1
|
Caruso P, Prandin G, Rossi L, Cegalin M, Lugnan C, Pasquin F, Sisto UG, Furlanis G, Naccarato M, Cominotto F, Manganotti P. Epidemiology and management of transient ischemic attack in Trieste district, how day hospital assessment improves outcomes: a five-year retrospective study. Neurol Sci 2024:10.1007/s10072-024-07443-6. [PMID: 38467952 DOI: 10.1007/s10072-024-07443-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/03/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Transient ischemic attack (TIA) is defined as a transient episode of neurologic dysfunction, without acute infarction or tissue injury lasting less than 24 h. Previous data suggest TIA precedes 15% of ischemic strokes, with a higher risk in the first week. Current practice guidelines advise evaluation through rapid neurological visit or admission to hospital. We provide data on TIA incidence in Trieste, and we compare three different types of assessment: day hospital (DH), stroke unit (SU), and emergency department/outpatients (ED). METHODS This is a 5-year retrospective study of transient cerebrovascular events admitted in the University Hospital of Trieste (230.623 inhabitants), between 2016 and 2020. We calculated TIA prevalence in Trieste district's general population. Our primary endpoint is ischemic recurrences within 90 days, and we evaluate the possible association between different types of management. RESULTS TIA incidence rate was 0.54/1000 inhabitants. In the multivariate analysis remained significantly associated with primary endpoint: ABCD2 (OR 1.625, CI 95% 1.114-2.369, p = 0.012) and DH evaluation (OR 0.260, CI 95% 0.082-0.819, p = 0.021). CONCLUSIONS Incidence of TIA in Trieste district is in line with previous data. We demonstrate the crucial role of DH evaluation over the outpatient/ED in reducing overall mortality and recurrence rate. Prompt recognition of patients at high risk for cerebrovascular events and specialist follow-up may reduce the incidence of major vascular events and death.
Collapse
Affiliation(s)
- Paola Caruso
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, ASUGI, University of Trieste, Strada Di Fiume 447, 34100, Trieste, Italy
| | - Gabriele Prandin
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, ASUGI, University of Trieste, Strada Di Fiume 447, 34100, Trieste, Italy.
| | - Lucrezia Rossi
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, ASUGI, University of Trieste, Strada Di Fiume 447, 34100, Trieste, Italy
| | - Matteo Cegalin
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, ASUGI, University of Trieste, Strada Di Fiume 447, 34100, Trieste, Italy
| | - Carlo Lugnan
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, ASUGI, University of Trieste, Strada Di Fiume 447, 34100, Trieste, Italy
| | - Fulvio Pasquin
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, ASUGI, University of Trieste, Strada Di Fiume 447, 34100, Trieste, Italy
| | - Ugo Giulio Sisto
- Emergency Department, University Hospital and Health Services of Trieste, ASUGI, University of Trieste, Strada Di Fiume 447, 34100, Trieste, Italy
| | - Giovanni Furlanis
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, ASUGI, University of Trieste, Strada Di Fiume 447, 34100, Trieste, Italy
| | - Marcello Naccarato
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, ASUGI, University of Trieste, Strada Di Fiume 447, 34100, Trieste, Italy
| | - Franco Cominotto
- Emergency Department, University Hospital and Health Services of Trieste, ASUGI, University of Trieste, Strada Di Fiume 447, 34100, Trieste, Italy
| | - Paolo Manganotti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, ASUGI, University of Trieste, Strada Di Fiume 447, 34100, Trieste, Italy
| |
Collapse
|
2
|
Siriratnam P, Huda S, Butzkueven H, van der Walt A, Jokubaitis V, Monif M. Risks and outcomes of pregnancy in neuromyelitis optica spectrum disorder: A comprehensive review. Autoimmun Rev 2024; 23:103499. [PMID: 38061621 DOI: 10.1016/j.autrev.2023.103499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 11/30/2023] [Indexed: 04/30/2024]
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is a rare central nervous system autoimmune disease. Aquaporin-4 antibody (AQP4-IgG) is present in over 75% of cases and criteria also exist for the diagnosis of seronegative NMOSD. AQP4-IgG NMOSD has a strong female predominance (9:1 ratio), with a median onset age of 40 years. Pregnancy in those with NMOSD is therefore an important topic. Fecundity in NMOSD is likely impaired, and for females who conceive, obstetric complications including miscarriages and pre-eclampsia are significantly higher in NMOSD compared to the general population and in related conditions such as multiple sclerosis (MS). In contrast to MS, NMOSD disease activity does not subside during pregnancy. Also, relapse risk substantially rises above pre-pregnancy rates in the early postpartum period. In view of the evolving landscape of NMOSD, we provide a contemporary update of the impacts of pregnancy in NMOSD.
Collapse
Affiliation(s)
- Pakeeran Siriratnam
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Saif Huda
- Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Anneke van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Vilija Jokubaitis
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Mastura Monif
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia; Department of Neurology, The Royal Melbourne Hospital, Parkville, VIC, Australia.
| |
Collapse
|
3
|
Belotti LMB, Di Martino M, Zenesini C, Vignatelli L, Baldin E, Baccari F, Ridley B, Nonino F. Impact of adherence to disease-modifying drugs in multiple sclerosis: A study on Italian real-world data. Mult Scler Relat Disord 2023; 80:105094. [PMID: 37913675 DOI: 10.1016/j.msard.2023.105094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 10/05/2023] [Accepted: 10/19/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Multiple Sclerosis (MS) is a chronic inflammatory disease of the central nervous system requiring complex diagnostic and therapeutic management. Treatment with Disease Modifying Drugs (DMDs) is aimed at reducing relapse rate and disease disability. Few real-world, population-based data are available on the impact of adherence on relapse rate. The objective of this study was to assess the impact of adherence to DMDs on relapses in a real-world Italian setting. METHODS Population-based cohort study. People with MS (PwMS) older than 18 years and residing in the Emilia-Romagna region, Northern Italy, were identified through administrative databases using a validated algorithm. A Cox regression model with a time-varying exposure was performed to assess the association between level of adherence to DMDs and relapses over a 5-year period. RESULTS A total of 2,528 PwMS receiving a first prescription of DMDs between 2015 and 2019 were included (average age of 42, two-thirds female). Highly adherent PwMS had a 25 % lower hazard of experiencing moderate or severe relapses than non-adherent PwMS (Hazard Ratio 0.75, 95 % CI 0.58 to 0.98), after adjusting for age and sex. Several sensitivity analyses supported the main result. CONCLUSION The results of our study support the hypothesis that a high level of DMD adherence in MS is associated with a lower risk of moderate or severe relapse. Therefore, choosing the DMD with which to start drug treatment and recommending adherence to treatment appear to be crucial aspects involving both physicians and patients.
Collapse
Affiliation(s)
- Laura Maria Beatrice Belotti
- Epidemiology and Statistics Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, Bologna 40139, Italy.
| | - Mirko Di Martino
- Department of Epidemiology of the Lazio Regional Health Service, ASL Roma 1, Via Cristoforo Colombo, 112-00147 Roma, Italy
| | - Corrado Zenesini
- Epidemiology and Statistics Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, Bologna 40139, Italy
| | - Luca Vignatelli
- Epidemiology and Statistics Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, Bologna 40139, Italy
| | - Elisa Baldin
- Epidemiology and Statistics Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, Bologna 40139, Italy
| | - Flavia Baccari
- Epidemiology and Statistics Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, Bologna 40139, Italy
| | - Ben Ridley
- Epidemiology and Statistics Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, Bologna 40139, Italy
| | - Francesco Nonino
- Epidemiology and Statistics Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, Bologna 40139, Italy
| |
Collapse
|
4
|
Keragala KARK, Gunathilaka MGRSS, Senevirathna RMISK, Jayaweera JAAS. Efficacy and safety of co-trimoxazole in eradication phase of melioidosis; systematic review. Ann Clin Microbiol Antimicrob 2023; 22:74. [PMID: 37592339 PMCID: PMC10436656 DOI: 10.1186/s12941-023-00620-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 07/23/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Melioidosis is an infectious disease caused by the bacterium Burkholderia pseudomallei. The two stages of melioidosis treatment are the intense intravenous phase and the oral eradication phase. Although co-trimoxazole has been in use for several years, the literature does not demonstrate uniformity of the drug doses, combinations, or durations suitable for the eradication phase of melioidosis. The safety profile of co-trimoxazole was not documented in the literature, nor have systematic studies of its effectiveness been done. This systematic review sought to study on the dose, duration and combination of co-trimoxazole therapy in view of clinical efficacy and safety in the eradication phase of melioidosis. MAIN BODY This systematic review included all of the published articles that employed co-trimoxazole in the eradication phase after 1989, including, randomized clinical trials, case-control studies, cohorts, case reports, and case series. Throughout the eradication (maintenance) phase, co-trimoxazole usage was permissible in any dose for any period. A total of 40 results were included in the analysis which contained six clinical trials, one cohort study, one Cochrane review, and thirty-two case series/case reports. Clinical and microbial relapse rates are low when co-trimoxazole is used in single therapy than in combination. There were several adverse events of co-trimoxazole, however, a quantitative analysis was not conducted as the data did not include quantitative values in most studies. SHORT CONCLUSION The dose of co-trimoxazole, duration of the eradication phase, and other combinations used in the treatment was varying between studies. Compared to combined therapy patients treated with co-trimoxazole alone the mortality and relapse rates were low. The lowest relapse rate and lowest mortality rate occur when using co-trimoxazole 1920 mg twice daily. The duration of therapy varies on the focus of melioidosis and it is ranged from 2 months to one year and minimum treatment duration associated with low relapse rate is 3 months. The use of co-trimoxazole over the maintenance phase of melioidosis is associated with clinical cure but has adverse effects.
Collapse
|
5
|
Hradilek P, Zapletalova O, Hanulikova P, Havrdova EK, Woznicova I, Mazouchova A, Drahota J, Lauer M, Stetkarova I, Valis M, Libertinova J, Stourac P, Adamkova J, Ampapa R, Vachova M, Dufek M, Martinková A, Peterka M, Recmanova E, Mares J, Horakova D. Is breastfeeding in MS harmful or not? An answer from real-world Czech data. Mult Scler Relat Disord 2023; 76:104790. [PMID: 37348317 DOI: 10.1016/j.msard.2023.104790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/18/2023] [Accepted: 06/01/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION The influence of breastfeeding and it´s duration on the course of multiple sclerosis (MS) is unclear. Here we analyzed a real-world data for breastfeeding women with MS and their disease course collected from a Czech national registry ReMuS. OBJECTIVES To identify risk factors associated with not initiating breastfeeding after delivery, to analyze the impact of breastfeeding on the MS disease course, evaluate the assumption, that breastfeeding is not harmful in MS patients, and compare the disease course by breastfeeding status. MATERIALS AND METHODS Using propensity score matching we compared Expanded Disability Status Scale (EDSS), confirmed disease worsening (CDW) and annual relapse rate (ARR) in breastfeeding and non-breastfeeding MS patients according to disease duration, disease modifying treatment (DMT) before pregnancy, last EDSS score before conception, age, and ARR during pregnancy. We also compared these parameters between breastfeeding patients not using a DMT and non-breastfeeding patients who resumed DMT within 3 months after delivery. EDSS, ARR, and CDW were collected at 12, 24, and 36 months after delivery. RESULTS A total of 1681 pregnancies that ended in delivery were analyzed from 2013 through 2020. Change in ARR and EDSS values and 6-months CDW did not significantly differ between the analyzed groups. Compared with non-breastfeeding women who resumed DMT early after delivery, breastfeeding women with MS did not experience worse clinical outcomes even without initiating a DMT. DISCUSSION Breastfeeding in Czech women with MS did not negatively affect the disease course and can be supported. Patients with MS can be treated with certain DMTs alongside breastfeeding and there is no need to stop breastfeeding, if the patient is clinically stable.
Collapse
Affiliation(s)
- Pavel Hradilek
- Faculty of Medicine, Ostrava University, Czech Republic; Department of Neurology, University Hospital Ostrava, Czech Republic.
| | - Olga Zapletalova
- Faculty of Medicine, Ostrava University, Czech Republic; Department of Neurology, University Hospital Ostrava, Czech Republic
| | - Petra Hanulikova
- Faculty of Medicine in Pilsen, The Institute for the Care of Mother and Child, Prague, Czech Republic
| | - Eva Kubala Havrdova
- Department of Neurology, and Center of Clinical Neuroscience, 1st Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Ivana Woznicova
- Department of Neurology, University Hospital Ostrava, Czech Republic
| | - Aneta Mazouchova
- IMPULS Endowment Fund, ReMuS Registry, Czech Republic; Department of Economic Statistics, Prague University of Economics and Business, Prague, Czech Republic
| | - Jiri Drahota
- Department of Neurology, and Center of Clinical Neuroscience, 1st Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic; IMPULS Endowment Fund, ReMuS Registry, Czech Republic
| | - Michal Lauer
- IMPULS Endowment Fund, ReMuS Registry, Czech Republic; Prague University of Economics and Business, Czech Republic
| | - Ivana Stetkarova
- Department of Neurology, 3rd Faculty of Medicine, Charles University in Prague and Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Martin Valis
- Department of Neurology, Faculty of Medicine and University Hospital Hradec Kralove, Charles University in Prague, Czech Republic
| | - Jana Libertinova
- Department of Neurology, Second Faculty of Medicine and Motol University Hospital, Charles University, Prague, Czech Republic
| | - Pavel Stourac
- Department of Neurology, University Hospital and Masaryk University Brno, Czech Republic
| | - Jana Adamkova
- Department of Neurology, Hospital Ceske Budejovice, Czech Republic
| | - Radek Ampapa
- Department of Neurology, Hospital of Jihlava, Czech Republic
| | - Marta Vachova
- Department of Neurology, and Center of Clinical Neuroscience, 1st Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic; Department of Neurology, KZ a.s., Hospital Teplice, Czech Republic
| | - Michal Dufek
- 1st Department of Neurology, University Hospital U Svate Anny, Brno, Czech Republic
| | | | - Marek Peterka
- Department of Neurology, Faculty of Medicine and University Hospital in Pilsen, Charles University
| | - Eva Recmanova
- Department of Neurology, Tomas Bata Hospital, Zlin, Czech Republic
| | - Jan Mares
- Department of Neurology, Faculty of Medicine, Palacky University and University Hospital Olomouc, Czech Republic
| | - Dana Horakova
- Department of Neurology, and Center of Clinical Neuroscience, 1st Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| |
Collapse
|
6
|
Mehta P, Balakrishnan A, Phatak S, Pathak M, Ahmed S. Diagnostic accuracy of antineutrophil cytoplasmic antibodies (ANCA) in predicting relapses of ANCA-associated vasculitis: systematic review and meta-analysis. Rheumatol Int 2023; 43:437-48. [PMID: 36040492 DOI: 10.1007/s00296-022-05192-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 08/16/2022] [Indexed: 10/14/2022]
Abstract
Relapse in antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) is associated with significant morbidity and mortality. Utility of ANCA for prediction of relapses is still controversial. PubMed/MEDLINE, Scopus, and WebOfScience were searched, screened and confirmed for inclusion [PROSPERO No: CRD42020220308]. Studies measuring serial ANCA by ELISA or indirect immunofluorescence (IF), reporting relapses with sufficient data to calculate sensitivity and specificity were included. Diagnostic odds ratio (OR), sensitivity, specificity and likelihood ratios (LR) were synthesized using a bivariate mixed-effect regression model. Sub-group analysis included a comparison between ELISA and IIF, anti-myeloperoxidase (MPO) and -proteinase 3(PR3), and type of rise in ANCA. For meta-analysis of survival outcomes, hazard ratios were synthesized using a random-effect model. QUADAS-2 was used for assessing quality of studies, I2 statistic for heterogeneity Begg's test for publication bias. 2946 abstracts and 43 full-texts were reviewed to identify 26 eligible studies that included 2623 patients with AAV and 848 relapses. Overall heterogeneity was high [I2 = 99%] and the overall risk of bias was low to moderate. ANCA positivity by either ELISA or immunofluorescence for predicting relapse of AAV had a sensitivity of 0.70(95% CI 0.58-0.81), specificity of 0.66(0.55-0.76), positive LR of 2.1(1.6-42.7) and negative LR of 0.44(0.30-0.60). ELISA performed marginally better [OR: 5(3-7)] than IIF [OR: 4(2-9)] with similar sensitivity, specificity, PLR and NLR. The area under the curve for PR3 was 0.74(0.7-0.77), while that for MPO was not computed as the number of eligible studies was only three. In the survival analysis, the hazard ratio for relapse was 3.11(1.7-5.65). The meta-analysis shows modest accuracy of ANCA in predicting relapses of ANCA vasculitis and supports the use of serial ANCA monitoring as a biomarker for relapse.
