Steroid-Sparing Effect, Effectiveness, and Tolerability of Mepolizumab with EGPA in Real World Clinical Practice

Abstract BackgroundEosinophilic polyangiitisgranulomatosa (EGPA) is a vasculitis syndrome that affects small and medium-sized blood vessels throughout the body. The mainstay of treatment is steroids, but there are no standardized doses or durations for steroids in combination with mepolizumab. MethodsWe investigated the efficacy, steroid administration, and course of steroid reduction in five patients who were diagnosed with EGPA and treated with mepolizumab for 1 year. Five patients who were diagnosed with EGPA using the American College of Rheumatology criteria and treated with mepolizumab for 1 year were included in our study from 2018–2020.ResultsEosinophil levels as well as the Birmingham Vasculitis Activity Score (BVAS), remission rate, annual relapse rate, and steroid dosage were observed at 1 year after mepolizumab treatment. Fifty-two weeks after mepolizumab treatment, eosinophils, BVAS, and the steroid dosage showed a trend toward improvement in four out of five patients. In the one patient who received no dose reduction, there was no exacerbation of bronchial asthma that had previously occurred during the follow-up period. Although neurological symptoms often remain even in remission, all patients with neurological symptoms at diagnosis improved. There were no cases of relapse in this study, including two anti-neutrophil cytoplasmic antibody-positive cases. ConclusionsManagement that includes early administration of mepolizumab may improve patients’ quality of life by alleviating lingering neurological symptoms that are caused by EGPA.

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Treatment with Diazepam in Acute Stroke Prevents Poststroke Seizures: A Substudy of the EGASIS Trial

Cerebrovascular Diseases ◽

10.1159/000512799 ◽

2021 ◽

pp. 1-6

Author(s):

Julia H. van Tuijl ◽

Elisabeth P.M. van Raak ◽

Robert J. van Oostenbrugge ◽

Albert P. Aldenkamp ◽

Rob P.W. Rouhl

Keyword(s):

Placebo Group ◽

Acute Stroke ◽

Incidence Rate Ratio ◽

Day Treatment ◽

Stroke Patients ◽

Early Administration ◽

Anterior Circulation ◽

Double Blind

Objective: The frequency of seizures after stroke is high, with a severe impact on the quality of life. However, little is known about their prevention. Therefore, we investigated whether early administration of diazepam prevents the development of seizures in acute stroke patients. Methods: We performed a substudy of the EGASIS trial, a multicenter double-blind, randomized trial in which acute stroke patients were treated with diazepam or placebo for 3 days. Follow-up was after 2 weeks and 3 months. The occurrence of seizures was registered prospectively as one of the prespecified secondary outcomes. Results: 784 EGASIS patients were eligible for this substudy (389 treated with diazepam [49.6%] and 395 treated with placebo [50.4%]). Seizures were reported in 19 patients (2.4% of the total patient group). Seizures occurred less frequently in patients treated with diazepam (1.5 vs. 3.3% in the placebo group); however, this difference was only statistically significant in patients with a cortical anterior circulation infarction (0.9% in the diazepam group vs. 4.6% in the placebo group, incidence rate ratio 0.20, 95% CI: 0.05–0.78, p = 0.02, NNT = 27). Conclusion: We found that a 3-day treatment with diazepam after acute cortical anterior circulation stroke prevents the occurrence of seizures in the first 3 months following stroke.

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Measuring the quality of the “comply or explain” approach

Managerial Auditing Journal ◽

10.1108/maj-08-2014-1060 ◽

2015 ◽

Vol 30 (4/5) ◽

pp. 373-412 ◽

Cited By ~ 18

Author(s):

Michail Nerantzidis

Keyword(s):

