scholarly journals Characteristics of pulmonary cryptococcosis in patients with rheumatoid arthritis

2021 ◽  
Vol 8 (1) ◽  
pp. e000805
Author(s):  
Chiaki Hosoda ◽  
Takashi Ishiguro ◽  
Ryuji Uozumi ◽  
Miyuki Ueda ◽  
Naomi Takata ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Medical Records ◽  
High Frequency ◽  
Clinical Course ◽  
Antifungal Treatment ◽  
Pulmonary Cryptococcosis ◽  
Radiological Findings ◽  
Antirheumatic Therapy ◽  
Negative Effect

Background and objectiveA high frequency of infections complicating rheumatoid arthritis (RA) has been reported due to the immunomodulatory effect of RA or to agents with immunosuppressive effects used in its treatment. We aimed to assess clinical and radiological characteristics of pulmonary cryptococcosis in patients with and without RA.MethodsWe retrospectively reviewed the medical records of 52 patients with pulmonary cryptococcosis and divided them into two groups, those with RA and without RA, and compared clinical characteristics and radiological findings between them.ResultsEleven (21.2%) of the 52 patients had RA. Median follow-up periods were 51.2 (range: 1.1–258.7) months for patients with RA and 19.1 (range: 0.63–246.9) months for patients without RA. Among the patients with RA, 81.8% were women, with a mean age of 68.1 years. Female sex and respiratory comorbidities were significantly more frequent in patients with RA than in patients without RA. Frequencies of concomitant cryptococcal meningitis and respiratory failure were not different between the groups. There were no significant differences in frequency of any radiological findings, locations and number between the two groups. Among patients with RA, all but one responded well to antifungal treatment. During the antifungal treatment course, one (9.1%) patient with RA died of cryptococcosis. Despite continuing antirheumatic drugs, no patients had recurrence of pulmonary cryptococcosis during follow-up.ConclusionOther than some differences in background, there were no clinical, radiological or prognostic differences between the patients with and without RA with pulmonary cryptococcosis. The administration of antirheumatic therapy had no negative effect on the clinical course of antifungal treatment.

scholarly journals Association of biological antirheumatic therapy with risk for type 2 diabetes: a retrospective cohort study in incident rheumatoid arthritis

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e042246
Author(s):  
Sanjoy K Paul ◽  
Olga Montvida ◽  
Jennie H Best ◽  
Sara Gale ◽  
Attila Pethö-Schramm ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Type 2 Diabetes ◽  
T Cell ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Therapy ◽  
Treatment Groups ◽  
Significant Difference ◽  
Necrosis Factor

ObjectiveTo explore possible associations of treatment with biological disease-modifying antirheumatic drugs (bDMARDs), including T-cell-based and interleukin-6 inhibition (IL-6i)-based therapies, and the risk for type 2 diabetes mellitus (T2DM) in patients with rheumatoid arthritis (RA).Study design, setting and participantsFive treatment groups were selected from a United States Electronic Medical Records database of 283 756 patients with RA (mean follow-up, 5 years): never received bDMARD (No bDMARD, n=125 337), tumour necrosis factor inhibitors (TNFi, n=34 873), IL-6i (n=1884), T-cell inhibitors (n=5935) and IL-6i+T cell inhibitor abatacept (n=1213). Probability and risk for T2DM were estimated with adjustment for relevant confounders.ResultsIn the cohort of 169 242 patients with a mean 4.5 years of follow-up and a mean 641 200 person years of follow-up, the adjusted probability of developing T2DM was significantly lower in the IL-6i (probability, 1%; 95% CI 0.6 to 2.0), T-cell inhibitor (probability, 3%; 95% CI 2.3 to 3.3) and IL-6i+T cell inhibitor (probability, 2%; 95% CI 0.1 to 2.9) groups than in the No bDMARD (probability, 5%; 95% CI 4.6 to 4.9) and TNFi (probability, 4%; 95% CI 3.7 to 4.7) groups. Compared with No bDMARD, the IL-6i and IL-6i+T cell inhibitor groups had 37% (95% CI of HR 0.42 to 0.96) and 34% (95% CI of HR 0.46 to 0.93) significantly lower risk for T2DM, respectively; there was no significant difference in risk in the TNFi (HR 0.99; 95% CI 0.93 to 1.06) and T-cell inhibitor (HR 0.96; 95% CI 0.82 to 1.12) groups.ConclusionsTreatment with IL-6i, with or without T-cell inhibitors, was associated with reduced risk for T2DM compared with TNFi or No bDMARDs; a less pronounced association was observed for the T-cell inhibitor abatacept.

