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Red cell distribution width and other red blood cell parameters in patients with cancer: association with risk of venous thromboembolism and mortality.

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Cancer patients are at high risk of developing venous thromboembolism (VTE). Red cell distribution width (RDW) has been reported to be associated with arterial and venous thrombosis and mortality in several diseases. Here, we analyzed the association between RDW and other red blood cell (RBC) parameters with risk of VTE and mortality in patients with cancer.

METHODS: RBC parameters were measured in 1840 patients with cancers of the brain, breast, lung, stomach, colon, pancreas, prostate, kidney; lymphoma, multiple myeloma and other tumor sites, that were included in the Vienna Cancer and Thrombosis Study (CATS), which is an ongoing prospective, observational cohort study of patients with newly diagnosed or progressive cancer after remission. Primary study outcome is occurrence of symptomatic VTE and secondary outcome is death during a maximum follow-up of 2 years.

RESULTS: During a median follow-up of 706 days, 131 (7.1%) patients developed VTE and 702 (38.2%) died. High RDW (>16%) was not associated with a higher risk of VTE in the total study cohort; in competing risk analysis accounting for death as competing variable the univariable subhazard ratio (SHR) was 1.34 (95% confidence interval [CI]: 0.80-2.23, p = 0.269). There was also no significant association between other RBC parameters and risk of VTE. High RDW was associated with an increased risk of mortality in the total study population (hazard ratio [HR, 95% CI]: 1.72 [1.39-2.12], p<0.001), and this association prevailed after adjustment for age, sex, hemoglobin, leukocyte and platelet count (HR [95% CI]: 1.34 [1.06-1.70], p = 0.016).

CONCLUSIONS: RDW and other RBC parameters were not independently associated with risk of VTE in patients with cancer and might therefore not be of added value for estimating risk of VTE in patients with cancer. We could confirm that high RDW is an independent predictor of poor overall survival in cancer.

Combined BNP and Echocardiographic assessment in interstitial lung disease for pulmonary hypertension detection

Natriuretic Peptides (B-type natriuretic peptide [BNP] and NT pro-BNP) are proposed biomarkers to differentiate between cardiac and pulmonary causes of acute dyspnea [1]. Some emerging data proposed the use in respiratory disease and particularly in patients with acute pulmonary embolism and pulmonary hypertension (PH) [2]. (Source: International Journal of Cardiology)

Inter-society consensus document on treatment and prevention of bronchiolitis in newborns and infants

Acute bronchiolitis is the leading cause of lower respiratory tract infection and hospitalization in children less than 1 year of age worldwide. It is usually a mild disease, but some children may develop severe symptoms, requiring hospital admission and ventilatory support in the ICU. Infants with pre-existing risk factors (prematurity, bronchopulmonary dysplasia, congenital heart diseases and immunodeficiency) may be predisposed to a severe form of the disease.Clinical diagnosis of bronchiolitis is manly based on medical history and physical examination (rhinorrhea, cough, crackles, wheezing and signs of respiratory distress). Etiological diagnosis, with antigen or genome detection to identify viruses involved, may have a role in reducing hospital transmission of the infection.Criteria ...

The Nasal and Sinus Microbiome in Health and Disease

Abstract There has been great interest in unraveling the complex inter-relationships between microbes and humans as they relate to human health and disease. This review will focus on recent advances in the appreciation and understanding of these relationships in terms of the upper respiratory tract, specifically the nose and paranasal sinuses. (Source: Current Allergy and Asthma Reports)

Middle East respiratory syndrome coronavirus (MERS-CoV) viral shedding in the respiratory tract: an observational analysis with infection control implications

Since the first description of Middle East respiratory syndrome coronavirus (MERS-CoV), it has not been known how long patients shed the virus in respiratory secretions. Thus, we analyzed the available data on time to negative MERS-CoV test in patients with confirmed MERS-CoV infection and asymptomatic positive contacts.

Methods : Data from repeated laboratory testing of respiratory samples received at the Saudi Arabian virology reference laboratory in Jeddah, Kingdom of Saudi Arabia from September 1, 2012 to September 31, 2013 were recorded. A real-time RT-PCR test for MERS-CoV was used. Data were analyzed by origin of sample, sample type, and MERS-CoV PCR test results.

Results : Twenty-six individuals (13 patients and 13 contacts) had repeated testing done until a negative test was obtained. Most samples from MERS-CoV cases were tracheal aspirate/sputum (p = 0.0006) and most samples from contacts were nose and throat swabs (p = 0.0002). Kaplan–Meier curve analysis showed that contacts cleared the virus at a much earlier time than patients. On day 12, 30% of contacts and 76% of cases were still positive for MERS-CoV by PCR.

Conclusions : Contacts cleared MERS-CoV earlier than ill patients. This finding could be related to the types of sample as well as the types of patient studied. More ill patients with significant comorbidities shed the virus for a significantly longer time. The results of this study could have critical implications for infection control guidance and its application in healthcare facilities handling positive cases.

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