Role of therapeutic plasma exchange as a desensitization therapy in human leukocyte antigen incompatible renal transplant patients: A single-center experience

Abstract Objective Despite an increase in the rate of successful live donor renal transplantation done annually, the number of potential recipients with acceptable donors is relegated to the ever-expanding cadaver-donor waiting list due to sensitization to human leukocyte antigen (HLA) antibodies. If not sufficiently suppressed, these preformed HLA antibodies can trigger antimicrobial resistance (AMR) and early graft loss. To ameliorate this situation, various desensitization treatments are administered to provide a survival benefit to highly sensitized patients. Method One hundred and six patients in the time frame of January 2017 to March 2019 were included in the study group. The desensitization protocol included therapeutic plasma exchange and administration of low-dose intravenous immunoglobulin (100 mg/kg per therapeutic plasma exchange (TPE) session) to highly sensitized patients (treatment group) who subsequently underwent renal transplantation after negative pre-transplant Centers for Disease Control and Prevention Luminex crossmatch (CDC/LumXM). We compared graft survival rates between the group undergoing desensitization (treatment group) and matched control group of patients that underwent HLA-compatible transplantation. Results In the treatment group, Kaplan-Meier analysis estimates an average rate of patient graft survival of 95.2% at 3 years post-transplant, as compared with the rate of 86.9% in the same time frame for the control-matched group (p < 0.05 for both comparisons). Conclusion Desensitization treatment with TPE before live donor renal transplantation in the case of patients with HLA sensitization provides better survival benefits along with monitoring for donor-specific antibodies (DSAs) and other infections, rather than waiting for a compatible organ donor. The data lays out evidence that desensitization treatments can assist overcome HLA incompatibility barriers in live donor renal transplantation.

Preoperative therapeutic plasma exchange to prevent acute rejection after ABO incompatible renal transplantation: a retrospective analysis / 中国输血杂志

【Objective】 To investigate the clinical efficacy of preoperative therapeutic plasma exchange(TPE) in preventing acute rejection after ABO incompatible kidney transplantation(ABOi-KT). 【Methods】 Nine patients with ABOi-KT who were admitted to the renal transplant department of our hospital from April 2022 to April 2024 were retrospectively analyzed. They received a total of 28 TPEs before kidney transplantation, and the treatment plan was summarized as follows: The proportion of the substitute fluid, as well as the frequency and volume of TPE were determined based on the patient′s ABO blood group system antibody titer, gender, height, weight, hematocrit and other indicators upon admission. The patient′s relevant laboratory indicators, including hemoglobin, platelets, leukocytes, coagulation function, total protein, albumin, globulin, A/G, creatinine and urea nitrogen upon admission and after TPE were monitored and statistically analyzed. After transplantation, changes in renal function indicators such as ABO blood group system antibody titers, creatinine and urinary excretion were observed, and clinical symptoms of acute rejection, such as swelling, pain and edema in the transplanted kidney area were observed. 【Results】 Nine ABOi-KT patients had an average of about 3 TPEs before transplantation surgery, with an average total volume of approximately 2 500 mL to 3 500 mL per TPE, or approximately about 1.01 to 1.16 plasma volume (PV). After multiple TPEs, pre-transplantation antibody titers decreased by an average of 3 times compared to before TPE. There were no statistically significant differences in Hb, PLT, PT, PTA, INR, TBil, ALB, Cr and BUN (P>0.05), while statistically significant differences were found in WBC, APTT, Fbg, TP, GLB and A/G (P<0.05). After surgery, the creatinine level of 9 patients dropped to approximately 100 to 140 μmol/L, the urine output was normal, and the urine protein dropped to weakly positive or negative values. None of the nine patients experienced acute rejection. 【Conclusion】 TPE can effectively reduce the level of ABO blood group antibody and prevent the occurrence of acute rejection in ABOi-KT patients.

