Utility of Anakinra in Acute Crystalline Diseases: A Retrospective Study Comparing a University Hospital with a Veterans Affairs Medical Center

2018 ◽  
Vol 46 (7) ◽  
pp. 748-750 ◽  
Author(s):  
Julianna Desmarais ◽  
Cong-Qiu Chu
Keyword(s):  
Retrospective Study ◽  
Adverse Effects ◽  
Medical Center ◽  
Veterans Affairs ◽  
Hospitalized Patients ◽  
University Hospital ◽  
Acute Gout ◽  
Efficacy And Safety ◽  
Inpatient Management ◽  
Gout Flares

Objective.To evaluate the efficacy and safety of anakinra in inpatient management of acute gout and pseudogout.Methods.Hospitalized patients with acute gout (n = 77) or pseudogout (n = 11) or both (n = 3) were analyzed for response to anakinra and adverse effects.Results.Half of all patients had comorbidities limiting the treatment choice. Anakinra was well tolerated, and 92% of gout flares and 79% of pseudogout flares responded to treatment.Conclusion.Anakinra is an effective and safe treatment for acute gout and pseudogout in hospitalized patients, particularly in those with comorbidities.

scholarly journals Efficacy and Safety of Rituximab in Immunobullous Diseases: A Retrospective Study from a Tertiary Care Centre of Nepal

2020 ◽  
Author(s):  
Sudip Parajuli ◽  
Jyoti Vidhan ◽  
Dinesh Binod Pokhrel ◽  
Upama Paudel
Keyword(s):  
Retrospective Study ◽  
Adverse Effects ◽  
Tertiary Care ◽  
Data Entry ◽  
Pemphigus Vulgaris ◽  
University Teaching ◽  
Efficacy And Safety ◽  
Tertiary Care Centre ◽  
Cutaneous Lesions

Introduction: Rituximab is effective and safe treatment of immunobullous disorders. There are variations in doses of drugs used in different studies and uncertainties on when to use it along with use of adjuvant therapies. Efficacy and safety of this drug has not been described in Nepalese population till date. Dermatologists have hesitation in starting this drug in immunobullous diseases because of lack of data on efficacy and safety. Aim: To assess the efficacy and side effects of Rituximab therapy in treating immunobullous disorders in Nepalese patients. Materials and Methods: This was a retrospective study of patients with immunobullous diseases treated with Rituximab in Dermatological ward of Tribhuvan University Teaching Hospital, Kathmandu, Nepal from May 2018 to August 2019. Data were analysed for duration of disease and treatment received before Rituximab therapy, duration of steroid used before Rituximab, adverse effects due to prolonged steroid use, time to remission from 1st Rituximab pulse, duration of remission, relapse, duration of steroid and adjuvant drug used post 1st pulse and adverse effects associated with Rituximab. SPSS version 20 was used for data entry and descriptive statistics was used for analysis of the data. Results: Nine patients (Pemphigus Vulgaris-8 (PV-8), Bullous Pemphigoid-1 (BP-1) were treated with Rituximab. Seven were treated for refractory disease not controlled by conventional therapy and two received Rituximab as first-line therapy. The patients were under follow-up for 15-60 weeks (mean 31.89±15.62 weeks). Out of these nine patients, eight were free of lesions in one to eight weeks (mean 5.125±2 weeks) of first pulse. One patient with Oral Pemphigus had persistence of old lesions, however there were no new cutaneous lesions after first pulse. Adverse effects were seen in four patients that included infusion reaction in one and infection in three. There was relapse in one patient at last follow-up. Conclusion: Rituximab is efficacious and is safe in treating immunobullous disorders in Nepalese Population.

Drug-induced liver injury: A 2-year retrospective study of 1169 hospitalized patients in a single medical center

Phytomedicine ◽  
2015 ◽  
Vol 22 (13) ◽  
pp. 1201-1205 ◽  
Author(s):  
Hong Jung Woo ◽  
Ha Yeon Kim ◽  
Eun Sol Choi ◽  
Young-hwan Cho ◽  
Youngchul Kim ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Liver Injury ◽  
Medical Center ◽  
Hospitalized Patients ◽  
Drug Induced ◽  
Drug Induced Liver Injury

scholarly journals THU0439 EFFICACY AND SAFETY OF ANAKINRA IN THE TREATMENT OF RECURRENT GOUT FLARES: RESULTS FROM THE EXTENSION PHASE OF THE ANAGO STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 456.1-457
Author(s):  
K. Saag ◽  
P. Khanna ◽  
R. Keenan ◽  
S. Ohlman ◽  
E. Sparve ◽  
...  
Keyword(s):  
Pain Intensity ◽  
Pain Reduction ◽  
Extension Phase ◽  
Acute Gout ◽  
Efficacy And Safety ◽  
Research Support ◽  
Treatment Groups ◽  
Study Enrollment ◽  
Secondary Endpoints ◽  
Gout Flares

