ABSTRACT
Background@#This study evaluated the safety and effectiveness of the cytomegalovirus (CMV) Specific Antigen Induced Interferon-Gamma ELISPOT (enzyme-linked immunosorbent spot)/ELISA (enzyme-linked immunosorbent assay) procedure in predicting the risk of CMV infection/disease in immunocompromised patients through a systematic literature review. @*Methods@#The searched electronic databases included MEDLINE, EMBASE and the Cochrane Library. A total of 884 non-duplicate citations were retrieved and a total of 25 studies (15 cohort studies, 10 cross-sectional studies) were included in this review. Study subjects were selected among patients with solid organ, hematopoietic stem cell transplantation, or those who were on hemodialysis. Data extraction and literature quality assessment were carried out independently by two researchers. @*Results@#Most of the studies were conducted on patients with solid organ transplants. As it is conducted outside the body, CMV Specific Antigen Induced Interferon-Gamma ELISPOT/ELISA assay was safe. Regarding its effectiveness, most studies on risk analysis based on prognosisrelated outcomes reported that the inactive group showed a significantly higher hazard ratio or odds ratio than the active group. Results of Kaplan-Meier survival analysis also showed that the inactive group had a significantly higher incidence of CMV event (CMV infection, CMV disease, other events) than the active group. However, various thresholds for CMV cell immune response were reported, as was a broad range of predictive diagnostic accuracies. @*Conclusion@#CMV Specific Antigen Induced Interferon-Gamma ELISPOT/ELISA assay has potential to stratify the risk of CMV infection/disease among solid organ transplant patients and to determine a policy for a prophylaxis/preemptive. However, additional literature evidence is needed to establish thresholds for CMV cell immune response and standardized tests.
ABSTRACT
Background@#This study evaluated the safety and effectiveness of the cytomegalovirus (CMV) Specific Antigen Induced Interferon-Gamma ELISPOT (enzyme-linked immunosorbent spot)/ELISA (enzyme-linked immunosorbent assay) procedure in predicting the risk of CMV infection/disease in immunocompromised patients through a systematic literature review. @*Methods@#The searched electronic databases included MEDLINE, EMBASE and the Cochrane Library. A total of 884 non-duplicate citations were retrieved and a total of 25 studies (15 cohort studies, 10 cross-sectional studies) were included in this review. Study subjects were selected among patients with solid organ, hematopoietic stem cell transplantation, or those who were on hemodialysis. Data extraction and literature quality assessment were carried out independently by two researchers. @*Results@#Most of the studies were conducted on patients with solid organ transplants. As it is conducted outside the body, CMV Specific Antigen Induced Interferon-Gamma ELISPOT/ELISA assay was safe. Regarding its effectiveness, most studies on risk analysis based on prognosisrelated outcomes reported that the inactive group showed a significantly higher hazard ratio or odds ratio than the active group. Results of Kaplan-Meier survival analysis also showed that the inactive group had a significantly higher incidence of CMV event (CMV infection, CMV disease, other events) than the active group. However, various thresholds for CMV cell immune response were reported, as was a broad range of predictive diagnostic accuracies. @*Conclusion@#CMV Specific Antigen Induced Interferon-Gamma ELISPOT/ELISA assay has potential to stratify the risk of CMV infection/disease among solid organ transplant patients and to determine a policy for a prophylaxis/preemptive. However, additional literature evidence is needed to establish thresholds for CMV cell immune response and standardized tests.
ABSTRACT
A 68-year-old man presented at the emergency room with sudden blindness. The day before, he had eaten sashimi and eel and drank alcohol for dinner. He experienced nausea, vomiting, and dizziness afterward. His medical history included hypertension and diabetes, and the latter was treated with metformin. Initial laboratory tests revealed severe metabolic acidosis (lactic acidosis). Massive hydration and intravenous sodium bicarbonate replacement therapies were initiated, but severe metabolic acidosis (lactic acidosis) did not resolve, in turn, leading to hemodialysis, which decreased metabolic acidosis. The patient's blindness improved, and his vision gradually recovered. As it is not easy to distinguish between blindness related to metformin-associated lactic acidosis (MALA) and blindness related to other causes, rapid correction of metabolic acidosis through hemodialysis might be helpful in differentiating this from of blindness from blindness related to other causes.