Comparison of methods for the analysis of airway macrophage particulate load from induced sputum, a potential biomarker of air pollution exposure.

BACKGROUND Air pollution is associated with a high burden or morbidity and mortality, but exposure cannot be quantified rapidly or cheaply. The particulate burden of macrophages from induced sputum may provide a biomarker. We compare the feasibility of two methods for digital quantification of airway macrophage particulate load. METHODS Induced sputum samples were processed and analysed using ImageJ and Image SXM software packages. We compare each package by resources and time required. RESULTS 13 adequate samples were obtained from 21 patients. Median particulate load was 0.38 μm(2) (ImageJ) and 4.0 % of the total cellular area of macrophages (Image SXM), with no correlation between results obtained using the two methods (correlation coefficient = -0.42, p = 0.256). Image SXM took longer than ImageJ (median 26 vs 54 mins per participant, p = 0.008) and was less accurate based on visual assessment of the output images. ImageJ's method is subjective and requires well-trained staff. CONCLUSION Induced sputum has limited application as a screening tool due to the resources required. Limitations of both methods compared here were found: the heterogeneity of induced sputum appearances makes automated image analysis challenging. Further work should refine methodologies and assess inter- and intra-observer reliability, if these methods are to be developed for investigating the relationship of particulate and inflammatory response in the macrophage

Improving Asthma Management in Hospital Emergency Departments with Interactive Webinars

Our objective was to create dialogue and share troubleshooting strategies for challenges identified by a 2012 survey of emergency department asthma management practices in Florida. Two complementary intervention sessions, each with its own post-test, were implemented. We created a virtual gathering of professionals from clinical asthma care and health services research settings throughout Florida. Participants included clinical care providers and health administrators from participating hospitals, health services researchers, and other emergency asthma care stakeholders from Florida. We examined enrollment of target professional groups, perceived utility of intervention format and content, and participant satisfaction with webinars. The webinars appealed strongly to target professional groups. A large majority of participants in both sessions perceived the content to be very useful, and expressed high satisfaction with their experiences. Interactive webinars offer effective resources for hospital emergency departments seeking to improve asthma care. These activities should continue in Florida and expand elsewhere as resources and interest permit

Early Detection and Timely Reporting of Non-Mumps Etiologies of Parotitis: An Example in Developing Clinical and Public Health Partnerships

Background. Parotitis, or inflammation of the parotid gland, is most notably known as a characteristic symptom of mumps virus infection. Although instances of parotid inflammation with a variety of non-mumps viral etiologies have been described in medical literature, parotitis is a rarely reported complication of influenza virus infection. Ongoing communication between the clinical community and public health partners was essential for the early detection and reporting of the increased occurrence of parotitis cases associated with non-mumps etiologies. Methods. On 10 December 2014, a university health center notified the Indiana State Department of Health (ISDH) regarding a case of parotitis in a patient fully vaccinated with measles/mumps/rubella (MMR) vaccine. On 22 December 2014, the ISDH was notified of two additional cases of parotitis in pediatric patients who tested positive for influenza A and were fully vaccinated with MMR. Recognizing that parotitis may be an unusual symptom associated with circulating 2014-2015 respiratory viruses, the ISDH contacted the Centers for Disease Control and Prevention (CDC) on 22 December 2014 and other Midwest states on 8 January 2015 to determine whether cases of parotitis associated with respiratory viral infection were occurring outside of Indiana. There was interest among the Midwest states to pursue case finding, which resulted in a multi-state investigation of parotitis cases spearheaded by CDC. Results. Between December 2014 and February 2015, 20 cases of parotitis in Indiana were confirmed positive for respiratory viral etiologies other than mumps, namely influenza A, parainfluenza 2 and 3, adenovirus, enterovirus/rhinovirus, coronavirus OC 43 and herpes simplex virus 1. Conclusion. The early detection and timely reporting of unusual occurrences of parotitis and the subsequent case finding efforts are indicative of well-developed communication between clinical and public health partners. Partnerships among the clinical community, state health departments and the CDC are critical to exploring novel disease presentations