Efficacy of three plasma exchange methods in improving renal insufficiency after kidney transplantation and the induction of plasma exchange related adverse reactions: a comparative study / 中国输血杂志

【Objective】 To compare the efficacy of double filtration plasmapheresis(DFPP), centrifugal therapeutic plasma exchange(cTPE) and centrifugation-filtration plasmapheresis(CFPP) in improving renal insufficiency after kidney transplantation, as well as the differences in inducing plasma exchange-related adverse reactions. 【Methods】 Clinical data from 46 patients who underwent plasma exchange after renal transplantation in our hospital were retrospectively collected, and patiens were divided into DFPP group(n=33), cTPE group(n=7) and CFPP group(n=6). Changes in peripheral blood creatinine, albumin, hemoglobin, platelets, fibrinogen levels and urine volume before and after TPE were compared and analyzed among the three groups. 【Results】 Among the DFPP group, cTPE group and CFPP group, the creatinine after TPE decreased by (31.40±25.38)%, (58.91±19.75)% and (39.44±28.64)%, respectively, with cTPE group significantly higher than the DFPP group(P0.05); the urine volume after TPE increased by (49.33±30.03)%, (54.62±39.32)% and (68.89±23.00)%, showing no significant differences(P>0.05); the hemoglobin after TPE decreased by (11.97±5.94)%, (20.17±5.75)% and (9.65±8.75)%, respectively, with the cTPE group significantly higher than the DFPP group and CFPP group(P0.05). The platelet count after TPE decreased by (37.88±18.39)%, (24.56±12.36)% and (21.40±12.51)%, respectively, with no significant differences between the three groups(P>0.05); the fibrinogen after TPE decreased by (0.57±0.20)%, (0.14±0.06)% and (0.26±0.22)%, respectively, with the DFPP group significantly higher than the cTPE group(P0.05); the albumin after TPE decreased by (11.41±5.97)%, (14.67±6.52)% and (25.18±5.10)%, respectively, with cTPE group and DFPP group significantly lower than the CFPP group(P0.05). 【Conclusion】 The effect of three plasma exchange methods varies on renal function, anemia and coagulation function of patients after kidney transplantation. It is necessary to consider the the patient’s disease characteristics and treatment needs, as well as the laboratory′s technical conditions and plasma supply when selecting TPE methods.

Risk factors of allergic reactions caused by therapeutic plasma exchange: a single-center analysis / 中国输血杂志

【Objective】 To review the occurrence of allergic reactions during therapeutic plasma exchange (TPE) and to explore the risk factors of TPE allergic reactions. 【Methods】 The clinical data of 929 patients treated with TPE using plasma components by the Department of Transfusion Medicine in our medical center from 2018 to 2023 were collected. The influencing factors of allergic reactions were analyzed by univariate analysis, and the independent risk factors of allergic reactions were analyzed by logistic multivariate regression analysis. 【Results】 A total of 4 071 TPEs were performed in 929 patients.Among them, 198 patients (21.31%) experienced 349 times (8.57%) of allergic reactions, with the incidence of grade Ⅰ, Ⅱ and Ⅲ allergic reactions of 16.33%, 81.38% and 2.29%, respectively, and no deaths. The univariate analysis showed that the patient′s age, allergy history, diagnosis of immune-related diseases, ICU admission, plasma consumption, total blood volume, maximum blood flow rate and combined use of albumin were related to the occurrence of allergic reactions (P<0.05). Multivariate regression analysis showed that young patients, a history of allergy, immune-related diseases and non-ICU patients were prone to allergic reactions in TPE, but the treatment options of TPE such as substitute fluid category, plasma consumption and blood flow rate were not related to the occurrence of allergic reactions. 【Conclusion】 There are significant individual differences in the occurrence of allergic reactions for TPE, and young age, history of allergies, immune-related diseases and non-ICU patients are risk factors for allergic reactions in TPE. Identifying patients with risk factors before TPE treatment and giving corresponding preventive measures can reduce the incidence of allergic reactions.

