scholarly journals Epidemiology and demographics of juvenile idiopathic arthritis in Africa and Middle East

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Sulaiman M. Al-Mayouf ◽  
Muna Al Mutairi ◽  
Kenza Bouayed ◽  
Sara Habjoka ◽  
Djohra Hadef ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Middle East ◽  
Treatment Guidelines ◽  
Local Treatment ◽  
Epidemiological Data ◽  
Joint Inflammation ◽  
Global Estimate ◽  
Medical Need ◽  
Prevalent Subtype ◽  
Children And Young Adults

AbstractJuvenile Idiopathic Arthritis (JIA) is a group of chronic heterogenous disorders that manifests as joint inflammation in patients aged <16 years. Globally, approximately 3 million children and young adults are suffering from JIA with prevalence rates consistently higher in girls. The region of Africa and Middle East constitute a diverse group of ethnicities, socioeconomic conditions, and climates which influence the prevalence of JIA. There are only a few studies published on epidemiology of JIA in the region. There is an evident paucity of adequate and latest data from the region. This review summarizes the available data on the prevalence of JIA and its subtypes in Africa and Middle East and discusses unmet needs for patients in this region. A total of 8 journal publications were identified concerning epidemiology and 42 articles describing JIA subtypes from Africa and Middle East were included. The prevalence of JIA in Africa and Middle East was observed to be towards the lower range of the global estimate. We observed that the most prevalent subtype in the region was oligoarticular arthritis. The incidence of uveitis and anti-nuclear antibody (ANA) positivity were found to be lower as compared to the incidence from other regions. There is a huge unmet medical need in the region for reliable epidemiological data, disease awareness, having regional and local treatment guidelines and timely diagnosis. Paucity of the pediatric rheumatologists and economic disparities also contribute to the challenges regarding the management of JIA.

scholarly journals Juvenile Idiopathic Arthritis

2021 ◽  
Author(s):  
Vadood Javadi Parvaneh ◽  
Khosro Rahmani
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Early Diagnosis ◽  
Joint Destruction ◽  
Joint Inflammation ◽  
Aggressive Treatment ◽  
Synovial Joint ◽  
Management Options ◽  
Biologic Dmards ◽  
Appropriate Treatment ◽  
Outcomes For Children

Juvenile idiopathic arthritis (JIA) is the most common form of chronic synovial joint inflammation in children. It potentially leads to disability and psychosocial outcomes for children and their families. In the absence of appropriate treatment, this can lead to joint destruction and disability. Thus, early diagnosis and aggressive treatment are essential. With the presentation of new biologic DMARDs, based on understanding the disease pathophysiology and molecular pathogenesis, the course of the disease and its outcome have been changed profoundly. In this chapter, the early diagnosis, appropriate treatment, and outcomes approaches are described. These include the latest diagnosis and management options.

scholarly journals Therapeutic Concepts for Oligometastatic Gastrointestinal Tumours

2020 ◽  
Vol 36 (5) ◽  
pp. 359-363
Author(s):  
Jens Ricke ◽  
Christoph Benedikt Westphalen ◽  
Max Seidensticker
Keyword(s):  
Treatment Guidelines ◽  
Local Treatment ◽  
Disease Free Survival ◽  
Free Survival ◽  
Organ Systems ◽  
Therapeutic Concepts ◽  
Gastrointestinal Tumours ◽  
Definition Of ◽  
Disease Free ◽  
Systemic Therapies

<b><i>Background:</i></b> Clinical trials have proven a survival benefit from applying local therapies for oligometastatic cancers of various origin. <b><i>Summary:</i></b> Today, the definition of oligometa­static disease is based on limited lesion numbers and organ systems involved. Treatment guidelines by the European Organisation for Research and Treatment of Cancer (EORTC), European Society for Medical Oncology (ESMO) and several other groups suggest a threshold of up to 5 tumours. Established biological markers indicating the aggressiveness of a given tumour (and therefore suggesting local treatment only or the addition of or complete switch to systemic therapies) are missing, except for disease-free survival, the only recommended parameter for patient selection beyond lesion count. <b><i>Key Message:</i></b> The following article discusses clinical implications as well as local techniques established for the treatment of oligometastatic disease.

scholarly journals Validation of an Empiric Candidemia Treatment Algorithm

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S89-S90
Author(s):  
Conor M Stack ◽  
Lovisa B Olafsdottir ◽  
Monica V Mahoney ◽  
Christopher McCoy ◽  
Howard S Gold ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Culture ◽  
Treatment Guidelines ◽  
Local Treatment ◽  
Treatment Algorithm ◽  
Bloodstream Infections ◽  
Initial Therapy ◽  
Development Of Resistance ◽  
Inappropriate Treatment ◽  
Susceptible Isolate

