Immunoglobulin, glucocorticoid, or combination therapy for multisystem inflammatory syndrome in children: a propensity-weighted cohort study

Background Multisystem inflammatory syndrome in children (MIS-C), a hyperinflammatory condition associated with SARS-CoV-2 infection, has emerged as a serious illness in children worldwide. Immunoglobulin or glucocorticoids, or both, are currently recommended treatments. Methods The Best Available Treatment Study evaluated immunomodulatory treatments for MIS-C in an international observational cohort. Analysis of the first 614 patients was previously reported. In this propensity-weighted cohort study, clinical and outcome data from children with suspected or proven MIS-C were collected onto a web-based Research Electronic Data Capture database. After excluding neonates and incomplete or duplicate records, inverse probability weighting was used to compare primary treatments with intravenous immunoglobulin, intravenous immunoglobulin plus glucocorticoids, or glucocorticoids alone, using intravenous immunoglobulin as the reference treatment. Primary outcomes were a composite of inotropic or ventilator support from the second day after treatment initiation, or death, and time to improvement on an ordinal clinical severity scale. Secondary outcomes included treatment escalation, clinical deterioration, fever, and coronary artery aneurysm occurrence and resolution. This study is registered with the ISRCTN registry, ISRCTN69546370. Findings We enrolled 2101 children (aged 0 months to 19 years) with clinically diagnosed MIS-C from 39 countries between June 14, 2020, and April 25, 2022, and, following exclusions, 2009 patients were included for analysis (median age 8·0 years [IQR 4·2–11·4], 1191 [59·3%] male and 818 [40·7%] female, and 825 [41·1%] White). 680 (33·8%) patients received primary treatment with intravenous immunoglobulin, 698 (34·7%) with intravenous immunoglobulin plus glucocorticoids, 487 (24·2%) with glucocorticoids alone; 59 (2·9%) patients received other combinations, including biologicals, and 85 (4·2%) patients received no immunomodulators. There were no significant differences between treatments for primary outcomes for the 1586 patients with complete baseline and outcome data that were considered for primary analysis. Adjusted odds ratios for ventilation, inotropic support, or death were 1·09 (95% CI 0·75–1·58; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids and 0·93 (0·58–1·47; corrected p value=1·00) for glucocorticoids alone, versus intravenous immunoglobulin alone. Adjusted average hazard ratios for time to improvement were 1·04 (95% CI 0·91–1·20; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids, and 0·84 (0·70–1·00; corrected p value=0·22) for glucocorticoids alone, versus intravenous immunoglobulin alone. Treatment escalation was less frequent for intravenous immunoglobulin plus glucocorticoids (OR 0·15 [95% CI 0·11–0·20]; p<0·0001) and glucocorticoids alone (0·68 [0·50–0·93]; p=0·014) versus intravenous immunoglobulin alone. Persistent fever (from day 2 onward) was less common with intravenous immunoglobulin plus glucocorticoids compared with either intravenous immunoglobulin alone (OR 0·50 [95% CI 0·38–0·67]; p<0·0001) or glucocorticoids alone (0·63 [0·45–0·88]; p=0·0058). Coronary artery aneurysm occurrence and resolution did not differ significantly between treatment groups. Interpretation Recovery rates, including occurrence and resolution of coronary artery aneurysms, were similar for primary treatment with intravenous immunoglobulin when compared to glucocorticoids or intravenous immunoglobulin plus glucocorticoids. Initial treatment with glucocorticoids appears to be a safe alternative to immunoglobulin or combined therapy, and might be advantageous in view of the cost and limited availability of intravenous immunoglobulin in many countries. Funding Imperial College London, the European Union's Horizon 2020, Wellcome Trust, the Medical Research Foundation, UK National Institute for Health and Care Research, and National Institutes of Health

Analysis of the impact of sex and age on the variation in the prevalence of antinuclear autoantibodies in Polish population: a nationwide observational, cross-sectional study

The detection of antinuclear autoantibody (ANA) is dependent on many factors and varies between the populations. The aim of the study was first to assess the prevalence of ANA in the Polish adult population depending on age, sex and the cutoff threshold used for the results obtained. Second, we estimated the occurrence of individual types of ANA-staining patterns. We tested 1731 patient samples using commercially available IIFA using two cutoff thresholds of 1:100 and 1:160. We found ANA in 260 participants (15.0%), but the percentage of positive results strongly depended on the cutoff level. For a cutoff threshold 1:100, the positive population was 19.5% and for the 1:160 cutoff threshold, it was 11.7%. The most prevalent ANA-staining pattern was AC-2 Dense Fine speckled (50%), followed by AC-21 Reticular/AMA (14.38%) ANA more common in women (72%); 64% of ANA-positive patients were over 50 years of age. ANA prevalence in the Polish population is at a level observed in other highly developed countries and is more prevalent in women and elderly individuals. To reduce the number of positive results released, we suggest that Polish laboratories should set 1:160 as the cutoff threshold

