Secondary immunodeficiency (SID) in patients with B-cell hematological malignancies is a common condition that presents with recurrent infection. SID is due to both the inherent immune defects due to ...the malignancy, as well as secondary to cancer therapies, many of which have B-cell depleting properties. The early diagnosis of SID and the optimization of intervention strategies are key to delivering the most effective cancer treatments and reducing infection-related morbidity and mortality. This review discusses current practice, recommendations, and challenges for SID diagnosis, based on the evaluation of clinical history and laboratory assessments, and the effectiveness of specific vaccines and immunoglobulin replacement therapy in reducing the frequency and recurrence of infections in patients with SID, and the healthcare system-associated costs.
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•Hematological malignancies predispose patients to secondary immunodeficiency (SID).•Treatment-induced SID can arise from therapies for hematological malignancies.•Timely SID diagnosis is key to developing optimal strategies to prevent infections.•Immunoglobulin replacement therapy (IgRT) reduces infectious episode frequency.•IgRT should be tailored to a patient’s condition and cancer therapy regimens.
Paget-Schroetter syndrome describes a primary thrombosis of the subclavian vein induced by effort. In most cases, the clinical presentation includes painful swelling, discoloration, and visible ...collateral circulation in the arm. Paget-Schroetter syndrome is treated with anticoagulation, rest, and physical therapy. In certain cases, invasive treatment such as thrombolysis and decompression surgery (first rib resection) may be necessary. We present the case of a 28-year-old healthy male patient with effort-induced deep vein thrombosis of the upper extremity after posterior shoulder subluxation. Anticoagulation, rest, and physical therapy were used to treat the patient, who became asymptomatic and was able to resume normal activities without restriction. To our knowledge, this is the first case of effort-induced upper extremity deep vein thrombosis after posterior shoulder subluxation. Paget-Schroetter syndrome is rare diagnosis that requires vigilance during musculoskeletal assessment for shoulder pain and swelling. The early detection, radiological confirmation, and prompt initiation of treatment are essential to successful management of Paget-Schroetter syndrome. The impact of associated posterior shoulder subluxation remains unclear.
There are multiple FDA-approved biologics to treat poorly controlled moderate-to-severe asthma. Given the heterogeneity of asthma and the lack of head-to-head data between biologics, selecting the ...best biologic for a patient can be difficult. This review summarizes the key literature to date, in hopes of facilitating an evidence-based approach to selecting the most appropriate biologic for patients with asthma.
In addition to unique mechanisms of action, there is increasing literature on predictors of response to each biologic, such as sensitizations to aeroallergens, peripheral eosinophil count, total serum IgE, and exhaled nitric oxide. Biologics available for asthma are also being increasingly studied in comorbid conditions with asthma, and this may facilitate selecting the most appropriate biologic for a patient. In the absence of head-to-head studies, there is literature of switching between biologics whenever necessary.
The authors outline an approach to selecting a biologic based on various considerations, and hope this suggested approach facilitates selecting the biologic most suitable for each individual with poorly controlled moderate-to-severe asthma.
•Deficit irrigation increased wheat grain yield by 11% to 136% compared to rainfed.•Deficit irrigation saved up to 197mm water with similar yields as full irrigation.•Irrigation recommended at ...jointing-booting and flowering (=water sensitive stages).•Moderate fertility levels recommended for suggested deficit irrigation.•Irrigation and fertility management can improve wheat yields in drought-prone area.
Proper utilization of water resources is very important in agro-based and drought-prone Bangladesh. Sustainable use of water resources in agriculture requires irrigation schedules based on local environmental conditions, soil type and water availability. In this study, the water productivity model AquaCrop was used to simulate different water and fertilizer management strategies in a drought prone area of Bangladesh to obtain management recommendations. First, the Standardised Precipitation Index (SPI) and Reconnaissance Drought Index (RDI) were determined to quantify the aggregated deficit between precipitation and the evaporative demand of the atmosphere, which confirm that meteorological drought is occurring frequently in the study area. Also, the AquaCrop model was successfully calibrated and validated for wheat in the area, which was confirmed by the several statistical indicators, and could be used to design water and fertilizer management strategies. Simulations identified stem elongation (jointing) to booting and flowering stage as the most water sensitive stages for wheat. Deficit irrigation during the most water sensitive stages could increase the interannual yield stability and the grain yield compared to rainfed conditions for different soil fertility levels on loamy and sandy soils by 21–136% and 11–71%, respectively, while it could increase water productivity compared to full irrigation strategies. Deficit irrigation resulted in grain yields almost equal to yields under full irrigation and could at the same time save 121–197mm of water per growing season. Specifically, we suggest two irrigation applications: one at the stem elongation (jointing) to booting stage and another at the flowering stage for loamy soils; and one at the end of seedling development to the beginning of crown root initiation stage and another at the flowering stage for sandy soils. Given the water scarcity in the region, instead of optimal fertility levels, moderate fertility levels are recommended that result in 60% of the potential biomass production for loamy soils and in 50% for sandy soils in combination with the suggested deficit irrigation strategies.
