Edin Jusufovic - Academia.edu (original) (raw)
Papers by Edin Jusufovic
Introduction: Growing body of evidence suggests that molecular markers could have important progn... more Introduction: Growing body of evidence suggests that molecular markers could have important prognostic value in non-small cell lung carcinoma (NSCLC) patients. Using targeted therapy based on these markers leads to improved outcomes in lung adenocarcinoma. However, progress of targeted therapy in squamous lung carcinoma is still modest. p16(ink4) protein acts as tumor suppressor. Aim: Purpose of this study was to evaluate the difference in p16(ink4) expression between squamous and adenocarcinoma of the lung; to evaluate the relationship of p16(ink4) expression to survival outcomes in NSCLC patients, and the difference of their prognostic values between squamous and adenocarcinoma subtypes. Material and Methods: 100 NSCLC patients (50 squamous and 50 adenocarcinoma) and 80 healthy individuals were included. p16(ink4) was immunohistochemicaly detected on formalin-fixed tissues. Oneand 2-year progression-free survival (PFS) and overall survival (OS) were observed. Results: p16(ink4) expression was significantly lower in squamous type compared to adenocarcinoma. In both squamous and adenocarcinoma, low p16(ink4) expression correlated with worse 1-and 2-year PFS, ARTICLE INFO
Lung Cancer, May 1, 2013
ABSTRACT Relationship of VEGF and p16(ink4) expression in tumour and tumour surrounding tissue to... more ABSTRACT Relationship of VEGF and p16(ink4) expression in tumour and tumour surrounding tissue to spirometry tests and survival outcomes of non-small-cell lung cancer patients Molecular mechanisms that underlie complex regulation of lung cancer development, progression and dissemination are poorly understood. However, increasing body of evidence indicates molecular markers as important prognostic markers in different human cancers including lung cancer. Purpose of this study was to evaluate differences in vascular endothelial growth factor (VEGF) and p16(ink4) expression profiles between tumor tissue and tumor surrounding tissue in non-small lung cancer (NSCLC) patients. Also, the purpose was to evaluate the relationship of VEGF and p16(ink4) expression to spirometry tests and survival outcomes. 32 squamous lung carcinoma, 18 lung adenocarcinoma and 45 healthy individuals were included. VEGF and p16(ink4) proteins were immunohistochemicaly detected. 3 formalin fixed and paraffin embedded tissues of NSCLC patients (tumor, tumor surroundings and healthy lung tissue) were compared. Spirometry tests were done: vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in first second (FEV1), Tiffeneau Index (FEV1/FVC ratio) and forced expiratory flow 25% to 75%. Expression of VEGF and p16(ink4) were significantly higher and lower respectively, in tumor tissue and surroundings compared to both healthy lung tissue of diseased patients and control. There was no difference between tumor and tumor surrounding tissue. High VEGF expression, low p16(ink4) expression and reduced spirometry tests were highly associated with both poor progression-free and overall survival. Severe impairments of spirometry tests had similar prognostic value as high VEGF expression, as well as low p16(ink4) expression. These observations strongly suggest similar pro-oncogenic and anti-oncogenic molecular alternations in NSCLC patients within tumour tissue and its surroundings that comprise specific microenvironment. Besides anti-VEGF therapy, the regulation of p16(ink4) expression could have therapeutic potential as it might suppress the tumour growth in lung cancer patients. Spirometry tests, nevertheless being widely achievable and affordable, are acceptable prognostic markers in NSCLC patients. Key words: VEGF, p16(ink4), spirometry tests, survival
Open Access Macedonian Journal of Medical Sciences, Oct 18, 2018
BACKGROUND: There is a lack of data related to real life, long-term safety, tolerability and comp... more BACKGROUND: There is a lack of data related to real life, long-term safety, tolerability and compliance of omalizumab treatment in asthma patients beyond 6 years. AIM: Study aimed to assess safety, tolerability, compliance and all reasons for treatment discontinuation during 10 years on omalizumab. SUBJECT AND METHODS: This is a retrospective, observational study of uncontrolled asthma patients receiving omalizumab for the last 10 years. All data were collected from patients' files (demographics, adverse events, comorbidities, compliance index, reasons for discontinuation of omalizumab). Reactions to omalizumab were classified as local and systemic, and their severity as mild, moderate or severe. Reactions were either immediate (minutes to hours after drug administration) or delayed (after days). Compliance to omalizumab, defined as Compliance index (CI), was calculated by comparing milligrams of given to milligrams of prescribed dose/ per year. RESULTS: Out of 35 patients receiving omalizumab, 15 drop out at different time points mostly due to treatment efficacy or appearance of new comorbidities. Patients who continue for the next ten years had mild to moderate adverse events related to omalizumab. There was no increased risk of severe adverse events during 10 years on omalizumab. Patient's treatment tolerability, despite mild to moderate adverse events, is in favour of compliance. CONCLUSION: Compliance with omalizumab mildly decreased over 10 years but was not affected by severe adverse events of treatment or new comorbidities. Although, omalizumab is safe medicine appearance of new comorbidities has to be closely followed up.
Acta medica sliniana, Aug 6, 2019
Sputum eosinophils might predict response to inhaled corticosteroids (ICS) in patients with advan... more Sputum eosinophils might predict response to inhaled corticosteroids (ICS) in patients with advanced chronic obstructive pulmonary disease (COPD). Induction of sputum requires expertise and may not always be successful. Aim was to investigate correlation and predictive relationship between peripheral blood eosinophils (bEo) and sputum eosinophils (sEo), and impact of peripheral blood eosinophilia on outcome of COPD exacerbation. 120 current smokers with COPD (GOLD group C) (57.4 ± 0.92 years, M/F ratio 1.4), with no blood (≥7% or >0.43x10 9 /L) nor sputum (≥3%) eosinophilia, were treated with moderate dose of ICS and long-acting bronchodilatator during stable disease, but systemic corticosteroids and antibiotics during exacerbation. According to sputum eosinophilia (≥4%) during exacerbation, patients were divided into eosinophilic (n=45) and noneosinophilic group (n=75). In stable disease, bEo and sEo were similar in both groups (p>0.05). During exacerbation, bEo and sEo were significantly higher in eosinophilic group (eosinophilic vs. noneosinophilic: blood: 1.42 ± 0.39 x10 9 /l vs. 0.23 ± 0.02 x10 9 /l, p<0.001; sputum: 8% (4, 19) vs. 1% (0, 3), p<0.0001), but bEo correlated with sEo in both groups (eosinophilic: r=0.52, p<0.001; non-eosinophilic: r=0.25, p<0.05). Relative bEo predicted sputum eosinophilia (area under the curve=0.71, standard error=0.05; 95% confidence interval [CI] =0.61-0.81; p<0.001) and enabled identification of the presence or absence of sputum eosinophilia in 82% of the cases at a threshold of ≥4% (specificity=83.56%, sensitivity=93.83%, positive likelihood ratio=3.67). Eosinophilic group during exacerbation showed less frequent hospitalisations and shorter exacerbation (eosinophilic vs. non-eosinophilic: hospitalisations: 26.7% vs. 60.0%, p<0.001; duration of exacerbation (days): 8.1±0.35 vs. 10.13±0.31, p<0.0001). In COPD exacerbation, relative peripheral blood eosinophils ≥4% might identify sputum eosinophilia. Blood eosinophilia indicate better outcome of COPD exacerbation. Further investigations are needed to predict eosinophilic exacerbation in COPD patients, with prior absence of sputum or blood eosinophilia.
