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Yin T, Han J, Hao J, Yu H, Qiu Y, Xu J, Peng Y, Wu X, Jin R, Zhou F. Clinical characteristics and risk factors of acute lymphoblastic leukemia in children with severe infection during maintenance treatment. Cancer Med 2023; 12:19372-19382. [PMID: 37768027 PMCID: PMC10587982 DOI: 10.1002/cam4.6495] [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: 04/23/2023] [Revised: 08/15/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Infection is the most common adverse event of acute lymphoblastic leukemia (ALL) treatment and is also one of the main causes of death. METHODS To investigate the clinical characteristics and risk factors of severe infections during the maintenance phase of ALL treatment, we conducted a retrospective study. RESULTS A total of 181 children were eligible and 46 patients (25.4%) suffered from 51 events of severe infection, most of which occurred in the first half year of the maintenance phase (52.9%). The most common infection was pulmonary infection (86.3%) followed by bloodstream infection (19.6%). The main symptoms of ALL patients with pulmonary infection were fever, cough, and shortness of breath. The main manifestations of computer tomography (CT) were ground glass shadow (56.8%), consolidation shadow (27.3%), and streak shadow (25%). Multivariate binary logistic regression analysis showed that agranulocytosis, agranulocytosis ≥7 days, anemia, and low globulin level were independent risk factors for severe infection during the maintenance phase (all p < 0.05). CONCLUSIONS Taken together, blood routine examinations and protein levels should be monitored regularly for ALL patients in the maintenance phase, especially in the first 6 months. For ALL patients with risk factors, preventive anti-infective or supportive therapies can be given as appropriate to reduce the occurrence of severe infections.
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Affiliation(s)
- Tiantian Yin
- Department of Pediatrics, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Juan Han
- Department of Pediatrics, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Jinjin Hao
- Department of Pediatrics, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Hui Yu
- Department of Pediatrics, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Yining Qiu
- Department of Pediatrics, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Jiawei Xu
- Department of Pediatrics, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Yun Peng
- Department of Pediatrics, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Xiaoyan Wu
- Department of Pediatrics, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Runming Jin
- Department of Pediatrics, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Fen Zhou
- Department of Pediatrics, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
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Pourvali A, Arshi S, Nabavi M, Bemanian MH, Shokri S, Khajoei S, Seif F, Fallahpour M. Sustained unresponsiveness development in wheat oral immunotherapy: predictive factors and flexible regimen in the maintenance phase. Eur Ann Allergy Clin Immunol 2022. [PMID: 35620981 DOI: 10.23822/eurannaci.1764-1489.254] [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] [Indexed: 11/17/2022]
Abstract
Summary Background and aim. Immunotherapy may induce sustained unresponsiveness (SU) in which the patient can tolerate the allergen without any severe symptoms after discontinuing immunotherapy. The present study evaluated serum and cutaneous markers for predicting SU in patients with wheat anaphylaxis who underwent oral immunotherapy. Moreover, we investigated the effectiveness of a flexible regimen of 5 to 10 g wheat protein (WP) in the maintenance phase of oral immunotherapy (OIT). Methods. This study was conducted on 19 patients with wheat anaphylaxis who underwent OIT. The result of the skin prick test (SPT), besides specific serum IgE (sIgE) and IgG4 (sIgG4) to WP, were evaluated before the desensitization. The maintenance dose started from the preferred dose of 5 to 10 g WP after the build-up phase, if the patient could tolerate it. All patients were recruited 7 to 9 months after undergoing this flexible regimen, and the results of SPT and sIgE, and sIgG4 levels were obtained once more. The patients underwent oral food challenge (OFC) after a 3-4-week avoidance to evaluate SU. Results. There was an association between mean IgE reduction and SU (p less than 0.0006), while no association was observed between the mean increase in specific IgG4 (p = 0.1) and the mean wheal diameter decrease (p = 0.29). In the present study, a 50% reduction in sIgE was associated with SU. Thirteen patients were considered to have a SU. Moreover, there was no association between the flexible regimen and the desensitization rate. Conclusions. The results revealed that the reduction of 50% sIgE is a predictive factor for SU in patients with IgE-mediated wheat allergy.