Content Analysis ◽

Web Sites ◽

Stock Exchange ◽

The Body ◽

Content Type ◽

Athens Stock Exchange ◽

Recent Financial Crisis ◽

The One ◽

Comply Or Explain

Purpose – This paper provides evidence regarding the efficacy of the “comply or explain” approach in Greece and has three objectives: to improve our knowledge of the concept of this accountability mechanism, to elevate auditors’ potential role in the control of corporate governance (CG) statements and to contribute to the discussion about the reform of this principle; a prolonged dialogue that has been started by European Commission in the light of the recent financial crisis. Design/methodology/approach – The approach taken is a content analysis of CG statements and Web sites of a non-probability sample of 144 Greek listed companies on the Athens Stock Exchange for the year 2011. Particularly, 52 variables were evaluated from an audit compliance perspective using a coding scheme. From this procedure, the level of compliance with Hellenic Federation of Enterprises (SEV) code, as well as the content of the explanations provided for non-compliance, were rated. Findings – The results show that although the degree of compliance is low (the average governance rating is 35.27 per cent), the evaluation of explanations of non-compliance is even lower (from the 64.73 per cent of the non-compliance, the 40.95 per cent provides no explanation at all). Research limitations/implications – The research limitations are associated with the content analysis methodology, as well as the reliability of CG statements. Practical implications – This study indicates that companies on the one hand tend to avoid the compliance with these recommendation practices, raising questions regarding the effectiveness of the SEV code; while on the other, they are not in line with the spirit of the CG code, as they do not provide adequate explanations. These results assist practitioners and/or policy-makers in perceiving the efficacy of the “comply or explain” approach. Originality/value – While there is a great body of research that has looked into the compliance with best practices, this study is different because it is the first one that rates not only the degree of the compliance with the code’s practices but also the content of the explanations provided for non-compliance. This is particularly interesting because it adds to the body of research by providing a new approach in measuring the quality of the “comply or explain” principle in-depth.

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The Different Impacts on the Long-Term Survival of Tunneled Internal Jugular Hemodialysis Catheters Based on Tip Position and Laterality

Blood Purification ◽

10.1159/000454670 ◽

2017 ◽

Vol 43 (4) ◽

pp. 315-320 ◽

Cited By ~ 1

Author(s):

Vedran Premuzic ◽

Drazen Perkov ◽

Ranko Smiljanic ◽

Bruna Brunetta Gavranic ◽

Bojan Jelakovic

Keyword(s):

Superior Vena ◽

Vena Cava ◽

The Body ◽

Term Survival ◽

Catheter Tip ◽

Tip Position ◽

The Impact

Background/Aims: The aim of this study was to examine the impact of different catheter tip positions on the life of the catheter, dysfunction, infection, and quality of hemodialysis and possible differences between the access site laterality in jugular-tunneled hemodialysis catheters. Methods: Catheters were evaluated for the following parameters: place of insertion, time of insertion, duration of use, and reason for removal. In all patients, the catheter tip position was checked using an X-ray. Results: The mean duration of implanted catheters with the tip placed in the cavo-atrial junction and right atrium was significantly longer. There were no differences in catheter functionality at follow-up or complications based on catheter laterality for each catheter tip position. Conclusion: According to our results, the localization of the catheter tip in superior vena cava still remains the least preferable method. Our results showed that the main factor responsible for better catheter functionality was not laterality but the depth to which the catheter tip is inserted into the body.

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Effectiveness of the Electromagnetic Shock Wave Therapy in the Treatment of Cellulite

Dermatology Research and Practice ◽

10.1155/2019/8246815 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Débora Apª O. Modena ◽

Caroline Nogueira da Silva ◽

Talita C. P. Delinocente ◽

Tatiane Bianca de Araújo ◽

Tania Maria de Carvalho ◽

...

Keyword(s):

