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Pereira M, Tocino MLS, Mas-Fontao S, Manso P, Burgos M, Carneiro D, Ortiz A, Arenas MD, González-Parra E. Dependency and frailty in the older haemodialysis patient. BMC Geriatr 2024; 24:416. [PMID: 38730386 PMCID: PMC11088105 DOI: 10.1186/s12877-024-04973-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 04/12/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Frailty among older adults undergoing hemodialysis is increasingly prevalent, significantly impacting cognitive function, mobility, and social engagement. This study focuses on the clinical profiles of very older adults in hemodialysis, particularly examining the interplay of dependency and frailty, and their influence on dialysis regimens. METHODS In this observational, descriptive study, 107 patients aged over 75 from four outpatient centers and one hospital unit were examined over a year. Patient data encompassed sociodemographic factors, dialysis specifics, analytical outcomes, lifestyle elements, and self-reported post-treatment fatigue. Malnutrition-inflammation scale was used to measure the Nutritional status; MIS scale for malnutrition-inflammation, Barthel index for dependency, Charlson comorbidity index; FRIED scale for frailty and the SF12 quality of life measure. RESULTS The study unveiled that a substantial number of older adults on hemodialysis faced malnutrition (55%), dependency (21%), frailty (46%), and diminished quality of life (57%). Patients with dependency were distinctively marked by higher comorbidity, severe malnutrition, enhanced frailty, nursing home residency, dependency on ambulance transportation, and significantly limited mobility, with 77% unable to walk. Notably, 56% of participants experienced considerable post-dialysis fatigue, correlating with higher comorbidity, increased dependency, and poorer quality of life. Despite varying clinical conditions, dialysis patterns were consistent across the patient cohort. CONCLUSIONS The older adult cohort, averaging over four years on hemodialysis, exhibited high rates of comorbidity, frailty, and dependency, necessitating substantial support in transport and living arrangements. A third of these patients lacked residual urine output, yet their dialysis regimen mirrored those with preserved output. The study underscores the imperative for tailored therapeutic strategies to mitigate dependency, preserve residual renal function, and alleviate post-dialysis fatigue, ultimately enhancing the physical quality of life for these patients.
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Affiliation(s)
- M Pereira
- Fundación Renal Íñigo Álvarez de Toledo, Madrid, 28003, Spain
| | - M L Sanchez Tocino
- Fundación Renal Íñigo Álvarez de Toledo, Madrid, 28003, Spain
- Facultad de Enfermería, Universidad de Salamanca, Salamanca, Spain
| | - Sebastian Mas-Fontao
- Instituto de Investigación Sanitaria Fundación Jimenez Díaz, Madrid, 28040, Spain.
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain.
- Facultad de Medicina y Biomedicina, Universidad Alfonso X, Villanueva de la Cañada, Spain.
| | - P Manso
- Fundación Renal Íñigo Álvarez de Toledo, Madrid, 28003, Spain
| | - M Burgos
- Fundación Renal Íñigo Álvarez de Toledo, Madrid, 28003, Spain
| | - D Carneiro
- Fundación Renal Íñigo Álvarez de Toledo, Madrid, 28003, Spain
| | - A Ortiz
- Instituto de Investigación Sanitaria Fundación Jimenez Díaz, Madrid, 28040, Spain
- Servicio de Nefrología, Fundación Jiménez Díaz, Madrid, Spain
| | - M D Arenas
- Fundación Renal Íñigo Álvarez de Toledo, Madrid, 28003, Spain
| | - E González-Parra
- Fundación Renal Íñigo Álvarez de Toledo, Madrid, 28003, Spain.
- Instituto de Investigación Sanitaria Fundación Jimenez Díaz, Madrid, 28040, Spain.
- Servicio de Nefrología, Fundación Jiménez Díaz, Madrid, Spain.
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Rojas JI, Carnero Contentti E, Alonso R, Tavolini D, Burgos M, Federico B, Patrucco L, Cristiano E. Burden of treatment and quality of life in relapsing remitting multiple sclerosis patients under early high efficacy therapy in Argentina: Data from the Argentinean registry. Mult Scler Relat Disord 2024; 85:105543. [PMID: 38520948 DOI: 10.1016/j.msard.2024.105543] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 03/25/2024]
Abstract
The objective of this study was to describe and compare the burden of treatment (BOT) and the quality of life (QoL) in early high efficacy therapy (HET) vs. escalation therapy in relapsing remitting multiple sclerosis (RRMS) patients included in RelevarEM, the Argentinean registry of MS (RelevarEM, NCT 03,375,177). METHODS cross sectional study conducted between September and December 2022. Participating patients were adults, RRMS patients who initiated (during the last three years) their treatment with a HET (natalizumab, ocrelizumab, alemtuzumab, cladribine) or with escalation treatment (beta interferon, glatiramer acetate, teriflunomide, dimethyl fumarate or fingolimod). Clinical and demographic aspect were collected. QoL and BOT was measured with the validated to Spanish MusiQol and BOT questionnaire. Propensity score (PS)-based nearest-neighbor matching was applied to homogenize groups. Comparisons were be done using a linear regression analysis model stratified by matched pairs, with BOT and QoL assessments as main outcomes. RESULTS 269 patients were included in the analysis, mean age 33.7 ± 5.7 years, 193 (71.7 %) were female. A total of 136 patients were on early HET while 133 were on escalation therapy. In the entire group the mean total BOT score (±SD) was 48.5 ± 15.3 while in the group of patients receiving early HET we observed that the mean BOT score (±SD) was 43.5 ± 12.2 vs. 54.3 ± 13.3 in escalation treatment (p < 0.0001). Regarding the score QoL (±SD), in the entire sample we observed a global score of 77.4 ± 11.2. When we stratified groups, in HET (±SD) it was 81.3 ± 14 vs. 74.1 ± 18.3 in escalation therapy (p = 0.0003). CONCLUSION in this multicenter study that included 269 patients from Argentina we observed in early HET a significantly lower BOT and higher QoL than patients receiving escalation therapy.
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Affiliation(s)
- Juan I Rojas
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Billinghurst 1611, Buenos Aires CP 1181, Argentina.
| | - Edgar Carnero Contentti
- Unidad de Neuroinmunología, Servicio de Neurología, Hospital Alemán de Buenos Aires, Argentina
| | - Ricardo Alonso
- Hospital Ramos Mejía, Buenos Aires, Argentina; Fundación Sanatorio Güemes, Buenos Aires, Argentina
| | | | | | | | - Liliana Patrucco
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Billinghurst 1611, Buenos Aires CP 1181, Argentina
| | - Edgardo Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Billinghurst 1611, Buenos Aires CP 1181, Argentina
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Deri N, Barboza A, Vrech C, Rey R, Burgos M, Fiol M, CalvoVildoso C, Patrucco L, Jose G, Aliberti P, Chirico D, Federico MB, Seifer G, Piedrabuena R. Clinical characterization of long-term multiple sclerosis (COLuMbus) patients in Argentina: A cross-sectional non-interventional study. Mult Scler Relat Disord 2024; 83:105421. [PMID: 38244525 DOI: 10.1016/j.msard.2023.105421] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/19/2023] [Accepted: 12/30/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Most Multiple Sclerosis (MS) clinical trials fail to assess the long-term effects of disease-modifying therapies (DMT) or disability. METHODS COLuMbus was a single-visit, cross-sectional study in Argentina in adult patients with ≥10 years of MS since first diagnosis. The primary endpoint was to determine patient disability using the Expanded Disability Status Scale (EDSS). The secondary endpoints were to evaluate the distribution of diagnoses between relapsing-remitting MS (RRMS) and secondary progressive MS (SPMS), patient demographics, disease history, and the risk of disability progression. The relationship between baseline characteristics and the current disability state and the risk of disability progression was assessed. RESULTS Out of the 210 patients included, 76.7 % had a diagnosis of RRMS and 23.3 % had been diagnosed with SPMS, with a mean disease duration of 17.9 years and 20.5 years, respectively. The mean delay in the initial MS diagnosis was 2.6 years for the RRMS subgroup and 2.8 years for the SPMS subgroups. At the time of cut-off (28May2020), 90.1 % (RRMS) and 75.5 % (SPMS) of patients were receiving a DMT, with a mean of 1.5 and 2.0 prior DMTs, respectively. The median EDSS scores were 2.5 (RRMS) and 6.5 (SPMS). In the RRMS and SPMS subgroups, 23 % and 95.9 % of patients were at high risk of disability, respectively; the time since first diagnosis showed a significant correlation with the degree of disability. CONCLUSIONS This is the first local real-world study in patients with long-term MS that highlights the importance of recognizing early disease progression to treat the disease on time and delay disability.
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Affiliation(s)
- Norma Deri
- Centro de Investigaciones Diabaid, Autonomous City of Buenos Aires, Argentina
| | | | - Carlos Vrech
- Centro Integral de Diagnóstico por Imágenes Marchegiani, Córdoba, Argentina
| | - Roberto Rey
- Neurology Department, Instituto Argentino de Investigación Neurológica (IADIN), Buenos Aires, Argentina
| | | | - Marcela Fiol
- Department of Neurology, Institute for Neurological Research (FLENI) Buenos Aires, Argentina
| | | | - Liliana Patrucco
- Centro de Esclerosis Múltiple de Buenos Aires, Hospital Italiano de Buenos Aires, Argentina
| | - Gustavo Jose
- Centro Médico Privado de Reumatología, Tucumán, Argentina (currently known as Centro de Investigaciones Médicas Tucumán), Argentina
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Carnero Contentti E, López PA, Pappolla A, Alonso R, Silva B, Deri N, Balbuena ME, Burgos M, Luetic G, Alvez Pinheiro A, Cabrera M, Hryb J, Nofal P, Pestchanker C, Vrech C, Tavolini D, Tkachuk V, Zanga G, Marrodan M, Ysrraelit MC, Correale J, Carrá A, Federico B, Garcea O, Fernandez Liguori N, Patrucco L, Cristiano E, Giunta D, Alonso Serena M, Rojas JI. Incidence of SARS-CoV-2 infection in patients with multiple sclerosis who received SARS-CoV-2 vaccines and are under treatment with high-efficacy therapies in Argentina. Neurol Sci 2024; 45:379-389. [PMID: 38159147 DOI: 10.1007/s10072-023-07282-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Abstract
We aimed to evaluate the incidence of SARS-CoV-2 breakthrough infection of SARS-CoV-2 vaccines in people with MS (PwMS) on high-efficacy disease-modifying therapies (HET) included in the national MS registry in Argentina (RelevarEM). METHODS Non-interventional, retrospective cohort study that collected information directly from RelevarEM. Adult PwMS who had been treated for at least 6 months with a HET (ocrelizumab, natalizumab, alemtuzumab, cladribine) who had received at least two doses of SARS-CoV-2 vaccines available in Argentina were included. Full course of vaccination was considered after the second dose of the corresponding vaccines. Cumulative incidence of SARS-CoV-2 infection was reported for the whole cohort by Kaplan-Meier survival curves (which is expressed in percentage) as well as incidence density (which is expressed per 10.000 patients/day with 95% CI). RESULTS Two hundred twenty-eight PwMS were included. Most frequent first and second dose received was AstraZeneca vaccine, followed by Sputnik vaccine. Most frequent HETs used in included patients were cladribine in 79 (34.8%). We found an incidence density of breakthrough COVID-19 infection of 3.5 × 10.000 patients/day (95% CI 2.3-6.7) after vaccination in Argentina. We described the incidence rate after vaccination for every HET used, it being significantly higher for ocrelizumab compared with other HETs (p = 0.005). Only five patients presented a relapse during the follow-up period with no differences regarding the pre-vaccination period. CONCLUSIONS We found an incidence density of breakthrough COVID-19 infection of 3.5 × 10.000 patients/day (95% CI 2.3-6.7) after vaccination in Argentina.
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Affiliation(s)
- Edgar Carnero Contentti
- Department of Neurosciences, Neuroimmunology Unit, Hospital Aleman, Buenos Aires, Argentina.
| | - Pablo A López
- Department of Neurosciences, Neuroimmunology Unit, Hospital Aleman, Buenos Aires, Argentina
| | - Agustín Pappolla
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ricardo Alonso
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, Buenos Aires, Argentina
- Sanatorio Güemes, Buenos Aires, Argentina
| | - Berenice Silva
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, Buenos Aires, Argentina
| | - Norma Deri
- Centro de Investigaciones Diabaid, Buenos Aires, Argentina
- Hospital Fernandez, Buenos Aires, Argentina
| | - María E Balbuena
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Marcos Burgos
- Servicio de Neurología, Hospital San Bernardo, Salta, Argentina
| | - Geraldine Luetic
- Instituto de Neurociencias de Rosario, San Lorenzo, Rosario, Santa Fé, Argentina
| | | | | | - Javier Hryb
- Servicio de Neurología, Hospital Carlos G Durand, Buenos Aires, Argentina
| | - Pedro Nofal
- Hospital de Clínicas Nuestra Señora del Carmen, Tucumán, Argentina
| | - Claudia Pestchanker
- Neurology Department, Hospital Central Dr. Ramon Carrillo, San Luis, Argentina
| | - Carlos Vrech
- Departamento de Enfermedades Desmielinizantes, Sanatorio Allende, Córdoba, Argentina
| | | | - Verónica Tkachuk
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Gisela Zanga
- Departamento de Neurología, Hospital Cesar Milstein, Buenos Aires, Argentina
| | | | | | - Jorge Correale
- Departamento de Neurología, FLENI, Buenos Aires, Argentina
| | - Adriana Carrá
- Sección de Enfermedades Desmielinizantes, Hospital Británico, Buenos Aires, Argentina
- Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
| | | | - Orlando Garcea
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, Buenos Aires, Argentina
| | | | - Liliana Patrucco
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
| | - Edgardo Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
| | - Diego Giunta
- Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Marina Alonso Serena
- Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Juan I Rojas
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
- Servicio de Neurología, Unidad de EM y Enfermedades Desmielinizantes, Hospital Universitario de CEMIC, Buenos Aires, Argentina
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Wortham JM, Haddad MB, Stewart RJ, Annambhotla P, Basavaraju SV, Nabity SA, Griffin IS, McDonald E, Beshearse EM, Grossman MK, Schildknecht KR, Calvet HM, Keh CE, Percak JM, Coloma M, Shaw T, Davidson PJ, Smith SR, Dickson RP, Kaul DR, Gonzalez AR, Rai S, Rodriguez G, Morris S, Armitige LY, Stapleton J, Lacassagne M, Young LR, Ariail K, Behm H, Jordan HT, Spencer M, Nilsen DM, Denison BM, Burgos M, Leonard JM, Cortes E, Thacker TC, Lehman KA, Langer AJ, Cowan LS, Starks AM, LoBue PA. Second Nationwide Tuberculosis Outbreak Caused by Bone Allografts Containing Live Cells - United States, 2023. MMWR Morb Mortal Wkly Rep 2024; 72:1385-1389. [PMID: 38175804 DOI: 10.15585/mmwr.mm725253a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
During July 7-11, 2023, CDC received reports of two patients in different states with a tuberculosis (TB) diagnosis following spinal surgical procedures that used bone allografts containing live cells from the same deceased donor. An outbreak associated with a similar product manufactured by the same tissue establishment (i.e., manufacturer) occurred in 2021. Because of concern that these cases represented a second outbreak, CDC and the Food and Drug Administration worked with the tissue establishment to determine that this product was obtained from a donor different from the one implicated in the 2021 outbreak and learned that the bone allograft product was distributed to 13 health care facilities in seven states. Notifications to all seven states occurred on July 12. As of December 20, 2023, five of 36 surgical bone allograft recipients received laboratory-confirmed TB disease diagnoses; two patients died of TB. Whole-genome sequencing demonstrated close genetic relatedness between positive Mycobacterium tuberculosis cultures from surgical recipients and unused product. Although the bone product had tested negative by nucleic acid amplification testing before distribution, M. tuberculosis culture of unused product was not performed until after the outbreak was recognized. The public health response prevented up to 53 additional surgical procedures using allografts from that donor; additional measures to protect patients from tissue-transmitted M. tuberculosis are urgently needed.
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Alonso R, Casas M, Lazaro L, Liguori NF, Pita C, Cohen L, Rojas JI, Pappolla A, Patrucco L, Cristiano E, Burgos M, Vrech C, Piedrabuena R, Pablo L, Deri N, Luetic G, Miguez J, Cabrera M, Martinez A, Zanga G, Tkachuk V, Tizio S, Carnero Contentti E, Knorre E, Leguizamon F, Mainella C, Nofal P, Liwacki S, Hryb J, Menichini M, Pestchanker C, Garcea O, Silva B. Evaluation of the use of high-efficacy treatments (HETs) in patients with relapsing-remitting multiple sclerosis in Argentina. Mult Scler Relat Disord 2023; 79:104935. [PMID: 37634468 DOI: 10.1016/j.msard.2023.104935] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/02/2023] [Accepted: 08/08/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Disease-modifying therapies (DMTs) in multiple sclerosis (MS) can be classified according to the efficacy in which they prevent inflammatory activity. To date, there are limited data regarding the use of high-efficacy treatments (HETs) in Latin America (LATAM). We aimed to analyze the use of HETs in Argentina, focusing on the clinical and sociodemographic characteristics of the patients who use these treatments and the changes in the trend of use over the years. METHODS A retrospective cohort study was done using the Argentina MS patient registry, RelevarEM. Patients diagnosed with relapsing-remitting MS (RRMS) according to validated diagnostic criteria and under treatment with natalizumab, alemtuzumab, cladribine, rituximab or ocrelizumab were included. RESULTS Out of 2450 RRMS patients under a DMT, 462 (19%) were on HETs. One third of those patients (35%) received HETs as the first treatment. The most frequent reason for switching to HETs was treatment failure to previous DMT (77%). The time from MS diagnosis to the first HET in treatment-naive patients was less than one year (IQR: 0-1 year) and in treatment-experienced patients it was 5 years (IQR: 3-9 years). Between 2015 and 2017 (P1), 729 patients included in RelevarEM started a new treatment, of which 85 (11.65%) were HETs. Between 2018 and 2020 (P2), 961 patients included in RelevarEM started a new treatment, of which 284 (29.55%) were HETs. When comparing P2 with P1, a significant increase in the use of HETs was observed (p < 0.01). The most frequently used HETs were alemtuzumab (50.59%) in P1, and cladribine (45.20%) in P2. CONCLUSION The demographic and clinical characteristics of patients under HET in Argentina were identified. Based on a real-world setting, we found a significant trend towards and a rapid increase in the use of HETs in clinical practice in patients with RRMS.
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Affiliation(s)
- Ricardo Alonso
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Ciudad de Buenos Aires, Argentina; Servicio de Neurología, Sanatorio Güemes, Ciudad de Buenos Aires, Argentina
| | - Magdalena Casas
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Ciudad de Buenos Aires, Argentina
| | - Luciana Lazaro
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Ciudad de Buenos Aires, Argentina
| | - Nora Fernandez Liguori
- Servicio de Neurología, Sanatorio Güemes, Ciudad de Buenos Aires, Argentina; Servicio de Neurología, Hospital Tornú, Ciudad de Buenos Aires, Argentina
| | - Cecilia Pita
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Ciudad de Buenos Aires, Argentina
| | - Leila Cohen
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Ciudad de Buenos Aires, Argentina
| | - Juan Ignacio Rojas
- Centro de esclerosis Múltiple Buenos Aires, Ciudad de Buenos Aires, Argentina; Servicio de Neurología, CEMIC, Ciudad de Buenos Aires, Argentina
| | - Agustín Pappolla
- Centro de esclerosis Múltiple Buenos Aires, Ciudad de Buenos Aires, Argentina
| | - Liliana Patrucco
- Centro de esclerosis Múltiple Buenos Aires, Ciudad de Buenos Aires, Argentina
| | - Edgardo Cristiano
- Centro de esclerosis Múltiple Buenos Aires, Ciudad de Buenos Aires, Argentina
| | - Marcos Burgos
- Servicio de Neurología, Hospital San Bernardo, Salta, Argentina
| | - Carlos Vrech
- Servicio de Neurología, Sanatorio Allende, Córdoba, Spain
| | - Raul Piedrabuena
- Servicio de Neurología, Clínica Universitaria Reina Fabiola, Córdoba, Spain
| | - Lopez Pablo
- Sección de Neuroinmunología, Hospital Alemán, Ciudad de Buenos Aires, Argentina
| | | | | | - Jimena Miguez
- Servicio de neurología, Hospital Italiano, Argentina
| | - Mariela Cabrera
- Servicio de neurología, Hospital Militar, Campo de Mayo, Argentina
| | - Alejandra Martinez
- Servicio de neurología, Hospital Posadas, Ciudad de Buenos Aires, Argentina
| | - Gisela Zanga
- Servicio de neurología, Hospital Cesar Milstein, Ciudad de Buenos Aires, Argentina
| | - Verónica Tkachuk
- Servicio de neurología, Hospital de Clínica José de San Martín, Ciudad de Buenos Aires, Argentina
| | - Santiago Tizio
- Servicio de neurología, Hospital Español, La Plata, Argentina
| | | | - Eduardo Knorre
- Servicio de neurología, Hospital Álvarez, Ciudad de Buenos Aires, Argentina
| | - Felisa Leguizamon
- Servicio de neurología, Hospital Álvarez, Ciudad de Buenos Aires, Argentina
| | | | - Pedro Nofal
- Servicio de neurología, Hospital Nuestra Señora del Carmen, Tucumán, Argentina
| | - Susana Liwacki
- Servicio de neurología, Hospital Córdoba, Córdoba, Spain
| | - Javier Hryb
- Servicio de neurología, Hospital Durand, Ciudad de Buenos Aires, Argentina
| | | | | | - Orlando Garcea
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Ciudad de Buenos Aires, Argentina
| | - Berenice Silva
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Ciudad de Buenos Aires, Argentina; Servicio de neurología, Hospital Italiano, Argentina.
