Comparison of Cidofovir and the Measles, Mumps, and Rubella Vaccine in the Treatment of Recurrent Respiratory Papillomatosis

We conducted a retrospective study of the use of cidofovir and the measles, mumps, and rubella (MMR) vaccineas adjunctive treatments to lesion debridement in patients with recurrent respiratory papillomatosis (RRP). Our study population was made up of 15 children—7 boys and 8 girls, aged 1 to 16 years at diagnosis (mean: 6.2)—with pathologically confirmed RRP who had been followed for at least 1 year. In addition to demographic data, we compiled information on disease severity, the type of adjunctive treatment administered to each patient, the frequency of debridements, the length of observation, and remission rates. Of the 15 patients, 5 had been treated with cidofovirafter debridement (cidofovir-only group), 6 were treated with MMR vaccine after debridement (MMR-only group), 3 were treated with one and later switched to the other based on parental preference, and 1 received neither treatment, only debridement. The initial mean Derkay disease severity scores were 12.6 for the cidofovir-only group and 11.0 for the MMR-only group (p = 0.61). The cidofovir-only patients underwent an average of 11.8 adjunctive treatments and the MMR-only patients an average of 17.7 (p = 0.33). The average duration of observation was 44.0 months in the cidofovir-only group and 64.7 months in the MMR-only group (p = 0.29). Remission rates were 20% in the cidofovir-only group and 50% in the MMR-only group (p = 0.54). Our study found insufficient evidence of any significant differences between cidofovir and the MMR vaccinein terms of the number and frequency of adjunctive treatments and the rates of remission.

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HPV Strain Predicts Severity of Juvenile-Onset Recurrent Respiratory Papillomatosis with Implications for Disease Screening

Cancers ◽

10.3390/cancers13112556 ◽

2021 ◽

Vol 13 (11) ◽

pp. 2556

Author(s):

Mary C. Bedard ◽

Alessandro de Alarcon ◽

Yann-Fuu Kou ◽

David Lee ◽

Alexandra Sestito ◽

...

Keyword(s):

Gene Expression ◽

Disease Severity ◽

Disease Onset ◽

Tissue Bank ◽

Benign Neoplasm ◽

Recurrent Respiratory Papillomatosis ◽

Clinical Severity ◽

Viral Gene ◽

Juvenile Onset ◽

Severity Scores

Juvenile-onset recurrent respiratory papillomatosis (JoRRP) is the most common benign neoplasm of the larynx in children, presenting with significant variation in clinical course and potential for progression to malignancy. Since JoRRP is driven by human papillomavirus (HPV), we evaluated viral factors in a prospective cohort to identify predictive factors of disease severity. Twenty children with JoRRP undergoing routine debridement of papillomas were recruited and followed for ≥1 year. Demographical features, clinical severity scores, and surgeries over time were tabulated. Biopsies were used to establish a tissue bank and primary cell cultures for HPV6 vs. HPV11 genotyping and evaluation of viral gene expression. We found that patients with HPV11+ disease had an earlier age at disease onset, higher frequency of surgeries, increased number of lifetime surgeries, and were more likely to progress to malignancy. However, the amplitude of viral E6/E7 gene expression did not account for increased disease severity in HPV11+ patients. Determination of HPV strain is not routinely performed in the standard of care for JoRRP patients; we demonstrate the utility and feasibility of HPV genotyping using RNA-ISH for screening of HPV11+ disease as a biomarker for disease severity and progression in JoRRP patients.

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Clinical Outcomes of Acute Pancreatitis in Patients with Cirrhosis According to Liver Disease Severity Scores

Digestive Diseases and Sciences ◽

10.1007/s10620-020-06575-x ◽

2020 ◽

Author(s):

C. Roberto Simons-Linares ◽

Suha Abushamma ◽

Carlos Romero-Marrero ◽

Amit Bhatt ◽

Rocio Lopez ◽

...

Keyword(s):

Acute Pancreatitis ◽

Liver Disease ◽

Clinical Outcomes ◽

Disease Severity ◽

Severity Scores ◽

Disease Severity Scores

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Psoriatic and psoriatic arthritis patients with and without jet-lag: does it matter for disease severity scores? Insights and implications from a pilot, prospective study

Chronobiology International ◽

10.1080/07420528.2019.1678629 ◽

2019 ◽

Vol 36 (12) ◽

pp. 1733-1740 ◽

Cited By ~ 1

Author(s):

G. Damiani ◽

N. L. Bragazzi ◽

S. Garbarino ◽

V. K. Chattu ◽

C. M. Shapiro ◽

...

