Primary vs. Secondary Antibody Deficiency: Clinical Features and Infection Outcomes of Immunoglobulin Replacement

<div><p>Secondary antibody deficiency can occur as a result of haematological malignancies or certain medications, but not much is known about the clinical and immunological features of this group of patients as a whole. Here we describe a cohort of 167 patients with primary or secondary antibody deficiencies on immunoglobulin (Ig)-replacement treatment. The demographics, causes of immunodeficiency, diagnostic delay, clinical and laboratory features, and infection frequency were analysed retrospectively. Chemotherapy for B cell lymphoma and the use of Rituximab, corticosteroids or immunosuppressive medications were the most common causes of secondary antibody deficiency in this cohort. There was no difference in diagnostic delay or bronchiectasis between primary and secondary antibody deficiency patients, and both groups experienced disorders associated with immune dysregulation. Secondary antibody deficiency patients had similar baseline levels of serum IgG, but higher IgM and IgA, and a higher frequency of switched memory B cells than primary antibody deficiency patients. Serious and non-serious infections before and after Ig-replacement were also compared in both groups. Although secondary antibody deficiency patients had more serious infections before initiation of Ig-replacement, treatment resulted in a significant reduction of serious and non-serious infections in both primary and secondary antibody deficiency patients. Patients with secondary antibody deficiency experience similar delays in diagnosis as primary antibody deficiency patients and can also benefit from immunoglobulin-replacement treatment.</p></div

Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

Seventeen Sustainable Development Goals (SDGs) were adopted by the global community to provide benchmark targets for global development between 2015 and 2030 and to reframe the Millennium Development Goals (MDGs) to achieve sustainable global development. This report presents data on maternal mortality in 195 countries from 1990 to 2015. Maternal mortality data were categorized in 3 formats, namely, number of deaths, cause-specific mortality rate per capita, and cause fraction. The overall maternal mortality was modeled using cause-of-death ensemble modeling (CODEm). The number of deaths, maternal mortality ratios (MMRs), and 95% uncertainty intervals were reported for all estimates. The results indicate that the overall decline in global maternal deaths from 1990 to 2015 was approximately 29% (390,185 in 1990; 374,321 in 2000; and 275,288 in 2015), and the reduction in MMR was 30% (282 in 1990, 288 in 2000, and 196 in 2015). In 1990, it was found that 60 countries had an MMR of more than 200, 40 countries had an MMR of more than 400, 15 countries had an MMR of more than 600, and 1 country had an MMR of more than 1000. By 2015, 122 countries had an MMR of less than 70, and 49 countries had an MMR of less than 15. Although MMR and Sociodemographic Index improved between 1990 and 2015 in almost all regions, it was observed that MMR did not universally track with Sociodemographic Index over the whole time period in any single region. The observed minus expected (O - E) MMR ratio was consistently found to be 1.25 or more in many regions; however, MMR reductions slowed considerably, and the O - E MMR ratio was 1.41 in 2015. The risk of maternal mortality increased greatly with age, but decreased greatly in almost all age groups from 1990 to 2015. It was observed that MMR in 10- to 14-year-old girls in 2015 was 278; it then decreased and was lowest in women aged 15 to 29 years before increasing significantly to 1832 in 50- to 54-year-old women. Direct obstetric causes accounted for 86% of all maternal deaths in 2015 due to maternal hemorrhage, maternal hypertensive disorders, and other maternal disorders in comparison to 1990 when direct complications accounted for 87% of all maternal deaths. Other maternal disorders caused approximately 74,299 deaths in 1990 and decreased to 32,734 deaths in 2015. The study authors conclude that although there is global progress in reducing maternal mortality in the past 15 years, more and better data collection systems should be put in place to devise better health care policies and to educate women about reproductive care options available to them

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015

BACKGROUND: The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. METHODS: We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors-the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). FINDINGS: Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6-58·8) of global deaths and 41·2% (39·8-42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. INTERPRETATION: Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden

A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990�2010: a systematic analysis for the Global Burden of Disease Study 2010

Geneeskunde en GesondheidswetenskappePsigiatriePlease help us populate SUNScholar with the post print version of this article. It can be e-mailed to: [email protected]