Collapse
|
7
|
Weerasooriya WALK, Abeyagunawardena AS, Thalgahagoda RS. Single vs split dose of prednisolone in the treatment of relapses of childhood nephrotic syndrome. Eur J Pediatr 2023; 182:1741-1747. [PMID: 36757496 DOI: 10.1007/s00431-023-04804-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 12/30/2022] [Accepted: 01/02/2023] [Indexed: 02/10/2023]
Abstract
Nephrotic syndrome is the commonest glomerular disease in childhood. It usually follows a relapsing and remitting course. Corticosteroids are the mainstay of treatment for both the first episode and subsequent relapses. This study was conducted at a single centre to compare the clinical response to a single dose vs. split dose of prednisolone in the treatment of relapses of childhood nephrotic syndrome. Children between the ages of 1 and 14 years admitted with a relapse of idiopathic steroid sensitive nephrotic syndrome from August 2019 to February 2020 were considered for recruitment. A block randomization method based on age was used for allocation. Patients randomised to group A received oral prednisolone at 60 mg/m2 as a single morning dose, while those randomised to group B received the same total dose as two divided doses, of which 2/3 was given in the morning and the rest in the evening. Treatment was continued until remission was achieved following which all patients were switched to alternate day prednisolone. An independent sample t test was used to compare the two groups. One hundred and four episodes of relapse occurring in 96 children were included of which 49 were treated with prednisolone as a split dose and 55 were treated with a single dose of prednisolone. The mean duration to achieve remission for the split-dose group was 8.02 days (SD 1.58) while it was 9.74 days (SD 3.72) for the single-dose group. This difference was statistically highly significant (t(102) = 3.004; p = 0.001; CI 0.58 to 2.86). There was no difference in the adverse events profile of the two groups. Conclusion: The use of prednisolone as a split dose results in a shorter duration to achieve remission when compared to a single morning dose, resulting in a lower cumulative dose of prednisolone to achieve remission. What is Known: • Corticosteroids are the mainstay of treatment for childhood nephrotic syndrome. • Corticosteroids are given as a single dose in the morning to minimise adrenocortical suppression. What is New: • A more rapid attainment of remission can be achieved with a split dose of corticosteroids.
Collapse
Affiliation(s)
- W A L K Weerasooriya
- Professorial Paediatric Unit, Teaching Hospital Peradeniya, Peradeniya, Sri Lanka
| | - A S Abeyagunawardena
- Department of Paediatrics, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - R S Thalgahagoda
- Department of Paediatrics, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
| |
Collapse
|
8
|
Okonechnikov K, Federico A, Schrimpf D, Sievers P, Sahm F, Koster J, Jones DTW, von Deimling A, Pfister SM, Kool M, Korshunov A. Comparison of transcriptome profiles between medulloblastoma primary and recurrent tumors uncovers novel variance effects in relapses. Acta Neuropathol Commun 2023; 11:7. [PMID: 36635768 PMCID: PMC9837941 DOI: 10.1186/s40478-023-01504-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 12/27/2022] [Indexed: 01/13/2023] Open
Abstract
Nowadays medulloblastoma (MB) tumors can be treated with risk-stratified approaches with up to 80% success rate. However, disease relapses occur in approximately 30% of patients and successful salvage treatment strategies at relapse remain scarce. Acquired copy number changes or TP53 mutations are known to occur frequently in relapses, while methylation profiles usually remain highly similar to those of the matching primary tumors, indicating that in general molecular subgrouping does not change during the course of the disease. In the current study, we have used RNA sequencing data to analyze the transcriptome profiles of 43 primary-relapse MB pairs in order to identify specific molecular features of relapses within various tumor groups. Gene variance analysis between primary and relapse samples demonstrated the impact of age in SHH-MB: the changes in gene expression relapse profiles were more pronounced in the younger patients (< 10 years old), which were also associated with increased DNA aberrations and somatic mutations at relapse probably driving this effect. For Group 3/4 MB transcriptome data analysis uncovered clear sets of genes either active or decreased at relapse that are significantly associated with survival, thus could be potential predictive markers. In addition, deconvolution analysis of bulk transcriptome data identified progression-associated differences in cell type enrichment. The proportion of undifferentiated progenitors increased in SHH-MB relapses with a concomitant decrease of differentiated neuron-like cells, while in Group 3/4 MB relapses cell cycle activity increases and differentiated neuron-like cells proportion decreases as well. Thus, our findings uncovered significant transcriptome changes in the molecular signatures of relapsed MB and could be potentially useful for further clinical purposes.
Collapse
Affiliation(s)
- Konstantin Okonechnikov
- grid.510964.fHopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany ,grid.7497.d0000 0004 0492 0584Division of Pediatric Neuro-Oncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Aniello Federico
- grid.510964.fHopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany ,grid.7497.d0000 0004 0492 0584Division of Pediatric Neuro-Oncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Daniel Schrimpf
- grid.7497.d0000 0004 0492 0584Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany ,grid.5253.10000 0001 0328 4908Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Philipp Sievers
- grid.7497.d0000 0004 0492 0584Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany ,grid.5253.10000 0001 0328 4908Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix Sahm
- grid.510964.fHopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany ,grid.7497.d0000 0004 0492 0584Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany ,grid.5253.10000 0001 0328 4908Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jan Koster
- grid.7177.60000000084992262Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers, University of Amsterdam and Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - David T. W. Jones
- grid.510964.fHopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany ,grid.7497.d0000 0004 0492 0584Division of Pediatric Glioma Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Andreas von Deimling
- grid.510964.fHopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany ,grid.7497.d0000 0004 0492 0584Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany ,grid.5253.10000 0001 0328 4908Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan M. Pfister
- grid.510964.fHopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany ,grid.7497.d0000 0004 0492 0584Division of Pediatric Neuro-Oncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany ,grid.5253.10000 0001 0328 4908Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Marcel Kool
- grid.510964.fHopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany ,grid.7497.d0000 0004 0492 0584Division of Pediatric Neuro-Oncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany ,grid.487647.ePrincess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
| | - Andrey Korshunov
- grid.510964.fHopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany ,grid.7497.d0000 0004 0492 0584Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany ,grid.5253.10000 0001 0328 4908Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany
| |
Collapse
|
9
|
Hernández JL, Napal JJ, Icardo M, Bores PG, Pérez-Montes R, Cerveró A, Salmón Z, Olmos JM, Martínez-Taboada VM. Adjusted global antiphospholipid syndrome score (aGAPSS) is useful to predict relapses in patients with retinal vein occlusion. Thromb Res 2023; 221:113-119. [PMID: 36525919 DOI: 10.1016/j.thromres.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND A significant proportion of patients with retinal vein occlusion (RVO) are antiphospholipid antibodies (aPL) carriers. Relapsing disease occurs in nearly 10 % of cases and the role of aPL has not been established. The adjusted global antiphospholipid syndrome score (aGAPSS) was developed to assess the risk of clinical events in aPL carriers and its role in the management of RVO patients is unknown. OBJECTIVE To analyze the values of aGAPSS in a large cohort of patients with RVO and population-based controls, and to assess its usefulness to predict RVO relapses. METHODS Case-control study of RVO patients and population-based controls of similar age and sex. We have assessed and compared the aPL profile and the aGAPSS score in patients with and without relapsing disease and controls. RESULTS Four-hundred and seventy-two RVO patients and 346 controls were included. Fifty-seven RVO patients had antiphospholipid syndrome (RVO-APS). Of them, 75.4 % had a high-risk profile compared to 3 % in controls (p = 0.0001). The median aGAPSS values were 8 [7-13], 3 [1-4], and 3 [0-4], in RVO-APS, RVO no-APS, and controls. Nineteen patients had had a recurrence of RVO before inclusion and 8 during the follow-up. APS was more prevalent in relapsing patients. In the adjusted multivariable regression model, the best predictor for RVO recurrence during the follow-up was an aGAPSS score ≥6 (OR 5.5, CI95% 1.3-23.7; p = 0.023). CONCLUSIONS In patients with RVO, once the control of vascular risk factors has been optimized, the aGAPSS might help to identify those at risk of relapsing disease.
Collapse
Affiliation(s)
- José L Hernández
- Internal Medicine Division, Hospital Marqués de Valdecilla, Santander, Spain; Department of Medicine and Psychiatry, University of Cantabria, Santander, Spain; Valdecilla Research Institute (IDIVAL), Santander, Spain
| | - José J Napal
- Internal Medicine Division, Hospital Marqués de Valdecilla, Santander, Spain
| | - Miguel Icardo
- Department of Medicine and Psychiatry, University of Cantabria, Santander, Spain
| | | | - R Pérez-Montes
- Hematology Division, Hospital Sierrallana, Torrelavega, Cantabria, Spain
| | - A Cerveró
- Ophthalmology Division, Hospital Marqués de Valdecilla, Santander, Spain; Rheumatology Division, Hospital Marqués de Valdecilla, Santander, Spain
| | - Zaida Salmón
- Internal Medicine Division, Hospital Marqués de Valdecilla, Santander, Spain; Department of Medicine and Psychiatry, University of Cantabria, Santander, Spain.
| | - José M Olmos
- Internal Medicine Division, Hospital Marqués de Valdecilla, Santander, Spain; Department of Medicine and Psychiatry, University of Cantabria, Santander, Spain; Valdecilla Research Institute (IDIVAL), Santander, Spain
| | - Víctor M Martínez-Taboada
- Rheumatology Division, Hospital Marqués de Valdecilla, Santander, Spain; Department of Medicine and Psychiatry, University of Cantabria, Santander, Spain; Valdecilla Research Institute (IDIVAL), Santander, Spain
| |
Collapse
|
10
|
Koutsouraki E. Is may be Time to Update the Current Definitions of the Types of Multiple Sclerosis. Mult Scler Relat Disord 2023; 69:104437. [PMID: 36463619 DOI: 10.1016/j.msard.2022.104437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/24/2022] [Accepted: 11/27/2022] [Indexed: 11/29/2022]
Abstract
Since 1996, a debate regarding the cause of disability in Multiple Sclerosis (MS) and the accuracy of the current definitions of MS types has not subsided. Recently, many researchers presented evidence supporting that relapses are a significant causative factor of the increased disability in multiple sclerosis (MS), primarily, but not exclusively, indicating that the disease's progression, which is independent of any relapse activity, plays a significant role in the patient's deterioration mainly in adult MS cases, and this gradually becomes the principle pathway with which disabilities compound in MS patients. We propose an updated definition of the types of MS, highlighting the central role of the disease's progression.
Collapse
|
11
|
Giorgiutti S, Jamilloux Y, Gerfaud-Valentin M, Bert A, Ballonzoli L, Kodjikian L, Korganow AS, Poindron V, Sève P. The course of non-infectious uveitis in pregnancy: a retrospective study of 79 pregnancies. Graefes Arch Clin Exp Ophthalmol 2022; 261:1391-1398. [PMID: 36565331 DOI: 10.1007/s00417-022-05949-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/21/2022] [Accepted: 12/17/2022] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The study aims to describe the course and management of non-infectious uveitis during pregnancy and postpartum period in European populations. METHODS A retrospective observational study in two tertiary centers in France was performed. Pregnant patients during the follow-up of a non-infectious uveitis as well as those with new-onset uveitis were included. The medical records were analyzed with a systematic collection of the characteristics of the uveitis, the treatment and evolution of the uveitis, and the course of the pregnancy including obstetric complications. RESULTS Seventy-nine pregnancies in 59 women were included: 48 patients (68 pregnancies) were followed for uveitis and 11 had a new-onset uveitis diagnosis. Most patients had idiopathic uveitis (32.2%) or sarcoid uveitis (27.1%). Among the patients followed for uveitis at the time of conception, there were 18 relapses (26.5%) requiring treatment escalation. Relapses occurred mainly in the two first trimester (n = 12) or during the postpartum period (n = 5) and were significantly associated with an active uveitis at the time of conception (OR = 9.2, 95% CI [1.57-48.4], p = 0.01). The characteristics of the new-onset uveitis were similar to those already existing before pregnancy. Obstetric complications occurred in 25 pregnancies (31.6%), mainly gestational hypertension and gestational diabetes. CONCLUSION The frequency of non-infectious uveitis relapses decreases as pregnancy progresses, in agreement with data from other non-European studies. However, multidisciplinary monitoring should be advised, especially to uncontrolled patients at the time of conception.
Collapse
Affiliation(s)
- S Giorgiutti
- Service d'Immunologie Clinique et Médecine Interne, CNR RESO, Maladies Auto-Immunes Et Systémiques Rares, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France. .,INSERM UMR - S1109, Université de Strasbourg, Strasbourg, France.
| | - Y Jamilloux
- Service de Médecine Interne, Centre Hospitalier Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.,LIFE, Lyon Immunopathology FEderation, Lyon, France
| | - M Gerfaud-Valentin
- Service de Médecine Interne, Centre Hospitalier Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - A Bert
- Service de Médecine Interne, Centre Hospitalier Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - L Ballonzoli
- Service d'Ophtalmologie, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - L Kodjikian
- Service d'Ophtalmologie, Centre Hospitalier Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.,Université Lyon 1, Lyon, France.,UMR5510 MATEIS, CNRS, INSA Lyon, Université Lyon 1, 69100, Villeurbanne, France
| | - A S Korganow
- Service d'Immunologie Clinique et Médecine Interne, CNR RESO, Maladies Auto-Immunes Et Systémiques Rares, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,INSERM UMR - S1109, Université de Strasbourg, Strasbourg, France
| | - V Poindron
- Service d'Immunologie Clinique et Médecine Interne, CNR RESO, Maladies Auto-Immunes Et Systémiques Rares, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,INSERM UMR - S1109, Université de Strasbourg, Strasbourg, France
| | - P Sève
- Service de Médecine Interne, Centre Hospitalier Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.,Hospices Civils de Lyon, Pôle IMER, Lyon, France.,Université de Lyon, Université Claude Bernard-Lyon 1, HESPER EA 7425, Lyon, France
| |
Collapse
|
12
|
Lescot L, Lefort M, Leguy S, Le Page E, Vukusic S, Edan G, Kerbrat A, Lebrun-Frenay C, De Sèze J, Laplaud DA, Wiertlewski S, Leray E, Michel L. Disease modifying therapies and disease activity during pregnancy and postpartum in a contemporary cohort of relapsing Multiple Sclerosis patients. Mult Scler Relat Disord 2022; 68:104122. [PMID: 36037756 DOI: 10.1016/j.msard.2022.104122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/14/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND In Multiple Sclerosis (MS) women, therapeutic management for pregnancy planning and during pregnancy still represents a challenge regarding timing of disease-modifying therapies (DMT) stop, risk of disease reactivation and potential fetal toxicity. The objective of this study was to describe disease activity during pregnancy and postpartum depending on treatment status before conception in women with MS. METHODS 339 MS patients who have achieved a pregnancy between 2007 and 2017 were included. Women were classified according to their exposure to DMT in the 18 months period prior to pregnancy (untreated / first- / second/third-line treatment). RESULTS 122 women were not exposed to DMT prior to conception, whereas 147 were exposed to first-line DMT and 70 to second/third line DMT (73% to natalizumab and 23% to fingolimod) before conception. In the first-line group, the ARR decreased from 0.39 during the year before conception to 0.21 during pregnancy, whereas it increased in the second/third-line group from 0.59 to 0.78. 47.1% of the second/third-line group faced at least one relapse during pregnancy and the time from conception to first relapse was significantly shorter in this group (p < 10-4). The risk of relapse during pregnancy and postpartum was associated with occurrence of pre-conception relapses and second/third line DMT exposure before pregnancy. CONCLUSION Careful consideration should be given to natalizumab and fingolimod exposed patients before conception as they are at higher risk of reactivation of MS during pregnancy.