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Haley CA, Schechter MC, Ashkin D, Peloquin CA, Peter Cegielski J, Andrino BB, Burgos M, Caloia LA, Chen L, Colon-Semidey A, DeSilva MB, Dhanireddy S, Dorman SE, Dworkin FF, Hammond-Epstein H, Easton AV, Gaensbauer JT, Ghassemieh B, Gomez ME, Horne D, Jasuja S, Jones BA, Kaplan LJ, Khan AE, Kracen E, Labuda S, Landers KM, Lardizabal AA, Lasley MT, Letzer DM, Lopes VK, Lubelchek RJ, Patricia Macias C, Mihalyov A, Misch EA, Murray JA, Narita M, Nilsen DM, Ninneman MJ, Ogawa L, Oladele A, Overman M, Ray SM, Ritger KA, Rowlinson MC, Sabuwala N, Schiller TM, Schwartz LE, Spitters C, Thomson DB, Tresgallo RR, Valois P, Goswami ND. Implementation of Bedaquiline, Pretomanid, and Linezolid in the United States: Experience Using a Novel All-Oral Treatment Regimen for Treatment of Rifampin-Resistant or Rifampin-Intolerant Tuberculosis Disease. Clin Infect Dis 2023; 77:1053-1062. [PMID: 37249079 PMCID: PMC11001496 DOI: 10.1093/cid/ciad312] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/20/2023] [Accepted: 05/27/2023] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Rifampin-resistant tuberculosis is a leading cause of morbidity worldwide; only one-third of persons start treatment, and outcomes are often inadequate. Several trials demonstrate 90% efficacy using an all-oral, 6-month regimen of bedaquiline, pretomanid, and linezolid (BPaL), but significant toxicity occurred using 1200-mg linezolid. After US Food and Drug Administration approval in 2019, some US clinicians rapidly implemented BPaL using an initial 600-mg linezolid dose adjusted by serum drug concentrations and clinical monitoring. METHODS Data from US patients treated with BPaL between 14 October 2019 and 30 April 2022 were compiled and analyzed by the BPaL Implementation Group (BIG), including baseline examination and laboratory, electrocardiographic, and clinical monitoring throughout treatment and follow-up. Linezolid dosing and clinical management was provider driven, and most patients had linezolid adjusted by therapeutic drug monitoring. RESULTS Of 70 patients starting BPaL, 2 changed to rifampin-based therapy, 68 (97.1%) completed BPaL, and 2 of the 68 (2.9%) experienced relapse after completion. Using an initial 600-mg linezolid dose daily adjusted by therapeutic drug monitoring and careful clinical and laboratory monitoring for adverse effects, supportive care, and expert consultation throughout BPaL treatment, 3 patients (4.4%) with hematologic toxicity and 4 (5.9%) with neurotoxicity required a change in linezolid dose or frequency. The median BPaL duration was 6 months. CONCLUSIONS BPaL has transformed treatment for rifampin-resistant or intolerant tuberculosis. In this cohort, effective treatment required less than half the duration recommended in 2019 US guidelines for drug-resistant tuberculosis. Use of individualized linezolid dosing and monitoring likely enhanced safety and treatment completion. The BIG cohort demonstrates that early implementation of new tuberculosis treatments in the United States is feasible.
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Affiliation(s)
- Connie A Haley
- Southeastern National Tuberculosis Center, Division of Infectious Diseases and Global Medicine, Department of Medicine in the College of Medicine, University of Florida, Gainesville, Florida, USA
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Marcos C Schechter
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Georgia State Tuberculosis Program, Atlanta, Georgia, USA
| | - David Ashkin
- Southeastern National Tuberculosis Center, Division of Infectious Diseases and Global Medicine, Department of Medicine in the College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Charles A Peloquin
- Translational Research, College of Pharmacy and Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
| | - J Peter Cegielski
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | | | - Marcos Burgos
- New Mexico Department of Health, Santa Fe, New Mexico, USA
- University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
- New Mexico Veterans Affairs Health Care System, Albuquerque, New Mexico, USA
| | - Lori A Caloia
- Louisville Metro Department of Public Health and Wellness, Louisville, Kentucky, USA
- Humana Healthy Horizons in Kentucky, Louisville, Kentucky, USA
| | - Lisa Chen
- Curry International Tuberculosis Center, University of California, San Francisco, California, USA
| | | | - Malini B DeSilva
- Saint Paul–Ramsey County Public Health, Saint Paul, Minnesota, USA
- HealthPartners Institute, Bloomington, Minnesota, USA
| | - Shireesha Dhanireddy
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Susan E Dorman
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
- South Carolina Department of Health and Environmental Control, Greenville, South Carolina, USA
| | - Felicia F Dworkin
- New York City Department of Health and Mental Hygiene, Bureau of Tuberculosis Control, New York, New York, USA
| | - Heidi Hammond-Epstein
- Southeastern National Tuberculosis Center, University of Florida, Gainesville, Florida, USA
| | - Alice V Easton
- New York City Department of Health and Mental Hygiene, Bureau of Tuberculosis Control, New York, New York, USA
| | - James T Gaensbauer
- Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Bijan Ghassemieh
- Public Health—Seattle & King County, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Maria E Gomez
- Southeastern National Tuberculosis Center, University of Florida, Gainesville, Florida, USA
| | - David Horne
- Pulmonary, Critical Care and Sleep Medicine, Harborview Medical Center, University of Washington, Seattle, Washington, USA
| | - Supriya Jasuja
- Cook County Department of Public Health, Forest Park, Illinois, USA
| | - Betsy A Jones
- Bureau of Public Health Laboratories, Florida State Tuberculosis Program, Jacksonville, Florida, USA
| | - Leonard J Kaplan
- Division of Infectious Diseases, Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois, USA
| | | | - Elizabeth Kracen
- Public Health—Seattle & King County, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Sarah Labuda
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Puerto Rico Department of Health, San Juan, Puerto Rico, USA
| | - Karen M Landers
- Alabama Department of Public Health, Montgomery, Alabama, USA
| | | | - Maria T Lasley
- Southeastern National Tuberculosis Center, University of Florida, Gainesville, Florida, USA
| | | | - Vinicius K Lopes
- Sheboygan County Health and Human Services, Sheboygan, Wisconsin, USA
- Southern California Infectious Diseases Associates, Inc., Newport Beach, California, USA
| | - Ronald J Lubelchek
- Cook County Department of Public Health, Forest Park, Illinois, USA
- Division of Infectious Diseases, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois, USA
- Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - C Patricia Macias
- Health Transformation Program NorthShore University, Chicago, Illinois, USA
- The International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Aimee Mihalyov
- Louisville Metro Department of Public Health and Wellness, Louisville, Kentucky, USA
| | - Elizabeth Ann Misch
- Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jason A Murray
- Emergency Medicine, Saint Elizabeth Healthcare System, Edgewood, Kentucky, USA
- Northern Kentucky Health Department, Florence, Kentucky, USA
| | - Masahiro Narita
- Public Health—Seattle & King County, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Diana M Nilsen
- New York City Department of Health and Mental Hygiene, Bureau of Tuberculosis Control, New York, New York, USA
| | | | - Lynne Ogawa
- Saint Paul–Ramsey County Public Health, Saint Paul, Minnesota, USA
| | | | - Melissa Overman
- South Carolina Department of Health and Environmental Control, Greenville, South Carolina, USA
| | - Susan M Ray
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Georgia State Tuberculosis Program, Atlanta, Georgia, USA
| | | | - Marie-Claire Rowlinson
- Bureau of Public Health Laboratories, Florida State Tuberculosis Program, Jacksonville, Florida, USA
- Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Nadya Sabuwala
- Minnesota Department of Health, Saint Paul, Minnesota, USA
| | | | | | - Christopher Spitters
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Snohomish County Health Department, Everett, Washington, USA
- Washington State Department of Health, Shoreline, Washington, USA
| | - Douglas B Thomson
- Barren River District Health Department, Bowling Green, Kentucky, USA
| | - Rene Rico Tresgallo
- Department of Medicine, University of Miami, Jackson Memorial Hospital, Miami, Florida, USA
| | - Patrick Valois
- Bureau of Public Health Laboratories, Florida State Tuberculosis Program, Jacksonville, Florida, USA
| | - Neela D Goswami
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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8
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Huaroto L, Huaman MA, Mugruza R, Ticona C, Rondan PL, Burgos M, Ticona E. Active case-finding of pulmonary TB in an urban emergency department. Int J Tuberc Lung Dis 2023; 27:202-208. [PMID: 36855035 DOI: 10.5588/ijtld.22.0458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND: The WHO recommends systematic screening of TB in high TB prevalence settings. We evaluated an active case-finding strategy using sputum screening regardless of symptoms in a high TB prevalence Emergency Department (ED) in Peru.METHODS: This was a cross-sectional study conducted at the Hospital Nacional Dos de Mayo ED, which serves low-income populations in downtown Lima, Peru. Adults presenting to the ED for any reason and able to provide sputum were enrolled. Participants provided one sputum specimen for acid-fast bacilli smear and culture. A second sputum specimen for Xpert® MTB/RIF testing was collected if the patient was admitted to an ED observation unit.RESULTS: Between September 2017 and March 2018, 5,171 individuals who presented to the ED were approached. Of 2,119 individuals able to provide sputum, 78 (3.7%) participants had a positive culture and/or Xpert result and were newly diagnosed with TB, whereas traditional screening using >2-week cough identified 41 (1.9%) cases (3.7% vs. 1.9%; P < 0.001). Twelve TB cases (15.4%) reported no TB symptoms of any duration.CONCLUSION: ED-based active case-finding of pulmonary TB using symptom-neutral sputum screening increased TB identification compared to traditional symptom-based screening. Our results align with current WHO recommendation of systematic screening in high TB prevalence areas, which may include ED settings.
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Affiliation(s)
- L Huaroto
- Hospital Nacional Dos de Mayo, Lima, Peru, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - M A Huaman
- Department of Internal Medicine, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - R Mugruza
- Hospital Nacional Dos de Mayo, Lima, Peru
| | - C Ticona
- Hospital Nacional Dos de Mayo, Lima, Peru, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - P L Rondan
- Hospital Nacional Dos de Mayo, Lima, Peru, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - M Burgos
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA, Medicine Service, Infectious Disease Section, Albuquerque VA Medical Center, Albuquerque, NM, USA
| | - E Ticona
- Hospital Nacional Dos de Mayo, Lima, Peru, Universidad Nacional Mayor de San Marcos, Lima, Peru
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9
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Alonso R, Casas M, Lazaro L, Fernandez Liguori N, Pita C, Cohen L, Rojas JI, Pappolla A, Patrucco L, Cristiano E, Burgos M, Vrech C, Piedrabuena R, Pablo L, Deri N, Luetic G, Miguez J, Cabrera M, Martinez A, Zanga G, Tkachuk V, Tizio S, Carnero Contentti E, Knorre E, Leguizamon F, Mainella C, Nofal P, Liwacki S, Hryb J, Menichini M, Pestchanker C, Alonso M, Garcea O, Silva B. Achieving no evidence of disease activity-3 in highly active multiple sclerosis patients treated with cladribine and monoclonal antibodies. Mult Scler J Exp Transl Clin 2023; 9:20552173231154712. [PMID: 36846108 PMCID: PMC9950613 DOI: 10.1177/20552173231154712] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/01/2023] [Indexed: 02/24/2023] Open
Abstract
Background We aimed to determine the proportion of highly active multiple sclerosis patients under high-efficacy therapies (HETs) achieve no evidence of disease activity-3 (NEDA-3) at 1 and 2 years, and to identify factors associated with failing to meet no evidence of disease activity 3 at 2 years. Methods This retrospective cohort study based on Argentina Multiple Sclerosis patient registry (RelevarEM), includes highly active multiple sclerosis patients who received HETs. Results In total, 254 (78.51%) achieved NEDA-3 at year 1 and 220 (68.12%) achieved NEDA-3 at year 2. Patients who achieved NEDA-3 at 2 years had a shorter duration of multiple sclerosis (p < 0.01) and a shorter time between first treatment and current treatment (p = 0.01). Early high-efficacy strategy patients reached NEDA-3 more frequently (p < 0.01). Being a naïve patient (odds ratio: 3.78, 95% confidence interval 1.50-9.86, p < 0.01) was an independent predictor to reach NEDA-3 at 2 years. No association was found between type of HETs and NEDA-3 at 2 years when adjusted for potential confounders (odds ratio: 1.73; 95% confidence interval 0.51-6.06, p 0.57). Conclusion We found a high proportion of patients who achieved NEDA-3 at 1 and 2 years. Early high-efficacy strategy patients had a higher probability of achieving NEDA-3 at 2 years.
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Affiliation(s)
- Ricardo Alonso
- Ricardo Alonso, Centro Universitario
Esclerosis Múltiple CUEM, Hospital Ramos Mejía, Urquiza 609, CP (1221) Ciudad de
Buenos Aires, Argentina; Facultad de Medicina, Universidad de Buenos Aires,
Ciudad de Buenos Aires, Argentina.
| | | | - Luciana Lazaro
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos
Mejía, Buenos Aires, Argentina
| | - Nora Fernandez Liguori
- Servicio de Neurología, Sanatorio Güemes, Buenos Aires, Argentina,Servicio de Neurología, Hospital Tornú, Buenos
Aires, Argentina
| | | | - Leila Cohen
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos
Mejía, Buenos Aires, Argentina
| | - Juan Ignacio Rojas
- Centro de esclerosis Múltiple Buenos Aires,
Buenos Aires, Argentina,Servicio de Neurología, CEMIC, Buenos Aires,
Argentina
| | | | | | | | - Marcos Burgos
- Servicio de Neurología, Hospital San Bernardo,
Salta, Argentina
| | - Carlos Vrech
- Servicio de Neurología, Sanatorio Allende,
Córdoba, Spain
| | - Raul Piedrabuena
- Servicio de Neurología, Clínica Universitaria
Reina Fabiola, Córdoba, Spain
| | - Lopez Pablo
- Sección de nueroinmunología, Hospital Alemán,
Buenos Aires, Argentina
| | | | | | - Jimena Miguez
- Servicio de neurología, Hospital Italiano,
Buenos Aires, Argentina
| | - Mariela Cabrera
- Servicio de neurología, Hospital Militar,
Campo de Mayo, Buenos Aires, Argentina
| | | | - Gisela Zanga
- Servicio de neurología, Hospital Cesar
Milstein, Buenos Aires, Argentina
| | - Verónica Tkachuk
- Servicio de neurología, Hospital de Clínica José de San
Martín, Buenos Aires, Argentina
| | - Santiago Tizio
- Servicio de neurología, Hospital Español, La Plata, Argentina
| | | | | | | | | | - Pedro Nofal
- Servicio de neurología, Hospital Nuestra
Señora del Carmen, Tucumán, Argentina
| | - Susana Liwacki
- Servicio de neurología, Hospital Córdoba,
Córdoba, Spain
| | - Javier Hryb
- Servicio de neurología, Hospital Durand,
Buenos Aires, Argentina
| | | | | | | | - Orlando Garcea
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos
Mejía, Buenos Aires, Argentina
| | - Berenice Silva
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos
Mejía, Buenos Aires, Argentina,Servicio de neurología, Hospital Italiano,
Buenos Aires, Argentina
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Rojas JI, Pappolla A, Patrucco L, Cristiano E, Miguez J, Liwacki S, Tkachuk V, Balbuena ME, Vrech C, Deri N, Correale J, Marrodan M, Ysrraelit MC, Fiol M, Leguizamon F, Luetic G, Menichini ML, Lopez PA, Pettinicchi JP, Criniti J, Caride A, Tavolini D, Mainella C, Zanga G, Burgos M, Hryb J, Barboza A, Lazaro L, Alonso R, Silva B, Fernández Liguori N, Nadur D, Chercoff A, Martinez A, Steinberg J, Garcea O, Carrá A, Alonso Serena M, Carnero Contentti E. Disability outcomes in NMOSD and MOGAD patients: data from a nationwide registry in Argentina. Neurol Sci 2023; 44:281-286. [PMID: 36166174 DOI: 10.1007/s10072-022-06409-w] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 09/13/2022] [Indexed: 01/10/2023]
Abstract
The objective was to evaluate time to reach an EDSS of 4, 6, and 7 in NMOSD and MOGAD patients included in the Argentinean MS and NMOSD registry (RelevarEM, NCT 03,375,177). METHODS NMOSD patients diagnosed according to 2015 criteria and with MOGAD were identified. Patients with at least 3 years of follow-up and periodic clinical evaluations with EDSS outcomes were included. AQP4-antibody and MOG-antibody status was recorded, and patients were stratified as seropositive and seronegative for AQP4-antibody. EDSS of 4, 6, and 7 were defined as dependent variables. Log rank test was used to identify differences between groups. RESULTS Registry data was provided for a total of 137 patients. Of these, seventy-five presented AQP4-ab-positive NMOSD, 45 AQP4-ab-negative NMOSD, and 11 MOGAD. AQP4-ab status was determined by cell-based assay (CBA) in 72% of NMOSD patients. MOG-ab status was tested by CBA in all cases. Mean time to EDSS of 4 was 53.6 ± 24.5 vs. 63.1 ± 32.2 vs. 44.7 ± 32 months in seropositive, seronegative NMOSD, and MOGAD, respectively (p = 0.76). Mean time to EDSS of 6 was 79.2 ± 44.3 vs. 75.7 ± 48.6 vs. 54.7 ± 50 months in seropositive, seronegative NMOSD, and MOGAD (p = 0.23), while mean time to EDSS of 7 was 86.8 ± 54 vs. 80.4 ± 51 vs. 58.5 ± 47 months in seropositive, seronegative NMOSD, and MOGAD (p = 0.39). CONCLUSION No differences were observed between NMOSD (seropositive and seronegative) and MOGAD in survival curves.
