Single Health Care Center Research Articles

Nonfunctioning Adrenal Incidentalomas are not Clinically Silent: A Longitudinal Cohort Study

The association between nonfunctioning adrenal incidentalomas (NFAIs) and cardiometabolic diseases remains controversial. This retrospective cohort study investigated whether NFAIs are related with prevalent and incident cardiometabolic diseases. This study included 154 patients with biochemically confirmed NFAIs and 1:3 age and sex-matched controls without adrenal incidentalomas (n = 462) among subjects who underwent abdominal computed tomography at a single healthcare center in 2003-2012. Electronic medical records were reviewed for comorbidities at baseline and during a mean follow-up of 7.5 years. The logistic regression analysis for prevalent cardiometabolic diseases and the survival analysis for incident cardiometabolic diseases were performed. The subjects were 55.7±8.8 years of age and predominantly male (73.1%). The NFAI group had a higher body mass index compared to the age and sex-matched control group (25.1±2.8 vs. 24.0±2.8 kg/m2; P<.001). In a cross-sectional design, covariate-adjusted logistic regression showed significantly higher odds ratios (ORs) for diabetes mellitus and hypertension in the NFAI group (adjusted OR [95% confidence interval [CI]], 1.89 [1.17 to 3.06] and 2.26 [1.47 to 3.50], respectively). The NFAI group had a 2-fold higher risk of insulin resistance (adjusted ORs [95% CI], 2.03 [1.06 to 3.90]). Moreover, NFAI subjects with diabetes mellitus had a greater increase in size of adrenal lesions than those without diabetes mellitus (3.4±5.5 vs. 1.4±5.5 mm; P =.048). However, in the survival analysis, the incidence of any cardiometabolic diseases did not differ between the NFAI and control groups. NFAIs are related to prevalent diabetes mellitus or hypertension in our cross-sectional study. However, the presence of NFAIs did not affect the development of cardiometabolic diseases. ACTH = adrenocorticotropic hormone; AI = adrenal incidentaloma; BMI = body mass index; CI = confidence interval; CT = computed tomography; HbA1c = hemoglobin A1c; HOMA-IR = homeostasis model assessment of insulin resistance; HU = Hounsfield units; MACE = mild autonomous cortisol excess; NFAI = nonfunctioning adrenal incidentaloma; OR = odds ratio.

Trends of Seroprevalence of Chagas´s diseases in healthy blood donors, solid organ donors and heart transplant recipients: experience of a single health care center in Colombia.

The prevalence of Chagas disease has decreased in the Americas region due to vector control measures. However, non-vectorial transmission through blood transfusions and organ transplantation has gained importance in recent years. Screening among blood and organ donors are essential to reduce Trypanosoma cruzi transmission and could provide information to estimate population prevalence. We conducted a cross-sectional study on the prevalence of immunoglobulin G (IgG) antibodies against T. cruzi in healthy blood donors, solid organ donors and heart transplant recipients from 2012 to 2019. We found a total of 99 357 IgG T. cruzi results during the study period. The cumulative seroprevalence in healthy blood donors was 0.13% (95% confidence interval (CI) 0.10–0.15), in organ donors was 0.53% (95% CI 0.06–1.92) and in heart transplant recipients was 3.03 (95% CI 0.07–15.75). Seroprevalence trend in healthy blood donors showed annual increase between 2012 and 2015, decreasing in the following years. No trend was seen in organ donors neither heart recipients. Adjusted rates did not show difference by sex and age among blood donors. No significant increases in seroprevalence T. cruzi were found during the study period. T. cruzi transmission remains low.

Needlestick and Sharps Injuries Among Resident Physicians

This cohort study reviews trends in all needlestick and other sharps injuries among resident physicians and other staff at a single health care center over 20 years.

Level of Agreement with the Microscopic Analysis of Joint Aspirate for the Diagnosis of Gout in the Lower Extremity.

