Primary Immunodeficiency Diseases in Latin America: First Report from Eight Countries Participating in the LAGID

The Latin American Group for Primary Immunodeficiencies, formed in 1993, presently includes 12 countries. One goal was to study the frequency of primary immunodeficiencies in various regions of the American continent and to enhance knowledge about these diseases among primary-care physicians, as well as allergist–immunologists. Important for this purpose was the development of a registry of primary immunodeficiencies using a uniform questionnaire and computerized database. To date, eight countries have collected information on a total of 1428 patients. Predominantly antibody deficiencies were reported in 58% of patients, followed by cellular and antibody immunodeficiencies associated with other abnormalities in 18%, immunodeficiency syndromes associated with granulocyte dysfunction in 8%, phagocytic disorders in 9%, combined cellular and antibody immunodeficiencies in 5%, and complement deficiencies in 2% of patients. The information gathered from this initial analysis of data will serve to expand the patient database to more areas within participating countries and to new countries and to increase collaboration toward better diagnosis and treatment of these diseases.     

Opsonophagocytosis of fluorescent polystyrene beads coupled to Neisseria meningitidis serogroup A, C, Y, or W135 polysaccharide correlates with serum bactericidal activity

We developed a polysaccharide-specific flow cytometric opsonophagocytic assay (OPA) for the simultaneous measurement of functional antibody to Neisseria meningitidis serogroups A, C, Y, and W135. OPA titers significantly correlated with serum bactericidal assay titers for all serogroups tested (mean r = 0.96; P < 0.001). OPA could be used in meningococcal vaccine evaluation.     

Atypical lipid-dependent Malassezia species isolated from dogs with otitis externa

During a survey of the occurrence of Malassezia species in the external ear canals of dogs with chronic otitis externa, lipid-dependent Malassezia species were isolated in three dogs. These species were identified as Malassezia furfur and M. obtusa but showed atypical assimilation patterns. To our knowledge, this is the first report of the isolation of lipid-dependent species of the genus Malassezia in association with canine otitis.     

Clinical features and outcome of maintenance hemodialysis patients with COVID-19 from a tertiary nephrology care center in Romania

Background There is limited information about the clinical characteristics, treatment and outcome of maintenance hemodialysis patients with COVID-19. Moreover, regional differences are also conceivable since the extend and severity of outbreaks varied among countries.Methods In this retrospective, observational, single-center study, we analyzed the clinical course and outcomes of 37 maintenance hemodialysis patients (median age 64 years, 51% men) hospitalized with COVID-19 from 24 March to 22 May 2020 as confirmed by real-time PCR.Results The most common symptoms at admission were fatigue (51%), fever (43%), dyspnea (38%) and cough (35%). There were 59% mild/moderate patients and 41% severe/critical patients. Patients in the severe/critical group had a significantly higher atherosclerotic burden since diabetic kidney disease and vascular nephropathies were the most common primary kidney diseases and eighty percent of them had coronary heart disease. Also, Charlson comorbidity score was higher in this group. At admission chest X-ray, 46% had ground-glass abnormalities. Overall, 60% patients received hydroxychloroquine, 22% lopinavir–ritonavir, 11% tocilizumab, 24% systemic glucocorticoids, and 54% received prophylactic anticoagulation. Seven (19%) patients died during hospitalization and 30 were discharged. The main causes of death were cardiovascular (5 patients) and respiratory distress syndrome (2 patients). In Cox regression analysis, lower oxygen saturation, anemia and hypoalbuminemia at admission were associated with increased mortality.Conclusions In conclusion, we observed a high mortality rate among maintenance hemodialysis patients hospitalized for COVID-19. Anemia, lower serum albumin and lower basal oxygen saturation at admission were factors associated with poor prognosis.     

Improvement in Breast Reconstruction Disparities following Medicaid Expansion under the Affordable Care Act

Background

 Under the Affordable Care Act, Medicaid expansion effective 1 January 2014 aimed to increase access to health care. We sought to determine the association of Medicaid expansion with disparities in utilization of breast reconstruction.

Methods

Non-Hispanic Black (NHB) and White (NHW) breast cancer patients undergoing mastectomy +/? reconstruction between 2010 and 2017 were selected from the National Cancer Database. Annual trends for utilization of breast reconstruction by race, income, and education were evaluated by Medicaid expansion status using difference-in-differences regression analyses. Medicaid expansion was categorized by expansion date as early (2010–2013), 2014 (1/2014), late (after 1/2014), or no expansion.

