Cutaneous dermatomyositis disease course followed over time using the Cutaneous Dermatomyositis Disease Area and Severity Index

AbstractInformation on the clinical staging of coronavirus disease 2019 (COVID-19) is still limited. This study aimed to propose a clinical staging proposal of the disease course in non-severe patients with COVID-19. In this retrospective study, 108 non-severe patients with COVID-19 were grouped according to the duration from symptoms onset to hospital admission: ≤ 1 week, > 1 to 2 weeks, > 2 to 3 weeks, > 3 to 5 weeks, respectively. The dynamic changes of clinical signs were profiled across the four groups. A clinical staging proposal of the disease course over time was proposed from the perspective of the interaction between the virus and host. The prodromal phase, characterized by pneumonia, significant lymphopenia, and slightly elevated inflammatory markers, occurred in the first week after symptoms onset. In the second week, all the hematological and inflammatory markers were at the peak or bottom. Meanwhile, progressive pneumonia as well as the secondary damage of other organs (e.g. cardiac damage, coagulopathy, etc.) was significant during this period, making the disease progress into the apparent manifestation phase. In the third week, the improvement of the majority of clinical signs accompanied by a relatively high degree of inflammatory response defined the remission phase. After 3 weeks, patients were in the convalescent phase, in which all the indicators were maintained at a relatively normal level. We concluded that the disease course over time in non-severe patients with COVID-19 could be divided into four phases: the prodromal phase (in the first week), the apparent manifestation phase (in the second week), the remission phase (in the third week), and the convalescent phase (after 3 weeks), respectively. In clinical practice, tailored therapies should be considered seriously in different stages of the disease course.

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Use of the Cutaneous Lupus Disease Area and Severity Index as an outcome measure in clinical trials: a descriptive study

Clinical and Experimental Dermatology ◽

10.1111/ced.14420 ◽

2020 ◽

Vol 46 (1) ◽

pp. 147-152

Author(s):

E. Mack ◽

L.S. Exton ◽

M.F. Mohd Mustapa ◽

C. McCourt ◽

D. O’Kane

Keyword(s):

Clinical Trials ◽

Outcome Measure ◽

Severity Index ◽

Descriptive Study ◽

Disease Area ◽

Cutaneous Lupus

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Faecal Microbiota Dynamics and their Relation to Disease Course in Crohn’s Disease

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz049 ◽

2019 ◽

Vol 13 (10) ◽

pp. 1273-1282 ◽

Cited By ~ 4

Author(s):

Gianluca Galazzo ◽

Danyta I Tedjo ◽

Dion S J Wintjens ◽

Paul H M Savelkoul ◽

Ad A M Masclee ◽

...

Keyword(s):

Crohn’S Disease ◽

Community Structure ◽

Microbial Community ◽

Disease Activity ◽

Microbial Community Structure ◽

Disease Course ◽

Microbiota Composition ◽

Faecal Microbiota ◽

Over Time

Abstract Background Microbial shifts have been associated with disease activity in Crohn’s disease [CD], but findings on specific taxa are inconsistent. This may be due to differences in applied methods and cross-sectional study designs. We prospectively examined the faecal microbiota in adult CD patients with changing or stable disease course over time. Methods Faeces were collected at two time-points from 15 healthy control individuals [HCs], 35 CD patients who were in remission and who maintained remission [RRs], and 22 CD patients during remission and also during subsequent exacerbation [RAs]. The microbial composition was assessed by 16S rRNA [V4] gene sequencing. Results Compared with HCs, patients with CD had a lower microbial richness [p = 0.0002] and diversity [p = 0.005]. Moreover, the microbial community structure of a subset of patients, clustered apart from HCs, was characterized by low microbial diversity and Faecalibacterium abundance. Patients within this cluster did not differ with respect to long-term disease course compared with patients with a ‘healthy-appearing’ microbiota. Over time, microbial richness and diversity did not change in RR versus RA patients. Although the microbial community structure of both RR and RA patients was less stable over time compared with that of HCs, no differences were observed between the patient groups [p = 0.17]; nor was the stability impacted by Montreal classification, medication use, or surgery. Conclusion The altered microbiota composition and stability in CD was neither associated with disease activity nor long-term disease course, questioning its involvement in the development of an exacerbation. The aberrant microbiota composition in a subset of CD patients warrants further exploration of a more microbiota-driven etiology in this group.