Quality Of Life ◽

Evaluation Method ◽

The Body ◽

P Value ◽

Therapeutic Modalities ◽

Shockwave Therapy ◽

Deformation Ability ◽

Post Hoc

In the past centuries, the human body was undervalued; nowadays, however, it is overvalued, and thus the manifestation of the dissatisfactions regarding the body has been increasing. Most of the time, these dissatisfactions are related to cellulite, which is most common in women. Its treatment is one of the challenges which encourage the development of new therapeutic modalities, among them the shockwave therapy. Objective. To evaluate the efficacy of ESWT in the treatment of cellulite in gluteus and posterior of thigh. Method. This is a prospective and comparative study, in which volunteer women who attended the criteria of inclusion were selected and who were subjected to 10 sessions of ESWT. The following were performed as an evaluation method: anthropometry, perimetry, skin viscoelasticity with the Cutometer®, thickness of hypodermis with diagnostic ultrasound, analysis of the scale of severity of cellulite (CSS), and quality of life by the Celluqol® questionnaire. The evaluations occurred before the first session (baseline), after 6 and 10 sessions, and during a follow-up of 3 months after the last session. The statistical test applied was the ANOVA one-way with post hoc of Tukey (P-value < 0.05). Results. There was significant improvement (P<0.05) for CSS, for the variable referring to gross elasticity and skin deformation ability evaluated in the Cutometer® and improvement of quality of life represented by Celluqol®. The result was maintained particularly in the follow-up of 3 months after the end of the treatment. Conclusion. The results presented demonstrated the effectiveness and safety of ESWT in the treatment of cellulite and in the decrease of the degrees, improvement of the aspect of the skin, and reestablishment of quality of life. This trial is registered with ClinicalTrials: NCT03275259.

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A Systematic Review: Outcomes in Adult Recurrent Respiratory Papillomatosis Treated with Intralesional Cidofovir or Bevacizumab

Otolaryngology ◽

10.1177/0194599816683384 ◽

2017 ◽

Vol 156 (3) ◽

pp. 435-441 ◽

Cited By ~ 9

Author(s):

Sarah Drejet ◽

Stacey Halum ◽

Matthew Brigger ◽

Elaine Skopelja ◽

Noah P. Parker

Keyword(s):

Quality Of Life ◽

Disease Severity ◽

Functional Outcomes ◽

Remission Rate ◽

A Priori ◽

Poor Quality ◽

Recurrent Respiratory Papillomatosis ◽

Related Quality

Objectives (1) To systematically identify studies evaluating the use of intralesional cidofovir or bevacizumab as an adjunct in adult recurrent respiratory papillomatosis, determine disease severity and functional outcomes, and assess study quality. (2) To compare outcomes between the 2 adjuncts. Data Sources Ovid Medline, EMBASE, Scopus, and Clinical-Trials.gov . Review Methods Data sources were systematically searched. A priori inclusion and exclusion criteria were instituted. Quality was evaluated with the Newcastle-Ottawa Quality Assessment Scale. A priori criteria were instituted to select studies suitable for comparison. Results A total of 254 identified studies led to 16 for full-text review, including 14 for cidofovir and 2 for bevacizumab. Disease severity outcomes were reported in all studies, including remission rate, Derkay scores, time interval between operations, and/or lesion volume reduction. Remission rate was the most commonly reported (14 studies). Functional outcomes were reported in 5 studies (36%), including quality-of-life questionnaires, acoustic/aerodynamic analysis, and perceptual voice analysis. Voice-related quality of life was the most commonly reported (2 studies). Of 16 studies, 12 (75%) were rated poor quality. Reports almost invariably showed improved disease severity and functional outcomes following treatment; however, variable outcome measures and inadequate follow-up disallowed direct comparison of adjuncts. Conclusion Remission rate was the most commonly reported disease severity outcome, and voice-related quality of life was the most commonly reported functional outcome. Most studies were of poor quality. No studies met criteria for comparative analysis between adjuncts. Future research would be improved by reporting consistent and comparable disease severity and functional outcomes, treatment protocols, and follow-up.

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Effects of a Multidisciplinary Educational Rehabilitative Intervention in Breast Cancer Survivors: The Role of Body Image on Quality of Life Outcomes

The Scientific World JOURNAL ◽

10.1155/2014/451935 ◽

2014 ◽

Vol 2014 ◽

pp. 1-11 ◽

Cited By ~ 10

Author(s):

Giovanni Morone ◽

Marco Iosa ◽

Augusto Fusco ◽

Antonella Scappaticci ◽

Maria Rosaria Alcuri ◽

...