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Affiliation(s)
- A Pourvali
- Department of Pediatrics, Amir Kabir Hospital, Arak University of Medical Sciences, Arak, Iran
| | - S Arshi
- Department of Allergy, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - M Nabavi
- Department of Allergy, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - M H Bemanian
- Department of Allergy, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - S Shokri
- Department of Allergy, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - S Khajoei
- Clinical Research Development Center, Imam Khomeini Hospital, Jiroft University of Medical Sciences, Jiroft, Iran
| | - F Seif
- Department of Immunology and Allergy, Academic Center for Education, Culture, and Research (ACECR), Tehran, Iran.,Neuroscience Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - M Fallahpour
- Department of Allergy, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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Gara S, Litaiem N, Bacha T, Jmour Y, Zeglaoui F. Maintenance Phototherapy for the Treatment of Early-stage Mycosis Fungoides. J Clin Aesthet Dermatol 2021; 14:25-26. [PMID: 34976285 PMCID: PMC8711619] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Mycosis fungoides (MF) is the most common type of cutaneous T cell lymphoma. Phototherapy is a first-line treatment option of early stages MF. The present study aimed at assessing the efficacy of phototherapy in Tunisian patients with MF treated with phototherapy and evaluate the efficacy of maintenance phase.
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Affiliation(s)
- Soumaya Gara
- All authors are with the Department of Dermatology, Charles Nicolle Hospital in Tunis, Tunisia
| | - Noureddine Litaiem
- All authors are with the Department of Dermatology, Charles Nicolle Hospital in Tunis, Tunisia
| | - Takwa Bacha
- All authors are with the Department of Dermatology, Charles Nicolle Hospital in Tunis, Tunisia
| | - Yosra Jmour
- All authors are with the Department of Dermatology, Charles Nicolle Hospital in Tunis, Tunisia
| | - Faten Zeglaoui
- All authors are with the Department of Dermatology, Charles Nicolle Hospital in Tunis, Tunisia
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Moody AE, Beutler BD, Moody CE. Predicting cost of inhalational anesthesia at low fresh gas flows: impact of a new generation carbon dioxide absorbent. Med Gas Res 2021; 10:64-66. [PMID: 32541130 PMCID: PMC7885709 DOI: 10.4103/2045-9912.285558] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
It is well known that low fresh gas flows result in lower cost of inhalational agents. A new generation of carbon dioxide absorbents allows low flow anesthesia with all anesthetics but these new compounds are more expensive. This study examines the cost of inhalational anesthesia at different fresh gas flows combined with the cost of absorbent. The cost of sevoflurane and desflurane is lower at low fresh gas flows. Paradoxically the cost of isoflurane is cheaper at 2 L/min than at lower fresh gas flows due to increased cost of carbon dioxide absorbent. Therefore low fresh gas flows should be used when feasible with sevoflurane and desflurane, but higher fresh gas flows up to 2 L/min may be more economical with isoflurane during maintenance phase of anesthesia.