Supporting business continuity management of a mine with the use of the OSCAD system

Tematyka artykułu dotyczy wybranych aspektów wspomagania zarządzania ciągłością działania zakładu górniczego z wykorzystaniem zintegrowanego, komputerowo wspomaganego systemu zarządzania ciągłością działania i bezpieczeństwem informacji OSCAD. System OSCAD, obejmujący zarówno warstwę proceduralno-organizacyjną jak i oprogramowanie wspomagające procesy zarządzania, został opracowany według obowiązujących na świecie standardów, m.in. BS 25999, dotyczącego ciągłości działania instytucji, oraz ISO/IEC 2700I, dotyczącego bezpieczeństwa informacji instytucji. Jest systemem otwartym, możliwym do zastosowania w instytucjach lub firmach o różnej wielkości i o różnym profilu funkcjonowania, jednak każdorazowo wymaga on przystosowania do potrzeb i wymagań danej dziedziny. W artykule dokonano krótkiego przeglądu możliwości systemu OSCAD pod kątem ich wykorzystania w specyficznych warunkach zakładu górniczego. Na tej podstawie wypracowano założenia dotyczące przystosowania systemu OSCAD, odzwierciedlające wymagania zakładu górniczego. Wyróżniono kilka możliwych zadań, które mogą być realizowane przez system OSCAD w warunkach zakładu górniczego po jego połączeniu z systemem monitorowania SD2000. Przedstawiono możliwość analizowania incydentów i spowodowanych przez nie strat, tworzenia związanych z tym statystyk, analizowania parametrów bezpieczeństwa i parametrów produkcji. Syntetyczny zestaw tego typu informacji umożliwia wyciąganie wniosków dotyczących doskonalenia procesów zarządzania w zakładzie górniczym. W podsumowaniu zwrócono uwagę na inne potencjalne możliwości wykorzystania oprogramowania OSCAD w górnictwie.The article refers to the selected aspects of supporting business continuity management of a mine with the use of an integrated, computer-aided system for business continuity and information security management — OSCAD. The OSCAD system, comprising both procedures and organization as well as software supporting management processes, was developed in compliance with the world-recognized standards, such as: BS 25999 on business continuity management and ISO/IEC 27001 on information security. OSCAD is an open system that can be used in organizations of different sizes and profiles. Yet, each time it has to be adapted to the needs and requirements of an organization. The article gives a short review of OSCAD's possibilities in the light of their application in specific conditions of a mine. On this basis some assumptions were formulated for OSCAD to meet the requirements of a mine. Several tasks were selected to be carried out by the OSCAD system in the conditions of a mine after the OSCAD's connection with the SD2000 monitoring system. The authors presented the possibility to analyze incidents and losses caused by these incidents, to create related statistics and to analyze security and production parameters. This information enables to draw conclusions how to improve management processes in a mine. In the summary the focus was put on the potential use of the OSCAD software in the mining industry

MOLECULAR DIAGNOSTICS IN BIOLOGY AND MEDICINE

W ostatnim dziesięcioleciu rozwój i wdrożenie technik molekularnych zrewolucjonizowało diagnostykę i monitorowanie chorób człowieka. Techniki badań kwasów nukleinowych, takie jak genotypowanie DNA mikroorganizmów, analiza polimorfizmu fragmentów restrykcyjnych (RFLP) i reakcja łańcuchowa polimerazy (PCR) przyczyniają się do stałego postępu w laboratoriach diagnostyki medycznej. Analiza sekwencji amplifikowanych fragmentów DNA umożliwia lepszą identyfikację patogenów, wykrywanie zmutowanych genów a także prognozowanie określonych chorób.In the last decade, the development and application of molecular techniques has revolutionised the diagnosis and monitoring of human diseases. Nucleic acids techniques, such as microbial DNA genotyping, analysis of restriction fragment length polymorphism (RFLP) and polymerase chain reaction (PCR), are making progress in medical diagnostic laboratories. Sequence analysis of amplified DNA allows better identification of pathogen, detection of mutant genes and more accurate prognosis of certain diseases

Effect of polymorphism in the LIF gene on reproductive performance of hybrid Polish Large White and Polish Landrace sows

The aim of the study was to determine the potential relationships between variants of the leukaemia inhibitory factor (LIF) gene and litter size in Landrace x Polish White sows. To identify polymorphisms within the LIF gene, the polymerase chain reaction–restriction fragment length polymorphism (PCR‒RFLP) method was applied, using specific primers and the DraIII enzyme. The researchers identified the presence of two alleles, T and C, with frequencies 0.64 and 0.36, giving three genotypes with frequencies of 0.44, 0.41 and 0.15, respectively, for TT, CT and CC. Analysis of relationships among the various genotypes of the LIF gene and selected reproductive traits showed differences. Sows with genotypes TT and TC in the LIF locus gave birth and raised significantly more live piglets in the first litter compared with sows with the CC genotype.Keywords: Leukaemia inhibitory factor gene, litter size, pig, reproduction, SN