"GOLD or lower limit of normal definition? a comparison with expert-based diagnosis of chronic obstructive pulmonary disease in a prospective cohort-study"

<p>Abstract</p> <p>Background</p> <p>The Global initiative for chronic Obstructive Lung Disease (GOLD) defines COPD as a fixed post-bronchodilator ratio of forced expiratory volume in 1 second and forced vital capacity (FEV1/FVC) below 0.7. Age-dependent cut-off values below the lower fifth percentile (LLN) of this ratio derived from the general population have been proposed as an alternative. We wanted to assess the diagnostic accuracy and prognostic capability of the GOLD and LLN definition when compared to an expert-based diagnosis.</p> <p>Methods</p> <p>In a prospective cohort study, 405 patients aged ≥ 65 years with a general practitioner's diagnosis of COPD were recruited and followed up for 4.5 (median; quartiles 3.9; 5.1) years. Prevalence rates of COPD according to GOLD and three LLN definitions and diagnostic performance measurements were calculated. The reference standard was the diagnosis of COPD of an expert panel that used all available diagnostic information, including spirometry and bodyplethysmography.</p> <p>Results</p> <p>Compared to the expert panel diagnosis, 'GOLD-COPD' misclassified 69 (28%) patients, and the three LLNs misclassified 114 (46%), 96 (39%), and 98 (40%) patients, respectively. The GOLD classification led to more false positives, the LLNs to more false negative diagnoses. The main predictors beyond the FEV1/FVC ratio for an expert diagnosis of COPD were the FEV1 % predicted, and the residual volume/total lung capacity ratio (RV/TLC). Adding FEV1 and RV/TLC to GOLD or LLN improved the diagnostic accuracy, resulting in a significant reduction of up to 50% of the number of misdiagnoses. The expert diagnosis of COPD better predicts exacerbations, hospitalizations and mortality than GOLD or LLN.</p> <p>Conclusions</p> <p>GOLD criteria over-diagnose COPD, while LLN definitions under-diagnose COPD in elderly patients as compared to an expert panel diagnosis. Incorporating FEV1 and RV/TLC into the GOLD-COPD or LLN-based definition brings both definitions closer to expert panel diagnosis of COPD, and to daily clinical practice.</p

Disposable sensors in diagnostics, food and environmental monitoring

Disposable sensors are low‐cost and easy‐to‐use sensing devices intended for short‐term or rapid single‐point measurements. The growing demand for fast, accessible, and reliable information in a vastly connected world makes disposable sensors increasingly important. The areas of application for such devices are numerous, ranging from pharmaceutical, agricultural, environmental, forensic, and food sciences to wearables and clinical diagnostics, especially in resource‐limited settings. The capabilities of disposable sensors can extend beyond measuring traditional physical quantities (for example, temperature or pressure); they can provide critical chemical and biological information (chemo‐ and biosensors) that can be digitized and made available to users and centralized/decentralized facilities for data storage, remotely. These features could pave the way for new classes of low‐cost systems for health, food, and environmental monitoring that can democratize sensing across the globe. Here, a brief insight into the materials and basics of sensors (methods of transduction, molecular recognition, and amplification) is provided followed by a comprehensive and critical overview of the disposable sensors currently used for medical diagnostics, food, and environmental analysis. Finally, views on how the field of disposable sensing devices will continue its evolution are discussed, including the future trends, challenges, and opportunities

Understanding how we age: insights into inflammaging

Inflammaging is characterized by the upregulation of the inflammatory response that occurs with advancing age; its roots are strongly embedded in evolutionary theory. Inflammaging is believed to be a consequence of a remodelling of the innate and acquired immune system, resulting in chronic inflammatory cytokine production. Complex interrelated genetic, environmental and age-related factors determine an individual’s vulnerability or resilience to inflammaging. These factors include polymorphisms to the promoter regions of cytokines, cytokine receptors and antagonists, age-related decreases in autophagy and increased adiposity. Anti-inflammaging describes the upregulation of the hypothalamic-pituitary axis in response to inflammaging, leading to higher levels of cortisol, which in turn may be detrimental, contributing to less successful ageing and frailty. This may be countered by the adrenal steroid dehydroepiandrosterone, which itself declines with age, leaving certain individuals more vulnerable. Inflammaging and anti-inflammaging have both been linked with a number of age-related outcomes, including chronic morbidity, functional decline and mortality. This important area of research offers unique insights into the ageing process and the potential for screening and targeted interventions

