Carotid web: the challenging diagnosis of an under-recognized entity

Journal of Neurology - Determining the cause of acute ischemic stroke is crucial for patient management, particularly for preventing future stroke. In recent years, carotid web (CW), a...     

Utility of a commercial immunoblot kit (BAG-Borrelia blot) in the diagnosis of the preliminary stages of Lyme disease

The aim of this study was to evaluate the usefulness of a commercial immunoblot (IgG and IgM BAG-Borrelia blot) in the serologic diagnosis of the early stages of Lyme disease. A total of 42 sera from patients with Lyme disease (24 patients with localized early stage (LES) and 18 patients with disseminated early stage (DES)) and 129 sera from patients with non-Lyme diseases (specificity control sera) were studied. IgG anti-p41 from Borrelia burgdorferi s.l. was present in 95.2% of patients followed by anti-p41/I PBi (16.7%), anti-p100 (9.5%) and anti-OspA (9.5%). IgM anti-p41 was present in 66.7% of patients, p41/iPBi (54.8%) and OspC (33.3%). IgM against p100, OspA and OspC were more frequent in DES patients (16.7%, 27.8% and 44.4%) than in LES patients (0.0%, 4.2% and 25.0%). In 4.8% of the cases no IgG bands were present and in 26.2% no IgM bands were present. With the exception of isolated p41 bands (59.5%), no band pattern exceeded 17%. Using manufacturer's instructions, test sensitivity in diagnosis of the early stage of Lyme disease is 61.9%, specificity 98.4% and positive and negative predictive values 92.8% and 88.8% respectively. Applying the EUCALB 5, 6 or 7 rules sensitivity increased to 73.8% although specificity decreased to 89.9%. Of the 129 specific control sera, 41.8% presented IgG anti-p41 and 10.8% IgM anti-p41. Patients with non-Lyme diseases that presented more IgG and IgM bands were those patients with syphilis (88.2%), patients with anti-HIV antibodies (57.8%) and patients with anti-nuclear antibodies (ANA) (52.3%).     

The clinical implications of platelet transfusions associated with ABO or Rh(D) incompatibility

Despite the time elapsed since their development, and substantial human and economical efforts searching for alternatives, platelet transfusion, continues to be the main therapeutic measure available for the management of patients suffering from quantitative and qualitative platelet disorders. However, there are still aspects of their use that are not completely established. One of these is ABO and/or Rh(D) compatibility. A major ABO group incompatibility appears to decrease the response to a platelet transfusion, whereas a minor ABO incompatibility can be associated with, sometimes lethal, acute hemolytic transfusion reactions in the recipient. Other detrimental effects on the recipient of a minor ABO incompatibility have also been reported. In contrast, the main problem associated to a Rh(D) incompatible platelet transfusion is the development of alloimmunization of a Rh(D)-negative woman in childbearing age or younger. Factors like degree of patient immunosuppression and red blood cell content in the platelet concentrate significantly modulate the risk of alloimmunization. New clinical studies are needed to define clearly the current risk associated to ABO- and/or Rh(D)-incompatible platelet transfusions, and such defined risks would help establish the most cost effective measures to prevent the appearance of the potential complications related to platelet use.     

Predictors and outcomes of unplanned early rehospitalization in the first year following lung transplantation

Unplanned early rehospitalization (UER), defined as an unscheduled admission within 30 days of a hospital discharge, is associated with graft loss and recipient mortality in some solid organ transplants but has not been investigated in lung transplant. In this retrospective study, we collected socio‐demographic and clinical factors to determine predictors and outcomes of UER in the first year following lung transplantation. There were 193 patients who underwent lung transplantation and survived to discharge during the 7.9‐year study period. There were 116 (60.1%) patients with at least one UER. Infections (32.8%) and post‐surgical complications (11.8%) were the most common reasons for UER. On multivariate analysis, the strongest predictor of having an UER was discharge to a long‐term acute care facility (odds ratio: 3.01, 95% confidence interval [CI] 1.46–6.20; P=.003). Patients with any UER in the first year following transplantation had worse adjusted survival (hazard ratio: 1.89, 95% CI 1.02–3.50; P=.04). It is unclear, however, to what extent UERs reflect preventable outcomes. Further large‐scale, prospective research is needed to identify the extent to which certain types of UER are modifiable and to define patients at high‐risk for preventable UER.     

Bortezomib may stabilize pediatric renal transplant recipients with antibody-mediated rejection

Background

Current therapeutic strategies to effectively treat antibody-mediated rejection (AMR) are insufficient. Thus, we aimed to determine the benefit of a therapeutic protocol using bortezomib for refractory C4d + AMR in pediatric kidney transplant patients.

Methods

We examined seven patients with treatment-refractory C4d + AMR. Immunosuppression included antithymocyte globulin or anti-CD25 monoclonal antibody for induction therapy with maintenance corticosteroids, calcineurin inhibitor, and anti-metabolite. Estimated glomerular filtration rate (eGFR) calculated by the Schwartz equation, biopsy findings assessed by 2013 Banff criteria, and human leukocyte antigen (HLA) donor-specific antibodies (DSA) performed using the Luminex single antigen bead assay were monitored pre- and post- bortezomib therapy.

Results

Seven patients (86 % male, 86 % with ≥6/8 HLA mismatch, and 14 % with pre-formed DSA) age 5 to 19 (median 15) years developed refractory C4d + AMR between 1 and 145 (median 65) months post-transplantation. All patients tolerated bortezomib. One patient had allograft loss. Of the six patients with surviving grafts (86 %), mean pre-bortezomib eGFR was 42 ml/min/1.73 m² and the mean 1 year post-bortezomib eGFR was 53 ml/min/1.73 m². Five of seven (71 %) had improvement of histological findings of AMR, C4d staining, and/or acute cellular rejection. Reduction in HLA DSAs was more effective for class I than class II.

Conclusions

Bortezomib appears safe and may correlate with stabilization of eGFR in pediatric kidney transplant patients with refractory C4d + AMR.

     

Fathers’ parenting self-efficacy during the transition to parenthood

Background: Little is known about the development of fathers’ parenting self-efficacy during the transition to parenthood.

Objectives: To analyse (1) fathers’ parenting self-efficacy developmental path and (2) the effects of anxious and depressive symptoms and coparenting support on fathers’ parenting self-efficacy developmental path, from the first trimester of pregnancy to 6 months postpartum.

Methods: Eighty-six fathers recruited at the first trimester of pregnancy completed self-report measures of anxious and depressive symptoms, coparenting support and parenting self-efficacy at the first and third trimesters of pregnancy, and at 1 and 6 months postpartum. Growth curve models were performed.

Results: An increase in fathers’ parenting self-efficacy was found from the first trimester of pregnancy to 6 months postpartum. The main effects of anxious symptoms and interaction effects of anxious symptoms and time were found on fathers’ parenting self-efficacy. Fathers with higher anxious symptoms revealed lower levels of parenting self-efficacy at the first trimester of pregnancy and a lower increase of parenting self-efficacy from this time to 6 months postpartum. The main effects of coparenting support were found in fathers’ parenting self-efficacy. At the first trimester of pregnancy, fathers who perceived more coparenting support revealed higher levels of parenting self-efficacy.

Conclusion: The present study may contribute to the literature by describing fathers’ parenting self-efficacy developmental path and the effects of anxious symptoms and coparenting support on fathers’ parenting self-efficacy developmental path during the transition to parenthood.