Patient characteristics that can predict response to omalizumab an [anti-IgE antibody] for achieving better control of asthmatic patients

Omalizumab is a monoclonal anti-immunoglobulin E [IgE] antibody indicated for the treatment of inadequately controlled severe persistent asthma despite optimal controller therapy. It is an expensive medication so there is a need to identify those patients most likely to benefit. To investigate characteristics associated with response to omalizumab in difficult asthma. The study enrolled 42 patients [15 female, 27 male] with age range [20 y-52 y] with severe asthma that was inadequately controlled despite step 4 treatment as described in [GINA] guidelines. Omalizumab was given as add-on therapy to concomitant asthma treatment and administered subcutaneously every 2 or 4 weeks according to patients' pretreatment bodyweight and baseline IgE levels, for at least 16 weeks. Those who showed better asthma control were analyzed to investigate whether pre-treatment patient baseline clinical characteristics could be reliably identified and to be predictive of a superior response to omalizumab. [[12/42 [28.6%]] of enrolled patients showed better asthma control. Using univariate and multivariate regression analysis, many variables showed significant effect on response to omalizumab including; age, duration of asthma, history of allergic rhinitis, history of allergic dermatitis, bronchial reversibility, no of positive results to common allergen in immediate skin-prick test, sputum eosinophilia and baseline total [IgE]. Omalizumab is an expensive medication so it is recommended to target its use to patients most likely to benefit rather than recommend widespread use. Further studies are needed to confirm these data

Electrodiagnostic study of phrenic nerve function in patients with systemic lupus erythematosus

Systemic lupus erythematosus [SLE] may affect respiratory muscles. Diaphragmatic weakness in patients with SLE is a controversial issue and is claimed to have a neuropathic, myopathic or unknown pathogenesis. To determine whether the diaphragmatic weakness could be explained on the basis of a phrenic neuropathy in patients with SLE. A total of 21 patients [18 female and 3 male] with systemic lupus erythematosus [SLE] [age range, 16-36yr] were included and studied by physical chest examination, chest radiography, spirometry, as well as serological examinations and bilateral transcutaneous phrenic nerve conduction studies. 14 [66.6%] patients complained of dyspnea, only one patient showed paradoxical abdominal movement. Pulmonary function tests showed proportional reduction of the forced vital capacity [FVC] and forced expiratory volume in 1 second [FEV[1]] in 17 [81%] patients, suggesting a restrictive process which was severe in 5 [23%] patients. Phrenic nerve evaluation using transcutaneous stimulation studies showed delayed latencies of the right, left and both phrenic nerve in 17 [81%], 19 [90%] and 17 [81%] patients respectively, confirm-ingademyelinating neuropathy. Also Phrenic nerve stimulation evoked a low-amplitude response from right, left and both phrenic nerve in 17 [81%], 15 [71%] and 14 [66.6%] of patients respectively, confirming axonal neuropathy. There were no significant differences in serum immune markers between individuals with and those without abnormal electrical phrenic nerve stimulation. All patients presented with dyspnea showed abnormal phrenic nerve conduction studies. There was tendency for small but clear lung fields in CXR of individuals with abnormal electrical phrenic nerve stimulation. Overall FVC% predicted was decreased in individuals with abnormal electrical phrenic nerve stimulation compared to those without. Diaphragmatic weakness in patients with SLE is both common and is very likely to be caused by a phrenic neuropathy with evidence of bilateral involvement in patients with SLE

Expression of c-met in malignant pleural mesothelioma: an immunohistochemical study

Most patients with malignant pleural mesothelioma present in advanced stages of disease. Response rates and survival with currently available therapies are poor. Therefore, it is critical to identify the molecular markers of mesothelioma which would provide a way of understanding this neoplasm and targeting these markers in therapy. To assess the immunoreactivity of c-Met in malignant pleural mesothelioma and to analyze the potential link of the c-MET expression to some clincopathological parameters such as tumor subtype, TNM stage and patients' survival. A total of 20 patients [7 females and 13 males] with pathologically confirmed MPM; age range, [35 to 63 years] were included in the study. The patient records for the clinical, radiological and laboratory investigations and the results of closed pleura biopsies were analyzed. Pleura biopsies were stained for c-Met using immunohistochemical technique applied to paraffin sections. Of the studied tumors 18 [90%] were immunoreactive for c-Met. There were no significant relations between c-Met and patient age [p=0.569] or gender [0.755]. Also there was no relation between c-Met expression and clinical symptoms. All tumors that showed distant metastasis were c-Met positive. While all c-Met negative tumors showed no metastasis. However, the difference was statistically insignificant. There was also no relation between c-Met and tumor subtype [p=0.40] or tumor stage [p=0.257]. However, all T3 and T4 tumors were c-Met positive and the two c-Met negative tumors were T[2]. The 2 c-Met negative patients showed one-year survival. Whereas [7/18] of patients with positive c-Met died. However, again the difference was statistically insignificant [p=0.755]. c-Met receptor was expressed in a high proportion of MPM. It may have a significant role in the development of MPM and could be a beneficial target for therapy. Though there was no statistically significant relation between c-Met expression and one-year survival or with different prognostic factors in MPM, we observed more c-met expression in more extensive cases and more deaths in c-Met positive cases. Additional larger-scale studies of MPM are needed to confirm the prognostic role of c-Met expression