Collapse
Affiliation(s)
- Lucile Lescot
- Neurology Department, CRCSEP, Rennes Clinical Investigation Centre CIC-P 1414, Service de Neurologie, CHU Pontchaillou, Rennes University Hospital Rennes University INSERM, Rennes 35033, France
| | - Mathilde Lefort
- EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS (Recherche sur les Services et Management en Santé) - U 1309, University Rennes, Rennes F-35000, France
| | - Soizic Leguy
- Neurology Department, CRCSEP, Rennes Clinical Investigation Centre CIC-P 1414, Service de Neurologie, CHU Pontchaillou, Rennes University Hospital Rennes University INSERM, Rennes 35033, France
| | - Emmanuelle Le Page
- Neurology Department, CRCSEP, Rennes Clinical Investigation Centre CIC-P 1414, Service de Neurologie, CHU Pontchaillou, Rennes University Hospital Rennes University INSERM, Rennes 35033, France
| | - Sandra Vukusic
- Service de neurologie, Sclérose en plaques, Pathologies de la myéline et neuro-inflammation et centre de recherche, Ressources et compétences sur la sclérose en plaques, Hospices civils de Lyon, Bron 69677, France; Inserm 1028 et CNRS UMR 5292, Observatoire français de la sclérose en plaques, Centre de recherche en neurosciences de Lyon, Lyon 69003, France; Université de Lyon, Université Claude-Bernard Lyon 1, Lyon 69000, France; Eugène Devic EDMUS Foundation against multiple sclerosis, State-approved foundation, Bron 69677, France
| | - Gilles Edan
- Neurology Department, CRCSEP, Rennes Clinical Investigation Centre CIC-P 1414, Service de Neurologie, CHU Pontchaillou, Rennes University Hospital Rennes University INSERM, Rennes 35033, France
| | - Anne Kerbrat
- Neurology Department, CRCSEP, Rennes Clinical Investigation Centre CIC-P 1414, Service de Neurologie, CHU Pontchaillou, Rennes University Hospital Rennes University INSERM, Rennes 35033, France
| | | | - Jérome De Sèze
- Centre d'investigation clinique, INSERM U1434, Centre Hospitalier Universitaire de Strasbourg, 1 Place de l'Hôpital, Strasbourg 67000, France
| | - David Axel Laplaud
- Centre de Recherche en Transplantation et Immunologie UMR1064, INSERM, Université de Nantes, Nantes, France
| | - Sandrine Wiertlewski
- Centre de Recherche en Transplantation et Immunologie UMR1064, INSERM, Université de Nantes, Nantes, France
| | - Emmanuelle Leray
- EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS (Recherche sur les Services et Management en Santé) - U 1309, University Rennes, Rennes F-35000, France
| | - Laure Michel
- Neurology Department, CRCSEP, Rennes Clinical Investigation Centre CIC-P 1414, Service de Neurologie, CHU Pontchaillou, Rennes University Hospital Rennes University INSERM, Rennes 35033, France; Microenvironment, Cell Differentiation, Immunology and Cancer unit, INSERM, Rennes I University, French Blood Agency, Rennes, France.
| |
Collapse
|
13
|
Conticini E, d'Alessandro M, Grazzini S, Fornaro M, Sabella D, Lopalco G, Giardina F, Colafrancesco S, Rizzo C, Guggino G, Priori R, Conti F, Iannone F, Bargagli E, Cantarini L, Frediani B. Relapses of idiopathic inflammatory myopathies after vaccination against COVID-19: a real-life multicenter Italian study. Intern Emerg Med 2022; 17:1921-1928. [PMID: 35754076 PMCID: PMC9244457 DOI: 10.1007/s11739-022-03028-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/06/2022] [Indexed: 11/05/2022]
Abstract
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccination plays a crucial role as pivotal strategy to curb the coronavirus disease-19 (COVID-19) pandemic. The present study described the clinical status of patients affected by idiopathic inflammatory myopathies (IIM) after COVID-19 vaccination to assess the number of relapses. We included all patients affected by IIM and followed by Myositis Clinic, Rheumatology and Respiratory Diseases Units, Siena University Hospital, Bari University Hospital, Policlinico Umberto I, Sapienza University, Rome, and Policlinico Paolo Giaccone, Palermo. They underwent a telephone survey. A total of 119 IIM patients (median, IQR 58 (47-66) years; 32males; 50 dermatomyositis, 39 polymyositis and 30 anti-synthetase syndrome) were consecutively enrolled. Except four patients who refused the vaccination, 94 (81.7%) received Comirnaty, 16 (13.9%) Spikevax, 5 (4.4%) Vaxzevria. Seven (6.1%) patients had flare after vaccination. One of them had life-threatening systemic involvement and died two months after second dose of COVID-19 vaccination. From logistic regression analysis, Chi2-log ratio = 0.045,the variable that most influences the development of flare was the number of organs involved (p = 0.047). Sixty-eight patients received the third dose of COVID-19 vaccination: 51(75%) Comirnaty and 17 (25%) Moderna. No patients had flares after third dose. Our study represents the largest cohort of IIM patients in which the incidence of recurrence after anti-SARS-CoV-2 vaccine was assessed. In line with real-life data from other diseases, we found a clinical non-statistically significant risk of relapse in our patients, which occurred seldom, usually mild and in patients with a more severe and aggressive course of disease.
Collapse
Affiliation(s)
- Edoardo Conticini
- Rheumatology Unit, Department of Medical and Surgical Sciences and Neurosciences, University of Siena, 53100, Siena, Italy
| | - Miriana d'Alessandro
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences and Neurosciences, University of Siena, Viale Bracci 1, 53100, Siena, Italy.
| | - Silvia Grazzini
- Rheumatology Unit, Department of Medical and Surgical Sciences and Neurosciences, University of Siena, 53100, Siena, Italy
| | - Marco Fornaro
- Rheumatology Unit, Department of Emergency and Organ Transplantation, University of Bari, Policlinico, Piazza G. Cesare 11, 70124, Bari, Italy
| | - Daniele Sabella
- Rheumatology Unit, Department of Emergency and Organ Transplantation, University of Bari, Policlinico, Piazza G. Cesare 11, 70124, Bari, Italy
| | - Giuseppe Lopalco
- Rheumatology Unit, Department of Emergency and Organ Transplantation, University of Bari, Policlinico, Piazza G. Cesare 11, 70124, Bari, Italy
| | - Federico Giardina
- Rheumatology Section, Department of Clinical Internal, Anesthetic and Cardiovascular Sciences, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Serena Colafrancesco
- Rheumatology Section, Department of Clinical Internal, Anesthetic and Cardiovascular Sciences, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Chiara Rizzo
- Rheumatology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Piazza delle Cliniche 2, 90110, Palermo, Italy
| | - Giuliana Guggino
- Rheumatology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Piazza delle Cliniche 2, 90110, Palermo, Italy
| | - Roberta Priori
- Rheumatology Section, Department of Clinical Internal, Anesthetic and Cardiovascular Sciences, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Fabrizio Conti
- Rheumatology Section, Department of Clinical Internal, Anesthetic and Cardiovascular Sciences, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Florenzo Iannone
- Rheumatology Unit, Department of Emergency and Organ Transplantation, University of Bari, Policlinico, Piazza G. Cesare 11, 70124, Bari, Italy
| | - Elena Bargagli
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences and Neurosciences, University of Siena, Viale Bracci 1, 53100, Siena, Italy
| | - Luca Cantarini
- Rheumatology Unit, Department of Medical and Surgical Sciences and Neurosciences, University of Siena, 53100, Siena, Italy
| | - Bruno Frediani
- Rheumatology Unit, Department of Medical and Surgical Sciences and Neurosciences, University of Siena, 53100, Siena, Italy
| |
Collapse
|
14
|
Leguy S, Lefort M, Lescot L, Michaud A, Vukusic S, Le Page E, Edan G, Kerbrat A, Lebrun-Frenay C, De Sèze J, Laplaud DA, Wiertlewski S, Leray E, Michel L. COPP-MS: COrticosteroids during the Post-Partum in relapsing Multiple Sclerosis patients. J Neurol 2022; 269:5571-5581. [PMID: 35737108 DOI: 10.1007/s00415-022-11215-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/02/2022] [Accepted: 06/03/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND No specific treatment has demonstrated its effectiveness to prevent post-partum relapses for multiple sclerosis (MS) women. OBJECTIVE To assess the effectiveness of preventive high-dose corticosteroids in the post-partum period by comparing two strategies: (1) no preventive treatment and (2) standardized preventive treatment. METHODS We selected five French Multiple Sclerosis centers using the same post-partum strategy for their patients-either high-dose steroids (treating centers TC) or no treatment (non-treating centers NTC). We included relapsing-remitting multiple sclerosis women who delivered between January 2007 and January 2017. Our primary outcomes were the time from delivery to first relapse, EDSS progression and MRI activity between patients of treating centers and non-treating centers, after propensity-score weighting. RESULTS 350 patients were included (116 from treating centers, 234 from non-treating centers). For both groups, the annualized relapse rate decreased during pregnancy (0.28 in treating centers and 0.34 in non-treating centers during the third trimester) and increased during the first post-partum trimester (0.45 and 0.69, respectively) with 11% and 14% (NS) of patients facing at least one relapse, respectively. Our primary outcomes were not statistically different between both groups. CONCLUSION This study provides class III evidence that systematic high-dose corticosteroids are not associated with a reduced inflammatory activity during the post-partum period in multiple sclerosis patients.
Collapse
Affiliation(s)
- Soizic Leguy
- Neurology Department, CRC-SEP Rennes, Rennes Clinical Investigation Center, Rennes University Hospital Rennes University INSERM, CHU Pontchaillou, 35033, Rennes, France
| | - Mathilde Lefort
- EHESP, CNRS, Inserm, Arènes, UMR 6051, RSMS (Recherche sur les Services et Management en Santé), University Rennes, U 1309, 35000, Rennes, France.,CHU Rennes, Inserm, CIC 1414 [(Centre d'Investigation Clinique de Rennes)], University Rennes, 35000, Rennes, France
| | - Lucile Lescot
- Neurology Department, CRC-SEP Rennes, Rennes Clinical Investigation Center, Rennes University Hospital Rennes University INSERM, CHU Pontchaillou, 35033, Rennes, France
| | - Audrey Michaud
- EHESP, CNRS, Inserm, Arènes, UMR 6051, RSMS (Recherche sur les Services et Management en Santé), University Rennes, U 1309, 35000, Rennes, France
| | - Sandra Vukusic
- Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation et Centre de Recherche, Ressources et Compétences sur la Sclérose en Plaques, Hospices Civils de Lyon, 69677, Bron, France.,Inserm 1028 et CNRS UMR 5292, Observatoire Français de la Sclérose en Plaques, Centre de Recherche en Neurosciences de Lyon, 69003, Lyon, France.,Université de Lyon, université Claude-Bernard Lyon 1, 69000, Lyon, France.,Eugène Devic EDMUS Foundation Against Multiple Sclerosis, state-approved foundation, 69677, Bron, France
| | - Emmanuelle Le Page
- Neurology Department, CRC-SEP Rennes, Rennes Clinical Investigation Center, Rennes University Hospital Rennes University INSERM, CHU Pontchaillou, 35033, Rennes, France.,CHU Rennes, Inserm, CIC 1414 [(Centre d'Investigation Clinique de Rennes)], University Rennes, 35000, Rennes, France
| | - Gilles Edan
- Neurology Department, CRC-SEP Rennes, Rennes Clinical Investigation Center, Rennes University Hospital Rennes University INSERM, CHU Pontchaillou, 35033, Rennes, France.,CHU Rennes, Inserm, CIC 1414 [(Centre d'Investigation Clinique de Rennes)], University Rennes, 35000, Rennes, France
| | - Anne Kerbrat
- Neurology Department, CRC-SEP Rennes, Rennes Clinical Investigation Center, Rennes University Hospital Rennes University INSERM, CHU Pontchaillou, 35033, Rennes, France.,CHU Rennes, Inserm, CIC 1414 [(Centre d'Investigation Clinique de Rennes)], University Rennes, 35000, Rennes, France
| | | | - Jérôme De Sèze
- CRCSEP, CHU de Nice Pasteur 2, Université Nice Côte d'Azur UR2CA URRIS, Nice, France.,Centre d'investigation Clinique, INSERM U1434, Centre Hospitalier Universitaire de Strasbourg, 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - David-Axel Laplaud
- Centre de Recherche en Transplantation et Immunologie UMR1064, INSERM; Université de Nantes, CHU de Nantes France, Nantes, France
| | - Sandrine Wiertlewski
- Centre de Recherche en Transplantation et Immunologie UMR1064, INSERM; Université de Nantes, CHU de Nantes France, Nantes, France
| | - Emmanuelle Leray
- EHESP, CNRS, Inserm, Arènes, UMR 6051, RSMS (Recherche sur les Services et Management en Santé), University Rennes, U 1309, 35000, Rennes, France.,CHU Rennes, Inserm, CIC 1414 [(Centre d'Investigation Clinique de Rennes)], University Rennes, 35000, Rennes, France
| | - Laure Michel
- Neurology Department, CRC-SEP Rennes, Rennes Clinical Investigation Center, Rennes University Hospital Rennes University INSERM, CHU Pontchaillou, 35033, Rennes, France. .,CHU Rennes, Inserm, CIC 1414 [(Centre d'Investigation Clinique de Rennes)], University Rennes, 35000, Rennes, France. .,Microenvironment, Cell Differentiation, Immunology and Cancer Unit, INSERM, Rennes I University, French Blood Agency, Rennes, France.
| |
Collapse
|
15
|
Bioque M, Mezquida G, Amoretti S, García-Rizo C, López-Ilundain JM, Diaz-Caneja CM, Zorrilla I, Mané A, Rodriguez-Jimenez R, Corripio I, Pomarol-Clotet E, Ibáñez Á, Usall J, Contreras F, Mas S, Vázquez-Bourgon J, Cuesta MJ, Parellada M, González-Pinto A, Hidalgo-Figueroa M, Bernardo M; 2EPs GROUP. Clinical and treatment predictors of relapse during a three-year follow-up of a cohort of first episodes of schizophrenia. Schizophr Res 2022; 243:32-42. [PMID: 35231832 DOI: 10.1016/j.schres.2022.02.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/24/2021] [Accepted: 02/17/2022] [Indexed: 12/13/2022]
Abstract
Relapses are frequent in the first years following a first episode of schizophrenia (FES), being associated with a higher risk of developing a chronic psychotic disorder, and poor clinical and functional outcomes. The identification and intervention over factors associated with relapses in these early phases are timely and relevant. In this study, 119 patients in remission after a FES were closely followed over three years. Participants came from the 2EPS Project, a coordinated, naturalistic, longitudinal study of 15 tertiary centers in Spain. Sociodemographic, clinical, treatment and substance abuse data were analyzed. 49.6% of the participants relapsed during the 3-years follow-up. None of the baseline demographic and clinical characteristics analyzed showed a statistically significant association with relapses. 22% of patients that finished the follow-up without relapsing were not taking any antipsychotic. The group that relapsed presented higher mean antipsychotics doses (381.93 vs. 242.29 mg of chlorpromazine equivalent/day, p = 0.028) and higher rates of antipsychotic polytherapy (28.6% vs. 13%, p < 0.001), benzodiazepines use (30.8% vs. 8.5%, p < 0.001), side effects reports (39.2% vs. 25%, p = 0.022), psychological treatment (51.8% vs. 33.9%, p = 0.03), and cannabis consumption (93.2% vs. 56.7%, p < 0.001). Clozapine use was notably higher in the group that reminded in remission (21.7% vs. 8.2%, p < 0.019). These findings may guide clinicians to detect subgroups of patients with higher risk to present a second episode of psychosis, focusing on measures to ensure an adequate treatment or facilitating cannabis use cessation. This study supports future research to identify relapse prevention strategies for patients in early phases of schizophrenia.
Collapse
|
16
|
Demuth S, Guillaume M, Bourre B, Ciron J, Zephir H, Sirejacob Y, Kerbrat A, Lebrun-Frenay C, Papeix C, Michel L, Laplaud D, Vukusic S, Maillart E, Cohen M, Audoin B, Marignier R, Collongues N. Treatment regimens for neuromyelitis optica spectrum disorder attacks: a retrospective cohort study. J Neuroinflammation 2022; 19:62. [PMID: 35236386 PMCID: PMC8892703 DOI: 10.1186/s12974-022-02420-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/21/2022] [Indexed: 11/29/2022] Open
Abstract
Background Neuromyelitis optica spectrum disorder (NMOSD) attacks require an urgent probabilistic anti-inflammatory therapeutic strategy. As inadequately treated attacks result in disability, there is a need to identify the optimal attack-treatment regimen. Our study aimed to identify predictors of outcome after a first attack in patients with an NMOSD presentation and propose the best treatment strategy. Methods We performed a retrospective cohort study on the French national NMOSD registry (NOMADMUS), a nested cohort of the French multiple sclerosis observatory (OFSEP) recruiting patients with NMOSD presentations in France. We studied the first attack for any independent locations of clinical core characteristic of NMOSD, in treatment-naïve patients. The primary outcome was the evolution of the Expanded Disability Status Scale (EDSS) score at 6 months, stratified in two ways to account for recovery (return to baseline EDSS score) and treatment response (classified as “good” if the EDSS score decreased by ≥ 1 point after a nadir EDSS score ≤ 3, or by ≥ 2 points after a nadir EDSS score > 3). We used ordinal logistic regression to infer statistical associations with the outcome. Results We included 211 attacks among 183 patients (104 with anti-AQP4 antibodies, 60 with anti-MOG antibodies, and 19 double seronegative). Attack treatment regimens comprised corticosteroids (n = 196), plasma exchanges (PE; n = 72) and intravenous immunoglobulins (n = 6). Complete recovery was reached in 40 attacks (19%) at 6 months. The treatment response was “good” in 134 attacks (63.5%). There was no improvement in EDSS score in 50 attacks (23.7%). MOG-antibody seropositivity and short delays to PE were significantly and independently associated with better recovery and treatment response. Conclusions We identified two prognostic factors: serostatus (with better outcomes among MOG-Ab-positive patients) and the delay to PE. We, therefore, argue for a more aggressive anti-inflammatory management of the first attacks suggesting an NMOSD presentation, with the early combination of PE with corticosteroids.