Although clinical findings, laboratory serum markers, and radiographic images are also used, the purported gold standard or standard reference test for the diagnosis of gout is microscopic analysis of aspirated joint fluid. This observational investigation sought to identify the level of agreement with the microscopic analysis of joint fluid aspirate for the diagnosis of gout in the lower extremity between two departments in a single health-care center. A retrospective medical record review identified consecutive patients seen for suspected gout who underwent diagnostic joint aspiration. Patients were included if a lower-extremity joint synovial fluid sample was obtained and were excluded if they were not independently evaluated by both the departments of rheumatology and pathology. We categorized the documented joint fluid findings into four groups: no crystals, sodium urate crystals, calcium pyrophosphate dihydrate crystals, or both sodium urate and calcium pyrophosphate dihydrate crystals. We defined a "clinically significant disagreement" as one department observing any type of crystals and the other department observing no crystals. We observed a clinically significant disagreement rate of 23.26% (intraclass correlation coefficient = 0.496). The department of rheumatology was more likely to observe the presence of crystals in a sample compared with the department of pathology (88.37% versus 65.12%; P = .02). These results provide evidence that microscopic analysis of joint fluid aspirate might lack the accuracy and reliability needed to be considered a gold standard diagnostic test for gout in the lower extremity.

Sexual Dysfunction and Satisfaction in Kidney Transplant Patients

Introduction10% of the world’s population suffers from chronic kidney disease. Kidney transplants provide an improvement in the quality of life of those patients. Sexual dysfunction is common after kidney transplantation, and its etiology is presumed to be multifactorial. It has a negative impact on sexual satisfaction and health-related quality-of-life. The integration of a new organ into the body can imply an adjustment of body image, which may eventually have a negative influence on intimacy and sexual behaviors. AimTo evaluate male sexual function, sexual satisfaction, and body image satisfaction among a convenience sample of patients who have had a kidney transplant. MethodsThis is a cross-sectional study that included 460 patients, from a single healthcare center, who had undergone a kidney transplant procedure >4 weeks ago. A total of 112 respondents (mean = 55.5 years, SD = 11.4) answered the questionnaires properly. Main Outcome MeasuresAll recruited patients answered a self-reported sociodemographic questionnaire, in addition to the International Index of Erectile function, the New Scale of Sexual Satisfaction, the Brief Symptom Inventory, and the Body Image Scale. ResultsA correlation was found between sexual function and sexual satisfaction (r = 0.598, P < .001, n = 112), as well as between body image satisfaction and sexual function (r = −0.193, P = .042, n = 112). The length of time after a kidney transplant (≤ or >36 months) was not associated with a difference in sexual functioning or sexual satisfaction. Clinical ImplicationsThis study showed the obvious implications of sexual function on sexual satisfaction, which should alert healthcare professionals to the importance of identifying and managing sexual dysfunction in patients with chronic kidney disease, to optimize their global and sexual health satisfaction. Strength & LimitationsThis study identified a high prevalence of sexual dysfunction among kidney transplant recipients. This should reinforce the need for the medical community to evaluate the quality-of-life domains of patients with chronic disease. There is still a lack of information concerning any longitudinal evaluation of kidney transplant patients’ sexual function and the effects that this surgery has on sexuality. ConclusionsThis study corroborated the severe effects that kidney transplant patients often report regarding their sexuality. Among the patients who participated in the study, sexual function proved to be relevant in relation to sexual satisfaction.Mota RL, Fonseca R, Santos JC, et al. Sexual Dysfunction and Satisfaction in Kidney Transplant Patients. J Sex Med 2019;16:1018–1028.

Physicians' Dietary Knowledge, Attitudes, and Counseling Practices: The Experience of a Single Health Care Center at Changing the Landscape for Dietary Education.

