scholarly journals Preventive Tuberculosis Services Reduces the Risk of Local Forms of Tuberculosis Development in Children on Immunosuppressive Therapy: Retrospective Cohort Study

2020 ◽  
Vol 19 (5) ◽  
pp. 346-351
Author(s):  
Valentina A. Aksenova ◽  
Nadezda I. Klevno ◽  
Alexey V. Kazakov ◽  
Dmitry A. Kudlay ◽  
Tatyana A. Sevostyanova ◽  
...  
Keyword(s):  
High Risk ◽  
Immunosuppressive Therapy ◽  
Preventive Treatment ◽  
Immunosuppressive Drugs ◽  
Genetically Engineered ◽  
Medical Documentation ◽  
Recombinant Allergen ◽  
Biologic Drugs ◽  
One Year ◽  
Tuberculosis Service

Background. Long-term immunosuppressive therapy in children (including genetically engineered biologic drugs, GEBD) is associated with a high risk of local tuberculosis (TB) development. Objective. The aim of the study was to examine efficacy of tuberculosis services in children with high risk of developing tuberculosis associated with immunosuppressive therapy.Methods. The study included children at the age from 0 to 17 years on immunosuppressive therapy due to autoimmune disease and who were referred to phthisiatrician consultation. The incidence of TB was estimated one year after in groups receiving preventive TB services (isoniazid and pyrazinamide for 3–6 months) due to the high risk of TB development (contact with TB patients and/or controversial or positive test results with tubercular recombinant allergen) or not receiving such therapy (no indications for preventive treatment, parents’ refusal). The source of any data was medical documentation.Results. Preventive tuberculosis service was performed in 167 (60%) out of 279 children included in the study, 112 children did not receive such treatment (5 cases — parents’ refusal, 107 cases — lack of indications for preventive treatment). TB was detected in 1 (0.6%) child after one year in the preventive treatment group, and in 14 (12.5%) children (p < 0.001) in the group without preventive treatment. Thoracic lymph nodes tuberculosis was diagnosed in 4 (27%) patients among all who has developed TB, tuberculous primary complex — in 3 (20%) patients, focal tuberculosis in 7 (46%) patients, disseminated tuberculosis in 1 (7%) patient.Conclusion. Preventive tuberculosis service reduces the risk of tuberculosis in children on administration of immunosuppressive drugs, including GEBD.

scholarly journals POS1152 COMORBID INFECTIONS IN PATIENTS WITH SPONDYLOARTHRITIS.

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 855.2-855
Author(s):  
M. Baranova ◽  
N. Muravyeva ◽  
B. Belov
Keyword(s):  
Chronic Hepatitis ◽  
Immunosuppressive Therapy ◽  
Viral Infections ◽  
Significant Risk ◽  
Acute Bronchitis ◽  
Immunosuppressive Drugs ◽  
Lung Damage ◽  
Medical Documentation ◽  
Biological Drugs ◽  
Tract Infections