Background:The anaGO (anakinra ingout) study was a multi-center, randomized, double-blind, double-dummy, phase 2 study investigating the efficacy and safety of anakinra for recurrent gout flares. Results from subsequent flares (extension phase) are presented in relation to the previously reported results from the 1stflare (flare at study enrollment).Objectives:The objective of the extension phase was to evaluate the efficacy, safety and immunogenicity of two anakinra regimens (100 or 200 mg daily s.c. injections for 5 days) compared to triamcinolone (single i.m. injection 40 mg) for subsequent flares after initial study enrollment flare. The primary endpoint of the study was change in patient-assessed flare pain intensity from baseline to 24-72 hours (average of 24, 48 and 72 hours) in the most affected joint measured on a visual analogue scale (0-100 VAS). Secondary endpoints included: patient’s and physician’s assessments of global response, anti-drug antibodies (ADA) and safety.Methods:The study included patients with acute gout (ACR/EULAR 2015 gout classification criteria) unsuitable for anti-inflammatory therapy with NSAIDs and colchicine due to contraindication, intolerance or inefficacy. Patients were eligible for treatment of subsequent flares for up to 2 years. Each patient received the same treatment for all flares, starying with the flare at enrollment.Results:161 patients were treated for 1 flare, 61 patients for 2 flares, 31 patients for 3, and 20 patients for 4 or more flares with 1 patient treated for 9 flares. In total, 300 flares were treated in the full study; anakinra 100 mg and 200 mg, 107 and 106 flares, respectively; and triamcinolone, 87 flares. Both anakinra doses and triamcinolone provided a clinical meaningful reduction in patient-assessed pain intensity in both the 1stand subsequent flares. Mean changes in pain intensity from baseline to 24–72 hours for total anakinra and triamcinolone were: 1stflare -41.2 and -39.4; 2ndflare -33.9 and -31.1; 3rdflare -31.8 and -51.2, respectively. Mean differences in pain reduction between anakinra and triamcinolone treatment groups were (negative value favors anakinra): 1stflare -1.8, 2ndflare -2.8 3rdflare 19.4. The majority of secondary endpoints favored anakinra, including patient’s and physician’s global assessement of response and physician’s assessement of the joint. No unexpected safety findings during subsequent flares were identified. 21 patients (19.6%) developed ADA to anakinra in low titers at some time point; 7 (6.5%) had pre-existing ADA at baseline and 12 (11.2%) developed treatment induced ADA. 2 patients had pre-existing ADA to triamcinolone at baseline. 4 patients on anakinra (3.7%) developed neutralizing antibodies (NAbs). Pre-dose 72 hour anakinra serum concentrations were in similar range for ADA+ and ADA- patients. Presence of ADA was not associated with adverse events or had an impact on pain reduction.Conclusion:The efficacy and safety of anakinra and triamcinolone in subsequent flares were similar to the findings from 1stflare in patients with acute gout. Patient-assessed pain in the 1stand 2ndflare was reduced to similar degrees in all treatment groups, but to a larger extent in the 3rdflare in the small triamcinolone group. Secondary endpoints were in favor of anakinra across flares 1 to 3. The overall incidence of ADA and NAb was low also after repeated anakinra dosing and did not appear to impact exposure, efficacy or safety. In conclusion, anakinra was shown to be an option in the treatment of recurrent gout flares in patients for whom conventional therapy is unsuitable.Disclosure of Interests: :Kenneth Saag Grant/research support from: Horizon, Sobi, Shanton, Grant/research support from: Horizon Pharma, Sobi, Shanton, Consultant of: Horizon and Sobi, Consultant of: Horizon Pharma, Amgen, Radius, LG-Pharma, Takeda, Sobi, Atom, Arthrosi, Puja Khanna Grant/research support from: Dyve, Selecta, Sobi, Consultant of: Sobi, Horizon, Robert Keenan Consultant of: Sobi, Selecta, Horizon, Sven Ohlman Shareholder of: Sobi, Employee of: Former employee of Sobi, Erik Sparve Shareholder of: Sobi, Employee of: Sobi, Daniel Lindqvist Employee of: Sobi, Ann-Charlotte Åkerblad Shareholder of: Sobi, Employee of: Sobi, Margareta Wikén Shareholder of: Sobi, Employee of: Former employee of Sobi, Alexander So Consultant of: Sobi, Grünenthal, Michael H. Pillinger Grant/research support from: Horizon, Hikma, Consultant of: Sobi, Horizon, Robert Terkeltaub Consultant of: Sobi, Selecta, Horizon, Astra-Zeneca

scholarly journals 314. A Retrospective Review of Dalbavancin Utilization at an Academic Medical Center