Acta medica sliniana, Aug 6, 2019
The development of industry, agriculture, transport and urbanization has resulted in excessive em... more The development of industry, agriculture, transport and urbanization has resulted in excessive emissions of heavy metals into the environment, which due to their bioaccumulative properties express negative effects on the environment and living organisms as a whole. In this work the presence of heavy metals in the soil samples of the urban area of Lukavac and Kalesija municipality and their effect on the health of the population were studied. Soil samples were collected in October 2017 at five locations in the urban area of Lukavac municipality and two urban locations in Kalesija municipality. Concentrations of chromium (Cr) copper (Cu), cobalt (Co), nickel (Ni), cadmium (Cd), lead (Pb), manganese (Mn), iron (Fe) and zinc (Zn) in the soil samples were determined. The results indicated that in some locations the concentration of heavy metals exceeded the maximum permissible concentration (MPC). MPC value for chromium was exceeded at four locations in the urban area of Lukavac, whereas MPC value for nickel and cadmium was exceeded at all locations. In Kalesija, MPC value was exceeded for chromium and nickel at one location, while cadmium MPC was exceeded at both locations. The negative impact of heavy metals on the health of the population is the cause of many malignant diseases. Statistical analysis of the number of patients with malignant diseases in the area of the Lukavac and Kalesija revealed significantly higher prevalence of malignant diseases of the breast and skin in the Lukavac (p<0,05) in comparisson to Kalesija municipality.
International Archives of Allergy and Immunology, 2019
Introduction: Although the skin prick test (SPT) is a reliable diagnostic tool in perennial aller... more Introduction: Although the skin prick test (SPT) is a reliable diagnostic tool in perennial allergic rhinitis (PER) for patients allergic to cats, the minimum necessary SPT wheal size required to distinguish cat sensitization from true allergy remains controversial. The cat nasal challenge test (cNCT) could be considered the gold standard for detecting true cat allergy. Aims: To assess the difference in the frequency of cNCT positivity between cat owners and non-owners and to determine an appropriate cut-off level for SPT wheal size in detecting positive cNCT in PER patients who are candidates for allergen immunotherapy (AIT) with cat allergen extracts. Subjects and Methods: cNCT in the form of a nasal spray was administered to 60 adult patients with PER, i.e., cat owners (n = 19) and cat non-owners (n = 41) with positive SPT to cat fur allergen (Diater, Spain). Subjective (total nasal symptom score [TNSS]) and objective measurements (peak nasal inspiratory flow [PNIF]) for assessment of nasal patency and nasal eosinophil count [NEo]) were used to assess the nasal response. Peak expiratory flow (PEF) was used as a safety parameter during cNCT. Results: No differences were obtained in SPT wheal size and cNCT positivity between cat owners and non-owners. Positive cNCT detecting true cat allergy could be predicted by a cat SPT wheal size > 6.5 mm with 71.11% sensitivity and 100% specificity. Conclusions: In adult patients with PER, the frequency of cat allergy was similar among cat owners and non-owners. A cat SPT wheal size ≥6.5 mm could be helpful in detecting true cat allergy by avoiding the demanding, time-consuming, and often unavailable cNCT when cat AIT is needed.
DOAJ (DOAJ: Directory of Open Access Journals), Aug 1, 2015
Aim To determine an influence of alpha-lipoic acid to reduction of body weight and regulation of ... more Aim To determine an influence of alpha-lipoic acid to reduction of body weight and regulation of total cholesterol concentration, triglycerides and glucose serum levels in obese patients with diabetes mellitus type 2. Methods A prospective study includes two groups of obese patients with diabetes mellitus and signs of peripheral polyneuropathia: examined group (30 patients; 15 females and 15 males), and control group (30 patients; 12 females and 18 males). All were treated with metformin (850-1700 mg/day). Examined patients were additionally treated with alpha-lipoic acid 600 mg/day during 20 weeks. Body mass index and concentrations of total cholesterol, triglycerides and glucose in serum were compared before and after the treatment. Results The group treated with 600 mg alpha-lipoic acid lost significantly more weight, and had lower triglyceride level than the control group. There were no significant differences in total cholesterol and glucose serum levels between the groups. Conclusion Alpha-lipoic acid of 600 mg/day treatment have influenced weight and triglycerides loss in obese patients with diabetes mellitus type 2. It should be considered as an important additive therapy in obese patients with diabetes mellitus type 2.
New prognostic factor of lung cancer are being intensively studied currently. A small number of s... more New prognostic factor of lung cancer are being intensively studied currently. A small number of studies compare the importance of molecular makers with so far known functional and clinical prognostic factors. Purpose of this study was to find out whetherp16(ink4) expression is more superior prognostic factor in survival rates in non-small lung cancer (NSCLC) patients than spirometry tests. 100 NSCLC patients (50 squamous and 50 adenocarcinoma) with IIIB and IVA stage and 80 healthy individuals were included. p16(ink4) was immunohistochemicaly detected on formalin-fixed tissues. We measured s pirometry tests : vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in first second (FEV1), Tiffeneau index (FEV1/FVC ratio) and forced expiratory flow 25% to 75%. 2-year progression-free survival (PFS) and overall survival (OS) were observed. Low p16(ink4) expression and impared spirometry parameters correlated with worse 2-year survival outcomes, in both adenocarcinoma and squamous carcinoma. In squamous carcinoma p16(ink4) expression was an independent negative prognostic marker. Severe impairments of spirometry tests had similar prognostic value as low p16(ink4) expression in both NSCLC subtypes. In contrast to p16 (ink4) as a negative molecular prognostic factor, spirometry testings are widely achievable and affordable and could be serviceable prognostic marker in NSCLC patients in advanced NSCLC. Further studies including all clinical stages of NSCLC are needed.