QTc, Tp-e Interval and Tp-e/QTc Ratio in Patients with Hypocalcemia-case Control Study

Abstract Background: To the best of our knowledge, there are studies related to QT and QTc interval in patients with hypocalcemia, but there are no studies evaluating T wave peak and end interval (Tp-e interval), Tp-e/QT and Tp-e/QTc ratios used to evaluate cardiac arrhythmia risk and ventricular repolarization changes rates. Objectives: Therefore, we aimed to investigate whether there is a change in Tp-e interval, Tp-e/QT and Tp-e/QTc ratios in patients with hypocalcemia. Methods: Retrospectively, 29 patients with hypocalcemia in the emergency department were included in the study. Twenty-nine patients with similar age and sex distribution were included in the study as the control group. All patients underwent 12-lead electrocardiography (ECG). In addition to routine measurements, Tp-e interval, Tp-e/QT and Tp-e/QTc ratios were measured on ECG. The study data were grouped as patients with and without hypocalcemia. Results: The mean age of the patients was 66.24 ± 4.95 years. QTc interval, Tp-e interval and Tp-e/QTc values were found to be significantly higher in patients with hypocalcemia (p <0.001 for each). QTc interval, Tp-e interval and Tp-e/QTc ratio showed a significant negative correlation with calcium levels. Conclusion: Tp-e interval and Tp-e/QTc ratios are significantly increased in patients with hypocalcemia compared to those without hypocalcemia and this can be used more effectively in the follow-up of cardiac fatal arrhythmias.

Acortamiento en la relación Tp-f/QTc tras angioplastia en pacientes con síndrome isquémico coronario agudo / Shortening in the Tp-e/QTc ratio after angioplasty in patients with acute coronary syndrome

Resumen Objetivo: La dispersión transmural de la repolarización ventricular (DTMRV) es un factor de riesgo para muerte en pacientes con síndrome isquémico coronario agudo (SICA). Con el objetivo de conocer el efecto de la realización de angioplastia sobre la DTMRV, se estudió la relación Tp-f/QTc en pacientes con SICA sometidos a angioplastia. Método: Se diseñó un estudio observacional, retrospectivo y descriptivo. Se incluyeron 150 pacientes (N = 150) con diagnóstico de SICA. Se valoró la relación Tp-f/QTc inicial y se evaluó su acortamiento posangioplastia. Como objetivo secundario, se comparó la asociación de dichos cambios en la relación Tp-f/QTc con la mortalidad cardiovascular y los eventos adversos cardiovasculares. Resultados: El promedio en la relación Tp-f/QTc inicial fue de 0.2529, mientras que posangioplastia fue de 0.2397. Por medio de prueba de rangos de Wilcoxon se evidenció un descenso significativo en la relación Tp-f/QTc posterior a la angioplastia, con un valor Z de −2.051 y una p < 0.04. En el análisis secundario se encontró que una Tp-f/QTc ≥ 0.29 posangioplastia es factor de riesgo para presentación de los siguientes eventos adversos: muerte intrahospitalaria (7.4 vs 0%; p < 0.003), nuevo SICA en seguimiento a 1 año (25.9 vs. 18.5%; p < 0.006) y reintervención en seguimiento a 1 año (29.6 vs. 15.0%; p < 0.002). Conclusiones: Existe un acortamiento significativo en la relación Tp-f/QTc posangioplastia en pacientes con SICA. Esta medida de la DTMRV puede servir como un predictor de muerte intrahospitalaria, eventos cardiovasculares y reintervención a 1 año en pacientes con SICA tratados con angioplastia.

Abstract Objective: Transmural Dispersion of Repolarization (TDR) is a Risk factor for Death in patients with Acute Coronary Syndrome (ACS). In order to know the effect of angioplasty on TDR, the Tp-e/QTc ratio was studied in patients with ACS undergoing angioplasty. Method: An observational, retrospective and descriptive study was designed. 150 patients (N = 150) with diagnosis of ACS were included. The initial Tp-e/QTc ratio was assessed and then its post-angioplasty shortening was evaluated. As a secondary objective, we compared the association of these Tp-e/QTc ratio changes with cardiovascular mortality and cardiovascular adverse events. Results: The average in the initial Tp-e/QTc ratio was 0.2529, while post-angioplasty was 0.2397. Through a Wilcoxon rage test, a significant decrease in the Tp-e/QTc ratio after angioplasty was observed, with a Z value of −2.051 and p < 0.04. In the secondary analysis, it was found that a Tp-e/QTc ≥ 0.29 post-angioplasty is a risk factor for presenting the following adverse events: in-hospital death (7.4 vs. 0%; p < 0.003), new ACS in 1-year follow-up (25.9 vs. 18.5%; p < 0.006), and reintervention in 1-year follow up (29.6 vs. 15%; p < 0.002). Conclusions: There is a significant shortening in the Tp-e/QTc ratio post-angioplasty in patients with ACS. This measure of TDR can serve as a predictor of in-hospital death, cardiovascular events and 1-year reintervention in patients with ACS treated initially by angioplasty.

