Panel to Investigate Alleged Slapping Incident at Sonipat Civil Hospital

Sonepat: Chaos erupted at Sonipat Civil Hospital after a Class IV employee posted in the X-ray room accused a female Deputy Civil Surgeon of physical assault. The employee alleged that the doctor slapped him, but the doctor denied the accusation, stating that the employee had acted inappropriately and had been recording videos of her.

Both of them filed a complaint against each other at the police station and also submitted a copy to the Civil Surgeon’s office. In response, Civil Surgeon Dr Jayant Ahuja has constituted a board of doctors to inquire into the incident. 

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In his complaint, the employee stated that he was working at the hospital in room 61 when the doctor and a staff nurse came to the room at around 10:15 in the morning and started abusing and misbehaving with him. Following this, he opened his mobile phone camera and started recording it. He claimed that the doctor slapped and physically assaulted him in front of staff and patients when he refused to stop recording.

Refuting the allegations, the doctor in her complaint alleged that she went to the Civil Surgeon’s office only for routine inspection as the employee was not on duty on Wednesday. As she asked him about his absence yesterday from duty, he started making videos and misbehaving with her and the staff nurse. 

When the incident became hectic and intense, the hospital authorities called the police who reached the spot immediately and prevented the situation from escalating further. 

Following the incident, all class IV employees resort to protest by boycotting their work. They left the hospital which caused major inconvenience to the patients as the OPD and X-Ray departments were shut down. 

Civil Surgeon Dr Jayant Ahuja told The Tribune, “A board has been constituted to inquire into the matter. prima facie it appeared to be some old tussle between the doctor and Class IV employees from CHC, Kharkhoda.”

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Machine Learning may Identify High-Risk Diabetic Cardiomyopathy Phenotype: Study

Researchers have found that using a machine learning-based method, it is possible to identify individuals with diabetes who are most at risk for developing heart failure due to diabetic cardiomyopathy (DbCM). DbCM is a recognized stage of subclinical myocardial abnormalities that precede clinical heart failure (HF), at which echocardiographic and cardiac biomarker abnormalities exist but symptoms of heart failure are absent. The recent study was conducted by Segar and colleagues and was published in the European Journal of Heart Failure.

1,199 participants in diabetes without cardiovascular disease who also did not have causes of cardiomyopathy were included from the cohort of Atherosclerosis Risk in Communities (ARIC). Unsupervised hierarchical approach of clustering stratified individuals based on 25 echocardiographic parameters as well as markers of cardiac biomarkers: neurohormonal markers of stress and markers of myocardial injury. Cluster analysis produced three phenogroups that were differentiated with one labeled as high risk for HF, given that it is associated with an increased rate of HF events at the 5-year follow-up. The data were used to train a DeepNN classifier, which was validated subsequently in two cohorts: the Cardiovascular Health Study (CHS) cohort of n=802 and the EHR cohort from the University of Texas Southwestern Medical Center of n=5071.

• Clustering analysis identified three phenogroups among diabetic patients. Phenogroup-3, consisting of 27% of the ARIC cohort, had a significantly higher 5-year HF incidence rate of 12.1% compared with Phenogroups 1 and 2, which had HF incidence rates of 3.1% and 4.6%, respectively. This high-risk phenotype was associated with higher NT-proBNP levels, increased left ventricular mass, larger left atrial size, and poorer diastolic function-all important markers of heightened HF risk.

• The DeepNN classifier had excellent predictive capability and identified 16% of high-risk DbCM cases in the CHS cohort and 29% in the UT Southwestern EHR cohort. Of great interest, the incidence of HF was significantly increased among the high-risk DbCM phenotype individuals identified by the classifier, with hazard ratios of 1.61 (95% CI 1.18–2.19) in the CHS cohort and 1.34 (95% CI 1.08–1.65) in the UT Southwestern EHR cohort.

This study has shown the potential of machine learning-based approaches to identify individuals with diabetes as having a high-risk DbCM phenotype, an opportunity for targeted HF prevention strategies. Researchers believe that predictive models in clinical practice will manage and mitigate the risk of HF in diabetic patients by earlier and more aggressive intervention strategies.