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Validation of the Cutaneous Lupus Erythematosus Disease Area and Severity Index and pSkindex27 for use in childhood-onset systemic lupus erythematosus

Lupus Science & Medicine ◽

10.1136/lupus-2018-000275 ◽

2018 ◽

Vol 5 (1) ◽

pp. e000275

Author(s):

Ashwaq AlE'ed ◽

Pinar Ozge Avar Aydin ◽

Nora Al Mutairi ◽

Alhanouf AlSaleem ◽

Hafize Emine Sonmez ◽

...

Keyword(s):

Quality Of Life ◽

Lupus Erythematosus ◽

Cutaneous Lupus Erythematosus ◽

Severity Index ◽

Assessment Tools ◽

Measurement Properties ◽

Childhood Onset ◽

Disease Area ◽

Cutaneous Lupus

ObjectiveTo determine the measurement properties of the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) and the paediatric adaptation of the Skindex29 (pSkindex27) when used in childhood-onset SLE (cSLE).MethodsPatients with mucocutaneous involvement of cSLE were evaluated at the study entry and 6 months later. Besides the CLASI and pSkindex27, the Pediatric Quality of Life Inventory Generic Core scale (PedsQL-GC), its Rheumatology Module (PedsQL-RM), the SLE Disease Activity Index (SLEDAI) and the SLE Damage Index (SDI) were completed.ResultsThe CLASI and pSkindex27 had high internal consistency (both Cronbach α >0.82). Children were able to complete the pSkindex27, with self-report and caregiver proxy-reports showing excellent agreement (intraclass correlation coefficient=0.97). The CLASI Activity Score (CLASI-A) was strongly correlated with the mucocutaneous domain score of the SLEDAI as was the CLASI Damage Score (CLASI-D) with that of the SDI (both: Spearman correlation coefficients (rs) >0.68). pSkindex27 summary scores were moderately correlated with those of the PedsQL-GC and PedsQL-RM (all: rs>|0.51|), the CLASI-A and CLASI-D (both: rs> 0.64), respectively. Patients who experienced a >50% improvement of the CLASI-A between study visits had significantly higher PedsQL-GC and pSkindex27 scores than those without improvement of mucocutaneous features.ConclusionBoth CLASI and pSkindex27 are useful assessment tools in cSLE, active and chronic mucocutaneous lesions and their changes over time can be measured using the CLASI and the pSkindex27 can capture the impact of mucocutaneous involvement on patient health-related quality of life.

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Quantifying the evolution of tumor architecture using serial circulating tumor DNA.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.4_suppl.600 ◽

2019 ◽

Vol 37 (4_suppl) ◽

pp. 600-600

Author(s):

Jason Henry ◽

Jonathan M. Loree ◽

John H. Strickler ◽

Kanwal Pratap Singh Raghav ◽

Van K. Morris ◽

...

Keyword(s):

Allele Frequency ◽

Limit Of Detection ◽

Circulating Tumor Dna ◽

Tumor Evolution ◽

Disease Course ◽

Serial Sampling ◽

Blood Specimens ◽

Serial Samples ◽

Tumor Dna ◽

Over Time

600 Background: There is limited data regarding changes in the genomic landscape in individual patients over time as serial tissue biopsy has risk and is of uncertain clinical benefit. The advent of circulating tumor DNA (ctDNA) allows for safe and repeated molecular sampling with the potential to investigate evolution of tumor architecture over the disease course. Methods: From 5/15 to 12/17, 116 patients with metastatic CRC had between three to 12 blood specimens taken over the treatment course. Plasma was tested using targeted NGS assay (Guardant360, Guardant Health, 68 gene). To account for variations in the amount of ctDNA in serial samples, a window of evaluable allele frequency was established for each patient as the fold change between the max allele frequency (mAF) and limit of detection for serial samples with the lowest mAF. Mutations not falling within this window were excluded from analysis. Substantial treatment induced selective pressure (SP) was defined as a decrease in the mutant mAF of > 50% in patients with at least an initial mAF of 1%. Results: 116 patients with a total of 317 serial blood samples were evaluable after accounting for ctDNA variations over time. Specimens were collected a median of 12 months apart, with a median of three specimens per patient. Thirteen patients (11%) did not have any changes in mutations on serial sampling, however the remainder of patients gained an average of 1.1 mutations per time point (mut/tp), and lost 1.0 mut/tp. 31% of patients demonstrated evidence of substantial treatment-induced SP. These patients were more likely to demonstrate a change in clonal architecture of the tumor (46% greater rate than those without SP, P = 0.04), predominantly through gain of new clones. In contrast, clonal hematopoiesis alterations that may be induced by chemotherapy, such as JAK2V617F, were neither gained or lost. Conclusions: After correction for variations over time in the total amount of ctDNA in circulation, we identify numerous changes in tumor architecture with serial sampling. For the first time in colorectal cancer we demonstrate that when treatment-induced SP is applied the rate of tumor evolution is increased, demonstrating potential value of monitoring changes in tumor architecture over the disease course.

