Postgraduate medicine
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Postgraduate medicine · Mar 2020
ReviewUnderstanding immunogenicity assessments for meningococcal serogroup B vaccines.
Invasive meningococcal disease (IMD) is a potentially devastating infection associated with high mortality and long-term sequelae; however, vaccines are available to protect against the five common disease-causing serogroups (A, B, C, W, and Y). Because traditional field efficacy clinical trials were not feasible due to low IMD incidence that necessitates a very large number of participants, serum bactericidal antibody (SBA) assays using rabbit (rSBA) or human (hSBA) complement were established as in vitro surrogates of meningococcal vaccine efficacy and are now routinely used to support vaccine licensure. Specifically, rSBA assays have been used to evaluate responses to meningococcal capsular polysaccharide-protein conjugate vaccines against serogroups A, C, W, and Y; the accepted correlate of protection for rSBA assays is a titer ≥1:8. ⋯ In contrast to MenACWY vaccines, because bacterial surface proteins are antigenically variable, MenB vaccines must be tested with hSBA assays using multiple test strains that represent the antigenic diversity of disease-causing isolates. As this complexity regarding SBA assessment methods can make data interpretation difficult, herein we describe the use of hSBA assays to evaluate MenB vaccine efficacy and to support licensure. In addition, we highlight how the two recently approved MenB vaccines differ in their use of hSBA assays in clinical studies to demonstrate broad protection against MenB IMD.
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Postgraduate medicine · Mar 2020
A nonlinear association between resting heart rate and ischemic stroke among community elderly hypertensive patients.
Background: Ischemic stroke is a major public health problem and a main cause of death in China. However, how resting heart rate may associate with ischemic stroke among patients with hypertension remains unclear. Objective: To investigate the association between resting heart rate and ischemic stroke among elderlies with hypertension in China. ⋯ Subgroup analysis showed that the relation between resting heart rate and risk of ischemic stroke was seem to be stronger in female (HR: 1.32 vs 1.11), those with uncontrolled hypertension (HR: 1.32 vs 1.12), people with combined diabetes and hypertension (HR: 1.31 vs 1.12), people with overweight (HR: 1.39 vs 1.02) and those who aged >75 (HR: 1.33 vs 1.11). Smoothing spline plots suggested the optimal resting heart rate for the lowest risk of ischemic stroke was between 60 and 80 bpm. Conclusions: In Chinese elderly hypertensive patients, elevated resting heart rate was an independent predictor of ischemic stroke, and the optimal resting heart rate was around 70 bpm.
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Postgraduate medicine · Mar 2020
Observational StudyReal-world management of hyperkalemia with patiromer among United States Veterans.
Objective: Patiromer is a sodium-free, non-absorbed, potassium (K+) binder approved for the treatment of hyperkalemia (HK). Among US Veterans with HK, this retrospective, observational cohort study evaluated patiromer utilization, RAASi continuation, and K+ concentration change following patiromer initiation. Methods: Using data from the Veterans Affairs Corporate Data Warehouse, Veterans with HK (K+ ≥5.1 mmol/L) were included upon patiromer initiation (index date) during the study period (1/2016-8/2018). ⋯ Clinically relevant K+ concentration reductions were observed at all study time points. The successful management of HK may have contributed to the observed high rate of RAASi therapy continuation. Further research is warranted to corroborate and extend these findings.
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Postgraduate medicine · Mar 2020
Immune checkpoint inhibitors and endocrine side effects, a narrative review.
Immune checkpoint inhibitors (ICPIs) are novel drugs in the field of oncology however carry the risk of immune-related dermatologic, gastrointestinal, and endocrine side effects which can be fatal. These new innovative immunoregulatory drugs have intertwined the fields of oncology and endocrinology. CTLA-4 and PD-1 are co-inhibitory receptors on T cells that turn the T cell 'off' when binding to receptors on APCs. ⋯ ICPIs have been used in a variety of malignancies including melanoma, kidney cancer, and non-small cell lung cancer. A unique underrecognized side effect of the autoimmune response is hypophysitis leading to central adrenal insufficiency which can be fatal. Additional immune-related adverse events (irAEs) include hypothyroidism, hyperthyroidism, diabetes, and hypoparathyroidism.
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Postgraduate medicine · Mar 2020
Case ReportsMycobacterium chimaera chorioretinitis as a biomarker of systemic disease activity following nosocomial acquisition during cardiopulmonary bypass.
Objectives: To understand the role of ophthalmoscopic examination (dilated retina examination and widefield fundus photography) in the diagnosis and management of nosocomial acquisition of Mycobacterium chimaera following open heart surgery with cardiopulmonary bypass utilizing a heater-cooler unit, an entity that is associated with >50% mortality during the worldwide outbreak that has occurred since 2013. Methods: Case report with review of previous cases. Results: Signature Mycobacterium chimaera chorioretinal lesions can be used as a diagnostic sign and a biomarker for assessment of treatment efficacy. Conclusions: Ophthalmologic examination can play a key role in diagnosis and management of systemic Mycobacterium chimaera following cardiopulmonary bypass; such examinations may yield earlier diagnosis, diminishing mortality rates.