scholarly journals International Consensus on Antinuclear Antibody em Portugal

2021 ◽  
Vol 34 (5) ◽  
pp. 347
Author(s):  
Maria José Sousa ◽  
Esmeralda Neves ◽  
Otília Figueiras ◽  
Ana Paula Cruz ◽  
Isabel Fernandes ◽  
...  
Keyword(s):  
Antinuclear Antibody ◽  
Standard Test ◽  
Reference Ranges ◽  
Systemic Autoimmune Diseases ◽  
International Consensus ◽  
Diagnostic Quality ◽  
Cell Patterns ◽  
Good Potential ◽  
Morphological Patterns

Introduction: Screening for autoantibodies in HEp-2 cells by indirect immunofluorescence is currently accepted as the gold-standard test for the diagnosis of systemic autoimmune diseases. The main objective of the International Consensus on ANA Patterns is to achieve a consensus on the nomenclature and description of antinuclear antibody morphological patterns. This work aims to build on the International Consensus on ANA Patterns project to establish a nomenclature consensus in Portugal, thus contributing to harmonization in autoimmune diagnosis and promoting diagnostic quality in autoimmune systemic rheumatic diseases.Material and Methods: Participating laboratories identified all the nuclear and cytoplasmic pattern designations in the International Consensus on ANA Patterns (including the anti-cell pattern code), and matched them with the corresponding Portuguese nomenclature in use. The results were aggregated and used as a foundation for nomenclature harmonization work. Consensus meetings followed an iterative process, until a final consensual proposal was drafted.Results: Prior agreement between laboratories was over 75% for 23 of the total 29 anti-cell patterns. The degree to which each laboratory is aligned with the International Consensus on ANA Patterns international reference ranges from 22.1% to 100%. It was possible to write a consensual version of the International Consensus on ANA Patterns nomenclature for Portugal.Discussion: There was a good consensus basis for the nomenclature in the International Consensus on ANA Patterns, despite relevant differences with some translations. The study highlights the need for collaboration among laboratories towards an unambiguous description of laboratory results.Conclusion: This study shows that there is good potential for collaboration between laboratories in order to produce the consensus needed to improve diagnosis and patient follow-up.

scholarly journals Clinical relevance of HEp-2 indirect immunofluorescent patterns: the International Consensus on ANA patterns (ICAP) perspective

2019 ◽  
Vol 78 (7) ◽  
pp. 879-889 ◽  
Author(s):  
Jan Damoiseaux ◽  
Luis Eduardo Coelho Andrade ◽  
Orlando Gabriel Carballo ◽  
Karsten Conrad ◽  
Paulo Luiz Carvalho Francescantonio ◽  
...  
Keyword(s):  
Clinical Relevance ◽  
Daily Practice ◽  
Immunofluorescence Assay ◽  
Classification Criteria ◽  
Systemic Autoimmune Diseases ◽  
International Consensus ◽  
Dichotomous Outcome ◽  
Interphase Cells ◽  
Indirect Immunofluorescent

The indirect immunofluorescence assay (IIFA) on HEp-2 cells is widely used for detection of antinuclear antibodies (ANA). The dichotomous outcome, negative or positive, is integrated in diagnostic and classification criteria for several systemic autoimmune diseases. However, the HEp-2 IIFA test has much more to offer: besides the titre or fluorescence intensity, it also provides fluorescence pattern(s). The latter include the nucleus and the cytoplasm of interphase cells as well as patterns associated with mitotic cells. The International Consensus on ANA Patterns (ICAP) initiative has previously reached consensus on the nomenclature and definitions of HEp-2 IIFA patterns. In the current paper, the ICAP consensus is presented on the clinical relevance of the 29 distinct HEp-2 IIFA patterns. This clinical relevance is primarily defined within the context of the suspected disease and includes recommendations for follow-up testing. The discussion includes how this information may benefit the clinicians in daily practice and how the knowledge can be used to further improve diagnostic and classification criteria.

scholarly journals Report of the First International Consensus on Standardized Nomenclature of Antinuclear Antibody HEp-2 Cell Patterns 2014–2015

2015 ◽  
Vol 6 ◽  
Author(s):  
Edward K. L. Chan ◽  
Jan Damoiseaux ◽  
Orlando Gabriel Carballo ◽  
Karsten Conrad ◽  
Wilson de Melo Cruvinel ◽  
...  
Keyword(s):  
Antinuclear Antibody ◽  
International Consensus ◽  
Cell Patterns

scholarly journals A Follow-Up Study of a European IgG4-Related Disease Cohort Treated with Rituximab