Reference:

Segar, M. W., Usman, M. S., Patel, K. V., Khan, M. S., Butler, J., Manjunath, L., Lam, C. S. P., Verma, S., Willett, D., Kao, D., Januzzi, J. L., & Pandey, A. (2024). Development and validation of a machine learning‐based approach to identify high‐risk diabetic cardiomyopathy phenotype. European Journal of Heart Failure. https://doi.org/10.1002/ejhf.3443

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Sitagliptin Improves Glycemic Control and Protect Kidneys in Adolescents with Type 1 Diabetes, New Study Finds

Egypt: A recent randomized controlled trial has demonstrated that sitagliptin, a DPP-4 inhibitor, significantly improves glycemic control and shows promise in managing early-stage diabetic nephropathy among adolescents with type 1 diabetes. The study utilized the advanced MiniMed 780G hybrid closed-loop (AHCL) system to optimize insulin delivery and improve diabetes management.

“Sitagliptin, when used as an add-on therapy to the advanced hybrid closed-loop (AHCL) system, demonstrated a reno-protective effect for individuals with type 1 diabetes and diabetic nephropathy. Additionally, it improved time in range, reduced glycemic variability, and did so without compromising safety,” the researchers wrote in Diabetologia Journal. 

Dipeptidyl peptidase-4 (DPP-4) inhibition has beneficial effects on various metabolic indicators in diabetes. Stromal cell-derived factor-1 (SDF-1), expressed in multiple organs, including the kidneys, is cleaved and inactivated by the DPP-4 enzyme. Given this context, Nancy S. Elbarbary, Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt, and colleagues conducted a randomized controlled trial to evaluate the impact of sitagliptin as an add-on therapy to the advanced hybrid closed-loop (AHCL) system in adolescents with type 1 diabetes and nephropathy.

For this purpose, the researchers conducted an open-label, parallel-group, randomized controlled trial at the Pediatric Diabetes Clinic at Ain Shams University in Egypt. The study involved 46 adolescents, with a mean age of 14.13 ± 2.43 years, who had been using the MiniMed 780G system for at least six months before the study. Participants had an HbA1c of ≤69 mmol/mol (8.5%) and exhibited diabetic nephropathy characterized by microalbuminuria. They were randomly assigned to two groups (n=23 each). The intervention group received oral sitagliptin at a dose of 50 mg for three months, while the control group continued using the AHCL system without sitagliptin.

The primary outcome measure was the change in the urinary albumin/creatinine ratio (UACR) after three months of sitagliptin administration, with the key secondary outcome being the change in SDF-1 levels from baseline following treatment.

The study revealed the following findings:

  • Data from all participants were analyzed, revealing no significant differences in baseline clinical and laboratory characteristics, as well as AHCL system settings, between the groups.
  • Serum SDF-1 levels were notably higher in all individuals with type 1 diabetes compared to healthy controls.
  • After three months of treatment, sitagliptin led to a significant reduction in SDF-1 levels, decreasing from 3.58 ± 0.73 to 1.99 ± 0.76 ng/ml, alongside an improvement in the urinary albumin/creatinine ratio (UACR), which changed from 7.27 ± 2.41 to 1.32 ± 0.31 mg/mmol.
  • Sitagliptin was associated with reduced postprandial glucose levels, lower sensor glucose readings, a decrease in the coefficient of variation, and a reduced total daily insulin dose.
  • Time in range (3.9–10.0 mmol/l or 70–180 mg/dl) and the insulin-to-carbohydrate ratio increased significantly.
  • Sitagliptin was safe and well-tolerated, with no instances of severe hypoglycemia or diabetic ketoacidosis reported.

The findings showed that DPP-4 inhibitor sitagliptin, administered at a dose of 50 mg orally daily for three months, is a safe add-on therapy to the AHCL system for adolescents with type 1 diabetes and diabetic nephropathy. Sitagliptin improved blood glucose levels and TIR while simultaneously reducing glycemic variability, insulin dosage, urinary albumin/creatinine ratio (UACR), and SDF-1 levels, resulting in a reno-protective effect among participants.

“However, further studies with extended follow-up periods are necessary to confirm these results, assess the full efficacy and safety profiles of sitagliptin, and investigate its long-term effects on kidney disease progression and other diabetes-related complications. Additionally, exploring whether sitagliptin improves diabetic nephropathy in type 1 diabetes through SDF-1 or alternative mechanisms presents an intriguing area for future research,” the researchers concluded.