A Comparative Clinical Study On The Efficacy Of Vishwadi Leha And Bharangydi Leha In The Management Of Vataja Kasa W.s.r Tropical Pulmonary Eosinophilia

Vataja Kasa (presented by Shushka Kasa, Prasakta Vega, Shirah Shoola, Hrit Shoola, Parshwa Shoola, Swara Bheda and kshamana) has an increasing prevalence overtime due to the external influences such as industrialisation, urbanisation, environmental pollution and population explosion. Since it’s a demanding health concern, Vataja Kasa was taken up for the present clinical study and was approximately co-related to Tropical Pulmonary Eosinophilia (TPE) which is an immune hyper-responsiveness to microfilariae trapped in the lungs, characterised by paroxysmal nocturnal cough, breathlessness, wheezing, chest pain, scanty sputum production and eosinophilia. The study was conducted with the prime aim of assessing the efficacy of the trial drugs Vishwadi Leha and Bharangyadi Leha in the management of Vataja kasa – TPE. The Clinical trial included 40 patients of Vataja Kasa categorized into two groups (20 in each). In Group A-Vishwadi Leha (3 gms) and in Group B- Bharangyadi Leha (3 gms) were administered thrice daily along with quantity sufficient warm water after food for 30 days. The findings were recorded, assessed and graded accordingly on the 14th and 30th day. The results were analysed statistically for ‘p’ value using student’s paired t-test before and after treatment. Significant results (p<0.001) were observed in both groups. Comparative study between percentages of improvement in Group A showed 5% (based on subjective parameters) and 7% (based on objective parameters) more improvement than that of Group B. Based on the results, it was concluded that Vishwadi Leha has a slightly better result than Bharangyadi Leha in the management of Vataja Kasa-TPE.

A study on therapeutic plasma exchange using apheresis in treatment of Guillain-Barré syndrome in a tertiary care teaching hospital

Background: Therapeutic plasma exchange (TPE) is the separation and removal of plasma from whole blood with replacement by a crystalloid/colloid solution (typically albumin or plasma). The DGHS has established guidelines and recommendations for application of therapeutic apheresis in clinical practice. Guillain-Barré syndrome (GBS) is considered category I indications for TPE. This study was undertaken to establish the effectiveness and safety of therapeutic plasma exchange in GBS which is one of the common indication for TPE at our tertiary care teaching hospital.Methods: A retrospective study of 30 patients admitted to a tertiary care teaching hospital, from January 2014 to December 2016 with clinical signs of Guillain-Barre syndrome (GBS) and/or GBS variants were evaluated for performing TPE. A total of 104 procedures were performed for 30 patients. Replacement of crystalloids and plasma was used. Medical Research Council scale was used to assess the clinical improvement by measuring the grade of muscle power. Information was collected in a structured proforma and statistical analysis was performed using SPSS software (version 20). P value less than 0.05 was considered statistically significant.Results: During the study period, 104 procedures were performed on 30 patients on an average of three procedures per patient. The average age of the patients was 41.4±10.4 years. The mean period of illness at admission was 14.5±5.4 (range 4-32) days. In 23 out of 30 patients, more than three TPE procedures were done, out of which 21 patients clinically improved. The common complications during the procedure were chills (16%), hypotension (10%) and non-hemolytic febrile transfusion reaction (10%) and they were managed accordingly. Two (6.7%) patients who were not ambulatory at discharge had significantly (p <0.05) lower grade of power in lower limbs at admission and all patients recovered fully on follow up.Conclusions: GBS is one of the most commonly occurring clinical paralytic disorders. 76.7% of patients underwent three or more cycles of TPE with 70% had excellent clinical improvement which was comparable with various other studies. Based on results published by various other studies, therapeutic plasma exchange is a comparatively safe and effective procedure

Effect of CO2 pneumoperitoneum combined with position changes on stability of cardiac electrophysiology in gynecological laparoscopy / 实用医学杂志