Results

Of 443,607 patients, 36.3% (n = 161,128) underwent reconstruction, 13.1% (n = 58,249) were NHB, 16.8% (n = 74,430) had median income < $40,227, and 17.1% (n = 75,718) were in the lowest education quartile. In non-expansion states, lower proportions of NHB patients underwent reconstruction than NHW patients in all years, with the smallest disparity (NHB% ? NHW%) (? 6.4%) in 2017. Decreases in disparities between NHB and NHW patients were seen with the smallest difference observed in 2014 (? 2.5%) in early-expansion states, in 2017 (? 0.7%) in 1/2014 expansion states, and in 2017 (? 4.5%) in late-expansion states. Similar findings for convergence of reconstruction utilization rates for the lowest two education levels and lowest two income quartiles were found with Medicaid expansion, with no convergence seen in non-expansion states over the study period.

Conclusions

Some improvement in breast reconstruction disparities followed Medicaid expansion. Failure to improve parity without Medicaid expansion should be a consideration with any modifications to Medicaid access.

     

Isolation of Malassezia furfur from a cat

During a survey of the occurrence of Malassezia species in the external ear canals of cats without otitis externa, Malassezia furfur was isolated. This is the first report of the isolation of M. furfur from cats.     

Die analyse von aluminium im serum und urin zur überwachung emonierter personen

Zusammenfassung Die Einführnung der flammenlosen Atomabsorptionsspektrometrie in die chemische Analytik ermöglicht eine einfache quantitative Bestimmung des Aluminiums im biologischen Material. Die verwendeten Analysen-methoden und deren Zuverlässigkeitskriterien wurden beschrieben. Entsprechend der heute üblichen Verfahren zur Überwachung schwermetallexponierter Personen wurden von uns bei verschiedenen Kollektiven Aluminiumbestimmungen im Blut und Urin durchgeführt. Untersucht wurde ein Kollektiv von 110 Arbeitern eines Korund-herstellenden und -verarbeitenden Werkes. 82 dieser Arbeiter waren durch staubförmigen Korund exponiert, während 28 Personen an den Öfen zusätzlich noch Metalldämpfen ausgesetzt waxen. Die Expositionsdauer betrug im Mittel 6,9 Jahre. Als Vergleichskollektiv dienten 40 männliche nicht aluminiumexponierte Probanden. Zusädtzlich wurden 33 Dialyse-Patienten, die mit Aluminiumhydroxid (Aludrox) therapiert wurden, in die Studie einbezogen.Für die Aluminiumausscheidung im Urin errechnete sich bei den Normalpersonen eine obere Normgrenze von 30 g/l. Die Ausscheidungswerte der aluminiumexponierten Personen lagen mit einem Median von 39 g Al/l signifikant höher als das Normalkollektiv. Erwartungsgemä zeigten die dampfförmig belasteten Personen einen statistisch signifikant höheren Al-Spiegel im Urin als die staubförmig belastete Gruppe.Die Serumanalysen ergaben keine Hinweise für einen signifikanten Unterschied gegenüber Normalpersonen. Aus den Untersuchungen der Seren von nicht aluminiumexponierten Probanden errechnete sich ein oberer Grenzwert von 35 g/l. Der Serum-Aluminium-Spiegel der exponierten Personen war von der Art und Dauer der Exposition nicht beeinflut. Dagegen lagen die Aluminium-Spiegel im Serum der Dialyse-Patienten im Bereich von 6 – 254 g/l. Bei dieser Patientengruppe mit erhöhten Serum-Aluminiumwerten wurden keine klinischen Zeichen einer manifesten Toxicität gefunden. Damit kommt den Aluminiumkonzentrationen im biologischen Material der aluminiumexponierten Arbeiter keine gesundheitsgefahrdende Relevanz zu.Bei der inhalativen Aufnahme von Aluminium scheint die Menge des resorbierten und in die Blutbahn übergehenden Aluminiums gering zu sein. Hinweise für eine Akkumulation des Metalls im Organismus wurde bei Versuchen mit D-Penicillamin nicht gefunden.Aluminiumbestimmungen im Serum oder Harn sind für die Überwachung von Korund-herstellenden und -verarbeitenden Personen nach diesen Ergebnissen nicht notwendig. Bei Substanzen, wie dem Aluminium, mit geringer Resorptions-quote und groer Toleranzbreite für den menschlichen Organismus sowie ohne manifeste signifikante Gesundheitsschäden erscheint ein Biological Monitoring nicht indiziert.D 29