801
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Abstract
BACKGROUND Adherence to acne medication is poor and is a major reason why treatment plans are ineffective. Recognizing solutions to nonadherence is critical. OBJECTIVE The purpose of this study is to describe the hurdles associated with acne nonadherence and to provide mechanisms on how to ameliorate them. METHODS PubMed database was searched. Of the 419 search results, 29 articles were reviewed to identify hurdles to adherence and corresponding solutions. RESULTS Hurdles to primary nonadherence where the medication is not even started, include lack of knowledge, confusion about usage, weak physician-patient relationship, fear of adverse reactions, and cost. Secondary nonadherence hurdles where the medication is started but is not taken as directed include lack of results, complex regimens, side effects, busy lifestyle, forgetfulness, inconvenience, and psychiatric comorbidity. Solutions to these hurdles include treatment simplification, technology, and dynamic education. LIMITATIONS Adherence is affected by numerous factors, but available literature analyzing acne adherence and interventions to improve adherence to treatment is limited. CONCLUSION There are several hurdles in adhering to acne treatment. Recognition of these hurdles and finding appropriate solutions may be as important to treatment outcomes as choosing the right medication to prescribe.
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Affiliation(s)
- Sara Moradi Tuchayi
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC
- Correspondence: Sara Moradi Tuchayi, Department of Dermatology, Wake Forest University School of Medicine, 4618 Country Club Road, Winston-Salem, NC 27104, USA, Tel +1 336 716 1763, Fax +1 336 716 7732, Email
| | | | - Anish Nadkarni
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC
- Department of Public Health Sciences
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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802
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Zhang M, Hong L, Zhang T, Lin Y, Zheng S, Zhou X, Fan R, Wang Z, Zhang C, Zhong J. Illness perceptions and stress: mediators between disease severity and psychological well-being and quality of life among patients with Crohn's disease. Patient Prefer Adherence 2016; 10:2387-2396. [PMID: 27920505 PMCID: PMC5125764 DOI: 10.2147/ppa.s118413] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Disease severity, illness perceptions, coping strategies, stress, psychological well-being, and quality of life were reported to have close relationships. According to the Common Sense Model, illness perceptions and coping strategies could mediate the relationship between illness stimuli and illness outcomes such as psychological health and quality of life. Stress was also associated with the individual's disease severity, anxiety, depression, and quality of life. OBJECTIVES The study aimed to explore the influencing factors of illness outcomes, and to what extent illness perceptions, coping strategies, and stress mediate the relationship between disease severity and anxiety, and depression and quality of life. METHODS Our study included 159 patients with Crohn's disease who were attending a tertiary hospital outpatient clinic or who were hospitalized. Disease severity was measured with the Crohn's Disease Activity Index. Illness perceptions were measured with the Brief Illness Perceptions Questionnaire. Coping strategies were measured with the Carver Brief Coping Questionnaire. Stress was measured with the Perceived Stress Questionnaire. Anxiety and depression were measured with the Hospital Anxiety and Depression Scale. Quality of life was measured with the Inflammatory Bowel Disease Questionnaire. RESULTS Disease severity, illness perceptions, maladaptive coping, stress, anxiety, depression and quality of life were significantly correlated with each other among patients with Crohn's disease. Using structural equation modeling to describe the inner relationship of the aforementioned variables, an excellent-fitted model was drawn. (χ2[10]=13.83, P=0.18, χ2/N=1.38, standardized root mean square residual [SRMR] <0.05, root mean square error of approximation [RMSEA] <0.05, goodness of fit index [GFI] >0.97, comparative fit index [CFI] >0.99). Disease severity had a direct influence on illness perceptions. Illness perceptions had a direct influence on stress. Both illness perceptions and stress had direct influences on anxiety, depression, and quality of life, while maladaptive coping did not directly influence anxiety, depression, or quality of life. Stress had a direct influence on maladaptive coping. Quality of life was also directly influenced by disease severity and anxiety. CONCLUSION Interrelationships between disease stimuli, disease perceptions and management and disease outcomes could be found in patients with Crohn's disease. Illness perceptions and stress mediated an individual's disease severity and anxiety, depression and quality of life, while coping strategy was not an applicable mediator.
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Affiliation(s)
| | | | | | - Yun Lin
- Department of Gastroenterology
| | | | | | | | | | - Chenli Zhang
- Exclusive Medical Center, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
- Chenli Zhang, Exclusive Medical Center, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197 Ruijin Er Road, Shanghai 200025, People’s Republic of China, Tel +86 21 6437 0045 ext 600907, Email
| | - Jie Zhong
- Department of Gastroenterology
- Correspondence: Jie Zhong, Department of Gastroenterology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197 Ruijin Er Road, Shanghai 200025, People’s Republic of China, Tel +86 21 6437 0045 ext 600907, Email
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803
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Sung SF, Chen SCC, Hsieh CY, Li CY, Lai ECC, Hu YH. A comparison of stroke severity proxy measures for claims data research: a population-based cohort study. Pharmacoepidemiol Drug Saf 2015; 25:438-43. [PMID: 26696591 DOI: 10.1002/pds.3944] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 10/21/2015] [Accepted: 11/24/2015] [Indexed: 01/03/2023]
Abstract
PURPOSE Confounding by disease severity has been viewed as an intractable problem in claims-based studies. A novel 7-variable stroke severity index (SSI) was designed for estimating stroke severity by using claims data. This study compared the performance of mortality models with various proxy measures of stroke severity, including the SSI, in patients hospitalized for acute ischemic stroke (AIS). METHODS Data from the Taiwan National Health Insurance Research Database (NHIRD) were analyzed. Three proxy measures of stroke severity were evaluated: Measure 1, the SSI; Measure 2, intensive care unit admission and length of stay; and Measure 3, surgical operation, mechanical ventilation, hemiplegia or hemiparesis, and residual neurological deficits. We performed logistic regression by including age, sex, vascular risk factors, Charlson comorbidity index, and one of the proxy measures as covariates to predict 30-day and 1-year mortality after AIS. Model discrimination was evaluated using the area under the receiver-operating characteristic curve (AUC). RESULTS We identified 7551 adult patients with AIS. Models using the SSI (Measure 1) outperformed models using the other proxy measures in predicting 30-day mortality (AUC 0.892 vs 0.851, p < 0.001 for Measure 2; 0.892 vs 0.853, p < 0.001 for Measure 3) and 1-year mortality (AUC 0.816 vs 0.784, p < 0.001 for Measure 2; 0.816 vs 0.782, p < 0.001 for Measure 3). CONCLUSIONS Using the SSI facilitated risk adjustment for stroke severity in mortality models for patients with AIS. The SSI is a viable methodological tool for stroke outcome studies using the NHIRD.
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Affiliation(s)
- Sheng-Feng Sung
- Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Solomon Chih-Cheng Chen
- Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Cheng-Yang Hsieh
- Department of Neurology, Tainan Sin Lau Hospital, Tainan City, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Edward Chia-Cheng Lai
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan City, Taiwan.,Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Ya-Han Hu
- Department of Information Management and Institute of Healthcare Information Management, National Chung Cheng University, Chiayi County, Taiwan
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804
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Kierszniewska-Stępień D, Pietras T, Ciebiada M, Górski P, Stępień H. Concentration of angiopoietins 1 and 2 and their receptor Tie-2 in peripheral blood in patients with chronic obstructive pulmonary disease. Postepy Dermatol Alergol 2015; 32:443-8. [PMID: 26755908 DOI: 10.5114/pdia.2014.44008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 01/31/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction Both angiopoietins (angiopoietin 1 – Ang-1, angiopoietin 2 – Ang-2) and angiopoietin receptors (Tie) are involved in angiogenesis and vascular remodeling. Aim To assess concentrations of Ang-1, Ang-2 and Tie-2 in blood of patients with chronic obstructive pulmonary disease (COPD) and evaluate if their concentrations depend on the severity of the disease. Material and methods Thirty patients with COPD (stage II–IV) and 8 healthy smokers as well as 8 healthy non-smokers were included in the study. Detailed history was taken, physical examination and spirometry tests were done and blood samples were taken for evaluation of serum concentrations of Ang-1, Ang-2 and Tie. Results Among COPD patients, 8 patients suffered from moderate disease, 8 patients had severe, while 14 patients had very severe disease. The concentrations of Ang-1 and Ang-2 were not significantly greater in patients with COPD than in healthy controls. The highest concentrations of Ang-1 and Ang-2 were observed in patients with moderate COPD, and levels of Ang-2 correlated with Tie-2 in this group of patients. The levels of Ang-1 were the lowest in healthy non-smokers and in patients with severe COPD, where they inversely correlated with Tie-2. The concentrations of Ang-2 were not significantly higher in patients with moderate COPD when compared with those with severe and very severe disease and healthy smokers, and were significantly higher than in healthy non-smokers. Conclusions It is possible that Ang-1, Ang-2 and Tie-2 play an important role especially in the early stage of COPD but not in the late phase when vascular complications of the disease occur.
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805
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Manali ED, Papadaki G, Konstantonis D, Tsangaris I, Papaioannou AI, Kolilekas L, Schams A, Kagouridis K, Karakatsani A, Orfanos S, Griese M, Papiris SA. Cardiovascular risk in pulmonary alveolar proteinosis. Expert Rev Respir Med 2015; 10:235-40. [PMID: 26558331 DOI: 10.1586/17476348.2016.1116389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We hypothesized that cardiovascular events and/or indices of cardiac dysfunction may be increased in pulmonary alveolar proteinosis (PAP). Systemic and pulmonary arterial hypertension, arrhythmias, pulmonary embolism, stroke and ischemic heart attack were reported. Patients underwent serum anti-GM-CSF antibodies, disease severity score (DSS), Doppler transthoracic echocardiograph, glucose, thyroid hormones, lipids, troponin and pro-Brain natriuretic peptide (BNP) examination. Thirteen patients (8 female) were studied, median age of 47. Pro-BNP inversely related to DLCO% and TLC%; troponin directly related to DSS, age, P(A-a)O2, left atrium-, left ventricle-end-diastole diameter and BMI. On multiple regression analysis DSS was the only parameter significantly and strongly related with troponin (R(2) = 0.776, p = 0.007). No cardiovascular event was reported during follow-up. In PAP cardiovascular risk indices relate to lung disease severity. Therefore, PAP patients could be at increased risk for cardiovascular events. Quantitation of its magnitude and potential links to lungs' physiologic derangement will be addressed in future studies.
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Affiliation(s)
- Effrosyni D Manali
- a 2nd Pulmonary Department , "Attikon" University Hospital, Athens Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - Georgia Papadaki
- a 2nd Pulmonary Department , "Attikon" University Hospital, Athens Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - Dimitrios Konstantonis
- b 2nd Critical Care Department, Pulmonary Hypertension Clinic , "Attikon" University Hospital, Athens Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - Iraklis Tsangaris
- b 2nd Critical Care Department, Pulmonary Hypertension Clinic , "Attikon" University Hospital, Athens Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - Andriana I Papaioannou
- a 2nd Pulmonary Department , "Attikon" University Hospital, Athens Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - Likurgos Kolilekas
- c 7th Pulmonary Department and Asthma Center , Athens Chest Hospital , Athens , Greece
| | - Andrea Schams
- d Hauner Children's University Hospital , Ludwig-Maximilians University, German Center for Lung Research , Munich , Germany
| | - Konstantinos Kagouridis
- a 2nd Pulmonary Department , "Attikon" University Hospital, Athens Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - Anna Karakatsani
- a 2nd Pulmonary Department , "Attikon" University Hospital, Athens Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - Stylianos Orfanos
- b 2nd Critical Care Department, Pulmonary Hypertension Clinic , "Attikon" University Hospital, Athens Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - Matthias Griese
- d Hauner Children's University Hospital , Ludwig-Maximilians University, German Center for Lung Research , Munich , Germany
| | - Spyros A Papiris
- a 2nd Pulmonary Department , "Attikon" University Hospital, Athens Medical School, National and Kapodistrian University of Athens , Athens , Greece
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806
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O'Farrell S, Sandström K, Garmo H, Stattin P, Holmberg L, Adolfsson J, Van Hemelrijck M. Risk of thromboembolic disease in men with prostate cancer undergoing androgen deprivation therapy. BJU Int 2015; 118:391-8. [PMID: 26497726 DOI: 10.1111/bju.13360] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate the risk of thromboembolic disease (TED) in men with prostate cancer (PCa) on androgen deprivation therapy (ADT), while accounting for known TED risk factors. MATERIALS AND METHODS We assessed TED risk for 42 263 men with PCa who were receiving ADT compared with a matched cohort of 190 930 without PCa. The associations between ADT and deep vein thrombosis (DVT) or pulmonary embolism (PE) were analysed using multivariate Cox proportional hazard regression models, while accounting for previous PCa-related surgeries and the following proxies for disease progression: transurethral resection of the prostate, palliative radiotherapy and nephrostomy. RESULTS Between 1997 and 2013, 11 242 men with PCa received anti-androgen monotherapy, 26 959 men received gonadotropin-releasing hormone (GnRH) agonists, 1 091 men received combined androgen blockade and 3 789 men underwent orchiectomy. When accounting for previous surgeries and proxies of disease progression, GnRH agonist users and surgically castrated men had a higher risk of TED than the comparison cohort: hazard ratios (HRs) 1.67 (95% confidence interval [CI] 1.40-1.98) and 1.61 (95% CI 1.15-2.28), respectively. Men on anti-androgen monotherapy had a lower risk: HR for DVT 0.49 (95% CI 0.33-0.74). TED risk was highest among those who switched from anti-androgen to GnRH agonists: HR for PE 2.55 (95% CI 1.76-3.70). This increased from 2.52 (95% CI 1.54-4.12) in year 1, to 4.05 (95% CI 2.51-6.55) in year 2. CONCLUSION The incidence of TED among men on ADT increased with the duration of therapy and the risk was highest for those who switched regimen, suggesting that disease progression as well as ADT contribute to the propagation of TED risk. Nonetheless, these findings support the hypothesis that only men with a relevant indication should receive systemic ADT.