Objective To observe the effect of CO2 pneumoperitoneum combined with position changes on the stability of cardiac electrophysiology in gynecological laparoscopy. Methods The gynecological laparoscopy was performed for 30 patients to undergo elective gynecological laparoscopy under general anesthesia ,with the pneumoperitoneum pressure of 12 mmHg and the Trendelenburg positionat 15° . The observations and analyses were done over the basic monitoring index and the QT interval (QT),T peak tend interval (Tp-e),heart rate corrected QT interval(QTc),QT dispersion(QTd),Tp-e/QT before anesthesia(T0),after anesthesia(T1),1 min after pneumoperitoneum (T2),30 min after pneumoperitoneum and head-down tilt (T3),30 min after deflation and supine position(T4). Results Compared with the time point of T0,QTd increased significantly at T1(P<0.05) and so it was with QT,QTc,QTd,Tp-e,Tp-e/QT at T2,T3,and T4(P<0.05). Compared with the time point of T2,QTc,QTd,Tp-e,Tp-e/QT significantly increased at T3(P < 0.05). Conclusions CO2 pneumoperitoneum combined with Trendelenburg position can prolong ventricular repolarization duration and destroy the stability of cardiac electrophysiology so it may increase the incidence of cardiovascular events.

The effect of blood glucose levels on programmed death-1 in patients with severe sepsis and type 2 diabetes mellitus / 中华急诊医学杂志

Objective To investigate the effect of blood glucose levels on peripheral blood T lymphocyte programmed death-1 factor (PD-1) and the prognosis of 28-day in patients with severe sepsis and type 2 diabetes mellitus (T2DM).Methods A total of 106 severe sepsis patients with T2DM and 50 healthy subjects as controls were included in this prospective study.According to the blood glucose levels at admission,patients were divided into three groups:the blood glucose ＜ 6.1 mmol/L group,the blood glucose 6.1 to 11.1 mmol/L group,and the blood glucose ＞ 11.1mmol/L group.The patients were followed up for trace the 28-day outcomes,and the levels of peripheral blood PD-1 + CD4 + T lymphocytes and PD-1 + CD8 + T lymphocytes were detected.The Kaplan-Meier survival curves were used to compare the risk of 28-day death in patients with different blood glucose levels.Results The levels of peripheral blood PD-1 + CD4 + T lymphocytes and PD-1 + CD8 + T lymphocytes were higher in patients with severe sepsis and T2DM than those in healthy subjects.The mortality of blood glucose ＜ 6.1 mmol/L group (56.52％) was higher than that of blood glucose 6.1 to 11.1 mmol/L group (24.3％) and the blood glucose ＞ 11.1 mmol/L group (28.3％) (P ＜ 0.05),Kaplan-Meier survival curve showed that the 28-day mortality risk of patients with blood glucose ＜ 6.1 mmol/L was higher than that of patients with blood glucose 6.1 to 11.1 mmol/L group and blood glucose ＞ 11.1 mmol/L group (The Log-rank test values were 6.523 and 5.794,the P values were 0.011 and 0.016).The level of PD-1 + CD8 + T lymphocytes in the blood glucose ＜ 6.1 mmol/L group was higher than that in the blood glucose 6.1 to 11.1 mmol/L group and the blood glucose ＞ 11.1 mmol/L group (P =0.013).Conclusions The patients with severe sepsis and T2DM getting blood glucose level ＜ 6.1 mmol/L at admission may be suffered from severe immunosuppression,and more attention should be paid to the risk of 28-days mortality in these patients..

Effects of target-controlled infusion of propofol with different concentrations on ventricular repolarization after preoperative infusion of cefuroxime sodium in patients undergoing gynecologic opera-tion / 临床麻醉学杂志

