scholarly journals Golimumab as Rescue Therapy for Refractory Immune-Mediated Uveitis: A Three-Center Experience

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Miguel Cordero-Coma ◽  
Vanesa Calvo-Río ◽  
Alfredo Adán ◽  
Ricardo Blanco ◽  
Carolina Álvarez-Castro ◽  
...  
Keyword(s):  
Retinal Thickness ◽  
Rescue Therapy ◽  
Therapeutic Option ◽  
Case Series ◽  
Tertiary Referral ◽  
Short Term ◽  
Complete Control ◽  
Safety And Efficacy ◽  
Immune Mediated ◽  
Different Types

Objective. To evaluate, in three Spanish tertiary referral centres, the short-term safety and efficacy of golimumab (GLM) for treatment of immune-mediated uveitis resistant to previous immunosuppressive therapy.Methods. Nonrandomized retrospective interventional case series. Thirteen patients with different types of uveitis that were resistant to treatment with at least 2 previous immunosuppressors were included in this study. All included patients were treated with GLM (50 mg every four weeks) during at least 6 months. Clinical evaluation and treatment-related side effects were assessed at least four times in all included patients.Results. Eight men and 5 women (22 affected eyes) with a median age of 30 years (range 20–38) and active immune-mediated uveitides were studied. GLM was used in combination with conventional immunosuppressors in 7 patients (53.8%). GLM therapy achieved complete control of inflammation in 12/13 patients (92.3%) after six months of treatment. There was a statistically significant improvement in mean BCVA (0.60 versus 0.68,P=0.009) and mean 1 mm central retinal thickness (317 versus 261.2 μ,P=0.05) at the six-month endpoint when compared to basal values. No major systemic adverse effects associated with GLM therapy were observed.Conclusions. GLM is a new and promising therapeutic option for patients with severe and refractory uveitis.

scholarly journals Convalescent Plasma Therapy for COVID-19: Current Status and Future Directions

2020 ◽  
Vol 7 (03) ◽  
pp. 140-147
Author(s):  
Jayanth Seshan ◽  
Surya K. Dube ◽  
Vanitha Rajagopalan ◽  
Pragyan S. Panda ◽  
Girija P. Rath
Keyword(s):  
Rescue Therapy ◽  
Therapeutic Option ◽  
Current Status ◽  
Past Century ◽  
Short Term ◽  
Plasma Therapy ◽  
Future Directions ◽  
Health Crisis ◽  
Influenza Outbreak ◽  
Initial Results

AbstractThe ongoing pandemic of coronavirus disease 2019 (COVID-19) has triggered a global health crisis probably due to a lack of a reliable cure till date. Several clinical trials are ongoing, but initial results have not been overly promising. Convalescent plasma (CP), which refers to plasma collected from individuals recovered from an illness and developed antibodies against the pathogen, is also being proposed as a therapeutic option for COVID-19 treatment in severe cases to achieve short-term immunity against the virus. Use of CP is not new, and it has been used in various outbreaks over the past century, ranging from the Spanish influenza outbreak in 1918 to the recent Middle East respiratory syndrome (MERS). However, data available on its use in COVID-19 patients is limited. Use of CP so far is restricted to a “rescue therapy” and needs further trials to assess its possible use in other situations (prevention, postexposure prophylaxis) and patient populations (considering age and comorbid illnesses). In this review, we will try to summarize the current status of use of CP for COVID-19 and ongoing trials in India and elsewhere and will discuss the possible avenues for its use in future.

scholarly journals Short-term comparative results of segmental resection versus radical resection in two patients with myxofibrosarcoma of the limbs - case series

2020 ◽  
Vol 3 (1) ◽  
pp. 9-14
Author(s):  
Sergiu-Andrei Iordache ◽  
Bogdan Şerban ◽  
Andreea Vlad ◽  
Adrian Cursaru
Keyword(s):  
Adjuvant Radiotherapy ◽  
Therapeutic Option ◽  
Case Series ◽  
Distant Metastases ◽  
Radical Resection ◽  
Segmental Resection ◽  
Lower Grade ◽  
Short Term ◽  
Comparative Results ◽  
Challenging Situation

