scholarly journals Recurrent pericarditis is less scary: the new therapeutic solutions

2021 ◽  
Vol 23 (Supplement_E) ◽  
pp. E83-E86
Author(s):  
Rita Del Pinto ◽  
Claudio Ferri
Keyword(s):  
Interleukin 1 ◽  
Treatment Strategies ◽  
Significant Risk ◽  
Intravenous Immunoglobulins ◽  
Refractory Disease ◽  
Recurrent Pericarditis ◽  
Recurrence Rates ◽  
Acute Complications ◽  
Inflammatory Drugs ◽  
Therapeutic Possibilities

Abstract Pericarditis is a common inflammatory disease affecting the pericardial sac, resulting from a variety of stimuli that trigger a stereotyped immune response. Generally self-limiting, this condition can be burdened by a significant risk of acute complications and relapses, with recurrence rates affecting up to 30% of patients, especially in the case of diagnostic and therapeutic delay. Therapeutic options in recurrent forms, initially based only on the use of traditional drugs such as colchicine, non-steroidal anti-inflammatory drugs, and corticosteroids, have recently been enriched with new molecules, such as interleukin 1 blockers anakinra and rilonacept, particularly indicated in refractory forms dependent on corticosteroids. Other medically relevant therapeutic possibilities in refractory disease include azathioprine, methotrexate, and intravenous immunoglobulins. This brief review aims to summarize the treatment strategies of recurrent pericarditis in light of the most up-to-date evidence and recommendations.

Anaphylactic reaction to anakinra in a child with steroid-dependent idiopathic recurrent pericarditis and successful management with canakinumab

2019 ◽  
Vol 29 (4) ◽  
pp. 549-551 ◽  
Author(s):  
Serdar Epçaçan ◽  
Sezgin Sahin ◽  
Ozgur Kasapcopur
Keyword(s):  
Anaphylactic Reaction ◽  
Interleukin 1 ◽  
Subsequent Treatment ◽  
Efficacy And Safety ◽  
Recurrent Pericarditis ◽  
Successful Management ◽  
Steroid Dependent ◽  
Inflammatory Drugs ◽  
First Time ◽  
Conventional Algorithm

AbstractConventional algorithm for treatment of pericarditis and prevention of recurrences consists of non-steroid anti-inflammatory drugs and/or colchicine, followed by corticosteroids in resistant patients. Anakinra has emerged as a promising and safe treatment modality for steroid-dependent idiopathic recurrent pericarditis. However, the efficacy and safety of canakinumab, another anti-interleukin-1 agent, has not been assessed up to date. Herein, we present development of an anaphylactic reaction due to anakinra and a successful subsequent treatment with canakinumab for the first time in the literature.

Interleukin-1 blockade in patients with pericardial constriction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Andreis ◽  
M Imazio ◽  
A Brucato ◽  
G.M De Ferrari ◽  
M Rinaldi ◽  
...  
Keyword(s):  
Clinical Assessment ◽  
Complete Resolution ◽  
Disease Duration ◽  
Clinical Course ◽  
Interleukin 1 ◽  
Funding Source ◽  
Recurrent Pericarditis ◽  
International Registry ◽  
Persistent Inflammation ◽  
Inflammatory Drugs

Abstract Background Recurrent pericarditis is very difficult to treat, especially when symptoms become refractory to conventional treatments (nonsteroidal anti-inflammatory drugs,colchicine,corticosteroids). Interleukin-1 (IL-1) blockade with anakinra has been proved to be useful in this setting. Indeed, persistent inflammation of the pericardium may lead to pericardial constriction, worsening prognosis. Purpose This study was aimed to assess the incidence and clinical course of pericardial constriction in patients with corticosteroid-dependent, colchicine-resistant recurrent pericarditis (CCRP) undergoing anti IL-1 treatment. Methods We selected patients included in the IRAP (International Registry of Anakinra for Pericarditis). A subgroup of 39 CCRP patients enrolled at the coordinating center underwent echocardiographic and clinical assessment for pericardial constriction. Results Thirty-nine patients were assessed, aged 42±12 years old, 67% females, 74% idiopathic etiology, with a median disease duration of 12 months (IQR 9–20) and a recurrence rate of 2.79 flares-patient/year before starting anakinra. Echocardiographic signs of pericardial constriction were demonstrated in 8 patients (21%). After starting anakinra, in 5/8 patients (63%) a complete resolution of pericardial constriction was observed within a median of 1.2 months,IQR 1–4. In other 3/8 patients (37%) pericardial constriction persisted and became chronic, requiring pericardiectomy within a median of 2.8 months, IQR 2–5. Compared with others, the 8 patients with pericardial constriction hadn't had a greater burden of pericardial flares before anakinra (3.87 flares-patient/year vs. 2.62/patient-year, p=0.07) and after anakinra (0.71 flares-patient/year vs. 0.72/patient-year, p=0.99). However, among 11 patients (28%) with incessant symptoms, an higher incidence of pericardial constriction was observed, compared with patients with recurrent symptoms (respectively 64% vs. 3.6%, RR=47, 95% CI 4.5–492, p<0.01). Conclusions In CCRP patients, pericardial constriction may be reversed by anti IL-1 agents. The risk of pericardial constriction is associated with incessant symptoms rather than simple recurrent course. Funding Acknowledgement Type of funding source: None