Objective To investigate the effects of target-controlled confusion of propofol with different concentrations on ventricular repolarization after prophylactic infusion of cefuroxime sodium. Methods Sixty ASA physical status Ⅰ or Ⅱ female patients,aged 18-65 years,undergoing elective gynecological surgery were randomly divided into three groups:group P2 (n =20)with TCI 2 μg/ml, group P3 (n =1 9)with TCI 3 μg/ml and group P4 (n =20)with TCI 4 μg/ml.Firstly,they were re-hydrated;secondly,the patients in groups P2,P3 and P4 were intravenous infused with cefuroxime sodium 2.5 g (in 100 ml normal saline)and then target-controlled infused of propofol 2 μg/ml,3μg/ml and 4 μg/ml in target plasma concentration,respectively.At three pionts of time:after rehy-dration before intravenous antibiotics (T0 ),after intravenous antibiotics before TCI of propofol (T1 ), after TCI of propofol (T2 ),QT interval,QTc interval,Tp-e interval were measured and recorded, respectively.Results Compared with T0 ,QTc [(469.9 ± 34.0)ms vs.(451.2 ± 24.9)ms],Tp-e [(107±25)ms vs.(94±20)ms]and Tp-e/QT (0.260±0.058 vs.0.236±0.043)in group P4 were sig-nificantly prolonged at T1 (P < 0.05 ).Compared with T1 ,QTc of groups P2 [(437.4 ± 24.4)ms vs. (453.3±28.0)ms]and P4 [(438.8±29.9)ms vs.(469.9±34.0)ms]were shortened significantly at T2 (P <0.05).Conclusion Propofol could improve ventricular reporlarization heterogeneity caused by cefu-roxime sodium.

Prolonged Tp-e Interval, Tp-e/QT Ratio and Tp-e/QTc Ratio in Patients with Type 2 Diabetes Mellitus

BACKGROUND: Type 2 diabetes mellitus (T2DM) is associated with increased risk of malignant ventricular arrhythmias. Cardiac electrical inhomogeneity may be the leading cause of the increased arrhythmic risk in patients with T2DM. The peak and the end of the T wave (Tp-e) interval and associated Tp-e/QT ratio are promising measures of ventricular repolarization indicating transmural dispersion of repolarization. The aim of this study was to assess ventricular repolarization in patients with T2DM by using Tp-e interval, Tp-e/QT ratio and Tp-e/corrected QT interval (QTc) ratio. METHODS: Forty-three patients with T2DM and 43 healthy control subjects, matched by gender and age, were studied. All participants underwent electrocardiography (ECG) recording. PR, RR and QT intervals represents the ECG intervals. These are not abbreviations. In all literature these ECG intervals are written like in this text. Tp-e intervals were measured from 12-lead ECG. Rate QTc was calculated by using the Bazett's formula. Tp-e/QT ratio and Tp-e/QTc ratio were also calculated. RESULTS: Mean Tp-e interval was significantly prolonged in patients with T2DM compared to controls (79.4±10.3, 66.4±8.1 ms, respectively; P<0.001). We also found significantly higher values of Tp-e/QT ratio and Tp-e/QTc ratio in patients with diabetes than controls (0.21±0.03, 0.17±0.02 and 0.19±0.02, 0.16±0.02, respectively; P<0.001). There was no difference in terms of the other ECG parameters between the groups. CONCLUSION: Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio were prolonged in patients with T2DM. We concluded that T2DM leads to augmentation of transmural dispersion of repolarization suggesting increased risk for ventricular arrhythmogenesis.

Detection and clinical significance of Tp-e interval extension of sudden coronary death / 中国现代医生

Objective To investigate the detection and clinical significance of Tp-e interval extension of sudden coro-nary death. Methods A total of 502 patients with coronary heart disease were selected, of which 46 patients with sud-den coronary death were assigned to the sudden death group and the other 456 patients were assigned to the survival group. The Tp-e, Tp-e/√RR , heart rate-corrected QT inverval (QTc) and left ventricular ejection fraction of the two groups were compared and the clinical significance of Tp-e interval extension for sudden coronary death was decided. Results Compared to the survival group, the sudden death group had significantly extended Tp-e, Tp-e/√RR and QTc(P<0.05);Compared to the survival group, the sudden death group had significantly reduced LVEF (P<0.05); Tp-e extension was positively correlated to sudden coronary death and QTc(P<0.05). Conclusion The Tp-e interval extended obviously in the patients with sudden coronary death and thus can serve as a predictive risk factor of sudden coronary death.

Evaluation of Adenosine Deaminase (ADA) Activity for Diagnosis of Tubercular Pleural Effusion.