Fibromuscular Dysplasia of the Internal Carotid Artery

Neurosurgery ◽  
1982 ◽  
Vol 10 (1) ◽  
pp. 39-43 ◽  
Author(s):  
Ralph P. Wells ◽  
Robert R. Smith
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Medical Records ◽  
Fibromuscular Dysplasia ◽  
Internal Carotid ◽  
Clinical Course ◽  
Oral Anticoagulants ◽  
Specific Therapy ◽  
The Mean

Abstract The natural course of fibromuscular dysplasia (FMD) of the internal carotid artery (ICA). a stenosing angiopathy associated with cerebrovascular insufficiency, has not been described. A search of medical records located 16 female patients with angiographically demonstrated FMD of the ICA. The identical twin of 1 patient was included in the registry on the basis of noninvasive studies consistent with FMD of the ICA. The mean age at diagnosis was 58 years. Follow-up examinations were performed an average of 3.8 years after diagnosis (range, 1 to 9 years); the evaluation included clinical, angiographic, and Doppler studies. Fifteen patients showed no evidence of progression of FMD, whereas 2 patients with coincident atherosclerotic disease had suffered strokes. One patient had undergone surgical dilatation of the ICA. 3 had received oral anticoagulants, and 13 had received either aspirin or no specific therapy. In light of the apparently benign clinical course of uncomplicated FMD of the ICA, it is concluded that dilatation is rarely warranted.

scholarly journals Symptomatic large or giant capillary telangiectasias: management and outcome in 5 cases

2016 ◽  
Vol 125 (1) ◽  
pp. 160-166 ◽  
Author(s):  
Tao Yu ◽  
Xingwen Sun ◽  
Yan You ◽  
Jie Chen ◽  
Jun-mei Wang ◽  
...  
Keyword(s):  
Vision Loss ◽  
Clinical Course ◽  
Complete Removal ◽  
Neurological Deficits ◽  
Radiological Findings ◽  
Brain Capillary ◽  
Generalized Seizures ◽  
Clinical Presentations ◽  
Uncontrolled Bleeding

Brain capillary telangiectasias (BCTs) are usually small and benign with a predilection in the pons and basal ganglion. Reports of large and symptomatic BCTs are rare. Large BCTs have a much higher risk of causing uncontrolled bleeding and severe neurological defects, and they can be fatal if left untreated. Therefore, large BCTs should be managed with special caution. Because of the lack of reports, diagnosis of large BCTs has been difficult. Strategies of management are undefined for large or giant BCTs. The current study presents 5 cases of giant and large BCTs. To the authors’ knowledge, this is the largest series of this disease ever reported. Radiological findings, histopathological characteristics, clinical presentations, and surgical management were analyzed in 5 symptomatic, unusually large BCTs (mean diameter 5.06 cm, range 1.8–8 cm). Four patients presented with focal or generalized seizures, and 1 patient presented with transient vision loss attributed to the lesions. Gross-total resection of the lesion was achieved in all patients. After surgery, the 4 patients with seizures were symptom free for follow-up periods varying from more than 1 to 5 years with no additional neurological deficits. The unique location, radiological characteristics, and clinical course suggest that giant BCTs could be a different entity from small BCTs. Surgery might be a good option for treatment of patients with intractable neurological symptoms, especially in those with surgically accessible locations. Complete removal would be anticipated to provide relief of the symptoms without causing new neurological deficits.

scholarly journals Clinical course and management of 73 hospitalized moderate patients with COVID-19 outside Wuhan

2020 ◽  
Author(s):  
Xiaojuan Peng ◽  
Qi Qi Liu ◽  
Zhaolin Chen ◽  
Guiyan Wen ◽  
Qing Li ◽  
...  
Keyword(s):  
Median Duration ◽  
Active Treatment ◽  
Medical Records ◽  
Clinical Course ◽  
Good Prognosis ◽  
Chest Tightness ◽  
Medical Observation ◽  
Sources Of Infection ◽  
Acid Test

Abstract Background: Moderate cases account for the majority in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and can also progress to severe/critical condition. Here, we investigated the clinical course and management of hospitalized moderate SARS-CoV-2 patients.Methods: The medical records and follow-up data were analyzed from the SARS-CoV-2 patients outside Wuhan.Results: A total of 73 moderate patients (38 men, 35 women) were included, with median age of 47.0 (38.5-57.5) years. Among them, only one patient (1.4%) died using active treatment to improve symptoms. The median duration of the four main symptoms cough, fever, chest tightness, and fatigue were about 1-2 weeks; the median duration of the positive nucleic acid test (NAT) results for SARS-CoV-2 was slightly more than 2 weeks; the median hospitalization time was almost four weeks in 72 moderate survivors. The duration of cough and fever was positively correlated with the duration of the positive NAT results. On admission, 50% had lymphopenia; less than 30% had abnormal blood biochemistry findings involving hyperglycemia, liver function and myocardial enzymes. At discharge, the laboratory indexes were substantially improved. Two weeks after discharge, 5.6% survivors experienced a recurrence of the positive NAT results. Conclusions: Moderate SARS-CoV-2 patients have a good prognosis by the active treatment. After discharge, it is necessary that moderate survivors undergo at least a 2-week collective medical observation in quarantine places, which can identify and treat a proportion of patients with re-positive NAT results and to prevent the spread of the potential sources of infection.