Morbidity and mortality associated with cardiovascular disease can be significantly modified through lifestyle interventions, yet there is little emphasis on nutrition and lifestyle in medical education. Improving nutrition education for future physicians would likely lead to improved preparedness to counsel patients on lifestyle interventions. An online anonymous survey of medical residents, cardiology fellows, and faculty in Internal Medicine and Cardiology was conducted at New York University Langone Health assessing basic nutritional knowledge, self-reported attitudes and practices. A total of 248 physicians responded (26.7% response rate). Nutrition knowledge was fair, but few (13.5%) felt adequately trained to discuss nutrition with patients. A majority (78.4%) agreed that additional training in nutrition would allow them to provide better clinical care. Based on survey responses, a dedicated continuing medical education (CME) conference was developed to improve knowledge and lifestyle counseling skills of healthcare providers. In postconference evaluations, attendees reported improved knowledge of evidence-based lifestyle interventions. Most noted that they would prescribe a Mediterranean or plant-based diet and would make changes to their practice based on the conference. An annual CME conference on diet and lifestyle can effectively help interested providers overcome barriers to lifestyle change in clinical practice through improved nutrition knowledge.

AN EMR BASED INITIATIVE TO DECREASE ATRIAL FIBRILLATION RELATED CARDIO-EMBOLIC STROKE IN A COMMUNITY HEALTH SYSTEM

Utilizing our EMR (EPIC) to identify patients with atrial fibrillation (AF) who are at risk for cardio-embolic stroke, and link them with best practice anticoagulant (AC) treatment by increasing provider awareness. Single health care center comprised of two community based hospitals, both inpatient

Factors Associated With Difficult Colonoscopy (From the Point of View of a Colonoscopist)

Introduction: Various factors including age, sex, body mass index (BMI) and history of operation have been linked to the colonoscopic intubation time. However, there has been few data about the factors which make the colonoscopists feel difficult colonoscopy. The aims of this study were to identify the factors associated with difficult colonoscopy. Methods: A total of 1228 consecutive subjects who underwent colonoscopy for a health checkup at a single health care center in Korea from August to December 2011 were studied prospectively. Patients' age, sex, BMI, height, waist circumference, history of operation, symptoms of irritable bowel syndrome, bowel preparation status, experience of colonoscopists, time required to reach the cecum (CIT), and the degree of difficultness which was 5 levels by the colonoscopist were analyzed. Results:. The mean age of the subjects was 51.0 ± 10.8 years, and 60.2% were male. Univariate analyses showed that experience of colonoscopists, female gender, old age, sedation, CIT, height, and prior history of surgery were associated with difficult colonoscopy. On multivariate analysis, experience of colonoscopy (OR 0.772, p=0.0002), age (OR 1.023, p=0.0001), and CIT (OR 1.007, p=1.06E-68) were related to difficult colonoscopy. Conclusion:. This study demonstrates the difficultness of insertion by colonoscopists is associated with CIT, patients' age, and experience of colonoscopists.

A single-centre, retrospective study of cryopreserved umbilical cord/amniotic membrane tissue for the treatment of diabetic foot ulcers.

Histopathological studies have shown a prolonged inflammatory phase in wounds of patients with diabetes, delaying formation of mature granulation tissue and reducing wound tensile strength, making these wounds difficult for physicians to heal. Cryopreserved human umbilical cord (cUC) tissues possess unique anti-inflammatory and anti-scarring properties and have been found to help improve closure of these chronic wounds. A retrospective chart review was performed to assess the efficacy of cUC as an advanced treatment modality to help promote the closure of chronic DFUs. Overall healing rate, duration to wound closure, and number of cUC applications used to achieve closure were used to assess cUC treatment efficacy. A total of 32 wounds in 29 patients treated at a single health-care centre were included in the study population The average initial wound area for all wounds was 10.6 ± 2.15cm2. Of the 32 wounds 28 achieved complete epithelialisation for an overall healing rate of 87.5%. Average time to wound closure was 13.8 ± 1.95 weeks with a median of 9 weeks and an average of 1.68 ± 0.18 cUC applications. The results suggest cUC allograft may be effective in improving the healing of DFUs ulcers as well as potentially reducing the medical costs associated with chronic DFUs due to the low number of applications needed to achieve complete wound closure. Prospective, randomised controlled trials are suggested to better understand the efficacy of cUC in chronic wound healing. Dr Raphael is a paid speaker for Amniox Medical, Inc.