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S229-S229
Author(s):  
Emma Napoli ◽  
Jasmin K Badwal ◽  
Emily R Kirkpatrick ◽  
Ruth Serrano Pinilla ◽  
Chen-Pin Wang ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Retrospective Review ◽  
Medical Center ◽  
Academic Medical Center ◽  
University Hospital ◽  
Source Control ◽  
Adherence Rate ◽  
Infectious Disease Physician ◽  
Outpatient Parenteral Antimicrobial Therapy

Abstract Background Dalbavancin is a novel long-acting lipoglycopeptide with increasing utilization for management of bone and joint infections as a two-dose regimen. The purpose of this study is to describe the patient characteristics, evaluate clinical outcomes, and calculate inpatient hospital days saved with use of dalbavancin as outpatient parenteral antimicrobial therapy (OPAT). Methods A retrospective review of patients treated with dalbavancin at University Hospital was conducted from Aug 2019- March 2020. Patients ≥ 17 yrs of age with plan to receive at least 1 dose of dalbavancin were included. All patients were initially evaluated by, and had clinic follow up with, an infectious disease physician. Information on baseline demographics, infection characteristics, treatments, and outcomes were recorded from the EMR. Results 42 patients met the study criteria. 62% were males with a median age of 49 yrs. 67% of patients had diabetes and 12% had a documented history of intravenous drug use. The most common indication was osteomyelitis (71%). S. aureus was the most commonly isolated organism in monomicrobial infections (MRSA 24%, MSSA 9.5%) and often a component of polymicrobial infections (33%). 90.5% of patients were adherent to their prescribed therapy; 1 patient missed both doses and 3 only received 1 of their recommended doses. Adverse effects were mild and noted in only 4 patients. 24 patients (57%) received concomitant antibiotics. 45% of patients achieved a cure with another 12% were classified as improved but requiring further antibiotics. 31% (N=13) had failure of therapy of which, 69% (N=9) did not achieve prior source control. 5 patients were lost to follow up. Our health system saved 160 inpatient days through dalbavancin use. Conclusion Dalbavancin treatment had a high adherence rate with minimal adverse effects and achieved a positive outcome in 57% of patients. Of patients that failed, the majority did not have appropriate source control. Dalbavancin use has the potential to save inpatient days while offering a more convenient option for treatment. However, further studies should be conducted to evaluate its efficacy in comparison to standard of care therapy at our institution. Disclosures All Authors: No reported disclosures

Delirium in hospitalized patients: A descriptive and retrospective study in the Clinical University Hospital of Valladolid

2011 ◽  
Vol 26 (S2) ◽  
pp. 397-397
Author(s):  
I. Sánchez Lorenzo ◽  
I. López Saracho ◽  
A. Ledo Rubio ◽  
D. Gómez Pizarro
Keyword(s):  
Retrospective Study ◽  
Negative Impact ◽  
Symptomatic Treatment ◽  
Acute Onset ◽  
Hospitalized Patients ◽  
University Hospital ◽  
Altered Level ◽  
Risk Patients ◽  
Impaired Attention ◽  
Serious Disease

IntroductionThe syndrome confusional acute (SCA) is one of the most frequent mental disorders in patients hospitalized by medical diseases. It is characterized by acute onset symptoms fluctuating course, impaired attention, unorganized thinking, and altered level of conciousness. Though it is considered to be a reversible disease, often it is a sign of future deterioration of the cognitive functions.ObjectiveTo determine delirium prevalence and risk factors in a cohort of hospitalized patients. To know the characteristics of this population and the psychopharmaceuticals used.MethodologyA descritptive and retrospective study was conducted, based on the review of 2642 medical records of hospitalized patients in the Clinical University Hospital of Valladolid between July, 2007 and February, 2010.Results893 (33,8%) presented delirium. 63,3% were men and 36,7% were women. The mean of age was 77 years. Turned out as significant predictive factors with highest percentages: cardiovascular disease (18,3%), traumophaty (15,1%). The principal motive of consultation was surgical pathology (48,1%). 30% presented cognitive deterioration also. They were medicated with tiaprizal (75%), olanzapina (24%), quetiapina (22,5%) and other medications.ConclusionsThe SCA is a frequent syndrome and has a negative impact on morbidity, as well as in resource use. It is possible to identify risk patients. The SCA can be the form of presentation of a physical serious disease or appear as a serious complication of a disease or of treatment. The treatment must divide in three principal aspects: prevention, treatment of the causal disease and symptomatic treatment of the delirium.

