Ko FWS, Wang JKL, Hui DSC, et al. J Asthma Allergy. 2023;16:173-182. The authors have advised there is an error in Table 1. Table 1 on Page 177, in the third-to-last row, data addressing Median (IQR) ...for Eosinophil count, cells/mm3 should read from 3.2 (1.7, 6.0) to 240.0 (110.0, 410.0). The authors apologize for this error. Correct Table 1:
The association between a robust or depressed antibody response and clinical severity of SARS remains unknown.
To study seroconversion and the magnitude of IgG responses in a SARS cohort with ...different disease severities.
A retrospective analysis of all acute and convalescent-phase sera collected from a cohort of laboratory-confirmed SARS cases. Anti-SARS-CoV IgG antibody was detected using indirect immunofluorescence technique and quantified by two-fold serial dilutions. Characteristics of patients who seroconverted “early” (<median interval) were compared to those documented to remain sero-negative during the same time interval. Median IgG levels in convalescent-phase sera (collected within 30 days) were compared among patients with different disease severities. Correlations between IgG levels and important laboratory parameters were assessed.
A total of 325 laboratory-confirmed SARS cases were analyzed; of which 301 (92.6%) had anti-SARS-CoV IgG detected in their sera at the time of sampling. IgG was first detected on day 4 of illness; seroconversion occurred at a median of 16 days (range 4–35 days), and IgG peak levels were reached in the fourth week. Early seroconversion (<day 16) occurred more frequently among patients who required ICU-admission (
χ
2;
p
=
0.011). Higher IgG levels were detected in patients who required supplemental oxygen (Mann–Whitney;
p
=
0.002), ICU-admission (
p
=
0.001), had negative pre-discharge fecal RT-PCR results (
p
=
0.004), and lymphopenia at presentation (
p
=
0.028). Peak IgG titres also correlated positively with peak LDH levels (Spearman's
r
=
+0.360;
p
<
0.001) among survivors.
Severe SARS is associated with a more robust IgG response.
Chronic obstructive pulmonary disease (COPD) is a global health problem that poses a heavy burden on most countries in the Asia-Pacific region. When compared to industrialised Western countries, the ...COPD burden in the Asia-Pacific region is higher in terms of the number of deaths, years spent living with disability and years of life lost. Given the high prevalence of tobacco smoking, poor indoor and outdoor air quality and the aging population in many Asian countries, urgent actions need to be taken to reduce the development, morbidity and mortality of this disease.
Most patients with locally advanced, unresectable, non-small-cell lung cancer (NSCLC) have disease progression despite definitive chemoradiotherapy (chemotherapy plus concurrent radiation therapy). ...This phase 3 study compared the anti-programmed death ligand 1 antibody durvalumab as consolidation therapy with placebo in patients with stage III NSCLC who did not have disease progression after two or more cycles of platinum-based chemoradiotherapy.
We randomly assigned patients, in a 2:1 ratio, to receive durvalumab (at a dose of 10 mg per kilogram of body weight intravenously) or placebo every 2 weeks for up to 12 months. The study drug was administered 1 to 42 days after the patients had received chemoradiotherapy. The coprimary end points were progression-free survival (as assessed by means of blinded independent central review) and overall survival (unplanned for the interim analysis). Secondary end points included 12-month and 18-month progression-free survival rates, the objective response rate, the duration of response, the time to death or distant metastasis, and safety.
Of 713 patients who underwent randomization, 709 received consolidation therapy (473 received durvalumab and 236 received placebo). The median progression-free survival from randomization was 16.8 months (95% confidence interval CI, 13.0 to 18.1) with durvalumab versus 5.6 months (95% CI, 4.6 to 7.8) with placebo (stratified hazard ratio for disease progression or death, 0.52; 95% CI, 0.42 to 0.65; P<0.001); the 12-month progression-free survival rate was 55.9% versus 35.3%, and the 18-month progression-free survival rate was 44.2% versus 27.0%. The response rate was higher with durvalumab than with placebo (28.4% vs. 16.0%; P<0.001), and the median duration of response was longer (72.8% vs. 46.8% of the patients had an ongoing response at 18 months). The median time to death or distant metastasis was longer with durvalumab than with placebo (23.2 months vs. 14.6 months; P<0.001). Grade 3 or 4 adverse events occurred in 29.9% of the patients who received durvalumab and 26.1% of those who received placebo; the most common adverse event of grade 3 or 4 was pneumonia (4.4% and 3.8%, respectively). A total of 15.4% of patients in the durvalumab group and 9.8% of those in the placebo group discontinued the study drug because of adverse events.
Progression-free survival was significantly longer with durvalumab than with placebo. The secondary end points also favored durvalumab, and safety was similar between the groups. (Funded by AstraZeneca; PACIFIC ClinicalTrials.gov number, NCT02125461 .).