Reference:

Elbarbary, N.S., Ismail, E.A., El-Hamamsy, M.H. et al. The DPP-4 inhibitor sitagliptin improves glycaemic control and early-stage diabetic nephropathy in adolescents with type 1 diabetes using the MiniMed 780G advanced hybrid closed-loop system: a randomised controlled trial. Diabetologia (2024). https://doi.org/10.1007/s00125-024-06265-7

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WHO Identifies 17 Top Priority Pathogens for New Vaccine Development

A new study by the World Health Organization (WHO) lists 17 bacteria, viruses and parasites that regularly cause disease as top priorities for new vaccine development.
The study is the first global effort to systematically prioritize endemic pathogens based on their regional and global health impact.
It reconfirms longstanding priorities for vaccine research and development (R&D), including for HIV, malaria, and tuberculosis – three diseases that collectively cause nearly 2.5 million deaths each year. Attention is also given to pathogens such as Group A streptococcus, which causes severe infections and contributes to 280,000 deaths from rheumatic heart disease, mainly in lower-income countries.
Another new priority is Klebsiella pneumoniae a bacteria that was associated with 790,000 deaths in 2019 and is responsible for 40 per cent of neonatal deaths due to blood infection in low-income countries. The new study supports the goal of ensuring that everyone, everywhere, can benefit from vaccines that provide protection against serious diseases. It aims to shift the focus in vaccine development away from commercial returns towards regional and global health needs, said WHO’s Dr. Mateusz Hasso-Agopsowicz, who works in vaccine research.
To carry out the study, WHO asked international and regional experts what they think is important when prioritizing pathogens for vaccines R&D. Criteria included deaths, disease and socioeconomic impact, or antimicrobial resistance. Analysis of those preferences, combined with regional data for each pathogen, resulted in top 10 priority pathogens for each of WHO’s six regions globally. The regional lists were then consolidated to form the global list, resulting in the 17 priority endemic pathogens for which new vaccines are urgently needed. To advance vaccine R&D, WHO has categorized each pathogen based on the stage of vaccine development and the technical challenges involved in creating effective vaccines.
Reference: https://news.un.org/en/story/2024/11/1156521

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Study Finds Pathophysiological Similarities Between Preeclampsia and COVID-19

Three years after the most lethal period of the COVID-19 pandemic, a review of the scientific literature published in the American Journal of Reproductive Immunology emphasizes the pathophysiological similarities between preeclampsia and COVID-19.
During the COVID-19 pandemic, above all before vaccines were available, an alarm was sounded regarding a possible correlation between severe cases of COVID-19 in pregnant women and preeclampsia. It can entail dangerous complications for mother and baby. Preeclampsia was more frequent in pregnant women infected by SARS-CoV-2 and was associated with a heightened risk of complications and death.
The protocols for treating the two conditions are different. In the case of preeclampsia, the pregnancy must be interrupted and the baby delivered as soon as possible by cesarean section, whereas in a woman with COVID-19 the pregnancy can proceed, with clinical support until the infection improves.
The study was conducted by researchers at the State University of Campinas in São Paulo state, Brazil, and Baylor College of Medicine in Houston, Texas (USA). The similarities highlighted in the article include shared pathways involving the renin-angiotensin system and angiotensin-converting enzyme 2 (ACE2), the receptor to which SARS-CoV-2 binds to infect human cells.
“The two conditions do indeed have many similarities. Both severe COVID-19 and preeclampsia can involve multiple organ dysfunction and high blood pressure. There are also similarities in the mechanism, as angiotensin-converting enzyme 2 plays a key role in regulating blood pressure. It’s possible therefore that COVID-19 heightens the risk of preeclampsia, as suggested by several studies that point to a higher frequency of preeclampsia in COVID-19 patients,” Maria Laura Costa do Nascimento, last author of the review article and a professor of obstetrics at UNICAMP.
The rise in maternal mortality during the pandemic cannot be blamed on the rise in cases of preeclampsia. “This is due to lack of both epidemiological surveillance findings and a proper diagnosis of the condition,” Nascimento said. “What we can say, based on a multicenter study we conducted during the pandemic with data from 16 maternity hospitals across Brazil, is that the risk of death or severe disease increases when both conditions are present. Moreover, our review of the literature shows that the prevalence of preeclampsia rises among COVID-19 patients.”
Reference: Nobrega, G. M., Jones, B. R., Mysorekar, I. U., & Costa, M. L. (2024). Preeclampsia in the Context of COVID‐19: Mechanisms, Pathophysiology, and Clinical Outcomes. American Journal of Reproductive Immunology, 92(2), e13915.

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Submerged reconstructive approach significantly enhances clinical outcomes of surgical treatment of periimplantitis suggests study

The submerged reconstructive approach significantly enhances clinical outcomes of surgical treatment of periimplantitis suggests a study published in the International Journal of Oral & Maxillofacial Implants.

