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Alerji ve Klinik İmmunoloji Polikliniğinde Takip Edilen Lateks Alerjik Hastaların Değerlendirilmesi
Abstract
Özet
Amaç:
Lateks, Havea Brasiliensis bitki öz suyunun içerisine birtakım katkı
maddelerinin eklenmesi sonucu elde edilen bir ürün olup sağlık alanında
birçok tıbbi araç ve gereç içerisinde günlük yaşamda yaygın olarak
kullanılmaktadır. Günümüzde lateks alerjisi sıklığı; spina bifida, mesane
ekstrofisi gibi sık cerrahi girişimlere maruz kalan duyarlı popülasyonda,
sağlık çalışanlarında, lateksle ilgili üretim yapan işçilerde ve genel popülasyonda gittikçe
artmaktadır.
Lateks alerjisi sıklığı sağlık çalışanlarında %9.7, duyarlı hasta grubunda %7.2 ve genel
popülasyonda %4.3 olarak bildirilmektedir 1 . Lateks alerjisi iritan veya alerjik kontakt
dermatitten ürtiker, angioödem, rinit, astım, konjonktivit hatta anafilaksiye kadar
gidebilen klinik tablolara yol açabilir 2,3 . Anafilaksiye neden olan ajanlar arasında
nöromuskuler bloke edici ilaçlardan sonra ikinci sırada yer alır 4,5 . Lateks alerjisinin
tanısında deri prick test, K82 lateks spesifik IgE ve bunlarla sonuç alınamadığı
durumlarda nasal provokasyon testleri kullanılır. Ayrıca lateks malzemelerde kullanılan
yardımcı katkı maddeleri ve buna bağlı gelişen dermatit ile ilgili deri patch testleri demevcuttur. Biz burada polikliniğimizde takip ettiğimiz hastaları derledik ve lateks
alerjisinin yaygınlığına ve sağlık çalışanlarında sık görülen bir meslek hastalığı olduğuna
dikkat çekmeyi amaçladık.
Gereç ve Yöntem:
2014-2020 yılları arasında hastanemiz Alerji ve İmmunoloji Polikliniği’ne başvuran ve
polikliniğimiz takibinde olan lateks alerjisi tanılı hastalar rektrospektif olarak tarandı.
Hastalar yaş, cinsiyet, meslek, deri prick testi sonucu, K82 lateks spesifik IgE ve
semptomlar açısından değerlendirildi.
Bulgular:
Hastaların 18 (%69,2)’i kadın, 8 (30,8)’i erkek ve yaş ortalaması 41,6 idi. Hastaların
çoğunluğunu
%77(20/26) (1 cerrah, 1 sağlık memuru, 1 diş teknisyeni, 17 hemşire
olmak üzere) sağlık çalışanları oluşturdu. Dört hasta lateks eldiven kullanan işçi, 1 hasta
memur, 1 hasta da ev hanımı idi. Lateks prick testleri 2+ ila 5+ arasındaydı. K82 lateks
spesifik IgE bakılabilen hastalarda 1+ ila 4+ arasında değişmekte idi, sadece 1 hastada
ise K82 lateks spesifik Ige negatif bulundu. Semtomların sıklığı; %92 (24) dermatit, %38
(10) angioödem, %35 (9) rinit, %19 (5) konjonktivit, %11(3) ürtiker, %3 (1) dispne, %3 (1)
astım, %8 (2) anafilaksi ve bu semptomların kombinasyonları mevcut idi.
Sonuç:
Lateks alerjisi, lateks eldiven kullananlarda, kauçuk ve lastik üretimi yapan işçilerde,
lateks büro malzemeleri kullanan memur ve ofis çalışanlarında ve daha büyük
çoğunlukta da sağlık çalışanlarında görülebilen bir hastalıktır. Lateks eldivenlerin ve
lateksten yapılmış tıbbi malzemelerin yaygın kullanımı da lateks alerjisinin duyarlıkişilerde ortaya çıkmasının altında yatan sebeptir. Sağlık çalışanlarında sık görüldüğü için
de bir meslek hastalığı olarak değerlendirilmesinin uygun olacağını düşünüyoruz.