scholarly journals Inflammatory process as an etiological and prognostic factor of stroke and the goal of potential treatment strategies

2021 ◽  
Vol 36 (4) ◽  
pp. 297-311
Author(s):  
Agnieszka Kraśniej-Dębkowska ◽  
Maciej Śnieżyński ◽  
Anna Członkowska
Keyword(s):  
Inflammatory Process ◽  
Interleukin 1 ◽  
Treatment Strategies ◽  
Risk Of Infection ◽  
Defence Mechanism ◽  
The Central Nervous System ◽  
Inflammatory Drugs ◽  
The Subject ◽  
Brain Tissue Damage

Objective. Inflammation is the body’s natural defence mechanism against factors that damage its tissues. However, if it lasts chronically, it may adversely affect the body’s homeostasis. Inflammation is not only a long-known risk factor for the development of atherosclerosis and its complications, but also develops brain tissue damage in the course of ischemic stroke or intracerebral haemorrhage, leading to even greater damage. In addition, the immune system functions are impaired, which increases the risk of infection. Literature review. Drugs that can reduce the risk of stroke by inhibiting vascular damage and modifying the inflammatory process in the central nervous system, including counteracting the risk of infection, have become the subject of many experimental and clinical studies on strokes. Such drugs include canakinumab, human recombinant interleukin-1 receptor antagonist, colchicine, fingolimod, siponimod or natalizumab. Conclusions. Considering all available research results, the therapeutic pathway using anti-inflammatory drugs has a high potential; however, the complications associated with evoked immunosuppression in patients should be kept in mind. The paper presents a review of the literature on the role of the inflammatory process in the pathogenesis of stroke as well as related therapeutic options.

Inborn error of immunity as the cause of recurrent pericarditis

2021 ◽  
Vol 14 (5) ◽  
pp. e241449
Author(s):  
Zane Lucane ◽  
Dace Freidenberga ◽  
Natalja Kurjane
Keyword(s):  
Positron Emission Tomography ◽  
Inborn Error ◽  
Laboratory Tests ◽  
Autoinflammatory Disease ◽  
Interleukin 1 ◽  
Emission Tomography ◽  
Recurrent Pericarditis ◽  
Positron Emission ◽  
Mediterranean Fever ◽  
Inflammatory Drugs

Familial Mediterranean fever (FMF) is an autoinflammatory disease caused by a pyrin dysfunction, leading to uncontrolled interleukin-1 production that triggers the attacks. Here we report a case of a 36-year-old female patient repeatedly admitted to the cardiology ward with recurrent episodes of pericarditis, with intervals of 1 and 2 months between the episodes. During the attacks, chest pain and fever were the only symptoms. Following the administration of steroids and non-steroidal anti-inflammatory drugs, the patient became afebrile. She also had lymphoma and thyroid carcinoma in anamnesis essential for differential diagnosis. Laboratory tests for infection and autoimmune disease were all negative, and the positron emission tomography–CT scan did not reveal lymphoma relapse. Genetic testing revealed a mutation in the MEFV gene. It is very rare for pericarditis to be the first and only manifestation of FMF.