The clinical value of eosinophils (Eo) in asthma has been shown, but asthma and obesity associati... more The clinical value of eosinophils (Eo) in asthma has been shown, but asthma and obesity association remains unclear. Aim was to analyse the impact of normalising of body mass index (BMI) in obese asthma patients on sputum and blood Eo count and asthma control. 140 obese patients (age:49.94±1.68 years; M/F ratio:0.82, BMI:30.3±0.3) with partially controlled asthma and eosinophilia in sputum and blood were included. Patients were divided in IgE high (≥100 IU/ml) and IgE low ( Before diet, BMI, sputum and blood Eo, predicted forced expiratory volume in first second (FEV1%), Asthma Control Test (ACT) and Asthma Quality of Life Questionnaire(AQLQ) were similar between IgE high and IgE low patients. Sputum Eo count decreased only in IgE low patients (before vs . after diet: 6.8±1.7 vs . 1.2±0.3; p vs . high: FEV1%: 81.9±0.5 vs . 78.9±0.5; p 19: 42% vs . 11%; p vs . 2.3±0.4; p Decreasing of BMI in obese patients with partially controlled asthma improves response to IGK resulting in improved lung function, asthma control and quality of life, particularly in IgE low patients.
DOAJ (DOAJ: Directory of Open Access Journals), Feb 1, 2019
Aim To assess efficacy of omalizumab in moderate to severe asthma and notable factors affecting i... more Aim To assess efficacy of omalizumab in moderate to severe asthma and notable factors affecting it, such as treatment compliance during the period of ten years. This retrospective, observational real life study is the first of this kind in the Gulf region and one of the worldwide rare long term omalizumab treatment studies. Methods The treatment for 35 patients started in 2008. Twenty patients (ongoing group) proceeded with treatment and were assessed annually until 2017. Reasons for treatment discontinuation in 15 patients (drop-out group) were also assessed. Results Before starting omalizumab the ongoing group of patients had history of ≥2 asthma exacerbations per year, which significantly decreased during the first year of the treatment (p<0.001), and for 14 (70%) patients ≤1 exacerbation stayed during the next 10 years. Since 2014 six (30%) patients had had ≥2 annual asthma exacerbations (p<0.05 in 2013; p<0.05 in 2014; p<0.001 in 2015; p<0.01 in 2016; p<0.001 in 2017). At the same time there was a significant drop in compliance index (CI) (p<0.0001). Conclusion To our knowledge this is the first 10-year study of compliance and effectiveness, which may help finalize some practical suggestions to improve CI in clinical practice and to note acceptable variation in CI. It is important to recognize factors that can possibly affect effectiveness of the treatment and identify the patients who will have the best benefit from a long term omalizumab treatment.
European annals of allergy and clinical immunology, Feb 1, 2018
Introduction. Sensitization to cat allergens is common worldwide. Currently, there is a trend tow... more Introduction. Sensitization to cat allergens is common worldwide. Currently, there is a trend towards costly and often unavailable diagnostic analysis. Objectives. The aim is to assess the reliability of skin prick test (SPT) and serum specific IgE (ssIgE) to cat sensitization, by performing nasal challenge test (NCT) in a community with low cat ownership but common presence of stray cats. Patients and methods. Forty-one patients with perennial allergic rhinitis (AR) who were mono or polysensitized (including cat) were included. We had 31 cat non-owners and 10 present cat owners. SPT (> 5 mm / diameter), ssIgE (≥ 0.70 IU/ml), nasal smear for eosinophil (Eo) and NCT were compared between groups. Outcomes included nasal challenge score, nasal Eo positivity, peak inspiratory and expiratory flow (PIF and PEF) 2 and 8 hours after the NCT, and were compared to baseline. Results. Baseline SPT wheal size and ssIgE level were similar in both groups. NCT positivity was more frequent in cat owners. The strongest nasal reaction was on the top concentration in both groups. Nasal Eo positivity in cat owners was higher before and 2 hours after NCT, but similar to non-owners at last measurement. NCT positive cat non-owners had bigger SPT wheal size than NCT negative non-owners, but smaller than NCT positive cat owners. In contrast to PEF, a significant fall in PIF was noticed in both groups. Mono and polysensitised patients showed similar NCT positivity. Conclusion. Stray cats may pose a relevant risk of developing perennial AR. Regardless of cat ownership status, SPT and ssIgE should be the first diagnostic tool. Nasal Eo and NCT seem to be good diagnostic tools in cat non-owners if diagnosis is elusive.
Frontiers in Pharmacology, 2021
Background: Drug hypersensitivity reactions (DHRs) are among the most frequent reasons for consul... more Background: Drug hypersensitivity reactions (DHRs) are among the most frequent reasons for consultation in allergy departments and are becoming more common due to increasing prevalence and case complexity.Objective: To describe the most common drugs associated with clinical reactions, diagnostic methods used, and outcomes of allergic evaluations of a national drug allergy registry over a 12-year period were used.Methods: An observational, prospective, patient’s data registry-based study was conducted to analyze all referrals to the drug allergy outpatient clinics at Al-Rashed Allergy Center, Kuwait, between 2007 and 2019. Demographics, description of DHRs, and results of allergy tests to potential causative medications were reviewed. Diagnostic methods were focused mainly on skin tests (STs) and drug provocation test (DPT), when indicated.Results: We evaluated 1,553 patients with reported DHRs. The mean age of the population was 41.52 ± 16.93 years, and the study population consiste...
Journal of lung, pulmonary & respiratory research, Dec 14, 2022
Molds are often found in patients with pre-existing asthma, when they can be the cause of worseni... more Molds are often found in patients with pre-existing asthma, when they can be the cause of worsening asthma and even death. However, they can also represent a risk factor for the development of asthma in a previously healthy person. The most allergenic molds causing respiratory diseases are: Aspergillus, Alternaria, Penicillium and Cladosporium with an emphasis on Aspergillus in patients with asthma. In order to be inhaled their spores must be ≤5 µm in size. Germination of inhaled mold spores in the lungs is related to Th2 and Th17 pathways, as well as activation of the innate immune system, but also could promote sensitization to allergens of other mushrooms, as well as allergy to pollens and dust mites. Sensitization rates in asthma patients range from 5-50% of patients. Molds can act as internal or external sources of respiratory allergens depending on the climatic conditions. The diagnosis of fungal allergy is complicated by the fact that patients with mold allergy are often polysensitized to pollen as well. Therefore, a good allergic anamnesis and clinical picture play a key role. Regarding diagnostic procedures, the most important are serum fungal-specific IgE or precipitins, total IgE, IgG against suspected fungus, peripheral blood eosinophils and fungal-specific skin prick tests. The role of antifungal therapy in severe asthma remains unclear. Further research is needed to better define the potential utility of antifungal drugs in patients with asthma and mold sensitization or allergy to identify drugs and populations of patients who would benefit from such treatment. There is also insufficient evidence for the safety and efficacy of allergen immunotherapy in moldsensitive patients. About 70% of patients with severe eosinophilic asthma with sensitization or allergy to Aspergillus and Penicillium could benefit with Mepolizumab therapy. On the other side, measures to avoid mold still remain key factor in therapy.