A study was done to complete a reanalysis study of two similarly designed prospective controlled studies exploring prognostic factors associated with the surgical outcomes of reconstructive treatment of peri-implantitis. Materials and Methods: Individual patient data of both studies were gathered. The initial study employed a submerged healing approach via primary wound closure with implant suprastructure removal and complete coverage of grafted sites. The second study employed a nonsubmerged healing protocol in which healing abutments were kept in place and the implants were not fully submerged.

Both studies measured all prognostic factors at similar time points throughout 1 year and included clinical defect fill (DF) and radiographic defect fill (RDF), reduction of pocket depth (PDR), and bleeding on probing (BoP). Multilevel regression was used for statistical assessment of outcomes relative to the impact of site, local, surgical, and patient-related variables. Results: Overall, 59 implants (30 submerged and 29 nonsubmerged) were treated. Statistically significant higher DF (on average 0.9 mm higher), RDF (1.7 mm), and PDR (1.3 mm) were observed when a submerged reconstructive approach was performed, whereas BoP reduction was similar.

After controlling for treatment (submerged/ nonsubmerged), there were no other significant associations with patient-related (age, sex, smoking, prior periodontitis etc), or implant-related (previous prosthesis type, arch, keratinized tissue width [KTW], etc) factors. Within the study’s limitations, we conclude that a submerged reconstructive approach for surgical management of peri-implantitis leads to significantly enhanced clinical and radiographic outcomes when compared to a nonsubmerged approach.

Reference:

Wen SC, Sabri H, Dastouri E, Huang WX, Barootchi S, Wang HL. Submerged vs Nonsubmerged Reconstructive Approach for Surgical Treatment of Peri-implantitis: Reanalysis of Two Prospective Clinical Studies. Int J Oral Maxillofac Implants. 2024 Aug 29;39(4):526-536. doi: 10.11607/jomi.10560. PMID: 37939242.

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Interstitial lung disease highly prevalent in late-stage systemic sclerosis patients: Study

A new study published in the journal of Arthritis & Rheumatology showed that interstitial lung disease (ILD) can occur in people with late-stage systemic sclerosis (SSc). Systemic sclerosis is a clinically diverse illness marked by intricate interactions between fibrosis, vasculopathy, and immunity. The skin, gastrointestinal tract, lungs, kidneys, and heart are among the organ systems that are impacted by this. Up to 60% of the mortality linked to SSc is caused by the two most prevalent pulmonary manifestations of the illness, interstitial lung disease and pulmonary arterial hypertension (PAH).

ILD in patients with SSc is usually characterized by bilateral, ground-glass opacities, lower-lobe predominant reticulations, and occasionally honeycombing when seen on high-resolution computed tomography (HRCT). Because mild ILD patients may not exhibit any symptoms in the early stages of the illness, they might not have pulmonary function tests or diagnostic radiography done until they start to express symptoms like dyspnea upon exercise and a persistent cough. On late presentations of ILD, nothing is clear. Thus, the team led by Sabrina Hoa carried out this investigation to describe the incidence, risk factors, and consequences of late-onset SSc-ILD.

The participants without common ILD who were enrolled in the Canadian Scleroderma Research Group (CSRG) cohort between 2004 and 2020 were included. The HRCT was used to assess the incidence and risk variables for ILD based on the length of the illness, which was above (late) and below (early) 7 years from the first non-Raynaud presentation. Multivariable Cox models and Kaplan-Meier models were employed to compare the risk of ILD progression.

Incident ILD occurred in 199 patients (21%) of the total 969 patients over a median of 2.4 [1.2, 4.3] years. When compared to earlier SSc, the incidence rate in late SSc was lower. Male sex, myositis, diffuse subtype, anti-topoisomerase I autoantibodies, and elevated C-reactive protein levels were risk factors for incident ILD.

Arthritis and anti-RNA-polymerase III autoantibodies were more common in patients with late-onset ILD, and they were also less likely to be White. The degree of lung disease was comparable for SSc-ILD with late and early start. Also, the rates of progression for SSc-ILD with late and early onsets were comparable. Overall, the findings of this study support that ILD may manifest in in late SSc patients. The risk variables and rates of progression overlapped with earlier-onset SSc-ILD.