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Affiliation(s)
- Juan I Rojas
- Centro de Esclerosis Múltiple de Buenos Aires, CABA, Argentina. .,Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Buenos Aires, Argentina. .,Centro de Esclerosis Múltiple de Buenos Aires, (CEMBA), Billinghurst 1611, CP 1181, Buenos Aires, Argentina.
| | - Agustín Pappolla
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Jimena Miguez
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Susana Liwacki
- Clínica Universitaria Reina Fabiola, Cordoba, Argentina.,Servicio de Neurología - Hospital Córdoba, Cordoba, Argentina
| | - Verónica Tkachuk
- Sección de Neuroinmunología Y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA, Argentina
| | - María E Balbuena
- Sección de Neuroinmunología Y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA, Argentina
| | - Carlos Vrech
- Departamento de Enfermedades Desmielinizantes - Sanatorio Allende, Cordoba, Argentina
| | - Norma Deri
- Centro de Investigaciones Diabaid, CABA, Argentina
| | | | | | | | - Marcela Fiol
- Departamento de Neurología - FLENI, CABA, Argentina
| | | | | | | | - Pablo A Lopez
- Neuroimmunology Unit, Department of Neurosciences, Hospital Alemán, Buenos Aires, Argentina
| | - Juan Pablo Pettinicchi
- Neuroimmunology Unit, Department of Neurosciences, Hospital Alemán, Buenos Aires, Argentina
| | - Juan Criniti
- Neuroimmunology Unit, Department of Neurosciences, Hospital Alemán, Buenos Aires, Argentina
| | - Alejandro Caride
- Neuroimmunology Unit, Department of Neurosciences, Hospital Alemán, Buenos Aires, Argentina
| | | | | | - Gisela Zanga
- Unidad Asistencial César Milstein, CABA, Argentina
| | - Marcos Burgos
- Servicio de Neurología - Hospital San Bernardo, Salta, Argentina
| | - Javier Hryb
- Servicio de Neurología - Hospital Carlos G. Durand, CABA, Argentina
| | | | | | - Ricardo Alonso
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Buenos Aires, Argentina.,Sanatorio Güemes, CABA, Argentina
| | - Berenice Silva
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Buenos Aires, Argentina
| | | | - Débora Nadur
- Sección de Neuroinmunología Y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA, Argentina.,Hospital Naval, CABA, Argentina
| | - Aníbal Chercoff
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA, Argentina
| | - Alejandra Martinez
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA, Argentina
| | - Judith Steinberg
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA, Argentina
| | - Orlando Garcea
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Buenos Aires, Argentina
| | - Adriana Carrá
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA, Argentina
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11
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Rojas JI, Luetic GG, Vrech C, Pappolla A, Patrucco L, Cristiano E, Marrodan M, Ysrraelit MC, Fiol M, Correale J, Cohen L, Alonso R, Silva B, Casas M, Garcea O, Deri N, Burgos M, Liwacki S, Tkachuk V, Barboza A, Piedrabuena R, Blaya P, Steinberg J, Martínez A, Carra A, Tavolini D, López P, Knorre E, Nofal P, Carnero Contentti E, Alves Pinheiro A, Leguizamon F, Silva E, Hryb J, Balbuena ME, Zanga G, Kohler M, Lazaro L, Tizio S, Mainella C, Blanche J, Parada Marcilla M, Fracaro ME, Menichini ML, Sgrilli G, Divi P, Jacobo M, Cabrera M, Míguez J, Fernandez Liguori N, Viglione JP, Nadur D, Alonso Serena M, Nuñez S. Incidence of COVID-19 after vaccination in people with multiple sclerosis in Argentina: Data from the nationwide registry RelevarEM. Mult Scler Relat Disord 2022; 68:104104. [PMID: 36057175 PMCID: PMC9371771 DOI: 10.1016/j.msard.2022.104104] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/16/2022] [Accepted: 08/10/2022] [Indexed: 12/15/2022]
Abstract
The objective of the study was to evaluate the incidence of COVID-19 after complete vaccination in people with multiple sclerosis (PwMS) included in the Argentinean MS and NMOSD registry (RelevarEM, NCT03375177). METHODS cohort study conducted between May 2021 and December 2021. The primary outcome was the appearance of infection during the follow-up time (at least three months after complete vaccination (second dose)). Data was collected through the contact between the treating physician and the patient. Specific information was requested (date, symptoms, need for hospitalization, ventilatory assistance, treatment, and evolution). The contact was made every 30 days during the period of 3 months after the full dose vaccination. A positive COVID-19 case was defined according to the definition established by the Ministry of Health in Argentina. Cumulative incidence was reported by Kaplan Meier survival curves as well as incidence density. RESULTS A total of 576 PwMS were included, mean age 45.2 ± 13 years, 432 (75%) RRMS, 403 (70%) were female. The mean and median time of follow-up after the second dose was 91 ± 17 and 94 ± 21 days respectively. Most frequent first and second dose received was Astra-Zeneca vaccine, followed by Sputnik V vaccine. During follow-up a total of twenty COVID-19 cases were observed for a total exposure time of 39,557 days. The overall cumulative incidence for the observed period was 3.4% (SE 0.4%) with an overall incidence density of 5 × 10.000 patients/day (95%CI 0.7-12). We observed more cases in woman than men with an incidence density of 6 × 10.000 patients/day (95%CI 0.9-9) vs. 3 × 10.000 patients/day (95%CI 0.2-6) respectively, but not significantly different (IRR 1.7 95% CI 0.56-7.37 p = 0.15). CONCLUSION we found an incidence density of breakthrough COVID-19 infection of 5 × 10.000 patients/day (95%CI 0.7-12) after vaccination in Argentina.
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Affiliation(s)
- Juan I. Rojas
- Centro de esclerosis múltiple de Buenos Aires, Billinghurst 1611, Buenos Aires CP 1181, Argentina,Servicio de Neurología, Unidad de EM y Enfermedades Desmielinizantes, Hospital Universitario de CEMIC, Buenos Aires, Argentina,Corresponding author
| | - Geraldine G. Luetic
- Instituto de Neurociencias de Rosario, San Lorenzo, Rosario, Santa Fé, Argentina
| | - Carlos Vrech
- Departamento de Enfermedades desmielinizantes, Sanatorio Allende, Córdoba, Argentina
| | - Agustín Pappolla
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina,Departamento de Neurología, FLENI, CABA, Argentina
| | - Liliana Patrucco
- Centro de esclerosis múltiple de Buenos Aires, Billinghurst 1611, Buenos Aires CP 1181, Argentina
| | - Edgardo Cristiano
- Centro de esclerosis múltiple de Buenos Aires, Billinghurst 1611, Buenos Aires CP 1181, Argentina
| | - Mariano Marrodan
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, CABA, Argentina
| | - María C. Ysrraelit
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, CABA, Argentina
| | - Marcela Fiol
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, CABA, Argentina
| | - Jorge Correale
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, CABA, Argentina
| | | | - Ricardo Alonso
- Sanatorio Güemes, CABA, Argentina,Centro de Investigaciones Diabaid, CABA, Argentina
| | - Berenice Silva
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, CABA, Argentina
| | - Magdalena Casas
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, CABA, Argentina
| | - Orlando Garcea
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, CABA, Argentina
| | - Norma Deri
- Centro de Investigaciones Diabaid, CABA, Argentina
| | - Marcos Burgos
- Servicio de Neurología, Hospital San Bernardo, Salta, Argentina
| | | | - Verónica Tkachuk
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, CABA, Argentina
| | | | - Raúl Piedrabuena
- Clínica Universitaria Reina Fabiola, Cordoba, Argentina,Instituto Lennox, Cordoba, Argentina
| | | | | | - Alejandra Martínez
- Sección de Enfermedades Desmielinizantes, Hospital Británico, CABA, Argentina
| | - Adriana Carra
- Sección de Enfermedades Desmielinizantes, Hospital Británico, CABA, Argentina,Hospital Universitario Fundación on Favaloro, Buenos Aires, Argentina
| | | | - Pablo López
- Department of Neurosciences, Neuroimmunology Unit, Hospital Aleman, Buenos Aires, Argentina
| | - Eduardo Knorre
- Hospital de Agudos, Dr. Teodoro Álvarez, CABA, Argentina
| | - Pedro Nofal
- Hospital de Clínicas Nuestra Señora ˜ del Carmen, Tucumán, Argentina
| | | | | | | | | | - Javier Hryb
- Servicio de Neurología, Hospital Carlos G Durand, Buenos Aires, Argentina
| | - María Eugenia Balbuena
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, CABA, Argentina
| | - Gisela Zanga
- Departamento de Neurología, Hospital Cesar Milstein, Buenos Aires, Argentina
| | | | | | | | | | - Jorge Blanche
- IRNEC (Instituto Regional de Neurociencias), San Miguel de Tucumán, Tucuman, Argentina
| | | | | | | | | | - Pablo Divi
- RIAPEM (Red Integral Asistencial al Paciente con Esclerosis Múltiple), Santiago del Estero, Argentina
| | - Miguel Jacobo
- RIAPEM (Red Integral Asistencial al Paciente con Esclerosis Múltiple), Santiago del Estero, Argentina
| | | | - Jimena Míguez
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Debora Nadur
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, CABA, Argentina
| | | | - Sebastián Nuñez
- Unidad de Infectología, Sanatorio Güemes, Buenos Aires, Departamento de Investigación Epidemiológica, Fundación Sanatorio Güemes, Buenos Aires, Argentina
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Calvo-Peña C, Burgos M, Diez-Galán A, Ibáñez A, Coque JJR, Cobos R. First Report of Pleurostoma richardsiae Associated with Twig and Branch Dieback of Olive Trees in Spain. Plant Dis 2022; 106:PDIS10212127PDN. [PMID: 34941373 DOI: 10.1094/pdis-10-21-2127-pdn] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- C Calvo-Peña
- Instituto de investigación de la Viña y el Vino, Universidad de León, 24009 León, Spain
| | - M Burgos
- Instituto de investigación de la Viña y el Vino, Universidad de León, 24009 León, Spain
| | - A Diez-Galán
- Instituto de investigación de la Viña y el Vino, Universidad de León, 24009 León, Spain
| | - A Ibáñez
- Instituto de investigación de la Viña y el Vino, Universidad de León, 24009 León, Spain
| | - J J R Coque
- Instituto de investigación de la Viña y el Vino, Universidad de León, 24009 León, Spain
| | - R Cobos
- Instituto de investigación de la Viña y el Vino, Universidad de León, 24009 León, Spain
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13
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Barboza A, Gaitán MI, Alonso R, Ysrraelit MC, Luetic G, Liwacki S, Patrucco L, Halfon MJ, Burgos M, Mainella C, Pierdabuena R, Recchia L, Steinberg J, Tkachuk VA, Zanga G, Carra A, Chertcoff A, Fernandez Liguori N, Lazaro L, Menichini ML, Miguez J, Orzuza G, Palavecino A, Pappolla A, Pigretti S, Pita C, Ruiz E, Silva B, Zentil G. Rebound activity after fingolimod cessation: A case - control study. Mult Scler Relat Disord 2022; 57:103329. [PMID: 35158443 DOI: 10.1016/j.msard.2021.103329] [Citation(s) in RCA: 6] [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] [Received: 03/23/2021] [Revised: 09/30/2021] [Accepted: 10/11/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND There has been an increase in the number of reports of multiple sclerosis (MS) rebound activity (RA), which is usually defined as a severe disease reactivation after natalizumab or fingolimod withdrawal that exceeds pre-treatment baseline inflammatory activity. The frequency and risk factors that could predict RA remain unknown. Fingolimod is currently the most frequently prescribed disease modifying therapy for MS in Argentina, so that there is a need to determine possible predictors of RA. OBJECTIVES To identify risk factors for developing RA after fingolimod cessation; to describe RA characteristics, management and evolution. METHODS The study was a multicenter, retrospective, case-control study of patients with MS who had discontinued fingolimod and were followed up to nine months after discontinuation. Demographic, clinical and paraclinical data was extracted, including age, gender, MS phenotype, reason for discontinuation, number of relapses during the year prior to suspension, time treated with fingolimod, EDSS before, during and after rebound, MRI findings. RESULTS 26 cases of RA were matched 1:1 with patients without RA. The median time elapsed to RA was 50 days. 68% showed worsening of the EDSS in the evaluation at 3 months of RA. When compared with the control group, no difference was found in terms of age, gender, phenotype, EDSS at the moment of suspension, reason for discontinuation, number of relapses in the previous year, and time on therapy. CONCLUSION In this case-controlled study, no risk factors could be identified to predict RA after fingolimod cessation. Further controlled, prospective, better powered studies are needed to confirm these findings.
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Affiliation(s)
- Andres Barboza
- Department of Neurology, Hospital Central de Mendoza, Mendoza, Argentina.
| | | | - Ricardo Alonso
- Centro Universitario de Esclerosis Multiple, Hospital Ramos Mejia, Buenos Aires, Argentina; Department of Neurology, Sanatorio Güemes, Buenos Aires, Argentina
| | | | | | - Susana Liwacki
- Department of Neurology, Hospital Cordoba, Cordoba, Argentina; Department of Neurology, Clinica Reina Fabiola. Cordoba, Argentina
| | - Liliana Patrucco
- Department of Neurology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Mario Javier Halfon
- Department of Neurology, Hospital Britanico de Buenos Aires, Buenos Aires, Argentina
| | - Marcos Burgos
- Department of Neurology, Hospital San Bernardo, Salta, Argentina
| | - Carolina Mainella
- Department of Neurology, Hospital Español de Rosario, Santa Fe, Argentina
| | - Raul Pierdabuena
- Department of Neurology, Clinica Reina Fabiola. Cordoba, Argentina
| | - Luciano Recchia
- Department of Neurology, Hospital Central de Mendoza, Mendoza, Argentina
| | - Judith Steinberg
- Department of Neurology, Hospital Britanico de Buenos Aires, Buenos Aires, Argentina
| | | | - Gisela Zanga
- Department of Neurology, ENERI, Buenos Aires, Argentina
| | - Adriana Carra
- Department of Neurology, Hospital Britanico de Buenos Aires, Buenos Aires, Argentina
| | - Aníbal Chertcoff
- Department of Neurology, Hospital Britanico de Buenos Aires, Buenos Aires, Argentina
| | | | - Luciana Lazaro
- Department of Neurology, Sanatorio Güemes, Buenos Aires, Argentina
| | | | - Jimena Miguez
- Department of Neurology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Gabriela Orzuza
- Department of Neurology, Hospital San Bernardo, Salta, Argentina
| | | | - Agustin Pappolla
- Department of Neurology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Santiago Pigretti
- Department of Neurology, Hospital Central de Mendoza, Mendoza, Argentina
| | - Cacilia Pita
- Centro Universitario de Esclerosis Multiple, Hospital Ramos Mejia, Buenos Aires, Argentina
| | - Emiliano Ruiz
- Department of Neurology, Clinica Reina Fabiola. Cordoba, Argentina
| | - Berenice Silva
- Centro Universitario de Esclerosis Multiple, Hospital Ramos Mejia, Buenos Aires, Argentina
| | - Guillermo Zentil
- Department of Neurology, Hospital Central de Mendoza, Mendoza, Argentina
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14
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Luetic GG, Menichini ML, Vrech C, Pappolla A, Patrucco L, Cristiano E, Marrodán M, Ysrraelit MC, Fiol M, Correale J, Cohen L, Alonso R, Silva B, Casas M, Garcea O, Deri N, Burgos M, Liwacki S, Tkachuk V, Barboza A, Piedrabuena R, Blaya P, Steinberg J, Martínez A, Carrá A, Tavolini D, López P, Knorre E, Nofal P, Volman G, Carnero Contentti E, Pinheiro AA, Leguizamon F, Silva E, Hryb J, Balbuena ME, Zanga G, Kohler M, Chertcoff A, Lazaro L, Tizio S, Mainela C, Reich E, Recchia L, Blanche J, Marcilla MP, Fracaro ME, Sgrilli G, Divi P, Jacobo M, Cabrera M, Pagani Cassara F, Sinay V, Curbelo C, Míguez J, Coppola M, Liguori NF, Martos I, Pettinicchi JP, Viglione JP, José G, Bestoso S, Manzi R, Vázquez G, Nadur D, Martínez C, Serena MA, Rojas JI. Clinical and demographic characteristics of male MS patients included in the national registry-RelevarEM. Does sex or phenotype make the difference in the association with poor prognosis? Mult Scler Relat Disord 2022; 58:103401. [PMID: 35216784 DOI: 10.1016/j.msard.2021.103401] [Citation(s) in RCA: 1] [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: 10/09/2021] [Revised: 10/27/2021] [Accepted: 11/13/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND In multiple sclerosis demographics there is a well-known female prevalence and male patients have been less specifically evaluated in clinical studies, though some clinical differences have been reported between sexes. OBJECTIVE The objective of this study was to assess clinical and demographic differences between male and female patients included in the national Argentine MS Registry-RelevarEM. MATERIAL AND METHODS This study was observational, retrospective, and was based on the data of 3099 MS patients included as of 04 April 2021. The statistical analysis plan included bivariate analyses with the crude data and also after adjustment for the MS phenotype, further categorized as progressive-onset MS or relapsing-onset MS. In the adjusted analysis, the Mantel-Haenszel odds ratio was compared to the crude odds ratio, to account for the phenotype as a confounder. RESULTS The data from 1,074 (34.7%) men and 2,025 (65.3%) women with MS diagnosis were analysed. Males presented primary progressive disease two times more often than women (11% and 5%, respectively). In the crude analyses by sex, the presence of exclusively infratentorial lesions in the magnetic resonance imaging studies was more frequent in males than in females, but after adjustment by MS onset phenotype, such difference was only present in males with relapsing-onset MS (p = 0.00006). Similarly, worse Expanded Disability Status Scale scores were confirmed only in men with relapsing-onset disease after phenotype adjustment (p = 0.02). CONCLUSION We did not find any statistically significant clinical or demographic difference between sexes when the progressive MS phenotype was specifically considered. However, the differences we found between the clinical phenotypes are in line with the literature and highlight the importance of stratifying the analyses by sex and phenotype when designing MS studies.
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Affiliation(s)
- Geraldine G Luetic
- Instituto de Neurociencias de Rosario, San Lorenzo, Rosario, Santa Fe 3598, Argentina.