Factors that determine prolonged cecal intubation time during colonoscopy: impact of visceral adipose tissue

Objective. Various factors including age, sex, body mass index (BMI) and history of operation have been linked to the colonoscopic intubation time. The aims of this study were to identify the factors predicting cecal intubation time (CIT) and to evaluate the effect of the visceral adipose tissue (VAT) area on CIT. Material and methods. A total of 1386 consecutive subjects who underwent colonoscopy and abdominal CT on the same day for a health checkup at a single health care center in Korea from August to December 2011 were studied prospectively. Age, sex, BMI, height, waist circumference, history of operation, symptoms of irritable bowel syndrome, bowel preparation status, experience of colonoscopists, VAT amount on abdominal CT and time required to reach the cecum were analyzed. Results. The mean age of the subjects was 53.0 ± 9.6 years, and 63.5% were male. The median CIT was 271 s. Univariate analyses showed that female gender, old age, shorter height, lower BMI, prior history of surgery and lower VAT were associated with longer CIT. To adjust for confounding effects of the gender, we investigated the genders separately in multivariate analysis. Older age and lower VAT were associated with prolonged CIT. However, the significance of association of VAT on prolonged CIT disappeared in women. Conclusion. This study demonstrates that CIT is prolonged by lower VAT area in men. This is the first study to demonstrate a direct association between VAT area and CIT.

Comparison of the Anyplex II HPV28 assay with the Hybrid Capture 2 assay for the detection of HPV infection

BackgroundHuman papillomavirus (HPV) testing is an important part of cervical cancer screening and management of women with abnormal cytology results. The Hybrid Capture 2 (HC2) has been recommended for use as a reference test. ObjectiveTo evaluate a new real-time PCR assay (Anyplex II HPV28) for detecting high risk (HR) HPV and to compare it to the HC2. In addition, we compared the genotyping results of the Anyplex II HPV28 to those of sequencing analysis. Study designA total of 1114 cervical swab specimens were consecutively obtained from a single healthcare center. We submitted all specimens for HPV detection with Anyplex II HPV28 and HC2, then analyzed the discordant results using multiplex PCR followed by direct sequencing. ResultsHC2 detected 72 (6.5%) cases with HR HPV, while Anyplex II HPV28 identified 138 (12.4%) cases. The overall agreement rate was 91.4% (1018/1114) of cases. Discordant results between these two assays were observed in 96 cases; 15 were positive only by HC2, and 81 were positive only by Anyplex II HPV28. Sequencing analyses performed in 80 cases of discordant results revealed 11 false-positive, and 67 false-negative results using HC2 tests and two false-positive results using Anyplex II HPV28. ConclusionsThe Anyplex II HPV28 assay is analytically more sensitive in the detection of the 13 HR types represented by the HC2 assay and exhibited a higher concordance with comprehensive genotyping based on the sequencing analysis, and it could be used as a laboratory testing method for identifying HPV genotypes.

SCEHSS: Secured Cloud Based Electronic Health Record Storage System with Re-Encryption at Cloud Service Provider

An electronic health record system is a collection of health related information. Instead of collecting data from single health care centre, data could be collected from various health care centers. Collected data could be further effectively utilized by healthcare and research community. Cloud computing paradigm gives better platform for connecting various communities providing data and location independence with less maintenance. A Cloud Electronic Health Record (CEHR) integrates data to serve different needs. The goal is to collect data once and use it multiple times to adopt latest technologies in medical domain. Security for data-in-transit is one of the major issues in cloud as well as in EHR systems. Our concentration is achieving highly secure data transmission through multiple encryption and re-encryption in the cloud environment without trusting cloud service provider cent percent. Using both symmetric and asymmetric algorithms the security levels of encryption is strengthened. In 2008, Libert and Vergnaud presented the first construction of unidirectional proxy re-encryption scheme with chosen-ciphertext security in the standard model. We extended the unidirectional proxy re-encryption scheme to cloud environment by assigning the responsibility of proxy to cloud service provider for securing data-in-transit.