Abstract Background Judicious use of echinocandins may limit the development of resistance in Candida species. Guidelines endorse the use of echinocandins as initial therapy in candidemia, with fluconazole as an alternate choice in select patients. We compared the ability of providers to predict the need for echinocandin therapy in Candida bloodstream infections to that of a proposed institutional treatment algorithm designed to optimize empiric antifungal use. Methods In this retrospective study (10/2015–10/2016), patients were included with Candida isolated in ≥1 blood culture, without candidemia in the prior 14 days. Empiric treatment (the first antifungal prescribed for ≥24 hours after index blood culture draw) was considered “overly broad” if an echinocandin was administered to a fluconazole-susceptible isolate and “inappropriate” if fluconazole was administered to a fluconazole-non-susceptible isolate. An institutional algorithm was created recommending empiric echinocandin use based on the presence of ≥1 risk factors (Table 1). Provider choice and the recommended agent according to the algorithm were compared with the final fluconazole susceptibility of the organism. Results Among 65 episodes of candidemia, the majority of isolates were C. glabrata (Figure 1). Ninety-one percent of patients received non-azole therapy, primarily micafungin. Fluconazole was recommended by the algorithm in 25% of cases but initially prescribed in only 9% (Figure 2). Providers prescribed both overly broad and inappropriate treatment at a higher rate than algorithm recommendations (Figure 3). Conclusion An algorithm using risk factors for fluconazole-non-susceptible Candida was able to predict appropriate empiric antifungal therapy better than provider decision making in cases of candidemia. Implementation of this algorithm into local treatment guidelines may improve empiric antifungal prescribing. Disclosures All authors: No reported disclosures.

scholarly journals Proteomic Analysis of Recurrent Joint Inflammation in Juvenile Idiopathic Arthritis

2006 ◽  
Vol 5 (8) ◽  
pp. 1988-1995 ◽  
Author(s):  
David S. Gibson ◽  
Sarah Blelock ◽  
Simon Brockbank ◽  
Jim Curry ◽  
Adrienne Healy ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Proteomic Analysis ◽  
Joint Inflammation

scholarly journals Joint inflammation assessed by physical examination and MRI of the knee in juvenile idiopathic arthritis: low predictive value for synovitis

2014 ◽  
Vol 12 (S1) ◽  
Author(s):  
Charlotte M Nusman ◽  
Robert Hemke ◽  
Dieneke Schonenberg ◽  
Koert Dolman ◽  
Marion van Rossum ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Physical Examination ◽  
Predictive Value ◽  
Joint Inflammation

scholarly journals Synovial Fluid Neutrophils in Oligoarticular Juvenile Idiopathic Arthritis Have an Altered Phenotype and Impaired Effector Functions

2021 ◽  
Author(s):  
Sabine Arve-Butler ◽  
Tobias Schmidt ◽  
Anki Mossberg ◽  
Elisabet Berthold ◽  
Birgitta Gullstrand ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Synovial Fluid ◽  
Oxidative Burst ◽  
Joint Inflammation ◽  
Mannose Receptor ◽  
Inactive Disease ◽  
Phagocytic Capacity ◽  
Effector Functions ◽  
Oligoarticular Juvenile Idiopathic Arthritis ◽  
And Function

Abstract BackgroundNeutrophils are the most prevalent immune cells in synovial fluid in inflamed joints of children with oligoarticular juvenile idiopathic arthritis (JIA). Despite this, little is known about neutrophil function at the site of inflammation in JIA and how local neutrophils contribute to disease pathogenesis. This study aimed to characterize phenotype and function of synovial fluid neutrophils in oligoarticular JIA.Methods Neutrophils obtained from paired blood and synovial fluid from patients with active oligoarticular JIA were investigated phenotypically (n=17) and functionally (phagocytosis and oxidative burst, n=13) by flow cytometry. In a subset of patients (n=6), blood samples were also obtained during inactive disease at a follow-up visit. Presence of CD206-expressing neutrophils was investigated in synovial biopsies from four patients by immunofluorescence. ResultsNeutrophils in synovial fluid had an activated phenotype, characterized by increased CD66b and CD11b levels, and most neutrophils had a CD16hi CD62Llow aged phenotype. A large proportion of the synovial fluid neutrophils expressed CD206, a mannose receptor not commonly expressed by neutrophils but by monocytes, macrophages and dendritic cells. CD206 expressing neutrophils were also found in synovial tissue biopsies. The synovial fluid neutrophil phenotype was not dependent on transmigration alone. Functionally, synovial fluid neutrophils had reduced phagocytic capacity and a trend towards impaired oxidative burst compared to blood neutrophils. In addition, the effector functions of the synovial fluid neutrophils correlated negatively with the proportion of CD206+ neutrophils.ConclusionsNeutrophils in the inflamed joint in oligoarticular JIA were altered, both regarding phenotype and function. Neutrophils in the synovial fluid were activated, had an aged phenotype, had gained monocyte-like features and had impaired phagocytic capacity. The impairment in phagocytosis and oxidative burst was associated to the phenotype shift. We speculate that these neutrophil alterations might play a role in the sustained joint inflammation seen in JIA.

