Background: Antinuclear antibody (ANA) testing is the first test ordered in any patient suspected of autoimmune diseases. Often ANA indirect immunofluorescence (IIF) screening tests have high ...sensitivity because of high background, which can lead to erroneous clinical diagnosis and management when ordered unnecessarily. The following study was undertaken to envisage the clinical importance of ANA-positive test results among cases presenting to a tertiary neuro-care center. Methods: Present study is a secondary data analysis of 166 ANA IIF positive samples. Serum samples were further subjected to specific antigen detection by ANA immunoblot assay. The final diagnosis was reviewed in the context of descriptive data as to why testing was ordered. Results: The overall positivity rate of ANA for 3 years was 2.12%. The peripheral nervous system was most commonly involved accounting for 56 (33.73%) cases followed by the central nervous system in 40 (24.09%) cases and others. The predominant ANA pattern observed was speckled in 73 (43.9%) cases. On ANA profiling, reactivity to Ro52 (35 40.22%) was most common. Females were predominantly (70.5%) affected than males (29.5%). There was no association found in ANA pattern with age, sex, duration of illness, and the clinical disorder. Conclusions: ANA positivity is sporadically associated with nervous system autoimmune disorders. Screening tests like ANA can be judiciously employed for meaningful clinical interpretation of neurological diseases.
Centipede has been prescribed for the treatment of cardiovascular diseases in Asian countries for several hundred years. Previously, a new antiplatelet tripeptide SQL (H-Ser-Gln-Leu-OH) was isolated ...and characterized from centipede. In this study, we investigated its antithrombotic activities in vivo and underlying mechanism. It was found that SQL inhibited platelet aggregation induced by adenosine diphosphate, thrombin, epinephrine, and collagen and attenuated thrombus formation in both the ferric chloride-induced arterial thrombosis model and arteriovenous shunt thrombosis model in rats. It did not prolong the bleeding time in mice even at the dose of 10 mg/kg that showed potent antithrombosis effects. Molecular docking revealed that SQL binds PI3Kβ with the binding free energy of -24.341 kcal/mol, which is close to that of cocrystallized ligand (-24.220 kcal/mol). Additionally, SQL displayed inhibition on the late (180 seconds) but did not influence the early (60 seconds) Akt Ser473 phosphorylation in the immunoblot assay. These results suggest that SQL inhibits thrombus formation in vivo and that SQL inhibits PI3K-mediated signaling or even the PI3K itself in platelets. This study may help elucidate the mechanism for centipede treating cardiovascular diseases.
We aimed to investigate the immunoglobulin E (IgE) detection rate and allergen patterns in patients with isolated allergic conjunctivitis using the multiple allergen simultaneous test ...(MAST)-immunoblot assay. A total of 120 patients with allergic conjunctivitis and no associated rhinitis, asthma, or dermatitis underwent the MAST-immunoblot assay to measure serum total IgE (TIgE) and serum specific IgE (SIgE) against 57 allergens. Patients were classified into subgroups based on the season when the eye symptoms were exacerbated, and TIgE and SIgE positivity. Differences between sex and age groups were also analyzed. Of the 120 patients, 57.5% (69 patients) and 69.2% (83 patients) were positive for TIgE (≥100 IU/mL) and SIgE (≥0.7 IU/mL), respectively. The allergens that most frequently triggered sensitization in the study population were
,
,
,
, and house dust. House dust mites, such as
and
, showed the highest detection rates regardless of the season. Men had a higher positive rate for TIgE than women, whereas a higher rate of sensitization, detected as SIgE positivity, was seen in younger patients. In conclusion, MAST-immunoblot assay can detect sensitizing allergens in patients with isolated allergic conjunctivitis.
The sexually transmitted infection (STI) syphilis remains a public health problem globally. The serological detection of specific antibodies to Treponema pallidum is particularly important in the ...diagnosis of syphilis. The purpose of this study was to evaluate the newly developed Elecsys Syphilis assay and compare it with the local market well-established ARCHITECT Syphilis TP assay.
A total of 1,097 clinical serum samples were obtained from routine diagnostic requests. All the serum or plasma samples were tested in parallel by Elecsys Syphilis assay and ARCHITECT Syphilis TP assay. Sensitivity, specificity, and agreement assay were verified. The inconsistent samples confirmed with a recombinant immunoblot assay as gold standard test.