2021 ◽  
Vol 10 (6) ◽  
pp. 1329
Author(s):  
Johanna Backhus ◽  
Christian Neumann ◽  
Lukas Perkhofer ◽  
Lucas A Schulte ◽  
Benjamin Mayer ◽  
...  
Keyword(s):  
Disease Activity ◽  
Clinical Activity ◽  
Inflammatory Disorder ◽  
International Consensus ◽  
Steroid Pulse ◽  
Related Disease ◽  
Igg4 Related Disease

Objectives: IgG4-related disease (IgG4-RD) is a chronic fibro-inflammatory disorder affecting virtually any organ. Type 1 autoimmune (type 1 AIP) is its pancreatic manifestation. To date, steroids are considered the first-line pancreatitis treatment. The CD20-binding antibody rituximab (RTX) appears a promising steroid-sparing therapy, although long-term data are lacking. We aimed to bridge this gap with a cohort of IgG4-RD patients treated with RTX and to assess the potential value of the Responder Index (RI) as a discriminatory score for disease activity. Methods: We retrospectively evaluated 46 patients from a tertiary referral centre who were diagnosed with IgG4-RD and/or type 1 AIP according to the International Consensus Diagnostic Criteria or Unifying-AIP criteria between June 2006 and August 2019. Results: Patients resembled previous cohorts in terms of characteristics, diagnosis, and therapeutic response. Thirteen of the 46 patients with IgG4-RD/type 1 AIP were treated with RTX pulse therapy due to relapse, adverse reactions to steroids, or high-risk constellations predicting a severe course of disease with multi-organ involvement. Median follow-up after diagnosis was 52 months for all subjects, and 71 months in IgG4-RD patients treated with RTX. While patients in the RTX group showed no significant response to an initial steroid pulse, clinical activity as measured by the RI significantly decreased in the short-term after RTX induction. Within 16 months, 61% of patients relapsed in the RTX group but responded well to re-induction. Clinical and laboratory parameters improved equally in response to RTX. Conclusion: RTX therapy in patients with IgG4-RD is an effective and safe treatment to induce treatment response and possible long-term remission. Repeated RTX administration after 6–9 months may be of value in reducing the risk of relapse. The RI appears to be a reasonable index to assess disease activity and to identify patients with IgG4-related disease who may benefit from B-cell-depleting therapy.

scholarly journals A prospective, observational clinical trial on the impact of COVID-19-related national lockdown on thyroid hormone in young males

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Giulia Brigante ◽  
Giorgia Spaggiari ◽  
Barbara Rossi ◽  
Antonio Granata ◽  
Manuela Simoni ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Serum Levels ◽  
Stressful Event ◽  
Italian Population ◽  
Reference Ranges ◽  
Endocrine Regulation ◽  
Before And After ◽  
Hpt Axis ◽  
The Impact

AbstractTrying to manage the dramatic coronavirus disease 2019 (COVID-19) infection spread, many countries imposed national lockdown, radically changing the routinely life of humans worldwide. We hypothesized that both the pandemic per se and the consequent socio-psychological sequelae could constitute stressors for Italian population, potentially affecting the endocrine system. This study was designed to describe the effect of lockdown-related stress on the hypothalamic-pituitary-thyroid (HPT) axis in a cohort of young men. A prospective, observational clinical trial was carried out, including patients attending the male infertility outpatient clinic before and after the national lockdown for COVID-19 pandemic. The study provided a baseline visit performed before and a follow-up visit after the lockdown in 2020. During the follow-up visit, hormonal measurements, lifestyle habits and work management were recorded. Thirty-one male subjects were enrolled (mean age: 31.6 ± 6.0 years). TSH significantly decreased after lockdown (p = 0.015), whereas no significant changes were observed in the testosterone, luteinising hormone, follicle-stimulating hormone, estradiol and prolactin serum levels. No patient showed TSH serum levels above or below reference ranges, neither before nor after lockdown. Interestingly, TSH variation after lockdown was dependent on the working habit change during lockdown (p = 0.042). We described for the first time a TSH reduction after a stressful event in a prospective way, evaluating the HPT axis in the same population, before and after the national lockdown. This result reinforces the possible interconnection between psychological consequences of a stressful event and the endocrine regulation.

scholarly journals Application of Supervised Machine Learning to Recognize Competent Level and Mixed Antinuclear Antibody Patterns Based on ICAP International Consensus

Diagnostics ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 642
Author(s):  
Yi-Da Wu ◽  
Ruey-Kai Sheu ◽  
Chih-Wei Chung ◽  
Yen-Ching Wu ◽  
Chiao-Chi Ou ◽  
...  
Keyword(s):  
Machine Learning ◽  
Pattern Recognition ◽  
Excellent Agreement ◽  
Antinuclear Antibody ◽  
Disease Diagnosis ◽  
Machine Learning Algorithms ◽  
Observer Agreement ◽  
Supervised Machine Learning ◽  
International Consensus ◽  
Testing Data