Keyword(s):

Psoriatic Arthritis ◽

Prospective Study ◽

Disease Severity ◽

Jet Lag ◽

Severity Scores ◽

Disease Severity Scores

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Effect ofPhytophthora cinnamomiisolate, inoculum delivery method, and flood and drought conditions on vigor, disease severity scores, and survival of blueberry plants

Acta Horticulturae ◽

10.17660/actahortic.2017.1180.13 ◽

2017 ◽

pp. 93-104

Author(s):

B.J. Smith ◽

M.A. Miller-Butler ◽

K.J. Curry ◽

H.F. Sakhanokho

Keyword(s):

Disease Severity ◽

Delivery Method ◽

Severity Scores ◽

Drought Conditions ◽

Disease Severity Scores

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Prospective validation of pediatric disease severity scores to predict mortality in Ugandan children presenting with malaria and non-malaria febrile illness

Critical Care ◽

10.1186/s13054-015-0773-4 ◽

2015 ◽

Vol 19 (1) ◽

pp. 47 ◽

Cited By ~ 16

Author(s):

Andrea L Conroy ◽

Michael Hawkes ◽

Kyla Hayford ◽

Sophie Namasopo ◽

Robert O Opoka ◽

...

Keyword(s):

Disease Severity ◽

Febrile Illness ◽

Severity Scores ◽

Disease Severity Scores

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Does Living Closer to a Medical Care Center Matter in Sickle Cell Disease?

Blood ◽

10.1182/blood.v112.11.875.875 ◽

2008 ◽

Vol 112 (11) ◽

pp. 875-875

Author(s):

Jude C Jonassaint ◽

Charles R. Jonassaint ◽

Charlene M. Flahiff ◽

Andrea Ball ◽

Soheir S. Adam ◽

...

Keyword(s):

Quality Of Life ◽

Disease Severity ◽

Sickle Cell ◽

Employment Status ◽

Medical Center ◽

Tertiary Care ◽

Cell Disease ◽

Severity Scores ◽

Disease Severity Scores

Abstract Many of the tertiary care hospitals in North Carolina (NC) are often frequented by patients who have to travel a long distance, given the rural nature of the state. Nearly one half of the adult sickle cell disease (SCD) patients seen at the Duke Comprehensive Sickle Cell Center (DCSCC) come from areas further than a 1-hr drive. The current study aims to determine whether geographical proximity to a comprehensive medical center is associated with SCD outcomes, as indicated by severity score, hospitalization frequency, and quality of life. Methods: Two hundred and two patients who primarily receive their SCD disease-related care from DCSCC were enrolled in the study. The sample included 101 males and 101 females, aged 20–69 years (mean=35.6), with SCD disease (SS: n=135; SC: n=47; other: n=20), and level of education ranging from 4–18 years (mean=13.1). Patients lived an average of 50.4 miles (median: 38.6, range:0.4 to 383) from DCSCC. Linear regressions, controlling for age and SCD diagnosis, were used to test associations between continuous variables. Severity scores measuring end organ damage were determined as previously described (Afenyi-Annan et al. 2008), and frequency of hospitalizations over the past 2 years was determined by self-report and medical record review. To measure mental and physical quality of life (QoL) domains, patients were administered the SF36 QoL scale. Hydroxyurea (HU) and opiate pain therapies were also recorded. Patients were considered to be on opiates if they had used opiates daily for a period of thirty days in the previous 12 months. Results and Discussion: Living closer to Duke had a statistically significant association with higher disease severity scores (β = −0.17, p=0.01). Moreover, proximity to Duke was associated with higher frequency of hospitalizations (β = −0.23, p=0.002). These associations were not modified by gender, employment status or education. Medication use did not account for the association between proximity and disease severity, or proximity and frequency of hospitalizations. The mental domain scores of self-reported QoL correlated negatively with hospitalizations (r= −0.18, p=0.02), whereas the physical domain score negatively correlated with both disease severity (r= −0.19, p <0.01) and hospitalizations (r = −0.26, p <0.01). However, proximity to DCSCC was not associated with the mental or the physical QoL domain. Therefore, it is unlikely that patients move closer to Duke due to higher perceived severity of illness and related medical needs. Conclusion: Patients who live closer to our tertiary care comprehensive center had higher disease severity scores and more hospitalizations over a two year period than patients who live farther away. Neither age, disease diagnosis, gender, employment status, education, nor HU and/or opiate medication use accounted for the negative association between proximity to DCSCC and disease outcomes. On the other hand, distance from DCSCC did not affect patients’ quality of life. The cross-sectional nature of the current study makes it difficult to determine causality. However, it is possible that patients who live close to a major medical center rely more on health system availability as a means to managing their disease, while those living further away rely on self-care at home or adhere to long-term medical regimens. Health care providers may need to focus on developing practice guidelines that encourage and empower patients to take a more active role in their medical care and be less dependent on their healthcare providers to decrease frequency of hospitalization and, perhaps decrease the progression of their disease.