NF-κB as a Key Mediator of Brain Inflammation in Alzheimer’s Disease

2019 ◽  
Vol 18 (1) ◽  
pp. 3-10 ◽  
Author(s):  
Chul Ju Hwang ◽  
Dong-Young Choi ◽  
Mi Hee Park ◽  
Jin Tae Hong
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Treatment Strategies ◽  
Close Correlation ◽  
Specific Protein ◽  
Brain Inflammation ◽  
Cytokines And Chemokines ◽  
Inflammatory Drugs ◽  
Peptide Fibrils

Alzheimer’s disease is the most common form of dementia. It is characterized by betaamyloid peptide fibrils which are extracellular deposition of a specific protein, accompanied by extensive neuroinflammation. Various studies show the presence of a number of inflammation markers in the AD brain: elevated inflammatory cytokines and chemokines, and an accumulation of activated microglia in the damaged regions. NF-κB is a family of redox sensitive transcriptional factors, and it is known that NF-κB has binding sites in the promoter region of the genes involved in amyloidogenesis and inflammation. Long-term use of non-steroidal anti-inflammatory drugs prevents progression of AD and delays its onset, suggesting that there is a close correlation between NF-κB and AD pathogenesis. This study aims to (1) assess the association between NF-κB activity and AD through discussion of a variety of experimental and clinical studies on AD and (2) review treatment strategies designed to treat or prevent AD with NF-κB inhibitors.

scholarly journals Molecular Subtypes and Precision Oncology in Intrahepatic Cholangiocarcinoma

2021 ◽  
Vol 10 (13) ◽  
pp. 2803
Author(s):  
Carolin Czauderna ◽  
Martha M. Kirstein ◽  
Hauke C. Tews ◽  
Arndt Vogel ◽  
Jens U. Marquardt
Keyword(s):  
Clinical Care ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Specific Treatment ◽  
Growth Factor Receptor ◽  
Treatment Modalities ◽  
Precision Oncology ◽  
Recurrence Rates ◽  
Isocitrate Dehydrogenase 1 ◽  
Liver Cancers

Cholangiocarcinomas (CCAs) are the second-most common primary liver cancers. CCAs represent a group of highly heterogeneous tumors classified based on anatomical localization into intra- (iCCA) and extrahepatic CCA (eCCA). In contrast to eCCA, the incidence of iCCA is increasing worldwide. Curative treatment strategies for all CCAs involve oncological resection followed by adjuvant chemotherapy in early stages, whereas chemotherapy is administered at advanced stages of disease. Due to late diagnosis, high recurrence rates, and limited treatment options, the prognosis of patients remains poor. Comprehensive molecular characterization has further revealed considerable heterogeneity and distinct prognostic and therapeutic traits for iCCA and eCCA, indicating that specific treatment modalities are required for different subclasses. Several druggable alterations and oncogenic drivers such as fibroblast growth factor receptor 2 gene fusions and hotspot mutations in isocitrate dehydrogenase 1 and 2 mutations have been identified. Specific inhibitors have demonstrated striking antitumor activity in affected subgroups of patients in phase II and III clinical trials. Thus, improved understanding of the molecular complexity has paved the way for precision oncological approaches. Here, we outline current advances in targeted treatments and immunotherapeutic approaches. In addition, we delineate future perspectives for different molecular subclasses that will improve the clinical care of iCCA patients.

scholarly journals Tailored Prediction Model of Survival after Liver Transplantation for Hepatocellular Carcinoma

2021 ◽  
Vol 10 (13) ◽  
pp. 2869
Author(s):  
Indah Jamtani ◽  
Kwang-Woong Lee ◽  
Yun-Hee Choi ◽  
Young-Rok Choi ◽  
Jeong-Moo Lee ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Prediction Model ◽  
Risk Group ◽  
Significant Risk ◽  
Risk Scores ◽  
Accurate Information ◽  
Survival Prediction ◽  
Good Prediction ◽  
Recurrence Rates

This study aimed to create a tailored prediction model of hepatocellular carcinoma (HCC)-specific survival after transplantation based on pre-transplant parameters. Data collected from June 2006 to July 2018 were used as a derivation dataset and analyzed to create an HCC-specific survival prediction model by combining significant risk factors. Separate data were collected from January 2014 to June 2018 for validation. The prediction model was validated internally and externally. The data were divided into three groups based on risk scores derived from the hazard ratio. A combination of patient demographic, laboratory, radiological data, and tumor-specific characteristics that showed a good prediction of HCC-specific death at a specific time (t) were chosen. Internal and external validations with Uno’s C-index were 0.79 and 0.75 (95% confidence interval (CI) 0.65–0.86), respectively. The predicted survival after liver transplantation for HCC (SALT) at a time “t” was calculated using the formula: [1 − (HCC-specific death(t’))] × 100. The 5-year HCC-specific death and recurrence rates in the low-risk group were 2% and 5%; the intermediate-risk group was 12% and 14%, and in the high-risk group were 71% and 82%. Our HCC-specific survival predictor named “SALT calculator” could provide accurate information about expected survival tailored for patients undergoing transplantation for HCC.