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Affiliation(s)
- Alastair E Moody
- Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA
| | - Bryce D Beutler
- Department of Internal Medicine, University of Nevada Reno, Reno, NV, USA
| | - Catriona E Moody
- Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA
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Nucera E, Ricci AG, Rizzi A, Mezzacappa S, Rienzo AD, Pecora V, Patriarca G, Buonomo A, Aruanno A, Schiavino D. Specific oral immunotherapy in food allergic patients: transient or persistent tolerance? Postepy Dermatol Alergol 2018; 35:392-396. [PMID: 30206453 PMCID: PMC6130139 DOI: 10.5114/ada.2018.77671] [Citation(s) in RCA: 4] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 06/20/2017] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The first therapeutic choice for food allergy is avoidance of the responsible food, but when this approach is not possible, specific oral desensitization could be considered as a good alternative. It is not clear yet whether the acquired tolerance is transient or persistent. AIM We report on a subset of 13 patients of a larger study, treated successfully with specific oral tolerance induction who experienced secondary loss of tolerance after a period of allergen avoidance. MATERIAL AND METHODS Thirteen patients affected by IgE-mediated food allergy: to cow milk (3 patients), to hen egg (3 patients), to cod fish (2 patients), to peanuts (1 patient) and to corn (1 patient) confirmed by a complete allergological workup and a double-blind placebo-controlled food challenge (DBPCFC), were treated with sublingual-oral desensitization. After the interruption of the maintenance phase, the laboratory tests were performed and 12 of 13 patients underwent DBPCFC. RESULTS Oral specific desensitization was completed successfully in all the 13 reported patients. At different times after the end of treatment, they decided, on their own initiative, to stop the ingestion of incriminated food. A new food allergen re-exposure caused adverse reactions in 12 of 13 patients. The detection of specific IgE and IgG4 during the period of allergen avoidance showed an increase in or a stable level of specific IgE and a decrease in specific IgG4 in 8 patients. CONCLUSIONS According to our experience, the tolerance obtained through the desensitizing treatment is transient and so the regular allergen intake is necessary for its maintenance.
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Affiliation(s)
- Eleonora Nucera
- Allergy Department, Catholic University, Policlinico A. Gemelli, Rome, Italy
| | - Anna Giulia Ricci
- Allergy Department, Catholic University, Policlinico A. Gemelli, Rome, Italy
| | - Angela Rizzi
- Allergy Department, Catholic University, Policlinico A. Gemelli, Rome, Italy
| | - Simona Mezzacappa
- Allergy Department, Catholic University, Policlinico A. Gemelli, Rome, Italy
| | - Alessia Di Rienzo
- Allergy Department, Catholic University, Policlinico A. Gemelli, Rome, Italy
| | - Valentina Pecora
- Allergy Department, Catholic University, Policlinico A. Gemelli, Rome, Italy
| | - Giampiero Patriarca
- Allergy Department, Catholic University, Policlinico A. Gemelli, Rome, Italy
| | - Alessandro Buonomo
- Allergy Department, Catholic University, Policlinico A. Gemelli, Rome, Italy
| | - Arianna Aruanno
- Allergy Department, Catholic University, Policlinico A. Gemelli, Rome, Italy
| | - Domenico Schiavino
- Allergy Department, Catholic University, Policlinico A. Gemelli, Rome, Italy
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Suzuki H, Hibino H, Inoue Y, Matsumoto H, Mikami K. One patient with schizophrenia showed reduced drug-induced extrapyramidal symptoms as a result of an alternative regimen of treatment with paliperidone 3 and 6 mg every other day. SAGE Open Med Case Rep 2017; 5:2050313X17742836. [PMID: 29276595 PMCID: PMC5734425 DOI: 10.1177/2050313x17742836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 01/14/2017] [Accepted: 10/11/2017] [Indexed: 11/24/2022] Open
Abstract
Background: Schizophrenia is a chronic disease that requires long-term management with antipsychotics. Antipsychotic drugs are given by tapering their dose, extending the dosing interval, and so on, as part of a treatment strategy to minimize the adverse effects while at the same time maintaining efficacy. Methods: We report the case of one patient with schizophrenia in whom the clinical symptoms were alleviated after treatment with 6 mg paliperidone. However, the patient developed extrapyramidal syndrome, for which 3 and 6 mg paliperidone were administered alternately every other day. Extrapyramidal syndrome was assessed using the Drug-Induced Extrapyramidal Symptoms Scale, Abnormal Involuntary Movement Scale, or Barnes Akathisia Scale. Results: There was improvement in Drug-Induced Extrapyramidal Symptoms Scale score and Abnormal Involuntary Movement Scale score. However, there was almost no change in the Positive and Negative Syndrome Scale total score, positive score, negative score, or general score. Conclusion: The results indicate the possibility of lessened adverse effects as a result of an alternative regimen of treatment with paliperidone 3 and 6 mg every other day in the maintenance phase.