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Body Image ◽

Breast Cancer Survivors ◽

The Body ◽

Life Outcomes ◽

Rehabilitative Intervention ◽

Psychological Features

In breast cancer survivors, own body image may change due to physical and psychological reasons, worsening women’s living. The aim of the study was to investigate whether body image may affect the functional and quality of life outcomes after a multidisciplinary and educational rehabilitative intervention in sixty women with primary nonmetastatic breast cancer who have undergone conservative surgery. To assess the quality of life was administered The European Organization for Research and Treatment of Cancer Study Group on Quality of Life core questionnaire, while to investigate the psychological features and self-image were administered the following scales: the Body Image Scale, the Hamilton Rating Scale for Depression, and the State-Trait Anxiety Inventory. To assess the recovery of the function of the shoulder were administered: the Disabilities of the Arm, Shoulder, and Hand Questionnaire and the Constant-Murley Score. Data were collected at the baseline, at the end of the intervention, and at 3-month follow-up. We found a general improvement in the outcomes related to quality of life, and physical and psychological features after treatment (P< 0.001). During follow-up period, a higher further improvement in women without alterations in body image in respect of those with an altered self-perception of their own body was found (P= 0.01). In conclusion, the body image may influence the efficacy of a rehabilitative intervention, especially in the short term of follow-up.

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Study on Water and Other Drinks Used for Hydration in Movement Activities

Revista de Chimie ◽

10.37358/rc.20.8.8297 ◽

2020 ◽

Vol 71 (8) ◽

pp. 249-254

Author(s):

Dragos Ioan Tohanean ◽

Vasilios Koronas ◽

Peter Sagat ◽

Ioan Turcu ◽

Ioana Maria Curitianu ◽

...

Keyword(s):

Good Health ◽

High Water ◽

The Body ◽

The Other ◽

Physical Effort ◽

Medium Level ◽

The One ◽

Water Purity ◽

Movement Activities

The main purpose of this study was to identify the types of water and other drinks used for hydration by those who perform movement activities and also to analyze the quality of these drinks. As a result of performing movement activities, through perspiration, a greater or lesser amount of water is lost from the body. Along with this, a number of nutrients are lost. Given these aspects, the main objective of the research was to understand more correctly, what is involved in proper hydration, which are the factors that must be taken into account to maintain good health. We analyzed and compared the level of the main electrolytes and carbohydrates for different categories of drinks and also measured with the help of two specific devices the level of purity and pH of three categories of drinking water. We indicated general values regarding the ratio of water consumption to weight on the one hand, and on the other hand, we indicated the indicative quantities that should be consumed before, during and after performing medium-level physical effort. As a general conclusion, the importance of sodium, alkaline water and high water purity was highlighted in relation to the categories of beverages analyzed in this study.

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Intensive Care Patients from the First COVID-19 Wave: One-Year Survival after Tocilizumab Treatment

Journal of Personalized Medicine ◽

10.3390/jpm11111234 ◽

2021 ◽

Vol 11 (11) ◽

pp. 1234

Author(s):

Gabriele Melegari ◽

Enrico Giuliani ◽

Chiara Dallai ◽

Lucia Veronesi ◽

Elisabetta Bertellini ◽

...

Keyword(s):

Treated Group ◽

Cytokine Storm ◽

Icu Patients ◽

Intensive Care Patients ◽

One Year ◽

The One ◽

Mortality Hazard Ratio ◽

New Onset

Introduction: An infection by COVID-19 triggers a dangerous cytokine storm, so tocilizumab has been introduced in Italy as an agent blocking the cytokine storm. This paper aims to describe the one-year survival of ICU patients treated with tocilizumab. Methods: This observational study enrolled all patients confirmed to be infected by COVID-19 who were admitted to the ICU in our center. We offered tocilizumab to all non-septic patients if they did not present any contraindications. Results: We enrolled 68 ICU patients in our center on 72 occasions during the enrollment period; we excluded four patients due to study criteria. The one-year mortality hazard ratio of treated patients was 0.64, with a confidence interval of 0.31 to 1.19, with p = 0.169. Among the survivors, 32 of 35 patients answered the phone interview (14 patients in the treated group and 18 in the untreated group); overall, the effect of COVID-19 on quality of life was 58.14%. These effects were lower in the tocilizumab group, with p = 0.016 *. Conclusions: Our observational data follow the most relevant largest trial. Patients treated with tocilizumab had lower rates of new-onset symptoms later COVID-19 ICU hospitalizations. As reported by recent medical literature, the presence of these symptoms suggests that a follow-up program for these types of patients could be useful.