Collapse
Affiliation(s)
- Stanislas Demuth
- Department of Neurology, Strasbourg University Hospital, Strasbourg, France
| | | | - Bertrand Bourre
- CHU de Rouen / Rouen University Hospital, 76000, Rouen, France
| | - Jonathan Ciron
- Department of Neurology, CRC-SEP, CHU Toulouse, 31059, Toulouse Cedex 9, France.,Institut Toulousain des Maladies infectieuses et Inflammatoires (Infinity), INSERM UMR1291 - CNRS UMR5051, Université Toulouse III, Toulouse, France.,Department of Neurology, CHU Poitiers, 86021, Poitiers, France
| | - Hélène Zephir
- Department of Neurology, Inserm U 1172, University Hospital of Lille, University of Lille, Lille, France
| | - Yoann Sirejacob
- Department of Clinical Research, Rouen University Hospital, 76000, Rouen, France
| | - Anne Kerbrat
- Department of Neurology, Rennes University Hospital, 35033, Rennes, France
| | - Christine Lebrun-Frenay
- Department of Neurology, CHU de Nice, UR2CA-URRIS, Nice Côte d'Azur University, Nice, France
| | - Caroline Papeix
- Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, 75013, Paris, France
| | - Laure Michel
- Department of Neurology, Rennes University Hospital, 35033, Rennes, France.,CRTI-InsermU1064, Nantes, France.,CHU de Nantes, Université de Nantes, Nantes, France
| | | | - Sandra Vukusic
- Department of Neurology, Hôpital Neurologique, Hospices Civils de Lyon, Bron, France
| | - Elisabeth Maillart
- Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, 75013, Paris, France
| | - Mikael Cohen
- Department of Neurology, CHU de Nice, UR2CA-URRIS, Nice Côte d'Azur University, Nice, France
| | - Bertrand Audoin
- Department of Neurology, University Hospital of Marseille, Marseille, France.,Aix-Marseille University, CRMBM UMR 7339, CNRS, Marseille, France
| | - Romain Marignier
- Department of Neurology, Hôpital Wertheimer, HCL, Bron, France.,Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, 69677, Lyon/Bron, France.,INSERM 1028 et CNRS UMR5292, Centre Des Neurosciences de Lyon, 69003, Lyon, France.,Université Claude Bernard Lyon 1, 69000, Lyon, France
| | - Nicolas Collongues
- Department of Neurology, Strasbourg University Hospital, Strasbourg, France.
| | | |
Collapse
|
17
|
Bernal Cobo R, Giraldo Tapias LM, Gómez Escobar T, Rueda Cárdenas LF, Zapata Berruecos JF, Vásquez Trespalacios EM, Giraldo Castrillón YM, Rojas-Gualdrón DF. Factors involved in time reduction between seizure relapses in patients with epilepsy attending emergency rooms in Medellín, Colombia. Epilepsy Behav 2022; 126:108458. [PMID: 34906900 DOI: 10.1016/j.yebeh.2021.108458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 11/08/2021] [Accepted: 11/21/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Seizure relapses are the leading cause of admission to emergency rooms (ER) in people with epilepsy. OBJECTIVE To analyze administrative and clinical factors associated with the duration between seizure relapses in people with epilepsy admitted to the Neurological Institute of Colombia (Medellin) between July 2018 and July 2019. MATERIALS AND METHODS A retrospective follow-up study of 156 patients over 18 years old, diagnosed with epilepsy, and treated for over a year. The outcome variable was the time between seizure relapses, identified through the record of ER attendances. In addition, difficulties in the prescription filling process (delay, omission, or brand change) and clinical characteristics were analyzed as potential associated influence factors. The statistical analysis was performed using the Prentice, Williams & Peterson-Gap Time survival model for recurrent events. Finally, Adjusted Hazard Ratios (aHR) with 95% confidence intervals (95%CI) are also presented. RESULTS One hundred fifty-six patients were analyzed. Their average age of diagnosis was 15.5 years (SD = 22.5), the median number of monthly seizures was 3 (SD = 9.3), and 50.6% were women. Moreover, difficulties in the prescription filling process were associated with a time reduction between seizure relapses (aHR = 2.61; 95%CI 1.49-4.57), showing a similar impact as having a history of three or four types of events (aHR = 2.96; 95%CI 1.23-7.12) and neuropsychiatric comorbidity (aHR = 1.89; 95%CI 1.04-3.54). CONCLUSION Neuropsychiatric comorbidity, history of several types of events, and experiencing difficulties with prescription filling are associated with lower benefit from treatment to control seizure relapses.
Collapse
Affiliation(s)
- Rafael Bernal Cobo
- Residente Universidad CES, Instituto Neurológico de Colombia, Medellín, Colombia
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Carnero Contentti E, Lopez PA, Pettinicchi JP, Criniti J, Pappolla A, Miguez J, Patrucco L, Cristiano E, Liwacki S, Tkachuk V, Balbuena ME, Vrech C, Deri N, Correale J, Marrodan M, Ysrraelit MC, Leguizamon F, Luetic G, Menichini ML, Tavolini D, Mainella C, Zanga G, Burgos M, Hryb J, Barboza A, Lazaro L, Alonso R, Fernández Liguori N, Nadur D, Chercoff A, Alonso Serena M, Caride A, Paul F, Rojas JI. Seasonal variation in attacks of neuromyelitis optica spectrum disorders and multiple sclerosis: Evaluation of 794 attacks from a nationwide registry in Argentina. Mult Scler Relat Disord 2021; 58:103466. [PMID: 34929456 DOI: 10.1016/j.msard.2021.103466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/12/2021] [Accepted: 12/11/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Identification of triggers that potentially instigate attacks in neuromyelitis optica spectrum disorders (NMOSD) and multiple sclerosis (MS) has remained challenging. We aimed to analyze the seasonality of NMOSD and MS attacks in an Argentinean cohort seeking differences between the two disorders. METHODS A retrospective study was conducted in a cohort of NMOSD and MS patients followed in specialized centers from Argentina and enrolled in RelevarEM, a nationwide, longitudinal, observational, non-mandatory registry of MS/NMOSD patients. Patients with complete relapse data (date, month and year) at onset and during follow-up were included. Attack counts were analyzed by month using a Poisson regression model with the median monthly attack count used as reference. RESULTS A total of 551 patients (431 MS and 120 NMOSD), experiencing 236 NMOSD-related attacks and 558 MS-related attacks were enrolled. The mean age at disease onset in NMOSD was 39.5 ± 5.8 vs. 31.2 ± 9.6 years in MS (p < 0.01). Mean follow-up time was 6.1 ± 3.0 vs. 7.4 ± 2.4 years (p < 0.01), respectively. Most of the included patients were female in both groups (79% vs. 60%, p < 0.01). We found a peak of number of attacks in June (NMOSD: 28 attacks (11.8%) vs MS: 33 attacks (5.9%), incidence rate ratio 1.82, 95%CI 1.15-2.12, p = 0.03), but no differences were found across the months in both disorders when evaluated separately. Strikingly, we observed a significant difference in the incidence rate ratio of attacks during the winter season when comparing NMOSD vs. MS (NMOSD: 75 attacks (31.7%) vs MS: 96 attacks (17.2%), incidence rate ratio 1.82, 95%CI 1.21-2.01, p = 0.02) after applying Poisson regression model. Similar results were observed when comparing the seropositive NMOSD (n = 75) subgroup vs. MS. CONCLUSIONS Lack of seasonal variation in MS and NMOSD attacks was observed when evaluated separately. Future epidemiological studies about the effect of different environmental factors on MS and NMOSD attacks should be evaluated prospectively in Latin America population.
Collapse
Affiliation(s)
- Edgar Carnero Contentti
- Department of Neurosciences, Neuroimmunology Unit, Hospital Alemán, Av. Pueyrredón 1640, Buenos Aires C1118AAT, Argentina.
| | - Pablo A Lopez
- Department of Neurosciences, Neuroimmunology Unit, Hospital Alemán, Av. Pueyrredón 1640, Buenos Aires C1118AAT, Argentina
| | - Juan Pablo Pettinicchi
- Department of Neurosciences, Neuroimmunology Unit, Hospital Alemán, Av. Pueyrredón 1640, Buenos Aires C1118AAT, Argentina
| | - Juan Criniti
- Department of Neurosciences, Neuroimmunology Unit, Hospital Alemán, Av. Pueyrredón 1640, Buenos Aires C1118AAT, Argentina
| | - Agustín Pappolla
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Jimena Miguez
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Liliana Patrucco
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Susana Liwacki
- Clínica Universitaria Reina Fabiola, Córdoba, Argentina; Servicio de Neurología - Hospital Córdoba, Córdoba, Argentina
| | - Verónica Tkachuk
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA, Argentina
| | - María E Balbuena
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA, Argentina
| | - Carlos Vrech
- Departamento de Enfermedades desmielinizantes - Sanatorio Allende, Córdoba, Argentina
| | - Norma Deri
- Centro de Investigaciones Diabaid, CABA, Argentina
| | | | | | | | | | | | | | | | | | - Gisela Zanga
- Unidad asistencial César Milstein, CABA, Argentina
| | - Marcos Burgos
- Servicio de Neurología - Hospital San Bernardo, Salta, Argentina
| | - Javier Hryb
- Servicio de Neurología - Hospital Carlos G. Durand, CABA, Argentina
| | | | | | | | | | - Débora Nadur
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA, Argentina; Hospital Naval, CABA, Argentina
| | - Aníbal Chercoff
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA, Argentina
| | | | - Alejandro Caride
- Department of Neurosciences, Neuroimmunology Unit, Hospital Alemán, Av. Pueyrredón 1640, Buenos Aires C1118AAT, Argentina
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Juan I Rojas
- Centro de esclerosis múltiple de Buenos Aires, CABA, Argentina; Servicio de Neurología, Hospital Universitario de CEMIC, CABA, Argentina
| |
Collapse
|
19
|
de Pina-Costa A, Silvino ACR, Dos Santos EM, Pedro RS, Moreira J, Umana GL, da Silva ADT, da Rosa Santos OHL, de Deus Henriques KM, Daniel-Ribeiro CT, Brasil P, Sousa TN, Siqueira AM. Increased primaquine total dose prevents Plasmodium vivax relapses in patients with impaired CYP2D6 activity: report of three cases. Malar J 2021; 20:341. [PMID: 34391426 PMCID: PMC8364036 DOI: 10.1186/s12936-021-03869-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 07/28/2021] [Indexed: 11/25/2022] Open
Abstract
Background The relapsing nature of Plasmodium vivax infection is a major barrier to its control and elimination. Factors such as adequate dosing, adherence, drug quality, and pharmacogenetics can impact the effectiveness of radical cure of P. vivax and need to be adequately evaluated. CYP2D6 pathway mediates the activation of primaquine (primaquine) into an active metabolite(s) in hepatocytes, and impaired activity has been linked to a higher risk of relapse. Cases presentation Three patients diagnosed with P. vivax malaria presented repeated relapses after being initially treated with chloroquine (25 mg/kg) and primaquine (3.5 mg/kg in 14 days) at a non-endemic travel clinic. Recurring episodes were subsequently treated with a higher dose of primaquine (7 mg/kg in 14 days), which prevented further relapses in two patients. However, one patient still presented two episodes after a higher primaquine dose and was prescribed 300 mg of chloroquine weekly to prevent further episodes. Impaired CYP2D6 function was observed in all of them. Conclusion Lack of response to primaquine was associated with impaired CYP2D6 activity in three patients presenting multiple relapses followed in a non-endemic setting. Higher primaquine dosage was safe and effectively prevented relapses in two patients and should be further investigated as an option in Latin America. It is crucial to investigate the factors associated with unsuccessful radical cures and alternative therapeutic options.
Collapse
Affiliation(s)
- Anielle de Pina-Costa
- Laboratório de Pesquisa Clínica em Doenças Febris Agudas-Instituto Nacional de Infectologia (INI) Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil.,Centro de Pesquisa Diagnóstico e Treinamento em Malária-Fiocruz, Rio de Janeiro, Brazil.,Centro Universitário Serra Dos Órgãos (UNIFESO), Teresópolis, RJ, Brazil
| | | | - Edwiges Motta Dos Santos
- Laboratório de Pesquisa Clínica em Doenças Febris Agudas-Instituto Nacional de Infectologia (INI) Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Renata Saraiva Pedro
- Laboratório de Pesquisa Clínica em Doenças Febris Agudas-Instituto Nacional de Infectologia (INI) Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil.,Assessoria Clínica-Instituto em Tecnologia em Imunobiológicos-Fiocruz, Rio de Janeiro, Brazil
| | - José Moreira
- Laboratório de Pesquisa Clínica em Doenças Febris Agudas-Instituto Nacional de Infectologia (INI) Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil.,Programa de Pós-Graduação Em Pesquisa Clínica, INI Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Gabriela Liseth Umana
- Laboratório de Pesquisa Clínica em Doenças Febris Agudas-Instituto Nacional de Infectologia (INI) Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Ana Danielle Tavares da Silva
- Laboratório de Pesquisa Clínica em Doenças Febris Agudas-Instituto Nacional de Infectologia (INI) Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Otília Helena Lupi da Rosa Santos
- Laboratório de Pesquisa Clínica em Doenças Febris Agudas-Instituto Nacional de Infectologia (INI) Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil.,Centro de Pesquisa Diagnóstico e Treinamento em Malária-Fiocruz, Rio de Janeiro, Brazil
| | - Karina Medeiros de Deus Henriques
- Laboratório de Pesquisa Clínica em Doenças Febris Agudas-Instituto Nacional de Infectologia (INI) Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil.,Programa de Pós-Graduação Em Pesquisa Clínica, INI Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Cláudio Tadeu Daniel-Ribeiro
- Centro de Pesquisa Diagnóstico e Treinamento em Malária-Fiocruz, Rio de Janeiro, Brazil.,Laboratório de Pesquisa Em Malária, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Patrícia Brasil
- Laboratório de Pesquisa Clínica em Doenças Febris Agudas-Instituto Nacional de Infectologia (INI) Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil.,Centro de Pesquisa Diagnóstico e Treinamento em Malária-Fiocruz, Rio de Janeiro, Brazil.,Programa de Pós-Graduação Em Pesquisa Clínica, INI Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | | | - André M Siqueira
- Laboratório de Pesquisa Clínica em Doenças Febris Agudas-Instituto Nacional de Infectologia (INI) Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil. .,Centro de Pesquisa Diagnóstico e Treinamento em Malária-Fiocruz, Rio de Janeiro, Brazil. .,Programa de Pós-Graduação Em Pesquisa Clínica, INI Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil.
| |
Collapse
|
20
|
Marrodan M, Crema S, Rubstein A, Alessandro L, Fernandez J, Correale J, Ysrraelit MC. Therapeutic plasma exchange in MS refractory relapses: Long-term outcome. Mult Scler Relat Disord 2021; 55:103168. [PMID: 34332460 DOI: 10.1016/j.msard.2021.103168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/26/2021] [Accepted: 07/22/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Therapeutic plasma exchange (TPE) is considered a treatment option for steroid-refractory multiple sclerosis (MS) relapses. Our objective was to assess long-term clinical response to TPE in MS steroid-refractory exacerbations. METHODS Retrospective study of relapsing remitting MS (RRMS) patients presenting intravenous methylprednisolone (IVMPS)-refractory relapses, who underwent TPE. Response to TPE was assessed at 1, 3, 6, 12 and 24-months post-treatment, and compared to a second group of RRMS patients with similar demographic and clinical characteristics presenting, IVMPS-refractory relapses but not treated with TPE. Multivariate regression analysis was used to assess potential predictors of significant clinical response. RESULTS Between 2011 to 2020, a total of 23 RRMS patients were treated with TPE. Twenty-one patients not receiving the treatment served as controls. No differences in demographic or clinical characteristics, or predictors of clinical improvement after TPE were detected between groups. Seventy-eight percent of patients treated with TPE presented clinical improvement at 24 months. TPE-treated patients presented lower EDSS scores at 6 and at 24 months. Younger age, presence of gadolinium-enhancing lesions and TPE treatment were associated with better clinical outcomes. No life-threatening side effects were reported. CONCLUSIONS TPE is a safe and well tolerated procedure that decreases long-term disability in RRMS patients with IVMPS-refractory relapses.