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Affiliation(s)
- Sean O'Farrell
- Division of Cancer Studies, Cancer Epidemiology Group, King's College London, London, UK.,NIHR Guy's and St Thomas' NHS Foundation Trust, King's College London's Comprehensive Biomedical Research Centre, London, UK
| | - Karin Sandström
- Division of Cancer Studies, Cancer Epidemiology Group, King's College London, London, UK
| | - Hans Garmo
- Division of Cancer Studies, Cancer Epidemiology Group, King's College London, London, UK.,Regional Cancer Centre, Uppsala Örebro, Uppsala, Sweden
| | - Pär Stattin
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Lars Holmberg
- Division of Cancer Studies, Cancer Epidemiology Group, King's College London, London, UK.,NIHR Guy's and St Thomas' NHS Foundation Trust, King's College London's Comprehensive Biomedical Research Centre, London, UK.,Regional Cancer Centre, Uppsala Örebro, Uppsala, Sweden.,Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Jan Adolfsson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Swedish Council for Health Technology Assessment, Stockholm, Sweden
| | - Mieke Van Hemelrijck
- Division of Cancer Studies, Cancer Epidemiology Group, King's College London, London, UK.,NIHR Guy's and St Thomas' NHS Foundation Trust, King's College London's Comprehensive Biomedical Research Centre, London, UK.,Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
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807
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Kwon YS, Jin HM, Cho YN, Kim MJ, Kang JH, Jung HJ, Park KJ, Kee HJ, Kee SJ, Park YW. Mucosal-Associated Invariant T Cell Deficiency in Chronic Obstructive Pulmonary Disease. COPD 2015; 13:196-202. [PMID: 26552490 DOI: 10.3109/15412555.2015.1069806] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Mucosal-associated invariant T (MAIT) cells have been reported to play an important role in mucosal immunity. However, little is known about the roles of MAIT cells in chronic obstructive pulmonary disease (COPD). The aims of this study were to examine the levels of circulating MAIT cells and their subsets in COPD patients and to investigate the potential relationship between clinical parameters and MAIT cell levels. Forty-five COPD patients and 57 healthy control subjects were enrolled in the study. Circulating MAIT cells and their subset levels in the peripheral blood were measured by flow cytometry. Disease grades were classified according to the GOLD criteria for the assessment of severity of COPD. Circulating MAIT cell levels were found to be significantly reduced in COPD patients. In particular, this MAIT cell deficiency was more prominent in CD8+ and double-negative T cell subsets. Interestingly, elevated serum C-reactive protein level and reduced FEV1/FVC ratio were associated with MAIT cell deficiency in COPD patients. Furthermore, the circulating MAIT levels were found to be significantly lower in patients with moderate to severe COPD than in patients with mild COPD. Our data shows that MAIT cells are numerically deficient in the peripheral blood of patients with COPD. In addition, this MAIT cell deficiency was found to reflect inflammatory activity and disease severity. These findings provide important information for monitoring the changes in MAIT cell levels and for predicting the prognosis during the disease course.
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Affiliation(s)
- Yong Soo Kwon
- a Department of Pulmonary and Critical Care Medicine , Chonnam National University Medical School and Hospital , Gwangju , Republic of Korea
| | - Hye-Mi Jin
- b Department of Rheumatology , Chonnam National University Medical School and Hospital , Gwangju , Republic of Korea
| | - Young-Nan Cho
- b Department of Rheumatology , Chonnam National University Medical School and Hospital , Gwangju , Republic of Korea
| | - Moon-Ju Kim
- b Department of Rheumatology , Chonnam National University Medical School and Hospital , Gwangju , Republic of Korea
| | - Jeong-Hwa Kang
- b Department of Rheumatology , Chonnam National University Medical School and Hospital , Gwangju , Republic of Korea
| | - Hyun-Ju Jung
- b Department of Rheumatology , Chonnam National University Medical School and Hospital , Gwangju , Republic of Korea
| | - Ki-Jeong Park
- b Department of Rheumatology , Chonnam National University Medical School and Hospital , Gwangju , Republic of Korea
| | - Hae Jin Kee
- c Heart Research Center , Chonnam National University Hospital , Gwangju , Republic of Korea
| | - Seung-Jung Kee
- d Department of Laboratory Medicine , Chonnam National University Medical School and Hospital , Gwangju , Republic of Korea
| | - Yong-Wook Park
- b Department of Rheumatology , Chonnam National University Medical School and Hospital , Gwangju , Republic of Korea
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808
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Song YZ, Guan J, Wang HJ, Ma W, Li F, Xu F, Ding LB, Xie L, Liu B, Liu K, Lv Z. Possible Involvement of Serum and Synovial Fluid Resistin in Knee Osteoarthritis: Cartilage Damage, Clinical, and Radiological Links. J Clin Lab Anal 2015; 30:437-43. [PMID: 26494484 DOI: 10.1002/jcla.21876] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 07/04/2015] [Accepted: 07/11/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Resistin is an adipocytokine associated with inflammation and insulin resistance. Recent studies have shown that resistin plays an important role in the pathogenesis and progression in osteoarthritis (OA) patients. The current study was aimed at investigating the relationship between resistin in serum and synovial fluid (SF) and disease severity in patients with knee osteoarthritis. METHOD Seventy-four patients diagnosed with knee OA and 79 healthy controls receiving regular body check in our hospital were recruited in the study. The Noyes score method was used to assess articular cartilage damage arthroscopically. The symptomatic severity was evaluated according to the Western Ontario McMaster University Osteoarthritis (WOMAC) scores. The radiographic disease severity of OA was assessed by the Kellgren-Lawrence (K-L) grading system. The resistin levels in serum and SF were determined by enzyme-linked immunosorbent assay. Cartilage degradation marker CTX-II in SF was also examined. RESULTS SF but not serum resistin levels are positively associated with Noyes scores, K-L grading scores WOMAC pain scores, physical functional scores and WOMAC total scores. In addition, SF resistin correlated positively with CTX-II. CONCLUSION Resistin in SF might serve as a potential biomarker for reflecting the disease severity and cartilage degenerative extent of knee OA.
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Affiliation(s)
- Yong-Zhou Song
- Department of Orthopedics, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Jian Guan
- Department of Orthopedics, The Third Hospital of Shi Jiazhuang, Shijiazhuang, Hebei Province, China
| | - Hua-Jun Wang
- Department of Orthopedics, the First Clinical College of Jinan University and the First Affiliated Hospital of Jinan University Guangzhou, Guangdong Province, China
| | - Wei Ma
- Department of Orthopedics, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Feng Li
- Department of Orthopedics, The Third Hospital of Shi Jiazhuang, Shijiazhuang, Hebei Province, China
| | - Fang Xu
- The Third Hospital of Shi Jiazhuang, Shijiazhuang, Hebei Province, China
| | - Luo-Bin Ding
- Department of Orthopedics, The Third Hospital of Shi Jiazhuang, Shijiazhuang, Hebei Province, China
| | - Lei Xie
- Department of Orthopedics, The Third Hospital of Shi Jiazhuang, Shijiazhuang, Hebei Province, China
| | - Bo Liu
- Department of Orthopedics, The Third Hospital of Shi Jiazhuang, Shijiazhuang, Hebei Province, China
| | - Kai Liu
- Department of Orthopedics, Guangzhou Orthopedic Hospital, Guangzhou, Guangdong Province, China
| | - Zhe Lv
- The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China.
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809
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Vaidya TS, Lewallen RS, Feldman SR. Erythrodermic psoriasis and severe hypotension requiring intensive care unit hospitalization: Poor treatment outcome as a result of poor adherence. J DERMATOL TREAT 2015; 27:134-135. [PMID: 26365523 DOI: 10.3109/09546634.2015.1087462] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Psoriasis is closely associated with cardiovascular comorbidities. Poor adherence can affect both psoriasis outcomes and the effectiveness of treatment for cardiovascular comorbidities. We discuss a case of psoriasis medication nonadherence resulting in admission to the dermatology inpatient service for erythrodermic psoriasis. Administration of the patient's prescribed home antihypertensive regimen on admission resulted in a severe hypotension requiring transfer to the medical intensive care unit (ICU). This case illustrates the role of poor adherence in an erythrodermic flare of psoriasis; this case also illustrates how new-onset regimented adherence, in a formerly nonadherent patient, may result in life-threatening iatrogenic disease.
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Affiliation(s)
- Toral S Vaidya
- a Department of Dermatology , University of Cincinnati College of Medicine , Cincinnati , OH , USA and
| | - Robin S Lewallen
- b Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - Steven R Feldman
- b Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA
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810
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Acarturk G, Acay A, Demir K, Ulu MS, Ahsen A, Yuksel S. Neutrophil-to-lymphocyte ratio in inflammatory bowel disease - as a new predictor of disease severity. ACTA ACUST UNITED AC 2015; 116:213-7. [PMID: 25773946 DOI: 10.4149/bll_2015_041] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aims of this study were to investigate the utility of neutrophil-to-lymphocyte ratio (NLR) as a simple and readily available predictor for clinical disease activity in inflammatory bowel disease (IBD). METHODS Sixty-six patients (22 CD, 44 UC) and 41 healthy controls were enrolled in the study. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) levels and complete blood count (CBC) were measured. The neutrophil and lymphocyte counts were recorded and NLR was calculated. The patients with active or inactive UC and CD were classified according to the severity of the disease. RESULT The serum NLR values of active CD patients were significantly higher than those of inactive ones and controls (p = 0.000, p = 0.000, respectively). NLR values of active UC patients were significantly higher than those of inactive ones and controls (p = 0.000, p = 0.000, respectively. The optimum NLR cut-off point for active CD and UC was 3.2 and 3.1. CONCLUSION This study demonstrates that NLR in subjects with IBD is strongly associated with active disease and correlated with clinical and laboratory indices (Tab. 5, Fig. 2, Ref. 31).
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811
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Ben-Shachar R, Koelle K. Minimal within-host dengue models highlight the specific roles of the immune response in primary and secondary dengue infections. J R Soc Interface 2015; 12:rsif.2014.0886. [PMID: 25519990 PMCID: PMC4305404 DOI: 10.1098/rsif.2014.0886] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
In recent years, the within-host viral dynamics of dengue infections have been increasingly characterized, and the relationship between aspects of these dynamics and the manifestation of severe disease has been increasingly probed. Despite this progress, there are few mathematical models of within-host dengue dynamics, and the ones that exist focus primarily on the general role of immune cells in the clearance of infected cells, while neglecting other components of the immune response in limiting viraemia. Here, by considering a suite of mathematical within-host dengue models of increasing complexity, we aim to isolate the critical components of the innate and the adaptive immune response that suffice in the reproduction of several well-characterized features of primary and secondary dengue infections. By building up from a simple target cell limited model, we show that only the innate immune response is needed to recover the characteristic features of a primary symptomatic dengue infection, while a higher rate of viral infectivity (indicative of antibody-dependent enhancement) and infected cell clearance by T cells are further needed to recover the characteristic features of a secondary dengue infection. We show that these minimal models can reproduce the increased risk of disease associated with secondary heterologous infections that arises as a result of a cytokine storm, and, further, that they are consistent with virological indicators that predict the onset of severe disease, such as the magnitude of peak viraemia, time to peak viral load, and viral clearance rate. Finally, we show that the effectiveness of these virological indicators to predict the onset of severe disease depends on the contribution of T cells in fuelling the cytokine storm.