Methicillin-ResistantStaphylococcus aureusOutbreak at a Veterans' Affairs Medical Center: Importance of Carriage of the Organism by Hospital Personnel

1990 ◽  
Vol 11 (6) ◽  
pp. 291-296 ◽  
Author(s):  
Annette C. Reboli ◽  
Joseph F. John ◽  
Christel G. Platt ◽  
J. Robert Cantey
Keyword(s):  
Infection Control ◽  
Healthcare Workers ◽  
Medical Center ◽  
Veterans Affairs ◽  
Control Measures ◽  
University Hospital ◽  
Contact Tracing ◽  
Hospital Personnel ◽  
Surgical Resident ◽  
Number Of Patients

AbstractThe reported prevalence of nasal carriage of methicillin-resistantStaphylococcus aureus (MRSA) by hospital personnel averages 2.5%. From August 1985 to September 1987, 155 patients at our Veterans' Affairs Medical Center (VAMC) were colonized or infected with MRSA. In December 1986, only two (2.1%) of 94 healthcare workers were identified as nasal carriers. Prompted by a sharp increase in the number of patients with MRSA in early 1987, contact tracing identified 450 employees, of whom 36 (8%) were nasal carriers. Thirty-five percent of surgical residents (7 of 20) were nasal carriers. Prior to being identified as a nasal carrier, one surgical resident was associated with the inter-hospital spread of the VAMC MRSA strain to the burn unit of the affiliated university hospital. Three family members of two employee carriers were also found to harbor the epidemic strain. All 36 carriers were decolonized with various antimicrobial combinations. Vigorous infection control measures were effective in controlling the epidemic. The frequency of MRSA carriage by hospital personnel at our medical center during the epidemic proved higher than previously appreciated. Thus, healthcare workers may comprise a sizable MRSA reservoir. During an MRSA epidemic, infection control should attempt to identify and decolonize this hospital reservoir, as these individuals can disseminate MRSA both within the hospital as well as into the community.

Characteristics of Hospital Acquired Pressure Injury and Factors Affecting Its Development: A Retrospective Study (Preprint)

2020 ◽  
Author(s):  
Hatan Mortada ◽  
Nader Malatani ◽  
Basim Awan ◽  
Hattan Aljaaly
Keyword(s):  
Retrospective Study ◽  
Pressure Ulcer ◽  
Neurological Deficit ◽  
Multinomial Logistic Regression ◽  
Influential Factors ◽  
Hospitalized Patients ◽  
University Hospital ◽  
Major Surgery ◽  
P Value ◽  
Pressure Injury

BACKGROUND Across the globe, Pressure Injury (PI) has been implicated billion costs annually and mortality were 60,000 deaths out of 2.5 million hospitalized patients from complication related to PI. Through avoiding PI will avoid the incidence of other illnesses, decrease the financial costs and improve the quality of life for our patients. OBJECTIVE Therefore, this retrospective study aimed to identify most influential factors which increase the risk of developing pressure injuries among hospitalized patients at a university hospital according to the Waterlow scale. METHODS Data were collected retrospectivity including patients who developed pressure injury during January 2016 to December 2018 were evaluated using Waterlow pressure injury risk assessment tool at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia. The analysis was performed in 95% confidence interval using the Statistical Package for Social Science (SPSS), version 23.0 (IBM, Armonk, NY, USA). Ethical approval was obtained from the Institutional Review Board and the Research Ethics Committee. RESULTS Total 272 cases were included in this study. Highest number of cases belong to age group 50 to 64 years, 83 (30.5%). The majority had stage 2 pressure ulcer, 165 (60.7%). The most frequent location of pressure ulcer was ‘back’, 97 (35.7%). History of undergoing major surgery was statistically significantly associated with higher stage of pressure ulcer (p-value .040). The mean Waterlow pressure injury score for all cases was 27.19 ± 13.143. There is a moderate uphill correlation between neurological deficit score and Waterlow PI score was observed, (Correlation coefficient: .447, p. <.001). Multinomial logistic regression analysis revealed increasing age is a significant predictive factor for developing higher stages of pressure ulcer (p .046). CONCLUSIONS This study indicated that major surgery, neurological deficit, low hemoglobin, and increasing age are strong predictors for developing higher stages of pressure injury. Therefore, health care contributors should consider these risks when applying a comprehensive pressure injury management plan.

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