Anafilaksi gibi ölümcül klinik tablolara yol açabilmesi de bu konunun önemine işaret
etmektedir.
Anahtar Kelimeler: Lateks Alerjisi, Semptom, Tanı, Sağlık Çalışanları
ResearchGate has not been able to resolve any citations for this publication.
Introduction: Primary Immunodeficiency diseases(PID) are common in patients with non-cystic
The current COVID-19 pandemic has caused severe morbidity and mortality worldwide. Although relevant studies show that the smoking rate of COVID-19 patients is relatively low, the current smoking status of people with COVID-19 cannot be accurately measured for reasons. Thus, it is difficult to assess the relationship between smoking and COVID-19. Smoking can increase the risk of severe COVID-19 symptoms and aggravate the condition of patients with COVID-19. Nicotine upregulates the expression of ACE2, which can also increase susceptibility to COVID-19, aggravatiing the disease. Although nicotine has certain anti-inflammatory effects, there is no evidence that it is related to COVID-19 treatment; therefore, smoking cannot be considered a preventative measure. Furthermore, smokers gathering and sharing tobacco may promote the spread of viruses. Despite the COVID-19 epidemic, the findings suggested that COVID-19 has not encouraged smokers to quit. Additionally, there is evidence that isolation at home has contributed to increased smoking behavior and increased quantities. Therefore, it is recommended that governments increase smoking cessation messaging as part of public health measures to contain the COVID-19 pandemic. This review analyzes the existing research on smoking’s impact on COVID-19 so that governments and medical institutions can develop evidence-based smoking-related prevention and control measures for COVID-19.
Objective. To determine the novel proposed nomogram model accuracy in the prediction of the lower-extremity amputations (LEA) risk in diabetic foot ulcer (DFU). Methods and Materials. In this retrospective study, data of 125 patients with diabetic foot ulcer who met the research criteria in Zhongnan Hospital of Wuhan University from January 2015 to December 2019 were collected by filling in the clinical investigation case report form. Firstly, univariate analysis was used to find the primary predictive factors of amputation in patients with diabetic foot ulcer. Secondly, single factor and multiple factor logistic regression analysis were employed to screen the independent influencing factors of amputation introducing the primary predictive factors selected from the univariate analysis. Thirdly, the independent influencing factors were applied to build a prediction model of amputation risk in patients with diabetic foot ulcer by using R4.3; then, the nomogram was established according to the selected variables visually. Finally, the performance of the prediction model was evaluated and verified by receiver working characteristic (ROC) curve, corrected calibration curve, and clinical decision curve. Results. 7 primary predictive factors were selected by univariate analysis from 21 variables, including the course of diabetes, peripheral angiopathy of diabetic (PAD), glycosylated hemoglobin A1c (HbA1c), white blood cells (WBC), albumin (ALB), blood uric acid (BUA), and fibrinogen (FIB); single factor logistic regression analysis showed that albumin was a protective factor for amputation in patients with diabetic foot ulcer, and the other six factors were risk factors. Multivariate logical regression analysis illustrated that only five factors (the course of diabetes, PAD, HbA1c, WBC, and FIB) were independent risk factors for amputation in patients with diabetic foot ulcer. According to the area under curve (AUC) of ROC was 0.876 and corrected calibration curve of the nomogram displayed good fitting ability, the model established by these 5 independent risk factors exhibited good ability to predict the risk of amputation. The decision analysis curve (DCA) indicated that the nomogram model was more practical and accurate when the risk threshold was between 6% and 91%. Conclusion. Our novel proposed nomogram showed that the course of diabetes, PAD, HbA1c, WBC, and FIB are the independent risk factors of amputation in patients with DFU. This prediction model was well developed and behaved a great accurate value for LEA so as to provide a useful tool for screening LEA risk and preventing DFU from developing into amputation.