Acta Medica Saliniana, 2019
Sputum eosinophils might predict response to inhaled corticosteroids (ICS) in patients with advan... more Sputum eosinophils might predict response to inhaled corticosteroids (ICS) in patients with advanced chronic obstructive pulmonary disease (COPD). Induction of sputum requires expertise and may not always be successful. Aim was to investigate correlation and predictive relationship between peripheral blood eosinophils (bEo) and sputum eosinophils (sEo), and impact of peripheral blood eosinophilia on outcome of COPD exacerbation. 120 current smokers with COPD (GOLD group C) (57.4 ± 0.92 years, M/F ratio 1.4), with no blood (≥7% or >0.43x109/L) nor sputum (≥3%) eosinophilia, were treated with moderate dose of ICS and long-acting bronchodilatator during stable disease, but systemic corticosteroids and antibiotics during exacerbation. According to sputum eosinophilia (≥4%) during exacerbation, patients were divided into eosinophilic (n=45) and non-eosinophilic group (n=75). In stable disease, bEo and sEo were similar in both groups (p>0.05). During exacerbation, bEo and sEo were s...
The Medicus, Oct 18, 2021
The prevalence of asthma in adults varies widely around the world, ranging from 0.2% to 21.0%. Po... more The prevalence of asthma in adults varies widely around the world, ranging from 0.2% to 21.0%. Population-based studies suggest that from 20% to 70% of people with asthma in the community remain undiagnosed. On the opposite side of the spectrum, 30-35% of adults and children diagnosed with asthma do not have current asthma. Overdiagnosis of current asthma can occur due to various reasons: 1. Physicians' failure to confirm airflow limitation; 2. New signs and symptoms in patients with long-term clinical remission of previous asthma; 3. Alternative diagnoses that mimic signs and symptoms of asthma. The most common differential diagnosis of asthma in adults is vocal cord dysfunction, airflow obstruction (e.g. tumors and foreign bodies), congestive heart failure, chronic obstructive pulmonary disease (COPD), chronic sinusitis and infection of upper airways. The consequences of the overdiagnosis of asthma are: 1. Not diagnosing and treating the actual disease; 2.
Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina, 2021
Aim To analyse the resolution of chest X-ray findings in relation to laboratory parameters in pat... more Aim To analyse the resolution of chest X-ray findings in relation to laboratory parameters in patients infected with acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a two- month followup. Analysis of chest X-ray findings in the first few months after the disease is the main goal of our work. Methods Out of the total of 343 patients chest X-ray findings were followed in 269 patients. Patients were divided into groups according to the severity of findings. D-dimer, inflammatory markers, blood cell count, neutrophil lymphocyte ratio (NLR) were analysed. Chest X-ray was analysed during the hospitalization on the day of admission, on the third, the seventh and the fourteenth day (scoring method was used). After discharge chest X-ray was performed in a two-week follow-up, then after one and two months, and after three months if necessary. Results Incomplete chest X-ray resolution was identified in 24 (39.34%) patients with severe, 27 (22.31 %) patients with moderate and in three ...
Background and aim: Skin prick test (SPT) with a wheal diameter of >3 mm, generally accepted a... more Background and aim: Skin prick test (SPT) with a wheal diameter of >3 mm, generally accepted as a positive, is most commonly use diagnostic tool for Allergic rhinitis. Aim was to validate wheal size of Skin Prick Test for the Bermuda grass, in desert environment, with positive Bermuda grass Nasal challenge in same environment. Methods: In 53 adults, mean age 33.43 ± 9.36 years, both gender (females: 33.96%), SPT positive on Bermuda grass with cut off wheal longest diameter of 3 mm, Bermuda grass nasal challenge test (bgNCT) was carried out. Response was assessed subjectively (scored) and objectively (PNIF). Safety profile was assessed by PEF measurement. Results: Mean weal size of SPT (mm) was bigger in bgNCT positive patients (n=47; 88.68%) 8 [4, 15] vs 5 [3, 6] (p<0.0001). ROC analysis showed Bermuda Grass SPT at the threshold of >6.5mm enabled identification of Bermuda challenge with sensitivity of 82.98% and specificity of 100.0% (area under the curve 0.9326, standard e...
European Annals of Allergy and Clinical Immunology, 2021
Background: Sensitization to Salsola kali (Sk) weed pollen allergen is the most common cause of s... more Background: Sensitization to Salsola kali (Sk) weed pollen allergen is the most common cause of seasonal allergic rhinitis (SAR) in Middle East countries. Aim: To identify Salsola kali skin prick test (SkSPT) wheal size cutoff , able to determine true allergy among adult patients with moderate to severe SAR, who are in need of Salsola kali allergen specific immunotherapy (SkAIT). Methods: In 151 adults with moderate to severe SAR, mean age 32.79 ± 10.79 years, of both gender (females: 43.05%), with a positive SkSPT, (i.e. cut off wheal longest diameter of 3 mm) and one or more other local weed pollens, Salsola kali nasal provocation test (SkNPT) was carried out. Response was assessed both subjectively, with scores, and objectively, by measuring peak nasal inspiratory flow (PNIF). Safety profile of SkNPT was assessed using peak expiratory flow rate (PEF) measurements. Results: SkNPT positive response was found in 125 patients (82.78%). Mean skin prick test (SPT) wheal size to Sk was bigger in the nasal provocatin test (NPT) positive group (9 mm) compared to the NPT negative patients (5 mm), p<0.0001. ROC analysis showed that a SPT wheal size to Sk at the threshold of >7.5 mm enabled identification of SkNPT positivity with a sensitivity of 73.6% and specificity of 100.0% (area under the curve 0.9498, standard error 0.01808; 95% confidence interval (CI): 0.9144 to 0.9853; p<0.0001). Conclusion: SPT wheal size of 3 mm might overestimate the presence of real allergy to Sk in a desert environment. A SPT wheal size >7.5 mm for Sk appears to distinguish individuals who develop disease from those who does not. Physicians should select the proper SPT wheal size value as an appropriate criterion according to the allergen than using a uniform cut off value in patients eligible for SkAIT.