AbstractIntroduction: Myxofibrosarcoma is a rare subtype of soft tissue sarcoma with a locally infiltrative behavior and ability to determine distant metastases.Materials and methods: We presented two myxofibrosarcoma cases who benefited from segmental or radical resection.Management and outcome: In the case of the 80-year-old woman, with grade 3 myxofibrosarcoma, we practiced radical surgery with scapulohumeral disarticulation followed by adjuvant radiotherapy.The therapeutic option for the 77-year-old man with grade 2 myxofibrosarcoma was segmental resection followed by adjuvant radiotherapy. After three months, the patient was in a good clinical condition with no sign of local recurrence, but with the presence of pulmonary metastases for the patient who benefited of segmental resection.Discussion: The radical resection had better short-term results, with no local or distant metastases at three months after surgery, although the tumor had a higher grade (G3), compared to segmental resection practiced for a lower grade tumor (G2), in which case the patient developed pulmonary metastasis at three months follow up.Conclusion: Myxofibrosarcoma represents a challenging situation regarding the management due to its unpredictive clinical course. Our cases raised the following question: should we consider treating it more aggressively in order to obtain good local control and reduce the risk of metastasis?

Efficacy of a novel self-assembling peptide hemostatic gel as rescue therapy for refractory acute gastrointestinal bleeding

Endoscopy ◽  
2020 ◽  
Vol 52 (09) ◽  
pp. 773-779
Author(s):  
Germana de Nucci ◽  
Raffaella Reati ◽  
Ilaria Arena ◽  
Cristina Bezzio ◽  
Massimo Devani ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Rescue Therapy ◽  
Ease Of Use ◽  
Peptic Ulcers ◽  
Endoscopic Retrograde ◽  
Additional Method ◽  
Safety And Efficacy ◽  
Acute Gastrointestinal Bleeding ◽  
Self Assembling ◽  
Different Types

Abstract Background Acute gastrointestinal bleeding (AGIB) results in significant morbidity and mortality. Topical hemostatic products have been developed for endoscopic use to help in the management of difficult bleeding. Our aim was to demonstrate the ease of use, safety, and efficacy of PuraStat, a novel hemostat, to control AGIB. Methods We describe 77 patients (41 men) who were treated for acute upper and lower AGIB in a 2-year period. In 50 patients, bleeding occurred as a complication of a previous endoscopic procedure, predominantly endoscopic mucosal resection (EMR) and endoscopic retrograde cholangiopancreatography (ERCP); however, in the other 27 patients, it derived from peptic ulcers, angiodysplasia, cancers, and surgical anastomoses. Bleeding was spurting in 13 of the 77 patients and oozing in 64. PuraStat was used after the failure of at least two conventional hemostatic methods. Results A mean of 2.6 conventional hemostatic methods had been attempted prior to the application of PuraStat. PuraStat achieved successful hemostasis in 90.9 % of patients. In 41 patients, once hemostasis was obtained with PuraStat, endoscopists further stabilized hemostasis by using at least one additional method. Recurrence of bleeding was observed in eight patients (10.4 %). In 16 patients with intraprocedural bleeding, it was possible to complete the procedures (14 EMR, 2 ERCP) after PuraStat hemostasis. No adverse events related to PuraStat were recorded. Conclusions PuraStat is feasible, safe, and effective in controlling different types of gastrointestinal hemorrhage after failure of conventional hemostatic methods. Its application also does not hinder continuing endotherapy.

scholarly journals Transitioning From Thrombopoietin Agonists to the Novel SYK Inhibitor Fostamatinib: A Multicenter, Real-World Case Series

2021 ◽  
Vol 12 (5) ◽  
Author(s):  
David M. Hughes, PharmD, BCOP ◽  
Charina Toste, DNP, APN ◽  
Christopher Nelson, ACNP-BC ◽  
Juliet Escalon, ANP ◽  
Frances Blevins, PA-C ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Adverse Events ◽  
Real World ◽  
Rescue Therapy ◽  
Case Series ◽  
Previous Treatment ◽  
Safety And Efficacy ◽  
Insufficient Response ◽  
Syk Inhibitor ◽  
Favorable Clinical Outcome