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The study of Cutaneous Lupus Erythematosus Disease Area and Severity Index in Indian patients with systemic lupus erythematosus

Lupus ◽

10.1177/0961203311418789 ◽

2011 ◽

Vol 20 (14) ◽

pp. 1510-1517 ◽

Cited By ~ 2

Author(s):

P Salphale ◽

D Danda ◽

L Chandrashekar ◽

D Peter ◽

N Jayaseeli ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Cutaneous Lupus Erythematosus ◽

Severity Index ◽

Skin Lesions ◽

Systemic Lupus ◽

Disease Area ◽

Indian Patients ◽

The Mean ◽

Cutaneous Lupus

The Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) is a newly described tool used to assess the activity of and damage caused by cutaneous lupus erythematosus (CLE). There is a paucity of data on CLASI from the Indian subcontinent. We sought to determine the applicability of CLASI in specific lesions of CLE in patients with systemic lupus erythematosus (SLE) attending a tertiary care hospital in India. In this prospective, cross-sectional study, 93 patients of SLE with cutaneous lesions were recruited. CLASI activity and damage scores of lupus erythematosus (LE)-specific skin lesions were done in 75 patients with SLE. The mean CLASI activity score was 15.4 ± 9.4 (range 0–39) and the mean damage score was 6.87 ± 7.75 (range 0–30). Higher mean CLASI activity scores were seen in patients with a combination of acute, subacute and chronic CLE and in those with widespread lesions. Patients with longstanding disease and long duration of skin lesions had higher damage scores. This study shows that CLASI is an effective tool to assess cutaneous activity of LE-specific lesions, and the damage caused by them, in Indian patients.

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Substance Use Among Patients Receiving Out- and Inpatient Dependence Care: a Prospective Norwegian Cohort Study From 2016 to 2020

10.21203/rs.3.rs-566225/v1 ◽

2021 ◽

Author(s):

Jørn Henrik Vold ◽

Fatemeh Chalabianloo ◽

Christer F. Aas ◽

Else-Marie Løberg ◽

Kjell Arne Johansson ◽

...

Keyword(s):

Substance Use ◽

Mixed Model ◽

Linear Mixed Model ◽

Severity Index ◽

Future Research ◽

Opioid Agonist ◽

Low Threshold ◽

The Mean ◽

The Impact ◽

Over Time

Abstract BackgroundContinuous use of amphetamines, alcohol, benzodiazepines, cannabis, cocaine, or opioids contributes to health impairments, increased morbidity, and overdose deaths among patients with substance use disorders (SUDs). This study evaluates the impact of inpatient detoxification, specialized opioid agonist therapy (OAT), and low-threshold municipality care on substance use over time. MethodsWe used data from a cohort of SUD patients in Norway through health assessments of self-reported substance use and sociodemographic and clinical factors. A total of 881 substance use measurements, including type and amount of substances, were assessed from 708 SUD patients in 2016-2020. Substance use for individual and total substances was calculated, creating a substance use severity index (SUSI) ranging from zero (no use) to one (daily use). We defined baseline as the first substance use measurement when the measurements were listed chronologically. Time was defined as years from baseline. We used a linear mixed model to analyze associations between the SUSI and inpatient detoxification, specialized OAT compared with low-threshold municipality care, as well as the factors like injecting substance use, gender, and age, presented with coefficients and 95% confidence intervals (CI).ResultsNeither inpatient detoxification (mean SUSI change: 0.01, -0.03;0.04) nor specialized OAT (0.03, -0.09;0.14) compared with low-threshold municipality care were associated with changes in substance use over time. Patients who were over 60 years of age (mean SUSI difference: -0.06, -0.13;0.00) had a lower SUSI than those under 30 years of age, while patients who injected substances had a higher SUSI than those who did not inject substances (0.18, 0.15;0.20) at baseline. The mean SUSI for the individual substances were 0.50 (standard deviation (SD): 0.38) for cannabis, 0.40 (0.37) for benzodiazepines, 0.33 (0.34) for amphetamines and cocaine, 0.31 (0.29) for alcohol, and 0.22 (0.31) for opioids at baseline. The mean SUSI of all substances was 0.35 (0.20). Conclusion The present study demonstrates that neither inpatient detoxification nor specialized OAT compared to low-threshold municipality care were associated with changes in substance use over time. Future research needs to evaluate the impact on substance use and healthy survival of multiple health care interventions to this patient group.