1. Introduction
As a common epidemic in the 21st century, the prevalence of diabetes is exploding all over the world and becoming a major public health concern [1]. According to statistics, about 415 million people worldwide are known to have diabetes in 2015, and this number is still continuously growing, up to an estimated 642 million people by 2040 with a 55% increase in the next 20 years [2]. At the same time, as an inevitable result of the rapid increase in the number of people with diabetes, the incidence of diabetes complications has also presented a corresponding dramatic rise which put low-income and middle-income countries at the greatest risk of death [3, 4].
Based on the two main etiological factors of diabetic peripheral neuropathy and peripheral arterial disease (PAD), diabetic foot ulcer (DFU) is one of the most serious complications of diabetes, which makes a great contribution to most causes of nontraumatic lower-extremity amputations (LEA) and leads high mortality [5, 6]. It is reported that the long-term prognosis after LEA, which is closely related to DFU, is extremely poor, with a 3-year mortality rate ranging from 35% to 50% [7]. In the longer term, the overall 5-year mortality rate was even higher, ranging from 52% to 80% with major amputations and from 53% to 100% for those with any amputation [8].
DFU and their worst adverse consequences, especially amputation, have a catastrophic impact on the mental and physical health of patients, including prolonged hospitalization, heavy economic burden, difficult treatment, significantly impaired quality of life, and eventually lead to high mortality, making it urgent to propose an efficient strategy for prevention and treatment [9]. Efforts to prevent amputation therefore deserve more focuses, and it could be achieved by risk factor identification. Previous studies have shown that there are many significant risk factors for amputation in patients with diabetic foot, including long-term hyperglycemia, inflammatory markers, duration of diabetes, PAD, age, Wagner grade, and osteomyelitis [9]. Regrettably, there is no efficient predictive tool has been yet developed in this direction to estimate the risk of amputation in patient with DFU.
Considering these challenges, we tent to establish a predictive nomograms model to quantify the risk of amputation in patients with diabetic foot and to propose precautionary protocols. The nomogram can graphically represent the numerical relationship between specific disease and risk factors and intuitively predict the incidence of adverse events through a scoring system without any complicated calculation formula. From this point of view and based on previous study, we hope to provide a useful tool for clinicians to early identify and develop optimal treatment regimen for patients with diabetic foot to avoid unpleasant events such as amputation.
2. Methods and Materials
2.1. Study Design and Participants
In order to solve this clinical problem, we designed and implemented a retrospective study and 125 type 2 DM patients with diabetic foot ulcer who were hospitalized in Zhongnan Hospital of Wuhan University from January 2015 to December 2019 were included in this study at all. Among the 125 patients, 66 patients were from the Trauma and Microorthopaedics Center of Zhongnan Hospital of Wuhan University, and 59 patients were from the Diabetes Center of Endocrinology Department of Zhongnan Hospital of Wuhan University. The criteria for inclusion and exclusion were as follows: inclusion criteria: (1) all participating patients meet the type 2 DM diagnostic criteria issued by WHO (World Health Organization) in 1999 and the DFU diagnostic criteria issued by IDWGF in 2015, (2) the age of patients was over 18 years, and (3) all patients have informed consent to this study; exclusion criteria: (1) type 1 DM patients or secondary DM patients, (2) diabetic patients during pregnancy and lactation, (3) patients with other infections except DFU infection, (4) patients with malignant tumor, and (5) patients with severe lack of case data. This study has been approved by the Ethics Committee of Zhongnan Hospital of Wuhan University.
2.2. Data Collection
We designed the clinical investigation case report form (CRF) to collect the clinical data of the patients from the Hospital Information System (HIS) system of Zhongnan Hospital, including general demographic data such as sex, age, BMI, course of diabetes; history of diabetic complications, including diabetic retinopathy (DR), diabetic nephropathy (DN), and peripheral angiopathy of diabetic (PAD); and results of fasting venous blood biochemical examination for the first time after admission, including fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), white blood cells (WBC), red cell distribution width (RDW), total protein (TP), albumin (ALB), total bilirubin (TBIL), direct bilirubin (DBIL), total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), blood uric acid (BUA), and fibrinogen (FIB). According to the CRF, we design an epidata database to collect survey data, and in order to control the quality of data, all data were input and checked in parallel by two people.