| | - María Laura Menichini
- Instituto de Neurociencias de Rosario, San Lorenzo, Rosario, Santa Fe 3598, Argentina; Sanatorio Británico, Rosario, Santa Fe, Argentina
| | - Carlos Vrech
- Departamento de Enfermedades desmielinizantes, Sanatorio Allende, Córdoba, Argentina
| | | | | | | | | | | | - Marcela Fiol
- Departamento de Neurología, FLENI, CABA, Argentina
| | | | - Leila Cohen
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, CABA, Argentina
| | - Ricardo Alonso
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, CABA, Argentina
| | - Berenice Silva
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, CABA, Argentina
| | - Magdalena Casas
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, CABA, Argentina
| | - Orlando Garcea
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, CABA, Argentina
| | - Norma Deri
- Centro de Investigaciones Diabaid, CABA, Argentina
| | - Marcos Burgos
- Servicio de Neurología, Hospital San Bernardo, Salta, Argentina
| | - Susana Liwacki
- Clínica Universitaria Reina Fabiola, Córdoba, Argentina; Servicio de Neurología, Hospital Córdoba, Córdoba, Argentina
| | - Verónica Tkachuk
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, CABA, Argentina
| | | | - Raúl Piedrabuena
- Clínica Universitaria Reina Fabiola, Córdoba, Argentina; Instituto Lennox, Córdoba, Argentina
| | | | - Judith Steinberg
- Sección de Enfermedades Desmielinizantes, Hospital Británico, CABA, Argentina
| | - Alejandra Martínez
- Sección de Enfermedades Desmielinizantes, Hospital Británico, CABA, Argentina; Hospital Nacional Alejandro Posadas, El Palomar, Buenos Aires, Argentina
| | - Adriana Carrá
- Sección de Enfermedades Desmielinizantes, Hospital Británico, CABA, Argentina; Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
| | | | - Pablo López
- Department of Neurosciences, Neuroimmunology Unit, Hospital Alemán, Buenos Aires, Argentina
| | - Eduardo Knorre
- Hospital de Agudos, Dr. Teodoro Álvarez, CABA, Argentina
| | - Pedro Nofal
- Hospital de Clínicas Nuestra Señora del Carmen, Tucumán, Argentina
| | - Gabriel Volman
- Hospital Pte. Perón, Avellaneda, Buenos Aires, Argentina
| | | | | | | | | | - Javier Hryb
- Servicio de Neurología, Hospital Carlos G Durand, Buenos Aires, Argentina
| | - María Eugenia Balbuena
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, CABA, Argentina
| | - Gisela Zanga
- Departamento de Neurología, Hospital Cesar Milstein, Buenos Aires, Argentina
| | - Matías Kohler
- Axis Neurociencias, Bahía Blanca, Buenos Aires, Argentina
| | - Aníbal Chertcoff
- Sección de Enfermedades Desmielinizantes, Hospital Británico, CABA, Argentina
| | | | | | | | - Edgardo Reich
- Instituto Médico Especializado, Buenos Aires, Argentina
| | | | - Jorge Blanche
- IRNEC (Instituto Regional de Neurociencias), San Miguel de Tucumán, Tucumán, Argentina
| | | | | | | | - Pablo Divi
- RIAPEM (Red Integral Asistencial al Paciente con Esclerosis Múltiple), Santiago del Estero, Argentina
| | - Miguel Jacobo
- RIAPEM (Red Integral Asistencial al Paciente con Esclerosis Múltiple), Santiago del Estero, Argentina
| | | | | | - Vladimiro Sinay
- Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
| | - Celeste Curbelo
- Policlínico Municipal Sofía T. de Santamarina, Buenos Aires, Argentina
| | | | | | - Nora Fernández Liguori
- Sanatorio Güemes, Buenos Aires, Argentina; Hospital Enrique Tornú, Buenos Aires, Argentina
| | - Iván Martos
- Clínica San Jorge, Ushuaia, Tierra del fuego, Argentina
| | - Juan Pablo Pettinicchi
- Department of Neurosciences, Neuroimmunology Unit, Hospital Alemán, Buenos Aires, Argentina
| | | | - Gustavo José
- Sección de enfermedades desmielinizantes, Servicio de Neurología, Hospital Padilla, Tucumán, Argentina
| | - Santiago Bestoso
- Servicio Neurología, Hospital Escuela José F. de San Martín Corrientes, Corrientes, Argentina
| | | | - Guido Vázquez
- Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
| | - Débora Nadur
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, CABA, Argentina
| | | | | | - Juan I Rojas
- Centro de esclerosis múltiple de Buenos Aires, CABA, Argentina; Servicio de Neurología, Hospital Universitario de CEMIC, CABA, Argentina
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15
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Carnero Contentti E, Lopez PA, Pettinicchi JP, Criniti J, Pappolla A, Miguez J, Patrucco L, Cristiano E, Liwacki S, Tkachuk V, Balbuena ME, Vrech C, Deri N, Correale J, Marrodan M, Ysrraelit MC, Leguizamon F, Luetic G, Menichini ML, Tavolini D, Mainella C, Zanga G, Burgos M, Hryb J, Barboza A, Lazaro L, Alonso R, Fernández Liguori N, Nadur D, Chercoff A, Alonso Serena M, Caride A, Paul F, Rojas JI. Seasonal variation in attacks of neuromyelitis optica spectrum disorders and multiple sclerosis: Evaluation of 794 attacks from a nationwide registry in Argentina. Mult Scler Relat Disord 2021; 58:103466. [PMID: 34929456 DOI: 10.1016/j.msard.2021.103466] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/12/2021] [Accepted: 12/11/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Identification of triggers that potentially instigate attacks in neuromyelitis optica spectrum disorders (NMOSD) and multiple sclerosis (MS) has remained challenging. We aimed to analyze the seasonality of NMOSD and MS attacks in an Argentinean cohort seeking differences between the two disorders. METHODS A retrospective study was conducted in a cohort of NMOSD and MS patients followed in specialized centers from Argentina and enrolled in RelevarEM, a nationwide, longitudinal, observational, non-mandatory registry of MS/NMOSD patients. Patients with complete relapse data (date, month and year) at onset and during follow-up were included. Attack counts were analyzed by month using a Poisson regression model with the median monthly attack count used as reference. RESULTS A total of 551 patients (431 MS and 120 NMOSD), experiencing 236 NMOSD-related attacks and 558 MS-related attacks were enrolled. The mean age at disease onset in NMOSD was 39.5 ± 5.8 vs. 31.2 ± 9.6 years in MS (p < 0.01). Mean follow-up time was 6.1 ± 3.0 vs. 7.4 ± 2.4 years (p < 0.01), respectively. Most of the included patients were female in both groups (79% vs. 60%, p < 0.01). We found a peak of number of attacks in June (NMOSD: 28 attacks (11.8%) vs MS: 33 attacks (5.9%), incidence rate ratio 1.82, 95%CI 1.15-2.12, p = 0.03), but no differences were found across the months in both disorders when evaluated separately. Strikingly, we observed a significant difference in the incidence rate ratio of attacks during the winter season when comparing NMOSD vs. MS (NMOSD: 75 attacks (31.7%) vs MS: 96 attacks (17.2%), incidence rate ratio 1.82, 95%CI 1.21-2.01, p = 0.02) after applying Poisson regression model. Similar results were observed when comparing the seropositive NMOSD (n = 75) subgroup vs. MS. CONCLUSIONS Lack of seasonal variation in MS and NMOSD attacks was observed when evaluated separately. Future epidemiological studies about the effect of different environmental factors on MS and NMOSD attacks should be evaluated prospectively in Latin America population.
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Affiliation(s)
- Edgar Carnero Contentti
- Department of Neurosciences, Neuroimmunology Unit, Hospital Alemán, Av. Pueyrredón 1640, Buenos Aires C1118AAT, Argentina.
| | - Pablo A Lopez
- Department of Neurosciences, Neuroimmunology Unit, Hospital Alemán, Av. Pueyrredón 1640, Buenos Aires C1118AAT, Argentina
| | - Juan Pablo Pettinicchi
- Department of Neurosciences, Neuroimmunology Unit, Hospital Alemán, Av. Pueyrredón 1640, Buenos Aires C1118AAT, Argentina
| | - Juan Criniti
- Department of Neurosciences, Neuroimmunology Unit, Hospital Alemán, Av. Pueyrredón 1640, Buenos Aires C1118AAT, Argentina
| | - Agustín Pappolla
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Jimena Miguez
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Liliana Patrucco
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Susana Liwacki
- Clínica Universitaria Reina Fabiola, Córdoba, Argentina; Servicio de Neurología - Hospital Córdoba, Córdoba, Argentina
| | - Verónica Tkachuk
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA, Argentina
| | - María E Balbuena
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA, Argentina
| | - Carlos Vrech
- Departamento de Enfermedades desmielinizantes - Sanatorio Allende, Córdoba, Argentina
| | - Norma Deri
- Centro de Investigaciones Diabaid, CABA, Argentina
| | | | | | | | | | | | | | | | | | - Gisela Zanga
- Unidad asistencial César Milstein, CABA, Argentina
| | - Marcos Burgos
- Servicio de Neurología - Hospital San Bernardo, Salta, Argentina
| | - Javier Hryb
- Servicio de Neurología - Hospital Carlos G. Durand, CABA, Argentina
| | | | | | | | | | - Débora Nadur
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA, Argentina; Hospital Naval, CABA, Argentina
| | - Aníbal Chercoff
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA, Argentina
| | | | - Alejandro Caride
- Department of Neurosciences, Neuroimmunology Unit, Hospital Alemán, Av. Pueyrredón 1640, Buenos Aires C1118AAT, Argentina
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Juan I Rojas
- Centro de esclerosis múltiple de Buenos Aires, CABA, Argentina; Servicio de Neurología, Hospital Universitario de CEMIC, CABA, Argentina
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16
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Contentti EC, Lopez PA, Pettinicchi JP, Criniti J, Pappolla A, Miguez J, Patrucco L, Carnero Contentti E, Liwacki S, Tkachuk V, Balbuena ME, Vrech C, Deri N, Correale J, Marrodan M, Ysrraelit MC, Leguizamon F, Luetic G, Menichini ML, Tavolini D, Mainella C, Zanga G, Burgos M, Hryb J, Barboza A, Lazaro L, Alonso R, Liguori NF, Nadur D, Chercoff A, Alonso Serena M, Caride A, Paul F, Rojas JI. Assessing attacks and treatment response rates among adult patients with NMOSD and MOGAD: Data from a nationwide registry in Argentina. Mult Scler J Exp Transl Clin 2021; 7:20552173211032334. [PMID: 34434560 PMCID: PMC8381444 DOI: 10.1177/20552173211032334] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/24/2021] [Indexed: 11/15/2022] Open
Abstract
We aimed to examine treatment interventions implemented in patients experiencing
neuromyelitis optica spectrum disorders (NMOSD) attacks (frequency, types, and
response).
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Affiliation(s)
| | | | | | - Juan Criniti
- Neuroimmunology Unit, Department of Neurosciences, Hospital Alemán, Buenos Aires, Argentina
| | | | | | - Liliana Patrucco
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | | | - María E Balbuena
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, CABA, Buenos Aires, Argentina
| | - Carlos Vrech
- Departamento de Enfermedades desmielinizantes, Sanatorio Allende, Córdoba, Argentina
| | - Norma Deri
- Centro de Investigaciones Diabaid, CABA, Buenos Aires, Argentina
| | | | | | | | - Felisa Leguizamon
- Hospital de Agudos, Dr. Teodoro Álvarez, CABA, Buenos Aires, Argentina
| | | | | | | | | | - Gisela Zanga
- Unidad Asistencial César Milstein, CABA, Buenos Aires, Argentina
| | - Marcos Burgos
- Servicio de Neurología, Hospital San Bernardo, Salta, Argentina
| | - Javier Hryb
- Servicio de Neurología, Hospital Carlos G. Durand, CABA, Buenos Aires, Argentina
| | | | | | | | | | - Débora Nadur
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, CABA, Buenos Aires, Argentina
| | - Aníbal Chercoff
- Sección de Enfermedades Desmielinizantes, Hospital Británico, CABA, Buenos Aires, Argentina
| | - Marina Alonso Serena
- Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, CABA, Buenos Aires, Argentina
| | - Alejandro Caride
- Neuroimmunology Unit, Department of Neurosciences, Hospital Alemán, Buenos Aires, Argentina
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Juan I Rojas
- Centro de Esclerosis Múltiple de Buenos Aires, CABA, Buenos Aires, Argentina
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17
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Kohler M, Kohler E, Vrech C, Pappolla A, Miguez J, Patrucco L, Correale J, Marrodan M, Gaitán MI, Fiol M, Negrotto L, Ysrraelit MC, Cristiano E, Carrá A, Steinberg J, Martinez AD, Curbelo MC, Cohen L, Alonso R, Garcea O, Pita C, Silva B, Luetic G, Deri N, Balbuena ME, Tkachuk V, Carnero Contentti E, Lopez PA, Pettinicchi JP, Caride A, Burgos M, Leguizamon F, Knorre E, Piedrabuena R, Barboza A, Liwacki S, Nofal P, Volman G, Alvez Pinheiro A, Hryb J, Tavolini D, Blaya P, Recchia L, Mainella C, Silva E, Blanche J, Tizio S, Saladino ML, Caceres F, Fernandez Liguori N, Lazaro L, Zanga G, Parada Marcilla M, Fracaro ME, Pagani Cassara F, Vazquez G, Sinay V, Sgrilli G, Divi P, Jacobo M, Reich E, Cabrera LM, Menichini ML, Coppola M, Martos I, Viglione JP, Jose G, Bestoso S, Manzi R, Giunta D, Doldan ML, Alonso Serena M, Rojas JI. Aggressive multiple sclerosis in Argentina: Data from the nationwide registry RelevarEM. J Clin Neurosci 2021; 89:360-364. [PMID: 34088579 DOI: 10.1016/j.jocn.2021.05.047] [Citation(s) in RCA: 1] [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] [Received: 06/09/2020] [Revised: 09/09/2020] [Accepted: 05/23/2021] [Indexed: 11/16/2022]
Abstract
The objectives of the present study were to describe the frequency of aggressive multiple sclerosis (aMS) as well as to compare clinical and radiological characteristics in aMS and non-aMS patients included in RelevarEM (NCT03375177). METHODS The eligible study population and cohort selection included adult-onset patients (≥18 years) with definite MS. AMS were defined as those reaching confirmed EDSS ≥ 6 within 5 years from symptom onset. Confirmation was achieved when a subsequent EDSS ≥ 6 was recorded at least six months later but within 5 years of the first clinical presentation. AMS and non-aMS were compared using the χ2 test for categorical and the Mann-Whitney for continuous variables at MS onset and multivariable analysis was performed using forward stepwise logistic regression with baseline characteristics at disease onset. RESULTS A total of 2158 patients with MS were included: 74 aMS and 2084 non-aMS. The prevalence of aMS in our cohort was 3.4% (95%CI 2.7-4.2). AMS were more likely to be male (p = 0.003), older at MS onset (p < 0.001), have primary progressive MS (PPMS) phenotype (p = 0.03), multifocal presentation (p < 0.001), and spinal cord as well as infratentorial lesions at MRI during disease onset (p = 0.004 and p = 0.002, respectively). CONCLUSION 3.4% of our patient population could be considered aMS. Men, patients older at symptom onset, multifocal presentation, PPMS phenotype, and spinal cord as well as brainstem lesions on MRI at clinical presentation all had higher odds of having aMS.
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Affiliation(s)
| | | | - Carlos Vrech
- Departamento de Enfermedades desmielinizantes - Sanatorio Allende, Córdoba, Argentina
| | - Agustín Pappolla
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Jimena Miguez
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Liliana Patrucco
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | | | - Marcela Fiol
- Departamento de Neurología - FLENI, CABA, Argentina
| | | | | | | | - Adriana Carrá
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA, Argentina; Instituto de Neurociencias - Fundación Favaloro/INECO, CABA, Argentina
| | - Judith Steinberg
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA, Argentina
| | | | - María C Curbelo
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA, Argentina
| | - Leila Cohen
- Centro Universitario de Esclerosis Múltiple - Hospital Dr. J. M. Ramos Mejía. Facultad de Medicina - UBA, CABA, Argentina
| | - Ricardo Alonso
- Centro Universitario de Esclerosis Múltiple - Hospital Dr. J. M. Ramos Mejía. Facultad de Medicina - UBA, CABA, Argentina; Sanatorio Güemes, CABA, Argentina
| | - Orlando Garcea
- Centro Universitario de Esclerosis Múltiple - Hospital Dr. J. M. Ramos Mejía. Facultad de Medicina - UBA, CABA, Argentina
| | - Cecilia Pita
- Centro Universitario de Esclerosis Múltiple - Hospital Dr. J. M. Ramos Mejía. Facultad de Medicina - UBA, CABA, Argentina
| | - Berenice Silva
- Centro Universitario de Esclerosis Múltiple - Hospital Dr. J. M. Ramos Mejía. Facultad de Medicina - UBA, CABA, Argentina
| | | | - Norma Deri
- Centro de Investigaciones Diabaid, CABA, Argentina
| | - Maria E Balbuena
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA, Argentina
| | - Verónica Tkachuk
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA, Argentina
| | | | - Pablo A Lopez
- Neuroimmunology Unit, Department of Neuroscience, Hospital Aleman, Buenos Aires, Argentina
| | - Juan P Pettinicchi
- Neuroimmunology Unit, Department of Neuroscience, Hospital Aleman, Buenos Aires, Argentina
| | - Alejandro Caride
- Neuroimmunology Unit, Department of Neuroscience, Hospital Aleman, Buenos Aires, Argentina
| | - Marcos Burgos
- Servicio de Neurología - Hospital San Bernardo, Salta, Argentina
| | | | - Eduardo Knorre
- Hospital de Agudos, Dr. Teodoro Álvarez, CABA, Argentina
| | - Raúl Piedrabuena
- Clínica Universitaria Reina Fabiola, Córdoba, Argentina; Instituto Lennox, Córdoba, Argentina
| | | | - Susana Liwacki
- Clínica Universitaria Reina Fabiola, Córdoba, Argentina; Servicio de Neurología - Hospital Córdoba, Córdoba, Argentina
| | - Pedro Nofal
- Hospital de Clínicas Nuestra Señora del Carmen, San Miguel de Tucumán, Tucumán, Argentina
| | - Gabriel Volman
- Hospital Presidente Perón de Avellaneda, Buenos Aires, Argentina
| | | | - Javier Hryb
- Servicio de Neurología - Hospital Carlos G. Durand, CABA, Argentina
| | - Dario Tavolini
- INECO Neurociencias Oroño - Fundación INECO, Rosario, Santa Fe, Argentina
| | | | | | | | - Emanuel Silva
- Predigma - Centro de Medicina Preventiva, Posadas, Misiones, Argentina
| | - Jorge Blanche
- IRNEC (Instituto Regional de Neurociencias), San Miguel de Tucumán, Argentina
| | | | | | | | | | | | - Gisela Zanga
- Unidad asistencial César Milstein, CABA, Argentina
| | | | | | | | - Guido Vazquez
- Instituto de Neurociencias - Fundación Favaloro/INECO, CABA, Argentina
| | - Vladimiro Sinay
- Instituto de Neurociencias - Fundación Favaloro/INECO, CABA, Argentina
| | | | - Pablo Divi
- RIAPEM (Red Integral Asistencial al Paciente con Esclerosis Múltiple), Santiago del Estero, Argentina
| | - Miguel Jacobo
- RIAPEM (Red Integral Asistencial al Paciente con Esclerosis Múltiple), Santiago del Estero, Argentina
| | - Edgardo Reich
- Servicio de Neurologia, Hospital Municipal Dr. Julio Méndez, CABA, Argentina
| | - Lorena M Cabrera
- Servicio de Neurología - Hospital Militar Central, CABA, Argentina; Hospital Militar Campo de Mayo, CABA, Argentina
| | | | - Mariano Coppola
- Servicio de Neurología, Hospital Ramón Santamarina, Tandil, Buenos Aires, Argentina
| | - Ivan Martos
- Clinica San Jorge, Ushuaia, Tierra del fuego, Argentina
| | | | - Gustavo Jose
- Sección de enfermedades desmielinizantes, Servicio de Neurología, Hospital Padilla, Tucumán, Argentina
| | - Santiago Bestoso
- Servicio Neurología - Hospital Escuela José F. de San Martín Corrientes, Corrientes, Argentina
| | | | - Diego Giunta
- Servicio de clínica médica, Hospital Italiano de Buenos Aires, CABA, Argentina
| | - Maria L Doldan
- Centro de esclerosis múltiple de Buenos Aires, CABA, Argentina
| | | | - Juan I Rojas
- Centro de esclerosis múltiple de Buenos Aires, CABA, Argentina; Servicio de Neurología, Hospital Universitario de CEMIC, CABA, Argentina.
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18
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Alonso R, Silva B, Garcea O, Diaz PEC, Dos Passos GR, Navarro DAR, Valle LAG, Salinas LCR, Negrotto L, Luetic G, Tkachuk VA, Míguez J, de Bedoya FHD, Goiry LG, Sánchez NER, Burgos M, Steinberg J, Balbuena ME, Alvarez PM, López PA, Ysrraelit MC, León RA, Cohen AB, Gracia F, Molina O, Casas M, Deri NH, Pappolla A, Patrucco L, Cristiano E, Tavolini D, Nadur D, Granda AMT, Weiser R, Cassará FP, Sinay V, Rodríguez CC, Lazaro LG, Menichini ML, Piedrabuena R, Escobar GO, Carrá A, Chertcoff A, Pujols BS, Vrech C, Tarulla A, Carvajal R, Mainella C, Becker J, Peeters LM, Walton C, Serena MA, Nuñez S, Rojas JI. COVID-19 in multiple sclerosis and neuromyelitis optica spectrum disorder patients in Latin America: COVID-19 in MS and NMOSD patients in LATAM. Mult Scler Relat Disord 2021; 51:102886. [PMID: 33744758 PMCID: PMC7937038 DOI: 10.1016/j.msard.2021.102886] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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: 12/31/2020] [Revised: 02/09/2021] [Accepted: 03/04/2021] [Indexed: 12/27/2022]
Abstract
Background There is no data regarding COVID-19 in Multiple Sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) patients in Latin America. Objective The objective of this study was to describe the clinical characteristics and outcomes of patients included in RELACOEM, a LATAM registry of MS and NMOSD patients infected with COVID-19. Methods RELACOEM is a longitudinal, strictly observational registry of MS and NMOSD patients who suffer COVID-19 and Dengue in LATAM. Inclusion criteria to the registry were either: (1) a biologically confirmed COVID-19 diagnosis based on a positive result of a COVID-19 polymerase chain reaction (PCR) test on a nasopharyngeal swab; or (2) COVID-19–typical symptoms (triad of cough, fever, and asthenia) in an epidemic zone of COVID-19. Descriptive statistics were performed on demographic and clinical variables. The cohort was later stratified for MS and NMOSD and univariate and multivariate logistic regression analysis was performed to identify variables associated with hospitalizations/intensive critical units (ICU) admission. Results 145 patients were included in the registry from 15 countries and 51 treating physicians. A total of 129 (89%) were MS patients and 16 (11%) NMOSD. 81.4% patients had confirmed COVID-19 and 18.6% were suspected cases. 23 (15.8%) patients were hospitalized, 9 (6.2%) required ICU and 5 (3.4 %) died due to COVID-19. In MS patients, greater age (OR 1.17, 95% CI 1.05 – 1.25) and disease duration (OR 1.39, 95%CI 1.14-1.69) were associated with hospitalization/ICU. In NMOSD patients, a greater age (54.3 vs. 36 years, p=<0.001), increased EDSS (5.5 vs 2.9, p=0.0012) and disease duration (18.5 vs. 10.3 years, p=0.001) were significantly associated with hospitalization/ICU. Conclusion we found that in MS patients, age and disease duration was associated with hospitalization and ICU admission requirement, while age, disease duration and EDSS was associated in NMOSD.