To find out a sensitive and specific marker for early diagnosis of tubercular pleural effusion, this cross sectional study was carried out in the of National Institute of Diseases of the Chest and Hospital (NIDCH), Dhaka. One hundred and three pleural effusion cases were enrolled in the study. Out of the 103 cases, 62 were tubercular pleural effusion cases and 49 were nontubercular cases. Among the nontubercular cases, 30 cases were due to malignancy, 8 were due to pneumonia and rest 3 cases were due to nephrotic syndrome, congestive cardiac failure and rheumatoid arthritis. Considering 40 U/L as a cut off value for ADA level, the test result was positive in 58 out of 62 patients of tuberculosis indicating sensitivity of the test as 94%; however, among 41 non-tuberculous patients, 5 presented ADA activity level more than 40U/L, which lowers the specificity of the test to 88%. ADA levels were significantly higher in tuberculous than in nontuberculous cases (p value <0.001). It may be concluded that ADA levels are significantly high in patients with tuberculous pleural effusion compared to that in non-tubercular group. Sensitivity (94%) and specificity (88%) of the test in tuberculous pleural effusions are very high, when cut off value set at 40U/L. The result indicated that the analysis of ADA levels in pleural effusion constitute a very useful marker for the diagnosis of tubercular pleural effusion (TPE) which, in addition, can be made quickly in a noninvasive way.

Diagnostic accuracy of immunological methods in patients with tuberculous pleural effusion from Venezuela / Precisión diagnóstica de métodos inmunológicos en pacientes con tuberculosis pleural de Venezuela

In recent years, better diagnostics for tuberculosis (TB) has received increasing attention, especially the diagnosis of tuberculous pleural effusion, which is difficult and at present the main tool in TPE diagnostic is pleural effusion smear and culture, but unfortunately, sensitivities are low, therefore better TPE diagnostic tools are needed. The aim of this study was to find a diagnostic algorithm to assess the progress in TPE diagnostic at the Hospital Vargas de Caracas, that permits identification of the majority of patients, at a satisfactory cost-benefit ratio, evaluating the levels of IFN-g and IL-12p40 in pleural effusion and serum, as well as the antibody reactivity in order to compare it with microbiological tests. A total of 60 individuals with pleural effusion were studied; 20 patients with tuberculous pleural effusion (TPE) formed the patient group and 40 patients with non-tuberculous pleural effusion (NTPE) formed the control group. The levels of IFN-g and IL-12p40 in effusion and serum and class and subclasses of IgG reactivity to Mycobacterium tuberculosis antigens were measured by ELISA. The utility of these methods for diagnosis of TPE was evaluated using receiver operating characteristic (ROC) curve analysis. The results of the 11 immunological methods evaluated showed that the anti-PPD IgG2 method was able to reach the highest specificity of 95% (CI: 88.3-101.8), positive predictive value (PPV)=75 (at 30% sensitivity); while that the overall sensitivity of methods was between 95% and 30%, of these, two methods reached higher sensitivities; increased levels of pleural IFN-g, with a sensitivity of 95% (CI: 85.5-104.5) with the highest negative predictive value (NPV)=97, (at 82.5% specificity), followed by decreased levels of serum IL-12p40 with a sensitivity of 95% (CI: 85.5-104.5), NPV=95.2 (at 50% specificity). In contrast, microbiological methods showed that smear had a sensitivity of only 20%, while smear plus ...