2.3. Statistical Analysis
The data of continuous variables obeying normal distribution and nonnormal distribution are represented by “mean±standard deviation (x±s)” and “median (lower quartile, upper quartile) (M (P25p75)), respectively. Continuous variables that obey normal distribution are tested by -test, and continuous variables that do not obey normal distribution are tested by nonparametric rank sum test (Wilcoxon). The categorical variables were expressed by percentage constituent ratio and chi-squared test used for comparison between groups. All the statistics were tested by two-side test, with value less than 0.05 considered to be statistically significant. All confidence intervals (CI) are set to 95%. Primary predictive factors were submitted to single factor logistic regression analysis and multivariate logistic regression analysis to distinguish if they were influence factor or independent influence factors of amputation in patients with diabetic foot if their values were less than 0.05 in the univariate analysis. Based on the independent influencing factors of amputation in patients with diabetic foot, we used the R4.2 software to establish a nomogram prediction model. Area under curve (AUC) of receiver operating characteristic curve was used to estimate the performance of the nomogram prediction model. The accuracy of the model was tested by the Hosmer-Lemeshow test, and a corrected calibration curve which includes 2000 bootstrap samples was used for the internal validation of the nomogram prediction model. The decision analysis curve (DCA) was employed to evaluate the clinical efficacy of the nomogram by analyzing the net benefit under different risk thresholds in patients with diabetic foot. All statistical analysis was carried out by using the SPSS26.0 and R4.2 software.
3. Results
3.1. Baseline Clinical Characteristics of Participants
Among the 125 DFU patients in the study, there were 22 patients with gangrene, 43 patients with severe infection, and 32 patients with severe PAD. Among these patients, there were 84 males and 41 females, of whom 58 (46.4%) underwent amputation (amputation group), with an average age of years old, and 67 (53.6%) without amputation (nonamputation group), with an average age of years. In the univariate analysis, the differences of the clinical data for 7 (course of DM, PAD, HbA1C, WBC, ALB, BUA, and FIB) of the 21 variables in the amputation group and nonamputation group were statistically significant (). There were no significant differences in age, sex, BMI, DR, DN, FBG, TP, RDW, TBIL, DBIL, TC, TG, HDL-C, and LDL-C between the two groups (),showed as Table 1.
Variables
Without amputation ()
Amputation ()
/ value
value
Age (years)
-0.445
0.657
Gender (male/female)
46/21
38/20
0.139
0.709
BMI (kg/m²)
25.54 (23.36, 28.25)
25.40 (22.94, 29.15)
-2.500
0.803
Course of T2DM (years)
6.00 (4.00, 9.00)
10.00 (8.00, 15.25)
-4.680
<0.001
DR
19/48
25/33
2.963
0.085
DN
34/33
30/28
0.012
0.913
PAD
22/45
40/18
16.233
<0.001
FBG (mmol/L)
9.58 (6.54, 11.97)
9.60 (6.54, 13.00)
-0.451
0.652
WBC (10⁹/L)
7.02 (4.92, 8.19)
7.68 (6.11, 11.20)
-2.725
0.006
RDW (%)
13.40 (12.80, 14.30)
13.45 (12.78, 14.33)
-0.446
0.656
HbA1c (%)
1.288
<0.001
TP (mmol/L)
-1.550
0.121
ALB (g/L)
0.657
0.002
TBIL (μmol/L)
9.00 (7.40, 12.00)
9.95 (7.65, 13.38)
-0.589
0.556
DBIL (μmol/L)
2.00 (1.50, 2.70)
2.30 (1.20, 3.43)
-0.860
0.390
BUA (mmol/L)
313.20 (238.00, 376.00)
262.10 (208.35, 352.85)
-1.671
0.095
TC (mmol/L)
3.76 (3.09, 4.80)
3.36 (3.04, 4.22)
-1.767
0.077
TG (mmol/L)
1.01 (0.67, 1.59)
1.12 (0.84, 1.41)
-1.802
0.441
HDL-C (mmol/L)
-0.893
0.374
LDL-C (mmol/L)
0.279
0.632
FIB (mg/dL)
394.00 (330.00, 454.00)
480.50 (390.75, 578.00)
-3.767
<0.001
Sarcoidosis is an inflammatory granulomatous disease that can affect any organ. Up to one-quarter of patients with systemic sarcoidosis may have evidence of cardiac involvement. The clinical manifestations of cardiac sarcoidosis (CS) include heart block, atrial arrhythmias, ventricular arrhythmias and heart failure. The diagnosis of CS can be challenging given the patchy infiltration of the myocardium but, with the increased availability of advanced cardiac imaging, more cases of CS are being identified. Immunosuppression with corticosteroids remains the standard therapy for the acute inflammatory phase of CS, but there is an evolving role of steroid-sparing agents. In this article, the authors provide an update on the diagnosis of CS, including the role of imaging; review the clinical manifestations of CS, namely heart block, atrial and ventricular arrhythmias and heart failure; discuss updated management strategies, including immunosuppression, electrophysiological and heart failure therapies; and identify the current gaps in knowledge and future directions for cardiac sarcoidosis.