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Affiliation(s)
- Ricardo Alonso
- Centro Universitario de Esclerosis Múltiple. Hospital Ramos Mejía, Buenos Aires, Argentina; Servicio de Neurología, Hospital Universitario Sanatorio Guemes, Argentina
| | - Berenice Silva
- Servicio de Neurología, Hospital Universitario Sanatorio Guemes, Argentina
| | - Orlando Garcea
- Servicio de Neurología, Hospital Universitario Sanatorio Guemes, Argentina
| | | | | | | | | | | | | | | | | | | | - Fernando Hamuy Diaz de Bedoya
- Departamento de Neurologia, Hospital IMT, Paraguay; Departamento de Neurologia de Diagnóstico Codas Thompson, Paraguay
| | | | | | | | | | - Maria E Balbuena
- Hospital de Clinicas Jose de San Martin, Buenos Aires, Argentina
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Debora Nadur
- Hospital Naval - Hospital de Clínicas, Buenos Aires, Argentina
| | | | | | - Fátima Pagani Cassará
- Hospital Universitario Austral, Buenos Aires, Argentina; Fundación Favaloro, Buenos Aires, Argentina
| | | | | | - Luciana G Lazaro
- Servicio de Neurología, Hospital Universitario Sanatorio Guemes, Argentina
| | | | - Raúl Piedrabuena
- Clinica Reina Fabiola, Córdoba, Argentina; Instituto Lennox, Córdoba, Argentina
| | | | | | | | | | | | | | | | | | - Jefferson Becker
- Hospital São Lucas - Pontifícia Universidade Católica do Rio Grande do Sul, Brazil
| | - Liesbet M Peeters
- University Multiple Sclerosis Center; Biomedical Research Institute & Data Science Institute, Hasselt University, Belgium
| | | | | | - Sebastián Nuñez
- Infectious Diseases Unit Sanatorio Güemes, Buenos Aires, Argentina
| | - Juan I Rojas
- Centro de esclerosis múltiple de Buenos Aires, Argentina; Servicio de Neurología, Hospital Universitario de CEMIC, Buenos Aires, Argentina
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19
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Carnero Contentti E, Lopez PA, Pettinicchi JP, Pappolla A, Miguez J, Patrucco L, Cristiano E, Vrech C, Tkachuk V, Liwacki S, Correale J, Marrodan M, Gaitán MI, Fiol M, Negrotto L, Ysrraelit MC, Burgos M, Leguizamon F, Tavolini D, Deri N, Balbuena ME, Mainella C, Luetic G, Blaya P, Hryb J, Menichini ML, Alvez Pinheiro A, Nofal P, Zanga G, Barboza A, Martos I, Lazaro L, Alonso R, Silva E, Bestoso S, Fracaro ME, Carrá A, Garcea O, Fernandez Liguori N, Alonso Serena M, Caride A, Rojas JI. What percentage of AQP4-ab-negative NMOSD patients are MOG-ab positive? A study from the Argentinean multiple sclerosis registry (RelevarEM). Mult Scler Relat Disord 2021; 49:102742. [PMID: 33454601 DOI: 10.1016/j.msard.2021.102742] [Citation(s) in RCA: 9] [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] [Received: 10/05/2020] [Revised: 11/10/2020] [Accepted: 01/04/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Myelin oligodendrocyte glycoprotein antibodies (MOG-ab) have been described in aquaporin-4-antibodies(AQP4-ab)-negative neuromyelitis optica spectrum disorder (NMOSD) patients. We aimed to evaluate the percentage of AQP4-ab-negative NMOSD patients who are positive for MOG-ab in a cohort of Argentinean patients included in RelevarEM (Clinical Trials registry number NCT03375177). METHODS RelevarEM is a longitudinal, strictly observational multiple sclerosis (MS) and NMOSD registry in Argentina. Of 3031 consecutive patients (until March 2020), 165 patients with phenotype of suspected NMOSD, whose relevant data for the purpose of this study were available, were included. Data on demographic, clinical, paraclinical and treatment in AQP4-ab (positive, negative and unknown) and MOG-ab (positive and negative) patients were evaluated. RESULTS A total of 165 patients (79 AQP4-Ab positive, 67 AQP4-Ab negative and 19 unknown) were included. Of these, 155 patients fulfilled the 2015 NMOSD diagnostic criteria. Of 67 AQP4-Ab-negative patients, 36 (53.7%) were tested for MOG-Ab and 10 of them (27.7%) tested positive. Serum AQP4-ab levels were tested by means of cell-based assay (CBA) in 48 (35.2%), based on tissue-based indirect immunofluorescence assays in 58 (42.6%) and enzyme-linked immunosorbent assay in 4 (2.9%). All MOG-ab were tested by CBA. Optic neuritis (90%) was the most frequent symptom at presentation and optic nerve lesions the most frequent finding (80%) in neuroimaging of MOG-ab-associated disease. Of these, six (60%) patients were under immunosuppressant treatments at latest follow-up. CONCLUSION We observed that 27.7% (10/36) of the AQP4-ab-negative patients tested for MOG-ab were positive for this antibody, in line with results from other world regions.
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Affiliation(s)
| | - Pablo A Lopez
- Neuroimmunology Unit, Department of Neurosciences, Hospital Alemán, Buenos Aires
| | | | - Agustín Pappolla
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires
| | - Jimena Miguez
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires
| | - Liliana Patrucco
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires
| | | | - Carlos Vrech
- Departamento de Enfermedades desmielinizantes - Sanatorio Allende, Córdoba
| | - Verónica Tkachuk
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA
| | - Susana Liwacki
- Clínica Universitaria Reina Fabiola, Córdoba; Servicio de Neurología - Hospital Córdoba, Córdoba
| | | | | | | | | | | | | | - Marcos Burgos
- Servicio de Neurología - Hospital San Bernardo, Salta
| | | | - Dario Tavolini
- INECO Neurociencias Oroño - Fundación INECO, Rosario, Santa Fe
| | | | - Maria E Balbuena
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA
| | | | | | | | - Javier Hryb
- Servicio de Neurología - Hospital Carlos G. Durand, CABA
| | | | | | - Pedro Nofal
- Hospital de Clínicas Nuestra Señora del Carmen, San Miguel de Tucumán, Tucumán
| | | | | | - Ivan Martos
- Clinica San Jorge. Ushuaia. Tierra del fuego
| | | | | | - Emanuel Silva
- Predigma - Centro de Medicina Preventiva, Posadas, Misiones
| | - Santiago Bestoso
- Servicio Neurología - Hospital Escuela José F. de San Martín Corrientes, Corrientes
| | | | - Adriana Carrá
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA; Instituto de Neurociencias - Fundación Favaloro/INECO, CABA
| | - Orlando Garcea
- Centro Universitario de Esclerosis Múltiple - Hospital Dr. J. M. Ramos Mejía. Facultad de Medicina - UBA, CABA
| | | | | | - Alejandro Caride
- Neuroimmunology Unit, Department of Neurosciences, Hospital Alemán, Buenos Aires
| | - Juan I Rojas
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA; Servicio de Neurología, Hospital Universitario de CEMIC, CABA
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20
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Cristiano E, Patrucco L, Ysrraelit MC, Alonso R, Balbuena ME, Ballario C, Barboza AG, Bestoso S, Burgos M, Cáceres FJ, Carrá A, Carnero-Contentti E, Deri N, Fernández-Liguori N, Garcea O, Hryb JP, Jacobo M, Kohler E, Luetic GG, Mainella C, Menichini ML, Míguez J, Nofal PG, Piedrabuena R, Rugilo C, Saladino ML, Silva BA, Silva E, Sinay V, Tavolini D, Tkachuk VA, Villa A, Vrech C, Rojas JI. [Argentinean consensus guidelines on the identification and clinical care of secondary progressive multiple sclerosis]. Rev Neurol 2021; 72:23-32. [PMID: 33378076 DOI: 10.33588/rn.7201.2020379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The identification, diagnosis, follow-up, and treatment of patients with secondary progressive multiple sclerosis (SPMS) show significant differences between health care professionals in Argentina. AIM To provide consensus recommendations on the management of patients with SPMS in Argentina to optimize patient care. DEVELOPMENT A panel of expert neurologists from Argentina dedicated to the diagnosis and care of multiple sclerosis patients gathered during 2019 and 2020 to carry out a consensus recommendation on the diagnosis and treatment of SPMS patients in Argentina. To achieve consensus, the methodology of 'formal consensus-RAND/UCLA method' was used. Recommendations were established based on published evidence and the expert opinion. Recommendations focused on how to define SPMS and how to follow SPMS patients. CONCLUSION The recommendations of this consensus guidelines attempt to optimize the care of SPMS patients in Argentina.
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Affiliation(s)
- E Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina
| | - L Patrucco
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - M C Ysrraelit
- Instituto de Investigaciones Neurológicas Dr. Raúl Carrea (FLENI), Buenos Aires, Argentina
| | - R Alonso
- Hospital Ramos Mejía. Universidad de Buenos Aires, Buenos Aires, Argentina.,Hospital Universitario Sanatorio Güemes, Buenos Aires, Argentina
| | - M E Balbuena
- Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | | | - A G Barboza
- Hospital Central de Mendoza, Mendoza, Argentina
| | - S Bestoso
- Hospital Escuela de Corrientes. Universidad Nacional del Nordeste, Corrientes, Argentina
| | - M Burgos
- Hospital San Bernardo, Salta, Argentina
| | - F J Cáceres
- Instituto de Neurociencias de Buenos Aires (INEBA), Buenos Aires, Argentina
| | - A Carrá
- Hospital Británico, Buenos Aires, Argentina.,Fundación Favaloro/INECO, Buenos Aires, Argentina
| | | | - N Deri
- Hospital General de Agudos Juan A. Fernández, Buenos Aires, Argentina.,Centro de Investigaciones Diabaid, Buenos Aires, Argentina
| | - N Fernández-Liguori
- Hospital Universitario Sanatorio Güemes, Buenos Aires, Argentina.,Hospital Enrique Tornu, Buenos Aires, Argentina
| | - O Garcea
- Hospital Ramos Mejía. Universidad de Buenos Aires, Buenos Aires, Argentina
| | - J P Hryb
- Hospital Carlos G. Durand, Buenos Aires, Argentina
| | - M Jacobo
- Red Integral Asistencial al Paciente con Esclerosis Múltiple (RIAPEM), Santiago del Estero, Argentina
| | - E Kohler
- Fundación Sinapsis, Santa Rosa, Argentina
| | - G G Luetic
- Instituto de Neurociencias de Rosario, Rosario, Argentina
| | - C Mainella
- Hospital Español de Rosario, Rosario, Argentina
| | - M L Menichini
- Sanatorio Británico, Rosario, Argentina.,Hospital Provincial del Centenario, Rosario, Argentina
| | - J Míguez
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - P G Nofal
- Hospital de Clínicas Nuestra Señora del Carmen, San Miguel de Tucumán, Argentina
| | - R Piedrabuena
- Instituto Lennox, Córdoba, Argentina.,Clínica Reina Fabiola, Córdoba, Argentina
| | - C Rugilo
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina.,Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - M L Saladino
- Instituto de Neurociencias de Buenos Aires (INEBA), Buenos Aires, Argentina
| | - B A Silva
- Hospital Ramos Mejía. Universidad de Buenos Aires, Buenos Aires, Argentina
| | - E Silva
- Predigma. Centro de Medicina Preventiva, Posadas, Argentina
| | - V Sinay
- Fundación Favoloro/INECO, Buenos Aires, Argentina
| | - D Tavolini
- Hospital Provincial del Centenario, Rosario, Argentina.,INECO Neurociencias Oroño, Rosario, Argentina
| | - V A Tkachuk
- Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - A Villa
- Hospital J. M. Ramos Mejía, Buenos Aires, Argentina
| | - C Vrech
- Sanatorio Allende, Córdoba, Argentina
| | - J I Rojas
- Hospital Universitario de CEMIC, Buenos Aires, Argentina.,Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina
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Cole B, Nilsen DM, Will L, Etkind SC, Burgos M, Chorba T. Essential Components of a Public Health Tuberculosis Prevention, Control, and Elimination Program: Recommendations of the Advisory Council for the Elimination of Tuberculosis and the National Tuberculosis Controllers Association. MMWR Recomm Rep 2020; 69:1-27. [PMID: 32730235 PMCID: PMC7392523 DOI: 10.15585/mmwr.rr6907a1] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
This report provides an introduction and reference tool for tuberculosis (TB) controllers regarding the essential components of a public health program to prevent, control, and eliminate TB. The Advisory Council for the Elimination of Tuberculosis and the National Tuberculosis Controllers Association recommendations in this report update those previously published (Advisory Council for the Elimination of Tuberculosis. Essential components of a tuberculosis prevention and control program. Recommendations of the Advisory Council for the Elimination of Tuberculosis. MMWR Recomm Rep 1995;44[No. RR-11]). The report has been written collaboratively on the basis of experience and expert opinion on approaches to organizing programs engaged in diagnosis, treatment, prevention, and surveillance for TB at state and local levels. This report reemphasizes the importance of well-established priority strategies for TB prevention and control: identification of and completion of treatment for persons with active TB disease; finding and screening persons who have had contact with TB patients; and screening, testing, and treatment of other selected persons and populations at high risk for latent TB infection (LTBI) and subsequent active TB disease. Health departments are responsible for public safety and population health. To meet their responsibilities, TB control programs should institute or ensure completion of numerous responsibilities and activities described in this report: preparing and maintaining an overall plan and policy for TB control; maintaining a surveillance system; collecting and analyzing data; participating in program evaluation and research; prioritizing TB control efforts; ensuring access to recommended laboratory and radiology tests; identifying, managing, and treating contacts and other persons at high risk for Mycobacterium tuberculosis infection; managing persons who have TB disease or who are being evaluated for TB disease; providing TB training and education; and collaborating in the coordination of patient care and other TB control activities. Descriptions of CDC-funded resources, tests for evaluation of persons with TB or LTBI, and treatment regimens for LTBI are provided (Supplementary Appendices; https://stacks.cdc.gov/view/cdc/90289).
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Mellinger S, Romero D, Visich A, Chanampa S, Ivetich G, Burgos M, Orzuza G. Not Described Variant of Notch3 Gen for Cadasil Disease. J Stroke Cerebrovasc Dis 2020; 29:104803. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.104803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 02/09/2020] [Accepted: 03/02/2020] [Indexed: 10/24/2022] Open
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23
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Liguori NF, Alonso R, Pinheiro AA, Balbuena ME, Barboza A, Bestoso S, Burgos M, Cáceres F, Carnero Contentti E, Carrá A, Cristiano E, Curbelo MC, Deri N, Fiol M, Gaitán MI, Garcea O, Halfon M, Hryb J, Jacobo M, José G, Knorre E, López P, Luetic G, Mainella C, Martínez A, Miguez J, Nofal P, Pagani Cassará F, Marcilla MP, Piedrabuena R, Pita C, Quarracino C, Rojas JI, Silva B, Sinay V, Steinberg J, Tarulla A, Tavolini D, Tkachuk V, Tizio S, Villa A, Vrech C, Ysrraelit C, Patrucco L. Consensus recommendations for family planning and pregnancy in multiple sclerosis in argentina. Mult Scler Relat Disord 2020; 43:102147. [PMID: 32442883 DOI: 10.1016/j.msard.2020.102147] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/30/2020] [Accepted: 04/22/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is the most common chronic immune-mediated neurological disorder in young adults, more frequently found in women than in men. Therefore, pregnancy-related issues have become an object of concern for MS professionals and patients. The aim of this work was to review the existing data to develop the first Argentine consensus for family planning and pregnancy in MS patients. METHODS A panel of expert neurologists from Argentina engaged in the diagnosis and care of MS patients met both virtually and in person during 2019 to carry out a consensus recommendation for family planning and pregnancy in MS. To achieve consensus, the procedure of the "formal consensus-RAND/UCLA method" was used. RESULTS Recommendations were established based on published evidence and expert opinion focusing on pre-pregnancy counseling, pregnancy, and postpartum issues. CONCLUSION The recommendations of these consensus guidelines are intended to optimize the management and treatment of MS patients during their reproductive age in Argentina.
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Affiliation(s)
- Nora Fernández Liguori
- Hospital Universitario Sanatorio Güemes, Buenos Aires, Argentina; Sección Neurología, Hospital Enrique Tornú, Buenos Aires, Argentina.
| | - Ricardo Alonso
- Hospital Universitario Sanatorio Güemes, Buenos Aires, Argentina; Centro Universitario de Esclerosis Múltiple, Hospital Dr. J. M. Ramos Mejía, Buenos Aires, Argentina
| | | | - María E Balbuena
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, Argentina
| | | | | | | | | | | | - Adriana Carrá
- Fundación Favaloro/INECO, Buenos Aires, Argentina; MS Section Hospital Británico, Buenos Aires, Argentina
| | | | | | - Norma Deri
- Centro de Investigaciones Diabaid, Argentina; Hospital Fernández de Buenos Aires, Argentina
| | - Marcela Fiol
- Department of Neurology, Institute for Neurological Research Dr Raul Carrea, FLENI, Argentina
| | - María I Gaitán
- Department of Neurology, Institute for Neurological Research Dr Raul Carrea, FLENI, Argentina
| | - Orlando Garcea
- Centro Universitario de Esclerosis Múltiple, Hospital Dr. J. M. Ramos Mejía, Buenos Aires, Argentina
| | | | - Javier Hryb
- Servicio de Neurología, Hospital Carlos G. Durand, CABA
| | - Miguel Jacobo
- RIAPEM (Red Integral Asistencial al Paciente con EM), Santiago del Estero, Argentina
| | - Gustavo José
- Servicio de Neurología, Hospital Ángel Padilla, Tucumán, Argentina
| | - Eduardo Knorre
- Servicio de Neurología, Hospital Teodoro Álvarez, Buenos Aires, Argentina
| | - Pablo López
- Department of Neuroscience - Neuroimmunology Unit, Hospital Alemán, Buenos Aires, Argentina
| | | | | | | | | | - Pedro Nofal
- Hospital de Clínicas Ntra. Sra. del Carmen, San Miguel de Tucumán, Argentina
| | | | | | | | - Cecilia Pita
- Centro Universitario de Esclerosis Múltiple, Hospital Dr. J. M. Ramos Mejía, Buenos Aires, Argentina
| | - Cecilia Quarracino
- Departamento de neurología, Instituto de Investigaciones Médicas Alfredo Lanari
| | - Juan I Rojas
- Centro de Esclerosis Múltiple de Buenos Aires, Argentina
| | - Berenice Silva
- Centro Universitario de Esclerosis Múltiple, Hospital Dr. J. M. Ramos Mejía, Buenos Aires, Argentina
| | | | | | - Adriana Tarulla
- Hospital de Agudos Parmenio Piñero, Municipalidad de Ciudad de Buenos Aires, MCBA, Argentina
| | - Darío Tavolini
- INECO Neurociencias Oroño. Fundación INECO Rosario, Argentina
| | - Verónica Tkachuk
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, Argentina
| | - Santiago Tizio
- Departamento de Neurología, Hospital Italiano y Español de La Plata, Argentina
| | - Andrés Villa
- Sección Neuroinmunología, Hospital Ramos Mejía, Buenos Aires, Argentina
| | - Carlos Vrech
- Departamento de Enfermedades desmielinizantes, Sanatorio Allende Córdoba, Argentina
| | - Célica Ysrraelit
- Department of Neurology, Institute for Neurological Research Dr Raul Carrea, FLENI, Argentina
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Sterling TR, Njie G, Zenner D, Cohn DL, Reves R, Ahmed A, Menzies D, Horsburgh CR, Crane CM, Burgos M, LoBue P, Winston CA, Belknap R. Guidelines for the treatment of latent tuberculosis infection: Recommendations from the National Tuberculosis Controllers Association and CDC, 2020. Am J Transplant 2020. [DOI: 10.1111/ajt.15841] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - Gibril Njie
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of Tuberculosis Elimination CDC Atlanta Georgia USA
| | - Dominik Zenner
- Institute for Global Health University College London London England
| | - David L. Cohn
- Denver Health and Hospital Authority Denver Colorado USA
| | - Randall Reves
- Denver Health and Hospital Authority Denver Colorado USA
| | - Amina Ahmed
- Levine Children’s Hospital Charlotte North Carolina USA
| | - Dick Menzies
- Montreal Chest Institute and McGill International TB Centre Montreal Canada USA
| | - C. Robert Horsburgh
- Boston University Schools of Public Health and Medicine Boston Massachusetts USA
| | - Charles M. Crane
- National Tuberculosis Controllers Association Smyrna Georgia USA
| | - Marcos Burgos
- National Tuberculosis Controllers Association Smyrna Georgia USA
- New Mexico Department of Health University of New Mexico Health Science Center Albuquerque New Mexico USA
| | - Philip LoBue
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of Tuberculosis Elimination CDC Atlanta Georgia USA
| | - Carla A. Winston
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of Tuberculosis Elimination CDC Atlanta Georgia USA
| | - Robert Belknap
- Denver Health and Hospital Authority Denver Colorado USA
- National Tuberculosis Controllers Association Smyrna Georgia USA
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25
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Doctorovich ED, Martín-Bertuzzi F, Goicochea MT, Miranda S, Figuerola ML, Schubaroff PA, Buonanotte F, Rocchi V, Rua I, Bruera OC, Giglio J, De Paz JJ, Pelli-Noble R, Arago L, Burgos M, Ayala LS, Davidow L, Bonamico L. [Argentinean consensus guidelines on the use of monoclonal antibodies in patients with migraine]. Rev Neurol 2020; 70:149-158. [PMID: 32043537 DOI: 10.33588/rn.7004.2019399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Migraine is a very prevalent disorder that is estimated to affect about 15% of adult subjects. Recently, the efficacy and safety of monoclonal antibodies that act on the calcitonin gene-related peptide pathway (MA-CGRP) has been evaluated in migraine. Several groups around the world have developed consensus guidelines about the use of monoclonal antibodies, however, in some regions is difficult to extrapolate the recommendations. AIM To provide recommendations for the use of MA-CGRP in migraine in Argentina. DEVELOPMENT A group of neurology experts from Argentina, by using the online surveys methodology as well as face to face meetings developed the intended consensus for the use of MA-CGRP in migraine in Argentina. Recommendations were established based on published evidence and the expert opinion. Recommendations focused on how, when, treatment duration and patients follow up. CONCLUSION The recommendations of this consensus guidelines attempt to optimize the use of MA-CGRP in migraine in Argentina.
