Immunoglobulin replacement therapy in patients with immunodeficiencies: impact of infusion method on patient-reported outcomes

BACKGROUND

Understanding the impact of different immunoglobulin (Ig) infusion methods (intravenous [IVIg] and subcutaneous [SCIg]) upon treatment experience can potentially facilitate optimization of patient outcomes. Here, the perspective of patients with primary and secondary immunodeficiency diseases (PID and SID, respectively) receiving IVIg and SCIg was evaluated, in terms of treatment satisfaction, accounting for treatment history, using Association des Patients Immunodéficients du Québec (APIQ) survey data.

METHODS

The online APIQ survey (shared October 2020-March 2021) of patients with immunodeficiencies in Canada contained 101 questions on: Ig use, history, and detailed infusion characteristics; as well as structured patient-reported outcomes such as treatment satisfaction (via TSQM-9), symptom state (via PASS), general health perception (via GHP), and physical and mental function (via PROMIS). Adult respondents (≥ 18 years old) currently using Ig were compared by their current Ig infusion method (IVIg or SCIg cohort) overall, and in a sub-analysis, the IVIg cohort was compared with the SCIg cohort after stratification by respondents who started SCIg when naïve to Ig ('SCIg naïve') or with previous IVIg experience ('SCIg switch').

RESULTS

In total, 54 respondents currently used IVIg and 242 used SCIg. The average duration per infusion of a weekly SCIg infusion was significantly shorter compared with the average duration of a 3-4 weekly IVIg infusion (p < 0.001). The SCIg cohort was associated with significantly higher scores for the TSQM-9 effectiveness domain compared with the IVIg cohort. The scores for TSQM-9 convenience and global satisfaction domains were similar in the two cohorts. The SCIg cohort was also associated with a significantly higher proportion of respondents who were in an acceptable symptom state and a lower proportion who reported very poor or poor perception of health compared with the IVIg cohort. Further, the SCIg naïve subgroup was associated with significantly higher TSQM-9 effectiveness and convenience domain scores compared with the IVIg cohort, while there was no significant difference between the SCIg switch subgroup and the IVIg cohort in terms of convenience.

CONCLUSIONS

A better understanding of how different IgRT administration methods impact treatment experience and satisfaction may assist with informed treatment decision making and ultimately further improvements in patient outcomes.

Effect of different propofol infusion methods during ultrasound-guided percutaneous microwave ablation on brain functional state indexes and circulatory function in patients with liver cancer

BACKGROUND

During percutaneous microwave coagulation therapy (PMCT), patients under local anesthesia are prone to body movement because they cannot tolerate high tempera-ture stimulation, which results in microwave needle displacement, so intravenous general anesthesia is required. Propofol is a short-acting intravenous anesthetic widely used in clinical practice. It has the characteristics of fast action, large distribution volume, and high clearance rate, and is widely used for induction and maintenance of general anesthesia.

AIM

To investigate the effect of different propofol infusion methods during ultrasound-guided PMCT on the cerebral functional status indexes and circulatory function in patients with liver cancer.

METHODS

A total of 74 patients with liver cancer treated at our hospital from January 2017 to January 2021 were selected as the research subjects, and they were randomly divided into either a target-controlled infusion group (group A, n = 37) or an intermittent injection group (group B, n = 37). The circulatory function [heart rate (HR) and mean arterial pressure (MAP)] between the two groups was compared before operation (T0), at the beginning of the operation (T1), 5 min after the beginning of the operation (T2), when the temperature of the cancerous focus reached 90 °C (T3), and when awaking (T4) after the operation. Brain function state [wavelet index (WLi), anxiety index (ANXi), and comfort index (CFi)], propofol dosage, recovery time from anesthesia, postoperative pain visual analogue scale (VAS) score, cognition mini-mental state examination (MMSE) score, and incidence of adverse reactions were also compared between the two groups.

RESULTS

At T1, T2, and T3, the MAP and HR of group A were significantly higher than those of group B (P < 0.05). At T1, T2, and T3, WLi, ANXi, and CFi of group A were significantly lower than those of group B (P < 0.05). Propofol dosage did not differ significantly between the two groups (P > 0.05). The recovery time from anesthesia in group A was significantly longer than that in group B (P < 0.05); VAS scores and differences at 30 min and 3 h after operation in group A were significantly lower than those in group B (P < 0.05). Compared with the score at 1 d before operation, MMSE scores at 1 and 2 d after operation were significantly decreased. MMSE score of group A was significantly higher than that of group B on the first day after operation (P < 0.05), though the difference in MMSE score between the two groups on the second day after operation was not statistically significant (P > 0.05). There was no respiratory depression in either group, and the incidence of body movement in group A was significantly lower than that in group B (P < 0.05).

CONCLUSION

During PMCT, intermittent intravenous injection and target-controlled infusion of propofol are both safe and effective for liver cancer patients, but the latter has relatively little effect on the brain function of patients, better analgesic effect and maintenance of body circulation stability, less body movement during the operation, and higher safety.

Estimated Contributions of Rooibos Tea to the Daily Manganese and Zinc Intakes Determined in Tea Leaves and Tea Infusions by Inductively Coupled Plasma-Mass Spectrometry

Rooibos tea, scientific name Aspalathus linearis, is a popular tea grown in South Africa and consumed worldwide for its unique taste and presumed health benefits. There is a growing interest in using rooibos tea as a supplement for the deficiency of metallic nutrients in South Africa. In this study, the total concentrations of manganese (Mn) and zinc (Zn) in acid-digested tea leaves and the corresponding tea infusions were determined by inductively coupled plasma-mass spectrometry (ICP-MS) to estimate the contribution of rooibos tea consumption to the recommended daily allowance (RDA) of Mn and Zn in consumers. The accuracy of microwave-assisted acid digestion and tea infusion methods were checked by analyzing INCT-TL-1 tea leaves certified reference material (CRM) and samples spiked with standards, respectively. Both methods yielded quantitative percentage recoveries for Mn and Zn. Rooibos tea leaves and the corresponding infusions are composed of higher levels of Mn than Zn where 40.9 to 85.7 μg Mn/g and 4.15 to 12.2 μg Zn/g were found in digested tea leaves and 11.8 to 30.2 μg Mn/g and 1.51 to 4.59 μg Zn/g in tea infusions. These results indicate the contribution of about 1.0 to 3.2% Mn and 0.03 to 0.08% Zn in males approximately ≥ 9 years of age and 1.3 to 3.8% Mn and 0.04 to 0.11% Zn in females of the same age group as males of the RDA from drinking a cup of tea obtained by infusing a 2-g bag of rooibos tea.