The Korean National Liver Cancer Surveillance Program: Experience of a Single Healthcare Center in 2011

ëª©ì : 간암 조기 검진을 위한 êµ­ê°€ì•”ê²€ì§„ì‚¬ì— ì˜ ìœ ìš©ì„±ê³¼ ë¬¸ì œì ì„ 조사하기 위해 단일 병원에서 일 ë „ê°„ 경험한 ê°„ì•”ê²€ì§„ì‚¬ì— ê²°ê³¼ë¥¼ 분석하였다. 방법: 2011ë „ 1월 1일부터 12월 31일까지 경희대학교병원에서 간암검진을 위해 복부 초음파 검사 또는 혈청 알파태아단백 검사(이하 AFP)를 받은 수검자를 대상으로 하였다. 이들의 ê¸°ë³¸ì ì¸ 특성, 간암 발견율, ê·¸ë¦¬ê³ ê°„ì•”ì„ 발견하기 위해 지출된 의료 비용을 위암과 비교 조사하였다. ê²°ê³¼: 일 ë „ê°„ 621ëª ì„ 검진하여 총 5ëª (0.8%)의 간세포암(이하 간암)을 발견하였다. 이 중 4ëª ì€ 복부 초음파 검사로 ë°œê²¬ë˜ì—ˆê³ ëª¨ë‘ ê·¼ì¹˜ì  치료(ìˆ˜ìˆ 2ëª , ê³ ì£¼íŒŒì‘ê³ ìˆ 2ëª )를 받았다. 나머지 한 ëª ì€ AFP 상승으로 ë°œê²¬ë˜ì—ˆê³ ì¹¨ìœ¤ì„± 간세포암으로 진단 후 2개월만에 사망하였다. 과거 ë³‘ë ¥ì„ ì¡°ì‚¬í• ìˆ˜ 있었던 492ëª ê°€ìš´ë° 45%가 Bí˜•ê°„ì—¼ì´ì—ˆê³ 5%가 C형간염, 1%가 B형 C형 동시감염, 3%가 알코올성 간경변증을 포함한 기타 간경변증이었다. 나머지 46%의 수검자들은 간암 ê³ ìœ„í—˜ì¸ìžë¥¼ 하나도 ê°€ì§€ê³ ìžˆì§€ 않았다. 간암 1ëª ì„ 발견하기 위해 사용된 의료 비용은 총 842ë§Œì›ì´ì—ˆê³ ì´ëŠ” 위암의 4,506만원에 비해 낮은 수준이었다. 비대상자들을 ì œì™¸í•˜ì˜€ì„ 때 간암 검진 비용은 556만원까지 낮출 수 있었다 ê²°ë¡ : ê°„ì•”ê²€ì§„ì‚¬ì— ì˜ 효율성과 형평성을 높이기 위해 ì ì ˆí•œ ê³ ìœ„í—˜êµ° ì„ ë³„ì„ 위한 ëŒ€ì± ë§ˆë ¨ì´ 시급하다. êµ­ê°€ì•”ê²€ì§„ì‚¬ì— ì´ ì ì ˆí•˜ê²Œ 수행된다면 약 1%의 수검자에서 ê°„ì•”ì„ë°œê²¬í• ìˆ˜ 있다. 완치가 가능한 초기 간암은 대부분 복부 초음파 검사로 발견되며 AFP는 초기 간암 발견에는 ìœ ìš©ì„±ì´ 떨어지는 편이다. 중심 단어: 간암; 집단 검진; 복부 초음파 검사; 알파태아단백

Immune monitoring of anti cytomegalovirus antibodies and risk of cytomegalovirus disease in heart transplantation

