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Utility of serum tryptase in Emergency Department patients with possible anaphylaxis
No full textTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadINNGANGUR
Tiltölulega einfalt er að greina bráðaofnæmiskast í dæmigerðum tilfellum
en birtingarmyndin getur þó verið fjölbreytt. Sýnt hefur verið fram á að hjá
einstaklingum með ódæmigerð einkenni getur mæling á s-tryptasa verið
gagnleg til viðbótar við klíníska greiningu læknis. Einnig nýtist mæling á
s-tryptasa til að greina sjúkdóminn mastfrumnager. Byrjað var að nota
s-tryptasamælingar á bráðamóttöku Landspítala árið 2011. Markmið
rannsóknarinnar var að meta tíðni og gagnsemi s-tryptasamælinga hjá
sjúklingum á bráðamóttöku.
EFNIVIÐUR OG AÐFERÐIR
Með leyfi siðanefndar heilbrigðisrannsókna á Landspítala voru skoðuð
öll þau tilvik þar sem blóðsýni var sent frá bráðamóttöku til mælingar
á s-tryptasa á ónæmisfræðideild á árunum 2011-2018. Upplýsingum
var safnað úr sjúkraskrám um uppvinnslu og meðferð sjúklinga á
bráðamóttöku og hjá ofnæmislækni.
NIÐURSTÖÐUR
Alls voru 214 sýni send til s-tryptasamælingar. Tryptasi var hækkaður
(>12 μg/L) í 36 tilvikum. Konur voru 131 (61,2%) og meðalaldur
var 40,6 ár. Algengi einkenna voru: húð- og slímhúðareinkenni
86,4%, blóðrásareinkenni 48,1%, öndunarfæraeinkenni 49,5% og
meltingarfæraeinkenni 36,0%. Af 126 endurkomusjúklingum mat
ofnæmislæknir 65 tilfelli sem bráðaofnæmiskast. Af þeim uppfylltu fjórir
einstaklingar ekki klínísk greiningarskilmerki bráðaofnæmiskasts en
voru með hækkuð tryptasagildi. Næmi s-tryptasamælingar var 40,9% og
sértæki 97,1%. Ekkert tilfelli leiddi til greiningar mastfrumnagers.
ÁLYKTANIR
Mælingar á s-tryptasa hjá sjúklingum á bráðamóttöku með möguleg
einkenni bráðaofnæmiskasts virðast veita gagnlegar upplýsingar til
greiningar sjúkdómsins til viðbótar við klínískt mat. Mælingin er sértæk
en með lágt næmi. Mælingarnar hafa ekki leitt til fjölgunar greininga á
mastfrumnageri.BACKGROUND Diagnosing anaphylaxis is often straightforward but can be challenging
if the presentation is atypical. In patients with atypical symptoms suspected to be due
to an acute allergic reaction, s-tryptase can give additional diagnostic information.
Measuring s-tryptase is also helpful in diagnosing mastocytosis. Obtaining s-tryptase
levels has been done in the emergency department (ED) at Landspitali since 2011. The
aim of this study was to evaluate the benefit of obtaining s-tryptase levels in the ED.
METHODS With institutional review board approval, all cases where s-tryptase
level was obtained in ED patients from 2011–2018 were retrospectively reviewed. A
database was collected including information on patient demographics, presenting
symptoms, treatment, diagnosis, s-tryptase level and follow up.
RESULTS A total of 214 patients had a s-tryptase level measured. Serum tryptase was
elevated (>12 μg/L) in 36 cases. Females were 131 and average age 40.6 years. Of
the patients, 86.4% had skin or mucosal symptoms, 48.1% cardiovascular symptoms,
49.5% respiratory symptoms and 36.0% had gastrointestinal symptoms. An allergist
reviewed 126 returning patients and 65 were considered to have had an episode of
anaphylaxis. Of those 65 were 4 patients which did not meet the diagnostic criteria for
anaphylaxis but had raised s-tryptase levels. Sensitivity of s-tryptase measurement
was 40.9% and specificity 97.1%.