Background: Antinuclear antibody pattern recognition is vital for autoimmune disease diagnosis but labor-intensive for manual interpretation. To develop an automated pattern recognition system, we established machine learning models based on the International Consensus on Antinuclear Antibody Patterns (ICAP) at a competent level, mixed patterns recognition, and evaluated their consistency with human reading. Methods: 51,694 human epithelial cells (HEp-2) cell images with patterns assigned by experienced medical technologists collected in a medical center were used to train six machine learning algorithms and were compared by their performance. Next, we choose the best performing model to test the consistency with five experienced readers and two beginners. Results: The mean F1 score in each classification of the best performing model was 0.86 evaluated by Testing Data 1. For the inter-observer agreement test on Testing Data 2, the average agreement was 0.849 (?) among five experienced readers, 0.844 between the best performing model and experienced readers, 0.528 between experienced readers and beginners. The results indicate that the proposed model outperformed beginners and achieved an excellent agreement with experienced readers. Conclusions: This study demonstrated that the developed model could reach an excellent agreement with experienced human readers using machine learning methods.

scholarly journals Implementation of an Antimicrobial Stewardship Program in Five Colombian Hospitals in 2018

2020 ◽  
Vol 41 (S1) ◽  
pp. s273-s273
Author(s):  
Christian Pallares ◽  
María Virginia Villegas Botero
Keyword(s):  
Infection Control ◽  
Antimicrobial Stewardship ◽  
Control Strategies ◽  
Education And Training ◽  
Public Hospitals ◽  
International Standards ◽  
International Consensus ◽  
Stewardship Program ◽  
And Training

Background: More than 50% of antibiotics used in hospitals are unnecessary or inappropriate. The antimicrobial stewardship programs (ASPs) are coordinated efforts to promote the rational and effective use of antibiotics including appropriate selection, dosage, administration, and duration of therapy. When an ASP integrates infection control strategies, it is possible to decrease the transmission of multidrug-resistant pathogens. Methods: In 2018, 5 Colombian hospitals were selected to implement an ASP. Private and public hospitals from different cities were included in the study, ranging from 200 to 700 beds. Our team, consisting of an infectious disease and hospital epidemiologist, visited each hospital to establish the baseline of their ASP program, to define the ASP outcomes according to each hospital’s needs, and to set goals for ASP outcomes in the following 6–12 months. Follow-up was scheduled every 2 months through Skype video conference. The baseline diagnosis or preintervention evaluation was done using a tool adapted from previous reports (ie, international consensus and The Joint Commission international standards). Documentation related to ASPs, such as microbiological profiles, antimicrobial guidelines (AMG) and indicators for the adherence to them as well as antimicrobial resistance (AMR) prevention through protocols, were written and/or updated. Prevention and infection control requirements and protocols were also updated, and cleaning and antiseptic policies were created. Training in rational use of antibiotic, infection control and prevention, and cleaning and disinfection were carried out with the healthcare workers in each institution. Results: Before the intervention, the development of the ASP according to the tool was 27% (range, 5%–47%). The lowest institutional scores were the item related to ASP feedback and reports (11% on average), followed by education and training (14%), defined ASP responsibilities (23%), ASP function according to priorities (26%), and AMR surveillance (27%). After the intervention, the ASP development increased to 57% (range, 39%–81%) in the hospitals. The highest scores achieved were for education and training (90%), surveillance (75%), and the activities of the infection control committee (70%). The items that made the greatest contribution to ASP development were the individual antibiogram, including the bacteria resistance profile, and the development of the AMG based on the local epidemiology in each hospital. Conclusions: The implementation of an ASP should include training and education as well as defining outcomes according to the hospital’s needs. Once the strategy is implemented, follow-up is key to achieving the goals.Funding: NoneDisclosures: None

Should all patients with a culture-negative periprosthetic joint infection be treated with antibiotics?

2022 ◽  
Vol 104-B (1) ◽  
pp. 183-188
Author(s):  
Maxime van Sloten ◽  
Joan Gómez-Junyent ◽  
Tristan Ferry ◽  
Nicolò Rossi ◽  
Sabine Petersdorf ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Joint Infection ◽  
Recurrent Infection ◽  
Molecular Techniques ◽  
Secondary Outcome ◽  
International Consensus ◽  
Joint Infections ◽  
Causative Microorganism ◽  
Culture Negative