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Evaluation of disc degeneration adjacent to AOspine A fractures: pre- and post-operative MRI analysis

SICOT-J ◽

10.1051/sicotj/2020032 ◽

2020 ◽

Vol 6 ◽

pp. 33

Author(s):

Laura Marie-Hardy ◽

Nicolas Barut ◽

Hedi Sari Ali ◽

Marc Khalifé ◽

Hugues Pascal-Moussellard

Keyword(s):

Great Majority ◽

Type A ◽

The Body ◽

Thoracolumbar Fractures ◽

Secondary Degeneration ◽

Bone Injury ◽

Post Traumatic ◽

Level Fusion

Introduction: The management of type A thoracolumbar fractures varies from conservative treatment to multiple level fusion. Indeed, although Magerl defined the type A fracture as a strictly bone injury, several authors suggested associated disc lesions or degeneration after trauma. However, the preservation of mobility of the adjacent discs should be a major issue. This study was conducted to analyze the presence of immediate post-traumatic disc injuries and to know if discs degenerate after receiving treatment. Methods: We retrospectively reviewed the files of 27 patients with an AOspine A fracture, corresponding to 34 fractures (64 discs) with pre and post-operative MRI (mean follow-up: 32.4 months). Based on Pfirrmann’s and Oner’s classifications of disc injuries, two observers analyzed independently the type of lesion in the discs adjacent to the fractured vertebra in immediate post-trauma and at the last follow-up. Results: The immediate post-traumatic analysis according to Pfirrmann’s classification found 97% of the cranial adjacent discs and 100% of the caudal discs classified Pfirrmann 3 or less. The analysis on the secondary MRI revealed that 78% of cranial adjacent discs and 88% of caudal adjacent discs still were classified Pfirrmann 3 or less. Conclusions: Since, the great majority of type A fractures does not cause immediate disc injuries, these fractures are, as described by Magerl, strictly bony injuries. The quality of the body reduction seems to prevent secondary degeneration. These results may encourage surgeons not to perform arthrodesis on type A fractures even for A3 and A4.

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GENERAL PRINCIPLES OF USE OF DOSED PHYSICAL EXERCISE IN PATIENTS WITH HEMODIALYSIS

Nephrology (Saint-Petersburg) ◽

10.24884/1561-6274-2018-22-4-102-107 ◽

2018 ◽

Vol 22 (4) ◽

pp. 102-107 ◽

Cited By ~ 1

Author(s):

K. A. Vishnevsky ◽

A. Sh. Rumyantsev ◽

N. Yu. Korosteleva

Keyword(s):

The Body ◽

Energy Deficiency ◽

Physical Exercises ◽

Protein Energy ◽

Training Mode ◽

Long Term Follow Up ◽

Almost All

The article reflects modern ideas about the causes and mechanisms of the physical functioning disorders in patients with chronic kidney disease receiving program hemodialysis. Various types of physical activity are considered and the rationale for their use in dialysis patients is justified. The diagnostics possibilities of the protein- energy deficiency main variants are presented. Possible directions for their correction are outlined. The possibilities and methods of regular physical training in such a complex cohort of patients with changes in almost all the basic systems of the body are described in detail. For patients who cannot perform physical exercises in a training mode, a new rehabilitation technique was developed and tested on a representative sample, and a new rehabilitation technique that was not previously used in nephrology – a cutaneous bilateral electrostimulation of the muscles of the lower extremities – was justified and considered in detail. The authors give their own data on long-term follow-up of patients, which confirm the possibilities of the presented methods not only in terms of improving physical performance, but also in improving the adequacy of dialysis and the quality of life.

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