Introduction: Growing body of evidence suggests that molecular markers could have important progn... more Introduction: Growing body of evidence suggests that molecular markers could have important prognostic value in non-small cell lung carcinoma (NSCLC) patients. Using targeted therapy based on these markers leads to improved outcomes in lung adenocarcinoma. However, progress of targeted therapy in squamous lung carcinoma is still modest. p16(ink4) protein acts as tumor suppressor. Aim: Purpose of this study was to evaluate the difference in p16(ink4) expression between squamous and adenocarcinoma of the lung; to evaluate the relationship of p16(ink4) expression to survival outcomes in NSCLC patients, and the difference of their prognostic values between squamous and adenocarcinoma subtypes. Material and Methods: 100 NSCLC patients (50 squamous and 50 adenocarcinoma) and 80 healthy individuals were included. p16(ink4) was immunohistochemicaly detected on formalin-fixed tissues. Oneand 2-year progression-free survival (PFS) and overall survival (OS) were observed. Results: p16(ink4) expression was significantly lower in squamous type compared to adenocarcinoma. In both squamous and adenocarcinoma, low p16(ink4) expression correlated with worse 1-and 2-year PFS, ARTICLE INFO
Lung Cancer, May 1, 2013
ABSTRACT Relationship of VEGF and p16(ink4) expression in tumour and tumour surrounding tissue to... more ABSTRACT Relationship of VEGF and p16(ink4) expression in tumour and tumour surrounding tissue to spirometry tests and survival outcomes of non-small-cell lung cancer patients Molecular mechanisms that underlie complex regulation of lung cancer development, progression and dissemination are poorly understood. However, increasing body of evidence indicates molecular markers as important prognostic markers in different human cancers including lung cancer. Purpose of this study was to evaluate differences in vascular endothelial growth factor (VEGF) and p16(ink4) expression profiles between tumor tissue and tumor surrounding tissue in non-small lung cancer (NSCLC) patients. Also, the purpose was to evaluate the relationship of VEGF and p16(ink4) expression to spirometry tests and survival outcomes. 32 squamous lung carcinoma, 18 lung adenocarcinoma and 45 healthy individuals were included. VEGF and p16(ink4) proteins were immunohistochemicaly detected. 3 formalin fixed and paraffin embedded tissues of NSCLC patients (tumor, tumor surroundings and healthy lung tissue) were compared. Spirometry tests were done: vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in first second (FEV1), Tiffeneau Index (FEV1/FVC ratio) and forced expiratory flow 25% to 75%. Expression of VEGF and p16(ink4) were significantly higher and lower respectively, in tumor tissue and surroundings compared to both healthy lung tissue of diseased patients and control. There was no difference between tumor and tumor surrounding tissue. High VEGF expression, low p16(ink4) expression and reduced spirometry tests were highly associated with both poor progression-free and overall survival. Severe impairments of spirometry tests had similar prognostic value as high VEGF expression, as well as low p16(ink4) expression. These observations strongly suggest similar pro-oncogenic and anti-oncogenic molecular alternations in NSCLC patients within tumour tissue and its surroundings that comprise specific microenvironment. Besides anti-VEGF therapy, the regulation of p16(ink4) expression could have therapeutic potential as it might suppress the tumour growth in lung cancer patients. Spirometry tests, nevertheless being widely achievable and affordable, are acceptable prognostic markers in NSCLC patients. Key words: VEGF, p16(ink4), spirometry tests, survival
Open Access Macedonian Journal of Medical Sciences, Oct 18, 2018
BACKGROUND: There is a lack of data related to real life, long-term safety, tolerability and comp... more BACKGROUND: There is a lack of data related to real life, long-term safety, tolerability and compliance of omalizumab treatment in asthma patients beyond 6 years. AIM: Study aimed to assess safety, tolerability, compliance and all reasons for treatment discontinuation during 10 years on omalizumab. SUBJECT AND METHODS: This is a retrospective, observational study of uncontrolled asthma patients receiving omalizumab for the last 10 years. All data were collected from patients' files (demographics, adverse events, comorbidities, compliance index, reasons for discontinuation of omalizumab). Reactions to omalizumab were classified as local and systemic, and their severity as mild, moderate or severe. Reactions were either immediate (minutes to hours after drug administration) or delayed (after days). Compliance to omalizumab, defined as Compliance index (CI), was calculated by comparing milligrams of given to milligrams of prescribed dose/ per year. RESULTS: Out of 35 patients receiving omalizumab, 15 drop out at different time points mostly due to treatment efficacy or appearance of new comorbidities. Patients who continue for the next ten years had mild to moderate adverse events related to omalizumab. There was no increased risk of severe adverse events during 10 years on omalizumab. Patient's treatment tolerability, despite mild to moderate adverse events, is in favour of compliance. CONCLUSION: Compliance with omalizumab mildly decreased over 10 years but was not affected by severe adverse events of treatment or new comorbidities. Although, omalizumab is safe medicine appearance of new comorbidities has to be closely followed up.
Acta medica sliniana, Aug 6, 2019
Sputum eosinophils might predict response to inhaled corticosteroids (ICS) in patients with advan... more Sputum eosinophils might predict response to inhaled corticosteroids (ICS) in patients with advanced chronic obstructive pulmonary disease (COPD). Induction of sputum requires expertise and may not always be successful. Aim was to investigate correlation and predictive relationship between peripheral blood eosinophils (bEo) and sputum eosinophils (sEo), and impact of peripheral blood eosinophilia on outcome of COPD exacerbation. 120 current smokers with COPD (GOLD group C) (57.4 ± 0.92 years, M/F ratio 1.4), with no blood (≥7% or >0.43x10 9 /L) nor sputum (≥3%) eosinophilia, were treated with moderate dose of ICS and long-acting bronchodilatator during stable disease, but systemic corticosteroids and antibiotics during exacerbation. According to sputum eosinophilia (≥4%) during exacerbation, patients were divided into eosinophilic (n=45) and noneosinophilic group (n=75). In stable disease, bEo and sEo were similar in both groups (p>0.05). During exacerbation, bEo and sEo were significantly higher in eosinophilic group (eosinophilic vs. noneosinophilic: blood: 1.42 ± 0.39 x10 9 /l vs. 0.23 ± 0.02 x10 9 /l, p<0.001; sputum: 8% (4, 19) vs. 1% (0, 3), p<0.0001), but bEo correlated with sEo in both groups (eosinophilic: r=0.52, p<0.001; non-eosinophilic: r=0.25, p<0.05). Relative bEo predicted sputum eosinophilia (area under the curve=0.71, standard error=0.05; 95% confidence interval [CI] =0.61-0.81; p<0.001) and enabled identification of the presence or absence of sputum eosinophilia in 82% of the cases at a threshold of ≥4% (specificity=83.56%, sensitivity=93.83%, positive likelihood ratio=3.67). Eosinophilic group during exacerbation showed less frequent hospitalisations and shorter exacerbation (eosinophilic vs. non-eosinophilic: hospitalisations: 26.7% vs. 60.0%, p<0.001; duration of exacerbation (days): 8.1±0.35 vs. 10.13±0.31, p<0.0001). In COPD exacerbation, relative peripheral blood eosinophils ≥4% might identify sputum eosinophilia. Blood eosinophilia indicate better outcome of COPD exacerbation. Further investigations are needed to predict eosinophilic exacerbation in COPD patients, with prior absence of sputum or blood eosinophilia.