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Affiliation(s)
- Rotem Ben-Shachar
- Program in Computational Biology and Bioinformatics, Duke University, Durham, NC, USA
| | - Katia Koelle
- Department of Biology, Duke University, Durham, NC, USA Fogarty International Center, National Institute of Health, Bethesda, MD, USA
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812
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Sabburg R, Obanor F, Aitken E, Chakraborty S. Changing fitness of a necrotrophic plant pathogen under increasing temperature. Glob Chang Biol 2015; 21:3126-3137. [PMID: 25767051 DOI: 10.1111/gcb.12927] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 02/11/2015] [Accepted: 02/12/2015] [Indexed: 06/04/2023]
Abstract
Warmer temperatures associated with climate change are expected to have a direct impact on plant pathogens, challenging crops and altering plant disease profiles in the future. In this study, we have investigated the effect of increasing temperature on the pathogenic fitness of Fusarium pseudograminearum, an important necrotrophic plant pathogen associated with crown rot disease of wheat in Australia. Eleven wheat lines with different levels of crown rot resistance were artificially inoculated with F. pseudograminearum and maintained at four diurnal temperatures 15/15°C, 20/15°C, 25/15°C and 28/15°C in a controlled glasshouse. To quantify the success of F. pseudograminearum three fitness measures, these being disease severity, pathogen biomass in stem base and flag leaf node, and deoxynivalenol (DON) in stem base and flag leaf node of mature plants were used. F. pseudograminearum showed superior overall fitness at 15/15°C, and this was reduced with increasing temperature. Pathogen fitness was significantly influenced by the level of crown rot resistance of wheat lines, but the influence of line declined with increasing temperature. Lines that exhibited superior crown rot resistance in the field were generally associated with reduced overall pathogen fitness. However, the relative performance of the wheat lines was dependent on the measure of pathogen fitness, and lines that were associated with one reduced measure of pathogen fitness did not always reduce another. There was a strong correlation between DON in stem base tissue and disease severity, but length of browning was not a good predictor of Fusarium biomass in the stem base. We report that a combination of host resistance and rising temperature will reduce pathogen fitness under increasing temperature, but further studies combining the effect of rising CO2 are essential for more realistic assessments.
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Affiliation(s)
- Rosalie Sabburg
- CSIRO Agriculture Flagship, Queensland Bioscience Precinct, 306 Carmody Road, St Lucia, Qld, 4067, Australia
- School of Agriculture and Food Science, The University of Queensland, St Lucia, Qld, 4072, Australia
| | - Friday Obanor
- CSIRO Agriculture Flagship, Queensland Bioscience Precinct, 306 Carmody Road, St Lucia, Qld, 4067, Australia
| | - Elizabeth Aitken
- School of Agriculture and Food Science, The University of Queensland, St Lucia, Qld, 4072, Australia
| | - Sukumar Chakraborty
- CSIRO Agriculture Flagship, Queensland Bioscience Precinct, 306 Carmody Road, St Lucia, Qld, 4067, Australia
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813
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Pomorska-Mól M, Markowska-Daniel I, Kwit K, Stępniewska K, Pejsak Z. Profile of the porcine acute-phase proteins response following experimental co-infection with H3N2 swine influenza virus and Pasteurella multocida. Biomarkers 2015; 20:189-95. [PMID: 26161700 DOI: 10.3109/1354750x.2015.1061600] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Acute phase proteins (APPs) are proposed as potential markers of the health status in pigs. OBJECTIVE Circulating APPs in pigs co-infected with swine influenza virus and Pasteurella multocida. METHODS Serum APPs were measured in co-infected and control pigs with the use of commercial ELISA tests. RESULTS All investigated APPs revealed significant changes in co-infected pigs during the study period. The concentration of C-reactive protein, haptoglobin and serum amyloid A (SAA) increased significantly at 2 dpi, before respiratory signs and fever were observed. Concentration of Pig-MAP increased significantly at 3 dpi. C-reactive protein and SAA reaction were rapid but short-lived. The concentration of Hp and Pig-MAP in serum also increased at very early stage of co-infection but remained elevated for a longer period of time. CONCLUSIONS Maximal concentration of serum amyloid A correlated with the disease severity in pigs.
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814
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Guan WJ, Gao YH, Xu G, Lin ZY, Tang Y, Gu YY, Liu GH, Li HM, Chen RC, Zhong NS. Sputum matrix metalloproteinase-8 and -9 and tissue inhibitor of metalloproteinase-1 in bronchiectasis: clinical correlates and prognostic implications. Respirology 2015; 20:1073-81. [PMID: 26122009 DOI: 10.1111/resp.12582] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 04/16/2015] [Accepted: 04/17/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVE The triplet of airway infection, inflammation and bronchial wall destruction associated with excessive matrix metalloproteinases (MMP) release and imbalance of tissue inhibitor metalloproteinase-1 (TIMP-1) is implicated in bronchiectasis. We sought to determine the associations between sputum MMP (MMP-8, MMP-9) and TIMP-1 and the severity of bronchiectasis; the utility of MMP in predicting risks of future bronchiectasis exacerbations (BE); and the changes in MMP levels during BE. METHODS We recruited 102 patients with stable bronchiectasis and 22 healthy subjects. For bronchiectasis patients, baseline measurements consisted of sputum inflammation and MMP measurements, bacterial culture, spirometry and chest high-resolution computed tomography (HRCT). Bronchiectasis patients were followed up for 1 year to determine the frequency of BE. Changes in MMP levels during BE were assessed in 36 bronchiectasis patients. RESULTS Sputum MMP-8, MMP-9 and MMP-9/TIMP-1 ratio in bronchiectasis patients were significantly increased compared with healthy subjects. MMP-8 and MMP-9 levels, but not TIMP-1, were positively correlated with clinical measures, including HRCT scores, spirometry and Bronchiectasis Severity Index. Seventy-nine bronchiectasis patients were included in survival analyses of BE. Lower levels of baseline MMP-9 were associated with reduced risks of and a longer time to the first BE during follow-up. MMP-8 and MMP-9, but not TIMP-1 or MMP-9/TIMP-1 ratio, were significantly heightened during BE. CONCLUSIONS Sputum MMP might be useful biomarkers for the assessment of bronchiectasis severity and the prediction of future risks of BE. Our results provide the rationales for the future clinical application of MMP inhibitors.
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Affiliation(s)
- Wei-Jie Guan
- Department of Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yong-Hua Gao
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Gang Xu
- Department of Geriatrics Medicine, Guangzhou First People's Hospital, Guangzhou, Guangdong, China
| | - Zhi-Ya Lin
- Department of Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yan Tang
- Department of Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Ying-Ying Gu
- Department of Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Gui-Hong Liu
- Department of Pathology, Panyu Central Hospital, Guangzhou, Guangdong, China
| | - Hui-Min Li
- Department of Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Rong-Chang Chen
- Department of Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Nan-Shan Zhong
- Department of Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
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815
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Abstract
Blinded readers examined peripheral smears of 108 children with steady sickle cell (SC) disease and controls by counting ten 100 × microscope fields and calculating percent of irreversible and reversible SC from total red cell population SC index (SCI). SCI was correlated to disease severity, and transfusion, hydroxyurea, or neither. Controls had a mean of 0.28% SC (range 0-0.64). Children with hemoglobin SS had a mean SCI of 5.12% ± 5.37 (range 0-30). SCI increased 0.33% with each increasing year (p < 0.0001). Patients with SCI >0.64 were 3.32 times as likely to experience clinical complications (p = 0.0124). Although blood transfusions and hydroxyurea decreased percent of SC, 72% treated patients had SCI >0.64, correlating with persistent sickling. This standardized method quantifies SC in peripheral smears. Percent of SC increased with age and correlated with disease severity, especially hemolytic complications, providing readily available information with minimal or no extra cost.
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Affiliation(s)
- Ofelia Alvarez
- Department of Pediatrics, Mailman Center Child Development, University of Miami , Miami, Florida , USA
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816
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Abstract
BACKGROUND Trait anger consists of affective, behavioral, and cognitive (ABC) dimensions and may increase vulnerability for interpersonal conflict, diminished social support, and greater psychological distress. The concurrent influence of anger and psychosocial dysfunction on Human Immunodeficiency Virus (HIV) disease severity is unknown. PURPOSE The purpose of this study was to examine plausible psychosocial avenues (e.g., coping, social support, psychological distress), whereby trait anger may indirectly influence HIV disease status. METHODS Three hundred seventy-seven HIV seropositive adults, aged 18-55 years (58% AIDS-defined), completed a battery of psychosocial surveys and provided a fasting blood sample for HIV-1 viral load and T lymphocyte count assay. RESULTS A second-order factor model confirmed higher levels of the multidimensional anger trait, which was directly associated with elevated psychological distress and avoidant coping (p<.001) and indirectly associated with greater HIV disease severity (p<.01) (comparative fit index (CFI)=0.90, root-mean-square error of approximation (RMSEA)=0.06, standardized root-mean-square residual (SRMR)=0.06). CONCLUSION The model supports a role for the ABC components of anger, which may negatively influence immune function through various psychosocial mechanisms; however, longitudinal study is needed to elucidate these effects.
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Affiliation(s)
- Roger C McIntosh
- Department of Psychology, University of Miami, Coral Gables, FL, 33124, USA,
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817
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Ferguson GT, Fležar M, Korn S, Korducki L, Grönke L, Abrahams R, Buhl R. Efficacy of Tiotropium + Olodaterol in Patients with Chronic Obstructive Pulmonary Disease by Initial Disease Severity and Treatment Intensity: A Post Hoc Analysis. Adv Ther 2015; 32:523-36. [PMID: 26112656 PMCID: PMC4486785 DOI: 10.1007/s12325-015-0218-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Indexed: 10/31/2022]
Abstract
INTRODUCTION The once-daily long-acting muscarinic antagonist (LAMA) tiotropium and once-daily long-acting β2-agonist (LABA) olodaterol have been studied as a once-daily fixed-dose combination (FDC) in patients with chronic obstructive pulmonary disease (COPD). Two large, 52-week, double-blind, parallel-group studies in patients with moderate-very severe COPD demonstrated that tiotropium + olodaterol significantly improved lung function and symptoms versus the monocomponents. This post hoc analysis determined effects on lung function by prior LAMA or LABA maintenance treatment and initial disease severity. METHODS 5162 patients were randomized and treated with olodaterol 5 µg, tiotropium 2.5 µg, tiotropium 5 µg, tiotropium + olodaterol 2.5/5 µg, or tiotropium + olodaterol 5/5 µg (all once daily via Respimat(®) inhaler). Primary efficacy (lung-function) end points were forced expiratory volume in 1 s (FEV1) area under the curve from 0 to 3 h (AUC0-3) and trough FEV1 responses (i.e., change from baseline). Pooled data are presented for the following subgroups: prior maintenance treatment with LAMA or LABA, Global initiative for chronic Obstructive Lung Disease (GOLD) 2 (predicted FEV1 50% to <80%) and 3 (30% to <50%)/4 (<30%), sex, age, and prior use of inhaled corticosteroids. RESULTS Tiotropium + olodaterol FDC improved lung function over the monocomponents in patients with GOLD 2 and 3-4 disease, irrespective of prior LAMA or LABA maintenance therapy; most comparisons between FDCs and their respective monocomponents were statistically significant (P < 0.05). FEV1 AUC0-3 and trough FEV1 responses for the individual treatments were generally greater in patients with less severe COPD at baseline. CONCLUSIONS Tiotropium + olodaterol 5/5 µg significantly improved FEV1 AUC0-3 and trough FEV1 in all GOLD severity groups compared to olodaterol 5 µg and tiotropium 5 µg alone, irrespective of whether patients had received prior LAMA or LABA maintenance treatment. Improvements from baseline in lung function were generally greater in patients with less severe disease. FUNDING Boehringer Ingelheim. TRIAL REGISTRATION ClinicalTrials.gov numbers, NCT01431274 and NCT01431287.
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Affiliation(s)
- Gary T Ferguson
- Pulmonary Research Institute of Southeast Michigan, Livonia, MI, USA,
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818
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Roll SC, Volz KR, Fahy CM, Evans KD. Carpal tunnel syndrome severity staging using sonographic and clinical measures. Muscle Nerve 2015; 51:838-45. [PMID: 25287477 DOI: 10.1002/mus.24478] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2014] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Ultrasonography may be valuable in staging carpal tunnel syndrome severity, especially by combining multiple measures. This study aimed to develop a preliminary severity staging model using multiple sonographic and clinical measures. METHODS Measures were obtained in 104 participants. Multiple categorization structures for each variable were correlated to diagnostic severity based on nerve conduction. Goodness-of-fit was evaluated for models using iterative combinations of highly correlated variables. Using the best-fit model, a preliminary scoring system was developed, and frequency of misclassification was calculated. RESULTS The severity staging model with best fit (rho 0.90) included patient-reported symptoms, functional deficits, provocative testing, nerve cross-sectional area, and nerve longitudinal appearance. An 8-point scoring scale classified severity accurately for 79.8% of participants. CONCLUSIONS This severity staging model is a novel approach to carpal tunnel syndrome evaluation. Including more sensitive measures of nerve vascularity, nerve excursion, or other emerging techniques may refine this preliminary model.
