Comparison of Flow Panel Reactive Assay (PRA)^TM Specific Test with Complement Dependent Cytotoxicity (CDC) to Define the HLA Antibodies Specificity: A Preliminary Study

To determine the specificity of flow cytometry based assay for HLA antibody screening prior to transplantation, we evaluated 11 positive sera that were tested by both Flow Panel Reactive Assay (PRA) TM class I and class II specific beads after initial FlowPRA TM . HLA specificity was compared with previous data from the complement dependent cytotoxicity (CDC) testing of these samples. We found that five samples (22%) were more HLA class II specific (DR- or DQ-) by FlowPRA TM than CDC. One sample, negative by FlowPRA TM screening, was shown to be HLA class I and class II reactive by FlowPRA TM -specific test. Class I specificity was only defined by CDC in this sample. Two other samples, shown to be HLA class I and class II reactive by FlowPRA TM screening and FlowPRA TM -specific test, were found to be HLA class I reactive only in the first sample and HLA class II reactive only in the second sample by CDC. Our study suggests that FlowPRA TM -specific test has higher specificity and sensitivity than CDC in identification of HLA class II specificity than CDC. Nevertheless, FlowPRA TM -specific test failed to identify precisely the HLA specificity in samples with broad-spectrum specificity, such as those that have HLA specific antibodies directed against large number of shared epitopes. A software protocol for specificity analysis might help overcome this problem. Also, studies involving larger number of samples are required to validate our findings

Experiences of Family Caregivers’ Involvement in Treatment Related- Decision-Making in Triadic Health Encounters

Purpose: To explore the experiences of family caregiver in health decision-making for patients with chronic diseases. Study Design: Qualitative Descriptive Design. Subjects and Methods: A descriptive qualitative approach was used. A purposive sample of fifteen family caregiver for patients with chronic diseases were interviewed in Amman, Jordan; fifteen caregivers; males (n= 2), females (n= 13). Average of age = 40 years old. Data were generated through phone messages voice records over a period of two months (March & April 2020) in Amman, Jordan. Data were analyzed using a five–step technique proposed by Giorgi (1985). Results: The findings of the study revealed that three major themes related to family caregivers’ experiences in health decision-making for patients with chronic diseases: 1) The patient has the right to decide about his health, 2) Healthcare providers know better, and 3) Roles of family caregivers in the decision making process. Conclusion: The vital role of the family members in taking decisions for patients with chronic diseases is well-recognized by healthcare providers. Continuous systematic assessment of family members’ preferences and needs is crucial to provide the needed support for their patients in decision-making

Checkpoint Inhibitor Colitis With Superimposed Clostridioides difficile Infection

Immune checkpoint inhibitors (ICI) are commonly used for various malignancies. A particular checkpoint inhibitor is the anti-PD-1 antibody pembrolizumab. Immune-mediated diarrhea and colitis (IMDC) is the most frequently observed immune-related adverse event (irAE) involving the gastrointestinal system. Although immune-mediated colitis precipitated by pembrolizumab is rarely life-threatening, it often necessitates a detailed diagnostic workup, including stool studies, imaging, and colonoscopy, to establish an accurate diagnosis. The coexistence of IMDC and Clostridioides difficile infection is not well understood, but patients undergoing pembrolizumab treatment have comparable risk factors to those who develop C. difficile infection. We report a case of a 76-year-old female with nonmetastatic non-small cell lung cancer who was diagnosed with IMDC responsive to steroid treatment but later developed worsening diarrhea leading to a diagnosis of checkpoint inhibitor colitis with superimposed C. difficile infection

First report of clinical, functional, and molecular investigation of chronic granulomatous disease in nine Jordanian families.

International audienceINTRODUCTION: Chronic granulomatous disease is a rare inherited immunodeficiency syndrome caused by mutations in four genes encoding essential nicotinamide adenine dinucleotide phosphate (NADPH) oxidase complex components. MATERIAL AND METHODS: Clinical, functional, and molecular investigations were conducted in 15 Jordanian CGD patients from nine families. RESULTS AND DISCUSSION: Fourteen patients were children of consanguineous parents and suffered from autosomal recessive (AR) CGD forms with mutations in the CYBA, NCF1, and NCF2 genes encoding p22phox, p47phox, and p67phox proteins, except for one patient in whom the mutation's location was not found. One patient had an extremely rare X(+)CGD subtype resulting from a novel missense mutation (G1234C) in exon 10 of CYBB. We found a genetic heterogeneity in the Jordanian families with a high frequency of rare ARCGD, probably because consanguineous marriages are common in Jordan. No clear correlation between the severity of the clinical symptoms and the CGD types could be established

Orofacial findings in chronic granulomatous disease: report of twelve patients and review of the literature

Abstract Background Chronic granulomatous disease is an extremely rare primary immunodeficiency syndrome that can be associated with various oral complications. This can affect high number of patients. However, data on oral complications is sparse. Here we will review the literature and describe the orofacial findings in 12 patients. Findings The age range was 5-31 years. Oral findings were variable, and reflected a low level of oral hygiene. They included periodontitis, rampant caries, gingivitis, aphthous-like ulcers, and geographic tongue. One patient had white patches on the buccal mucosa similar to lichen planus. Another patient had a nodular dorsum of the tongue associated with fissured and geographic tongue. Biopsies from the latter two lesions revealed chronic non-specific mucositis. Panoramic radiographs showed extensive periodontitis in one patient and periapical lesions in another patient. Conclusion Patients with chronic granulomatous disease may develop oral lesions reflecting susceptibility to infections and inflammation. It is also possible that social and genetic factors may influence the development of this complication. Therefore, oral hygiene must be kept at an optimum level to prevent infections that can be difficult to manage.</p