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Background: Monthly intravenous immunoglobulin (IVIG) and weekly subcutaneous immunoglobulin (SCIG) have been regarded as therapeutically equivalent treatments for primary immunodeficiency diseases (PIDD). Immunoglobulin G (IgG) trough level is used as a monitoring measure for infection prevention. Objective: A systematic review and meta-analysis were performed to elucidate the relationship between IgG dosing, trough IgG levels with overall infection incidence in patients with PIDD receiving IVIG and SCIG therapy. Methods: Medline, EMBASE, Cochrane, Central, and Scopus were searched for studies published from Jan 2010–June 2018, fulfilling the inclusion criteria. DerSimonian and Laird random-effects method were used to pool the difference of IgG trough levels. Random-effect meta-regression was used to evaluate infection incidence per 100 mg/dl IgG trough increase though IVIG and SCIG. Results: Out of 24 observational studies included, 11 compared IgG trough levels among SCIG and IVIG (mean difference: 73.4 mg/dl, 95% CI: 31.67–119.19 mg/dl, I2 = 45%, p = 0.05), favoring weekly SCIG. For every 100 mg/dl increase in the trough, a linear trend of decreased incidence rates of infection was identified in SCIG patients (p = 0.03), but no similar trend was identified in trough levels vs. infection rates for patients receiving IVIG (p = 0.67). Conclusion: In our study, weekly SCIG attained a higher trough level in comparison to monthly IVIG. Higher SCIG troughs were associated with lower infection rates, while IVIG troughs demonstrated no relationship. Keywords: PIDD, Primary immunodeficiency disease, IgG trough, IVIG, SCIG

Introduction Asthma exacerbations are an important cause of emergency department visits. The 30-day readmission rate, which is a marker of asthma severity, remains substantial. The aim of our study was to assess demographic and clinical factors associated with early asthma readmissions. Methods We used data from the Nationwide Readmission Database (NRD). We identified adults (≥18 years) with index hospitalizations for an acute asthma exacerbation and calculated odds ratio (ORs) of various factors with 30-day readmission. As the database contains de-identified patient data, IRB approval was not required. Results In 2014, we identified 162,142 (estimated total of 352,750 in the US) index discharges for asthma exacerbation, 4,991 (estimated 10,808, ∼ 3%) of whom were readmitted within 30 days. On multivariate analysis, nondependent abuse or dependence on prescription medications (opiates, anxiolytics, sedatives, hypnotics) were associated with the highest odds of early readmission (OR 1.56, 95 % CI 1.34–1.80, p Conclusions Prescription opiates and anxiolytics have been previously identified as predictors for early hospital readmission. Steroid use likely indicates baseline disease severity, with subsequent higher readmissions. Mounting evidence demonstrates that obesity and GERD adversely affect asthma inception, severity, and response to therapy. It is important to identify high-risk features for readmission in order to target preventative interventions to those at highest risk. Factors Associated with Early Readmission in Acute Asthma Exacerbation on Uni- and Multi-variate Analyses Figure 1. Factors associated with increased Early (30-day) Readmission in Hospitalizations with Acute Exacerbation of Asthma.

Introduction According to the American Heart Association update in 2017, 2,804 patients underwent heart transplantation (HT) in the US in 2015. The outcome of cardiopulmonary resuscitation (CPR) in HT patients in comparison to patients without HT during hospitalization is not known. Methods We utilized the National Inpatient Sample database from years 2000 - 2014. We selected non-pregnant patients over the age of 18 who underwent CPR during admission in US hospitals over the specified period. We selected patients with ventricular fibrillation (VF) and cardiac arrest based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and Clinical Classification Software-Diagnoses codes supplied by the Healthcare Cost and Utilization Project (HCUP). Non-VF patients were cardiac arrest patients excluding VF. We used STATA version 13.0 (College Station, TX) for database analysis. Results Our study population consisted of 280,790 discharge records. Baseline characteristics are presented in Table 1 . Multivariable logistic regression analysis of mortality and length of stay (LOS) in patients with in-hospital cardiopulmonary resuscitation for cardiac arrest, VF arrest and non-VF arrest with or without HT did not reach statistical significance. Discussion Heart transplant patients are at increased risk of ventricular arrhythmias and death from accelerated atherosclerosis of transplanted heart (cardiac allograft vasculopathy, CAV) or allograft rejection. These patients are susceptible to bradycardic events and electromechanical dissociation related to CAV. Conclusion Through our study, we can conclude that the outcome of HT patients who undergo CPR is the same as those without history of HT.