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Affiliation(s)
- Shawn C Roll
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
| | - Kevin R Volz
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Christine M Fahy
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Kevin D Evans
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA
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819
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Trigg R, Jones RW, Knapp M, King D, Lacey LA. The relationship between changes in quality of life outcomes and progression of Alzheimer's disease: results from the dependence in AD in England 2 longitudinal study. Int J Geriatr Psychiatry 2015; 30:400-8. [PMID: 24920081 DOI: 10.1002/gps.4150] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 04/28/2014] [Accepted: 05/08/2014] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The relationship between conventional indicators of Alzheimer's disease (AD) progression and quality of life (QoL) outcomes is unclear. Dependence on others has been recommended as a unifying construct in defining AD severity. This study examined the relationship between indicators of disease severity (including dependence) and changes in QoL and utility over 18 months. METHODS A multi-centre, cohort study was conducted across 18 UK sites. One hundred and forty-five patients with possible/probable AD and their caregivers completed assessments of disease severity (Dependence Scale, Mini-mental state examination, Neuropsychiatric Inventory, Disability Assessment for Dementia), dementia-specific QoL (DEMQOL, DEMQOL-Proxy) and generic health-related utility (EQ-5D) at both time points. RESULTS There was evidence of individual change in QoL over 18 months, with over 50% of patients reporting either maintenance or improvement of life quality. The EQ-5D proxy suggested a mean decline in QoL, whereas the DEMQOL-Proxy indicated overall improvement. In the subsample of people who self-reported QoL and utility, no mean change was evident. Changes in dependence did not explain changes on any QoL or utility outcome. There was a weak association between the EQ-5D proxy and changes in cognition, whereas changes on the DEMQOL-Proxy were partly explained by changes in behavioural disturbance. CONCLUSIONS The natural progression of AD over 18 months does not lead to inevitable decline in QoL or utility. There are no clear or consistent direct relationships between changes in disease severity and QoL outcomes. The impact of increasing dependence and worsening disease severity is likely buffered by a combination of psychological, social and environmental factors.
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820
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Hu R, Xu F, Han Y, Sheng Y, Qi S, Miao Y, Yang Q. Trichoscopic findings of androgenetic alopecia and their association with disease severity. J Dermatol 2015; 42:602-7. [PMID: 25810236 DOI: 10.1111/1346-8138.12857] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 02/10/2015] [Indexed: 11/26/2022]
Abstract
Trichoscopy is a novel tool for the diagnosis of hair loss disorders such as androgenetic alopecia (AGA), but there are still few reports on the association between trichoscopic findings and disease severity, especially in the Chinese population. A case-control observational study was conducted to observe the trichoscopic findings of AGA and to evaluate their relationship with disease severity. Trichoscopic examination was performed with a handheld dermoscope on 750 Chinese male AGA (MAGA) and 200 female AGA (FAGA) patients, along with 100 male and 50 female normal controls. Trichoscopically, AGA was featured by hair shaft thickness heterogeneity (HSTH), brown peripilar sign (BPPS), white peripilar sign (WPPS), yellow dots, pinpoint white dots, focal atrichia and scalp pigmentation. No significant difference in the occipital area was found between AGA and controls (P > 0.05). HSTH of more than 20% was demonstrated in all MAGA patients, and HSTH of more than 10% was seen in all FAGA patients. WPPS, yellow dots, pinpoint white dots, focal atrichia and scalp pigmentation were positively related to severity of disease (P < 0.05), while BPPS was the contrary (P < 0.05). HSTH is an essential criterion for diagnosing AGA. BPPS was more common in early AGA. However, WPPS, yellow dots, pinpoint white dots, focal atrichia and scalp pigmentation are positively correlated with advanced AGA.
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Affiliation(s)
- Ruiming Hu
- Department of Dermatology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Feng Xu
- Department of Dermatology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yumei Han
- Department of Dermatology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Youyu Sheng
- Department of Dermatology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Sisi Qi
- Department of Dermatology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ying Miao
- Department of Dermatology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qinping Yang
- Department of Dermatology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
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821
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Thijs JL, van Seggelen W, Bruijnzeel-Koomen C, de Bruin-Weller M, Hijnen D. New Developments in Biomarkers for Atopic Dermatitis. J Clin Med 2015; 4:479-87. [PMID: 26239250 DOI: 10.3390/jcm4030479] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 02/09/2015] [Accepted: 02/24/2015] [Indexed: 12/24/2022] Open
Abstract
The application of biomarkers in medicine is evolving. Biomarkers do not only give us a better understanding of pathogenesis, but also increase treatment efficacy and safety, further enabling more precise clinical care. This paper focuses on the current use of biomarkers in atopic dermatitis, new developments and future perspectives. Biomarkers can be used for many different purposes, including the objective determination of disease severity, confirmation of clinical diagnosis, and to predict response to treatment. In atopic dermatitis, many biomarkers have been investigated as a marker for disease severity. Currently serum thymus and activation-regulated chemokine (TARC) is the superior biomarker for assessing disease severity. However, we have recently shown that the use of a panel of serum biomarkers is more suitable for assessing disease severity than an individual biomarker. In this overview, we will discuss alternative sources for biomarkers, such as saliva and capillary blood, which can increase the user friendliness of biomarkers in atopic dermatitis (AD). Both methods offer simple, non-invasive and cost effective alternatives to venous blood. This provides great translational and clinical potential. Biomarkers will play an increasingly important role in AD research and personalized medicine. The use of biomarkers will enhance the efficacy of AD treatment by facilitating the individualization of therapy targeting the patients' specific biological signature and also by providing tools for predicting and monitoring of therapeutic response.
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822
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Dormond L, Jaton K, de Vallière S, Genton B, Greub G. Malaria real-time PCR: correlation with clinical presentation. New Microbes New Infect 2015; 5:10-2. [PMID: 25905022 PMCID: PMC4404418 DOI: 10.1016/j.nmni.2015.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 12/31/2014] [Accepted: 02/18/2015] [Indexed: 11/25/2022] Open
Abstract
Among 112 patients infected only by Plasmodium falciparum, WHO criteria of severity were compared with parasite load assessed by microscopy and quantitative PCR. Clinical severity was significantly correlated with higher parasite load as determined by microscopy (p < 0.001) and by PCR (p < 0.001). Hence, quantitative PCR might be useful to predict outcome.
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Affiliation(s)
- L Dormond
- Institute of Microbiology, University Hospital Centre and University of Lausanne, Lausanne, Switzerland
| | - K Jaton
- Institute of Microbiology, University Hospital Centre and University of Lausanne, Lausanne, Switzerland
| | - S de Vallière
- Travel Clinic, Department of Ambulatory Care and Community Medicine, University Hospital, Lausanne, Switzerland
| | - B Genton
- Travel Clinic, Department of Ambulatory Care and Community Medicine, University Hospital, Lausanne, Switzerland ; Service for Infectious Diseases, University Hospital Centre, Lausanne, Switzerland ; Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - G Greub
- Institute of Microbiology, University Hospital Centre and University of Lausanne, Lausanne, Switzerland ; Service for Infectious Diseases, University Hospital Centre, Lausanne, Switzerland
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823
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Wei F, Fan R, Dong H, Shang W, Xu X, Zhu H, Yang J, Hu X. Threshold microsclerotial inoculum for cotton verticillium wilt determined through wet-sieving and real-time quantitative PCR. Phytopathology 2015; 105:220-229. [PMID: 25098492 DOI: 10.1016/b978-0-12-372180-8.50042-1] [Citation(s) in RCA: 6457] [Impact Index Per Article: 717.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Quantification of Verticillium dahliae microsclerotia is an important component of wilt management on a range of crops. Estimation of microsclerotia by dry or wet sieving and plating of soil samples on semiselective medium is a commonly used technique but this method is resource-intensive. We developed a new molecular quantification method based on Synergy Brands (SYBR) Green real-time quantitative polymerase chain reaction of wet-sieving samples (wet-sieving qPCR). This method can detect V. dahliae microsclerotia as low as 0.5 CFU g(-1) of soil. There was a high correlation (r=0.98) between the estimates of conventional plating analysis and the new wet-sieving qPCR method for 40 soil samples. To estimate the inoculum threshold for cotton wilt, >400 soil samples were taken from the rhizosphere of individual plants with or without visual wilt symptoms in experimental and commercial cotton fields at the boll-forming stage. Wilt inoculum was estimated using the wet-sieving qPCR method and related to wilt development. The estimated inoculum threshold varied with cultivar, ranging from 4.0 and 7.0 CFU g(-1) of soil for susceptible and resistant cultivars, respectively. In addition, there was an overall relationship of wilt incidence with inoculum density across 31 commercial fields where a single composite soil sample was taken at each field, with an estimated inoculum threshold of 11 CFU g(-1) of soil. These results suggest that wilt risk can be predicted from the estimated soil inoculum density using the new wet-sieving qPCR method. We recommend the use of 4.0 and 7.0 CFU g(-1) as an inoculum threshold on susceptible and resistant cultivars, respectively, in practical risk prediction schemes.
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824
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Wei F, Fan R, Dong H, Shang W, Xu X, Zhu H, Yang J, Hu X. Threshold microsclerotial inoculum for cotton verticillium wilt determined through wet-sieving and real-time quantitative PCR. Phytopathology 2015; 105:220-229. [PMID: 25098492 DOI: 10.1094/phyto-05-14-0139-r] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Quantification of Verticillium dahliae microsclerotia is an important component of wilt management on a range of crops. Estimation of microsclerotia by dry or wet sieving and plating of soil samples on semiselective medium is a commonly used technique but this method is resource-intensive. We developed a new molecular quantification method based on Synergy Brands (SYBR) Green real-time quantitative polymerase chain reaction of wet-sieving samples (wet-sieving qPCR). This method can detect V. dahliae microsclerotia as low as 0.5 CFU g(-1) of soil. There was a high correlation (r=0.98) between the estimates of conventional plating analysis and the new wet-sieving qPCR method for 40 soil samples. To estimate the inoculum threshold for cotton wilt, >400 soil samples were taken from the rhizosphere of individual plants with or without visual wilt symptoms in experimental and commercial cotton fields at the boll-forming stage. Wilt inoculum was estimated using the wet-sieving qPCR method and related to wilt development. The estimated inoculum threshold varied with cultivar, ranging from 4.0 and 7.0 CFU g(-1) of soil for susceptible and resistant cultivars, respectively. In addition, there was an overall relationship of wilt incidence with inoculum density across 31 commercial fields where a single composite soil sample was taken at each field, with an estimated inoculum threshold of 11 CFU g(-1) of soil. These results suggest that wilt risk can be predicted from the estimated soil inoculum density using the new wet-sieving qPCR method. We recommend the use of 4.0 and 7.0 CFU g(-1) as an inoculum threshold on susceptible and resistant cultivars, respectively, in practical risk prediction schemes.
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825
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Metanat M, Sharifi-Mood B, Tabatabaei M, Sarraf-Shirazi M. Can serum ferritin level predict disease severity in patients with crimean-congo hemorrhagic Fever? Eurasian J Med 2015; 45:108-14. [PMID: 25610262 DOI: 10.5152/eajm.2013.22] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 05/16/2013] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE Crimean-Congo hemorrhagic fever (CCHF) is an acute viral disease. Several factors have already been suggested to explain the pathogenesis as well as predict the disease severity. In our study we aim to investigate the role of serum ferritin level as a possible predicting factor of disease severity in these patients. MATERIALS AND METHODS We evaluated all patients with laboratory confirmed diagnosis of CCHF who were admitted to Boo-Ali Hospital of Zahedan from May 2011 to June 2012. Confirmation of the disease determined using the presence of anti- CCHFV IgM in the serum by enzyme-linked immunosorbent assay (ELISA) or by polymerase chain reaction(PCR). After ethical approval, patients were categorized into two groups of mild and severe disease according to disseminated intravascular coagulation (DIC) severity using the scoring system of International Society on Thrombosis and Hemostasis (ISTH). Serum ferritin levels were evaluated and compared between these two groups. Receiver operating characteristic (ROC) curve analysis was performed to assess the optimal cutoff value of serum ferritin for predicting the disease severity. RESULTS A total of 42 patients (36 men, 6 women, age range: 17-78 years) were included in this study, of whom 38% had Persian and 62% had Baloch ethnicity. According to DIC severity score, 54.7% of the patients had severe disease and 45.3% had mild disease. The area under the ROC curve was 0.896 and 95% CI was 0.801-0.991 (p<0.0001). A cut-off point of 1060 ng/dL, had a sensitivity of 78.9%, a specificity of 87%, a positive predictive value of 6% and a negative predictive value of 100%. Positive and negative likelihood ratios for this serum ferritin level were 6.05 and 0.24, respectively. CONCLUSION Increased serum ferritin level has a significant positive correlation with disease severity in patients with CCHF and can evaluate the prognosis of these patients with a high sensitivity and specificity.