Background:
Tranexamic acid (TXA) is widely used across surgical specialties to reduce perioperative bleeding. It has been shown to be effective in spinal surgery and lower limb arthroplasty. Among ...all languages, there are no systematic reviews or meta-analyses investigating its clinical effectiveness for all types of shoulder surgery.
Purpose:
To investigate the clinical effectiveness of TXA in all types of shoulder surgery, including open and arthroscopic procedures. To investigate the effect of TXA on bleeding and non–bleeding-related outcomes.
Study Design:
Systematic review and meta-analysis.
Methods:
A protocol for the study was designed and registered with PROSPERO (CRD42020185482). The literature search included the MEDLINE, Embase, PsycINFO, and Cochrane Library databases. All randomized controlled trials evaluating the use of TXA against placebo, in all types of shoulder surgery, were included. Assessments were undertaken for risk of bias and certainty of evidence. The primary outcome was total blood loss. Secondary outcomes included those not directly related to bleeding. Data from comparable outcomes were pooled and analyzed quantitatively or descriptively, as appropriate.
Results:
Eight randomized controlled trials were included in the systematic review, and data from 7 of these studies were pooled in the meta-analysis. Pooled analysis demonstrated a significant reduction in 2 of 3 outcomes measuring perioperative bleeding with TXA compared with controls: estimated total blood loss (mean difference, −209.66 mL; 95% CI, −389.11 to −30.21; P = .02) and postoperative blood loss as measured by drain output (mean difference, −84.8 mL; 95% CI, −140.04 to −29.56; P = .003). Hemoglobin reduction was reduced but not statistically significant (mean difference, –0.33 g/dL; 95% CI −0.69 to 0.03; P = .07). This result became significant with sensitivity analysis excluding arthroscopic procedures.
Conclusion:
This systematic review and meta-analysis indicated that TXA was effective in reducing blood loss in shoulder surgery. Larger randomized controlled trials with low risk of bias for specific surgical shoulder procedures are required.
Clinical Relevance:
TXA can be used across shoulder surgery to reduced perioperative blood loss. The use of TXA may have other beneficial features, including reduced postoperative pain and reduced operative time.
(
) is a commensal skin bacterium, primarily found in sebaceous glands and hair follicles, with a high prevalence in the shoulder region. It is the most common pathogenic organism in prosthetic joint ...infections after shoulder arthroplasty. Because of its low virulence, its diagnosis remains difficult.
To evaluate the relative effects of topical preparations in reducing
in shoulder surgery.
Meta-analysis; Level of evidence, 1.
We searched the MEDLINE, Embase, PsychINFO, and Cochrane Library databases in March 2022. Randomized controlled trials (RCTs) comparing any form of topical preparation in arthroscopic or open shoulder surgery were included. The primary outcome was a reduction in the number of positive
cultures. Secondary outcomes were adverse events related to the application of topical preparations. We performed a network meta-analysis to facilitate simultaneous comparisons between multiple preparations across studies. We calculated differences between preparations using odds ratios and their 95% CIs. The risk of bias was assessed using the Cochrane risk-of-bias tool.
The search yielded 17 RCTs (1350 patients), of which 9 were suitable for the network meta-analysis (775 patients). Overall, 2 RCTs were deemed as having a low risk of bias, and 15 raised "some concerns" of bias. Preparations included benzoyl peroxide (BPO), BPO combined with clindamycin, chlorhexidine gluconate, hydrogen peroxide, povidone-iodine, and water with soap. Only BPO resulted in significantly lower odds of a positive
culture compared with placebo or soap and water (odds ratio, 0.12 95% CI, 0.04-0.36). There was no statistically significant difference with all other topical preparations. The only adverse events were skin irritation from BPO and chlorhexidine gluconate in a small number of reported cases.
BPO was the most effective topical agent in reducing the prevalence of
in shoulder surgery. These results were limited by a combination of indirect and direct data. Future studies should focus on establishing the optimal frequency and duration of preoperative BPO to further reduce the burden of
.
CRD42022310312 (PROSPERO).