scholarly journals Treatment Landscape of Nonmetastatic Castration-Resistant Prostate Cancer: A Window of Opportunity

2021 ◽  
Vol 11 (11) ◽  
pp. 1190
Author(s):  
Fernando López-Campos ◽  
Antonio Conde-Moreno ◽  
Marta Barrado Los Arcos ◽  
Antonio Gómez-Caamaño ◽  
Raquel García-Gómez ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Treatment Guidelines ◽  
Standard Of Care ◽  
Phase Iii ◽  
Metastatic Progression ◽  
Castration Resistant Prostate Cancer ◽  
Phase Iii Clinical Trials ◽  
Castration Resistant ◽  
Medical Need ◽  
Clinical Benefits

The treatment for nonmetastatic castration-resistant prostate cancer (nmCRPC) is a highly unmet medical need. The classic treatment approach for these patients—androgen deprivation therapy (ADT) alone—until metastatic progression is now considered suboptimal. Several randomized phase III clinical trials have demonstrated significant clinical benefits—including significantly better overall survival (OS)—for treatments that combine ADT with apalutamide, enzalutamide, and darolutamide. As a result, these approaches are now included in treatment guidelines and are considered a standard of care. In the present article, we discuss the changing landscape of the management of patients with nmCRPC.

scholarly journals ACORN (A Clinically-Oriented Antimicrobial Resistance Surveillance Network): a pilot protocol for case based antimicrobial resistance surveillance

2020 ◽  
Vol 5 ◽  
pp. 13
Author(s):  
Paul Turner ◽  
Elizabeth A. Ashley ◽  
Olivier J. Celhay ◽  
Anousone Douangnouvong ◽  
Raph L. Hamers ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Treatment Guidelines ◽  
Clinical Care ◽  
Local Treatment ◽  
Laboratory Data ◽  
Added Value ◽  
Pilot Phase ◽  
Surveillance Network ◽  
Antimicrobial Resistance Surveillance ◽  
The Impact

Background: Antimicrobial resistance (AMR) / drug resistant infections (DRIs) are a major global health priority. Surveillance data is critical to inform infection treatment guidelines, monitor trends, and to assess interventions. However, most existing AMR / DRI surveillance systems are passive and pathogen-based with many potential biases. Addition of clinical and patient outcome data would provide considerable added value to pathogen-based surveillance. Methods: The aim of the ACORN project is to develop an efficient clinically-oriented AMR surveillance system, implemented alongside routine clinical care in hospitals in low- and middle-income country settings. In an initial pilot phase, clinical and microbiology data will be collected from patients presenting with clinically suspected meningitis, pneumonia, or sepsis. Community-acquired infections will be identified by daily review of new admissions, and hospital-acquired infections will be enrolled during weekly point prevalence surveys, on surveillance wards. Clinical variables will be collected at enrolment, hospital discharge, and at day 28 post-enrolment using an electronic questionnaire on a mobile device. These data will be merged with laboratory data onsite using a flexible automated computer script. Specific target pathogens will be Streptococcus pneumoniae, Staphylococcus aureus, Salmonella spp., Klebsiella pneumoniae, Escherichia coli, and Acinetobacter baumannii. A bespoke browser-based app will provide sites with fully interactive data visualisation, analysis, and reporting tools. Discussion: ACORN will generate data on the burden of DRI which can be used to inform local treatment guidelines / national policy and serve as indicators to measure the impact of interventions. Following development, testing and iteration of the surveillance tools during an initial six-month pilot phase, a wider rollout is planned.

scholarly journals Juvenile Idiopathic Arthritis: A Review of Novel Diagnostic and Monitoring Technologies

Healthcare ◽  
2021 ◽  
Vol 9 (12) ◽  
pp. 1683
Author(s):  
Amelia J. Garner ◽  
Reza Saatchi ◽  
Oliver Ward ◽  
Daniel P. Hawley
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Functional Disability ◽  
Three Dimensional ◽  
Joint Damage ◽  
Joint Inflammation ◽  
Infrared Thermal Imaging ◽  
Insidious Onset ◽  
Assessment And Monitoring ◽  
Monitoring Technologies ◽  
Tools And Techniques

Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease of childhood and is characterized by an often insidious onset and a chronic relapsing–remitting course, once diagnosed. With successive flares of joint inflammation, joint damage accrues, often associated with pain and functional disability. The progressive nature and potential for chronic damage and disability caused by JIA emphasizes the critical need for a prompt and accurate diagnosis. This article provides a review of recent studies related to diagnosis, monitoring and management of JIA and outlines recent novel tools and techniques (infrared thermal imaging, three-dimensional imaging, accelerometry, artificial neural networks and fuzzy logic) which have demonstrated potential value in assessment and monitoring of JIA. The emergence of novel techniques to assist clinicians’ assessments for diagnosis and monitoring of JIA has demonstrated promise; however, further research is required to confirm their clinical utility.

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