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Affiliation(s)
- Maliheh Metanat
- Infectious Diseases and Tropical Medicine Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Batool Sharifi-Mood
- Infectious Diseases and Tropical Medicine Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mehdi Tabatabaei
- Infectious Diseases and Tropical Medicine Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mohammad Sarraf-Shirazi
- Infectious Diseases and Tropical Medicine Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
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826
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Deckers IE, van der Zee HH, Boer J, Prens EP. Correlation of early-onset hidradenitis suppurativa with stronger genetic susceptibility and more widespread involvement. J Am Acad Dermatol 2015; 72:485-8. [PMID: 25582541 DOI: 10.1016/j.jaad.2014.11.017] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 11/11/2014] [Accepted: 11/15/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND The reported mean age of onset of hidradenitis suppurativa (HS) is between 20 and 24 years. Prepubertal onset is thought to be rare. OBJECTIVE We sought to determine the prevalence of early-onset HS and to compare clinical characteristics between early-onset and normal-onset HS in a retrospective study. METHODS Data were collected from 855 patients with HS. Early-onset HS was defined as onset before the thirteenth birthday. Clinical characteristics were analyzed in relation to the age of onset. RESULTS In all, 66 patients (7.7%) reported early-onset HS. A family history for HS was significantly higher in early-onset patients (55.6% vs 34.2%; odds ratio 2.1, 95% confidence interval 1.2-3.6, P = .006). They developed inflammatory lesions at more body sites than patients with normal-onset HS (odds ratio 3.0, 95% confidence interval 1.8-4.9, P < .001). Distribution of the Hurley stages of severity showed no differences between the 2 groups (odds ratio 1.1, 95% confidence interval 0.7-1.8, P = .72). LIMITATIONS Some data were based on patient-reported information. CONCLUSION Early-onset HS occurs more frequently than previously believed. Patients with early-onset HS often report a family history for HS and develop lesions at more body sites.
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Affiliation(s)
- Inge E Deckers
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Hessel H van der Zee
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jurr Boer
- Department of Dermatology, Deventer Hospital, Deventer, The Netherlands
| | - Errol P Prens
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
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827
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Chapman KR, Bateman ED, Chen H, Hu H, Fogel R, Banerji D. QVA149 Improves Lung Function, Dyspnea, and Health Status Independent of Previously Prescribed Medications and COPD Severity: A Subgroup Analysis from the SHINE and ILLUMINATE Studies. Chronic Obstr Pulm Dis 2015; 2:48-60. [PMID: 28848830 DOI: 10.15326/jcopdf.2.1.2014.0140] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: QVA149 is a dual bronchodilator combining the long-acting β2-agonist(LABA) indacaterol and the long-acting muscarinic antagonist (LAMA) glycopyrronium, for maintenance treatment of COPD. This post hoc analysis evaluated the improvements in lung function, dyspnea, and health status in subgroups of patients based on prior medication use, disease severities, baseline cough score, and baseline rescue medication use, achieved with QVA149 compared with placebo and other active comparators in 2 phase III clinical studies. Methods: In both the SHINE (NCT01202188) and ILLUMINATE (NCT01315249) studies, symptomatic patients aged ≥40 years with moderate-to-severe COPD were randomized to once-daily QVA149 (110/50 µg), indacaterol (150 µg), glycopyrronium (50 µg), tiotropium (18 μg), or placebo (2:2:2:2:1) and once-daily QVA149 (110/50 µg) or twice-daily salmeterol/fluticasone ([SFC]; 50/500 µg), respectively for 26 weeks. Here, we present the improvements in lung function, transition dyspnea index (TDI) and St. George's Respiratory Questionnaire (SGRQ) total score by prior medication use and COPD disease severity separately from both studies. Results: In total, 2144 and 523 patients were randomized in the SHINE and ILLUMINATE studies; 89.1% and 82.6%, respectively, completed the study. QVA149 showed significant improvements in lung function compared with placebo (SHINE study) and SFC (ILLUMINATE study) regardless of prior medication, disease severity, baseline cough score, and rescue medication use. TDI and SGRQ total scores were also improved with QVA149 compared with placebo and SFC in most of the analyzed subgroups. Conclusion: QVA149 showed improvements in lung function, dyspnea, and health status in both moderate and severe COPD patients independent of previous medication use and baseline cough score.
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Affiliation(s)
- Kenneth R Chapman
- Asthma and Airway Centre, University Health Network, Toronto Western Hospital, Ontario, Canada
| | - Eric D Bateman
- Department of Medicine, University of Cape Town, South Africa
| | - Hungta Chen
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Hulin Hu
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Robert Fogel
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Donald Banerji
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
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828
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Goka EA, Vallely PJ, Mutton KJ, Klapper PE. Single and multiple respiratory virus infections and severity of respiratory disease: a systematic review. Paediatr Respir Rev 2014; 15:363-70. [PMID: 24361079 PMCID: PMC7106320 DOI: 10.1016/j.prrv.2013.11.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 10/30/2013] [Accepted: 11/01/2013] [Indexed: 12/20/2022]
Abstract
INTRODUCTION There are suggestions that virus co-infections may influence the clinical outcome of respiratory virus illness. We performed a systematic review of the literature to summarise the evidence. METHODS MEDLINE, EMBASE, Ovid and WEB of Science databases, major organisation websites and reference lists of published studies were searched. The quality of studies was assessed using the STROBE tool (von Elm et al., 1) Individual study data was analyzed using odds ratios and 95% confidence intervals as a measure of association between exposure (co-infection), patient outcome and results summarised using forest plots and tables RESULTS Nineteen (19) studies from all over the world were identified and included in the review. Most of the studies 73.7% (14/19) recruited children ≤ 6 years old. Evidence on the role of co-infection in increasing disease severity was inconclusive. In five out of eight studies, co-infection significantly increased risk of admission to general ward (OR: 2.4, 95% CI: 1.3 - 4.4, p = 0.005; OR: 2.4, 95% CI: 1.1 - 7.7, P = 0.04; OR: 3.1, 95% CI: 2.0 - 5.1, p = <0.001; OR: 2.4, 95% CI: 1.7-3.4, p = <0.0001 and OR: 2.3, 95% CI: 1.1 - 5.1, p = 0.34), one found it did not (OR: 0.59, 95% CI: 0.4 - 0.9, p = 0.02) and the other 2 had insignificant results. Similarly on risk of admission to ICU, some studies found that co-infection significantly increased risk of admission to ICU (OR: 2.9, 95% CI: 1.4 - 5.9, p = 0.004 and OR: 3.0, 95% CI: 1.7 - 5.6, p = <0.0001), whereas others did not (OR: 0.18, 95% CI: 0.05 - 0.75, p = 0.02 and OR: 0.3, 95% CI: 0.2 - 0.6, p = <0.0001). There was no evidence for or against respiratory virus co-infections and risk of bronchiolitis or pneumonia. CONCLUSION The influence of co-infections on severe viral respiratory disease is still unclear. The observed conflict in outcomes could be because they were conducted in different seasons and covered different years and periods. It could also be due to bias towards the null, especially in studies where only crude analysis was conducted. Future studies should employ stratified analysis.
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Affiliation(s)
- Edward Anthony Goka
- Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester.
| | - Pamela J. Vallely
- Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester
| | - Kenneth J. Mutton
- Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester,Department of Clinical Virology, Central Manchester Universities NHS Trust
| | - Paul E. Klapper
- Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester,Department of Clinical Virology, Central Manchester Universities NHS Trust
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829
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Deniz R, Ozen G, Yilmaz-Oner S, Alibaz-Oner F, Erzik C, Aydin SZ, Inanc N, Eren F, Bayalan F, Direskeneli H, Atagunduz P. Familial Mediterranean fever gene (MEFV) mutations and disease severity in systemic lupus erythematosus (SLE): implications for the role of the E148Q MEFV allele in inflammation. Lupus 2014; 24:705-11. [PMID: 25413357 DOI: 10.1177/0961203314560203] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 10/28/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Observed low prevalence of SLE among familial Mediterranean fever (FMF) patients in several large cohorts suggests a possible protective effect of the MEFV mutations from SLE. In contrast, SLE patient carriers for the common MEFV mutations had rather complex disease expression with an increased frequency of febrile episodes and pleurisy and a decreased renal complication rate. Our aim was to investigate the prevalence of MEFV gene mutations in patients with SLE and their effect on organ involvement in a well-defined group of biopsy-proven SLE nephritis patients. MATERIAL AND METHOD The prevalence of four MEFV gene mutations (M694V, M680I, V726A and E148Q) was investigated in 114 SLE patients and effect on disease severity was analyzed in patients with biopsy-proven SLE nephritis. RESULTS None of the SLE patients fulfilled the revised Tel-Hashomer criteria. Fourteen of 114 SLE patients (12.2%) were found to carry at least one MEFV mutation. A single patient in the SLE-Nephritis group was compound heterozygous for M694V/M680I mutations and only one patient in the SLE-Mild group was homozygous for E148Q mutation. Carrier frequency was similar to controls in SLE patients (12.2 vs 18.8%, p = 0.34). After the exclusion of the less penetrant E148Q mutation, re-analysis revealed an association between exon 10 mutations and SLE nephritis (p = 0.050, odds ratio (OR) = 4.16, 95% confidence interval (CI) = 1.04-16.6). Carrier rate for the E148Q mutation decreased in the SLE group (controls vs. SLE = 20/186 vs. 3/114, p = 0.08) and E148Q mutation was absent in SLE nephritis (controls vs. SLE nephritis = 20/186 vs. 0/47, p = 0.016, OR = 11.69, 95% CI = 0.69-197.13). CONCLUSIONS Carrier rate for the studied MEFV mutations was slightly lower in the SLE group, which is in agreement with previous observations that FMF may confer some protection from SLE. Exon 10 mutations were associated with SLE nephritis after the exclusion of the E148Q mutation. The significance of the E148Q as a disease-causing mutation is controversial, and whether E148Q substitution is a polymorphism generally affecting inflammatory pathways is not addressed in the current literature. In this regard, absence of the E148Q mutation in SLE nephritis may serve as a clue for further investigation into its role as a general modulatory polymorphism for inflammation. This clarification is necessary to conclude whether other more penetrant MEFV gene mutations confer susceptibility to nephritis in SLE.
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Affiliation(s)
- R Deniz
- Marmara University Faculty of Medicine, Istanbul, Turkey
| | - G Ozen
- Marmara University Faculty of Medicine, Department of Rheumatology, Istanbul, Turkey
| | - S Yilmaz-Oner
- Marmara University Faculty of Medicine, Department of Rheumatology, Istanbul, Turkey
| | - F Alibaz-Oner
- Marmara University Faculty of Medicine, Department of Rheumatology, Istanbul, Turkey
| | - C Erzik
- Marmara University Faculty of Medicine, Department of Medical Biology, Istanbul, Turkey
| | - S Z Aydin
- Goztepe Training and Research Hospital, Department of Rheumatology, Istanbul, Turkey
| | - N Inanc
- Marmara University Faculty of Medicine, Department of Rheumatology, Istanbul, Turkey
| | - F Eren
- Marmara University Faculty of Medicine, Department of Medical Biology, Istanbul, Turkey
| | - F Bayalan
- Marmara University Faculty of Medicine, Department of Rheumatology, Istanbul, Turkey
| | - H Direskeneli
- Marmara University Faculty of Medicine, Department of Rheumatology, Istanbul, Turkey
| | - P Atagunduz
- Marmara University Faculty of Medicine, Department of Rheumatology, Istanbul, Turkey
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830
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Mehta R, Scheffler M, Tapia L, Aideyan L, Patel KD, Jewell AM, Avadhanula V, Mei M, Garofalo RP, Piedra PA. Lactate dehydrogenase and caspase activity in nasopharyngeal secretions are predictors of bronchiolitis severity. Influenza Other Respir Viruses 2014; 8:617-25. [PMID: 25132512 PMCID: PMC4262276 DOI: 10.1111/irv.12276] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2014] [Indexed: 01/19/2023] Open
Abstract
Background Bronchiolitis is the leading cause of hospitalization in infants. Biomarkers of disease severity might help in clinical management. Objective To determine the clinical predictiveness of NW-LDH, NW-caspase 3/7, and NW-LDH/NW-caspase 3/7 ratio in bronchiolitis. Methods Previously healthy children less than 24 months of age with bronchiolitis were recruited from the Texas Children's emergency room and intensive care unit from October 2010 to April 2011. Demographic, clinical information, and NW samples were obtained at enrollment. NW samples were analyzed for respiratory viruses, caspase 3/7, and LDH. Results A viral pathogen was detected in 91·6% of 131 children, with the most common being respiratory syncytial virus and human rhinovirus. A single infection was found in 61·8% of subjects and co-infection in 29·8%. Children admitted to ICU had significantly higher NW-LDH than children sent home from the ER or admitted to the general floor (P = 0·02). Children infected with RSV had the highest NW-LDH concentration (P = 0·03) compared with other viral infections. NW-LDH and NW-caspase were significantly correlated (r = 0·77, P < 0·0001). The univariate models showed NW-LDH and NW-LDH/NW- caspase 3/7 ratio were directly associated with hospitalization. Mutivariate regression analyses suggested a complex interaction between the biomarkers, demographics, and disposition. Conclusions NW-LDH, NW-caspase 3/7 and NW-LDH/NW-caspase 3/7 ratio and their interactions with demographic factors are predictive of bronchiolitis severity and can help distinguish children requiring ICU-level care from those admitted to the general floor, or discharged home from the emergency center.