Collapse
|
21
|
|
22
|
Liu P, Shen L, Wang S, Qin P, Si Y, Pan M, Zeng W, Qin Y, Chen X, Zhang Y, Li C, Xiang Z, Menezes L, Huang Y, Cui L, Yang Z. Increasing proportions of relapsing parasite species among imported malaria in China's Guangxi Province from Western and Central Africa. Travel Med Infect Dis 2021; 43:102130. [PMID: 34166802 DOI: 10.1016/j.tmaid.2021.102130] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/14/2021] [Accepted: 06/16/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Travel-related malaria in non-endemic areas returning from endemic areas presents important challenges to diagnosis and treatment. Imported malaria to newly malaria-free countries poses further threats of malaria re-introduction and potential resurgence. For those traveling to places with high Plasmodium falciparum prevalence, prophylaxis against this parasite is recommended, whereas causal prophylaxis against relapsing malaria is often overlooked. METHODS We analyzed a cluster of imported malaria among febrile patients in Shanglin County, Guangxi Province, China, who had recent travel histories to Western and Central Africa. Malaria was diagnosed by microscopy and subsequently confirmed by species- and subspecies-specific PCR. Plasmodium vivax was genotyped using a barcode consisting of 42 single nucleotide polymorphisms. RESULTS Investigations of 344 PCR-confirmed malaria cases revealed that in addition to Plasmodium falciparum being the major parasite species, the relapsing parasites Plasmodium ovale and P. vivax accounted for ~40% of these imported cases. Of the 114 P. ovale infections, 65.8% and 34.2% were P. ovale curtisi and P. ovale wallikeri, respectively, with the two subspecies having a ~2:1 ratio in both Western and Central Africa. Phylogenetic analysis of 14 P. vivax isolates using a genetic barcode demonstrated that 11 formed a distinct clade from P. vivax populations from Eastern Africa. CONCLUSION This study provides support for active P. vivax transmission in areas with the predominant Duffy-negative blood group. With relapsing malaria making a substantial proportion of the imported malaria, causal prophylaxis should be advocated to travelers with a travel destination to Western and Central Africa.
Collapse
Affiliation(s)
- Penglu Liu
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, Yunnan Province, 650500, China
| | - Lijie Shen
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, Yunnan Province, 650500, China
| | - Siqi Wang
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, Yunnan Province, 650500, China
| | - Pien Qin
- Shanglin County People's Hospital, Shanglin, Guangxi, 530500, China
| | - Yu Si
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, Yunnan Province, 650500, China
| | - Maohua Pan
- Shanglin County People's Hospital, Shanglin, Guangxi, 530500, China
| | - Weilin Zeng
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, Yunnan Province, 650500, China
| | - Yucheng Qin
- Shanglin County People's Hospital, Shanglin, Guangxi, 530500, China
| | - Xi Chen
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, Yunnan Province, 650500, China
| | - Yanmei Zhang
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, Yunnan Province, 650500, China
| | - Cuiying Li
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, Yunnan Province, 650500, China
| | - Zheng Xiang
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, Yunnan Province, 650500, China
| | - Lynette Menezes
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, 3720 Spectrum Boulevard, Suite 304, MDC84, Tampa, FL, 33612, USA
| | - Yaming Huang
- Guangxi Center for Disease Prevention and Control, Nanning, Guangxi, 530021, China
| | - Liwang Cui
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, 3720 Spectrum Boulevard, Suite 304, MDC84, Tampa, FL, 33612, USA.
| | - Zhaoqing Yang
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, Yunnan Province, 650500, China.
| |
Collapse
|
23
|
Royston M, Kielhorn A, Weycker D, Shaff M, Houde L, Tanvir I, Bhattacharyya S, Levy M. Neuromyelitis Optica Spectrum Disorder: Clinical Burden and Cost of Relapses and Disease-Related Care in US Clinical Practice. Neurol Ther 2021; 10:767-783. [PMID: 34046846 PMCID: PMC8571448 DOI: 10.1007/s40120-021-00253-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/22/2021] [Indexed: 12/30/2022] Open
Abstract
Introduction Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune condition characterized by unpredictable relapses that affect the optic nerves and spinal cord, which can lead to blindness, paralysis, and increased mortality rates. Evidence on the clinical and economic burden of NMOSD in the USA is currently lacking. Methods A retrospective, observational cohort study was conducted using data from the IQVIA PharMetrics Plus Healthcare Claims Database between January 1, 2012 and March 31, 2019. Adults (aged 18 years or more) with evidence of NMOSD and a matched group of comparison patients were identified. Outcomes, including NMOSD relapses, healthcare utilization, and healthcare expenditure (reported in 2018 US dollars), were evaluated during the follow-up period (maximum 6 years). Healthcare utilization and expenditure were assessed overall (all-cause) and during NMOSD relapses. Results The study included 1363 patients with NMOSD; the mean age was 44.9 years, and 75.3% were female. During the follow-up period (median 2.0 years), 47.7% of patients with NMOSD had one or more relapses, corresponding to an annualized relapse rate of 0.8 (95% confidence interval [CI] 0.7–0.9). When analyzing healthcare expenditure per patient, the mean annualized all-cause healthcare expenditure among patients with NMOSD was $60,599 (95% CI $52,112–66,716) compared with $8912 (95% CI $7084–10,727) among comparison patients, representing a difference of $51,687 (95% CI $43,820–58,664) attributable to NMOSD. The mean annualized total expenditure for NMOSD relapses was $10,070 (95% CI $7726–12,660) per patient, with hospital/inpatient care requiring more expenditure than ambulatory/outpatient care. Conclusion Findings of this large, retrospective, observational study indicate that relapses among patients with NMOSD are common in US clinical practice, leading to substantial healthcare utilization and expenditure. Therapies with the highest relapse risk reduction could lead to markedly lower relapse-associated healthcare utilization and clinical burden in patients with NMOSD. Supplementary Information The online version contains supplementary material available at 10.1007/s40120-021-00253-4. Neuromyelitis optica spectrum disorder (NMOSD) is a severely debilitating neurological disease that affects the nerves in the brain and spinal cord. People who have NMOSD may experience recurrent attacks, or relapses, that can cause blindness and disability. These relapses may lead to hospitalizations, doctor’s office visits, and pharmacy costs that are paid by health insurance plans. Overall, the cost of treating relapses in patients with NMOSD is substantial. Our study analyzed healthcare claims data from the USA. During a median follow-up time of 2.0 years, our study showed that 47.7% of patients with NMOSD experienced one or more relapses, resulting in hospital/inpatient admissions and ambulatory/outpatient treatments. In addition, the average healthcare cost among patients with NMOSD was $60,599 per year compared with $8912 per year for patients without NMOSD. This represents a difference of $51,687 per year, which can be attributed to NMOSD. Among patients with three or more relapses during the follow-up period, the average total healthcare cost was more than $83,000 per patient. Therefore, medicines that prevent relapses could lead to fewer relapse-associated hospitalizations and outpatient treatments for patients with NMOSD.
Collapse
Affiliation(s)
| | | | - Derek Weycker
- Policy Analysis Inc. (PAI), 822 Boylston Street, Suite 206, Chestnut Hill, MA, 02467, USA.
| | - Melody Shaff
- Policy Analysis Inc. (PAI), 822 Boylston Street, Suite 206, Chestnut Hill, MA, 02467, USA
| | - Linnea Houde
- Policy Analysis Inc. (PAI), 822 Boylston Street, Suite 206, Chestnut Hill, MA, 02467, USA
| | | | - Shamik Bhattacharyya
- Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Michael Levy
- Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
24
|
Tseng YC, Chang YC, Lee C, Hsu SF, Chang PC, Hsu JJ, Lin PB, Lu MC, Tien N, Hsiao CT. Molecular diagnosis and therapy for Plasmodium ovale infection of a returned traveler from East Africa. J Formos Med Assoc 2022; 121:434-8. [PMID: 33966940 DOI: 10.1016/j.jfma.2021.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 11/22/2022] Open
Abstract
Malaria is an infectious disease caused by Plasmodium parasites that are mainly transmitted through the bites of infected female Anopheles mosquitoes. The average annual number of malaria cases was less than ten in Taiwan in the last five years. Most of the cases were caused by Plasmodium vivax and Plasmodium falciparum, and were primarily diagnosed in travelers who returned from Southeast Asia and Africa. Here, we report the first case of Plasmodium ovale infection within five years that was confirmed by peripheral blood smear examination and molecular identification in a 25-year-old Asian female patient who returned from Uganda.
Collapse
|
25
|
Boudot de la Motte M, Louapre C, Papeix C, Depaz R, Assouad R, Roux T, Lubetzki C, Maillart E. Challenges of switching towards anti-CD20 monoclonal antibodies in RR-MS: A monocentric study. Mult Scler Relat Disord 2021; 52:102981. [PMID: 34004434 DOI: 10.1016/j.msard.2021.102981] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/22/2021] [Accepted: 04/22/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Anti-CD20 monoclonal antibodies (mAb) have demonstrated their drastic efficacy in the treatment of active relapsing-remitting multiple sclerosis (RR-MS). This study investigates the management of their initiation after another disease modifying therapy (DMT). The objective of this study was to assess the frequency and the risk factors of relapses during the wash-out period (WP) between cessation of last DMT and initiation of anti-CD20 mAb in RR-MS. METHODS All non-naive RR-MS patients who initiated a treatment with Rituximab or Ocrelizumab between 2016 and 2019 have been included in this retrospective monocentric study. Univariate and multivariate analysis were conducted to evaluate risk factors of relapses during the WP. RESULTS 73 patients (mean age 35.3 years, standard deviation (SD): 8.7 years) were included, with a mean number of 3.1 (SD: 1.3) previous DMTs. The DMT most frequently received before the switch was Fingolimod (Fg, 31 patients, 42.5%). 20 patients (27.4%) experienced relapses during the WP. Risk factors were previous treatment by Fg (p = 0.001) and WP duration (p = 0.032). Among patients switching from Fg, the probability of experiencing a relapse was 35% after 1 month of wash-out. CONCLUSION This study suggests to shorten the WP duration when switching towards anti-CD20 mAb, especially after Fg, to avoid relapses.
Collapse
|
26
|
Kuschnir RC, Pereira LS, Dutra MRT, de Paula L, Silva-Freitas ML, Corrêa-Castro G, da Costa Cruz Silva S, Cota G, Santos-Oliveira JR, Da-Cruz AM. High levels of anti-Leishmania IgG3 and low CD4 + T cells count were associated with relapses in visceral leishmaniasis. BMC Infect Dis 2021; 21:369. [PMID: 33874901 DOI: 10.1186/s12879-021-06051-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/08/2021] [Indexed: 01/10/2023] Open
Abstract
Background Visceral leishmaniasis (VL) is severe and potentially fatal. Brazil is one of the countries with the greatest endemicity for the disease in the world. The reduction of CD4+ T lymphocytes, B cells activation and high levels of inflammatory cytokines (IL-6/IL-8/TNF/IL-1β), plasma LPS, soluble CD14, anti-Leishmania IgG3 and low leptin levels are involved in the immunopathogenesis of VL, most associated with severe VL. Despite relapses occurring in about 4–5% of patients with VL not associated with HIV infection, the factors underlying relapses are little known. Our aim was to identify clinical, laboratory and immunological parameters that may be associated with recurrences in VL. Methods Fifteen VL patients recruited from Hospital Eduardo de Menezes (BH-MG) were grouped into relapsing (R-VL, n = 5) and non-relapsing (NR-VL, n = 10) and evaluated during active disease, immediately after treatment (post-treatment) and 6 months post-treatment (6mpt). Clinical and laboratory data obtained from medical records were correlated with CD4+ and CD8+ T cell counts and anti-Leishmania Igs and IL-6 plasma levels and compared to those parameters of ten healthy controls. Results During the active phase of VL, despite similarity in the clinical symptoms, the rates of thrombocytopenia, elevated transaminases (AST and ALT) and hyperbilirubinemia were higher in the NR-VL group compared to R-VL (p < 0.05), a profile reversed during the post-treatment phase. All patients had low CD4+ T counts in active phase, however, NR-VL patients had a higher gain of this cell type than R-VL in the post-treatment (p < 0.05). There was a significant reduction in IgG3 levels during the follow-up in the NR-VL group compared to the R-VL, especially at 6mpt (p < 0.05). In addition, IgG3 levels were negatively correlated with CD4+ T counts in the R-VL group (r = − 0.52). Elevated levels of IL-6 were observed in active VL and correlated with clinical markers of severity. Conclusions During active phase of VL, the NR-VL patients presented more severe laboratorial abnormalities compared to R-VL, probably because the latter had already received previous treatment. On the other hand, R-VL exhibited greater impairment of immune reconstitution and a high degree of B lymphocyte activation, which must be a factor that favored relapses. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06051-5.
Collapse
|
27
|
Santangelo G, Corte MD, Sparaco M, Miele G, Garramone F, Cropano M, Esposito S, Lavorgna L, Gallo A, Tedeschi G, Bonavita S. Coping strategies in relapsing-remitting multiple sclerosis non-depressed patients and their associations with disease activity. Acta Neurol Belg 2021; 121:465-71. [PMID: 31571134 DOI: 10.1007/s13760-019-01212-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 09/19/2019] [Indexed: 10/25/2022]
Abstract
Few studies evaluated coping strategies in people with multiple sclerosis (pwMS) in relation to annualized relapse rate (ARR) and lesion load (LL). Overall, results might have been influenced by the inclusion of depressed patients. To investigate the coping strategies and their association to disease activity, we studied relapsing-remitting pwMS accurately selected to avoid the confounding effect of depression. Sixty-seven relapsing-remitting pwMS and 67 healthy subjects (HS) underwent to Coping Orientation to Problems Experienced (I-COPE) and Coping Inventory for Stressful Situation (CISS) and Beck Depression Inventory-II. Cognitive performances, ARR, physical disability and magnetic resonance imaging T2-LL were assessed for correlation with coping and depression scores. pwMS showed lower scores than HSs on social support and turning to religion subscales of I-COPE and on emotion dimension of CISS. In pwMS, higher ARR was related to higher positive attitude and lower score on the turning to religion subscale of I-COPE. The present study revealed a less employment of emotion-based coping strategies in pwMS. A scarce use of faith for support and a frequent adoption of a positive attitude were associated with an increase of MS activity in terms of ARR.
Collapse
|
28
|
Bouvet L, Fontana M, Bouthors AS, Bonnin M, Storme B, Bayoumeu F, Corsia G, Vukusic S, Chassard D. Post-partum relapse in women with multiple sclerosis after neuraxial labour analgesia or neuraxial anaesthesia: A multicentre retrospective cohort study. Anaesth Crit Care Pain Med 2021; 40:100834. [PMID: 33753296 DOI: 10.1016/j.accpm.2021.100834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/01/2020] [Accepted: 09/29/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND The proportion of women with multiple sclerosis experiencing a relapse in the post-partum period after neuraxial labour analgesia or neuraxial anaesthesia remains uncertain. This study aimed to assess the association between neuraxial labour analgesia or neuraxial anaesthesia and the occurrence of relapse during the first three months post-partum. METHODS In this retrospective cohort study, cases of women with a diagnosis of multiple sclerosis delivering between January 2010 and April 2015 were analysed. Demographic, anaesthetic and obstetric characteristics, occurrence and number of relapses in the year preceding pregnancy, during pregnancy, and the first three post-partum months, were recorded. Logistic regression analyses were performed for the identification of factors associated with the occurrence of post-partum relapse. RESULTS A total of 118 deliveries in 104 parturients were included, these were 78 (66%) vaginal deliveries and 40 (34%) caesarean deliveries. Neuraxial analgesia was provided in 50 deliveries, and neuraxial anaesthesia in 46 deliveries; no neuraxial anaesthesia or analgesia was administered in remaining 22 deliveries. Post-partum relapse occurred in 31 women (26%). There was no association between obstetric or anaesthetic characteristics and post-partum relapse. Both the occurrence and number of relapses prior to and during pregnancy, and the time between last relapse and delivery, were significantly associated with post-partum relapse in univariate analysis. The occurrence of relapse within the year preceding the pregnancy was the sole independent factor associated with post-partum relapse. CONCLUSION Neuraxial procedures were not associated with increased rate of post-partum relapse; only disease activity prior to pregnancy was predictive of post-partum relapse.
Collapse
|
29
|
Zecca C, Disanto G, Riccitelli GC, Candrian U, Deandrea M, Limone PP, Sacco R, Gobbi C. A randomized pilot trial of oral prednisone taper vs placebo following iv methylprednisolone for multiple sclerosis relapses: Effects on adrenal function and clinical efficacy. Mult Scler Relat Disord 2021; 50:102867. [PMID: 33677411 DOI: 10.1016/j.msard.2021.102867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/26/2021] [Accepted: 02/22/2021] [Indexed: 11/23/2022]
Abstract
We performed a pilot trial investigating the effect of a steroid taper on adrenal function and safety measures after acute MS relapses. Twenty-five patients were randomized to either prednisone taper (n=12) or placebo (n=13) after 3 days of intravenous methylprednisolone. No patient showed signs of adrenal insufficiency at any time by cortisol response to ACTH. This significantly increased between baseline and 6 months in both groups. Patients remained clinically and radiologically stable, but those under prednisone taper experienced more frequently mood disorders, hyperglycaemia and weight increase. If confirmed by sufficiently powered studies, these results would question the need of a steroid taper following short-term intravenous methylprednisolone.
