ABSTRACT
Background: Antibody deficiencies result from reduced immunoglobulin levels and function, increasing susceptibility to, primarily, bacterial infection. Primary antibody deficiencies comprise intrinsic defects in B-cell physiology, often due to inherited errors. Hematological malignancies or B-cell suppressive therapy are major causes of secondary antibody deficiency. Although immunoglobulin replacement therapy (IGRT) reduces infectious burden in antibody deficiency patients, respiratory tract infections remain a significant health burden. We hypothesize that lung pathology and gastroesophageal reflux disease (GORD) increase the risk of pneumonia in antibody deficiency patients, as in the general population. Objective: For our cohort of patients with primary antibody deficiency and secondary antibody deficiency, we reviewed their respiratory infectious burden and the impact of lung pathologies and GORD. Methods: The medical records of 231 patients on IGRT at a tertiary referral center, from October 26, 2014, to February 19, 2021, were reviewed to determine microbial isolates from sputum samples and prevalence of common lung pathologies and GORD. Results: Haemophilus and Pseudomonas species represent a large infectious burden, being identified in 30.2% and 21.4% of sputum samples demonstrating growth, respectively; filamentous fungal and mycobacterial infections were rare. Diagnosed lung pathology increased the proportion of patients with Pseudomonas, Klebsiella, Stenotrophomonas, and Candida species isolated in their sputum, and diagnosed GORD increased the proportion with Enterobacter and Candida species isolated. Conclusions: Bacterial respiratory infectious burden remains in primary antibody deficiency and secondary antibody deficiency despite IGRT. Lung pathologies encourage growth of species less susceptible to IGRT, so specialist respiratory medicine input and additional treatments such as inhaled antibiotics are indicated to optimize respiratory outcomes.
ABSTRACT
BACKGROUND/AIMS: This article reports on the career choice of foundation doctors going through a local foundation programme and whether they planned to take an F3 year. The authors also prospectively gathered views relating to their career choice and the need for an F3 year. METHOD: Data were gathered from 193 foundation doctors training in Nottinghamshire between 2015 and 2020 through an unstructured interview process. Data were anonymised and used to learn about career pathway choices and whether they planned to take an F3 year option. Reasons for this pathway were also explored. RESULTS: Data showed that there was a steady increase in the proportion of trainees opting for F3 over time. CONCLUSIONS: The local picture in terms of trainees taking an F3 option reflects the national trend. Some trainees find foundation training a stressful time and so need to be offered support. The authors comment on the factors that make a career appealing to trainees.