Summary
Interleukin‐1β (IL‐1β), a potent pro‐inflammatory cytokine, has been implicated in many diseases, including atherosclerosis. Activation of IL‐1β is controlled by a multi‐protein complex, the ...inflammasome. The exact initiating event in atherosclerosis is unknown, but recent work has demonstrated that cholesterol crystals (CC) may promote atherosclerosis development by activation of the inflammasome. High‐density lipoprotein (HDL) has consistently been shown to be anti‐atherogenic and to have anti‐inflammatory effects, but its mechanism of action is unclear. We demonstrate here that HDL is able to suppress IL‐1β secretion in response to cholesterol crystals in THP‐1 cells and in human‐monocyte‐derived macrophages. HDL is able to blunt inflammatory monocyte cell recruitment in vivo following intraperitoneal CC injection in mice. HDL appears to modulate inflammasome activation in several ways. It reduces the loss of lysosomal membrane integrity following the phagocytosis of CC, but the major mechanism for the suppression of inflammasome activation by HDL is decreased expression of pro‐IL‐1β and NLRP3, and reducing caspase‐1 activation. In summary, we have described a novel anti‐inflammatory effect of HDL, namely its ability to suppress inflammasome activation by CC by modulating the expression of several key components of the inflammasome.
High‐density lipoprotein (HDL) is a complex molecule that has been shown to have a wide range of functions, but the importance of each function with regard to prevention of atherosclerosis is unclear. Here we demonstrated a novel way in which HDL is able to suppress the activation of the inflammasome, an important component in atherosclerosis development, in response to cholesterol crystals. We demonstrate that HDL can suppress several integral components of the inflammasome and stabilize lysosomal integrity.
Vanadium is listed on the United States Environment Protection Agency (USEPA) candidate contaminant list # 2 (CCL2), and regulatory guidelines for vanadium exist in some US states. The USEPA requires ...treatability studies before making regulatory decisions on CCL2 contaminants. Previous studies have examined vanadium adsorption onto some metal hydroxides but not onto commercially available adsorbents. This paper briefly summarizes known vanadium occurrence in North American groundwater and assesses vanadium removal by three commercially available metal oxide adsorbents with different mineralogies.
GTO (Dow) is TiO2 based and
E-33 (Seven Trents) and
GFH (US Filter) are iron based. Preliminary vanadate adsorption kinetics onto GFH, E-33 and GTO has been studied and the homogenous surface diffusion model (HSDM) is used to describe the adsorption kinetics data. The effects of pH, vanadium concentration, and volume/mass ratio are assessed. Vanadium adsorption decreases with increasing pH, with maximum adsorption capacities achieved in at pH 3–4. Results indicate that all adsorbents remove vanadium; GFH has the highest adsorption capacity, followed by GTO and E-33. Data are best fit with the Langmuir model rather than Freundlich isotherms. Both the sorption maxima (Xm) and binding energy constant (
b) follow the trend GFH>GTO>E-33. Naturally occurring vanadium is also removed from Arizona ground water in rapid small-scale column tests (RSSCTs). Metal oxide adsorption technologies currently used for arsenic removal may also remove vanadium but not always with the same effectiveness.
Direct challenge (DC) is an emerging safe and effective alternative to penicillin skin testing (PST) in patients reporting a low-risk reaction history, but limited data exist for the inpatient ...setting.
To demonstrate the safety and efficacy of DC of penicillin-based antibiotics in the inpatient setting in patients with low-risk, cutaneous-only reaction histories more than 20 years ago.
Adult inpatients reporting penicillin allergy and receiving antibiotics were screened by an infectious disease PharmD for appropriateness for penicillin allergy delabeling. Patients with low-risk, cutaneous-only reaction histories (rash, hives, itching) more than 20 years ago were offered a 3-step DC. Patients with a cutaneous reaction history less than 20 years ago, a history of angioedema, or reactions involving multiple body systems underwent PST followed by a 1-time observed dose of amoxicillin.
A total of 372 patients were screened during the study period, with 100 of these patients undergoing further evaluation, 52 with histories appropriate for PST and 48 with histories appropriate for DC. In the PST group, 44 of 52 (84.6%) patients were PST negative. In the DC group, 47 of 48 (97.9%) patients initially tolerated the DC, with 2 of 48 (4.2%) experiencing a delayed reaction. The sole patient with an immediate DC reaction was treated with an antihistamine alone. Beta-lactam antibiotics were subsequently used in 56 of the 100 total patients. Total direct antibiotic savings was $23,375.27. DC was less costly than PST, at $206.18/patient versus $419.63/patient.
DC is a safe, effective, and less expensive method for penicillin delabeling in adult inpatients with a low-risk, cutaneous-only reaction history more than 20 years ago.
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