Collapse
|
30
|
Martínez-Loredo V, Macipe V, Errasti Pérez JM, Al-Halabí S. Clinical symptoms and personality traits predict subpopulations of treatment-seeking substance users. J Subst Abuse Treat 2021; 125:108314. [PMID: 34016301 DOI: 10.1016/j.jsat.2021.108314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/09/2020] [Accepted: 01/25/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND The heterogeneity of treatment-seeking substance users represents a challenge, as most studies include participants having problems with specific substances or merge polysubstance users into the same category without considering differences between profiles. Considering the inconsistent literature on predictors of treatment outcomes, this study aimed to identify subpopulations of individuals with substance use disorders (SUDs) and analyze the association among class membership, previous relapses, and treatment retention. METHODS The study recruited a total of 159 participants (mean age = 40.60, SD = 8.70; 85.5% males) from two treatment facilities (outpatient daycare and inpatient residential centers). The baseline assessment gathered lifetime and current substance use, and personality and psychopathology measures. The study performed a latent class analysis to identify subpopulations of substance users and explored predictors of class membership using a multinomial regression analysis. RESULTS The study found six different classes of substance users based on their diagnosis and pattern of substance use: class 1 (6.92% of participants): individuals with cannabis as primary substance, alcohol/cocaine as secondary substance and additional use of stimulants or other drugs; class 2 (30.82%): cocaine as primary substance, alcohol as secondary and additional cannabis use; class 3 (20.13%): alcohol as primary substance, cocaine as secondary and additional cannabis use; class 4 (17.61%): cocaine as primary substance, cannabis as secondary and additional alcohol/other drugs use; class 5 (16.35%): alcohol as primary and cannabis as secondary substance; class 6 (8.18%): heroin as primary substance, cocaine as secondary and additional alcohol use. Several traits and clinical symptoms predicted distinct class memberships. Participants pertaining to class 6 presented the highest number of relapses (M = 2.54, SD = 1.56). CONCLUSIONS These results have several clinical implications. Belonging to class 6 was associated with a greater number of previous relapses. Also, specific psychopathological symptoms and personality traits may impact SUD treatment response, which may help clinicians to guide initial assessment and treatment allocation.
Collapse
Affiliation(s)
- V Martínez-Loredo
- Department of Psychology, University of Oviedo, Oviedo, Asturias, Spain; Department of Psychology and Sociology, University of Zaragoza, Teruel, Aragón, Spain.
| | - V Macipe
- Department of Psychology, University of Oviedo, Oviedo, Asturias, Spain
| | - J M Errasti Pérez
- Department of Psychology, University of Oviedo, Oviedo, Asturias, Spain
| | - S Al-Halabí
- Department of Psychology, University of Oviedo, Oviedo, Asturias, Spain
| |
Collapse
|
31
|
Vinayagamani S, Sabarish S, Nair SS, Tandon V, Kesavadas C, Thomas B. Quantitative susceptibility-weighted imaging in predicting disease activity in multiple sclerosis. Neuroradiology 2021; 63:1061-1069. [PMID: 33403447 DOI: 10.1007/s00234-020-02605-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/10/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Repeated use of Gadolinium (Gd) contrast for multiple sclerosis (MS) imaging leads to Gd deposition in brain. We aimed to study the utility of phase values by susceptibility weighted imaging (SWI) to assess the iron content in MS lesions to differentiate active and inactive lesions. METHODS MS persons who underwent MRI were grouped into group 1 with active lesions and group 2 with inactive lesions based on the presence or absence of contrast enhancing lesions. Phase values of lesions (PL) and contralateral normal white matter (PN) were calculated using the SPIN software by drawing ROI. Subtracted phase values (PS = PL - PN) and iron content (PS/3) of the lesions were calculated in both groups. RESULTS We analyzed 69 enhancing lesions from 22 patients (group 1) and 84 non-enhancing lesions from 29 patients (group 2). Mean-subtracted phase values and iron content corrected for voxels in ROI were significantly lower in enhancing lesions compared to non-enhancing lesions (p < 0.001). A cut-off value 2.8 μg/g for iron content showed area under the curve of 0.909 with good sensitivity. CONCLUSION Quantification of iron content using SWI phase values holds promise as a biomarker to differentiate active from inactive lesions of MS.
Collapse
Affiliation(s)
- Selvadasan Vinayagamani
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Sekar Sabarish
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Sruthi S Nair
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Vaibhav Tandon
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Chandrasekharan Kesavadas
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Bejoy Thomas
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India.
| |
Collapse
|
32
|
Strålin P, Skott M, Cullberg J. Early predictors for late hospitalizations up to 14 years after first episode psychosis. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1371-1380. [PMID: 33263822 PMCID: PMC8316245 DOI: 10.1007/s00127-020-01991-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/10/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE New hospitalizations after first episode psychosis (FEP) may be viewed as an indicator of instability in a psychotic disorder. In the current study we wanted to analyse long term risk for psychosis hospitalizations after FEP. We also wanted to analyse predictors for late hospitalizations, with focus on early antipsychotic medication. METHODS First episode psychosis cases were recruited to the Swedish Parachute project in 1996-1997. The program offered highly available and continuous psychosocial support and a cautious use of antipsychotic medication for 5 years from inclusion. Longitudinal data from population registers on psychiatric hospitalizations up to 14 years after inclusion were analysed. One hundred and sixty-one cases were included of the original 175 in the project. Associations with possible early predictive factors from the original project data were analysed with COX regression. RESULTS A majority of the cases (67%) had hospitalizations in the first year after inclusion in the study. The cohort then diverged into a group (46%) with new hospitalizations for psychosis after the first year, most of them multiple times, and another group (54%) without new hospitalizations for psychosis, many without any late antipsychotic medication. Forty-two percentage of the cases had antipsychotic medication by month 12, and it was significantly associated with later psychosis hospitalizations (HR = 2.5, p value < 0.001). CONCLUSIONS The study demonstrates that a large part of FEP cases have a good outcome as measured by absence of new hospitalizations for psychosis, and that many cases may terminate antipsychotic medication within a year of FEP onset without later relapses needing hospitalizations.
Collapse
Affiliation(s)
- Pontus Strålin
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Maria Skott
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
| | - Johan Cullberg
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
33
|
Akaishi T, Misu T, Takahashi T, Takai Y, Nishiyama S, Fujimori J, Ishii T, Aoki M, Fujihara K, Nakashima I. Progression pattern of neurological disability with respect to clinical attacks in anti-MOG antibody-associated disorders. J Neuroimmunol 2020; 351:577467. [PMID: 33388541 DOI: 10.1016/j.jneuroim.2020.577467] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/17/2020] [Accepted: 12/20/2020] [Indexed: 12/22/2022]
Abstract
The progression pattern of neurological disability among patients with anti-myelin oligodendrocyte glycoprotein antibody-associated disorders (MOGAD) was evaluated. Neurological disability was evaluated annually for 408 person-years in 50 patients. More than 30% of the patients had clinical relapses in the first 5 years. Disability progression independent of relapse activity (PIRA) was not seen, whereas a stepwise disability progression was observed after clinical attacks in some instances. Disability worsening was more frequent after relapses than after the onset episode (p < 0.01). Similar to patients with anti-aquaporin-4 antibodies, attack-related stepwise disability progression without PIRA is typical in MOGAD, suggesting the importance of relapse prevention.
Collapse
Affiliation(s)
- Tetsuya Akaishi
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan.
| | - Tatsuro Misu
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toshiyuki Takahashi
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Neurology, National Hospital Organization Yonezawa National Hospital, Yonezawa, Japan
| | - Yoshiki Takai
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shuhei Nishiyama
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Juichi Fujimori
- Department of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Tadashi Ishii
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuo Fujihara
- Department of Multiple Sclerosis Therapeutics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Ichiro Nakashima
- Department of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| |
Collapse
|
34
|
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is a rare, relapsing-remitting neuroinflammatory disorder of the central nervous system. Advances in the understanding of NMOSD pathogenesis and identification of the NMO-specific pathogenic anti-AQP4 autoantibody have led to the development of highly effective disease-modifying strategies. Five placebo-controlled, randomized trials for NMOSD have been successfully completed as of 2020. These trials support the efficacy of rituximab and tocilizumab and led to the FDA approval of eculizumab, satralizumab and inebilizumab for NMOSD. Our review provides an update on these evidence-based disease-modifying therapies and discussed the treatment of acute relapses in NMOSD.
Collapse
Affiliation(s)
- Asya Izraelit Wallach
- Alfiero and Lucia Palestroni MS Comprehensive Care Center, Holy Name Medical Center, 718 Teaneck Road, Teaneck, NJ 07666, USA.
| | - Matthew Tremblay
- MS Comprehensive Care Center, RWJ Barnabas Health, 200 South Orange Avenue, Suite 124-A, Livingston, NJ 07039, USA
| | - Ilya Kister
- Department of Neurology, Comprehensive MS Center, NYU Grossman School of Medicine, 240 East 38th Street, New York, NY 10016, USA
| |
Collapse
|
35
|
Moorani KN, Zubair AM, Veerwani NR, Hotchandani HJ. Efficacy of Levamisole in children with Frequent Relapsing and Steroid Dependent Nephrotic Syndrome at Tertiary Care Center-Karachi. Pak J Med Sci 2020; 36:1193-1198. [PMID: 32968379 PMCID: PMC7500995 DOI: 10.12669/pjms.36.6.2337] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objectives: To determine the effectiveness of levamisole in maintaining remission of proteinuria in children with frequent relapsing and steroid dependent nephrotic syndrome (FR/SDNS). Methods: This observational study on 81 children with FR /SDNS was carried out from June 2007 - June 2017 at The Kidney Center-Postgraduate Training Institute, Karachi-Pakistan. Levamisole (leva) along with low dose prednisolone on alternate day (AD) was used after induction of remission with daily oral prednisolone in children with FR/ SDNS for 6-36 months. Patients with steroid resistance were excluded. Data was analyzed using descriptive statistics. Results: Eighty-one patients with FR (66) or SD (15) received levamisole treatment. Mean age at diagnosis was 3.72 ±2.33 years. Levamisole was used on AD in 59.25% and daily in 40.74% of cases. Twenty-four could not complete six months and were excluded, 57 patients completed treatment duration of 15.68±9.93 months and 51 post-leva follow-up of 11.70±11.23 months. Mean leva-dose was 1.73±0.67 mg/kg/ patient. Mean cumulative prednisolone dose per patient before, on-leva and post-leva was 3389.81±2785.22, 2471.97±2024.98 and 661.37± 905.37 mg respectively. Mean relapse rate per year before leva, on -leva and post -leva was 3.30 ±0.50,0.98± 1.1and 0.79±1.27 respectively. Levamisole was effective in 90% of patients. During post-leva follow up, 76.4% patients, maintained remission, whereas 23.5% behaved as FR/SD and require further immunosuppressive therapy. Conclusions: Levamisole was effective in maintaining remission in 90% while on treatment, whereas it maintained remission after discontinuation in 76.4% cases. Levamisole may be used as first steroid sparing agent before other immunosuppressive therapies in children with FR/SDNS. Further studies are required for optimal duration and dosage schedule.
Collapse
Affiliation(s)
- Khemchand N Moorani
- Khemchand N Moorani, FCPS, MCPS, MBBS. Professor of Pediatric Nephrology, Department of Pediatric Nephrology, The Kidney Center Postgraduate Training Institute, Karachi Sindh, Pakistan, Department of Pediatric Nephrology, National Institute of Child Health, JSMU, Karachi, Pakistan
| | - Aasia Mohammad Zubair
- Aasia Mohammad Zubair, FCPS, MBBS. Medical Officer, Department of Pediatric Nephrology, The Kidney Center Postgraduate Training Institute, Karachi Sindh, Pakistan, Department of Pediatric Nephrology, National Institute of Child Health, JSMU, Karachi, Pakistan
| | - Nanga Ram Veerwani
- Nanga Ram Veerwani, FCPS, MBBS. Medical Officer, Department of Pediatric Nephrology, The Kidney Center Postgraduate Training Institute, Karachi Sindh, Pakistan
| | - Harnam Jaichand Hotchandani
- Harnam Jaichand Hotchandani, MBBS. Senior Medical Officer, Department of Pediatric Nephrology, The Kidney Center Postgraduate Training Institute, Karachi Sindh, Pakistan
| |
Collapse
|
36
|
Aparicio J, García Del Muro X, Maroto P, Terrasa J, Castellano D, Bastús R, Gumà J, Sagastibeltza N, Durán I, Ochenduszko S, Meana JA, García-Sánchez J, Arranz JA, Gironés R, Germà JR. Patterns of relapse and treatment outcome after active surveillance or adjuvant carboplatin for stage I seminoma: a retrospective study of the Spanish Germ Cell Cancer Group. Clin Transl Oncol 2020; 23:58-64. [PMID: 32462393 DOI: 10.1007/s12094-020-02393-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/10/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Active surveillance (AS) and adjuvant chemotherapy (AC) with carboplatin are valid alternatives for managing stage I seminoma, and most relapses can be cured with cisplatin-based chemotherapy. However, some reports suggest that AC may modify the classical pattern of recurrences. METHODS We analyzed all relapses observed in a series of 879 patients with stage I seminoma included in 4 consecutive studies of the Spanish Germ Cell Cancer Group. After a median follow-up of 67 months, recurrences were detected in 56/467 (12%) low-risk cases on AS and 13/412 (3%) high-risk cases after AC (p < 0.001). The objective was to describe clinical features, treatment and outcome. Univariate comparisons were performed between both groups. RESULTS No significant differences were found between relapses on AS and those after AC in terms of time to relapse (13 vs 17 months), size (26 vs 27 mm), location (retroperitoneum in 88% vs 85%), and method of detection (computed tomography in 77% vs 69%). Treatment consisted of chemotherapy (etoposide + cisplatin ± bleomycin) in 89% and 92%, respectively. Late relapses (after > 3 years) were seen in 11% vs 7.7% (p = NS) and second or successive recurrences in 1.8 vs 23% (p < 0.05). With a median follow-up of 130 moths, two patients died of seminoma-unrelated causes (AS group) and the rest are alive and disease-free. CONCLUSION In the setting of a risk-adapted treatment of stage I seminoma, the administration of two courses of AC in patients with tumor size > 4 cm and/or rete testis invasion is associated with a higher incidence of second recurrences but does not significantly modify the pattern of relapses or their outcome.
Collapse
Affiliation(s)
- J Aparicio
- Servicio de Oncología Médica, Hospital Universitario y Politécnico La Fe, Avda. Abril Martorell 106, 46026, Valencia, Spain.
| | - X García Del Muro
- Institut Catalá d'Oncologia Hospitalet, IDIBELL, University of Barcelona, Barcelona, Spain
| | - P Maroto
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - J Terrasa
- Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - D Castellano
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - R Bastús
- Hospital Universitari Mútua Terrassa, Terrassa, Spain
| | - J Gumà
- Hospital Universitari Sant Joan, URV, IISPV, Reus, Spain
| | | | - I Durán
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - S Ochenduszko
- Hospital Universitario Doctor Peset, Valencia, Spain
| | - J A Meana
- Hospital General Universitario, Alicante, Spain
| | | | - J A Arranz
- Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - R Gironés
- Servicio de Oncología Médica, Hospital Universitario y Politécnico La Fe, Avda. Abril Martorell 106, 46026, Valencia, Spain
| | - J R Germà
- Institut Catalá d'Oncologia Hospitalet, IDIBELL, University of Barcelona, Barcelona, Spain
| |
Collapse
|
37
|
Izri A, Cojean S, Leblanc C, Cohen Y, Bouchaud O, Durand R. Plasmodium vivax severe imported malaria in two migrants in France. Malar J 2019; 18:422. [PMID: 31842880 PMCID: PMC6916050 DOI: 10.1186/s12936-019-3067-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 12/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With less than one severe case per year in average, Plasmodium vivax is very rarely associated with severe imported malaria in France. Two cases of P. vivax severe malaria occurred in patients with no evident co-morbidity. Interestingly, both cases did not occur at the primary infection but during relapses. CASE PRESENTATIONS Patient 1: A 27-year old male, born in Afghanistan and living in France since 2012, was admitted on August 2015 to the Avicenne hospital because of abdominal pain, intense headache, fever and hypotension. The patient was haemodynamically unstable despite 5 L of filling solution. A thin blood film showed P. vivax trophozoites within the red blood cells. To take care of the septic shock, the patient was given rapid fluid resuscitation, norepinephrine (0.5 mg/h), and intravenous artesunate. Nested polymerase chain reactions of the SSUrRNA gene were negative for Plasmodium falciparum but positive for P. vivax. The patient became apyretic in less than 24H and the parasitaemia was negative at the same time. Patient 2: A 24-year old male, born in Pakistan and living in France, was admitted on August 2016 because of fever, abdominal pain, headache, myalgia, and nausea. The last travel of the patient in a malaria endemic area occurred in 2013. A thin blood film showed P. vivax trophozoites within the red blood cells. The patient was treated orally by dihydroartemisinin-piperaquine and recovered rapidly. Nine months later, the patient returned to the hospital with a relapse of P. vivax malaria. The malaria episode was uncomplicated and the patient recovered rapidly. Three months later, the patient came back again with a third episode of P. vivax malaria. Following a rapid haemodynamic deterioration, the patient was transferred to the intensive care unit of the hospital. In all the patient received 10 L of filling solution to manage the septic shock. After 5 days of hospitalization and a specific treatment, the patient was discharged in good clinical conditions. CONCLUSION Clinicians should be aware of the potential severe complications associated with P. vivax in imported malaria, even though the primary infection is uncomplicated.