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Is intralesional cidofovir worthwhile in juvenile recurrent respiratory papillomatosis?

The Journal of Laryngology & Otology ◽

10.1017/s0022215106000983 ◽

2006 ◽

Vol 120 (7) ◽

pp. 561-565 ◽

Cited By ~ 12

Author(s):

P Sheahan ◽

S Sexton ◽

J D Russell

Keyword(s):

Disease Severity ◽

Severity Score ◽

Prospective Observational Study ◽

Recurrent Respiratory Papillomatosis ◽

Prolonged Treatment ◽

Disease Remission ◽

Treatment Regimes ◽

Severity Scores ◽

Surgical Debulking ◽

Reduce Disease Severity

Objective: To investigate the efficacy of intralesional cidofovir in the treatment of recurrent respiratory papillomatosis (RRP) in children.Methods: Prospective observational study of four consecutive children with RRP treated at an academic tertiary children's hospital. Laryngo-bronchoscopy was performed at three- to five-weekly intervals. Photodocumentation was obtained and disease severity assessed using an anatomical RRP severity score. Surgical debulking of large papillomas was then performed, and cidofovir (5 mg/ml) injected into any remaining papillomas as well as submucosally at the sites of resected papillomas. The efficacy of cidofovir was assessed by the change in papilloma severity score over the course of the treatment.Results: Complete disease remission was obtained in one patient, with a partial response seen in two others. One patient showed no significant response. The greatest beneficial effect was seen after the fourth cidofovir injection; however, two patients demonstrated a deterioration in severity scores after treatment was withheld at this point. Both responded well to further cidofovir injections. However, a clear plateau in the response to cidofovir was seen in all patients by the eighth injection.Conclusion: Intralesional cidofovir may help control papilloma regrowth and reduce disease severity in many children with RRP. In most cases, cidofovir would appear to be less efficacious in causing disease eradication. There appears to be little evidence to support prolonged treatment regimes (i.e. more than eight treatments).

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Machine Learning Model to Predict Hypotension After Starting Continuous Renal Replacement Therapy

10.21203/rs.3.rs-125446/v1 ◽

2020 ◽

Author(s):

Min Woo Kang ◽

Seonmi Kim ◽

Yong Chul Kim ◽

Dong Ki Kim ◽

Kook-Hwan Oh ◽

...

Keyword(s):

Machine Learning ◽

Renal Replacement Therapy ◽

Continuous Renal Replacement Therapy ◽

Replacement Therapy ◽

Disease Severity ◽

Support Vector ◽

Learning Models ◽

Severity Scores ◽

Disease Severity Scores ◽

Machine Learning Models

Abstract Background: Hypotension after starting continuous renal replacement therapy (CRRT) is associated with worse outcome, but it is difficult to predict because several factors have interactive and complex effects on the risk. The present study applied machine learning algorithms to develop models to predict hypotension after initiating CRRT.Methods: Among 2,349 adult patients who started CRRT due to acute kidney injury, 70% and 30% were randomly assigned into the training and testing sets, respectively. Hypotension was defined as a reduction in mean arterial pressure (MAP) ≥20 mmHg from the initial value within 6 hours. The area under the receiver operating characteristic curves (AUROCs) in machine learning models, such as support vector machine (SVM), deep neural network (DNN), and light gradient boosting machine (LGBM), were compared with those in disease-severity scores such as the Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II.Results: The DNN model showed the highest AUROC (0.822 [0.789–0.856]), and the LGBM and SVM models followed with AUROCs of 0.810 (0.776–0.845) and 0.807 (0.772–0.842), respectively; all machine learning AUROC values were higher than those obtained from disease-severity scores (AUROCs <0.6). Although different definitions of hypotension were used such as a reduction of MAP ≥30 mmHg or a reduction occurring within 1 hour, the AUROCs of machine learning models were higher than those of disease-severity scores. These machine learning models were well calibrated.Conclusion: Machine learning models successfully predict hypotension after starting CRRT and can serve as the basis of systems to predict hypotension before starting CRRT.

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