Background:Data on the frequency and structure of comorbid infections (CI) in spondyloarthritis (SpA) are few and contradictory.Objectives:The aim of the study was to study the frequency and structure of CI in the inpatient population of SpA patients in the course of a one-moment retrospective study.Methods:The study included 208 patients with SpA (121 men, 87 women, mean age 39.1±12.2 years) who were hospitalized at the V.A. Nasonova Research Institute of Rheumatology. Ankylosing spondylitis was diagnosed in 133 patients, psoriatic arthritis - in 57, spondyloarthritis associated with Crohn’s disease - in 1, undifferentiated spondyloarthritis - in 17. The majority of respondents had higher education (60.6%). None of the patients consumed alcohol on a daily basis, 124 patients never smoked. The Charlson comorbidity index, equal to 0, had 98 respondents, 1 - 51, 2 - 27, 3 - 15, 4 - 10, 5 or more - 7. Most patients (n=168) received nonsteroidal anti-inflammatory drugs (NSAIDs), as well as glucocorticoids-GC (average duration of administration 239.5±65.8 months), methotrexate-MT (32.4±46.2), sulfasalazine (21.0±32.1), leflunomide (24.0±46.6), biological drugs - TNF-α inhibitors (21.5±23.3), inhibitors of interleukin (iIL)-12/23 (9.0±5.2), iIL-17 (11.0±9.3). Patients were interviewed by a research doctor with the completion of a unified questionnaire, additional data were obtained from medical documentation.Results:Leading in the structure of CI in patients with SpA were respiratory tract infections: acute nasopharyngitis (n=168), tonsillitis (74), acute bronchitis (34), sinusitis (33), pneumonia (29, including 9 cases by the virus SARS-CoV-2), influenza (31), tuberculosis-TB (5, including 2 cases on infliximab therapy, which was the reason for withdrawal of the drug). Infectious diseases of other localization include herpes-viral infections (n=109), mycoses (51), urinary tract infections (47), conjunctivitis and blepharitis (37), otitis (25), genital infections (15), skin infections (14), intestinal infections (13), COVID-19 without lung damage (19), nervous system infections (2), bone infections (2), chronic hepatitis B (1), chronic hepatitis C (1), HIV infection (1), rubella in adulthood (1), measles in adulthood (1). 20.2% of patients reported more frequent development of CI after the onset of the of SpA: 35 of them received immunosuppressive therapy, 7 – monotherapy of NSAIDs. In SpA patients receiving immunosuppressive drugs, there was an increase in the frequency of acute nasopharyngitis (more often 3 times a year), sinusitis, acute bronchitis, pneumonia and herpes-viral infections, in particular herpes zoster. 29.8% of patients reported a more severe course of CI against the background of SpA (12 of them did not receive immunosuppressive drugs). Temporary discontinuation of therapy due to the development of CI occurred in 26.4% of patients. At the same time, in 5 patients treated with GC (including in combination with MT, n=3), the development of furunculosis was the reason for changing the treatment regimen. In one patient, MT therapy was discontinued due to the frequent development of purulent tonsillitis. Exacerbation of SpA after CI was diagnosed in 84 patients (70 of them received immunosuppressive therapy).Conclusion:The data obtained indicate the important of the problem of CI in SpA. Further studies are needed on large samples of patients in order to find significant risk factors for CI, study their relationship with clinical characteristics and influence on the course of SpA.Disclosure of Interests:None declared.

Pharmacoeconomic analysis of using genetically engineered biologic drugs for treating adult patients with moderate to severe plaque psoriasis in the Russian Federation

2020 ◽  
pp. 57-65
Author(s):  
Maksim Frolov ◽  
Vladimir Rogov ◽  
Alla Salasyuk
Keyword(s):  
Plaque Psoriasis ◽  
Impact Analysis ◽  
Pharmacoeconomic Analysis ◽  
Certolizumab Pegol ◽  
Genetically Engineered ◽  
Adult Patients ◽  
Comparable Efficacy ◽  
Biologic Drugs ◽  
Severe Plaque Psoriasis ◽  
Cost Minimisation Analysis

The aim of the study was to assess clinical and economic effectiveness of netakimab compared to other genetically engineered biologic drugs (infliximab, adalimumab, etanercept, ustekinumab, secukinumab, ixekizumab, certolizumab pegol) for the treatment of adult patients with moderate to severe plaque psoriasis. We have conducted cost-benefit analysis, cost-minimisation analysis, and budget impact analysis. We have considered only direct medical costs. The results of the study show that netakimab has higher or comparable efficacy and significantly lower costs compared to other biologic drugs, that makes it the most preferable treatment option for patients with moderate to severe plaque psoriasis. Use of netakimab in clinical practice will significantly reduce budget expenditures and increase patient access to biologic therapy.

scholarly journals New risk model is able to identify patients with a low risk of progression in systemic sclerosis

