meyer ◽  
Shannon Remers
Keyword(s):  
Mental Health ◽  
Outcome Measures ◽  
Service Providers ◽  
Routine Outcome Monitoring ◽  
Completion Rates ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Online System ◽  
Health Service Providers ◽  
Outcome Monitoring

BACKGROUND The use of Routine Outcome Monitoring (ROM) in the treatment of mental health has emerged as a method of improving psychotherapy treatment outcomes. Despite this, very few clinicians regularly use ROM in clinical practice. Online ROM has been suggested as a solution to increase adoption. OBJECTIVE To identify the influence of moving ROM online on client completion rates of self-reported outcome measures and to identify implementation and utilization barriers to online ROM by assessing clinicians’ views on their experience utilizing the online system over previous paper-based methods. METHODS Client completion rates of self-reported outcome measures were compared pre and post implementation of an online system of ROM. In addition, a survey questionnaire was administered to 340 mental health service providers regarding their perception of benefits with an online system of ROM. RESULTS Client completion rates of self-reported measures increased from 15% to 54% after moving online. Fifty-eight% of service providers found the new system less time consuming than previous paper-based ROM and 64% found that it helped monitor clients. However, the perceived value of the system remains in doubt as only 23% found it helped them identify clients at risk for treatment failure, and only 18% found it strengthened the therapeutic alliance. CONCLUSIONS Although the current study suggests mixed results regarding service providers’ views on their experience using an online system for ROM, it has identified barriers and challenges that are actionable for improvement.

scholarly journals Analysis of naturally occurring delayed-type hypersensitivity reactions in leprosy by in situ hybridization.

1989 ◽  
Vol 169 (5) ◽  
pp. 1565-1581 ◽  
Author(s):  
C L Cooper ◽  
C Mueller ◽  
T A Sinchaisri ◽  
C Pirmez ◽  
J Chan ◽  
...  
Keyword(s):  
In Situ Hybridization ◽  
Fold Increase ◽  
Delayed Type Hypersensitivity ◽  
Cell Mediated Immunity ◽  
Serine Esterase ◽  
Ifn Gamma ◽  
Cytotoxic Cells ◽  
Selective Increase ◽  
Reversal Reaction

Analysis of tissue lesions of the major reactional states of leprosy was undertaken to study the immune mechanisms underlying regulation of cell-mediated immunity and delayed-type hypersensitivity (DTH) in man. In situ hybridization hybridization of reversal reaction biopsy specimens for INF-gamma mRNA expression revealed a 10-fold increase in specific mRNA-containing cells over that observed in unresponsive lepromatous patients. Expression of huHF serine esterase, a marker for T cytotoxic cells, were fourfold increased in reversal reaction and tuberculoid lesions above that detected in unresponsive lepromatous individuals. Immunohistology of reversal reactions confirmed a selective increase of Th and T cytotoxic cells in the cellular immune response. Of interest, the microanatomic location of these serine esterase mRNA-containing cells was identical to the distribution of CD4+ cells. Analysis of erythema nodosum leprosum (ENL) lesions revealed differences in the underlying immune processes in comparison with reversal reaction lesions. Although phenotypic Th cells predominated in ENL lesions, IFN-gamma and serine esterase gene expression were markedly reduced. We suggest that reversal reactions represent a hyperimmune DTH response characterized by a selective increase of CD4+ IFN-gamma producing cells and T cytotoxic cells, which result in the clearing of bacilli and concomitant tissue damage. In contrast, ENL reactions may be viewed as a transient diminution of Ts cells and activity leading to a partial and transient augmentation in cell-mediated immunity, perhaps sufficient to result in antibody and immune complex formation, but insufficient to clear bacilli from lesions.

scholarly journals Do CAMHS collect less PROM data from certain sociodemographic groups?

2020 ◽  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Outcome Measures ◽  
Treatment Efficacy ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Outcome Monitoring ◽  
Patient Reported ◽  
Low Rate

Patient-reported outcome measures (PROMs) are routinely used to inform clinicians and policymakers on clinical need and treatment efficacy. Yet despite their great value and utility, it seems that there is a low rate of outcome monitoring in Child and Adolescent Mental Health Services (CAMHS).

scholarly journals Pediatric neurodevelopment by prenatal Zika virus exposure: A cross-sectional study of the Microcephaly Epidemic Research Group Cohort

2020 ◽  
Author(s):  
paula sobral Silva ◽  
Sophie Helena Eickmann ◽  
Ricardo Arraes de Alencar Ximenes ◽  
Ulisses Ramos Montarroyos ◽  
Marília de Carvalho Lima ◽  
...  
Keyword(s):  
At Risk ◽  
Zika Virus ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Early Assessment ◽  
Cross Sectional ◽  
Group 4 ◽  
Neurological Abnormalities ◽  
Development Delay ◽  
And Behavior

Abstract Background: The implications of congenital Zika Virus (ZIKV) infections for pediatric neurodevelopment and behavior remain inadequately studied. The aim of this study is to investigate patterns of neurodevelopment and behavior in children with different levels of ZIKV-related microcephaly or with prenatal ZIKV exposure in the absence of microcephaly. Methods: We conducted a cross-sectional study, nested in a cohort, of 274 children (aged 10-45 months) who were born during the peak and decline of the microcephaly epidemic in Northeast Brazil. Participants were evaluated between February 2017 and August 2019 at two tertiary care hospitals in Recife, Brazil. We analyzed the children in four groups assigned based on clinical and laboratory criteria: Group 1 had severe microcephaly; Group 2 had moderate microcephaly; Group 3 had prenatal ZIKVxposure confirmed by maternal RT-PCR testing and no microcephaly; and Group 4 was a neurotypical control group. Groups were evaluated clinically for neurological abnormalities and compared using the Survey of Wellbeing of Young Children (SWYC), a neurodevelopment and behavior screening instrument, and a SWYC adapted form to compare severe cases. Results: Based on the SWYC screening, we observed differences between the groups for developmental milestones but not behavior. Among children with severe microcephaly of whom 98.2% presented with neurological abnormalities, 99.1% were at risk of development delay, and presented similar performance whether evaluated under or over 24 months of age. Among children with moderate microcephaly of whom 60% presented with neurological abnormalities, 65% were at risk of development delay. For children without microcephaly, the percentages found to be at risk of developmental delays were markedly lower and did not differ by prenatal ZIKV exposure status: Groups 3, 13.8%; Group 4, 21.7%. Conclusions: Among groups of children with prenatal ZIKV exposure, we found a gradient of risk of development delay. Children with severe microcephaly were at highest risk, while normocephalic ZIKV-exposed children had similar risks to unexposed control children. We propose that ZIKV-exposed children should undergo first-line screening for neurodevelopment and behavior using the SWYC. Early assessment and follow-up will enable at-risk children to be referred to a more comprehensive developmental evaluation and to multidisciplinary care management.

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