Abstract Bronchoscopy is considered a stressful procedure performed on patients. Hence, the use of music to ease the anxiety of patients has been examined in various studies, but the results have ...been inconclusive. The aim of this review is to synthesize the findings of previous studies on the effects of music therapy on the physiological outcomes of patients undergoing bronchoscopy. An electronic database search was performed to identify the literature. Random-effects model was used to combine the results, and meta-regression was used to explore the heterogeneity. Seven studies with 829 subjects were included. Results showed that the combined mean differences (95% confidence interval) for systolic and diastolic blood pressure were −11.99 (−15.82, −6.57) and −4.84 (−7.78, −1.90) mm Hg, respectively, whereas that for heart rate was −10.57 (−16.63, −4.51) beats per minute. In conclusion, listening to music reduced blood pressure and heart rate among patients undergoing bronchoscopy.
Summary Objectives Early diagnosis of smear-negative tuberculosis remains challenging. The role of an interferon-gamma release assay (IGRA) in discriminating active pulmonary tuberculosis (PTB) among ...cases of ‘pneumonia’ was investigated. Methods Consecutive patients admitted to an acute hospital in Hong Kong (intermediate TB burden) during 2006–2008 because of pneumonia and suspected PTB were recruited for IGRA (Quantiferon-TB Gold, QFN-G) study. Diagnosis of tuberculosis was confirmed by mycobacterial culture or histology. Results Altogether 179 patients were recruited (median (IQR) age 59 (44–75), 68.7% male); active PTB was confirmed in 63 (35.2%). Among the AFB-smear-negative ‘pneumonias’ ( n = 152), age>50 (OR 0.27, 95% CI 0.09–0.84), absence of weight loss (OR 0.30, 95% CI 0.10–0.88), and negative IGRA (OR 0.08, 95% CI 0.03–0.25) were independently associated with lower risks of PTB. The overall sensitivity, specificity, positive and negative predictive values for the IGRA in diagnosing active PTB were 60%, 87%, 72% and 80% respectively. Among smear-negative ‘pneumonias’ ( n = 152), the performance values of IGRA were 64%, 87%, 62% and 88% respectively; in the absence of characteristic clinical or radiographic features of PTB, the negative predictive value (NPV) improved to 90–95%. Conclusions The high NPV of QFN-G among smear-negative ‘pneumonias’ can be useful for risk stratification in hospitalized patients suspected of PTB. Further investigation on the role of these assays in patient management is warranted.
Severe acute respiratory syndrome (SARS) is a highly infectious disease with a significant morbidity and mortality. Respiratory failure is the major complication, and patients may progress to acute ...respiratory distress syndrome. Health care workers are particularly vulnerable to SARS. SARS has the potential of being converted from droplet to airborne transmission. There is currently no proven effective treatment of SARS, so early recognition, isolation, and stringent infection control are the key to controlling this highly contagious disease. Horseshoe bats are implicated in the emergence of novel coronavirus infection in humans. Further studies are needed to examine host genetic markers that may predict clinical outcome.
Belimumab (Benlysta) is a fully-humanized monoclonal antibody that inhibits B-lymphocyte stimulator (also known as B cell activating factor) and was approved by the U.S. Federal Drug Administration ...and European Medicines Evaluation Agency for treatment in adults with autoantibody-positive systemic lupus erythematosus (SLE). Rituximab (Rituxan) is a chimeric anti-CD20 monoclonal antibody targeting B lymphocytes. This review discusses the key findings of the phase III trials in adults with SLE and of real-world use of belimumab and rituximab in the care of both adult and pediatric SLE patients. It highlights the safety profile of belimumab and rituximab and gives insight into the consideration of these therapies for specific SLE disease states. It concludes with a discussion of the current clinical trials investigating B cell therapies in specific SLE disease states and a look to the future, with ongoing clinical trials.
Summary
Background
Exhaled nitric oxide (eNO) may represent a useful noninvasive marker of airway inflammation, but data on the reference population values in schoolchildren are limited. No reference ...eNO study in Asian children has been published.
Methods
Levels of eNO in a sample of 531 schoolchildren aged 11–18 years recruited from five schools (three international schools) in Hong Kong were measured online by a chemiluminescence analyser according to ERS/ATS standard. Each student also completed an International Study of Asthma and Allergic disease in Childhood questionnaire.
Results
Among the children without a physician's diagnosis of asthma or symptoms of wheeze, rhinitis and eczema, there were 258 Chinese and 33 Caucasians. In control Chinese children, the eNO level (median: interquantile range) was significantly higher (P<0.001) in males (17.0 parts per billion (p.p.b.); 10.7–36.6) than in females (10.8 p.p.b.; 7.8–17.6). When compared with Caucasian control males (11.6 p.p.b.; 8.2–19.3) and females (9.1 p.p.b.; 7.5–11.9), the Chinese children had significantly higher eNO levels for both males (P=0.011) and females (P=0.037). For Chinese asthmatic males, the median eNO (interquartile range) was 39.8 p.p.b. (12.5–73.8), and for asthmatic females, 18.0 (9.6–56.3). After controlling for sex in Chinese controls, eNO did not have any significant correlation with height, weight and body mass index or body surface area.
Conclusions
This study demonstrates a gender difference of eNO level in healthy Chinese schoolchildren. When compared with Caucasians, Chinese children have significantly higher eNO levels.
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