Fostamatinib is an oral spleen tyrosine kinase (SYK) inhibitor used for the treatment of adult patients with chronic immune thrombocytopenia (ITP) who have had an insufficient response to a previous treatment. Clinical and operational barriers may exist that warrant bridging or switching from thrombopoietin receptor agonists (TPO-RAs), such as volatility or unpredictability of platelets, adverse events, and quality of life or patient preference. While fostamatinib demonstrated durable platelet responses, the safety and efficacy in combination, bridging, and/or switching with TPO-RAs is not well documented. The objective of this article is to provide guidance from real-world case studies for a safe and effective strategy for the transitioning of patients from TPO-RAs to fostamatinib, with some degree of overlap between the two agents. Currently, the evidence does not exist to guide the safe and effective use of combination therapy or transition between therapies in ITP. This case series highlights the importance to further understand the complexities of managing this disease, as well as successfully combining, bridging, and/or switching patients over to fostamatinib without the need for rescue therapy or increase in adverse events. The need for real-world evidence that guides providers on the safety and efficacy of short- and long-term combination therapy of fostamatinib and TPO-RAs is crucial. The rationale for combination therapy is to target different pathways, platelet destruction, and production without added toxicities. Additionally, gradual tapering off of TPO-RAs may provide a more favorable clinical outcome when switching to fostamatinib. The need for additional data is necessary to provide clinicians with guidance when managing patients with ITP.

Intravenous immunoglobulin treatment in multifocal motor neuropathy and other chronic immune-mediated neuropathies

1997 ◽  
Vol 3 (2) ◽  
pp. 93-97 ◽  
Author(s):  
G. Comi ◽  
R. Nemni ◽  
S. Amadio ◽  
G. Galardi ◽  
L. Leocani
Keyword(s):  
Plasma Exchange ◽  
Chronic Inflammatory Demyelinating Polyneuropathy ◽  
Case Series ◽  
Multifocal Motor Neuropathy ◽  
Initial Therapy ◽  
Motor Neuropathy ◽  
Short Term ◽  
Term Efficacy ◽  
Immune Mediated

This review deals with the use of intravenous IVIg immunoglobulines in the treatment of chronic immune-mediated neuropathies: multifocal motor neuropathy, chronic inflammatory demyelinating polyneuropathy, neuropathies associated with monoclonal gammopathies. A particular attention is given to case series and trials which compare IVIg to other therapies, such as steroid treatment, immunosuppressors and plasma exchange. At present, clinical and instrumental data seem to indicate the short term efficacy of IVIg in multifocal motor neuropathies, especially as early treatment; further studies are need in order to prove its long term efficacy in this disease. Concerning chronic inflammatory demyelinating polyneuropathies, short term IVIg efficacy is comparable to that of plasma exchange and in the long term most patients need repeated treatments. Most patients respond to the initial therapy and the initial nonresponders usually improve with a second treatment modality.

New Transcatheter Mitral Valve Treatment

2011 ◽  
Vol 6 (1) ◽  
pp. 62
Author(s):  
Raquel del Valle-Fernández ◽  
Carlos E Ruiz ◽  
◽  
Keyword(s):  
Mitral Valve ◽  
Financial Crisis ◽  
Mitral Regurgitation ◽  
Research And Development ◽  
Therapeutic Option ◽  
Percutaneous Treatment ◽  
Severe Mitral Regurgitation ◽  
Proof Of Concept ◽  
Safety And Efficacy

Percutaneous treatment of severe mitral regurgitation is a very interesting therapeutic option for those patients considered not to be suitable candidates for surgery. Different technologies have already demonstrated proof-of-concept, and one of these devices (the Mitraclip device) has already obtained the Conformité Europeéne mark. However, demonstrating safety and efficacy for most of these technologies is being harder than anticipated. Recently, research and development has become more compromised due to the financial crisis. This paper reviews the venues that are currently under evaluation.

Comprehensive Effects of Short-Term Rental Platforms Across Hotel Types in U.S. and International Destinations

2021 ◽  
pp. 193896552110335
Author(s):  
John W. O’Neill ◽  
Jihwan Yeon
Keyword(s):  
Service Providers ◽  
Comprehensive Analysis ◽  
Competitive Market ◽  
Substitution Effects ◽  
Short Term ◽  
Hotel Performance ◽  
The World ◽  
Different Types ◽  
Location Type ◽  
The Impact

In recent years, short-term rental platforms in the lodging sector, including Airbnb, VRBO, and HomeAway, have received extensive attention and emerged as potentially alternative suppliers of services traditionally provided by established commercial accommodation providers, that is, hotels. Short-term rentals have dramatically increased the available supply of rooms for visitors to multiple international destinations, potentially siphoning demand away from hotels to short-term rental businesses. In a competitive market, an increase in supply with constant demand would negatively influence incumbent service providers. In this article, we examine the substitution effects of short-term rental supply on hotel performance in different cities around the world. Specifically, we comprehensively investigate the substitution effects of short-term rental supply on hotel performance based on hotel class, location type, and region. Furthermore, we segment the short-term rental supply based on its types of accommodations, that is, shared rooms, private rooms, and entire homes, and both examine and quantify the differential effects of these types of short-term rentals on different types of hotels. This study offers a comprehensive analysis regarding the impact of multiple short-term rental platforms on hotel performance and offers both conceptual and practical insights regarding the nature and extent of the effects that were identified.