Anaphylaxis is a severe, potentially life-threatening systemic hypersensitivity reaction that is still rarely diagnosed. For safety reasons, patients should visit an allergologist to identify potential causes and cofactors of this reaction. This paper presents the analysis of data from the Anaphylaxis Registry gathered over ten years at the Allergy Clinic, Pomeranian Medical University (PMU). A questionnaire-based survey was used for patients visiting the Allergy Clinic to identify potential augmentation factors/comorbidities and/or cofactors of anaphylaxis in patients with a history of moderate to severe anaphylaxis. The registry comprised patients with grade II or higher anaphylaxis. The gathered data concerned chronic comorbidities (cardiovascular diseases, respiratory diseases, and others), recurrence of anaphylaxis, and potential cofactors in anaphylaxis. In the analyzed group, the incidence rate of anaphylaxis was the highest for women aged 19–60 years. Most common comorbidities in patients with moderate to severe anaphylaxis included: cardiovascular diseases, respiratory tract diseases, features of atopy, and thyroid diseases. More than 30% of drug-induced reactions were anaphylactic reactions due to the re-exposure to the same drug, which points to the need for educational initiatives in this area. The incidence rate of anaphylaxis induced by Hymenoptera stings was comparable in patients who had a previous generalized reaction and those who had good tolerance to the previous sting. It is important to take these cofactors into consideration when evaluating patients with anaphylaxis as they may play a role in future anaphylactic reactions.
Introduction
The COVID-19 pandemic has forced governments to take exceptional measures to minimize its spread, imposing lockdown policies. The aim of this study was to evaluate the impact of lockdown on type 1 diabetes (T1D) glycemic control.
Material and Methods
People with T1D using flash glucose monitoring were included. Data from the 14 days before lockdown were compared with data from the last 14 days after 8 weeks of lockdown.
Results
A total of 307 patients were included (age 45.8±12.6 years, 50.2% male, diabetes duration 21.1±12.3 years). Only one patient had COVID-19 infection.
Mean glucose decreased from 166.89±29.4 mg/dL to 158.0±29.0 and estimated HbA1c declined from 7.4±1.0 to 7.1±1.0% (54±10.9 vs 57±10.9 mmol/mol; p<0.001). Time in range increased from 57.8±15.8 to 62.46±16.1%. Time in hyperglycemia >180 mg/dL and >250 mg/dL decreased from 37.3±1.9% to 32.0±17.1% and from 13.0±11.3 to 10.3±10.6%, respectively; (p<0.001). Time in hypoglycemia <70mg/dL increased from 4.9±4.0% to 5.5±4.4% (p<0.001). No differences in time <54 mg/dl, coefficient of variation (CV%) or number of scans per day were found.
Conclusion
Despite the limitations of lockdown, glycemic control improved in patients with T1D. These results suggest that having more time for self-management may help improve glycemic control in the short term.
Objectives
Italy is one of the first countries that imposed a nationwide stay-at-home order during the COVID-19 outbreak, inevitably resulting in changes in lifestyles and addictive behaviours. The aim of this work is to investigate the impact of lockdown restrictions on smoking habits using data collected within the Lost in Italy project.