The diagnostic performances of the two assays were very similar: both Elecsys Syphilis and ARCHITECT Syphilis TP assay performed with a sensitivity of 100% (95% CI, 85.7 to 100%) and 100% (95% CI, 85.7 to 100%), whereas the specificity was 99.90% (95% CI, 99.5 to 99.90%) and 99.49% (95% CI, 99.0 to 99.6%), respectively. The consistency in positive results between Elecsys and ARCHITECT Syphilis TP assay was 79.3%. The consistency in negative results between Elecsys and ARCHITECT Syphilis TP assay was 99.7%. The overall consistency between Elecsys and ARCHITECT Syphilis TP assay was 99.1%.
The Elecsys Syphilis assay can demonstrate excellent diagnostic sensitivity and specificity and correlate well with ARCHITECT Syphilis TP assay. It is a reliable and appropriate assay for routine use in a diagnostic laboratory.
Laboratory testing plays a major role in hepatitis C virus (HCV) diagnosis and patient follow‐up. The high false positive rates of HCV screening tests require confirmation through a supplementary ...test. According to the 2003 CDC guidelines, recombinant immunoblot assay (RIBA) is indispensible to confirm positive screening results and differentiate biologic false positivity from true HCV exposure. However, RIBA has been permanently discontinued since 2011. In the 2013 update of its guidelines, CDC called for further studies on HCV laboratory testing without RIBA. In this study, we analyzed the applicability of quantitative real‐time PCR (qPCR) as a supplementary HCV diagnostic test. By comparing our HCV testing performances before and after RIBA discontinuation, we found that omitting RIBA has no significant effect on the accurate and efficient identification of HCV infection, provided that HCV antibody signal‐to‐cutoff ratio is considered. Furthermore, we proposed a new HCV testing algorithm that incorporates semiquantitative assessment of HCV antibody positivity and HCV viral load measurement by qPCR. By following the algorithm, we were able to address confirmation of positive HCV screening results and to provide useful information generally required by clinicians, including the needs of further laboratory testing or clinical follow‐up, as well as HCV viral titers.
SUMMARY
Oral pemphigoid (OP) is a chronic autoimmune disease, involving the oral cavity, characterized by a homogenous linear deposition of immunoglobulins, complement, or both along the basement ...membrane zone (BMZ) and a subepithelial blister formation. The α6/β4 heterodimer is an integrin family of adhesion receptors, which mediates basal cell to matrix interactions. Recent evidence suggests a pathophysiologic role for antibodies against human α6 integrin in blister formation in OP, in organ culture studies. Fifty percent of OP patients have been reported to experience disease progression to involve other mucosal tissues, including the eye and larynx. To prevent this extension of disease, systemic therapy with systemic corticosteroids, dapsone, and immunosuppressive agents has been recommended. The use of intravenous immunoglobulin (IVIg) in the treatment of pemphigoid has been recently described. In this study, we present the use of IVIg, in a group of seven patients, with severe OP, in whom systemic conventional treatment was contraindicated. To determine the influence of treatment on antibodies to human α6 integrin in OP, seven patients with OP treated with IVIg therapy and a comparable control group of seven patients with OP, treated with conventional therapy, were evaluated at monthly intervals, for a 12 consecutive month treatment period. An effective clinical response was observed in all seven patients treated with IVIg therapy, after a mean treatment period of 4·5 months. IVIg therapy induced a prolonged and sustained clinical remission in all seven patients after a mean treatment period of 26·9 months. A statistically significant difference was observed in the quality of life pre‐ and post‐IVIg therapy (P < 0·001). Both the study and the control groups had a very similar initial serological response to treatment. A statistically significant reduction in the antibody titres was observed after four months of treatment, in both groups (P = 0·015). Thereafter, patients treated with IVIg therapy had a faster rate of decline in the antibody titres, and the difference in the rate of decline between the study and control groups became statistically significant after six months of treatment (P = 0·03). The use of IVIg therapy resulted in reduction of antiα6 antibody titres and in inducing and maintaining both a sustained, clinical and serological remission.
Background and Aim: Long‐term trends of anti‐hepatitis C virus (HCV) antibody titer and their associated factors in patients with sustained virological response (SVR) were investigated.
Methods: ...From May 1999 to July 2005, a total of 166 SVR consecutive patients (M/F: 86/80) were enrolled. Anti‐HCV titer, samples to cut‐off (S/CO) ratios, were measured with AxSYM HCV version 3.0. Their S/CO ratios were followed every 6 months after SVR and the patterns over time were identified by trajectory analyses. Changes of recombinant immunoblot assay (RIBA) pattern before treatment and end of follow‐up were compared (n = 64).