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TrackSOM: mapping immune response dynamics through sequential clustering of time- and disease-course single-cell cytometry data

10.1101/2021.06.08.447468 ◽

2021 ◽

Author(s):

Givanna Haryono Putri ◽

Jonathan Chung ◽

Davis N Edwards ◽

Felix Marsh-Wakefield ◽

Suat Dervish ◽

...

Keyword(s):

Immune Response ◽

Immune System ◽

West Nile Virus ◽

Immune Cells ◽

Immune Cell ◽

West Nile Virus Infection ◽

Cell Populations ◽

Disease Course ◽

Response Dynamics ◽

Over Time

Mapping the dynamics of immune cell populations over time or disease-course is key to understanding immunopathogenesis and devising putative interventions. We present TrackSOM, an algorithm which delineates cellular populations and tracks their development over a time- or disease-course of cytometry datasets. We demonstrate TrackSOM-enabled elucidation of the immune response to West Nile Virus infection in mice, uncovering heterogeneous sub-populations of immune cells and relating their functional evolution to disease severity. TrackSOM is easy to use, encompasses few parameters, is quick to execute, and enables an integrative and dynamic overview of the immune system kinetics that underlie disease progression and/or resolution.

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Efficacy of Online Versus In-Person Cognitive Behavioral Therapy for Insomnia

Proceedings of IMPRS ◽

10.18060/24800 ◽

2020 ◽

Vol 3 ◽

Author(s):

Emily Wilson ◽

Aaron Roberts

Keyword(s):

Cognitive Behavioral Therapy ◽

Clinical Decision Making ◽

Behavioral Therapy ◽

Adult Population ◽

Severity Index ◽

The United States ◽

Cognitive Behavioral ◽

Control Group ◽

Insomnia Severity ◽

Over Time

Background and Hypothesis: Up to 30% of the adult population may suffer from insomnia symptoms. Insomnia not only diminishes the individual’s quality of life, but also has a broad financial impact, costing the United States over $100 billion per year. Systemic barriers limit access to cognitive behavioral therapy for insomnia (CBT-I), the first-line treatment for insomnia. However, newly developed internet CBT-I (iCBT-I) programs, if effective, may reduce this disparity. In this study, we hypothesized that there is no difference in the efficacy of the experimental iCBT-I and the control CBT-I interventions in reducing insomnia severity over time. Project Methods: A projected 120 participants will be recruited for this non-inferiority prospective cohort study. 60 patients will be assigned to each arm of the study (CBT-I and iCBT-I). The control group will attend 6 in-person CBT-I sessions over 6 weeks. The experimental group will complete the iCBT-I program Go! To Sleep over 6 weeks. Participants will complete the Insomnia Severity Index (ISI) before and after treatment, as well as 3, 6, and 12 months after finishing the program. The Kruskal-Wallis statistical test will utilize ISI data to compare efficacy of the interventions over time. Results: Based on previous literature, the projected results of this study align with the hypothesis that there will be no difference in efficacy of the CBT-I and iCBT-I interventions over time. Potential Impact: If indeed there is no difference in effectiveness between the iCBT-I program and in-person CBT-I, this result would have implications in clinical decision-making. Improved access to iCBT-I may reduce prescriptions for addictive pharmacologic treatments, as well as offer an inexpensive, convenient, and effective treatment for insomnia. Future studies could compare efficacy of iCBT-I in patients with co-morbidities, such as anxiety or depression.

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