RMD Open ◽  
2021 ◽  
Vol 7 (2) ◽  
pp. e001524
Author(s):  
Nina Marijn van Leeuwen ◽  
Marc Maurits ◽  
Sophie Liem ◽  
Jacopo Ciaffi ◽  
Nina Ajmone Marsan ◽  
...  
Keyword(s):  
Machine Learning ◽  
Systemic Sclerosis ◽  
High Risk ◽  
Disease Progression ◽  
Risk Model ◽  
Immunosuppressive Drugs ◽  
Low Risk ◽  
Expert Assessment ◽  
Risk Of Progression

ObjectivesTo develop a prediction model to guide annual assessment of systemic sclerosis (SSc) patients tailored in accordance to disease activity.MethodsA machine learning approach was used to develop a model that can identify patients without disease progression. SSc patients included in the prospective Leiden SSc cohort and fulfilling the ACR/EULAR 2013 criteria were included. Disease progression was defined as progression in ≥1 organ system, and/or start of immunosuppression or death. Using elastic-net-regularisation, and including 90 independent clinical variables (100% complete), we trained the model on 75% and validated it on 25% of the patients, optimising on negative predictive value (NPV) to minimise the likelihood of missing progression. Probability cutoffs were identified for low and high risk for disease progression by expert assessment.ResultsOf the 492 SSc patients (follow-up range: 2–10 years), disease progression during follow-up was observed in 52% (median time 4.9 years). Performance of the model in the test set showed an AUC-ROC of 0.66. Probability score cutoffs were defined: low risk for disease progression (<0.197, NPV:1.0; 29% of patients), intermediate risk (0.197–0.223, NPV:0.82; 27%) and high risk (>0.223, NPV:0.78; 44%). The relevant variables for the model were: previous use of cyclophosphamide or corticosteroids, start with immunosuppressive drugs, previous gastrointestinal progression, previous cardiovascular event, pulmonary arterial hypertension, modified Rodnan Skin Score, creatine kinase and diffusing capacity for carbon monoxide.ConclusionOur machine-learning-assisted model for progression enabled us to classify 29% of SSc patients as ‘low risk’. In this group, annual assessment programmes could be less extensive than indicated by international guidelines.

scholarly journals Post-transplant absolute lymphocyte count predicts early cytomegalovirus infection after heart transplantation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Minjae Yoon ◽  
Jaewon Oh ◽  
Kyeong-Hyeon Chun ◽  
Chan Joo Lee ◽  
Seok-Min Kang
Keyword(s):  
High Risk ◽  
Heart Transplantation ◽  
Immunosuppressive Therapy ◽  
Lymphocyte Count ◽  
Cytomegalovirus Infection ◽  
Absolute Lymphocyte Count ◽  
Cmv Infection ◽  
Igg Antibody ◽  
Post Transplant ◽  
The Relationship

AbstractImmunosuppressive therapy can decrease rejection episodes and increase the risk of severe and fatal infections in heart transplantation (HT) recipients. Immunosuppressive therapy can also decrease the absolute lymphocyte count (ALC), but the relationship between early post-transplant ALC and early cytomegalovirus (CMV) infection is largely unknown, especially in HT. We retrospectively analyzed 58 HT recipients who tested positive for CMV IgG antibody and received basiliximab induction therapy. We collected preoperative and 2-month postoperative data on ALC and CMV load. The CMV load > 1200 IU/mL was used as the cutoff value to define early CMV infection. Post-transplant lymphopenia was defined as an ALC of < 500 cells/μL at postoperative day (POD) #7. On POD #7, 29 (50.0%) patients had post-transplant lymphopenia and 29 (50.0%) patients did not. The incidence of CMV infection within 1 or 2 months of HT was higher in the post-transplant lymphopenia group than in the non-lymphopenia group (82.8% vs. 48.3%, P = 0.013; 89.7% vs. 65.5%, P = 0.028, respectively). ALC < 500 cells/μL on POD #7 was an independent risk factor for early CMV infection within 1 month of HT (odds ratio, 4.14; 95% confidence interval, 1.16–14.77; P = 0.029). A low ALC after HT was associated with a high risk of early CMV infection. Post-transplant ALC monitoring is simple and inexpensive and can help identify patients at high risk of early CMV infection.