Acta medica sliniana, Aug 6, 2019
The development of industry, agriculture, transport and urbanization has resulted in excessive em... more The development of industry, agriculture, transport and urbanization has resulted in excessive emissions of heavy metals into the environment, which due to their bioaccumulative properties express negative effects on the environment and living organisms as a whole. In this work the presence of heavy metals in the soil samples of the urban area of Lukavac and Kalesija municipality and their effect on the health of the population were studied. Soil samples were collected in October 2017 at five locations in the urban area of Lukavac municipality and two urban locations in Kalesija municipality. Concentrations of chromium (Cr) copper (Cu), cobalt (Co), nickel (Ni), cadmium (Cd), lead (Pb), manganese (Mn), iron (Fe) and zinc (Zn) in the soil samples were determined. The results indicated that in some locations the concentration of heavy metals exceeded the maximum permissible concentration (MPC). MPC value for chromium was exceeded at four locations in the urban area of Lukavac, whereas MPC value for nickel and cadmium was exceeded at all locations. In Kalesija, MPC value was exceeded for chromium and nickel at one location, while cadmium MPC was exceeded at both locations. The negative impact of heavy metals on the health of the population is the cause of many malignant diseases. Statistical analysis of the number of patients with malignant diseases in the area of the Lukavac and Kalesija revealed significantly higher prevalence of malignant diseases of the breast and skin in the Lukavac (p<0,05) in comparisson to Kalesija municipality.
International Archives of Allergy and Immunology, 2019
Introduction: Although the skin prick test (SPT) is a reliable diagnostic tool in perennial aller... more Introduction: Although the skin prick test (SPT) is a reliable diagnostic tool in perennial allergic rhinitis (PER) for patients allergic to cats, the minimum necessary SPT wheal size required to distinguish cat sensitization from true allergy remains controversial. The cat nasal challenge test (cNCT) could be considered the gold standard for detecting true cat allergy. Aims: To assess the difference in the frequency of cNCT positivity between cat owners and non-owners and to determine an appropriate cut-off level for SPT wheal size in detecting positive cNCT in PER patients who are candidates for allergen immunotherapy (AIT) with cat allergen extracts. Subjects and Methods: cNCT in the form of a nasal spray was administered to 60 adult patients with PER, i.e., cat owners (n = 19) and cat non-owners (n = 41) with positive SPT to cat fur allergen (Diater, Spain). Subjective (total nasal symptom score [TNSS]) and objective measurements (peak nasal inspiratory flow [PNIF]) for assessment of nasal patency and nasal eosinophil count [NEo]) were used to assess the nasal response. Peak expiratory flow (PEF) was used as a safety parameter during cNCT. Results: No differences were obtained in SPT wheal size and cNCT positivity between cat owners and non-owners. Positive cNCT detecting true cat allergy could be predicted by a cat SPT wheal size > 6.5 mm with 71.11% sensitivity and 100% specificity. Conclusions: In adult patients with PER, the frequency of cat allergy was similar among cat owners and non-owners. A cat SPT wheal size ≥6.5 mm could be helpful in detecting true cat allergy by avoiding the demanding, time-consuming, and often unavailable cNCT when cat AIT is needed.
DOAJ (DOAJ: Directory of Open Access Journals), Aug 1, 2015
Aim To determine an influence of alpha-lipoic acid to reduction of body weight and regulation of ... more Aim To determine an influence of alpha-lipoic acid to reduction of body weight and regulation of total cholesterol concentration, triglycerides and glucose serum levels in obese patients with diabetes mellitus type 2. Methods A prospective study includes two groups of obese patients with diabetes mellitus and signs of peripheral polyneuropathia: examined group (30 patients; 15 females and 15 males), and control group (30 patients; 12 females and 18 males). All were treated with metformin (850-1700 mg/day). Examined patients were additionally treated with alpha-lipoic acid 600 mg/day during 20 weeks. Body mass index and concentrations of total cholesterol, triglycerides and glucose in serum were compared before and after the treatment. Results The group treated with 600 mg alpha-lipoic acid lost significantly more weight, and had lower triglyceride level than the control group. There were no significant differences in total cholesterol and glucose serum levels between the groups. Conclusion Alpha-lipoic acid of 600 mg/day treatment have influenced weight and triglycerides loss in obese patients with diabetes mellitus type 2. It should be considered as an important additive therapy in obese patients with diabetes mellitus type 2.
New prognostic factor of lung cancer are being intensively studied currently. A small number of s... more New prognostic factor of lung cancer are being intensively studied currently. A small number of studies compare the importance of molecular makers with so far known functional and clinical prognostic factors. Purpose of this study was to find out whetherp16(ink4) expression is more superior prognostic factor in survival rates in non-small lung cancer (NSCLC) patients than spirometry tests. 100 NSCLC patients (50 squamous and 50 adenocarcinoma) with IIIB and IVA stage and 80 healthy individuals were included. p16(ink4) was immunohistochemicaly detected on formalin-fixed tissues. We measured s pirometry tests : vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in first second (FEV1), Tiffeneau index (FEV1/FVC ratio) and forced expiratory flow 25% to 75%. 2-year progression-free survival (PFS) and overall survival (OS) were observed. Low p16(ink4) expression and impared spirometry parameters correlated with worse 2-year survival outcomes, in both adenocarcinoma and squamous carcinoma. In squamous carcinoma p16(ink4) expression was an independent negative prognostic marker. Severe impairments of spirometry tests had similar prognostic value as low p16(ink4) expression in both NSCLC subtypes. In contrast to p16 (ink4) as a negative molecular prognostic factor, spirometry testings are widely achievable and affordable and could be serviceable prognostic marker in NSCLC patients in advanced NSCLC. Further studies including all clinical stages of NSCLC are needed.