CONCLUSIONS Obtaining a s-tryptase level from ED patients with possible anaphylaxis
seems to be useful in atypical cases. The measurement is specific but not sensitive. No
cases of mastocytosis were identified in the patient cohort
Global Landscape Review of Serotype-Specific Invasive Pneumococcal Disease Surveillance among Countries Using PCV10/13: The Pneumococcal Serotype Replacement and Distribution Estimation (PSERENADE) Project.
Get PDFTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadSerotype-specific surveillance for invasive pneumococcal disease (IPD) is essential for assessing the impact of 10- and 13-valent pneumococcal conjugate vaccines (PCV10/13). The Pneumococcal Serotype Replacement and Distribution Estimation (PSERENADE) project aimed to evaluate the global evidence to estimate the impact of PCV10/13 by age, product, schedule, and syndrome. Here we systematically characterize and summarize the global landscape of routine serotype-specific IPD surveillance in PCV10/13-using countries and describe the subset that are included in PSERENADE. Of 138 countries using PCV10/13 as of 2018, we identified 109 with IPD surveillance systems, 76 of which met PSERENADE data collection eligibility criteria. PSERENADE received data from most (n = 63, 82.9%), yielding 240,639 post-PCV10/13 introduction IPD cases. Pediatric and adult surveillance was represented from all geographic regions but was limited from lower income and high-burden countries. In PSERENADE, 18 sites evaluated PCV10, 42 PCV13, and 17 both; 17 sites used a 3 + 0 schedule, 38 used 2 + 1, 13 used 3 + 1, and 9 used mixed schedules. With such a sizeable and generally representative dataset, PSERENADE will be able to conduct robust analyses to estimate PCV impact and inform policy at national and global levels regarding adult immunization, schedule, and product choice, including for higher valency PCVs on the horizon.
Keywords: global; invasive pneumococcal disease; pneumococcal conjugate vaccines; pneumococcal meningitis; surveillance.Bill and Melinda Gates Foundation as part of theWorld Health Organization Pneumococcal Vaccines Technical Coordination Projec
Effect of comorbidities on survival in patients >80 years of age at onset of renal replacement therapy: data from the ERA-EDTA Registry.
No full textTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadBackground: The number of elderly patients on renal replacement therapy (RRT) is increasing. The survival and quality of life of these patients may be lower if they have multiple comorbidities at the onset of RRT. The aim of this study was to explore whether the effect of comorbidities on survival is similar in elderly RRT patients compared with younger ones.
Methods: Included were 9333 patients ≥80 years of age and 48 352 patients 20-79 years of age starting RRT between 2010 and 2015 from 15 national or regional registries submitting data to the European Renal Association-European Dialysis and Transplantation Association Registry. Patients were followed until death or the end of 2016. Survival was assessed by Kaplan-Meier curves and the relative risk of death associated with comorbidities was assessed by Cox regression analysis.
Results: Patients ≥80 years of age had a greater comorbidity burden than younger patients. However, relative risks of death associated with all studied comorbidities (diabetes, ischaemic heart disease, chronic heart failure, cerebrovascular disease, peripheral vascular disease and malignancy) were significantly lower in elderly patients compared with younger patients. Also, the increase in absolute mortality rates associated with an increasing number of comorbidities was smaller in elderly patients.
Conclusions: Comorbidities are common in elderly patients who enter RRT, but the risk of death associated with comorbidities is less than in younger patients. This should be taken into account when assessing the prognosis of elderly RRT patients.
Keywords: ESKD; comorbidity; elderly; renal replacement therapy; survival.Munuaissaatio
Finnish Medical Foundation
ERAEDT
Increased respiratory morbidity associated with exposure to a mature volcanic plume from a large Icelandic fissure eruption.
Get PDFTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadThe 2014-15 Holuhraun eruption in Iceland was the largest fissure eruption in over 200 years, emitting prodigious amounts of gas and particulate matter into the troposphere. Reykjavík, the capital area of Iceland (250 km from eruption site) was exposed to air pollution events from advection of (i) a relatively young and chemically primitive volcanic plume with a high sulphur dioxide gas (SO2) to sulphate PM (SO42-) ratio, and (ii) an older and chemically mature volcanic plume with a low SO2/SO42- ratio. Whereas the advection and air pollution caused by the primitive plume were successfully forecast and forewarned in public advisories, the mature plume was not. Here, we show that exposure to the mature plume is associated with an increase in register-measured health care utilisation for respiratory disease by 23% (95% CI 19.7-27.4%) and for asthma medication dispensing by 19.3% (95% CI 9.6-29.1%). Absence of public advisories is associated with increases in visits to primary care medical doctors and to the hospital emergency department. We recommend that operational response to volcanic air pollution considers both primitive and mature types of plumes.UK Research & Innovation (UKRI)
Natural Environment Research Council (NERC)
Icelandic Research fund (RANNIS) 15258705
Loss-of-Function Variants in the Tumor-Suppressor Gene Confer Increased Cancer Risk.
