Association of Upon-Diagnosis Blood Eosinophilic Count with Frequency and Severity of Annual Exacerbation in Chronic Obstructive Pulmonary Disease: A Prospective Longitudinal Analysis.

Introduction: There is a controversy regarding the relationship between blood eosinophil count and COPD exacerbation. We aimed to determine whether peripheral eosinophils upon COPD diagnosis could affect the frequency and severity of annual acute exacerbation of COPD (AECOPD). Methods: This prospective study was conducted on 973 newly diagnosed COPD patients who were under 1-year follow-up in a pulmonology center in Iran. The Cox proportional model, polynomial regression, and receiver operator characteristic curves were conducted to evaluate the impact of the eosinophil levels on AECOPD. A linear regression model was conducted to evaluate the continuous association of eosinophilic count with AECOPDs. Results: Patients with eosinophil >200 cells/microliter were higher pack-year smokers with more pulmonary hypertension prevalence compared to COPD patients with <200 cells/microliter. There was a positive correlation between the eosinophilic count and the frequency of AECOPDs. Eosinophil >900 cells/microliter and eosinophil >600 cells/microliter had a sensitivity of 71.1% and 64.3%, respectively, in predicting the occurrence of more than one AECOPD. Eosinophilic count cutoff of 800 cells/microliter had the highest Youden index with sensitivity and specificity of 80.2% and 76.6%, respectively, for incident AECOPD in newly diagnosed patients. Using a linear model, increasing 180 cells/microliter in serum eosinophils was associated with further exacerbation. Evaluating gender, BMI, smoking pack-year, FEV1/FVC, CAT score, GOLD score, pulmonary hypertension, annual influenza, pneumococcal vaccinations, leukocytosis, and blood eosinophils, only blood eosinophils (hazard ratio (HR) = 1.44; 95% confidence interval = 1.33-2.15; p value = 0.03) and GOLD score (HR = 1.19; 95% CI = 1.30-1.52; p value = 0.03) were found as independent risk factors of AECOPD >3 episodes/year. Requirement for ICU admission, invasive ventilation, and mortality rate due to AECOPDs was similar between eosinophilic and noneosinophilic groups. Conclusion: Eosinophilia upon COPD diagnosis is a factor of recurrent AECOPDs. To reduce the risk of AECOPDs and the burden of disease, clinicians may consider inhaler corticosteroids and domiciliary oxygen with a lower threshold for eosinophilic-COPD patients regardless of their clinical status.

Serum Exosomal miRNAs Are Associated with Active Pulmonary Tuberculosis.

INTRODUCTION: Tuberculosis (TB) remains a major threat to human health. Due to the limited accuracy of the current TB diagnostic tests, it is critical to determine novel biomarkers for this disease. Circulating exosomes have been used as diagnostic biomarkers in various diseases. OBJECTIVE OF THE STUDY: In this pilot study, we examined the expression of miRNAs as biomarker candidates for the diagnosis of TB infection. METHODS: Serum-derived exosomes were isolated from TB patients and matched control subjects. The expression of miR-484, miR-425, and miR-96 was examined by RT-PCR methods. RESULTS: The expression of miR-484, miR-425, and miR-96 were significantly increased in serum of TB patients which correlated with the TB infection level. A receiver operating characteristic (ROC) curve analysis showed the diagnostic potency of each individual serum exosomal miRNA with an area under the curve (AUC) = 0.72 for miR-484 (p < 0.05), 0.66 for miR-425 (p < 0.05), and 0.62 for miR-96 (p < 0.05). CONCLUSION: These results demonstrate that exosomal miRNAs have diagnostic potential in active tuberculosis. The diagnostic power may be improved when combined with conventional diagnostic markers.

Investigation of urine lipoarabinomannan in human immunodeficiency virus patients with or without coinfection with Tuberculosis in Iran.

OBJECTIVE/BACKGROUND: Tuberculosis (TB) remains the leading cause of AIDS-related deaths among adults in countries with resource limitations. The emergence of the Xpert MTB/RIF rapid molecular assay and its subsequent World Health Organization endorsement in 2010 transformed the TB-diagnostic landscape. Xpert provided diagnostic accuracy that was far superior to that of the sputum-smear microscopy test previously used. The detection of mycobacterial lipoarabinomannan (LAM) antigen in urine has emerged as a potential point-of-care test for TB. LAM antigen is a lipopolysaccharide present in mycobacterial cell walls which is released from metabolically active or degenerating bacterial cells and appears to be present only in people with active TB. Urine-based testing has advantages over sputum-based testing because urine is easy to collect and store and lacks the infection control risks associated with sputum collection. A previously study reported that urinary-LAM testing is a rapid, low-cost, ante-mortem diagnosis for human immunodeficiency virus (HIV)-associated TB. The objective of this study was to investigate the levels of LAM in HIV patients referred to the Mashih Daneshvari Hospital Tehran, Iran. METHODS: Urine from 31 HIV patients without TB, 33 HIV patients with pulmonary TB, and eight HIV patients with extrapulmonary TB was analyzed for LAM using enzyme-linked immunosorbent assay kits (Mybiosource, San Diego, CA, USA). RESULTS: The plasma levels of LAM in pulmonary TB/HIV patients was 7.67±2.3ng/ml compared with 4.5±1.6ng/ml in extrapulmonary TB/HIV and 6.7±1.2ng/ml in HIV patients without TB. There was no significant difference in urine LAM levels between the three groups. CONCLUSION: Our results highlight the limitations of using urine LAM levels for differentiating HIV-associated TB patients in Iran.

Using competing risks model and competing events in outcome of pulmonary tuberculosis patients.

INTRODUCTION: Although tuberculosis (TB) is curable, the rate of failure and mortality is high in comparison to other infectious diseases worldwide. It has been shown that majority of TB patients leave treatment before completing the therapeutic regimen. The aftermath of incomplete regimens might result in drug resistant-TB bacilli (DR-TB), relapses, and death. For this reason, proper knowledge about the disease and associated risk factor is crucial to decreasing TB cases among the general population. In the present study, we aimed to investigate the associated factors and competing events among pulmonary tuberculosis patients. MATERIALS AND METHODS: Based on a cohort study, associated risk factors and competing events from 2366 confirmed TB patients that referred to the National Center for Tuberculosis for diagnosis and treatment (2005-2015) were collected and analyzed. RESULTS: Our results showed that gender, age, marital status, TB contact, drug adverse effect, and HIV positive, imprisoned, significantly affect the relapse cases, drug resistance, and mortality rate (P-value <0.05). CONCLUSIONS: Use of competing risks model with competing events can provide a better way to understand the associated risk factors co-related with outcome of the pulmonary TB process, especially among DR-TB patients.