The clinical value of eosinophils (Eo) in asthma has been shown, but asthma and obesity associati... more The clinical value of eosinophils (Eo) in asthma has been shown, but asthma and obesity association remains unclear. Aim was to analyse the impact of normalising of body mass index (BMI) in obese asthma patients on sputum and blood Eo count and asthma control. 140 obese patients (age:49.94±1.68 years; M/F ratio:0.82, BMI:30.3±0.3) with partially controlled asthma and eosinophilia in sputum and blood were included. Patients were divided in IgE high (≥100 IU/ml) and IgE low ( Before diet, BMI, sputum and blood Eo, predicted forced expiratory volume in first second (FEV1%), Asthma Control Test (ACT) and Asthma Quality of Life Questionnaire(AQLQ) were similar between IgE high and IgE low patients. Sputum Eo count decreased only in IgE low patients (before vs . after diet: 6.8±1.7 vs . 1.2±0.3; p vs . high: FEV1%: 81.9±0.5 vs . 78.9±0.5; p 19: 42% vs . 11%; p vs . 2.3±0.4; p Decreasing of BMI in obese patients with partially controlled asthma improves response to IGK resulting in improved lung function, asthma control and quality of life, particularly in IgE low patients.
DOAJ (DOAJ: Directory of Open Access Journals), Feb 1, 2019
Aim To assess efficacy of omalizumab in moderate to severe asthma and notable factors affecting i... more Aim To assess efficacy of omalizumab in moderate to severe asthma and notable factors affecting it, such as treatment compliance during the period of ten years. This retrospective, observational real life study is the first of this kind in the Gulf region and one of the worldwide rare long term omalizumab treatment studies. Methods The treatment for 35 patients started in 2008. Twenty patients (ongoing group) proceeded with treatment and were assessed annually until 2017. Reasons for treatment discontinuation in 15 patients (drop-out group) were also assessed. Results Before starting omalizumab the ongoing group of patients had history of ≥2 asthma exacerbations per year, which significantly decreased during the first year of the treatment (p<0.001), and for 14 (70%) patients ≤1 exacerbation stayed during the next 10 years. Since 2014 six (30%) patients had had ≥2 annual asthma exacerbations (p<0.05 in 2013; p<0.05 in 2014; p<0.001 in 2015; p<0.01 in 2016; p<0.001 in 2017). At the same time there was a significant drop in compliance index (CI) (p<0.0001). Conclusion To our knowledge this is the first 10-year study of compliance and effectiveness, which may help finalize some practical suggestions to improve CI in clinical practice and to note acceptable variation in CI. It is important to recognize factors that can possibly affect effectiveness of the treatment and identify the patients who will have the best benefit from a long term omalizumab treatment.
European annals of allergy and clinical immunology, Feb 1, 2018
Introduction. Sensitization to cat allergens is common worldwide. Currently, there is a trend tow... more Introduction. Sensitization to cat allergens is common worldwide. Currently, there is a trend towards costly and often unavailable diagnostic analysis. Objectives. The aim is to assess the reliability of skin prick test (SPT) and serum specific IgE (ssIgE) to cat sensitization, by performing nasal challenge test (NCT) in a community with low cat ownership but common presence of stray cats. Patients and methods. Forty-one patients with perennial allergic rhinitis (AR) who were mono or polysensitized (including cat) were included. We had 31 cat non-owners and 10 present cat owners. SPT (> 5 mm / diameter), ssIgE (≥ 0.70 IU/ml), nasal smear for eosinophil (Eo) and NCT were compared between groups. Outcomes included nasal challenge score, nasal Eo positivity, peak inspiratory and expiratory flow (PIF and PEF) 2 and 8 hours after the NCT, and were compared to baseline. Results. Baseline SPT wheal size and ssIgE level were similar in both groups. NCT positivity was more frequent in cat owners. The strongest nasal reaction was on the top concentration in both groups. Nasal Eo positivity in cat owners was higher before and 2 hours after NCT, but similar to non-owners at last measurement. NCT positive cat non-owners had bigger SPT wheal size than NCT negative non-owners, but smaller than NCT positive cat owners. In contrast to PEF, a significant fall in PIF was noticed in both groups. Mono and polysensitised patients showed similar NCT positivity. Conclusion. Stray cats may pose a relevant risk of developing perennial AR. Regardless of cat ownership status, SPT and ssIgE should be the first diagnostic tool. Nasal Eo and NCT seem to be good diagnostic tools in cat non-owners if diagnosis is elusive.
Frontiers in Pharmacology, 2021
Background: Drug hypersensitivity reactions (DHRs) are among the most frequent reasons for consul... more Background: Drug hypersensitivity reactions (DHRs) are among the most frequent reasons for consultation in allergy departments and are becoming more common due to increasing prevalence and case complexity.Objective: To describe the most common drugs associated with clinical reactions, diagnostic methods used, and outcomes of allergic evaluations of a national drug allergy registry over a 12-year period were used.Methods: An observational, prospective, patient’s data registry-based study was conducted to analyze all referrals to the drug allergy outpatient clinics at Al-Rashed Allergy Center, Kuwait, between 2007 and 2019. Demographics, description of DHRs, and results of allergy tests to potential causative medications were reviewed. Diagnostic methods were focused mainly on skin tests (STs) and drug provocation test (DPT), when indicated.Results: We evaluated 1,553 patients with reported DHRs. The mean age of the population was 41.52 ± 16.93 years, and the study population consiste...
Journal of lung, pulmonary & respiratory research, Dec 14, 2022
Molds are often found in patients with pre-existing asthma, when they can be the cause of worseni... more Molds are often found in patients with pre-existing asthma, when they can be the cause of worsening asthma and even death. However, they can also represent a risk factor for the development of asthma in a previously healthy person. The most allergenic molds causing respiratory diseases are: Aspergillus, Alternaria, Penicillium and Cladosporium with an emphasis on Aspergillus in patients with asthma. In order to be inhaled their spores must be ≤5 µm in size. Germination of inhaled mold spores in the lungs is related to Th2 and Th17 pathways, as well as activation of the innate immune system, but also could promote sensitization to allergens of other mushrooms, as well as allergy to pollens and dust mites. Sensitization rates in asthma patients range from 5-50% of patients. Molds can act as internal or external sources of respiratory allergens depending on the climatic conditions. The diagnosis of fungal allergy is complicated by the fact that patients with mold allergy are often polysensitized to pollen as well. Therefore, a good allergic anamnesis and clinical picture play a key role. Regarding diagnostic procedures, the most important are serum fungal-specific IgE or precipitins, total IgE, IgG against suspected fungus, peripheral blood eosinophils and fungal-specific skin prick tests. The role of antifungal therapy in severe asthma remains unclear. Further research is needed to better define the potential utility of antifungal drugs in patients with asthma and mold sensitization or allergy to identify drugs and populations of patients who would benefit from such treatment. There is also insufficient evidence for the safety and efficacy of allergen immunotherapy in moldsensitive patients. About 70% of patients with severe eosinophilic asthma with sensitization or allergy to Aspergillus and Penicillium could benefit with Mepolizumab therapy. On the other side, measures to avoid mold still remain key factor in therapy.