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Affiliation(s)
| | | | - M T Goicochea
- Instituto de Investigaciones Neurológicas Dr. Raúl Carrea (FLENI), Buenos Aires, Argentina
| | - S Miranda
- Instituto Central de Medicina de La Plata, Buenos Aires, Argentina
| | - M L Figuerola
- Hospital de Clínicas José San Martín. Universidad de Buenos Aires, Buenos Aires, Argentina.,Hospital Alemán, Buenos Aires, Argentina
| | - P A Schubaroff
- Hospital Municipal Prof. Dr. Bernardo A. Houssay, Vicente López, Argentina
| | - F Buonanotte
- Hospital Nacional de Clínicas. Universidad de Córdoba, Córdoba, Argentina
| | - V Rocchi
- Hospital General de Agudos Juan A. Fernández, Buenos Aires, Argentina
| | - I Rua
- Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - O C Bruera
- Instituto de Neurociencias de Buenos Aires (INEBA), Buenos Aires, Argentina
| | - J Giglio
- Hospital R. Rossi, Buenos Aires, Argentina.,Instituto de Diagnóstico de La Plata, Buenos Aires, Argentina
| | - J J De Paz
- Asociación Mendocina de Neurología Clínica, San Martín, Argentina
| | - R Pelli-Noble
- Centro Neurológico Tucumán, San Miguel Tucumán, Argentina
| | - L Arago
- Hospital Interzonal General de Agudos Eva Perón, San Martín, Argentina
| | - M Burgos
- Hospital San Bernardo, Salta, Argentina
| | - L S Ayala
- Hospital Interzonal General de Agudos "Dr. José Penna", Bahía Blanca, Argentina
| | - L Davidow
- Fundación Rosarina de Neurorrehabilitación, Rosario, Argentina
| | - L Bonamico
- Instituto de Investigaciones Neurológicas Dr. Raúl Carrea (FLENI), Buenos Aires, Argentina
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26
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Sterling TR, Njie G, Zenner D, Cohn DL, Reves R, Ahmed A, Menzies D, Horsburgh CR, Crane CM, Burgos M, LoBue P, Winston CA, Belknap R. Guidelines for the Treatment of Latent Tuberculosis Infection: Recommendations from the National Tuberculosis Controllers Association and CDC, 2020. MMWR Recomm Rep 2020; 69:1-11. [PMID: 32053584 PMCID: PMC7041302 DOI: 10.15585/mmwr.rr6901a1] [Citation(s) in RCA: 207] [Impact Index Per Article: 51.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Comprehensive guidelines for treatment of latent tuberculosis infection (LTBI) among persons living in the United States were last published in 2000 (American Thoracic Society. CDC targeted tuberculin testing and treatment of latent tuberculosis infection. Am J Respir Crit Care Med 2000;161:S221–47). Since then, several new regimens have been evaluated in clinical trials. To update previous guidelines, the National Tuberculosis Controllers Association (NTCA) and CDC convened a committee to conduct a systematic literature review and make new recommendations for the most effective and least toxic regimens for treatment of LTBI among persons who live in the United States. The systematic literature review included clinical trials of regimens to treat LTBI. Quality of evidence (high, moderate, low, or very low) from clinical trial comparisons was appraised using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. In addition, a network meta-analysis evaluated regimens that had not been compared directly in clinical trials. The effectiveness outcome was tuberculosis disease; the toxicity outcome was hepatotoxicity. Strong GRADE recommendations required at least moderate evidence of effectiveness and that the desirable consequences outweighed the undesirable consequences in the majority of patients. Conditional GRADE recommendations were made when determination of whether desirable consequences outweighed undesirable consequences was uncertain (e.g., with low-quality evidence). These updated 2020 LTBI treatment guidelines include the NTCA- and CDC-recommended treatment regimens that comprise three preferred rifamycin-based regimens and two alternative monotherapy regimens with daily isoniazid. All recommended treatment regimens are intended for persons infected with Mycobacterium tuberculosis that is presumed to be susceptible to isoniazid or rifampin. These updated guidelines do not apply when evidence is available that the infecting M. tuberculosis strain is resistant to both isoniazid and rifampin; recommendations for treating contacts exposed to multidrug-resistant tuberculosis were published in 2019 (Nahid P, Mase SR Migliori GB, et al. Treatment of drug-resistant tuberculosis. An official ATS/CDC/ERS/IDSA clinical practice guideline. Am J Respir Crit Care Med 2019;200:e93–e142). The three rifamycin-based preferred regimens are 3 months of once-weekly isoniazid plus rifapentine, 4 months of daily rifampin, or 3 months of daily isoniazid plus rifampin. Prescribing providers or pharmacists who are unfamiliar with rifampin and rifapentine might confuse the two drugs. They are not interchangeable, and caution should be taken to ensure that patients receive the correct medication for the intended regimen. Preference for these rifamycin-based regimens was made on the basis of effectiveness, safety, and high treatment completion rates. The two alternative treatment regimens are daily isoniazid for 6 or 9 months; isoniazid monotherapy is efficacious but has higher toxicity risk and lower treatment completion rates than shorter rifamycin-based regimens. In summary, short-course (3- to 4-month) rifamycin-based treatment regimens are preferred over longer-course (6–9 month) isoniazid monotherapy for treatment of LTBI. These updated guidelines can be used by clinicians, public health officials, policymakers, health care organizations, and other state and local stakeholders who might need to adapt them to fit individual clinical circumstances.
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Jakeman B, Logothetis SJ, Roberts MH, Bachyrycz A, Fortune D, Borrego ME, Ferreira J, Burgos M. Addressing Latent Tuberculosis Infection Treatment Through a Collaborative Care Model With Community Pharmacies and a Health Department. Prev Chronic Dis 2020; 17:E14. [PMID: 32053480 PMCID: PMC7021458 DOI: 10.5888/pcd17.190263] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction The objective of this study was to evaluate a novel collaborative care model using community pharmacies as additional access points for latent tuberculosis infection (LTBI) treatment for patients using combination weekly therapy with isoniazid and rifapentine (3HP) plus directly observed therapy for 12 weeks. Methods This prospective pilot study included adult patients diagnosed with LTBI. Patients were eligible for study participation if they spoke English or Spanish and were followed by the New Mexico Department of Health (NM DOH). Patients were excluded if they were pregnant, receiving concomitant HIV antiretroviral therapy, or had contraindications to 3HP due to allergy or drug interactions. Community pharmacy sites included chain, independent, and hospital outpatient pharmacies in Albuquerque and Santa Fe, New Mexico. Results A total of 40 patients initiated treatment with 3HP and were included. Most were female (55%) and had a mean age of 46 years (standard deviation, 12.6 y). A total of 75.0% of patients completed LTBI treatment with 3HP in a community pharmacy site. Individuals of Hispanic ethnicity were more likely to complete treatment (76.7% vs 40.0%, P = .04). Most patients (60%; n = 24) reported experiencing an adverse drug event (ADE) with 3HP therapy. Patients who completed treatment were less likely to experience an ADE than patients who discontinued treatment (50.0% vs 90.0%, P = .03). Pharmacists performed 398 LTBI treatment visits (40 initial visits, 358 follow-up visits), saving the NM DOH approximately 143 hours in patient contact time. Conclusion High completion rates and safe administration of LTBI treatment can be achieved in the community pharmacy setting.
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Affiliation(s)
- Bernadette Jakeman
- University of New Mexico College of Pharmacy, Department of Pharmacy Practice and Administrative Sciences, Albuquerque, New Mexico.,University of New Mexico College of Pharmacy, 1 University of New Mexico, MSC09 5360, Albuquerque, NM 87131. E-mail:
| | - Stefanie J Logothetis
- University of New Mexico College of Pharmacy, Department of Pharmacy Practice and Administrative Sciences, Albuquerque, New Mexico
| | - Melissa H Roberts
- University of New Mexico College of Pharmacy, Department of Pharmacy Practice and Administrative Sciences, Albuquerque, New Mexico
| | - Amy Bachyrycz
- University of New Mexico College of Pharmacy, Department of Pharmacy Practice and Administrative Sciences, Albuquerque, New Mexico
| | - Diana Fortune
- New Mexico Department of Health, Tuberculosis Program, Santa Fe, New Mexico
| | - Matthew E Borrego
- University of New Mexico College of Pharmacy, Department of Pharmacy Practice and Administrative Sciences, Albuquerque, New Mexico
| | - Julianna Ferreira
- New Mexico Department of Health, Tuberculosis Program, Santa Fe, New Mexico
| | - Marcos Burgos
- New Mexico Department of Health, Tuberculosis Program, Santa Fe, New Mexico.,University of New Mexico School of Medicine, Division of Infectious Diseases, Albuquerque, New Mexico.,New Mexico Veterans Affairs Health Care System, Albuquerque, New Mexico
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Cristiano E, Rojas JI, Alonso R, Alvez Pinheiro A, Bacile EA, Balbuena ME, Barboza AG, Bestoso S, Burgos M, Cáceres F, Carnero Contentti E, Curbelo MC, Deri N, Fernandez Liguori N, Gaitán MI, Garcea O, Giunta D, Halfon MJ, Hryb JP, Jacobo M, Kohler E, Luetic GG, Maglio I, Martínez AD, Míguez J, Nofal PG, Patrucco L, Piedrabuena R, Rotta Escalante R, Saladino ML, Silva BA, Sinay V, Tkachuk V, Villa A, Vrech C, Ysrraelit MC, Correale J. Consensus recommendations on the management of multiple sclerosis patients in Argentina. J Neurol Sci 2020; 409:116609. [DOI: 10.1016/j.jns.2019.116609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 11/29/2019] [Accepted: 12/02/2019] [Indexed: 10/25/2022]
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Rojas JI, Alonso Serena M, Garcea O, Patrucco L, Carrá A, Correale J, Vrech C, Pappolla A, Miguez J, Doldan ML, Silveira F, Alonso R, Cohen L, Pita C, Silva BA, Fiol M, Gaitán MI, Marrodan M, Negrotto L, Ysrraelit MC, Deri N, Luetic G, Caride A, Carnero Contentti E, Lopez PA, Pettinicchi JP, Curbelo C, Martinez AD, Steinberg JD, Balbuena ME, Tkachuk V, Burgos M, Knorre E, Leguizamon F, Piedrabuena R, Liwacki SDV, Barboza AG, Nofal P, Volman G, Alvez Pinheiro A, Hryb J, Tavolini D, Blaya PA, Silva E, Blanche J, Tizio S, Caceres F, Saladino ML, Zanga G, Fracaro ME, Sgrilli G, Pagani Cassara F, Vazquez G, Sinay V, Menichini ML, Lazaro L, Cabrera LM, Bestoso S, Divi P, Jacobo M, Kohler E, Kohler M, Giunta D, Mainella C, Manzi R, Parada Marcilla M, Viglione JP, Martos I, Reich E, Jose G, Cristiano E, Fernández Liguori N. Multiple sclerosis and neuromyelitis optica spectrum disorders in Argentina: comparing baseline data from the Argentinean MS Registry (RelevarEM). Neurol Sci 2020; 41:1513-1519. [DOI: 10.1007/s10072-019-04230-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 12/24/2019] [Indexed: 12/27/2022]
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Sanabria A, Nieto-Jiménez C, Corrales-Sanchez V, Montero J, Burgos M, Galán-Moya E, Pandiella A, Ocaña A. Pharmacological screening with Chk1 inhibitors identifies synergistic agents to overcome resistance to platinums in basal breast and ovarian cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz268.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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31
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Nuncia-Cantarero M, Nieto-Jiménez C, Burgos M, Montero J, Ocaña A, Galán-Moya E. The tyrosine kinase inhibitor dasatinib blocks tumour growth, invasion and recurrence potential by interrupting the communication between cancer cells and their surrounding microenvironment in triple negative breast cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz238.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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32
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Nieto-Jiménez C, Galán-Moya E, Corrales-Sanchez V, Noblejas López M, Burgos M, Domingo B, Montero J, Perez-Peña J, Gómez-Juárez M, Pandiella A, Ocaña A. In vitro and in vivo rescue of resistance to BET inhibitors by targeting PLK1 in triple negative breast cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz241.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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33
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Noblejas López M, Nieto-Jiménez C, Galán-Moya E, Burgos M, Montero J, Gómez-Juárez M, Pandiella A, Ocaña A. Activity of BET-proteolysis targeting chimeric (PROTAC) compounds in triple negative breast cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz241.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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34
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Galan-Moya E, Nuncia-Cantarero M, Serrano-Oviedo L, Morcillo-García S, Nieto-Jiménez C, Burgos M, Győrffy B, Ocaña A. Identification of a stemness-related gene panel associated with BET inhibition in triple negative breast cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz268.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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35
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Rojas JI, Carrá A, Correale J, Cristiano E, Fernández Liguori N, Alonso R, Alvez Pinheiro A, Balbuena ME, Barboza AG, Bestoso S, Blaya PA, Burgos M, Cabrera LM, Caride A, Carnero Contentti E, Cohen L, Curbelo C, Deri N, Divi P, Fiol M, Fracaro ME, Gaitán MI, Hryb J, Jacobo M, Knorre E, Leguizamon F, Giunta D, Alonso Serena M, Doldan ML, De Lio GF, Liwacki SDV, Lopez PA, Luetic G, Mainella C, Manzi R, Marrodan M, Martinez AD, Miguez J, Negrotto L, Nofal P, Parada Marcilla M, Pettinicchi JP, Silva BA, Silva E, Silveira F, Steinberg JD, Tavolini D, Tizio S, Tkachuk V, Vazquez G, Volman G, Vrech C, Ysrraelit MC, Zanga G, Garcea O, Patrucco L. The Argentinean multiple sclerosis registry (RelevarEM): Methodological aspects and directions. Mult Scler Relat Disord 2019; 32:133-137. [DOI: 10.1016/j.msard.2019.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 04/10/2019] [Accepted: 05/12/2019] [Indexed: 11/30/2022]
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Mellinger S, Dias D, Flores N, Palavecino A, Vigo G, Burgos D, Tomas F, Rollan I, Herrera G, Floridia J, Furlan C, Frissia F, Aleman A, Perez Frías J, Casali J, Burgos M. Multiple sclerosis prevalence in Salta City, Argentina. Mult Scler Relat Disord 2018; 25:212-215. [DOI: 10.1016/j.msard.2018.07.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 07/14/2018] [Accepted: 07/18/2018] [Indexed: 11/25/2022]
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Jindani A, Borgulya G, de Patiño IW, Gonzales T, de Fernandes RA, Shrestha B, Atwine D, Bonnet M, Burgos M, Dubash F, Patel N, Checkley AM, Harrison TS, Mitchison D. A randomised Phase II trial to evaluate the toxicity of high-dose rifampicin to treat pulmonary tuberculosis. Int J Tuberc Lung Dis 2018; 20:832-8. [PMID: 27155189 DOI: 10.5588/ijtld.15.0577] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Randomised Phase IIB clinical trial. OBJECTIVES To assess whether increasing the dose of rifampicin (RMP) from 10 mg/kg to 15 or 20 mg/kg results in an increase in grade 3 or 4 hepatic adverse events and/or serious adverse events (SAE). METHODS Three hundred human immunodeficiency virus negative patients with newly diagnosed microscopy-positive pulmonary tuberculosis (TB) were randomly assigned to one of three regimens: 1) the control regimen (R10), comprising daily ethambutol (EMB), isoniazid (INH), RMP and pyrazinamide for 8 weeks, followed by INH and RMP daily for 18 weeks; 2) Study Regimen 1 (R15), as above, with the RMP dose increased to 15 mg/kg body weight daily for the first 16 weeks; and 3) Study Regimen 2 (R20), as above, with RMP increased to 20 mg/kg. Serum alanine transferase (ALT) levels were measured at regular intervals. RESULTS There were seven grade 3 increases in ALT levels, 1/100 (1%) among R10 arm patients, 2/100 (2%) in the R15 arm and 4/100 (4%) in the R20 arm (trend test P = 0.15). One (R15) patient developed jaundice, requiring treatment modification. There were no grade 4 ALT increases. There was a non-significant increase in culture negativity at 8 weeks with increasing RMP dosage: 75% (69/92) in R10, 82.5% (66/80) in R15 and 83.1% (76/91) R20 patients (P = 0.16). CONCLUSIONS No significant increase in adverse events occurred when the RMP dose was increased from 10 mg/kg to 15 mg/kg or 20 mg/kg.
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Affiliation(s)
- A Jindani
- St George's, University of London, London, UK
| | - G Borgulya
- St George's, University of London, London, UK
| | | | - T Gonzales
- Division of Infectious Diseases, School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - R A de Fernandes
- Division of Infectious Diseases, School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - B Shrestha
- German Nepal Tuberculosis Project, Kathmandu, Nepal
| | | | | | - M Burgos
- Division of Infectious Diseases, School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - F Dubash
- St George's, University of London, London, UK
| | - N Patel
- St George's, University of London, London, UK
| | | | | | - D Mitchison
- St George's, University of London, London, UK
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Cristiano E, Alonso R, Alvez Pinheiro A, Bacile EA, Balbuena ME, Ballario C, Barboza AG, Bestoso S, Burgos M, Cáceres F, Carnero Contentti E, Carrá A, Crespo E, Curbelo MC, Deri N, Fernandez J, Fernández Liguori N, Fiol M, Gaitán MI, Garcea O, Giunta D, Halfon MJ, Hryb JP, Jacobo M, Kohler E, Linares R, Luetic GG, Martínez AD, Míguez J, Nofal PG, Patrucco L, Piedrabuena R, Rojas JI, Rotta Escalante R, Saladino ML, Silva BA, Sinay V, Steinberg JD, Tarulla A, Vétere SA, Villa A, Vrech C, Ysrraelit MC, Correale J. Argentinean recommendations on the identification of treatment failure in relapsing remitting multiple sclerosis patients. J Neurol Sci 2018; 385:217-224. [DOI: 10.1016/j.jns.2018.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 12/01/2017] [Accepted: 01/03/2018] [Indexed: 12/11/2022]
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39
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Nieto R LM, Mehaffy C, Creissen E, Troudt J, Troy A, Bielefeldt-Ohmann H, Burgos M, Izzo A, Dobos KM. Virulence of Mycobacterium tuberculosis after Acquisition of Isoniazid Resistance: Individual Nature of katG Mutants and the Possible Role of AhpC. PLoS One 2016; 11:e0166807. [PMID: 27893795 PMCID: PMC5125630 DOI: 10.1371/journal.pone.0166807] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 11/03/2016] [Indexed: 11/28/2022] Open
Abstract
In the last decade, there were 10 million new tuberculosis cases per year globally. Around 9.5% of these cases were caused by isoniazid resistant (INHr) Mycobacterium tuberculosis (Mtb) strains. Although isoniazid resistance in Mtb is multigenic, mutations in the catalase-peroxidase (katG) gene predominate among the INHr strains. The effect of these drug-resistance-conferring mutations on Mtb fitness and virulence is variable. Here, we assessed differences in bacterial growth, immune response and pathology induced by Mtb strains harboring mutations at the N-terminus of the katG gene. We studied one laboratory and one clinically isolated Mtb clonal pair from different genetic lineages. The INHr strain in each pair had one and two katG mutations with significantly reduced levels of the enzyme and peroxidase activity. Both strains share the V1A mutation, while the double mutant clinical INHr had also the novel E3V katG mutation. Four groups of C57BL/6 mice were infected with one of the Mtb strains previously described. We observed a strong reduction in virulence (reduced bacterial growth), lower induction of proinflammatory cytokines and significantly reduced pathology scores in mice infected with the clinical INHr strain compared to the infection caused by its INHs progenitor strain. On the other hand, there was a subtle reduction of bacteria growth without differences in the pathology scores in mice infected with the laboratory INHr strain. Our results also showed distinct alkyl-hydroperoxidase C (AhpC) levels in the katG mutant strains, which could explain the difference in the virulence profile observed. The difference in the AhpC levels between clonal strains was not related to a genetic defect in the gene or its promoter. Cumulatively, our results indicate that the virulence, pathology and fitness of INHr strains could be negatively affected by multiple mutations in katG, lack of the peroxidase activity and reduced AhpC levels.