scholarly journals Clinical course and management of 73 hospitalized moderate patients with COVID-19 outside Wuhan

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0249655
Author(s):  
Xiaojuan Peng ◽  
Qi Liu ◽  
Zhaolin Chen ◽  
Guiyan Wen ◽  
Qing Li ◽  
...  
Keyword(s):  
Nucleic Acid ◽  
Liver Function ◽  
Median Duration ◽  
Active Treatment ◽  
Medical Records ◽  
Clinical Course ◽  
Good Prognosis ◽  
Chest Tightness ◽  
Acid Test

Moderate cases account for the majority in hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and can also progress to severe/critical condition. Here, we investigated the clinical course and management of hospitalized moderate SARS-CoV-2 patients. The medical records and follow-up data were analyzed from the SARS-CoV-2 patients outside Wuhan. A total of 73 moderate patients (38 men, 35 women) were included, with median age of 47.0 (38.5–57.5) years. Among them, only one patient (1.4%) died using active treatment to improve symptoms. The median duration of the four main symptoms cough, fever, chest tightness, and fatigue were 11.0, 8.0, 11.0, and 7.0 days, respectively; the median duration of the positive nucleic acid test (NAT) results for SARS-CoV-2 was 16.5 days; the median hospitalization time was 25.0 days in 72 moderate survivors. The duration of cough and fever was positively correlated with the duration of the positive NAT results. On admission, 50% had lymphopenia; less than 30% had abnormal blood biochemistry findings involving hyperglycemia, liver function and myocardial enzymes. At discharge, the laboratory indexes were substantially improved. Two weeks after discharge, 5.6% survivors experienced a recurrence of the positive NAT results. Moderate SARS-CoV-2 patients have a good prognosis by the active treatment. A small proportion of the recovered moderate patients still may be virus carriers and require an additional round of viral detection.

scholarly journals SAFETY AND EFFECTIVENESS OF TRI VALENT INACTIVATED SPLIT VIRION INFLUENZA VACCINE IN PATIENTS WITH RHEUMATOID DISORD ERS

The Clinician ◽  
2018 ◽  
Vol 12 (1) ◽  
pp. 25-28
Author(s):  
D. V. Bukhanova ◽  
В. S. Belov ◽  
G. M. Tarasova ◽  
Sh. F. Erdes ◽  
T. V. Dubinina ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Influenza Vaccine ◽  
Clinical Effectiveness ◽  
Control Group ◽  
Low Grade ◽  
Antirheumatic Therapy ◽  
Post Vaccination ◽  
Flu Virus ◽  
Study Inclusion

Objective: to evaluate the safety and effectiveness of vaccination with trivalent split virion influenza vaccine in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS), estimate the effect of vaccination on rheumatoid disorder (RD) activity and influenza and influenzalike illnesses morbidity.Materials and methods. The study included 86 patients (58 females and 28 males aged 22–82 years) with RDs (52 patients with RA and 34 patients with AS), as well as 40 subjects without RD (control group). At the time of study inclusion, all patients were receiving drug therapy. Duration of RD varied from 2 months to 46 years. The Vaxigrip vaccine containing the currents trains of the flu virus for 2016–2017 season or 2017–2018 season was administered subcutaneously as 1 dose (0.5 ml) with continuing antirheumatic therapy. The main control stages were visits 1, 3, and 6 months after vaccination. During the visits, standard clinical and labtests, clinical examination with disease activity evaluation were performed.Results. In 98 patients, vaccination tolerability was high, no post vaccination reactions were observed. In 20 cases, pain, swelling, and hyperemia of the skin 2 cm in diameter at the point of vaccination were observed; in 8 cases, low-grade fever, myalgia, discomfort, headache were observed. No RD flares or development of new autoimmune disorders were diagnosed during the follow-up period. No cases of influenza or influenza-like illnesses were registered during the follow-up period.Conclusion. The obtained data demonstrate high tolerability, clinical effectiveness of trivalent split virion influenza vaccine in patients with RA and AS.

scholarly journals Clinical and functional features of bronchial asthma in pregnancy