Aims The aim of this study was to analyze the prevalence of culture-negative periprosthetic joint infections (PJIs) when adequate methods of culture are used, and to evaluate the outcome in patients who were treated with antibiotics for a culture-negative PJI compared with those in whom antibiotics were withheld. Methods A multicentre observational study was undertaken: 1,553 acute and 1,556 chronic PJIs, diagnosed between 2013 and 2018, were retrospectively analyzed. Culture-negative PJIs were diagnosed according to the Muskuloskeletal Infection Society (MSIS), International Consensus Meeting (ICM), and European Bone and Joint Society (EBJIS) definitions. The primary outcome was recurrent infection, and the secondary outcome was removal of the prosthetic components for any indication, both during a follow-up period of two years. Results None of the acute PJIs and 70 of the chronic PJIs (4.7%) were culture-negative; a total of 36 culture-negative PJIs (51%) were treated with antibiotics, particularly those with histological signs of infection. After two years of follow-up, no recurrent infections occurred in patients in whom antibiotics were withheld. The requirement for removal of the components for any indication during follow-up was not significantly different in those who received antibiotics compared with those in whom antibiotics were withheld (7.1% vs 2.9%; p = 0.431). Conclusion When adequate methods of culture are used, the incidence of culture-negative PJIs is low. In patients with culture-negative PJI, antibiotic treatment can probably be withheld if there are no histological signs of infection. In all other patients, diagnostic efforts should be made to identify the causative microorganism by means of serology or molecular techniques. Cite this article: Bone Joint J 2022;104-B(1):183–188.

Antinukleäre Antikörper

2019 ◽  
Vol 39 (01) ◽  
pp. 28-36
Author(s):  
Verena Jansen
Keyword(s):  
Antinuclear Antibody ◽  
International Consensus ◽  
Antinukleäre Antikörper

ZusammenfassungBei der Diagnose und Klassifikation systemischer autoimmuner rheumatischer Erkrankungen kommt dem positiven Nachweis Antinukleärer Antikörper (ANA) große Bedeutung zu. Als methodischer Goldstandard hat sich der Indirekte Immunfluoreszenztest (IIFT) unter Verwendung der HEp2-Zelle als Substrat durchgesetzt, mit dem bei Vorliegen von ANA charakteristische Fluoreszenzmuster mikroskopisch unterschieden werden können. Um ANA-Befunde besser vergleichen zu können, wurde von einer internationalen Initiative, dem International Consensus on Antinuclear Antibody Patterns (ICAP), ein Standard entwickelt, mit dem die Muster beschrieben und nummeriert werden. Die Zielsetzung der ICAP-Initiative, die neue Nomenklatur, Maßnahmen der Qualitätssicherung und noch offene Fragen sollen hier vorgestellt werden.

scholarly journals Kidney Involvement in Patients with Type 1 Autoimmune Pancreatitis

2019 ◽  
Vol 8 (2) ◽  
pp. 258
Author(s):  
Miroslav Vujasinovic ◽  
Raffaella Pozzi Mucelli ◽  
Roberto Valente ◽  
Caroline Verbeke ◽  
Stephan Haas ◽  
...  
Keyword(s):  
Autoimmune Pancreatitis ◽  
Lymphocytic Infiltration ◽  
Normal Serum ◽  
International Consensus ◽  
Kidney Involvement ◽  
Type 1 Autoimmune Pancreatitis ◽  
Elevated Creatinine ◽  
Imaging Signs

Introduction: Autoimmune pancreatitis (AIP) type 1 is a special form of chronic pancreatitis with a strong lymphocytic infiltration as the pathological hallmark and other organ involvement (OOI). IgG4-related kidney disease (IgG4-RKD) was first reported as an extrapancreatic manifestation of AIP in 2004. The aim of the present study was to determine the frequency and clinical impact of kidney lesions observed in patients with AIP type 1. Methods: We performed a single-centre retrospective study on a prospectively collected cohort of patients with a histologically proven or highly probable diagnosis of AIP according to the International Consensus Diagnostic Criteria (ICDC) classification. Results: Seventy-one patients with AIP were evaluated. AIP type 1 was diagnosed in 62 (87%) patients. Kidney involvement was present in 17 (27.4%) patients with AIP type 1: 15 (88.2%) males and 2 (11.8%) females. Laboratory and/or imaging signs of kidney involvement were presented at the time of AIP diagnosis in eight (47.1%) patients. In other patients, the onset of kidney involvement occurred between four months and eight years following diagnosis. At the time of the diagnosis of kidney involvement, eight (47.1%) patients showed elevated creatinine, and nine (52.9%) patients showed normal serum creatinine. None of the patients were treated with dialysis. Conclusions: IgG4-RKD was present in 27.4% of patients with AIP type 1, with male gender predominance. In cases of early diagnosis and cortisone treatment, the clinical course was mild in most cases. Regular laboratory control of renal function should be a part of the follow-up of patients with AIP type 1.

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