ANTİ-IL-17 TEDAVİSİNE BAĞLI FASYAL PALSİ VE YENİ BAŞLANGIÇ ÜLSERATİF KOLİT: PSORİAZİSLİ İKİ OLGU

GİRİŞSecukinumab ve ixekizumab interlökin (IL) -17A\"yı seçici olarak nötralize eden monoklonal antikorlardır. (1) Bell paralizisinin etiyolojisi bilinmemektedir, gizli bir virüsün otoimmün reaksiyonu tetikleyebileceği ve fasiyal sinirde demiyelinizasyona neden olabileceği öne sürülmüştür. (2) IL-17 inhibisyonu ile inflamatuar bağırsak hastalığı (IBD) gelişim mekanizması belirsizdir. (3) Secukinumab tedavisinden sonra gelişen bir fasiyal paralizi ve ixekizumab tedavisinden sonra yeni başlayan bir ülseratif kolit olgusu sunuyoruz.OLGU 110 yıldır kronik plak psoriazisi olan secukinumab tedavisi alan 31 yaş erkek hastada 5 haftalık indüksiyon aşamasını tamamladıktan birkaç gün sonra, dilde ve başının arkasında uyuşma gelişti. Secukinumab tedavisi sonlandırıldı. Hastanın bilateral karotis ve vertebral renkli doppler ultrason muayenesi normaldi. İki gün sonra yüzün sol tarafında uyuşma ile başvurdu ve muayene sırasında sol tarafta azalmış yüz hareketleri tespit edildi. Elektromiyografide, sol fasiyal sinirin amplitüdü sağdan %22 daha düşüktü. Hastanın diğer nörolojik muayenesi normaldi. Diğer infeksiyöz ve otoimmün hastalıklar tespit edilmedi ve hastanın başka bir sistemik hastalığı yoktu. Şikayetleri üç hafta içinde metilprednizolon tedavisi ile geriledi. İki aylık takipte nüks gözlenmedi.OLGU 25 yıl boyunca kronik plak tip ve şiddetli tırnak psoriazisi olan ve ixekizumab tedavisi alan 27 yaşında bir erkek hastada tedavinin 28. haftasından itibaren tekrarlayan karın ağrısı ve kanlı ishal atakları gelişti. Kolonoskopi ve intestinal biyopsinin histopatolojik bulguları ülseratif kolit ile uyumluydu. Ixekizumab tedavisi sonlandırıldı. Kolit atakları metilprednizolon, azatiyoprin ve mesalazin tedavisi ile kontrol edildi. 8 aydır psoriazis için tedavi almayan hastanın psoriatik lezyonları ve tırnak bulguları yeniden ortaya çıktı ve hasta için anti-IL23 biyolojik tedavi planlanıyor. Hastalardan yayın izni için bilgilendirilmiş onam alındı.TARTIŞMAPsoriazis ve psoriatik artrit için secukinumab kullanan 306 hastanın çalışmasında, tek bir fasiyal paralizi olgusu bildirilmiştir. (1) Şimdiye kadar, ixekizumab tedavisinden sonra 3 IBD geliştiği bildirilen 5 vaka raporu ve secukinumab ile tedaviden sonra IBD geliştiren 3 vaka serisi olmuştur. (4) Anti-IL-17 ajanlarına başlamadan önce, hastalardan IBD açısından ayrıntılı bir kişisel ve aile öyküsü alınlamalıdır. Hastalar bu ilişki hakkında bilgilendirilmeli ve gastrointestinal semptomlarını izlemeleri istenmelidir.Anahtar Kelimeler: psoriazis, biyolojikler, anti IL17A, fasiyal paralizi, ülseratif koli