Source:

Hoa, S., Berger, C., Lahmek, N., Larche, M., Osman, M., Choi, M., Pope, J., Thorne, C., & Hudson, M. (2024). Characterisation of incident interstitial lung disease in late systemic sclerosis. In Arthritis & Rheumatology. Wiley. https://doi.org/10.1002/art.43051

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AI imaging helps enhance early diabetic retinopathy detection and improve patient outcomes: JAMA

A recent retrospective cohort study published in the JAMA Ophthalmology highlighted the slow adoption of artificial intelligence (AI) systems for detecting diabetic retinopathy (DR) in the United States, despite their proven efficacy. The study analyzed the use of Current Procedural Terminology (CPT) code 92229, established in January 2021 to support reimbursement for AI-based DR screening, across a database of over 107 million patients spanning 62 healthcare organizations.

The findings revealed that, out of nearly 5 million patients with diabetes examined from January 2019 to December 2023, only 4.2% underwent any ophthalmic imaging for DR. Within this subset, the use of AI-based imaging represented just 0.09% of total screenings, with only 3,440 patients utilizing the AI code 92229 since its inception. By 2023, the frequency of AI imaging had seen only a marginal increase, from 58.0 to 58.6 instances per 100,000 diabetic patients which indicated a slow adoption.

Also, traditional imaging techniques such as optical coherence tomography (OCT, CPT code 92134) and fundus photography (CPT code 92250) were more commonly used. OCT was performed in 80.3% of patients with at least one type of ophthalmic imaging, while fundus photography was utilized in 35.0% of cases. Traditional remote imaging (CPT codes 92227 and 92228) remained minimally used, accounting for only 1.0% and 2.5% of patients, respectively.

While the overall use of remote imaging methods surged by 90.16% between 2021 and 2023, AI-based screening remained disproportionately low. The data indicated that AI-based imaging had a higher referral rate to OCT (7.74%) when compared to traditional remote imaging (5.53%) by showing its potential for more targeted and effective DR detection. However, adoption hurdles such as cost, lack of awareness, and integration issues may be limiting widespread use. More than 80% of patients receiving AI-based imaging were concentrated in the South, a region comprising only 40% of other imaging modalities. Additionally, nearly half of the patients screened with AI systems were Black, in contrast to roughly a quarter seen in other imaging methods.

Despite FDA approval for AI-based systems like LumineticsCore and EyeArt, the broader implementation will require improved support for workflow integration and collaboration between primary care providers and ophthalmologists. The programs such as the Stanford Teleophthalmology Autonomous Testing and Universal Screening initiative highlight the importance of streamlined processes and patient-centered scheduling. Overall, the study points to a need for targeted strategies to boost the uptake of AI imaging, enhance early DR detection, and improve patient outcomes through more accessible and integrated screening solutions.

Source:

Shah, S. A., Sokol, J. T., Wai, K. M., Rahimy, E., Myung, D., Mruthyunjaya, P., & Parikh, R. (2024). Use of Artificial Intelligence–Based Detection of Diabetic Retinopathy in the US. In JAMA Ophthalmology. American Medical Association (AMA). https://doi.org/10.1001/jamaophthalmol.2024.4493

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Sacubitril-Valsartan Improves Cardiac Function Despite Kidney Decline in HFrEF Patients, study reveals

South Korea: A recent study published in Kidney Research and Clinical Practice has shed light on the impact of sacubitril-valsartan therapy on cardiac and kidney outcomes, particularly in patients with heart failure with reduced ejection fraction (HFrEF). The findings indicate that while patients experienced notable improvements in heart function, there was also a concerning decline in kidney function, raising important questions about the treatment’s dual effects.

“Patients with HFrEF who received sacubitril-valsartan showed notable enhancements in cardiovascular outcomes, even in the presence of acute kidney injury (AKI)” the researchers wrote.

Sacubitril-valsartan, a combination medication designed to enhance cardiac function and reduce cardiovascular mortality by inhibiting neprilysin and blocking angiotensin II receptors, has emerged as a pivotal therapy for HFrEF. However, the long-term protective effects of sacubitril-valsartan on cardiac function in the presence of concurrent AKI are still uncertain. To fill this knowledge gap, Hyo Jeong Kim, Yonsei University College of Medicine, Seoul, Republic of Korea, and colleagues examined the relationship between the recovery of cardiac function and the decline in kidney function.

For this purpose, the researchers enrolled 512 patients with HFrEF who began treatment with either sacubitril-valsartan or valsartan in cohort 1. They also included patients from cohort 2 who experienced acute kidney injury (AKI) and underwent follow-up transthoracic echocardiography. In cohort 1, the analysis focused on short- and long-term kidney outcomes. For cohort 2, the researchers examined changes in cardiac function with changes in kidney function following the initiation of the medication.