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Affiliation(s)
| | - Hiroyuki Hibino
- Department of Psychiatry, Fukui Kinen Hospital, Kanagawa, Japan
| | - Yuichi Inoue
- Department of Psychiatry, Shakomae Kokorono Clinic, Tokyo, Japan
| | - Hideo Matsumoto
- Department of Psychiatry, Tokai University School of Medicine, Kanagawa, Japan
| | - Katsunaka Mikami
- Department of Psychiatry, Tokai University School of Medicine, Kanagawa, Japan
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Suzuki H, Hibino H, Inoue Y, Matsumoto H, Mikami K. The effect of switching from oral low-dose aripiprazole to aripiprazole once-monthly 300 mg on the quality of life in three patients with schizophrenia. SAGE Open Med Case Rep 2017; 5:2050313X17710594. [PMID: 28596830 PMCID: PMC5448866 DOI: 10.1177/2050313x17710594] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 04/13/2017] [Indexed: 11/30/2022] Open
Abstract
Background: Schizophrenia is a chronic disease that requires long-term management with antipsychotics; however, an important barrier to the success of long-term treatment is drug noncompliance, which increases the risk of recurrence and hospitalization. Second-generation long-acting injectable antipsychotics have improved drug adherence, and the pharmacological effects of the drugs, and therefore, have become useful treatment options. Methods: We report on three schizophrenia patients who switched from oral low-dose aripiprazole to aripiprazole once-monthly 300 mg. We examined the efficacy and safety of aripiprazole once-monthly 300 mg, as well as its influence on quality of life, from baseline to 20 weeks after aripiprazole once-monthly 300 mg treatment. Results: Aripiprazole once-monthly 300 mg did not exacerbate the depressive and negative symptoms, and extrapyramidal symptoms were improved, which may have helped improve the quality of life. Conclusion: The results suggest the efficacy of aripiprazole once-monthly 300 mg in maintenance treatment for schizophrenia when mental symptoms are stable.
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Affiliation(s)
| | - Hiroyuki Hibino
- Department of Psychiatry, Fukui Kinen Hospital, Kanagawa, Japan
| | - Yuichi Inoue
- Department of Psychiatry, Shakomae Kokorono Clinic, Tokyo, Japan
| | - Hideo Matsumoto
- Department of Psychiatry, School of Medicine, Tokai University, Kanagawa, Japan
| | - Katsunaka Mikami
- Department of Psychiatry, School of Medicine, Tokai University, Kanagawa, Japan
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Awaluddin A, Jali N, Bahari R, Jamil Z, Haron N. Roles of primary care physicians in managing bipolar disorders in adults. Malays Fam Physician 2015; 10:27-31. [PMID: 27570605 PMCID: PMC4992351] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Management of bipolar disorder (BD) is challenging due to its multiple and complex facets of presentations as well as various levels of interventions. There is also limitation of treatment accessibility especially at the primary care level. Local evidence-based clinical practice guidelines address the importance of integrated care of BD at various levels. Primary care physicians hold pertinent role in maintaining remission and preventing relapse by providing systematic monitoring of people with BD. Pharmacological treatment in particular mood stabilisers remain the most effective management with psychosocial interventions as adjunct. This paper highlights the role of primary care physicians in the management of BD.
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Affiliation(s)
- A Awaluddin
- MD (UKM), MMed (Psych) (UKM), Cert. POST (Melb) Head of Department and Consultant Psychiatrist, Hospital Putrajaya
| | - N Jali
- MD (UKM), MMed (Family Medicine) (UKM) Family Medicine Specialist, Klinik Kesihatan Sg. Besar
| | - R Bahari
- MBBchBAO (Queens's Univ Belfast), MRCPsych (UK) Lecturer and Psychiatrist, Cyberjaya University College of Medical Sciences
| | - Z Jamil
- BPsych (UKM), MClinPsych (UKM), DPsych (Clin) (Melb) Lecturer and Clinical Psychologist, Universiti Putra Malaysia
| | - N Haron
- BPharm (Hons) (USM), MPharm Clinical (UKM) Head of Pharmacy Department, Hospital Putrajaya
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