scholarly journals Assessment of acute kidney injury risk using a machine-learning guided generalized structural equation model: a cohort study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Wen En Joseph Wong ◽  
Siew Pang Chan ◽  
Juin Keith Yong ◽  
Yen Yu Sherlyn Tham ◽  
Jie Rui Gerald Lim ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
High Risk ◽  
Hospital Mortality ◽  
Structural Equation Model ◽  
Structural Equation ◽  
Injury Risk ◽  
Kidney Injury ◽  
Equation Model ◽  
Surgical Icu ◽  
One Year

Abstract Background Acute kidney injury is common in the surgical intensive care unit (ICU). It is associated with poor patient outcomes and high healthcare resource usage. This study’s primary objective is to help identify which ICU patients are at high risk for acute kidney injury. Its secondary objective is to examine the effect of acute kidney injury on a patient’s prognosis during and after the ICU admission. Methods A retrospective cohort of patients admitted to a Singaporean surgical ICU between 2015 to 2017 was collated. Patients undergoing chronic dialysis were excluded. The outcomes were occurrence of ICU acute kidney injury, hospital mortality and one-year mortality. Predictors were identified using decision tree algorithms. Confirmatory analysis was performed using a generalized structural equation model. Results A total of 201/940 (21.4%) patients suffered acute kidney injury in the ICU. Low ICU haemoglobin levels, low ICU bicarbonate levels, ICU sepsis, low pre-ICU estimated glomerular filtration rate (eGFR) and congestive heart failure was associated with the occurrence of ICU acute kidney injury. Acute kidney injury, together with old age (> 70 years), and low pre-ICU eGFR, was associated with hospital mortality, and one-year mortality. ICU haemoglobin level was discretized into 3 risk categories for acute kidney injury: high risk (haemoglobin ≤9.7 g/dL), moderate risk (haemoglobin between 9.8–12 g/dL), and low risk (haemoglobin > 12 g/dL). Conclusion The occurrence of acute kidney injury is common in the surgical ICU. It is associated with a higher risk for hospital and one-year mortality. These results, in particular the identified haemoglobin thresholds, are relevant for stratifying a patient’s acute kidney injury risk.

What Should Be Done in Inflammatory Bowel Disease Patients with Prior Malignancy?

2017 ◽  
Vol 35 (1-2) ◽  
pp. 50-55 ◽  
Author(s):  
Jacques Cosnes
Keyword(s):  
Inflammatory Bowel Disease ◽  
Urinary Tract ◽  
High Risk ◽  
Bowel Disease ◽  
Immunosuppressive Treatment ◽  
Intestinal Resection ◽  
Immunosuppressive Drugs ◽  
Inflammatory Bowel ◽  
Risk Of Cancer ◽  
Prior Malignancy

Background: Treatment of inflammatory bowel disease (IBD) in patients with prior malignancy is challenging because therapeutic immunosuppression required for controlling IBD activity may increase the risk of cancer recurrence. Key Messages: Contrary to the observations in the post-transplant population, retrospective observational studies of IBD patients with prior malignancy have not demonstrated that immunosuppressive drugs increased significantly the risk of new or recurrent cancer. However, these studies are highly biased and do not permit the use of these drugs. Factors like the time since treatment completion, severity, and subtype of prior cancer should be weighed along with the current IBD activity before choosing the best therapeutic strategy. In practice, most cases of prior cancer require a delay of at least 2 years before starting or resuming immunosuppressants, including anti-TNF agents. This delay should be extended to 5 years in cancer with a high risk of recurrence including cancer of the urinary tract, gastrointestinal cancer, leukemias, and multiple myeloma. A special attention should be paid to cancers with a high risk of late metastasis (breast, melanoma, renal cell carcinoma). Enteral nutrition, Budesonide, mesalamine, and limited intestinal resection should be considered following the completion of cancer treatment and prior to the safe initiation of immunosuppressive treatment for IBD. Thiopurines should be avoided in case of prior Epstein-Barr virus-related lymphoma, HPV-related carcinomas, and cancer of the urinary tract. Methotrexate and anti-TNF agents seem to be safe except for the risk of recurrent melanoma for the latter. Conclusion: IBD patients with prior malignancy should benefit from individual decisions made on a case-by-case basis.