Gastrointestinal Kohlmeier-Degos disease: a narrative review

INTRODUCTION: Kohlmeier-Degos (K-D) disease is a rare obliterative vasculopathy that can present as a benign cutaneous form or with potentially malignant systemic involvement. The gastrointestinal tract is most frequently involved in systemic disease and mortality is often related to bowel perforations. Herein, we provide information to providers and patients regarding gastrointestinal K-D symptomology, pathology, treatment, and diagnosis, with a focus on the importance of timely diagnostic laparoscopy. We present three new cases of gastrointestinal K-D to highlight varying disease presentations and outcomes. BODY: Based on reviewed reports, perforation is preceded by at least one gastrointestinal symptom: abdominal pain/cramping, anorexia/weight loss, vomiting, diarrhea, nausea, gastrointestinal bleeding, obstipation, constipation, and abdominal fullness. Perforation most commonly occurs in the small intestine and often results in sepsis and death. Although underutilized, laparoscopy is the most sensitive and specific diagnostic technique, demonstrating serosal porcelain plaques similar to those on the skin and characteristic for K-D. The combination of eculizumab and treprostinil is presently the most effective treatment option for gastrointestinal K-D. The pathology of gastrointestinal K-D is characterized by an obliterative intimal arteriopathy eventuating in occlusive acellular deposits of mucin and collagen along with an extravascular pauci-cellular sclerosing process resembling scleroderma confined to the subserosal fat. C5b-9 and interferon-alpha are both expressed in all caliber of vessels in the affected intestine. While C5b-9 blockade does not prevent the intimal expansion, enhanced type I interferon signaling is likely a key determinant to intimal expansion by, causing an influx of monocytes which transdifferentiate into procollagen-producing myofibroblast-like cells. CONCLUSION: Prompt laparoscopic evaluation is necessary in any K-D patient with an abdominal symptom to facilitate diagnosis and treatment initiation, as well as to hopefully decrease mortality. Those with gastrointestinal K-D should start on eculizumab as soon as possible, as onset of action is immediate

Prognosis Prediction in Cardiac Amyloidosis by Cardiac Magnetic Resonance Imaging: A Systematic Review with Meta-Analysis

Cardiac involvement is the foremost determinant of the clinical progression of amyloidosis. The diagnostic role of cardiac magnetic resonance (CMR) imaging in cardiac amyloidosis has been established, but the prognostic role of various right and left CMR tissue characterization and functional parameters, including global longitudinal strain (GLS), late gadolinium enhancement (LGE), and parametric mapping, is yet to be delineated. We searched EMBASE, PubMed, and MEDLINE for studies analysing the prognostic use of CMR imaging in patients with light chain amyloidosis or transthyretin amyloidosis cardiac amyloidosis. The primary endpoint was all-cause mortality. A random effects model was used to calculate a pooled odds ratio using inverse-variance weighting. Nineteen studies with 2199 patients [66% males, median age 59.7 years, interquartile range (IQR) 58–67] were included. Median follow-up was 24 months (IQR 20–32), during which 40.8% of patients died. Both tissue characterization left heart parameters such as elevated extracellular volume [hazard ratio (HR) 3.95, 95% confidence interval (CI) 3.01–5.17], extension of left ventricular (LV) LGE (HR 2.69, 95% CI 2.07–3.49) elevated native T1 (HR 2.19, 95% CI 1.12–4.28), and functional parameters such as reduced LV GLS (HR 1.91, 95% CI 1.52–2.41) and reduced LV ejection fraction (EF; HR 1.20, 95% CI 1.17–1.23) were associated with increased all-cause mortality. Unlike the presence of right ventricular (RV) LGE (HR 3.40, 95% CI 0.51–22.54), parameters such as RV GLS (HR 2.08, 95% CI 1.6–2.69), RVEF (HR 1.13, 95% CI 1.05–1.22), and tricuspid annular systolic excursion (TAPSE) (HR 1.11, 95% CI 1.02–1.21) were also associated with mortality. In this large meta-analysis of patients with cardiac amyloidosis, CMR parameters assessing RV and LV function and tissue characterization were associated with an increased risk of mortality