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Affiliation(s)
- Reena Mehta
- Department of Pediatrics, University of Texas Medical Branch, Galveston, TX, USA
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831
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Bediako SM, Lanzkron S, Diener-West M, Onojobi G, Beach MC, Haywood C. The Measure of Sickle Cell Stigma: Initial findings from the Improving Patient Outcomes through Respect and Trust study. J Health Psychol 2014; 21:808-20. [PMID: 24997169 DOI: 10.1177/1359105314539530] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Research about the influence of stigma on health outcomes in sickle cell disease is limited. We administered the recently developed Measure of Sickle Cell Stigma to 262 patients in the United States. The Measure of Sickle Cell Stigma yielded very good internal consistency and four interpretable factors. Significant associations among stigma, pain-related healthcare utilization, and perceived disease severity were observed for three of the four stigma factors (F range = 2.78-5.44). The Measure of Sickle Cell Stigma appears to be a useful tool for measuring disease-specific stigma among adults living with sickle cell disease, and further assessment of its clinical utility is warranted.
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Affiliation(s)
| | | | | | | | - Mary C Beach
- The Johns Hopkins University School of Medicine, USA
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832
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Jhun BW, Kim SJ, Kim K, Lee JE. Clinical implications of initial peripheral eosinophilia in acute eosinophilic pneumonia. Respirology 2014; 19:1059-65. [PMID: 24985714 DOI: 10.1111/resp.12342] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 04/10/2014] [Accepted: 04/21/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE The initial peripheral eosinophil count (PEC) is rarely elevated but tends to increase during the clinical course of acute eosinophilic pneumonia (AEP). We evaluated whether initial peripheral eosinophilia is an indicator of mild disease in patients with AEP. METHODS We retrospectively examined associations between initial peripheral absolute eosinophil count, inflammatory markers and clinical characteristics in 85 patients with AEP. RESULTS Of 85 patients, 24 (28%) had initial peripheral eosinophilia (>500/μL). Initial peripheral absolute eosinophil count was inversely correlated to white blood cell (WBC) count (ρ = -0.386, P < 0.001), neutrophil percentage (ρ = -0.645, P < 0.001) and C-reactive protein (CRP; ρ = -0.495, P < 0.001). During treatment, peripheral absolute eosinophil counts increased, while inflammatory markers (WBC, neutrophil percentage, and CRP) decreased. Patients with initial peripheral eosinophilia had a longer duration from onset of symptoms to admission (P = 0.006), had lower WBC counts, neutrophil percentages and CRP values (all P < 0.001), and higher oxygen saturation (P = 0.004) than patients with normal peripheral eosinophil counts. Oxygen requirements (P = 0.013), duration of oxygen administration (P = 0.028) and intensive care unit admission rates (P = 0.003) were lower in patients with initial peripheral eosinophilia. All patients survived and recovered fully after corticosteroid or conservative treatment. CONCLUSIONS Initial PEC may be related to a milder disease status on admission, compared with normal PEC in patients with AEP. This may help to stratify disease severity in AEP.
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Affiliation(s)
- Byung Woo Jhun
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, The Armed Forces Capital Hospital, Seong-nam, Republic of Korea
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833
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Granström S, Friedrich RE, Langenbruch AK, Augustin M, Mautner VF. Influence of learning disabilities on the tumour predisposition syndrome NF1--survey from adult patients' perspective. Anticancer Res 2014; 34:3675-3681. [PMID: 24982386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM To analyze psychosocial burdens associated with neurofibromatosis type-1 (NF1) phenotype--visible symptoms, medical complications, learning disabilities (LD)--from patients' perspective with focus on LD. PATIENTS AND METHODS A survey of 228 adult patients with NF1 was carried-out. Symptoms to estimate disease severity and visibility, and learning disability were assessed. Outcome parameters were social situation and psychosocial aspects. RESULTS Social situation and psychosocial aspects differed depending on NF1 phenotype. Patients with LD (n=55) were less frequently in a partnership (p=0.005) or had children (p=0.015) than those without (n=132). They also reported a higher frequency of depression (p=0.019) and sensitivity to stress (p<0.001) and more uncertainty regarding NF1-associated symptoms. These differences were significant when adjusting for disease severity and self-perceived disease visibility. CONCLUSION Beside the psychosocial needs of patients with LD with NF1, medical management of this sub-group should include doctor-patient communication in easy language to compensate for patients' lack of knowledge about symptoms associated with cancer.
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Affiliation(s)
| | - Reinhard E Friedrich
- Neurofibromatosis Laboratory, Hamburg, Germany Oral and Cranio-Maxillofacial Surgery, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Katharina Langenbruch
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Augustin
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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834
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Delatycki MB, Tai G, Corben L, Yiu EM, Evans-Galea MV, Stephenson SEM, Gurrin L, Allen KJ, Lynch D, Lockhart PJ. HFE p.C282Y heterozygosity is associated with earlier disease onset in Friedreich ataxia. Mov Disord 2014; 29:940-3. [PMID: 24390816 DOI: 10.1002/mds.25795] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Revised: 11/26/2013] [Accepted: 12/03/2013] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Friedreich ataxia (FRDA) generally results from reduced frataxin, a mitochondrial protein involved in iron metabolism. We assessed whether HFE p.C282Y and/or p.H63D heterozygosity modifies age at disease onset or disease severity in individuals with FRDA. METHODS One hundred seventy individuals with FRDA were assessed for the association of HFE p.C282Y and p.H63D with (1) age at disease onset and (2) Friedreich Ataxia Rating Scale (FARS) score. RESULTS After adjusting for the smaller FXN GAA repeat size and sex, individuals with FRDA and heterozygous for p.C282Y had disease onset on average 3.72 years earlier than those homozygous for the wild-type amino acid (P = 0.02). Neither mutation affected disease severity as measured by FARS. CONCLUSIONS It is hypothesized that the association between p.C282Y heterozygosity and an earlier age at FRDA onset relates to exacerbation of the already dysregulated iron metabolism that plays a major role in the pathogenesis of FRDA.
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Affiliation(s)
- Martin B Delatycki
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Clinical Genetics, Austin Health, Heidelberg, Victoria, Australia; Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia; School of Psychology and Psychiatry, Monash University, Clayton, Victoria, Australia
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835
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Chiewchengchol D, Murphy R, Morgan T, Edwards SW, Leone V, Friswell M, Pilkington C, Tullus K, Rangaraj S, McDonagh JE, Gardner-Medwin J, Wilkinson N, Riley P, Tizard J, Armon K, Sinha MD, Ioannou Y, Mann R, Bailey K, Davidson J, Baildam EM, Pain CE, Cleary G, McCann LJ, Beresford MW. Mucocutaneous manifestations in a UK national cohort of juvenile-onset systemic lupus erythematosus patients. Rheumatology (Oxford) 2014; 53:1504-12. [PMID: 24692572 DOI: 10.1093/rheumatology/keu137] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To determine whether mucocutaneous manifestations are associated with major organ involvement in a UK national cohort of juvenile-onset SLE (JSLE) patients. METHODS JSLE patients (n = 241) from 15 different centres whose diagnosis fulfilled four or more of the ACR criteria were divided into two groups: those with at least one ACR mucocutaneous criterion (ACR skin feature positive) and those without (ACR skin feature negative) at diagnosis. The relative frequency of skin involvement was described by the paediatric adaptation of the 2004 British Isles Lupus Assessment Group (pBILAG-2004) index. RESULTS One hundred and seventy-nine patients (74%) had ACR-defined skin involvement with no significant demographic differences compared with those without. ACR skin feature negative patients showed greater haematological (84% vs 67%), renal (43% vs 26%) (P < 0.05) and neurological (16% vs 4%) involvement (P = 0.001). Forty-two per cent of ACR skin feature negative patients had skin involvement using pBILAG-2004, which included maculopapular rash (17%), non-scaring alopecia (15%), cutaneous vasculitis (12%) and RP (12%). ACR skin feature negative patients with moderate to severe skin involvement by pBILAG-2004 showed greater renal and haematological involvement at diagnosis and over the follow-up period (P < 0.05). Higher immunosuppressive drug use in the skin feature negative group was demonstrated. CONCLUSION Patients who fulfil the ACR criteria but without any of the mucocutaneous criteria at diagnosis have an increased risk of major organ involvement. The pBILAG-2004 index has shown that other skin lesions may go undetected using the ACR criteria alone, and these lesions show a strong correlation with disease severity and major organ involvement.
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Affiliation(s)
- Direkrit Chiewchengchol
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Ruth Murphy
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Thomas Morgan
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Steven W Edwards
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Valentina Leone
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Mark Friswell
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Clarissa Pilkington
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Kjell Tullus
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Satyapal Rangaraj
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Janet E McDonagh
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Janet Gardner-Medwin
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Nick Wilkinson
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Phil Riley
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Jane Tizard
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Kate Armon
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Manish D Sinha
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Yiannis Ioannou
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Rebecca Mann
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Kathryn Bailey
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK. Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, Universi
| | - Joyce Davidson
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Eileen M Baildam
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Clare E Pain
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Gavin Cleary
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Liza J McCann
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Michael W Beresford
- Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust Hospital and Institute of Integrative Biology, University of Liverpool, Liverpool, Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, Institute of Integrative Biology, University of Liverpool, Liverpool, Leeds General Infirmary, Leeds Teaching Hospital Trust, Leeds, Great North Children's Hospital Foundation Trust, Newcastle-upon-Tyne, Great Ormond Street Hospital for Children NHS Trust, London, Nottingham Children's Hospital and Nottingham University Hospital NHS Trust, Nottingham, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, School of Medicine, Glasgow University, Glasgow, Children's Hospital, Oxford Radcliffe Hospital NHS Trust, Oxford, Royal Manchester Children's NHS Trust Hospital, Manchester, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, Jenny Lind Children's Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, University College London Hospitals NHS Foundation Trust and Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, University Hospital Coventry and Warwickshire NHS Trust, Coventry, George Eliot Hospital NHS Trust, Nuneaton, Royal Hospital for Sick Children NHS Lothian University Trust, Edinburgh and Royal Hospital for Sick Children NHS Greater Glasgow and Clyde, Glasgow and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK.
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836
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Gabra N, Alromaih S, Endam LM, Brito RM, Larivière F, Al-Mot S, LeDeist F, Desrosiers M. Clinical features of cytotoxic CD8+ T-lymphocyte deficiency in chronic rhinosinusitis patients: a demographic and functional study. Int Forum Allergy Rhinol 2014; 4:495-501. [PMID: 24639246 DOI: 10.1002/alr.21313] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 01/04/2014] [Accepted: 01/07/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND Identification of Staphylococcus aureus intracellularly in chronic rhinosinusitis (CRS) suggests an underlying cellular immunodeficiency. Supporting this, we have previously reported low CD8+ (cytotoxic) T-lymphocyte levels in a subpopulation of CRS patients and identified polymorphisms in the CD8A gene associated with CRS. In order to better understand the role of low CD8+ in CRS, we wished to determine the phenotype for CRS/Low CD8+ in comparison to that of conventional CRS. METHODS Sixty-seven low CD8+ CRS patients identified during investigation of CRS were compared for demographics, disease evolution, and bacteriology on endoscopic culture were compared with an existing population of 480 patients with CRS with nasal polyposis previously recruited for genetic association studies. RESULTS Mean level of CD8+ in the CRS/Low CD8+ population was 0.15 × 10(9)/L (range, 0.20-1.5 × 10(9)/L). There was no difference between both groups in terms of history of allergy, asthma, eczema, acetylsalicylic acid (ASA) intolerance or smoking. The bacteriology was similar between both groups (S. aureus: CRS/Low CD8+: 35%; CRS 32%, p = 0.643). Evolution of disease was somewhat milder in CRS/Low CD8+, with fewer patients requiring surgery, and first surgery performed at a more advanced age. However, antibiotic use was higher in CRS/Low CD8+. Subgroup analysis restricted to CRS with nasal polyposis (CRSwNP)/Low CD8 or CRS without nasal polyposis (CRSsNP)/Low CD8 phenotypes did not substantially alter these results. CONCLUSION Low CD8+ levels are often identified in CRS patients; however, these patients have disease remarkably similar to those with conventional CRS. This suggests that immune deficiency, whether systemic or locally mediated, is well tolerated and may be present in other forms in CRS. CRS patients with low CD8+ levels may possibly require antibacterial therapies as part of ongoing management.