scholarly journals Treatment strategies for cerebrospinal shunt infections: a systematic review of observational studies

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e038978
Author(s):  
Joan L Robinson ◽  
Dolores Freire ◽  
Liza Bialy
Keyword(s):  
Systematic Review ◽  
Small Sample Size ◽  
Treatment Strategies ◽  
Small Sample ◽  
Cochrane Library ◽  
Csf Shunt ◽  
Entry Site ◽  
Recurrence Rates ◽  
Ovid Medline ◽  
Shunt Infections

ObjectiveA systematic review was conducted of studies comparing time to cerebrospinal fluid (CSF) sterilisation or rate of recurrence with different treatment strategies for CSF shunt infections.MethodsA librarian-directed search was conducted of Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid Medline Daily and Ovid Medline, Ovid Embase, Wiley Cochrane Library, CINAHL Plus with Full Text via EBSCOhost, Scopus Advanced Search, and Web of Science Core Collection from 1990 to May 2019. Studies of any design that compared outcomes in groups of any age with different management strategies were included. Studies that compared complete versus incomplete shunt removal were excluded. Quality assessment was performed with the Newcastle-Ottawa Scale.ResultsThe search identified 2208 records, of which 8 met the inclusion criteria. All were cohort studies of moderate quality. Four studies compared the duration of antibiotics; none demonstrates that a longer course prevented recurrences. Two studies analysed addition of rifampin, with one showing a decrease in recurrences while the other had a small sample size. No studies analysed the addition of intraventricular antibiotics, but one showed equally good results with once versus twice daily administration. One study reported no difference in recurrences with placement of antibiotic-impregnated catheters. Recurrence rates did not differ with shunt replacement minimum of 7 days vs less than 7 days after CSF became sterile. There were no recurrences in either group when shunt replacement was performed after sterile CSF cultures were obtained at 24 vs 48 hours after antibiotics were discontinued. A new shunt entry site did not decrease recurrences.DiscussionThe main limitations are the lack of high-quality studies, the small sample sizes and the heterogeneity which precluded meta-analysis. Addition of rifampin for staphylococcal infections may decrease relapse but requires further study.

Factors Impacting Recurrence Rate After Open Ganglion Cyst Excision

Hand ◽  
2020 ◽  
pp. 155894472092147
Author(s):  
Landon M. Cluts ◽  
John R. Fowler
Keyword(s):  
Recurrence Rate ◽  
Ganglion Cyst ◽  
Significant Risk ◽  
Recurrence Rates ◽  
Cyst Excision ◽  
Small Series ◽  
Ganglion Cysts ◽  
Surgeon Experience ◽  
Cyst Recurrence ◽  
Open Excision

Background: The recurrence rate after open excision of ganglion cysts is approximately 20%. However, this literature is based on a small series of subjects. This study aims to determine the rate and risk of recurrence after open excision of ganglion cysts in a large patient series. Methods: This study included 628 patients who had ganglion cyst excision from 2010 to 2018. A retrospective chart review recorded the following: age, sex, laterality, volar/dorsal location, and recurrence. An overall recurrence rate was calculated. In addition, a 1-way analysis of variance test was used to compare recurrence rates among the individual surgeons, and unpaired t tests were used to compare age of recurrence, dorsal cyst recurrence, laterality of cyst, and recurrence based on sex. Finally, a comparison of recurrence rate over time was conducted for surgeon 3. Results: The overall recurrence rate was 3.8% (24 of 628). The recurrence rates for each surgeon were 3% (9 of 353), 2% (3 of 167), and 11% (12 of 107), P = .02. The age of those with and without a recurrence did not differ (32 years vs 38 years), P = .06. The recurrence rate of dorsal ganglion cysts was 4.1% (14 of 341) compared with 3.5% (10 of 286) for volar ganglion cysts, P = .69. Male patients had a recurrence in 6.4% (13 of 204) of cases compared with 2.6% (11 of 424) of female patients, P = 0.01. There was a decrease in the rate of recurrence from 42.9% to 5.3% over 5 years for surgeon 3. Conclusion: In our sample, male sex and surgeon experience were significant risk factors in ganglion cyst recurrence.

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