Recientemente existe un gran interés hacia un mejor y más rápido diagnóstico de tuberculosis (TB), especialmente de tuberculosis pleural, el cual es difícil. Al presente las principales herramientas diagnósticas son la baciloscopia y el cultivo de líquido pleural; desafortunadamente, las sensibilidades de estos métodos son bajas, por lo que el desarrollo de nuevas herramientas diagnósticas es necesario. El objetivo del presente estudio consistió en encontrar un algoritmo que permita la rápida identificación de la mayoría de los pacientes con TB pleural que ingresan en el Hospital Vargas de Caracas a un buen costo-beneficio. Para esto se evaluaron los niveles de las citocinas Interferón-gamma (IFN-g) y la Interleucina 12p40 (IL-12p40) en líquido pleural y suero, así como la reactividad de anticuerpos contra antígenos de Mycobacterium tuberculosis. Se estudiaron 60 individuos con derrame pleural; 20 individuos con líquido pleural tuberculoso (LPT) conformaron el grupo de pacientes y 40 individuos con líquido pleural no tuberculoso (LPNT) el grupo de controles. La técnica de inmunoensayo de ELISA fue utilizada para medir los niveles de IFN-g y IL-12p40; así como las reactividades de los diversos isotipos y subclases de inmunoglobulina G (IgG) frente a antígenos del bacilo. La utilidad de los métodos fue evaluada utilizando el análisis de las curvas ROC (receiver operating characteristic). Los resultados de los 11 métodos inmunológicos evaluados mostraron que el método IgG2 anti-PPD alcanzó la mayor especificidad de 95%, (CI: 88,3-101,8) con un valor predictivo positivo (VPP) de 75. La sensibilidad de los métodos estuvo entre 30% y 95%; dos métodos alcanzaron altas sensibilidades: los altos niveles de IFN-g en líquido pleural, con sensibilidad de 95% (CI: 85,5-104,5), con un valor predictivo negativo (VPN) de 97, seguido de los bajos niveles de IL-12p40 en suero, con una sensibilidad de 95% (CI: 85,5-104,5) con un VPN de 95,2. En contraste, ...

Effect of oxytocin on Tp-e and QTc interval during caesarean section / 中国医师进修杂志

Objective To evaluate the effect of oxytocin on Tp-e and QTc interval during caesarean section under spinal anesthesia in healthy puerperas. Methods Forty ASA Ⅰ puerperas were selected and allocated to receive oxytocin intravenous bolus group (group-IB) or oxytocin continuous infusion group (group-CI) with 20 puerperas in each by random digits table. An intravenous bolus of 5% glucose 5 ml and 5 U oxytocin was administered after delivery a 55-60 s period. A continuous infusion of 5% glucose 5 ml and 5U oxytocin was administered after delivery a 10 min period. Measured the QTc interval,Tp-e interval,mean arterial pressure (MAP) and beart rate ( HR ) pre-operatively, then 1,3 and 5 ain after spinal anesthesia, and at least 1,3,5 and 10 min after oxytocin injection. Results In group-IB:HR was fast 1 min after oxytocin injection compared with pre-operatively [(89 ± 13) beats/min vs. (73 ± 12) beats/min] ,MAP was decreased [(69 ± 12 ) mm Hg ( 1 mm Hg= 0. 133 kPa ) vs. ( 82 ± 13 ) mm Hg] and QTc interval was prolonged [(426 ±21 ) ms vs. (405 ± 18 ) ms] (P ＜ 0.01 ); but Tp-e interval was prolonged 1,3,5 min after oxytocin injection compared with pre-operatively (P ＜ 0.01 or ＜ 0.05 ). Conclusions Single large dose of oxytocin intravenous bolus (5 U) can prolong QTc interval and Tp-e interval in healthy puerperas, and Tp-e interval can exact predict the occurrence of ventricular arrhythmias. The risk-benefit balance of oxytocin bolus during caesarean delivery should be discussed with women with a history of long QT syndrome.

A Case of Removal Myoglobin by Plasmapheresis in Rhabdomyolysis / 대한수혈학회지

Rhabdomyolysis is defined as necrosis of the skeletal muscle fibers with release of the intracellular muscle constituents, including myoglobins,into the blood and urine. Severe myoglobinemia causes obstruction and necrosis of the renal tubule, resulting in acute renal failure (ARF). In this case, a patient with rhabdomyolysis-induced ARF was in recovery phase after treatment with fluid replacement and continuous renal replacement therapy (CRRT). However, a sudden relapse of severe myoglobinemia occurred during CRRT. To remove myoglobinas rapidly as possible, we applied two sessions of plasmapheresis (total plasma exchange, TPE) in addition to CRRT for two days. The myoglobin level of the patient successfully decreased by 91%, and clinical symptoms and laboratory-measuredabnormalities subsequently improved. If severe myoglobinemia is persistent, or if relapse in spite of CRRT occurs, it would be reasonable to consider TPEas an additional therapy.

Absorptivity of Different Infusion Sets on Paclitaxel Injection / 中国药房

0.05).CONCLUSION:Three infusion sets have no absorbability on paclitaxel.