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Affiliation(s)
- Nathalie Gabra
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
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837
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Paletta Guedes RA, Paletta Guedes VM, Freitas SM, Chaoubah A. Utility values for glaucoma in Brazil and their correlation with visual function. Clin Ophthalmol 2014; 8:529-35. [PMID: 24648717 PMCID: PMC3958501 DOI: 10.2147/opth.s60105] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
PURPOSE We sought to identify the utility values in a group of Brazilian patients with primary open-angle glaucoma (POAG), and to assess its impact on visual acuity (VA) and mean deviation index values. MATERIALS AND METHODS This was a cross-sectional study of consecutive patients with POAG, who were interviewed using three methods for obtaining utility values: time trade-off (TTO), standard gamble anchored at risk of death (SG1), and standard gamble anchored at risk of blindness (SG2). Visual function variables (VA and mean deviation index in the better eye) and sociodemographic characteristics (age, sex, race, and educational level) were also obtained for statistical analysis. RESULTS The mean age (± standard deviation) of the study population (n=227) was 65.7 (±15.1) years. Mean utility values for the entire population were 0.82 from TTO, 0.90 from SG1, and 0.93 from SG2 (P<0.0001). Age, race, and sex had no influence on the utility values. Higher education tended to predict higher values by TTO, but not by SG1 or SG2. Visual function variables had an influence on utility values. The more advanced the visual loss, whether measured by VA or perimetry, in the better eye, the lower the utility values by all three methods. CONCLUSION We obtained utility values for Brazilian patients with POAG, as well as specific values for different levels of vision loss.
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Affiliation(s)
- Ricardo Augusto Paletta Guedes
- Federal University of Juiz de Fora, Juiz de Fora, Brazil
- Paletta Guedes Ophthalmological Center, Juiz de Fora, Brazil
- Santa Casa de Misericórdia Hospital, Juiz de Fora, Brazil
| | - Vanessa Maria Paletta Guedes
- Federal University of Juiz de Fora, Juiz de Fora, Brazil
- Paletta Guedes Ophthalmological Center, Juiz de Fora, Brazil
- Santa Casa de Misericórdia Hospital, Juiz de Fora, Brazil
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838
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Cantone E, Castagna G, Sicignano S, Ferranti I, Rega F, Di Rubbo V, Iengo M. Impact of intranasal sodium hyaluronate on the short-term quality of life of patients undergoing functional endoscopic sinus surgery for chronic rhinosinusitis. Int Forum Allergy Rhinol 2014; 4:484-7. [PMID: 24591296 DOI: 10.1002/alr.21310] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Revised: 12/21/2013] [Accepted: 01/28/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Functional endoscopic sinus surgery (FESS) has become the treatment of choice for patients with medically resistant chronic rhinosinusitis (CRS) and nasal polyps. Despite the consolidated use of different treatments, the postoperative period is often very painful and uncomfortable, especially during the first month. Although evidence on the effectiveness of sodium hyaluronate (SH) on postoperative care following FESS is available, data on the quality of life (QoL) from the patients' perspective are still lacking. This study aimed to evaluate for the first time the effectiveness of nasal douche with SH in reducing patients' discomfort during the first month following FESS. METHODS A double-blind randomized controlled study was carried out on 124 subjects undergoing FESS for CRS with nasal polyposis. They were divided into 2 groups: group I was treated with nasal douche containing 9 mg of high molecular weight SH plus saline solution and group II was treated with saline solution alone. To assess QoL in CRS patients, the Short Form-36 (SF-36) test, the Sino-Nasal Outcome Test-22 (SNOT-22), and the visual analogue scale (VAS) questionnaires were administered. RESULTS At baseline, there were no statistically significant differences between the 2 groups. However, after 30 days of long postoperative treatments, we found clinically significant improvements in QoL of subjects treated with SH, as evidenced by all QoL scales. CONCLUSION Our data indicate that SH significantly improves patients' short-term QoL following FESS in terms of both general health and specific sinonasal status.
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Affiliation(s)
- Elena Cantone
- Department of Neuroscience, Reproductive and Odontostomatologic Science, ENT Unit, "Federico II" University, Naples, Italy; Department of Molecular Medicine and Medical Biotechnology, "Federico II" University, Naples, Italy
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839
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Güven AS, Sancakdar E, Kaya A, Uysal EB, Oflaz MB, Bolat F, Karapınar H, Koç E, Icagasioglu FD. Value of ABO blood group in predicting the severity of children with Crimean-Congo hemorrhagic fever. Int J Clin Exp Med 2014; 7:416-420. [PMID: 24600498 PMCID: PMC3931597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 01/20/2014] [Indexed: 06/03/2023]
Abstract
PURPOSE The aim of this study was to assess the role of ABO blood groups in predicting disease severity and bleeding potential in children with Crimean-Congo hemorrhagic fever (CCHF). METHODS One hundred fifty-one hospitalized patients with CCHF were enrolled in this retrospective study. The patients were divided according to O- and non-O- (A, B and AB) blood groups (n=91 and n=60, respectively). They were also classified into two groups (severe and non-severe) based on disease severity (n=29 and n=122, respectively). Demographic characteristics, clinical findings, and hematologic and biochemical parameters of all patients were recorded on admission and discharge. RESULTS Although, in all cases, compared to the non-O blood group, the ratio of the blood group O was considerably higher (60% vs. 40%) and similarly so in severe cases (58.6% vs. 41.4%), this difference was not statistically significant (p>0.05). The aPTT at discharge and fever duration of the O-blood group were significantly higher than those of the non-O-blood group (p=0.042, p=0.034, respectively). The factor VIII level of the O-blood group was significantly lower than that of the non-O-blood group (p=0.040). Although the ratios of bleeding and severity were higher in the O-blood group compared to the other group, statistical significance was not reached (p>0.05). CONCLUSIONS Consideration of the ABO blood group is important during diagnostic follow-up to assess the severity of CCHF. In clinical practice, pediatric CCHF patients with the O blood group need to be followed closely for tendency to bleed.
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Affiliation(s)
- Ahmet Sami Güven
- Department of Pediatrics, Faculty of Medicine, Cumhuriyet UniversitySivas, Turkey
| | - Enver Sancakdar
- Department of Biochemistry, Faculty of Medicine, Cumhuriyet UniversitySivas, Turkey
| | - Ali Kaya
- Department of Pediatrics, Faculty of Medicine, Cumhuriyet UniversitySivas, Turkey
| | - Elif Bilge Uysal
- Department of Microbiology, Faculty of Medicine, Cumhuriyet UniversitySivas, Turkey
| | - Mehmet Burhan Oflaz
- Department of Pediatrics, Faculty of Medicine, Cumhuriyet UniversitySivas, Turkey
| | - Fatih Bolat
- Department of Pediatrics, Faculty of Medicine, Cumhuriyet UniversitySivas, Turkey
| | - Hekim Karapınar
- Department of Cardiology, Faculty of Medicine, Cumhuriyet UniversitySivas, Turkey
| | - Elif Koç
- Department of Pediatrics, Faculty of Medicine, Cumhuriyet UniversitySivas, Turkey
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840
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Ranjbaran R, Okhovat MA, Mobarhanfard A, Aboualizadeh F, Abbasi M, Moezzi L, Golafshan HA, Behzad-Behbahani A, Bagheri M, Sharifzadeh S. Relationship between AHSP gene expression, β/α globin mRNA ratio, and clinical severity of the β-thalassemia patients. Ann Clin Lab Sci 2014; 44:189-193. [PMID: 24795058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Alpha hemoglobin stabilizing protein (AHSP) is a chaperone-like molecule specialized for erythroid series which binds to free α-globin chain. According to this characteristic, AHSP can be considered an important factor which reduces beta thalassemia symptoms. MATERIALS AND METHODS Reticulocytes RNA extraction and a subsequent cDNA synthesis were performed, followed by Relative qRT-PCR for AHSP, alpha, and beta globin chain genes. The beta actin gene was used as an endogenous reference as well. The relationship between AHSP gene expression, disease severity, and the β/α globin mRNA ratio was studied among different homozygote β-thalassemia patients (mild, moderate and severe) and compared with minor thalassemia and the normal population. RESULTS Analysis of the β-globin/α-globin mRNA ratio has shown that disease severity enhanced with a decrease in this proportion. Evaluation of the correlation between AHSP gene expression and the average of the β-globin/α-globin expression ratio indicated a significant but indirect relationship in considered groups. Our results demonstrated that the AHSP gene expression increases in accordance with augmentation of clinical symptoms. CONCLUSIONS Although one of the main reasons for reduced clinical severity in homozygote β-thalassemia can be the high level of AHSP gene expression as a chaperon molecule, our findings indicated that AHSP gene expression decreased in a mild category as compared to that in severe and moderate groups.
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Affiliation(s)
- Reza Ranjbaran
- PhD.; Deputy Paramedical Education, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; phone:+987112270240;
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841
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Abstract
Binary toxin (CDT) is frequently observed in Clostridium difficile strains associated with increased severity of C. difficile infection (CDI). CDT belongs to the family of binary ADP-ribosylating toxins consisting of two separate toxin components: CDTa, the enzymatic ADP-ribosyltransferase which modifies actin, and CDTb which binds to host cells and translocates CDTa into the cytosol. CDTb is activated by serine proteases and binds to lipolysis stimulated lipoprotein receptor. ADP-ribosylation induces depolymerization of the actin cytoskeleton. Toxin-induced actin depolymerization also produces microtubule-based membrane protrusions which form a network on epithelial cells and increase bacterial adherence. Multiple clinical studies indicate an association between binary toxin genes in C. difficile and increased 30-d CDI mortality independent of PCR ribotype. Further studies including measures of binary toxin in stool, analyses of CDI mortality caused by CDT-producing strains, and examination of the relationship of CDT expression to TcdA and TcdB toxin variants and PCR ribotypes are needed.
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Affiliation(s)
- Dale N Gerding
- Loyola University Chicago Stritch School of Medicine; Hines Veterans Affairs Hospital; Hines, IL USA,Correspondence to: Dale N Gerding,
| | - Stuart Johnson
- Loyola University Chicago Stritch School of Medicine; Hines Veterans Affairs Hospital; Hines, IL USA
| | - Maja Rupnik
- Institute of Public Health Maribor; University of Maribor, Medical Faculty, and Centre of Excellence for Integrated Approaches in Chemistry and Biology of Proteins; Ljubljana, Slovenia
| | - Klaus Aktories
- Institute of Experimental and Clinical Pharmacology and Toxicology; Albert-Ludwigs-University Freiburg; Freiburg, Germany
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842
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Likness MM, Pallanch JF, Sherris DA, Kita H, Mashtare TL, Ponikau JU. Computed tomography scans as an objective measure of disease severity in chronic rhinosinusitis. Otolaryngol Head Neck Surg 2013; 150:305-11. [PMID: 24301090 DOI: 10.1177/0194599813513881] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES A truly objective method of measuring disease severity in chronic rhinosinusitis (CRS) has only recently existed. We evaluated computed tomography (CT) scans of CRS patients using this novel objective 3D computerized system and compared results with a novel 2D computerized analysis of a single coronal slice through the osteomeatal complex (OMC) and subjective methods including Lund-Mackay and Zinreich's modified Lund-Mackay. STUDY DESIGN Prospective multicenter study. SETTING Two academic tertiary referral centers. SUBJECTS AND METHODS Forty-six adults with a diagnosis of CRS underwent CT examination and received an intramuscular triamcinolone injection, dosage weight dependent, followed by CT scan 4 to 5 weeks later. Recruitment lasted 21 months. Scans were evaluated with all 4 scoring methods over 5 months. RESULTS The Lin's concordance class correlation (CCC) of the OMC method revealed the best correlation to the 3D volumetric computerized values (0.915), followed by the Zinreich (0.904) and Lund-Mackay methods (0.824). Posttreatment results demonstrated that both the OMC (0.824) and Zinreich's (0.778) methods had strong agreement with the 3D volumetric methods and were very sensitive to change, whereas the Lund-Mackay (0.545) had only moderate agreement. CONCLUSION Computerized CT analysis provides the most comprehensive, objective, and reproducible method of measuring disease severity and is very sensitive to change induced by treatment intervention. A 2D coronal image through the OMC provides a valid, user-friendly method of assessing CRS and is representative of CRS severity in all sinuses. Zinreich's subjective method correlated well overall, but the Lund-Mackay method lagged behind in disease representation and sensitivity to change.
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Affiliation(s)
- Micah M Likness
- State University of New York at Buffalo, Department of Otolaryngology, Buffalo, New York, USA
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843
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Kilic G, Kilic E, Akgul O, Ozgocmen S. Increased risk for bone loss in women with systemic sclerosis: a comparative study with rheumatoid arthritis. Int J Rheum Dis 2013; 19:405-11. [PMID: 24283757 DOI: 10.1111/1756-185x.12242] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
AIM To assess bone mass in women with systemic sclerosis (SSc) in comparison to age and sex-matched patients with rheumatoid arthritis (RA), and to evaluate factors influencing bone mineral density (BMD). METHODS Patients were consecutively recruited and assessed for BMD at the lumbar spine and hip by dual-energy X-ray absorptiometry (DEXA) using a densitometer. In SSc, the extent of skin involvement, modified Rodnan skin thickness score (mRSS) and Medsger disease severity index were assessed. RESULTS Forty-three patients with SSc and 38 age-matched patients with RA were included. There was no difference in BMD measurements between patients with diffuse or limited SSc. Patients with SSc had similar risk factors associated with osteoporosis (OP) or low bone mass except for low body mass index (BMI) and low vitamin D levels compared to patients with RA. Lumbar spinal BMD and T score were similar between groups. Total hip and femoral neck BMD and T score at femoral neck and total hip were significantly lower in patient with SSc versus RA. There was significant association between mRSS, Medsger severity score (peripheral vascular involvement and skin) and femoral BMD. CONCLUSION There is an increased risk for bone loss in patients with SSc and the risk of OP is associated with disease severity, prolonged menopause and disease duration. The complex pathophysiology of bone metabolism as well as complex pathogenesis of the SSc pose some difficulty reaching clear-cut conclusions on the causal relationship between SSc and bone loss.
