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Rheumatologic diseases and antiphospholipid syndrome
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Thomas J. Santoro, Michiyo Tomita, Alfonse T. Masi
The aPL antibodies are heterogeneous, polyclonal and may vary in titer over the course of follow-up. LACs are aPL antibodies that block phospholipid surfaces and reduce the coagulant potential of plasma, thereby prolonging the clotting time in coagulation tests based on the activated partial thromboplastin time (146). The presence of LAC is determined functionally by (i) a failure to correct the prolonged clotting time after mixing with normal platelet-free plasma and (ii) the dilute Russell’s viper venom time (147). aCL Are IgG, IgM, or IgA antibodies that bind to the phospholipid cardiolipin. They do not prolong functional assessments of clotting (i.e., coagulation assays). Detection of aCL is done using an enzyme-linked immunosorbent assay (148). It is generally believed that aCL antibodies are significant only when present in the context of a thrombotic event and that anti-IgG antibodies carry greater pathogenetic significance than do those of the IgM isotype (149). The aCL antibodies are sensitive, being present in 80% of patients with APS, but not as specific as that of LAC and ~ have been reported in numerous infectious diseases (150–153). False-positive tests for syphilis occur with increased frequency in individuals with LAC and aCL activities using a variety of tests (e.g., the rapid plasma reagin and Venereal Disease Research Laboratories tests). These tests are not reliable indicators of clinically important outcomes. In patients with false-positive syphilis tests secondary to aPL antibodies, the fluorescent treponema antibody test remains negative (154).
The Etiology of the Antiphospholipid Syndrome
Published in Howard J.A. Carp, Recurrent Pregnancy Loss, 2020
Sara De Carolis, Giuseppina Monteleone, Cristina Garufi, Rotem Inbar, Miri Blank, Yehuda Shoenfeld
For the role of single aPL positivity, the PROMISSE study on pregnancy outcome in women with APS and/or SLE underlined the adverse prognostic value of LAC, in addition to the well-known adverse role of triple aPL positivity [69]. Otherwise, the presence of anti-β2GPI IgG was the antibody associated with the lowest live-birth rate and highest incidence of preeclampsia, IUGR, and stillbirth, compared to anticardiolipin antibodies or lupus anticoagulant alone [70], while aCL is the most common sole aPL. The presence of single positivity for aPL was associated with a good response to treatment [71].
Mosquitoes
Published in Gail Miriam Moraru, Jerome Goddard, The Goddard Guide to Arthropods of Medical Importance, Seventh Edition, 2019
Gail Miriam Moraru, Jerome Goddard
LaCrosse Encephalitis. LaCrosse encephalitis (LAC) has historically affected children in the midwestern states of Ohio, Indiana, Minnesota, and Wisconsin; however, it is increasingly being diagnosed in the southern states (Figure 25.26). The mortality rate of LAC is generally less than 1%, but seizures (even status epilepticus) and cerebral herniation may result from LAC infection. In fact, most LAC patients present with seizures. The national average for LAC is about 70 per year.65 Cases occur in July, August, and September. LAC is a bunyavirus that is transmitted to humans primarily by Aedes triseriatus, but possibly also Aedes albopictus and Ae. canadensis. Interestingly, the virus may be transferred vertically from adult female Ae. triseriatus to her offspring through ovarial contamination. Some amplification of the virus takes place in nature through an Ae. triseriatus small-mammal cycle.
Equitable Allocation of Remdesivir for the COVID-19 Pandemic in Los Angeles County
Published in Prehospital Emergency Care, 2023
Nichole Bosson, Ryan DeVivo, Juliana Tolles, Richard Tadeo, Terry Crammer, Marianne Gausche-Hill
We determined the total number of patients treated in LAC by totaling the patient data submitted by each hospital. For descriptive data, we calculated frequencies and proportions or medians and inter-quartile ranges (IQR) as appropriate using R software. Missing data for each variable were described. We compared demographic characteristics of patients treated with the donated remdesivir to the overall population of hospitalized patients with COVID-19 as reported by the LAC-DPH. For gender, we compared binary male/female with a chi-square test and report the risk difference, using male as the reference, with 95% confidence interval. We compared age and race categories using a chi-square test and then performed follow-up tests for individual age and race categories either using a chi-square test with a Bonferroni correction or, in the case that there were fewer than 10 observations in a given category, a Fisher exact test with a Bonferroni correction. For the comparisons, unknown values were excluded.
HPV vaccine introduction in the Americas: a decade of progress and lessons learned
Published in Expert Review of Vaccines, 2022
Lucia H. De Oliveira, Cara B. Janusz, Maria Tereza Da Costa, Nathalie El Omeiri, Paul Bloem, Merle Lewis, Silvana Luciani
From clinical trials to post-marketing surveillance and post-introduction observational studies, HPV vaccines have demonstrated excellent safety, efficacy, and effectiveness profiles for use against several clinical HPV endpoints [1]. Since the availability of first vaccines in 2006, more than 365 million HPV vaccine doses have been administered globally and no serious adverse events causally linked to the vaccine have been observed since licensure [22,23]. The primary benefit of HPV vaccines is to prevent HPV-related precancerous lesions and cancers of the cervix [1]. In the absence of timely detection, safe surgical intervention or treatment, these cancers are often fatal [24] and the vaccines prevent against this leading cause of premature death in women. All four vaccines are considered to protect equally against HPV16/18, demonstrating close to 100% efficacy against HPV16/18-related advanced cervical precancerous lesions (CIN 2/3 and AIS) in women naïve to these HPV types, i.e. girls who have not been infected with these HPV types prior to vaccination [1,25]. For the vaccines that protect against other HPV-related endpoints, the quadrivalent and nonavalent, these vaccines show highly favorable efficacy also against type-specific cancers of the anus, head, and neck [1]. Table 1 summarizes technical characteristics of the available vaccines currently used in LAC and the most recent evidence inputs regarding their use in national immunization programs.
Antiphospholipid syndrome: the need for new international classification criteria
Published in Expert Review of Clinical Immunology, 2021
Georges El Hasbani, Ali T Taher, Savino Sciascia, Imad Uthman
The recent data in APS are paving the way to discuss whether other antibody specificities should be included in the criteria set. It is common in clinical practice to observe patients with high clinical suspicion of APS (e.g., young age, unprovoked thrombosis, thrombocytopenia) who are negative for LAC and aCL, or aβ2GPI antibodies. In such cases, other antibodies to anionic phospholipids might be playing a role in inducing APS clinical manifestations. Examples on these antibodies include IgG/IgM aPS/PT. Since aPL can also recognize plasma proteins bound to anionic surfaces, antibodies against PT have been detected [69]. Prothrombin can be antigenically recognized via calcium ions on PS-treated plates [70]. The binding of PT to PS forms bivalent trimolecular immunocomplexes and increases the sensitivity of antibody detection by ELISA [70]. Antibodies against the aPS/PT complex were found in up to 56% of patients who only satisfy the clinical criteria of APS [71], and their association with thrombotic events has been largely debated [72,73]. These antibodies were strongly correlated with LAC activity, which may help in cases where immunologic deficits or anti-coagulant drugs prevent a correct LAC interpretation [74]. More recently, data from at least two systematic reviews support the use of aPS/PT to improve the diagnostic accuracy in patients suspected for APS [73,75].