We sought to determine whether quantitative assessment of anti-cytomegalovirus (CMV) antibodies could be useful to identify patients at risk of cytomegalovirus (CMV) disease after heart transplantation (HT). 75 patients who underwent HT at a single health care center were prospectively studied. Induction therapy included 2 doses of daclizumab and maintenance tacrolimus ( n = 42) or cyclosporine ( n = 29), mycophenolate mofetil and prednisone. All patients received prophylaxis with gancyclovir or valganciclovir. Anti-CMV intravenous immunoglobulin (CMV-IG) was added in high risk patients (CMV D+/R − serostatus). Serial determinations of anti-CMV antibodies, immunoglobulins (IgG, IgA, IgM) and IgG-subclasses were analysed. CMV infection was based on detection of the virus by antigenemia. CMV disease consisted of detection of signs or symptoms attributable to this microorganism. Ten patients (13.3%) developed CMV disease. Mean time of development of CMV disease was 3.4 ± 1.6 months. In Cox regression analysis, patients with low baseline anti-CMV titers (< 4.26 natural logarithm of titer, RH: 8.1, 95%CI: 1.93–34.1, p = 0.004) and recipients with 1-month post-HT IgG hypogammaglobulinemia (IgG < 500 mg/dl, RH: 4.49, 95%CI: 1.26–15.94, p = 0.02) were at higher risk of having CMV disease. Despite use of prophylactic CMV-IG, D+/R − patients showed significantly lower titers of anti-CMV antibodies at 7 d, 30 d and 90 d post HT as compared with HT recipients without infections. Four out of 6 of these patients developed late CMV disease. Monitoring of specific anti-CMV antibodies on the bedside warrants further evaluation as a potential tool to identify heart transplant recipients at higher risk of CMV disease.

Incidence and Clinical Features of Ganciclovir- Resistant Cytomegalovirus Disease in Heart Transplant Recipients

The incidence and clinical and virologic aspects of ganciclovir-resistant cytomegalovirus (CMV) disease have not been well-characterized in heart transplant recipients. We retrospectively analyzed all patients who underwent their first heart transplantation during the period from 1 January 1995 through 30 June 2005 at a single health care center. Cox proportional hazard regression was used to assess the relationship between clinical variables and CMV disease. Portions of the UL97 gene were sequenced in patients with slow clinical and/or virologic response to ganciclovir therapy. Cytomegalovirus disease developed in 32 (11.7%) of 274 patients at a median of 4.2 months after transplantation (range, 1.8-11.6 months after transplantation) and was independently associated with donor-seropositive/recipient-seronegative (D+/R-) serostatus (adjusted hazard ratio, 6.93; P<.001). The incidence of ganciclovir-resistant CMV disease was 1.5% overall (4 of 274 patients), 5% among D+/R- serostatus recipients (4 of 80 patients), and 12.5% among patients who developed CMV disease (4 of 32 patients). Ganciclovir-resistant CMV disease was significantly associated with D+/R- serostatus (4 [5%] of 80 vs. 0 [0%] of 153 patients; P=.02), greater prior exposure to ganciclovir (median duration of exposure, 150 vs. 69 days; P=.003), and substantial morbidity, including prolonged CMV-associated hospitalization (median duration of hospitalization, 66 vs. 0 days; P<.01). CMV disease, including ganciclovir-resistant disease, is an important clinical problem in D+/R- heart transplant recipients who receive antiviral prophylaxis. Strategies specifically designed to reduce the incidence and impact of CMV disease in this population are warranted.