Methods
A web-based cross-sectional study was conducted on a representative sample of 6003 Italian adults aged 18–74 years. Study subjects were recruited from 27 April to 3 May 2020 and were asked to report changes in smoking habits before the lockdown and at the time of interview.
Results
During the lockdown, 5.5% of the overall sample quit or reduced smoking, but 9.0% of the sample started, relapsed smoking or increased their smoking intensity. In total, the lockdown increased cigarette consumption by 9.1%. An improvement in smoking habits was associated with younger age, occasional smoking and unemployment, whereas a worsening was mainly associated with mental distress. In particular, an increase in cigarette consumption during lockdown was more frequently reported among those with worsening quality of life (OR: 2.05; 95% CI: 1.49 to 2.80), reduction in sleep quantity (OR: 2.29; 95% CI: 1.71 to 3.07) and increased anxiety (OR: 1.83; 95% CI: 1.38 to 2.43) and depressive symptoms (OR: 2.04; 95% CI: 1.54 to 2.71).
Conclusions
COVID-19 lockdown had a huge impact on smoking consumption of the Italian general population. The main concern is for smokers who increase their cigarette consumption due to an increased mental distress. Providing greater resources for cessation services capable of reducing mental health symptoms in smokers is urgently needed.
This article provides an update on the global cancer burden using the GLOBOCAN 2020 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer. Worldwide, an estimated 19.3 million new cancer cases (18.1 million excluding nonmelanoma skin cancer) and almost 10.0 million cancer deaths (9.9 million excluding nonmelanoma skin cancer) occurred in 2020. Female breast cancer has surpassed lung cancer as the most commonly diagnosed cancer, with an estimated 2.3 million new cases (11.7%), followed by lung (11.4%), colorectal (10.0 %), prostate (7.3%), and stomach (5.6%) cancers. Lung cancer remained the leading cause of cancer death, with an estimated 1.8 million deaths (18%), followed by colorectal (9.4%), liver (8.3%), stomach (7.7%), and female breast (6.9%) cancers. Overall incidence was from 2-fold to 3-fold higher in transitioned versus transitioning countries for both sexes, whereas mortality varied <2-fold for men and little for women. Death rates for female breast and cervical cancers, however, were considerably higher in transitioning versus transitioned countries (15.0 vs 12.8 per 100,000 and 12.4 vs 5.2 per 100,000, respectively). The global cancer burden is expected to be 28.4 million cases in 2040, a 47% rise from 2020, with a larger increase in transitioning (64% to 95%) versus transitioned (32% to 56%) countries due to demographic changes, although this may be further exacerbated by increasing risk factors associated with globalization and a growing economy. Efforts to build a sustainable infrastructure for the dissemination of cancer prevention measures and provision of cancer care in transitioning countries is critical for global cancer control.
We have reviewed the available literature on thyroid diseases and coronavirus disease 2019 (COVID-19), and data from the previous coronavirus pandemic, the severe acute respiratory syndrome (SARS) epidemic. We learned that both SARS and COVID-19 patients had thyroid abnormalities. In the limited number of SARS cases, where it was examined, decreased serum T3, T4 and TSH levels were detected. In a study of survivors of SARS approximately 7% of the patients had hypothyroidism. In the previous evaluation evidence was found that pituitary function was also affected in SARS. Others suggested a hypothalamic-pituitary-adrenal axis dysfunction. One result published recently indicates that a primary injury to the thyroid gland itself may play a key role in the pathogenesis of thyroid disorders in COVID-19 patients, too. Subacute thyroiditis, autoimmune thyroiditis and an atypical form of thyroiditis are complications of COVID-19. Thyroid hormone dysfunction affects the outcome by increasing mortality in critical illnesses like acute respiratory distress syndrome, which is a leading complication in COVID-19. Angiotensin-converting enzyme 2 is a membrane-bound enzyme, which is also expressed in the thyroid gland and the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) uses it for docking, entering as well as replication. Based on the available results obtained in the SARS-CoV-2 pandemic, beside others, we suggest that it is necessary to monitor thyroid hormones in COVID-19.