The study revealed the following findings:

  • The average age of the patients was 68.3 years, and 57.4% were male.
  • Acute kidney injury occurred in 15.9% of those in the sacubitril-valsartan group and 12.5% in the valsartan group.
  • After experiencing AKI, 78.4% of patients on sacubitril-valsartan and 71.4% on valsartan recovered.
  • The researchers also looked at the heart health of patients who developed AKI after starting the medication in cohort 2. They found that the sacubitril-valsartan group had a greater improvement in heart function as compared to the valsartan group, with an increase of 12.4% versus 1.4%.
  • Heart and kidney function changes were –1.76 for the sacubitril-valsartan group and –0.20 for the valsartan group.

The study demonstrated that the decline in kidney function with sacubitril-valsartan was comparable to that seen with valsartan. Among patients who experienced acute kidney injury, those on sacubitril-valsartan showed greater improvements in cardiovascular health than those on valsartan.

“These findings offer valuable insights for managing patients with HFrEF and underscore the complexities involved in addressing both heart failure and kidney function,” the researchers concluded.

Reference:

Kim, Hyo Jeong, et al. “Cardiac and Kidney Outcomes After Sacubitril-valsartan Therapy: Recovery of Cardiac Function Relative to Kidney Function Decline.” Kidney Research and Clinical Practice, vol. 43, no. 5, 2024, pp. 614-625.

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Scoping Review Highlights Diagnostic Value of Direct Immunofluorescence in Cutaneous Vasculitis

USA: A recent scoping review has highlighted the diagnostic utility of direct immunofluorescence (DIF) test panels in assessing cutaneous vasculitis, a group of disorders characterized by inflammation of blood vessels in the skin.

The review, published in the Journal of Cutaneous Pathology emphasizes that DIF testing plays a crucial role not only in confirming a diagnosis of vasculitis but also in classifying disease subtypes and predicting potential systemic associations.

Cutaneous vasculitis can manifest in various ways, leading to skin lesions that may mimic other dermatological conditions. Accurate diagnosis is vital, as the treatment and management of vasculitis can differ significantly from other skin disorders.

Given the immune-mediated nature of non-infectious cutaneous vasculitis, skin biopsy samples are frequently sent for DIF testing when vasculitis is suspected clinically. However, the clinical significance of DIF testing has not been thoroughly evaluated in the existing literature. To fill this knowledge gap, Julia S Lehman, Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA, and colleagues systematically assessed the peer-reviewed literature on the utility of DIF in vasculitis to help inform the development of appropriate use criteria by the American Society of Dermatopathology.

For this purpose, the researchers searched two electronic databases for articles on direct immunofluorescence (DIF) and vasculitis, covering the period from January 1975 to October 2023. They included relevant case series featuring three or more patients, published in English, and available in full text. Additional articles were identified through manual reference review. Given the heterogeneity of the studies, the findings were analyzed descriptively.

The key findings were as follows:

  • Out of 255 articles identified, 61 met the inclusion criteria, collectively representing over 1,000 DIF specimens.
  • Several studies estimated the sensitivity of DIF to be around 75%.
  • Vascular immunoglobulin A (IgA) deposits identified by DIF were linked to renal disease, while other systemic associations varied.
  • Vascular IgG deposition may be more prevalent in ANCA-associated vasculitis.
  • The presence of granular vascular and epidermal basement membrane zone immunoglobulin deposition was able to differentiate between hypocomplementemic and normocomplementemic urticarial vasculitis. However, few studies have explored the added value of DIF compared to routine microscopy alone in vasculitis.

“The use of DIF testing, along with biopsy and hematoxylin and eosin staining, continues to be a cornerstone of the gold standard work-up for diagnosing vasculitis. This is particularly true for IgA vasculitis, where IgA deposits are closely linked to an increased risk of renal disease,” the researchers wrote.

“Further studies are needed to compare the sensitivity of DIF testing with that of histopathology,” they concluded.

Reference:

Lehman JS, Ferringer TC, Fung MA, Cassarino DS, Shalin SC. Diagnostic utility of direct immunofluorescence test panels for cutaneous vasculitis: A scoping review. J Cutan Pathol. 2024 Sep 22. doi: 10.1111/cup.14722. Epub ahead of print. PMID: 39307568.

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