Results: The mean duration of follow‐up was 4.7 ± 1.5 years (median 4.3; range 3–9 years). The rates of S/CO ratios decreased annually (P < 0.001). Two of them (1.2%) achieved seroreversion. Trajectory groups included lower pretreatment S/CO ratios (LAB, n = 83), rapid decrease (RD, n = 62) and slow decrease (SD, n = 21) groups. Comparing LAB to RD group, odds ratio (OR) of increased platelet count per 1 unit and interferon regimen was 1.12 (95% confidence interval CI 1.04–1.20) and 2.17 (95% CI 1.04–4.52) respectively. Comparing SD to LAB and RD groups, the OR of advanced fibrotic stage, using mild fibrotic stage as a reference, was 4.33 (95% CI 1.49–12.63). Reaction strength of all four RIBA bands decreased significantly at the end of follow‐up.
Conclusions: Anti‐HCV titers decreased annually during long‐term follow‐up after SVR. Higher pretreatment platelet count, interferon regimen and mild fibrosis were associated with decreased anti‐HCV titers. However, only a few cases achieved seroreversion. All RIBA bands decreased significantly after long‐term follow‐up.
We studied the use of the INNO-LIA syphilis score assay in the resolution of discordant positive screening results of the Murex ICE Syphilis enzyme immunoassay (EIA) with the confirmatory results of ...both the Serodia Treponema pallidum particle agglutination (TPPA) and the fluorescent treponemal antibody-absorption (FTA-Abs) assays, for the serological diagnosis of syphilis. This was an observational study on the serum samples received by the Syphilis Laboratory, Hong Kong, during the period from January 2006 to December 2012. A total of 801 serum samples with discordant positive screening EIA results were used. Consensus results of such serum samples were derived from results of the EIA, TPPA and FTA-abs assays. The age range of the individuals was 14 to 104 years (median of 52). There were 369 males and 432 females. Of 378 serum samples, 139 showed agreement among positive results, 23 of 310 showed agreement among indeterminate results and 277 of 465 showed agreement among negative results. The proportions of agreement among positive, indeterminate and negative results were 0.37 (95% CI 0.32-0.42), 0.07 (95% CI 0.05-0.11) and 0.60 (95% CI 0.55-0.64), respectively; kappa 0.55 (95% CI 0.49-0.60). There were 60 serum samples with positive consensus results but negative INNO-LIA syphilis score results and 10 with negative consensus results but positive INNO-LIA syphilis score results. Although the INNO-LIA syphilis score assay can be considered a valid alternative confirmatory test for the serological diagnosis of syphilis, the present study showed that its use in the resolution of discordant positive screening EIA results was moderate. A more extensive characterization of serum samples with discordant reactive screening treponemal test results is necessary.
Background/Aims: Hepatitis C virus (HCV) infection results in a high frequency of chronic disease. The aim of this study was to identify early prognostic markers of disease resolution by performing a ...comprehensive analysis of viral and host factors during the natural course of acute HCV infection. Methods: The clinical course of acute hepatitis C was determined in 34 consecutive patients. Epidemiological and virological parameters, as well as cell mediated immunity (CMI) and distribution of human leukocyte antigens (HLA) alleles were analysed. Results: Ten out of 34 patients experienced self-limiting infection, with most resolving patients showing fast kinetics of viral clearance: at least one negative HCV RNA test during this phase predicted a favourable outcome. Among other clinical epidemiological parameters measured, the self-limiting course was significantly associated with higher median peak bilirubin levels at the onset of disease, and with the female sex, but only the latter parameter was independently associated after multivariate analysis. No significant differences between self-limiting or chronic course were observed for the distribution of DRB1 and DQB1 alleles. HCV specific T cell response was more frequently detected during acute HCV infection, than in patients with chronic HCV disease. A significantly broader T cell response was found in patients with self-limiting infection than in those with chronic evolving acute hepatitis C. Conclusion: The results suggest that host related factors, in particular sex and CMI, play a crucial role in the spontaneous clearance of this virus. Most importantly, a negative HCV RNA test and broad CMI within the first month after onset of the symptoms represent very efficacious predictors of viral clearance and could thus be used as criteria in selecting candidates for early antiviral treatment.
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