Collapse
Affiliation(s)
- Arezki Izri
- Service de Parasitologie- Mycologie, CHU Avicenne, Assistance Publique-Hôpitaux de Paris, 125 rue de Stalingrad, 93009, Bobigny Cedex, France.,Unité des Virus Émergents (UVE: Aix-Marseille Univ-IRD 190-Inserm 1207-IHU Méditerranée Infection), Marseille, France.,UFR SMBH, Université Paris 13, Bobigny, France
| | - Sandrine Cojean
- UMR 8076 CNRS BioCIS, Université Paris-Sud, Université Paris-Saclay, Châtenay-Malabry, France.,Centre National de Référence du Paludisme, hôpital Bichat-Claude Bernard, APHP, Paris, France
| | - Claire Leblanc
- Service de Pédiatrie générale, CHU Jean Verdier, Bondy, France
| | - Yves Cohen
- Réanimation Médico-Chirurgicale, CHU Avicenne, Bobigny, France
| | - Olivier Bouchaud
- Service de Maladies Infectieuses et Tropicales, CHU Avicenne, Bobigny, France
| | - Rémy Durand
- Service de Parasitologie- Mycologie, CHU Avicenne, Assistance Publique-Hôpitaux de Paris, 125 rue de Stalingrad, 93009, Bobigny Cedex, France. .,UMR 8076 CNRS BioCIS, Université Paris-Sud, Université Paris-Saclay, Châtenay-Malabry, France.
| |
Collapse
|
38
|
Mengesha T, Squires N, Oas J, Imitola J. A possible link between intracranial lipomas and localization-related relapses in multiple sclerosis. Mult Scler Relat Disord 2019; 38:101502. [PMID: 31715501 DOI: 10.1016/j.msard.2019.101502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 10/03/2019] [Accepted: 11/04/2019] [Indexed: 11/28/2022]
Abstract
Intracranial lipomas are congenital malformations representing less than 0.5% of intracranial tumors. They are found incidentally and are asymptomatic in the majority of patients. Here we present three patients with Multiple sclerosis (MS) and intracranial lipomas (IL). The patients showed increased flares and burden of disabling and worsening MS symptoms with cognitive, neurovestibular dysfunction, and gait alterations associated with the localization of the Lipoma. The parenchyma near the Lipomas showed areas of demyelination and atrophy. We postulate that the location and content of the Lipomas may participate in the pathophysiology of MS symptoms in these patients. We conclude that in concurrent IL and MS, the lipomas localization may provoke incapacitating relapses.
Collapse
Affiliation(s)
- Thomas Mengesha
- Division of Neuroimmunology and Multiple Sclerosis and Departments of Neurology and Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH, United states; The James Comprehensive Cancer Hospital, Columbus, OH United States
| | - Natalie Squires
- Division of Neuroimmunology and Multiple Sclerosis and Departments of Neurology and Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH, United states; The James Comprehensive Cancer Hospital, Columbus, OH United States
| | - John Oas
- Division of Neuroimmunology and Multiple Sclerosis and Departments of Neurology and Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH, United states; The James Comprehensive Cancer Hospital, Columbus, OH United States
| | - Jaime Imitola
- Division of Neuroimmunology and Multiple Sclerosis and Departments of Neurology and Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH, United states; The James Comprehensive Cancer Hospital, Columbus, OH United States.
| |
Collapse
|
39
|
Corona-Vázquez T, Flores Rivera JDJ, RodríguezViolante M, Cervantes-Arriaga A. Air Pollution, Multiple Sclerosis and its Relevance to Mexico City. Arch Med Res 2019; 50:111-112. [PMID: 31495387 DOI: 10.1016/j.arcmed.2019.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/19/2019] [Accepted: 07/15/2019] [Indexed: 11/30/2022]
Abstract
Long-term exposure to air pollution has been linked with the development of neurodegenerative diseases. The proposed mechanisms include neuroinflammation and brain oxidative stress. Multiple sclerosis (MS) is a neurodegenerative disease with an auto-immune physiopathology and some studies have associated it with long-term exposure to airborne particulate matter. In this opinion we discuss the current body of knowledge regarding air pollution and the risk of MS as well as MS relapses. Also, its relevance in the case of Mexico City is discussed.
Collapse
Affiliation(s)
- Teresa Corona-Vázquez
- Instituto Nacional de Neurología y Neurocirugía, Unidad Clínica de Investigación en Enfermedades Neurodegenerativas, Ciudad de México, Mexico
| | - Jose De Jesus Flores Rivera
- Instituto Nacional de Neurología y Neurocirugía, Unidad Clínica de Investigación en Enfermedades Neurodegenerativas, Ciudad de México, Mexico
| | - Mayela RodríguezViolante
- Instituto Nacional de Neurología y Neurocirugía, Unidad Clínica de Investigación en Enfermedades Neurodegenerativas, Ciudad de México, Mexico
| | - Amin Cervantes-Arriaga
- Instituto Nacional de Neurología y Neurocirugía, Unidad Clínica de Investigación en Enfermedades Neurodegenerativas, Ciudad de México, Mexico.
| |
Collapse
|
40
|
Ghorbani Behnam S, Mousavi SA, Emamian MH. The effects of transcranial direct current stimulation compared to standard bupropion for the treatment of tobacco dependence: A randomized sham-controlled trial. Eur Psychiatry 2019; 60:41-8. [PMID: 31100611 DOI: 10.1016/j.eurpsy.2019.04.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 04/25/2019] [Accepted: 04/28/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Current treatments for smoking cessation are not effective for most smokers. This study aims to examine the effectiveness of transcranial Direct Current Stimulation (tDCS) on smoking cessation. METHODS In this randomized, sham-controlled trial study, tobacco-dependent (by DSM-5) male participants were recruited from the general public invitation. Participants were randomly allocated to 5 groups; (A), treatment with 300 mg bupropion for 8 weeks; (B), active tDCS (20 sessions for 4 weeks); (C), sham for group B ; (D), active tDCS (20 sessions for 12 weeks), and (E), sham for group D. The electrode montage was anode F3 and cathode F4. Study outcomes include salivary cotinine, Fagerstrom test for nicotine dependence, and smoked cigarette per day, were examined on three time points. Repeated-measures analysis of variances and the generalized estimation equation (GEE) model were employed for data analysis. RESULTS Among 210 volunteers, 170 participants completed the study. Mean age of participants was 42.9 years, ranging from 21 to 64 years. The 6-month point abstinence rates in groups A, B and D were 20%, 7% and 25.7%, and in C, D sham groups were 3.1% and 3% respectively. Results of the GEE model showed that although group D was not different from group A in abstinence rate, i.e., salivary cotinine >4 (p = 0.266), nicotine dependency by Fagerstrom test was lower in this group compared to group A (p = 0.019). CONCLUSIONS The 12-week tDCS had a clinically good therapeutic effect on smoking cessation and its dependency. It may be a substitute for bupropion treatment.
Collapse
|
41
|
Chen N, Dowd S, Gatton ML, Auliff A, Edstein MD, Cheng Q. Cytochrome P450 2D6 profiles and their relationship with outcomes of primaquine anti-relapse therapy in Australian Defence Force personnel deployed to Papua New Guinea and East Timor. Malar J 2019; 18:140. [PMID: 30999967 PMCID: PMC6471761 DOI: 10.1186/s12936-019-2774-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 04/11/2019] [Indexed: 11/10/2022] Open
Abstract
Background Primaquine, an 8-aminoquinoline with anti-hypnozoite activity against Plasmodium vivax, is metabolized by human cytochrome P450 2D6 (CYP2D6) to its active metabolite. Human CYP2D6 activities may influence the metabolism of primaquine and the risk of experiencing Plasmodium relapses following primaquine anti-relapse therapies (PART). In this study, the CYP2D6 profile and its relationship with outcomes of PART in Australian Defence Force (ADF) personnel is retrospectively investigated. Methods Genomic DNA was isolated from stored and de-identified serum or blood samples from ADF personnel deployed on peacekeeping duties to Papua New Guinea (PNG) (1999) and East Timor (1999–2000) who received PART before returning to Australia and after experiencing relapses. CYP2D6 allelic type was determined by PCR and Sanger sequencing. CYP2D6 allele frequency, predicted phenotypes and activity scores were compared among personnel who did not experience P. vivax (ADF-NR, n = 48) and those who experience at least one (ADF-R, n = 109) relapse, as well as between those who experienced 1 (n = 79), 2 (n = 21) and 3–5 (n = 9) relapses within the ADF-R group. Results 16 CYP2D6 alleles were observed in 157 ADF personnel. Alleles *1, *4, *2 and *41 were major alleles (> 5%). The CYP2D6 allele frequency profile in the ADF-NR group matched that of a European population. There was an increased proportion of non-functional CYP2D6 alleles in the ADF-R group compared to the European population and ADF-NR group. However, frequencies of predicted CYP2D6 phenotype and activity score were not different between the ADF-R and ADF-NR groups, nor among sub-groups experiencing multiple relapses within the ADF-R group. Conclusions CYP2D6 phenotype or activity score based on the allele classification was not a major contributor to P. vivax relapse in this ADF cohort. Other factors such as adherence and/or parasite tolerance to primaquine are likely contributing factors to P. vivax relapses in this cohort.
Collapse
Affiliation(s)
- Nanhua Chen
- Australian Defence Force Malaria and Infectious Disease Institute, Brisbane, QLD, Australia
| | - Simone Dowd
- Australian Defence Force Malaria and Infectious Disease Institute, Brisbane, QLD, Australia
| | - Michelle L Gatton
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Alyson Auliff
- Australian Defence Force Malaria and Infectious Disease Institute, Brisbane, QLD, Australia
| | - Michael D Edstein
- Australian Defence Force Malaria and Infectious Disease Institute, Brisbane, QLD, Australia
| | - Qin Cheng
- Australian Defence Force Malaria and Infectious Disease Institute, Brisbane, QLD, Australia.
| |
Collapse
|
42
|
Lhenaff M, Tunon de Lara C, Fournier M, Charitansky H, Brouste V, Mathoulin-Pelissier S, Pinsolles V, Rousvoal A, Bussieres E, Chassaigne F, Croce S, Ben Rejeb H, MacGrogan G. A single-center study on total mastectomy versus skin-sparing mastectomy in case of pure ductal carcinoma in situ of the breast. Eur J Surg Oncol 2019; 45:950-955. [PMID: 30683448 DOI: 10.1016/j.ejso.2019.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 12/17/2018] [Accepted: 01/11/2019] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Ductal carcinoma in situ (DCIS) accounts for 15% of all breast cancers and generally, the prognosis is good if treated optimally. The standard treatment includes breast conservative surgery along with adjuvant radiotherapy. Skin-sparing mastectomy (SSM) preserves the breast skin envelope but its oncological safety poses a few concerns. Moreover, no DCIS-specific studies have compared the local recurrence (LR) rate following total mastectomy (TM) or SSM. We evaluated the LR rate in DCIS patients who underwent either TM or SSM. METHODS This is a retrospective study on women who underwent mastectomy with or without immediate breast reconstruction or secondary reconstruction for pure DCIS of the breast. All patients treated at Institut Bergonié by mastectomy for DCIS from January 1990 to December 2010 were included. LR and overall survival (OS) rates were estimated. RESULTS The study population included 399 patients who were categorized into two groups, 207 in the TM group and 192 in the SSM group. At 10 years of follow-up, the LR rate was 0.97% in the TM group and 1.04% in the SSM group (p = NS). The OS of the entire population was 94.7% [95% CI; 91.6-96.7], 92.8% [95% CI, 87.9-95.8] for the TM group and 96.8% [95% CI, 91.6-98.8] for the SSM group. CONCLUSIONS In our study, the LR rate following mastectomy is low, regardless of the surgical technique used, with an excellent OS at 10 years.
Collapse
Affiliation(s)
- Margaux Lhenaff
- Université de Bordeaux, 351 Cours de la Liberation, 33400, Talence, France
| | | | - Marion Fournier
- Institut Bergonié, 229 cours de l'Argonne, 33076, Bordeaux, Department of Surgery, France
| | - Hélène Charitansky
- Institut Bergonié, 229 cours de l'Argonne, 33076, Bordeaux, Department of Surgery, France
| | - Véronique Brouste
- Institut Bergonié, 229 cours de l'Argonne, 33076, Bordeaux, Department of Biostatistics, France
| | - Simone Mathoulin-Pelissier
- Université de Bordeaux, 351 Cours de la Liberation, 33400, Talence, France; Institut Bergonié, 229 cours de l'Argonne, 33076, Bordeaux, Department of Biostatistics, France
| | - Vincent Pinsolles
- Université de Bordeaux, 351 Cours de la Liberation, 33400, Talence, France
| | - Aurelien Rousvoal
- Institut Bergonié, 229 cours de l'Argonne, 33076, Bordeaux, Department of Surgery, France
| | - Emmanuel Bussieres
- Université de Bordeaux, 351 Cours de la Liberation, 33400, Talence, France; Institut Bergonié, 229 cours de l'Argonne, 33076, Bordeaux, Department of Surgery, France
| | - Florence Chassaigne
- Institut Bergonié, 229 cours de l'Argonne, 33076, Bordeaux, Department of Pathology, France
| | - Sabrina Croce
- Institut Bergonié, 229 cours de l'Argonne, 33076, Bordeaux, Department of Pathology, France
| | - Houda Ben Rejeb
- Institut Bergonié, 229 cours de l'Argonne, 33076, Bordeaux, Department of Pathology, France
| | - Gaétan MacGrogan
- Institut Bergonié, 229 cours de l'Argonne, 33076, Bordeaux, Department of Pathology, France
| |
Collapse
|
43
|
Castronovo V, Galbiati A, Sforza M, Poletti M, Giarolli L, Kuo T, Zucconi M, Manconi M, Hensley M, Morin C, Ferini-Strambi L. Long-term clinical effect of group cognitive behavioral therapy for insomnia: a case series study. Sleep Med 2018; 47:54-59. [PMID: 29753926 DOI: 10.1016/j.sleep.2018.03.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/08/2018] [Accepted: 03/11/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Cognitive-behavioral therapy for insomnia (CBT-I) is recognized as the first-choice intervention for insomnia. One of the best-known advantages of CBT-I in comparison with pharmacotherapy is its long-term effect. However, only few studies have assessed its benefits with follow-up periods of longer than three years. In this clinical case series study we aimed to describe the long-term effects of group CBT-I after a mean 7.8 ± 1.6 years of follow-up (range 4-10 years). METHODS A total of 292 insomnia disorder (ID) patients were consecutively enrolled at the Sleep Disorders Center of San Raffaele Hospital, Milan; 123 patients (82 (66.7%) females and 41 (33.3%) males, mean age 40.59 ± 11.89 years) completed the follow-up evaluation within a range of 4-10 years. RESULTS In the 258 patients who completed the treatment, insomnia severity index (ISI) total score improved significantly as well as all variables of the sleep diaries. Using ISI as the primary outcome, we demonstrated that the effect of CBT-I is maintained up to 10 years after the end of treatment. Furthermore, we found that patients that used only CBT-I techniques to deal with relapses were the ones with better outcomes, in particular compared to the patients that re-used medications. CONCLUSION To the best of our knowledge this is the longest follow-up evaluation in the literature, both for group and individual CBT-I. These findings have an important clinical implication both suggesting and confirming that CBT-I can be considered the treatment of choice for insomnia.