Publicaciones sobre evaluación de la atención primaria en España tras veinte años de reforma (1984-2004): análisis temático y bibliométrico

In view of the widespread opinion as to the lack of data for evaluating the results of the Primary Care reform which began in Spain in 1984, the conducting of a thematic and bibliometric analysis for the published evaluation studies is posed. The documents published within the 1984-2004 time period, located by means of systematic bibliographic search both in biomedical journals and in theses, reports or books on any of the components of Primary Care included within the proposed thematic classification and referred to scopes broader than one single healthcare center. Three complimentary search strategies were used: electronic databases, manual review of indexes and reference work quote-based searches. A total of 684 documents met the criteria for inclusion: 85% having been taken from biomedical journals, 12.3% having been doctoral theses, and 2.6% reports or books. Documents were located in 49 different journals (29 foreign), Atención Primaria (52.7%) being the journal having provided the largest number of articles. A total 12.7% of the articles were published in journals indexed in the SCI, and 8.6% in foreign journals. In 32% of the studies, the first author was working at a reformed healthcare center. Two-thirds of the evaluations revolved around the analysis of the process; the topics most often evaluated having been related to healthcare spending (pharmacy), the system organization (emergencies) and professional satisfaction. Broad-based documentation is provided with evaluations of primary care in Spain. Studies have been focused more on the evaluation of the process than on that of the results. Research in this field requires including studies not published in journals (theses and reports).

Pathological fractures in epilepsy

Fracture rates in epilepsy are two to three times that for the general population, although the influence of gender and age is not well defined. We examined, over a 7-year period at a single health care center, 750 patients with epilepsy who sustained the fractures. Among these patients, 293 (39%) had pathological fractures and 457 (61%) had traumatic/seizure-related fractures. Pathological fractures accounted for 71% of the 146 patients >60 years, a group traditionally at risk for pathological fractures ( P < 0.02). Fractures in epilepsy are distributed with bimodal peaks in the fifth and eighth decades of life, although pathological fractures are a significant contributor across the life span, accounting for 20 to 40% of patients traditionally thought not to be at risk for involutional osteoporotic fractures. Together these findings suggest that epilepsy, and/or its treatment, is a dominant influence in the pathogenesis of fractures and may exacerbate the effects of aging-related involutional osteoporosis.

Cytomegalovirus infection after liver transplantation using different prophylaxes

We sought to determine whether quantitative assessment of anti-cytomegalovirus (CMV) antibodies could be useful to identify patients at risk of cytomegalovirus (CMV) disease after heart transplantation (HT). 75 patients who underwent HT at a single health care center were prospectively studied. Induction therapy included 2 doses of daclizumab and maintenance tacrolimus (n = 42) or cyclosporine (n = 29), mycophenolate mofetil and prednisone. All patients received prophylaxis with gancyclovir or valganciclovir. Anti-CMV intravenous immunoglobulin (CMV-IG) was added in high risk patients (CMV D+/R− serostatus). Serial determinations of anti-CMV antibodies, immunoglobulins (IgG, IgA, IgM) and IgG-subclasses were analysed. CMV infection was based on detection of the virus by antigenemia. CMV disease consisted of detection of signs or symptoms attributable to this microorganism. Ten patients (13.3%) developed CMV disease. Mean time of development of CMV disease was 3.4 ± 1.6 months. In Cox regression analysis, patients with low baseline anti-CMV titers (< 4.26 natural logarithm of titer, RH: 8.1, 95%CI: 1.93–34.1, p = 0.004) and recipients with 1-month post-HT IgG hypogammaglobulinemia (IgG < 500 mg/dl, RH: 4.49, 95%CI: 1.26–15.94, p = 0.02) were at higher risk of having CMV disease. Despite use of prophylactic CMV-IG, D+/R− patients showed significantly lower titers of anti-CMV antibodies at 7 d, 30 d and 90 d post HT as compared with HT recipients without infections. Four out of 6 of these patients developed late CMV disease. Monitoring of specific anti-CMV antibodies on the bedside warrants further evaluation as a potential tool to identify heart transplant recipients at higher risk of CMV disease.

Association between exposure to crystalline silica and risk of sarcoidosis.

OBJECTIVES: The possibility of an association between exposure to silica and autoimmune diseases has recently come under discussion. In the following case-referent study, a cohort exposed to diatomaceous earth and...