Acta Medica Saliniana, 2019
Sputum eosinophils might predict response to inhaled corticosteroids (ICS) in patients with advan... more Sputum eosinophils might predict response to inhaled corticosteroids (ICS) in patients with advanced chronic obstructive pulmonary disease (COPD). Induction of sputum requires expertise and may not always be successful. Aim was to investigate correlation and predictive relationship between peripheral blood eosinophils (bEo) and sputum eosinophils (sEo), and impact of peripheral blood eosinophilia on outcome of COPD exacerbation. 120 current smokers with COPD (GOLD group C) (57.4 ± 0.92 years, M/F ratio 1.4), with no blood (≥7% or >0.43x109/L) nor sputum (≥3%) eosinophilia, were treated with moderate dose of ICS and long-acting bronchodilatator during stable disease, but systemic corticosteroids and antibiotics during exacerbation. According to sputum eosinophilia (≥4%) during exacerbation, patients were divided into eosinophilic (n=45) and non-eosinophilic group (n=75). In stable disease, bEo and sEo were similar in both groups (p>0.05). During exacerbation, bEo and sEo were s...
The Medicus, Oct 18, 2021
The prevalence of asthma in adults varies widely around the world, ranging from 0.2% to 21.0%. Po... more The prevalence of asthma in adults varies widely around the world, ranging from 0.2% to 21.0%. Population-based studies suggest that from 20% to 70% of people with asthma in the community remain undiagnosed. On the opposite side of the spectrum, 30-35% of adults and children diagnosed with asthma do not have current asthma. Overdiagnosis of current asthma can occur due to various reasons: 1. Physicians' failure to confirm airflow limitation; 2. New signs and symptoms in patients with long-term clinical remission of previous asthma; 3. Alternative diagnoses that mimic signs and symptoms of asthma. The most common differential diagnosis of asthma in adults is vocal cord dysfunction, airflow obstruction (e.g. tumors and foreign bodies), congestive heart failure, chronic obstructive pulmonary disease (COPD), chronic sinusitis and infection of upper airways. The consequences of the overdiagnosis of asthma are: 1. Not diagnosing and treating the actual disease; 2.
Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina, 2021
Aim To analyse the resolution of chest X-ray findings in relation to laboratory parameters in pat... more Aim To analyse the resolution of chest X-ray findings in relation to laboratory parameters in patients infected with acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a two- month followup. Analysis of chest X-ray findings in the first few months after the disease is the main goal of our work. Methods Out of the total of 343 patients chest X-ray findings were followed in 269 patients. Patients were divided into groups according to the severity of findings. D-dimer, inflammatory markers, blood cell count, neutrophil lymphocyte ratio (NLR) were analysed. Chest X-ray was analysed during the hospitalization on the day of admission, on the third, the seventh and the fourteenth day (scoring method was used). After discharge chest X-ray was performed in a two-week follow-up, then after one and two months, and after three months if necessary. Results Incomplete chest X-ray resolution was identified in 24 (39.34%) patients with severe, 27 (22.31 %) patients with moderate and in three ...
Background and aim: Skin prick test (SPT) with a wheal diameter of >3 mm, generally accepted a... more Background and aim: Skin prick test (SPT) with a wheal diameter of >3 mm, generally accepted as a positive, is most commonly use diagnostic tool for Allergic rhinitis. Aim was to validate wheal size of Skin Prick Test for the Bermuda grass, in desert environment, with positive Bermuda grass Nasal challenge in same environment. Methods: In 53 adults, mean age 33.43 ± 9.36 years, both gender (females: 33.96%), SPT positive on Bermuda grass with cut off wheal longest diameter of 3 mm, Bermuda grass nasal challenge test (bgNCT) was carried out. Response was assessed subjectively (scored) and objectively (PNIF). Safety profile was assessed by PEF measurement. Results: Mean weal size of SPT (mm) was bigger in bgNCT positive patients (n=47; 88.68%) 8 [4, 15] vs 5 [3, 6] (p<0.0001). ROC analysis showed Bermuda Grass SPT at the threshold of >6.5mm enabled identification of Bermuda challenge with sensitivity of 82.98% and specificity of 100.0% (area under the curve 0.9326, standard e...
European Annals of Allergy and Clinical Immunology, 2021
Background: Sensitization to Salsola kali (Sk) weed pollen allergen is the most common cause of s... more Background: Sensitization to Salsola kali (Sk) weed pollen allergen is the most common cause of seasonal allergic rhinitis (SAR) in Middle East countries. Aim: To identify Salsola kali skin prick test (SkSPT) wheal size cutoff , able to determine true allergy among adult patients with moderate to severe SAR, who are in need of Salsola kali allergen specific immunotherapy (SkAIT). Methods: In 151 adults with moderate to severe SAR, mean age 32.79 ± 10.79 years, of both gender (females: 43.05%), with a positive SkSPT, (i.e. cut off wheal longest diameter of 3 mm) and one or more other local weed pollens, Salsola kali nasal provocation test (SkNPT) was carried out. Response was assessed both subjectively, with scores, and objectively, by measuring peak nasal inspiratory flow (PNIF). Safety profile of SkNPT was assessed using peak expiratory flow rate (PEF) measurements. Results: SkNPT positive response was found in 125 patients (82.78%). Mean skin prick test (SPT) wheal size to Sk was bigger in the nasal provocatin test (NPT) positive group (9 mm) compared to the NPT negative patients (5 mm), p<0.0001. ROC analysis showed that a SPT wheal size to Sk at the threshold of >7.5 mm enabled identification of SkNPT positivity with a sensitivity of 73.6% and specificity of 100.0% (area under the curve 0.9498, standard error 0.01808; 95% confidence interval (CI): 0.9144 to 0.9853; p<0.0001). Conclusion: SPT wheal size of 3 mm might overestimate the presence of real allergy to Sk in a desert environment. A SPT wheal size >7.5 mm for Sk appears to distinguish individuals who develop disease from those who does not. Physicians should select the proper SPT wheal size value as an appropriate criterion according to the allergen than using a uniform cut off value in patients eligible for SkAIT.