Collapse
Affiliation(s)
- Vincenza Castronovo
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Andrea Galbiati
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy; "Vita-Salute" San Raffaele University, Faculty of Psychology, Milan, Italy
| | - Marco Sforza
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Mattia Poletti
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Laura Giarolli
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Tracy Kuo
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Marco Zucconi
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Mauro Manconi
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Lugano, Switzerland
| | - Michael Hensley
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton, NSW, 2305, Australia
| | - Charles Morin
- Université Laval, École de Psychologie, Québec City, QC, Canada
| | - Luigi Ferini-Strambi
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy; "Vita-Salute" San Raffaele University, Faculty of Psychology, Milan, Italy.
| |
Collapse
|
44
|
Mishra K, Kanwal SK, Sajjan SV, Bhaskar V, Rath B. Predictors of poor outcome in children with steroid sensitive nephrotic syndrome. Nefrologia 2018; 38:420-4. [PMID: 29429831 DOI: 10.1016/j.nefro.2017.11.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 11/19/2017] [Accepted: 11/28/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Nearly 50% of the children with steroid sensitive nephrotic syndrome (SSNS) have a frequently relapsing (FR) or steroid dependent (SD) course, experiencing steroid toxicities and complications of immunosuppression. The study aimed to compare parameters between children with infrequent relapsing (IFR) and FR/SD nephrotic syndrome and to identify the factors associated with a FR/SD course. METHODS A retrospective analysis of medical records from 2009 to 2014, of children with SSNS attending the pediatric nephrology clinic in a tertiary care medical college and hospital. RESULTS Out of 325 children (226 males) with SSNS, 213 were IFR and 112 were FRNS/SDNS. The median age of onset was 34 (IQR 24-48) months. The median time to the first relapse was 4 (IQR 3-7) months and 6 (IQR 4-12) months in FR/SD and IFR group respectively. Multivariate logistic regression analysis showed "adequate treatment (≥12 weeks) of the first episode" (odds ratio 0.56, 95% CI 0.34-0.91; p value=0.02) and "shorter median time to the first relapse" (odds ratio 1.04, 95% CI=1.01-1.08; p value=0.04) to be independent predictors of FR/SD course. An ROC curve was constructed which showed that time to first relapse <5.5 months was associated with a sensitivity of 69% and specificity of 60% in predicting a FR/SD course. CONCLUSION Adequate treatment of the first episode is associated with less chance of an FR/SD course. After treatment of first episode, the first relapse occurring within 5.5 months may predict a frequently relapsing or steroid dependent course.
Collapse
|
45
|
Miranda Acuña J, Hidalgo de la Cruz M, Ros AL, Tapia SP, Martínez Ginés ML, de Andrés Frutos CD. Elevated plasma fibrinogen levels in multiple sclerosis patients during relapse. Mult Scler Relat Disord 2017; 18:157-160. [PMID: 29141800 DOI: 10.1016/j.msard.2017.09.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 09/25/2017] [Accepted: 09/27/2017] [Indexed: 01/03/2023]
Abstract
Fibrinogen is a protein that plays a key role in blood coagulation and thrombosis and it is involved in several inflammatory processes; in multiple sclerosis (MS) may be related with blood-brain barrier (BBB) disruption. We analysed the relationship between plasma fibrinogen levels and the presence of active lesions on magnetic resonance imaging (MRI) during relapses of multiple sclerosis (MS) and clinically isolated syndrome (CIS) patients. METHODS We collected data of patients admitted to a tertiary-care hospital with relapse of MS and CIS from 2008 to 2013 and we analysed the relation between plasma fibrinogen levels (normal: 200mg/dl-417mg/dl) and the presence of active lesions on brain or spinal MRI. RESULTS A total of 58 patients were included, 45 (77%) CIS patients, 12 (21%) relapsing-remitting MS (RR-MS) and 1 (2%) active progressive MS (P-MS). 17 patients had high plasma fibrinogen levels (> 417mg/dl). Among total of patients with elevated plasma fibrinogen, 15 (88%) had active lesions on MRI and only 2 (12%) did not have active lesion on MRI (p = 0,013) with a specificity of 95%. All patients with fibrinogen > 417mg/dl were CIS (p = < 0.05). DISCUSSION We observed that high plasma fibrinogen levels had a high specificity high specificity, but low sensitivity (only 40%) for detection of active lesions on MRI during relapses of MS. These findings support the hypothesis that fibrinogen could play an important role on the development of MS lesions, however, additional studies are needed to confirm these results.
Collapse
Affiliation(s)
- Jahir Miranda Acuña
- Department of Neurology, Hospital General Universitario Gregorio Marañon, Madrid, Spain.
| | | | - Alberto Lozano Ros
- Department of Neurology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Saskia Prasca Tapia
- Hemostasis and Thrombosis Division, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | | | | |
Collapse
|
46
|
Solís-Flores L, Acuña-Rojas R, López-Medina L, Meléndez-Mier G. [The counseling of nursing decreases symptomatology and relapses in pediatric patients with allergic rhinitis]. Bol Med Hosp Infant Mex 2017; 74:349-356. [PMID: 29382478 DOI: 10.1016/j.bmhimx.2017.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 04/13/2017] [Accepted: 05/11/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Allergic rhinitis (AR) is considered to be a public health problem, therefore it is essential to test health education strategies such as nursing counseling (NC) aimed at population groups such as children with allergic rhinitis and their tutors. This study aimed to measure the health benefits of children with this disease for a year. METHODS Longitudinal, randomized, comparative study with a sample of 100 pediatric patients of both sexes, aged 6 to 12 years, with diagnosis of allergic rhinitis, with counseling (study group) and without counseling (control group). In both groups, an informed consent letter signed by both tutors was obtained, in addition to knowledge and assessment papers; the latter included a scale of symptomatology and Morisky Green (adherence to treatment). The children in the study group received intervention based on personalized education, didactic material, support of the multidisciplinary group if necessary (doctor, dermatologist and psychologist). The control group received usual care. In both groups, telephone follow-up was performed, which allowed the number of relapses to be identified in one year. RESULTS The Wilcoxon rank-sum test (Mann-Whitney) was used to compare the results; the presence of relapses in the control group was statistically significant compared to the study group. CONCLUSIONS It was found that the infant population that receives NC, has as a better benefit the control of the symptomatology and decrease of relapses per year.
Collapse
Affiliation(s)
- Laura Solís-Flores
- Departamento de Educación, Capacitación e Investigación en Enfermería del Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México
| | - Rosalinda Acuña-Rojas
- Servicio de Pediatría del Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México
| | - Leobardo López-Medina
- Unidad 309 de Alergia, Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México.
| | - Guillermo Meléndez-Mier
- Departamento de Registro y Seguimiento de proyectos de la Dirección de Investigación del Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México
| |
Collapse
|
47
|
Kessler RA, Mealy MA, Jimenez-Arango JA, Quan C, Paul F, López R, Hopkins S, Levy M. Anti-aquaporin-4 titer is not predictive of disease course in neuromyelitis optica spectrum disorder: A multicenter cohort study. Mult Scler Relat Disord 2017; 17:198-201. [PMID: 29055457 DOI: 10.1016/j.msard.2017.08.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 08/10/2017] [Accepted: 08/11/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune disease associated with a serological antibody to aquaporin-4 (AQP4) detectable in up to 80% of patients. The enzyme-linked immunosorbent assay (ELISA) is one of the most popular methods of testing for anti-AQP4 antibodies that results with a titer in which < 3 Units/ml is negative, 3-5 is borderline and 5+ is positive. The value of the positive titer in predicting long term disease course is currently unknown. METHODS This is a retrospective analysis of NMOSD patients from five centers around the world: Baltimore, USA, Philadelphia, USA, Shanghai, China, Berlin, Germany, and Medellin, Columbia, where ELISA titers on anti-AQP4 antibody testing is available. Inclusion criteria include a diagnosis of NMOSD and seropositive anti-AQP4 antibody test with titer = /> 3 Units/ml. Patients were stratified into three groups by titer: 3-30 Units/ml (low), 31-100 Units/ml (medium), and 101+ Units/ml (high). Demographic factors such as age at onset, race, and sex were collected along with clinical features such as annualized relapse rate, duration of disease, location of relapses, and treatment history. RESULTS A total of 139 NMOSD patients met criteria for inclusion in this study, stratified into three groups by titer: 42 subjects with low titers of 3-30 Units/ml, 30 subjects with medium titers of 31-100 Units/ml and 67 subjects with high titers of 101 or greater ELISA Units/ml. The average age at onset, sex and race distribution were not significantly different among the groups. The number of patients untreated in each group was similar (< 25%) as was the average annualized relapse rate (0.591-0.821 relapses/year). With an average of 10 years follow up, the average disability level was not different among the three titer groups (EDSS range 3.03-3.48). The distribution of lesions, as well as their preventive treatment regimens did not differ significantly. CONCLUSION Beyond a positive/borderline/negative result, the titer of the anti-AQP4 antibody ELISA assay is not predictive in the disease course for patients with NMOSD. Low titer patients experience the same disease course as medium-titer and high-titer anti-AQP4 antibody patients with NMOSD.
Collapse
|
48
|
Harding K, Tilling K, MacIver C, Willis M, Joseph F, Ingram G, Hirst C, Wardle M, Pickersgill T, Ben-Shlomo Y, Robertson N. Seasonal variation in multiple sclerosis relapse. J Neurol 2017; 264:1059-1067. [PMID: 28424900 PMCID: PMC5486559 DOI: 10.1007/s00415-017-8485-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 04/03/2017] [Accepted: 04/03/2017] [Indexed: 11/25/2022]
Abstract
Relapses are a characteristic clinical feature of multiple sclerosis (MS), but an appreciation of factors that cause them remains elusive. In this study, we have examined seasonal variation of relapse in a large population-based MS cohort and correlated observed patterns with age, sex, disease course, and climatic factors. Relapse data were recorded prospectively in 2076 patients between 2005 and 2014. 3902 events were recorded in 1158 patients (range 0-24). There was significant seasonal variation in relapse rates (p < 0.0001) and this was associated with monthly hours of sunshine (odds ratio OR 1.08, p = 0.02). Relapse rates were highest in patients under the age of 30 (OR 1.42, p = 0.0005) and decreased with age. There was no evidence of different relapse rates for males compared to females (OR 0.90, p = 0.19). Identification of potentially modifiable environmental factors associated with temporal variation in relapse rates may allow alteration of risk on a population basis and alteration of outcome of established disease once established. Future epidemiological studies should examine dynamic environmental factors with serial prospective measurements and biological sampling. Significant seasonal differences in relapse rates highlight the importance of environmental factors in disease expression and should be taken into account when planning clinical trials in which relapse frequency is an outcome. In addition, identification of potentially modifiable factors associated with this variation may offer unique opportunities for alteration of risk of relapse and long-term outcome on a population level, and suggest putative biological mechanisms for relapse initiation.
Collapse
Affiliation(s)
- Katharine Harding
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK.,Department of Neurology, Helen Durham Centre for Neuroinflammatory Disease, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK.,Department of Neurology, Royal Gwent Hospital, Cardiff Road, Newport, NP20 2UB, UK
| | - Kate Tilling
- School of Social and Community Medicine, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Claire MacIver
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK.,Department of Neurology, Royal Gwent Hospital, Cardiff Road, Newport, NP20 2UB, UK
| | - Mark Willis
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK.,Department of Neurology, Helen Durham Centre for Neuroinflammatory Disease, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - Fady Joseph
- Department of Neurology, Royal Gwent Hospital, Cardiff Road, Newport, NP20 2UB, UK
| | - Gillian Ingram
- Department of Neurology, Helen Durham Centre for Neuroinflammatory Disease, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK.,Department of Neurology, Morriston Hospital, Heol Maes Eglwys, Morriston, Swansea, SA6 6NL, UK
| | - Claire Hirst
- Department of Neurology, Helen Durham Centre for Neuroinflammatory Disease, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK.,Department of Neurology, Morriston Hospital, Heol Maes Eglwys, Morriston, Swansea, SA6 6NL, UK
| | - Mark Wardle
- Department of Neurology, Helen Durham Centre for Neuroinflammatory Disease, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - Trevor Pickersgill
- Department of Neurology, Helen Durham Centre for Neuroinflammatory Disease, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Neil Robertson
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK. .,Department of Neurology, Helen Durham Centre for Neuroinflammatory Disease, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK.
| |
Collapse
|
49
|
Cohen Aubart F, Bouvry D, Galanaud D, Dehais C, Mathey G, Psimaras D, Haroche J, Pottier C, Hie M, Mathian A, Devilliers H, Nunes H, Valeyre D, Amoura Z. Long-term outcomes of refractory neurosarcoidosis treated with infliximab. J Neurol 2017; 264:891-7. [PMID: 28260120 DOI: 10.1007/s00415-017-8444-9] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 02/26/2017] [Accepted: 02/27/2017] [Indexed: 10/20/2022]
Abstract
Central nervous system localizations of sarcoidosis may be refractory to conventional treatment such as steroids and immunosuppressive drugs. Infliximab, a TNF-α antagonist chimeric antibody, has been shown to be effective for treatment of these localizations. The aim of this study was to evaluate the efficacy and safety, in particular the long-term outcomes, of the use of infliximab for the treatment of neurosarcoidosis. We retrospectively reviewed medical records of patients with neurosarcoidosis who had been treated with infliximab between 2009 and 2015. All patients had histologically proven non-caseating granulomas. Eighteen patients with histologically proven sarcoidosis were included in this study. All had neurological involvement consisting of meningeal (n = 16), cerebral (n = 10), spinal cord (n = 6), and/or optic nerve (n = 5) involvement. Sixteen patients had previously received at least one immunosuppressive drug in addition to corticosteroids, including cyclophosphamide in 11 patients. All patients received treatment with infliximab (3-7.5 mg/kg) associated with corticosteroids (n = 18), low-dose methotrexate (n = 15), azathioprine (n = 2), or mycophenolate (n = 1). Sixteen out of 18 patients improved clinically (initial median modified Rankin scale score of 3, final median score of 1; p < 0.0001). At 6 months after initiation of infliximab, six patients obtained complete remission (33%), ten attained partial remission (56%), and two had stable disease (11%). The median follow-up time was 20 months (range 6-93). Nine patients relapsed during follow-up (50%). Eight patients developed toxic side effects and seven of these side effects were infectious events. Infliximab is an efficacious treatment of refractory neurosarcoidosis. However, relapses frequently occurred during follow-up.
Collapse
|
50
|
Herath N, Ratnatunga N, Weerakoon K, Wazil A, Nanayakkara N. Clinicopathological findings, treatment response and predictors of long-term outcome in a cohort of lupus nephritis patients managed according to the Euro-lupus regime: a retrospective analysis in Sri Lanka. BMC Res Notes 2017; 10:80. [PMID: 28148285 PMCID: PMC5288939 DOI: 10.1186/s13104-017-2402-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 01/24/2017] [Indexed: 11/18/2022] Open
Abstract
Background Despite the improvement in survival of patients with lupus nephritis (LN) globally, there is sparse data from Sri Lanka (SL). The current study aims to describe the clinicopathological findings, treatment response and predictors of long-term outcome of patients with WHO class III–IV LN in SL, managed according to the Euro-lupus regime. Results Of 72 patients, 64 were females. In half of them, LN was diagnosed within the 1st year of the illness. The most common presenting feature was sub-nephrotic proteinuria. Sixteen and twenty patients had nephrotic syndrome and abnormal renal function respectively at the time of diagnosis. Fifty-four patients (75%) responded to the Euro-lupus regimen [CR, 20 (28%); PR, 34(47%)]. Later at 6 months, 65 patients (90%) achieved remission [CR, 31(43%); PR, 34 (47%)]. Seven patients experienced treatment failure. During the total duration of follow up, 54 patients remained in complete or partial remission, 26 developed renal relapses, and 19 suffered severe infective episodes. Renal relapses were more common in people who achieved partial remission than complete remission. The long term renal outcome was not associated with age, sex, severity of proteinuria, class of LN or initial renal function. Patients who achieved remission at 6 months had a good long-term outcome. Conclusions The demographic and clinical features of WHO class III and IV LN in Sri Lankan patients were similar to that reported in the global literature. 75% of patients responded to the Euro-lupus regimen. Therefore, this regime is a suitable initial regimen for LN patients in SL. Good long-term renal outcome can be predicted by early response to therapy. Further studies are necessary to explore better treatment options for patients who fail to achieve remission during initial therapy.
Collapse
Affiliation(s)
- Nalaka Herath
- Nephrology Unit, Teaching Hospital, Karapitiya, Galle, Sri Lanka.
| | - Neelakanthi Ratnatunga
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Kosala Weerakoon
- Department of Parasitology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Abdul Wazil
- Nephrology Unit, Teaching Hospital, Kandy, Sri Lanka
| | | |
Collapse
|