scholarly journals Forty-One-Year-Old Man with Pulmonary Embolism 5 Months After COVID-19

2021 ◽  
Vol 15 ◽  
pp. 117954842098665
Author(s):  
Muhanad Taha ◽  
Paul Nguyen ◽  
Aditi Sharma ◽  
Mazen Taha ◽  
Lobelia Samavati
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Venous Thrombosis ◽  
Case Summary ◽  
One Year

Background: Hypercoagulation is one of the striking features of COVID-19. Patients hospitalized with COVID-19 are at high risk for venous thromboembolism. However, it is unknown if the risk for venous thromboembolism persists after discharge. Case Summary: We report a case with pulmonary embolism 5 months after COVID-19. No risk factors for venous thrombosis have been identified. Conclusion: In COVID-19 related hospitalization, large studies are needed to identify the risk of venous thromboembolism after discharge.

Abstract TP165: Cardiac Screening Does not Improve One-year Mortality Among Patients With Cerebrovascular Disease

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Jason J Sico ◽  
Fitsum Baye ◽  
Laura J Myers ◽  
John Concato ◽  
Linda S Williams ◽  
...  
Keyword(s):  
High Risk ◽  
Cerebrovascular Disease ◽  
Stress Testing ◽  
Cerebrovascular Event ◽  
Mortality Benefit ◽  
Cardiac Stress ◽  
Cardiac Screening ◽  
All Cause Mortality ◽  
Cardiac Stress Testing ◽  
One Year

Introduction: Guidelines recommend the use of cardiac stress testing to screen for occult coronary heart disease (CHD) among patients with ischemic stroke/TIA who have a ‘high risk’ Framingham Cardiac Risk score (FCRS). It is unclear whether implementation of this guideline confers a mortality benefit among patients with cerebrovascular disease. Hypothesis: We assessed the hypothesis that cardiac stress testing would be associated with lower odds of one-year all-cause mortality. Methods: Administrative data from a sample of 11,306 Veterans admitted to 134 Veterans Health Administration (VHA) facilities with a stroke or TIA in fiscal year 2011 were analyzed. Patients were excluded (n=6915) on the basis of: prior CHD history, receipt of cardiac stress testing within 18-months prior to cerebrovascular event, death within 90 days of discharge, being discharged to hospice, transferred to a non-VHA acute care facility, or missing/unknown race. A FCRS was calculated for each patient; a score of ≥ 20% was classified as ‘high risk’ of having CHD. Administrative data were used to identify whether cardiac stress testing was performed within 90-days after the cerebrovascular event. Logistic regression was used to assess whether cardiac stress testing was associated with one-year all-cause mortality. Results: Of the 4391 eligible patients, 62.8% (2759) had FCRS ≥ 20%, with 4.5% (n=123) of these patients receiving cardiac stress testing within 90 days of discharge. After adjusting for sociodemographic characteristics and medical comorbidities, FCRS ≥ 20% was associated with one-year mortality (aOR=2.18; CI 95 :1.59, 3.00), however, receipt of stress testing was not (aOR=0.59; CI 95 :0.26, 1.30). Conclusion: Cardiac screening did not confer a one-year all-cause mortality benefit among patients with cerebrovascular disease. Additional work is needed to assess outcomes among patients with cerebrovascular disease who are at ‘high risk’ for CHD.

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