2005 ◽  
pp. 73-76
Author(s):  
O. B. Prikhodko ◽  
Yu. S. Landyshev ◽  
E. B. Romantsova
Keyword(s):  
Respiratory Failure ◽  
Lung Function ◽  
Bronchial Asthma ◽  
High Frequency ◽  
Clinical Course ◽  
Perinatal Complications ◽  
Functional Features ◽  
Complicated Pregnancy ◽  
In Pregnancy

Clinical course of bronchial asthma (BA) was followed-up during pregnancy (in I, II, and III trimesters). We observed 62.3 % of patients with mild BA, 29.8 % with moderate and 7.9 % with severe BA. Acute bronchial asthma was diagnosed in 68.4 % of the patients, of them 40.5 % were in the I trimester, 55.7 % were in the II trimester and 54.4 % were in the III trimester. During the follow-up period BA was stable in 43 % of the cases, improved in 14 % and worsened in 43 %. Complicated pregnancy course was diagnosed in 94.7 % of the patients. High frequency of perinatal complications was found. A complex assessment of lung function using spirography and zonal reography of the lungs allows early detection of the respiratory failure and timely diagnosis of BA impairment.

Clinical course and postoperative follow-up of aortic regurgitation in rheumatoid arthritis

1987 ◽  
Vol 8 (suppl J) ◽  
pp. 101-103
Author(s):  
N. Danchin ◽  
A. Balaud ◽  
K. Isaaz ◽  
A. T. De La Chaise ◽  
D. Amrein ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Aortic Regurgitation ◽  
Clinical Course

Characterization of colorectal cancer (CRC) in Lynch syndrome (LS) patients with MSH6 or PMS2 mutations.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 1555-1555
Author(s):  
Jean Kyung Lee ◽  
Jinru Shia ◽  
Rohini Rau-Murthy ◽  
Marina Corines ◽  
Erin E. Salo-Mullen ◽  
...  
Keyword(s):  
Medical Records ◽  
High Frequency ◽  
Disease Onset ◽  
Stage Iv ◽  
Clinical Genetics ◽  
Crc Screening ◽  
Genetic Features ◽  
Revised Bethesda Guidelines

1555 Background: The majority of LS patients harbor germline mutations in the MLH1 or MSH2 genes. However, ~10% have MSH6 and ~<5% PMS2 mutations. An attenuated form of LS has been suggested in MSH6/PMS2 carriers with decreased CRC risk and older age of disease onset. As recent guidelines suggest that initiation of CRC screening may be delayed in such patients, we characterized our patients with MSH6/PMS2-associated CRC. Methods: We obtained an IRB waiver to identify all LS patients with CRC, defined as the presence of a deleterious germline mutation in a MMR gene, from the Clinical Genetics database at MSKCC. Clinical, pathologic, and genetic features were extracted from medical records and Progeny software. Results: Of 147 LS patients with CRC, 23 had mutations in the MSH6 (n=16, 11%) or PMS2 (n=7, 5%) genes. Mean age at CRC diagnosis was 48.5 yrs (range 32-70) in MSH6 and 40.7 (range 22-57) in PMS2 carriers. 16 (70%) and 5 (22%) were diagnosed at age ≤50 or ≤35, respectively. 4 (17%) had metachronous and 3 (13%) synchronous primary CRCs, and 5 (22%) had additional LS-associated cancer. Although all 23 LS patients met Revised Bethesda guidelines, only 50% of MSH6 and 0 of the PMS2 carriers met Amsterdam I/II criteria (AC). Of 32 independent primary CRCs, 18 (56%) were stage I/II, 9 (28%) stage III, and 1 (3%) stage IV. 9/9 MSH6 and 4/4 PMS2 CRCs had high-frequency microsatellite instability. In MSH6 carriers, 11/13 had absence of MSH6protein expression only on IHC, 1 had inconclusive MSH6 staining, and 1 had absence of both MSH6 & MSH2 proteins. In PMS2carriers, 7/7 had absence of PMS2 on IHC, 2 also had equivocal/focal MLH1 staining. Right-sided CRC was present in 50% and at least 40% had mucinous features. 26/29 (90%) of tumors underwent segmental resection. 6/11 stage II patients received adjuvant chemotherapy including 2 with pT4N0 tumors. With a mean follow-up of 5.6 yrs to date, 1 patient is known to have developed recurrent CRC. Conclusions: Although the majority of MSH6/PMS2 CRC patients do not meet AC, 70% of CRCs were diagnosed at age ≤50, 22% at age ≤35, and 30% had synchronous/metachronous CRCs. These findings have important implications for CRC surveillance and may not support delaying colonoscopy initiation in MSH6/PMS2 LS families.

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