No full textTo access publisher's full text version of this article click on the hyperlink belowThe success of genome-wide association studies (GWAS) in identifying common, low-penetrance variant-cancer associations for the past decade is undisputed. However, discovering additional high-penetrance cancer mutations in unknown cancer predisposing genes requires detection of variant-cancer association of ultra-rare coding variants. Consequently, large-scale next-generation sequence data with associated phenotype information are needed. Here, we used genotype data on 166,281 Icelanders, of which, 49,708 were whole-genome sequenced and 408,595 individuals from the UK Biobank, of which, 41,147 were whole-exome sequenced, to test for association between loss-of-function burden in autosomal genes and basal cell carcinoma (BCC), the most common cancer in Caucasians. A total of 25,205 BCC cases and 683,058 controls were tested. Rare germline loss-of-function variants in PTPN14 conferred substantial risks of BCC (OR, 8.0; P = 1.9 × 10-12), with a quarter of carriers getting BCC before age 70 and over half in their lifetime. Furthermore, common variants at the PTPN14 locus were associated with BCC, suggesting PTPN14 as a new, high-impact BCC predisposition gene. A follow-up investigation of 24 cancers and three benign tumor types showed that PTPN14 loss-of-function variants are associated with high risk of cervical cancer (OR, 12.7, P = 1.6 × 10-4) and low age at diagnosis. Our findings, using power-increasing methods with high-quality rare variant genotypes, highlight future prospects for new discoveries on carcinogenesis. SIGNIFICANCE: This study identifies the tumor-suppressor gene PTPN14 as a high-impact BCC predisposition gene and indicates that inactivation of PTPN14 by germline sequence variants may also lead to increased risk of cervical cancer.Common Fund of the Office of the Director of the National Institutes of Health
United States Department of Health & Human Services
National Institutes of Health (NIH) - USA
NIH National Cancer Institute (NCI)
United States Department of Health & Human Services
National Institutes of Health (NIH) - USA
NIH National Human Genome Research Institute (NHGRI)
United States Department of Health & Human Services
National Institutes of Health (NIH) - USA
NIH National Heart Lung & Blood Institute (NHLBI)
United States Department of Health & Human Services
National Institutes of Health (NIH) - USA
NIH National Institute on Drug Abuse (NIDA)
United States Department of Health & Human Services
National Institutes of Health (NIH) - USA
NIH National Institute of Mental Health (NIMH)
United States Department of Health & Human Services
National Institutes of Health (NIH) - USA
NIH National Institute of Neurological Disorders & Stroke (NINDS
Successful years of collaboration between Acta Ophthalmologica and the European Association for Vision and Eye Research.
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Relapse risk following truncation of pegylated asparaginase in childhood acute lymphoblastic leukemia.