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Affiliation(s)
- Luisa Maria Nieto R
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, United States of America
| | - Carolina Mehaffy
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, United States of America
| | - Elizabeth Creissen
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, United States of America
| | - JoLynn Troudt
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, United States of America
| | - Amber Troy
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, United States of America
| | - Helle Bielefeldt-Ohmann
- School of Veterinary Science, University of Queensland, Gatton, Queensland, Australia; Australian Infectious Diseases Research Centre, University of Queensland, St Lucia, Queensland, Australia
- School of Chemistry and Molecular Biosciences, University of Queensland, St Lucia, Queensland, Australia
| | - Marcos Burgos
- Division of Infectious Diseases, Department of Medicine, University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Angelo Izzo
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, United States of America
| | - Karen M. Dobos
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, United States of America
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Mitnick CD, White RA, Lu C, Rodriguez CA, Bayona J, Becerra MC, Burgos M, Centis R, Cohen T, Cox H, D'Ambrosio L, Danilovitz M, Falzon D, Gelmanova IY, Gler MT, Grinsdale JA, Holtz TH, Keshavjee S, Leimane V, Menzies D, Migliori GB, Milstein MB, Mishustin SP, Pagano M, Quelapio MI, Shean K, Shin SS, Tolman AW, van der Walt ML, Van Deun A, Viiklepp P. Multidrug-resistant tuberculosis treatment failure detection depends on monitoring interval and microbiological method. Eur Respir J 2016; 48:1160-1170. [PMID: 27587552 PMCID: PMC5045442 DOI: 10.1183/13993003.00462-2016] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 06/03/2016] [Indexed: 11/12/2022]
Abstract
Debate persists about monitoring method (culture or smear) and interval (monthly or less frequently) during treatment for multidrug-resistant tuberculosis (MDR-TB). We analysed existing data and estimated the effect of monitoring strategies on timing of failure detection. We identified studies reporting microbiological response to MDR-TB treatment and solicited individual patient data from authors. Frailty survival models were used to estimate pooled relative risk of failure detection in the last 12 months of treatment; hazard of failure using monthly culture was the reference. Data were obtained for 5410 patients across 12 observational studies. During the last 12 months of treatment, failure detection occurred in a median of 3 months by monthly culture; failure detection was delayed by 2, 7, and 9 months relying on bimonthly culture, monthly smear and bimonthly smear, respectively. Risk (95% CI) of failure detection delay resulting from monthly smear relative to culture is 0.38 (0.34–0.42) for all patients and 0.33 (0.25–0.42) for HIV-co-infected patients. Failure detection is delayed by reducing the sensitivity and frequency of the monitoring method. Monthly monitoring of sputum cultures from patients receiving MDR-TB treatment is recommended. Expanded laboratory capacity is needed for high-quality culture, and for smear microscopy and rapid molecular tests. Monthly culture monitoring is crucial to earlier detection of treatment failure in MDR-TB patientshttp://ow.ly/w2MI301mK8M
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Affiliation(s)
- Carole D Mitnick
- Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA Partners in Health, Boston, MA, USA
| | - Richard A White
- Dept of Infectious Disease Epidemiology, Norwegian Institute of Public Health, Oslo, Norway Dept of Health Statistics, Norwegian Institute of Public Health, Oslo, Norway
| | - Chunling Lu
- Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, USA
| | - Carly A Rodriguez
- Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | | | - Mercedes C Becerra
- Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA Partners in Health, Boston, MA, USA Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, USA
| | - Marcos Burgos
- Dept of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Rosella Centis
- WHO Collaborating Centre for TB and Lung Diseases, Fondazione S. Maugeri, Care and Research Institute, Tradate, Italy
| | - Theodore Cohen
- Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Helen Cox
- Médecins Sans Frontières, Cape Town, South Africa
| | - Lia D'Ambrosio
- WHO Collaborating Centre for TB and Lung Diseases, Fondazione S. Maugeri, Care and Research Institute, Tradate, Italy Public Health Consulting Group, Lugano, Switzerland
| | | | - Dennis Falzon
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | | | | | - Jennifer A Grinsdale
- Tuberculosis Control, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Timothy H Holtz
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Salmaan Keshavjee
- Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA Partners in Health, Boston, MA, USA Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, USA
| | - Vaira Leimane
- State Agency for Tuberculosis and Lung Diseases (TPSVA), Riga, Latvia
| | - Dick Menzies
- Montreal Chest Institute, McGill University, Montreal, QC, Canada
| | - Giovanni Battista Migliori
- WHO Collaborating Centre for TB and Lung Diseases, Fondazione S. Maugeri, Care and Research Institute, Tradate, Italy
| | - Meredith B Milstein
- Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | | | - Marcello Pagano
- Dept of Biostatistics, Harvard School of Public Health, Boston, MA, USA
| | - Maria I Quelapio
- Tropical Disease Foundation, Philippine Institute of Tuberculosis, Makati City, Philippines
| | - Karen Shean
- Lung Infection and Immunity Unit, Division of Pulmonology and UCT Lung Institute, Dept of Medicine, University of Cape Town, Cape Town, South Africa
| | - Sonya S Shin
- Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA Partners in Health, Boston, MA, USA Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, USA Socios en Salud Sucursal, Lima, Peru
| | - Arielle W Tolman
- Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Martha L van der Walt
- South African Medical Research Council, Tuberculosis Research Platform, Pretoria, South Africa
| | | | - Piret Viiklepp
- National Institute for Heath Development, Tallinn, Estonia
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Ticona E, Huaman MA, Huaroto LM, Burgos M, Brett M, Escombe R, Moore DAJ. Tuberculosis screening using ability to provide sputum in an endemic emergency department. Eur Respir J 2016; 47:330-3. [PMID: 26493789 PMCID: PMC4703042 DOI: 10.1183/13993003.00877-2015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 09/10/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Eduardo Ticona
- Infectious Diseases and Tropical Medicine Service, Dept of Medical Specialties, Hospital Nacional Dos de Mayo, Lima, Peru Dept of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Moises A Huaman
- Division of Infectious Diseases, Dept of Medicine, University of Kentucky, Lexington, KY, USA
| | - Luz Maria Huaroto
- Infectious Diseases and Tropical Medicine Service, Dept of Medical Specialties, Hospital Nacional Dos de Mayo, Lima, Peru Dept of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Marcos Burgos
- Division of Infectious Diseases, Dept of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Meghan Brett
- Division of Infectious Diseases, Dept of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Rod Escombe
- TB Centre and Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - David A J Moore
- TB Centre and Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
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Escudero D, Valentín MO, Escalante JL, Sanmartín A, Perez-Basterrechea M, de Gea J, Martín M, Velasco J, Pont T, Masnou N, de la Calle B, Marcelo B, Lebrón M, Pérez JM, Burgos M, Gimeno R, Kot P, Yus S, Sancho I, Zabalegui A, Arroyo M, Miñambres E, Elizalde J, Montejo JC, Domínguez-Gil B, Matesanz R. Intensive care practices in brain death diagnosis and organ donation. Anaesthesia 2015; 70:1130-9. [PMID: 26040194 DOI: 10.1111/anae.13065] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2015] [Indexed: 12/30/2022]
Abstract
We conducted a multicentre study of 1844 patients from 42 Spanish intensive care units, and analysed the clinical characteristics of brain death, the use of ancillary testing, and the clinical decisions taken after the diagnosis of brain death. The main cause of brain death was intracerebral haemorrhage (769/1844, 42%), followed by traumatic brain injury (343/1844, 19%) and subarachnoid haemorrhage (257/1844, 14%). The diagnosis of brain death was made rapidly (50% in the first 24 h). Of those patients who went on to die, the Glasgow Coma Scale on admission was ≤ 8/15 in 1146/1261 (91%) of patients with intracerebral haemorrhage, traumatic brain injury or anoxic encephalopathy; the Hunt and Hess Scale was 4-5 in 207/251 (83%) of patients following subarachnoid haemorrhage; and the National Institutes of Health Stroke Scale was ≥ 15 in 114/129 (89%) of patients with strokes. Brain death was diagnosed exclusively by clinical examination in 92/1844 (5%) of cases. Electroencephalography was the most frequently used ancillary test (1303/1752, 70.7%), followed by transcranial Doppler (652/1752, 37%). Organ donation took place in 70% of patients (1291/1844), with medical unsuitability (267/553, 48%) and family refusal (244/553, 13%) the main reasons for loss of potential donors. All life-sustaining measures were withdrawn in 413/553 of non-donors (75%).
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Affiliation(s)
- D Escudero
- Intensive Care Unit, Central University Hospital of Asturias, Oviedo, Spain
| | - M O Valentín
- Spanish National Transplant Organization (ONT), Madrid, Spain
| | - J L Escalante
- Intensive Care Unit, Gregorio Marañón University Hospital, Madrid, Spain
| | - A Sanmartín
- Intensive Care Unit, Virgen de la Arrixaca Hospital, Murcia, Spain
| | - M Perez-Basterrechea
- Unit of Transplants, Cell Therapy and Regenerative Medicine, Central University Hospital of Asturias, Oviedo, Spain
| | - J de Gea
- Intensive Care Unit, Virgen de la Arrixaca Hospital, Murcia, Spain
| | - M Martín
- Intensive Care Unit, Central University Hospital of Asturias, Oviedo, Spain
| | - J Velasco
- Intensive Care Unit, Son Espases University Hospital, Palma de Mallorca, Spain
| | - T Pont
- Intensive Care Unit, Vall D'Hebron Hospital, Barcelona, Spain
| | - N Masnou
- Intensive Care Unit, Vall D'Hebron Hospital, Barcelona, Spain
| | - B de la Calle
- Intensive Care Unit, Gregorio Marañón University Hospital, Madrid, Spain
| | - B Marcelo
- Intensive Care Unit, Infanta Cristina University Hospital, Badajoz, Spain
| | - M Lebrón
- Intensive Care Unit, Carlos Haya Hospital, Málaga, Spain
| | - J M Pérez
- Intensive Care Unit, Virgen de las Nieves University Hospital, Granada, Spain
| | - M Burgos
- Intensive Care Unit, Virgen de las Nieves University Hospital, Granada, Spain
| | - R Gimeno
- Intensive Care Unit, La Fe University Hospital, Valencia, Spain
| | - P Kot
- Intensive Care Unit, La Paz University Hospital, Madrid, Spain
| | - S Yus
- Intensive Care Unit, La Paz University Hospital, Madrid, Spain
| | - I Sancho
- Intensive Care Unit, Miguel Servet University Hospital, Zaragoza, Spain
| | - A Zabalegui
- Intensive Care Unit, General Yagüe Hospital, Burgos, Spain
| | - M Arroyo
- Intensive Care Unit, General Yagüe Hospital, Burgos, Spain
| | - E Miñambres
- Intensive Care Unit, Marqués de Valdecilla University Hospital, Santander, Spain
| | - J Elizalde
- Intensive Care Unit, Asistential Complex of Navarra, Pamplona, Spain
| | - J C Montejo
- Intensive Care Unit, 12 de Octubre University Hospital, Madrid, Spain
| | - B Domínguez-Gil
- Spanish National Transplant Organization (ONT), Madrid, Spain
| | - R Matesanz
- Spanish National Transplant Organization (ONT), Madrid, Spain
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Nunn AJ, Cook SV, Burgos M, Rigouts L, Yorke-Edwards V, Anyo G, Kim SJ, Enarson DA, Jindani A, Lienhardt C. Results at 30 months of a randomised trial of FDCs and separate drugs for the treatment of tuberculosis. Int J Tuberc Lung Dis 2015; 18:1252-4. [PMID: 25216842 DOI: 10.5588/ijtld.14.0281] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Study C was an open-label, non-inferiority, randomised controlled trial of fixed-dose combination (FDC) or separate drugs given during the intensive phase of treatment to 1585 patients with smear-positive pulmonary tuberculosis conducted at 11 sites in Africa, Asia and Latin America. Thirty months post-randomisation, the failure/relapse rates in the per protocol population were 7.4% of 591 patients on FDCs and 6.5% of 587 patients on separate drugs; the site-adjusted difference was 0.3% (90%CI -1.8 to 2.3). In the modified intention-to-treat analysis, the corresponding results were respectively 17.9% of 683 and 16.1% of 671; the site-adjusted difference was 2.0% (90%CI -1.2 to 5.2).
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Affiliation(s)
- A J Nunn
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - S V Cook
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - M Burgos
- Division of Infectious Diseases, Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - L Rigouts
- Mycobacteriology Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | - V Yorke-Edwards
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - G Anyo
- American Society for Microbiology, Washington DC, USA
| | - S-J Kim
- Korean Institute of Tuberculosis, Osong, South Korea
| | - D A Enarson
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - A Jindani
- Department of Cellular and Molecular Medicine, St George's, University of London, London, UK
| | - C Lienhardt
- Stop TB Partnership, World Health Organization, Geneva, Switzerland
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Ejo M, Gehre F, Barry MD, Sow O, Bah NM, Camara M, Bah B, Uwizeye C, Nduwamahoro E, Fissette K, De Rijk P, Merle C, Olliaro P, Burgos M, Lienhardt C, Rigouts L, de Jong BC. First insights into circulating Mycobacterium tuberculosis complex lineages and drug resistance in Guinea. Infect Genet Evol 2015; 33:314-9. [PMID: 26004194 PMCID: PMC4503999 DOI: 10.1016/j.meegid.2015.05.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/19/2015] [Accepted: 05/20/2015] [Indexed: 11/23/2022]
Abstract
First insight into resistance levels and genetic diversity of TB in Guinea. Rapid expansion of drug-resistance prone LAM10 Cameroon family. Population structure reveals less ‘ancestral’ TB than in surrounding countries. Knowledge of genetic diversity is relevant for tuberculosis control programs.
In this study we assessed first-line anti-tuberculosis drug resistance and the genotypic distribution of Mycobacterium tuberculosis complex (MTBC) isolates that had been collected from consecutive new tuberculosis patients enrolled in two clinical trials conducted in Guinea between 2005 and 2010. Among the total 359 MTBC strains that were analyzed in this study, 22.8% were resistant to at least one of the first line anti-tuberculosis drugs, including 2.5% multidrug resistance and 17.5% isoniazid resistance, with or without other drugs. In addition, further characterization of isolates from a subset of the two trials (n = 184) revealed a total of 80 different spoligotype patterns, 29 “orphan” and 51 shared patterns. We identified the six major MTBC lineages of human relevance, with predominance of the Euro-American lineage. In total, 132 (71.7%) of the strains were genotypically clustered, and further analysis (using the DESTUS model) suggesting significantly faster spread of LAM10_CAM family (p = 0.00016). In conclusion, our findings provide a first insight into drug resistance and the population structure of the MTBC in Guinea, with relevance for public health scientists in tuberculosis control programs.
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Affiliation(s)
- Mebrat Ejo
- Institute of Tropical Medicine (ITM), Antwerp, Belgium; University of Gondar, Gondar, Ethiopia
| | - Florian Gehre
- Institute of Tropical Medicine (ITM), Antwerp, Belgium; Medical Research Council (MRC), Fajara, Gambia.
| | | | - Oumou Sow
- Reference Laboratory for Mycobacteria, Conakry, Guinea; National University Hospital IgnaceDeen, Conakry, Guinea
| | | | - Mory Camara
- Reference Laboratory for Mycobacteria, Conakry, Guinea
| | - Boubacar Bah
- National University Hospital IgnaceDeen, Conakry, Guinea
| | | | | | | | - Pim De Rijk
- Institute of Tropical Medicine (ITM), Antwerp, Belgium
| | - Corinne Merle
- London School of Hygiene and Tropical Medicine, London, UK; UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), Geneva, Switzerland
| | - Piero Olliaro
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), Geneva, Switzerland; Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Marcos Burgos
- Division of Infectious Diseases, Department of Internal Medicine, University of New Mexico, Albuquerque, United States
| | - Christian Lienhardt
- Clinical Trial Division, International Union against Tuberculosis and Lung Disease, Paris, France; World Health Organization, Geneva, Switzerland
| | - Leen Rigouts
- Institute of Tropical Medicine (ITM), Antwerp, Belgium; University of Antwerp, Antwerp, Belgium
| | - Bouke C de Jong
- Institute of Tropical Medicine (ITM), Antwerp, Belgium; Medical Research Council (MRC), Fajara, Gambia; New York University (NYU), New York, United States
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Burgos M, Sierra A, Ortega T, Forja JM. Anthropogenic effects on greenhouse gas (CH4 and N2O) emissions in the Guadalete River Estuary (SW Spain). Sci Total Environ 2015; 503-504:179-189. [PMID: 24993513 DOI: 10.1016/j.scitotenv.2014.06.038] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [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: 04/15/2014] [Revised: 06/02/2014] [Accepted: 06/10/2014] [Indexed: 06/03/2023]
Abstract
Coastal areas are subject to a great anthropogenic pressure because more than half of the world's population lives in its vicinity causing organic matter inputs, which intensifies greenhouse gas emissions into the atmosphere. Dissolved concentrations of CH4 and N2O have been measured seasonally during 2013 in the Guadalete River Estuary, which flows into the Cadiz Bay (southwestern Spanish coast). It has been intensely contaminated since 1970. Currently it receives wastewater effluents from cities and direct discharges from nearby agriculture crop. Eight sampling stations have been established along 18 km of the estuary. CH4 and N2O were measured using a gas chromatograph connected to an equilibration system. Additional parameters such as organic matter, dissolved oxygen, nutrients and chlorophyll were determinate as well, in order to understand the relationship between physicochemical and biological processes. Gas concentrations increased from the River mouth toward the inner part, closer to the wastewater treatment plant discharge. Values varied widely within 21.8 and 3483.4 nM for CH4 and between 9.7 and 147.6 nM for N2O. Greenhouse gas seasonal variations were large influenced by the precipitation regime, masking the temperature influence. The Guadatete Estuary acted as a greenhouse gas source along the year, with mean fluxes of 495.7 μmol m(-2)d(-1) and 92.8 μmol m(-2)d(-1) for CH4 and N2O, respectively.