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Affiliation(s)
- Gamze Kilic
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Gevher Nesibe Hospital, Erciyes University, Kayseri, Turkey
| | - Erkan Kilic
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Gevher Nesibe Hospital, Erciyes University, Kayseri, Turkey
| | - Ozgur Akgul
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Gevher Nesibe Hospital, Erciyes University, Kayseri, Turkey
| | - Salih Ozgocmen
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Gevher Nesibe Hospital, Erciyes University, Kayseri, Turkey
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844
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Abstract
Chronic Obstructive Pulmonary Disease (COPD) management represents a significant health resource use burden. Understanding of current resource use, treatment strategies and outcomes can improve future COPD management, for patient benefit and to aid efficient service delivery. This study aimed to describe exacerbation frequency, pharmacotherapy and health resource use in COPD management in routine UK primary care. A retrospective, observational study using routine clinical records of 511 patients with COPD, was undertaken in 10 General Practices in England. Up to 3 years' patient data were collected and analysed. 75% (234/314) patients with mild-moderate COPD (≥50% predicted FEV1) received inhaled corticosteroids (ICS). 11% of patients (54/511) received ICS monotherapy. Mean (standard deviation) annual exacerbation frequency was 1.1 (1.2) in mild-moderate, 1.7 (1.6) in severe (30-49% predicted FEV1) and 2.2 (2.0) in very severe (<30% predicted FEV1) COPD. 14% patients (69/511) had a mean exacerbation frequency of ≥3/year ('frequent-exacerbators'); 9% (27/314) of patients with mild-moderate, 19% (27/145) with severe and 29% (15/52) with very severe COPD. 14% (10/69) of frequent-exacerbators failed to receive inhaled long-acting beta agonists (LABA), 25% (17/69) inhaled long-acting muscarinic antagonists (LAMA), and 12% (`/69) ICS. Frequent-exacerbators had a median of 6.67 primary care contacts/year, 1.0 secondary care visits/year and 21% were hospitalised for COPD/year. Inhaled therapy was frequently inappropriate, with over-use of ICS in patients with mild-moderate COPD. COPD exacerbations were associated with high health resource use and occurred at all levels of disease severity. COPD management strategies should encompass risk-stratification for both exacerbation frequency and physiological impairment.
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Affiliation(s)
- Mike Thomas
- 1Department of Primary Care Research, University of Southampton , UK
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845
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Franciosi S, Shim Y, Lau M, Hayden MR, Leavitt BR. A systematic review and meta-analysis of clinical variables used in Huntington disease research. Mov Disord 2013; 28:1987-94. [PMID: 24142393 DOI: 10.1002/mds.25663] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 06/24/2013] [Accepted: 08/11/2013] [Indexed: 11/12/2022] Open
Abstract
Treatment effect in Huntington disease (HD) clinical trials has relied on primary outcome measures such as total motor score or functional rating scales. However, these measures have limited sensitivity, particularly in pre- to early stages of the disease. We performed a systematic review of HD clinical studies to identify endpoints that correlate with disease severity. Using standard HD keywords and terms, we identified 749 published studies from 1993 to 2011 based on the availability of demographic, biochemical, and clinical measures. The average and variability of each measure was abstracted and stratified according to pre-far, pre-close, early, mild, moderate, and severe HD stages. A fixed-effect meta-analysis on selected variables was conducted at various disease stages. A total of 1,801 different clinical variables and treatment outcomes were identified. Unified Huntington Disease Rating Scale (UHDRS) Motor, UHDRS Independence, and Trail B showed a trend toward separation between HD stages. Other measures, such as UHDRS Apathy, Verbal Fluency, and Symbol Digit, could only distinguish between pre- and early stages of disease and later stages, whereas other measures showed little correlation with increasing HD stages. Using cross-sectional data from published HD clinical trials, we have identified potential endpoints that could be used to track HD disease progression and treatment effect. Longitudinal studies, such as TRACK-HD, are critical for assessing the value of potential markers of disease progression for use in future HD therapeutic trials. A list of variables, references used in this meta-analysis, and database is available at http://www.cmmt.ubc.ca/research/investigators/leavitt/publications.
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Affiliation(s)
- Sonia Franciosi
- Center for Molecular Medicine and Therapeutics and Department of Medical Genetics, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
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846
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McNamara M, Antun A, Kempton CL. The role of disease severity in influencing body mass index in people with haemophilia: a single-institutional cross-sectional study. Haemophilia 2013; 20:190-5. [PMID: 24118577 DOI: 10.1111/hae.12279] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2013] [Indexed: 11/30/2022]
Abstract
The aim of this study was to evaluate the effect of haemophilia disease severity and potential intermediaries on body mass index (BMI) in patients with haemophilia. A secondary analysis of a cross-sectional study of 88 adults with haemophilia was undertaken. On bivariate analysis, persons with severe haemophilia had 9.8% lower BMI (95% CI -17.1, -3.0) than persons with non-severe haemophilia. The effect of haemophilia severity on BMI varied significantly by human immunodeficiency virus (HIV) status. Among HIV-positive subjects, haemophilia severity was not associated with BMI (+5.0%, 95% CI -22.4, 41.9). Among HIV-negative subjects, severe haemophilia was associated with 15.1% lower BMI (95% CI, -23.6, -5.7). Older (>41 years) HIV-negative subjects with severe haemophilia had a BMI that was 24.8% lower (95% CI -39.1, -7.0) than those with non-severe haemophilia. No statistically significant association was detected between BMI and severe vs. non-severe haemophilia for younger HIV-negative subjects. Although joint disease, as measured by the World Federation of Hemophilia (WFH) joint score, did not influence the association between haemophilia disease severity and BMI, adjustment for the atrophy component of the WFH score reduced the association between haemophilia severity and BMI by 39.1-69.9%. This suggested that muscle atrophy mediated at least part of the relationship between haemophilia severity and BMI. Haemophilia disease severity is associated with BMI and appears to be mediated by muscle atrophy of surrounding joints. This association appears to be modified by HIV status and possibly age.
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Affiliation(s)
- M McNamara
- Emory University School of Medicine, Atlanta, GA, USA
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847
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Abstract
INTRODUCTION In progressive conditions, such as Duchenne and Becker muscular dystrophy (DBMD), the need for care may outpace care use. We examined correlates that contribute to utilization of needed care. METHODS Structured interviews were conducted on use of care among 34 young men with DBMD who were born before 1982. RESULTS Disease severity, per capita income, and presence of other relatives with DBMD predicted greater use of services. Race/ethnicity, acculturation, and level of caregiver education did not significantly predict service utilization. CONCLUSIONS We identified disparities in receipt of healthcare and related services in adult men with DBMD that can affect quality of life. Despite the high disease severity identified in this population, these men utilized only half of the services available to individuals with significant progressive conditions. Providers should be aware of low service utilization and focus on awareness and assistance to ensure access to available care.
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Affiliation(s)
- Jennifer G Andrews
- Department of Pediatrics, University of Arizona, P.O. Box 245073, Tucson, Arizona, 85724-5073, USA
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848
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Bexelius C, Wachtmeister K, Skare P, Jönsson L, Vollenhoven RV. Drivers of cost and health-related quality of life in patients with systemic lupus erythematosus (SLE): a Swedish nationwide study based on patient reports. Lupus 2013; 22:793-801. [PMID: 23761101 DOI: 10.1177/0961203313491849] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of this paper is to investigate drivers of cost and health-related quality of life (HRQoL) related to disease activity and fatigue among patients with systemic lupus erythematous (SLE). A questionnaire was sent to members of a patient organization with a self-reported diagnosis of SLE, requesting information on demographics and disease characteristics, medications, resource utilization, informal care, loss of productivity, fatigue and HRQoL in relation to SLE. Mean annual costs per patient were estimated from a societal perspective. HRQoL was measured through EQ-5D and fatigue was measured through a 10 cm VAS scale. Patient-reported disease activity was measured through the Systemic Lupus Activity Questionnaire (SLAQ) and corticosteroid dose. Drivers of costs and HRQoL were analyzed through regression analysis. A total of 339 patients out of 737 returned the questionnaire. Mean age was 55; 94% were female. The mean HRQoL measured through the five-item EQ-5D instrument was 0.64 and total costs were estimated at €22,594 (direct costs €7818; indirect costs €14,776). Disease activity, fatigue and corticosteroid doses had a statistically significant impact on costs and HRQoL. This study demonstrates that Swedish patients with SLE have low HRQoL and incur high societal costs and that are both associated with and most likely driven by disease activity, fatigue and corticosteroid use.
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849
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Pettersson L, Thunberg T, Rocklöv J, Klingström J, Evander M, Ahlm C. Viral load and humoral immune response in association with disease severity in Puumala hantavirus-infected patients--implications for treatment. Clin Microbiol Infect 2013; 20:235-41. [PMID: 23742660 PMCID: PMC4286007 DOI: 10.1111/1469-0691.12259] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 04/10/2013] [Accepted: 04/25/2013] [Indexed: 01/11/2023]
Abstract
Hantaviruses are the causative agents of haemorrhagic fever with renal syndrome (HFRS) in Eurasia and of hantavirus cardiopulmonary syndrome (HCPS) in the Americas. The case fatality rate varies between different hantaviruses and can be up to 40%. At present, there is no specific treatment available. The hantavirus pathogenesis is not well understood, but most likely, both virus-mediated and host-mediated mechanisms are involved. The aim of the present study was to investigate the association among Puumala hantavirus (PUUV) viral RNA load, humoral immune response and disease severity in patients with HFRS. We performed a study of 105 PUUV-infected patients that were followed during the acute phase of disease and for up to 1–3 months later. Fifteen of the 105 patients (14%) were classified as having moderate/severe disease. A low PUUV-specific IgG response (p <0.05) and also a higher white blood cell count (p <0.001) were significantly associated with more severe disease. The PUUV RNA was detected in a majority of patient plasma samples up to 9 days after disease onset; however, PUUV RNA load or longevity of viraemia were not significantly associated with disease severity. We conclude that a low specific IgG response was associated with disease severity in patients with HFRS, whereas PUUV RNA load did not seem to affect the severity of HFRS. Our results raise the possibility of passive immunotherapy as a useful treatment for hantavirus-infected patients.
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Affiliation(s)
- L Pettersson
- Department of Clinical Microbiology, Virology, Umeå University, Umeå, Sweden
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850
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Ricart S, Marcos MA, Sarda M, Anton A, Muñoz-Almagro C, Pumarola T, Pons M, Garcia-Garcia JJ. Clinical risk factors are more relevant than respiratory viruses in predicting bronchiolitis severity. Pediatr Pulmonol 2013; 48:456-63. [PMID: 22949404 PMCID: PMC7167901 DOI: 10.1002/ppul.22633] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Accepted: 04/16/2012] [Indexed: 11/11/2022]
Abstract
BACKGROUND The role of respiratory viruses in the pathogenesis of bronchiolitis was re-evaluated with the use of molecular methods such as PCR for virus detection. Whether specific viruses or the classical clinical risk factors are more important in determining severe bronchiolitis is not well established. AIM To analyze the specific viruses and clinical variables that can predict severe bronchiolitis at admission. METHODS Nasopharyngeal aspirates were prospectively collected from 484 children <12 months admitted to the pediatrics ward or PICU at Universitary Hospital Sant Joan de Déu (Barcelona, Spain) for bronchiolitis from October 2007 to October 2008. Clinical and demographic data were collected. Sixteen respiratory viruses were studied using PCR. Severity was assessed with a bronchiolitis clinical score (BCS). RESULTS Four hundred ten infants that tested positive for respiratory viruses were analyzed. Mixed viral infections did not increase the severity of the disease. Rhinovirus was associated with severe BCS in univariate analysis (P = 0.041), but in the multivariate logistic regression including viruses and clinical data only bronchopulmonary dysplasia (OR 7.2; 95% CI 1.2-43.3), congenital heart disease (OR 4.7; 95% CI 1.1-19.9), prematurity (OR 2.6; 95% CI 1.3-5.1), and fever (OR 1.8, 95% CI 1.1-3.1) showed statistical significance for predicting severe BCS. CONCLUSIONS Classical clinical risk factors have more weight in predicting a severe BCS in infants with acute bronchiolitis than the involved viruses.
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Affiliation(s)
- Silvia Ricart
- Department of Pediatrics, Hospital Universitari Sant Joan de Déu, Barcelona, Spain.
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