scholarly journals Feasibility of Proton Beam Therapy as a Rescue Therapy in Heavily Pre-Treated Retinoblastoma Eyes

Cancers ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 1862
Author(s):  
Eva Biewald ◽  
Tobias Kiefer ◽  
Dirk Geismar ◽  
Sabrina Schlüter ◽  
Anke Manthey ◽  
...  
Keyword(s):  
Proton Beam ◽  
Rescue Therapy ◽  
Therapeutic Option ◽  
Proton Beam Therapy ◽  
External Beam Radiation ◽  
Time Interval ◽  
Beam Radiation ◽  
Primary Tumors ◽  
Increased Risk

Despite the increased risk of subsequent primary tumors (SPTs) external beam radiation (EBRT) may be the only therapeutic option to preserve a retinoblastoma eye. Due to their physical properties, proton beam therapy (PBT) offers the possibility to use the effectiveness of EBRT in tumor treatment and to decisively reduce the treatment-related morbidity. We report our experiences of PBT as rescue therapy in a retrospectively studied cohort of 15 advanced retinoblastoma eyes as final option for eye-preserving therapy. The average age at the initiation of PBT was 35 (14–97) months, mean follow-up was 22 (2–46) months. Prior to PBT, all eyes were treated with systemic chemotherapy and a mean number of 7.1 additional treatments. Indication for PBT was non-feasibility of intra-arterial chemotherapy (IAC) in 10 eyes, tumor recurrence after IAC in another 3 eyes and diffuse infiltrating retinoblastoma in 2 eyes. Six eyes (40%) were enucleated after a mean time interval of 4.8 (1–8) months. Cataract formation was the most common complication affecting 44.4% of the preserved eyes, yet 77.8% achieved a visual acuity of >20/200. Two of the 15 children treated developed metastatic disease during follow-up, resulting in a 13.3% metastasis rate. PBT is a useful treatment modality as a rescue therapy in retinoblastoma eyes with an eye-preserving rate of 60%. As patients are at lifetime risk of SPTs consistent monitoring is mandatory.

scholarly journals Autoimmune Hemolytic Anemia as a Complication of Congenital Anemias. A Case Series and Review of the Literature

2021 ◽  
Vol 10 (15) ◽  
pp. 3439
Author(s):  
Irene Motta ◽  
Juri Giannotta ◽  
Marta Ferraresi ◽  
Kordelia Barbullushi ◽  
Nicoletta Revelli ◽  
...  
Keyword(s):  
Hemolytic Anemia ◽  
Autoimmune Hemolytic Anemia ◽  
Case Series ◽  
Intravenous Immunoglobulins ◽  
Point Of View ◽  
First Line ◽  
Human Erythropoietin ◽  
Immune Mediated ◽  
Hemolytic Crisis ◽  
Life Threatening

Congenital anemias may be complicated by immune-mediated hemolytic crisis. Alloantibodies are usually seen in chronically transfused patients, and autoantibodies have also been described, although they are rarely associated with overt autoimmune hemolytic anemia (AIHA), a serious and potentially life-threatening complication. Given the lack of data on the AIHA diagnosis and management in congenital anemias, we retrospectively evaluated all clinically relevant AIHA cases occurring at a referral center for AIHA, hemoglobinopathies, and chronic hemolytic anemias, focusing on clinical management and outcome. In our cohort, AIHA had a prevalence of 1% (14/1410 patients). The majority were warm AIHA. Possible triggers were recent transfusion, infection, pregnancy, and surgery. All the patients received steroid therapy as the first line, and about 25% required further treatment, including rituximab, azathioprine, intravenous immunoglobulins, and cyclophosphamide. Transfusion support was required in 57% of the patients with non-transfusion-dependent anemia, and recombinant human erythropoietin was safely administered in one third of the patients. AIHA in congenital anemias may be challenging both from a diagnostic and a therapeutic point of view. A proper evaluation of hemolytic markers, bone marrow compensation, and assessment of the direct antiglobulin test is mandatory.

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