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Affiliation(s)
- M Burgos
- Dpto. Química-Física, CACYTMAR, Universidad de Cádiz, Campus Río San Pedro, s/n, Puerto Real, Cádiz, Spain
| | - A Sierra
- Dpto. Química-Física, CACYTMAR, Universidad de Cádiz, Campus Río San Pedro, s/n, Puerto Real, Cádiz, Spain
| | - T Ortega
- Dpto. Química-Física, CACYTMAR, Universidad de Cádiz, Campus Río San Pedro, s/n, Puerto Real, Cádiz, Spain
| | - J M Forja
- Dpto. Química-Física, CACYTMAR, Universidad de Cádiz, Campus Río San Pedro, s/n, Puerto Real, Cádiz, Spain
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Ysrraelit C, Caceres F, Villa A, Marcilla MP, Blanche J, Burgos M, Parera IC, Colombo O, Crespo E, Deri N, Labal P, Maluendez M, Martinez A, Melcon M, Nofal P, Reich E, Sinay V, Tarulla A, Vetere S, Barboza A, Rey R, Moreno M, Bacile A, Rojas JI, Kuperman G, Resk M, Seifer G, Machinicki G, Cuneo J. ENCOMS: Argentinian survey in cost of illness and unmet needs in multiple sclerosis. Arq Neuropsiquiatr 2014; 72:337-43. [PMID: 24863508 DOI: 10.1590/0004-282x20140016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 02/10/2014] [Indexed: 11/22/2022]
Abstract
UNLABELLED The objective of the study was to assess the cost of multiple sclerosis (MS) patients in Argentina categorized by disease severity using a societal perspective. METHOD Cross-sectional study including MS patients from 21 MS centers in 12 cities of Argentina. Patients were stratified by disease severity using the expanded disability status scale (EDSS) (group 1 with EDSS score between 0 and 3; group 2 with EDSS >3 and <7; group 3 with EDSS ≥7). Direct and indirect costs were analyzed for the second quarter of 2012 from public sources and converted to US Dollars. RESULTS 266 patients were included. Mean annual cost per MS patient was USD 36,025 (95%CI 31,985-38,068) for patients with an EDSS between 0-3; USD 40,705 (95%CI 37,199-46,300) for patients with EDSS >3 and <7, and USD 50,712 (95%CI 47,825-62,104) for patients with EDSS ≥7. CONCLUSIONS This is the first Argentine study evaluating the costs of MS considering disease severity.
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Affiliation(s)
| | - Fernando Caceres
- Instituto Neurociencias de Buenos Aires, Buenos Aires, Argentina
| | | | | | | | | | | | | | | | - Norma Deri
- Hospital Fernandez, Buenos Aires, Argentina
| | | | | | | | | | - Pedro Nofal
- Centro Regional Integral de Neurociencia, Argentina
| | | | | | | | | | | | - Roberto Rey
- Instituto Argentino de Investigación Neurologica, Buenos Aires, Argentina
| | | | | | - Juan I Rojas
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Fali T, Renaudineau Y, Burgos M, Bariller E, Jousse S, Saraux A, Hanrotel C, Cornec D, Jamin C, Mignen O, Pers JO. A3.20 The calcium sensor stromal interaction molecule 1 (STIM1) controls regulatory B cell functions and its activity is impaired in Systemic Lupus Erythematosus patients. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2013-205124.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Castellano G, Cafiero C, Divella C, Sallustio F, Gigante M, Gesualdo L, Kirsch AH, Smaczny N, Riegelbauer V, Sedej S, Hofmeister A, Stojakovic T, Brodmann M, Pilger E, Rosenkranz A, Eller K, Eller P, Meier P, Lucisano S, Arena A, Donato V, Fazio MR, Santoro D, Buemi M, Wornle M, Ribeiro A, Koppel S, Pircher J, Czermak T, Merkle M, Rupanagudi K, Kulkarni OP, Lichtnekert J, Darisipudi MN, Mulay SR, Schott B, Hartmann G, Anders HJ, Pletinck A, Glorieux G, Schepers E, Van Landschoot M, Eloot S, Van Biesen W, Vanholder R, Castoldi A, Oliveira V, Amano M, Aguiar C, Caricilli A, Vieira P, Burgos M, Hiyane M, Festuccia W, Camara N, Djudjaj S, Rong S, Lue H, Bajpai A, Klinkhammer B, Moeller M, Floege J, Bernhagen J, Ostendorf T, Boor P, Wornle M, Ribeiro A, Koppel S, Merkle M, Ito S, Aoki R, Hamada K, Edamatsu T, Itoh Y, Osaka M, Yoshida M, Oliva E, Maritati F, Palmisano A, Alberici F, Buzio C, Vaglio A, Grabulosa C, Cruz E, Carvalho J, Manfredi S, Canziani M, Cuppari L, Quinto B, Batista M, Cendoroglo M, Dalboni M, Wornle M, Ribeiro A, Merkle M, Niemir Z, Swierzko A, Polcyn-Adamczak M, Cedzynski M, Sokolowska A, Szala A, Baudoux T, Hougardy JM, Pozdzik A, Antoine MH, Husson C, De Prez E, Nortier J, Ni HF, Chen JF, Zhang MH, Pan MM, Liu BC, Machcinska M, Bocian K, Korczak-Kowalska G, Tami Amano M, Castoldi A, Andrade-Oliveira V, da Silva M, Miyagi MYS, Olsen Camara N, Xu L, Jin Y, Zhong F, Liu J, Dai Q, Wang W, Chen N, Grosjean F, Tribioli C, Esposito V, Catucci D, Azar G, Torreggiani M, Merlini G, Esposito C, Fell LH, Zawada AM, Rogacev KS, Seiler S, Fliser D, Heine GH, Neprintseva N, Tchebotareva N, Bobkova I, Kozlovskaya L, Virzi GM, Brocca A, de Cal M, Bolin C, Vescovo G, Ronco C, Fuchs A, Eidenschink K, Steege A, Fellner C, Bollheimer C, Gronwald W, Schroeder J, Banas B, Banas MC, Zawada AM, Luthe A, Seiler SS, Rogacev K, Fliser D, Heine GH, Trimboli D, Graziani G, Haroche J, Lupica R, Fazio MR, Lucisano S, Donato V, Cernaro V, Montalto G, Pettinato G, Buemi M, Cho E, Lee JW, Kim MG, Jo SK, Cho WY, kim HK. Immune and inflammatory mechanisms. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Gonads are the only organs with 2 possible developmental pathways, testis or ovary. A consequence of this unique feature is that mutations in genes controlling gonad development give rise not only to gonadal malformation or dysfunction but also to frequent cases of sex reversal, including XY females, XX males and intersexes. Most of our current knowledge on mammalian sex determination, the genetic process by which the gonadal primordia are committed to differentiate as either testes or ovaries, has derived mainly from the study of sex-reversed mice obtained by direct genetic manipulation. However, there are also numerous cases of natural exceptions to normal gonad development which have been described in a variety of mammals, including both domestic and wild species. Here, we review the most relevant cases of: (1) natural, non-induced sex reversal and intersexuality described in laboratory rodents, including Sxr and B6-Y(DOM) mice; (2) sex reversal in domestic animals, including freemartinism in bovids and pigs, XX sex reversal in pigs, goats and dogs, XY sex reversal in the horse, and sex chromosome chimerism and sex reversal in the cat, and (3) sex reversal in wild mammals, including the generalised true hermaphroditism described in talpid moles, XY sex reversal in Akodon, Microtus and Dicrostonyx species, males lacking a Y chromosome and SRY in Ellobius lutescens, the X* chromosome of Myopus schisticolor, and sex chromosome mosaicism and X0 females in Microtus oregoni. These studies are necessary to elucidate particular aspects of mammalian gonad development in some instances and to understand how the genetic mechanisms controlling gonad development have evolved.
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Affiliation(s)
- R Jiménez
- Departamento de Genética e Instituto de Biotecnología, Universidad de Granada, Laboratorio 127 CIBM, Centro de Investigación Biomédica, ES–18100 Armilla, Granada, Spain.
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50
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Ahuja SD, Ashkin D, Avendano M, Banerjee R, Bauer M, Bayona JN, Becerra MC, Benedetti A, Burgos M, Centis R, Chan ED, Chiang CY, Cox H, D'Ambrosio L, DeRiemer K, Dung NH, Enarson D, Falzon D, Flanagan K, Flood J, Garcia-Garcia ML, Gandhi N, Granich RM, Hollm-Delgado MG, Holtz TH, Iseman MD, Jarlsberg LG, Keshavjee S, Kim HR, Koh WJ, Lancaster J, Lange C, de Lange WCM, Leimane V, Leung CC, Li J, Menzies D, Migliori GB, Mishustin SP, Mitnick CD, Narita M, O'Riordan P, Pai M, Palmero D, Park SK, Pasvol G, Peña J, Pérez-Guzmán C, Quelapio MID, Ponce-de-Leon A, Riekstina V, Robert J, Royce S, Schaaf HS, Seung KJ, Shah L, Shim TS, Shin SS, Shiraishi Y, Sifuentes-Osornio J, Sotgiu G, Strand MJ, Tabarsi P, Tupasi TE, van Altena R, Van der Walt M, Van der Werf TS, Vargas MH, Viiklepp P, Westenhouse J, Yew WW, Yim JJ. Multidrug resistant pulmonary tuberculosis treatment regimens and patient outcomes: an individual patient data meta-analysis of 9,153 patients. PLoS Med 2012; 9:e1001300. [PMID: 22952439 PMCID: PMC3429397 DOI: 10.1371/journal.pmed.1001300] [Citation(s) in RCA: 365] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 07/17/2012] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Treatment of multidrug resistant tuberculosis (MDR-TB) is lengthy, toxic, expensive, and has generally poor outcomes. We undertook an individual patient data meta-analysis to assess the impact on outcomes of the type, number, and duration of drugs used to treat MDR-TB. METHODS AND FINDINGS Three recent systematic reviews were used to identify studies reporting treatment outcomes of microbiologically confirmed MDR-TB. Study authors were contacted to solicit individual patient data including clinical characteristics, treatment given, and outcomes. Random effects multivariable logistic meta-regression was used to estimate adjusted odds of treatment success. Adequate treatment and outcome data were provided for 9,153 patients with MDR-TB from 32 observational studies. Treatment success, compared to failure/relapse, was associated with use of: later generation quinolones, (adjusted odds ratio [aOR]: 2.5 [95% CI 1.1-6.0]), ofloxacin (aOR: 2.5 [1.6-3.9]), ethionamide or prothionamide (aOR: 1.7 [1.3-2.3]), use of four or more likely effective drugs in the initial intensive phase (aOR: 2.3 [1.3-3.9]), and three or more likely effective drugs in the continuation phase (aOR: 2.7 [1.7-4.1]). Similar results were seen for the association of treatment success compared to failure/relapse or death: later generation quinolones, (aOR: 2.7 [1.7-4.3]), ofloxacin (aOR: 2.3 [1.3-3.8]), ethionamide or prothionamide (aOR: 1.7 [1.4-2.1]), use of four or more likely effective drugs in the initial intensive phase (aOR: 2.7 [1.9-3.9]), and three or more likely effective drugs in the continuation phase (aOR: 4.5 [3.4-6.0]). CONCLUSIONS In this individual patient data meta-analysis of observational data, improved MDR-TB treatment success and survival were associated with use of certain fluoroquinolones, ethionamide, or prothionamide, and greater total number of effective drugs. However, randomized trials are urgently needed to optimize MDR-TB treatment. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Shama D. Ahuja
- Bureau of Tuberculosis, New York, New York, United States of America
| | - David Ashkin
- A.G. Holley Hospital, Lantana, Florida, United States of America
| | | | - Rita Banerjee
- Mayo Clinic, Rochester, Minnesota, United States of America
| | - Melissa Bauer
- Montreal Chest Institute, McGill University, Montreal, Canada
| | - Jamie N. Bayona
- The Dartmouth Center for Health Care Delivery Science, Hanover, New Hampshire, United States of America
| | - Mercedes C. Becerra
- Harvard Medical School, Boston, Massachusetts, United States of America
- Partners in Health, Boston, Massachusetts, United States of America
| | | | - Marcos Burgos
- University of New Mexico School of Medicine, Albuquerque, New Mexico, United States of America
| | - Rosella Centis
- WHO Collaborating Centre for TB and Lung Diseases, Care and Research Institute, Fondazione S. Maugeri, Tradate, Italy
| | - Eward D. Chan
- Denver Veterans Affair Medical Center, Denver, Colorado, United States of America
| | - Chen-Yuan Chiang
- Wan Fang Hospital, School of Medicine-Taipei Medical University, Taiwan
| | - Helen Cox
- Médecins Sans Frontières, Capetown, South Africa
| | - Lia D'Ambrosio
- WHO Collaborating Centre for TB and Lung Diseases, Care and Research Institute, Fondazione S. Maugeri, Tradate, Italy
| | - Kathy DeRiemer
- UC Davis School of Medicine, Davis, California, United States of America
| | | | - Donald Enarson
- International Union against Tuberculosis and Lung Disease, Paris, France
| | | | | | - Jennifer Flood
- California Department of Public Health, Sacramento, California, United States of America
| | | | - Neel Gandhi
- Albert Einstein College of Medicine, Bronx, New York, United States of America
| | | | | | | | | | - Leah G. Jarlsberg
- University of California, San Francisco, San Francisco, United States of America
| | - Salmaan Keshavjee
- Harvard Medical School, Boston, Massachusetts, United States of America
| | | | | | - Joey Lancaster
- South African Medical Research Council, Pretoria, South Africa
| | | | | | - Vaira Leimane
- Clinic of Tuberculosis and Lung Diseases, Riga, Latvia
| | | | - Jiehui Li
- New York City Health and Mental Hygiene, New York, New York, United States of America
| | - Dick Menzies
- Montreal Chest Institute, McGill University, Montreal, Canada
- * E-mail:
| | - Giovanni B. Migliori
- WHO Collaborating Centre for TB and Lung Diseases, Care and Research Institute, Fondazione S. Maugeri, Tradate, Italy
| | | | - Carole D. Mitnick
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Masa Narita
- University of Washington, Seattle, Washington, United States of America
| | | | - Madhukar Pai
- Montreal Chest Institute, McGill University, Montreal, Canada
| | | | | | | | - Jose Peña
- Universidad Autonoma Madrid, Madrid, Spain
| | | | | | - Alfredo Ponce-de-Leon
- Instituto Nacional de Ciencias Médicas y de Nutrición “Salvador Zubirán”, Mexico, Mexico
| | | | | | - Sarah Royce
- University of California, San Francisco, San Francisco, United States of America
| | | | - Kwonjune J. Seung
- Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Lena Shah
- Montreal Chest Institute, McGill University, Montreal, Canada
| | - Tae Sun Shim
- University of Ulsan College of Medicine, Seoul, Korea
| | - Sonya S. Shin
- Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | | | - José Sifuentes-Osornio
- Instituto Nacional de Ciencias Médicas y de Nutrición “Salvador Zubirán”, Mexico, Mexico
| | | | | | | | | | | | | | | | - Mario H. Vargas
- Instituto Nacional de Enfermedades Respiratorias, Mexico, Mexico
| | | | - Janice Westenhouse
- Center for Infectious Diseases-California Department of Public Health, Sacramento, California, United States of America
| | | | - Jae-Joon Yim
- Seoul National University College of Medicine, Seoul, Korea
| | - Collaborative Group for Meta-Analysis of Individual Patient Data in MDR-TBAhujaShama D.Bureau of Tuberculosis, New York, New York, United States of AmericaAshkinDavidA.G. Holley Hospital, Lantana, Florida, United States of AmericaAvendanoMonikaUniversity of Toronto, Toronto, Canada,BanerjeeRitaMayo Clinic, Rochester, Minnesota, United States of AmericaBauerMelissaMontreal Chest Institute, McGill University, Montreal, CanadaBayonaJamie N.The Dartmouth Center for Health Care Delivery Science, Hanover, New Hampshire, United States of AmericaBecerraMercedes C.Harvard Medical School, Boston, Massachusetts, United States of America; Partners in Health, Boston, Massachusetts, United States of AmericaBenedettiAndreaMontreal Chest Institute, McGill University, Montreal, CanadaBurgosMarcosUniversity of New Mexico School of Medicine, Albuquerque, New Mexico, United States of AmericaCentisRosellaWHO Collaborating Centre for TB and Lung Diseases, Care and Research Institute, Fondazione S. Maugeri, Tradate, ItalyChanEward D.Denver Veterans Affair Medical Center, Denver, Colorado, United States of AmericaChiangChen-YuanWan Fang Hospital, School of Medicine-Taipei Medical University, TaiwanCoxHelenMédecins Sans Frontières, Capetown, South AfricaD'AmbrosioLiaWHO Collaborating Centre for TB and Lung Diseases, Care and Research Institute, Fondazione S. Maugeri, Tradate, ItalyDeRiemerKathyUC Davis School of Medicine, Davis, California, United States of AmericaDungNguyen HuyNational TB Control Program, Hanoi, VietnamEnarsonDonaldInternational Union against Tuberculosis and Lung Disease, Paris, FranceFalzonDennisWorld Health Organization, Geneva, SwitzerlandFlanaganKatherineMRC Laboratories, Banjul, The GambiaFloodJenniferCalifornia Department of Public Health, Sacramento, California, United States of AmericaGarcia-GarciaMaria L.Instituto Nacional de Salud Pública, Mexico, MexicoGandhiNeelAlbert Einstein College of Medicine, Bronx, New York, United States of AmericaGranichReuben M.World Health Organization, Geneva, SwitzerlandHollm-DelgadoMaria G.Montreal Chest Institute, McGill University, Montreal, CanadaHoltzTimothy H.Thailand MOPH & US CDC Collaboration, Bangkok, ThailandIsemanMichael D.National Jewish Health, Denver, Colorado, United States of AmericaJarlsbergLeah G.University of California, San Francisco, San Francisco, United States of AmericaKeshavjeeSalmaanHarvard Medical School, Boston, Massachusetts, United States of AmericaKimHye-RyounKorea Cancer Center Hospital, Seoul, KoreaKohWon-JungSamsung Medical Center, Seoul, KoreaLancasterJoeySouth African Medical Research Council, Pretoria, South AfricaLangeChristopheMedical Clinic, Tuberculosis Center Borstel, Borstel, Germanyde LangeWiel C. M.University Medical Center Groningen, Groningen, The NetherlandsLeimaneVairaClinic of Tuberculosis and Lung Diseases, Riga, LatviaLeungChi ChiuTuberculosis and Chest Services, Hong KongLiJiehuiNew York City Health and Mental Hygiene, New York, New York, United States of AmericaMenziesDickMontreal Chest Institute, McGill University, Montreal, CanadaMiglioriGiovanni B.WHO Collaborating Centre for TB and Lung Diseases, Care and Research Institute, Fondazione S. Maugeri, Tradate, ItalyMishustinSergey P.Tomsk Oblast Tuberculosis Dispensary, Tomsk, RussiaMitnickCarole D.Harvard Medical School, Boston, Massachusetts, United States of AmericaNaritaMasaUniversity of Washington, Seattle, Washington, United States of AmericaO'RiordanPhillyCity Road Medical Centre, London, United KingdomPaiMadhukarMontreal Chest Institute, McGill University, Montreal, CanadaPalmeroDomingoHospital F.J. Muñiz, Buenos Aires, ArgentinaParkSeung-kyuTB Center, Seoul, KoreaPasvolGeoffreyImperial College London, London, United KingdomPeñaJoseUniversidad Autonoma Madrid, Madrid, SpainPérez-GuzmánCarlosInstituto de Salud del Estado de Aguascalientes, Mexico, MexicoQuelapioMaria I. D.Tropical Disease Foundation, Makati City, PhilippinesPonce-de-LeonAlfredoInstituto Nacional de Ciencias Médicas y de Nutrición “Salvador Zubirán”, Mexico, MexicoRiekstinaVijaClinic of Tuberculosis and Lung Diseases, Riga, LatviaRobertJeromeBactériologie-Hygiène – UPMC, Paris, FranceRoyceSarahUniversity of California, San Francisco, San Francisco, United States of AmericaSchaafH. SimonStellenbosch University, Stellenbosch, South AfricaSeungKwonjune J.Brigham and Women's Hospital, Boston, Massachusetts, United States of AmericaShahLenaMontreal Chest Institute, McGill University, Montreal, CanadaShimTae SunUniversity of Ulsan College of Medicine, Seoul, KoreaShinSonya S.Brigham and Women's Hospital, Boston, Massachusetts, United States of AmericaShiraishiYujiFukujuji Hospital, Tokyo, JapanSifuentes-OsornioJoséInstituto Nacional de Ciencias Médicas y de Nutrición “Salvador Zubirán”, Mexico, MexicoSotgiuGiovanniUniversity of Sassari, Sassari, ItalyStrandMatthew J.National Jewish Health, Denver, Colorado, United States of AmericaTabarsiPayamShaheed Beheshti Medical University, Tehran, IranTupasiThelma E.Tropical Disease Foundation, Makati City, Philippinesvan AltenaRobertUniversity Medical Center Groningen, Groningen, The NetherlandsVan der WaltMartieSouth African Medical Research Council, Pretoria, South AfricaVan der WerfTjip S.University Medical Center Groningen, Groningen, The NetherlandsVargasMario H.Instituto Nacional de Enfermedades Respiratorias, Mexico, MexicoViikleppPirettNational Institute for Health Development, Tallinn, EstoniaWestenhouseJaniceCenter for Infectious Diseases-California Department of Public Health, Sacramento, California, United States of AmericaYewWing WaiGrantham Hospital, Hong Kong
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