No full textTo access publisher's full text version of this article click on the hyperlink belowTruncation of asparaginase treatment due to asparaginase-related toxicities or silent inactivation (SI) is common and may increase relapse risk in acute lymphoblastic leukemia (ALL). We investigated relapse risk following suboptimal asparaginase exposure among 1401 children aged 1 to 17 years, diagnosed with ALL between July 2008 and February 2016, treated according to the Nordic Society of Pediatric Hematology and Oncology (NOPHO) ALL2008 protocol (including extended asparaginase exposure [1000 IU/m2 intramuscularly weeks 5-33]). Patients were included with delayed entry at their last administered asparaginase treatment, or detection of SI, and followed until relapse, death, secondary malignancy, or end of follow-up (median, 5.71 years; interquartile range, 4.02-7.64). In a multiple Cox model comparing patients with (n = 358) and without (n = 1043) truncated asparaginase treatment due to clinical toxicity, the adjusted relapse-specific hazard ratio (HR; aHR) was 1.33 (95% confidence interval [CI], 0.86-2.06; P = .20). In a substudy including only patients with information on enzyme activity (n = 1115), the 7-year cumulative incidence of relapse for the 301 patients with truncation of asparaginase treatment or SI (157 hypersensitivity, 53 pancreatitis, 14 thrombosis, 31 other, 46 SI) was 11.1% (95% CI, 6.9-15.4) vs 6.7% (95% CI, 4.7-8.6) for the 814 remaining patients. The relapse-specific aHR was 1.69 (95% CI, 1.05-2.74, P=.03). The unadjusted bone marrow relapse-specific HR was 1.83 (95% CI, 1.07-3.14, P=.03) and 1.86 (95% CI, 0.90- 3.87, P=.095) for any central nervous system relapse. These results emphasize the importance of therapeutic drug monitoring and appropriate adjustment of asparaginase therapy when feasible. This trial was registered at www.clinicaltrials.gov as #NCT03987542.Danish Childhood Cancer Foundation
Swedish Childhood Cancer Fun
Prevalence, admission rates and hypoxia due to COVID-19 in patients with rheumatic disorders treated with targeted synthetic or biologic disease modifying antirheumatic drugs or methotrexate: a nationwide study from Iceland.
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A nationwide population-based prospective study of cirrhosis in Iceland.
Get PDFTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadBackground & aims: The incidence of cirrhosis in Iceland has been the lowest in the world with only 3 cases per 100,000 inhabitants. Alcohol consumption has almost doubled in Iceland from 1980 to 2016. Obesity has also risen and hepatitis C virus has spread among people who inject drugs in Iceland. The aim of this study was to evaluate the effects of these risk factors on the incidence and aetiology of cirrhosis in Iceland.
Methods: The study included all patients diagnosed with cirrhosis for the first time during 2010-2015. Diagnosis was based on liver histology or 2 of 4 criteria: cirrhosis on imaging, ascites, varices, and/or elevated INR.
Results: Overall, 157 patients were diagnosed, 105 (67%) males, mean age 61 years. The overall incidence was 9.7 cases per 100,000 inhabitants annually. Alcohol was the only underlying cause in 48/157 (31%), non-alcoholic fatty liver disease (NAFLD) in 34/157(22%), and alcohol and hepatitis C together in 23/157(15%) were the most common causes. Only 6% of patients had an unknown cause of cirrhosis. Upon diagnosis, the median model for end-stage liver disease score was 11 (IQR 8-15), 53% were of Child-Pugh class A whereas 61 (39%) had ascites, 11% encephalopathy, and 8% variceal bleeding. In all, 25% of deaths were from HCC and 25% from liver failure.
Conclusion: A major increase in incidence of cirrhosis has occurred in Iceland associated with increases in alcohol consumption, obesity, and hepatitis C. In a high proportion NAFLD was the aetiology and very few had unknown cause of cirrhosis. The highest death rate was from HCC.
Lay summary: In a nationwide population-based study from Iceland, including all patients diagnosed with cirrhosis of the liver over a period of 5 years, we found the incidence of new cases had increased 3-fold compared with a previous study 20 years ago. The increase is attributable to increased alcohol consumption, an epidemic of diabetes and obesity, and infection with the hepatitis C virus. Furthermore, we found that with thorough investigations, a specific cause for cirrhosis could be found in 94% of patients. Patients with cirrhosis frequently die of liver cancer and other complications related to their liver disease.
Keywords: AIH, autoimmune hepatitis; ALD, alcoholic liver disease; Aetiology of cirrhosis; Alcohol; CIF, cumulative incidence function; CRR, competing-risks regression; Cirrhosis; HCC, hepatocellular carcinoma; Hepatitis C; Incidence of cirrhosis; MELD, model for end-stage liver disease; NAFLD; NAFLD, non-alcoholic fatty liver disease; NALD, non-alcoholic liver disease; NASH, non-alcoholic steatohepatitis; PBC, primary biliary cirrhosis; PSC, primary sclerosing cholangitis; SHRs, subhazard ratios.Landspitali University Hospital scientific committe
International comparisons and holistic patient care.
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