Infliximab seems to be the most efficacious of the three available anti-TNF agents for ulcerative colitis (UC) but little is known when it is used as the second anti-TNF.
To compare the clinical and ...treatment outcomes of a second subcutaneous or intravenous anti-TNF in UC patients.
Retrospective observational study.
Patients from the ENEIDA registry treated consecutively with infliximab and a subcutaneous anti-TNF (or vice versa), naïve to other biological agents, were identified and grouped according to the administration route of the first anti-TNF into IVi (intravenous initially) or SCi (subcutaneous initially).
Overall, 473 UC patients were included (330 IVi and 143 SCi). Clinical response at week 14 was 42.7% and 48.3% in the IVi and SCi groups (non-statistically significant), respectively. Clinical remission rates at week 52 were 32.8% and 31.4% in the IVi and SCi groups (nonsignificant differences), respectively. A propensity-matched score analysis showed a higher clinical response rate at week 14 in the SCi group and higher treatment persistence in the IVi group. Regarding long-term outcomes, dose escalation and discontinuation due to the primary failure of the first anti-TNF and more severe disease activity at the beginning of the second anti-TNF were inversely associated with clinical remission.
The use of a second anti-TNF for UC seems to be reasonable in terms of efficacy, although it is particularly reduced in the case of the primary failure of the first anti-TNF. Whether the second anti-TNF is infliximab or subcutaneous does not seem to affect efficacy.
Background Obesity hypoventilation syndrome (OHS) is associated with a high burden of cardiovascular morbidity (CVM) and mortality. The majority of patients with OHS have concomitant OSA, but there ...is a paucity of data on the association between CVM and OSA severity in patients with OHS. The objective of our study was to assess the association between CVM and OSA severity in a large cohort of patients with OHS. Methods In a cross-sectional analysis, we examined the association between OSA severity based on tertiles of oxygen desaturation index (ODI) and CVM in 302 patients with OHS. Logistic regression models were constructed to quantify the independent association between OSA severity and prevalent CVM after adjusting for various important confounders. Results The prevalence of CVM decreased significantly with increasing severity of OSA based on ODI as a continuous variable or ODI tertiles. This inverse relationship between OSA severity and prevalence of CVM was seen in the highest ODI tertile and it persisted despite adjustment for multiple confounders. Chronic heart failure had the strongest negative association with the highest ODI tertile. No significant CVM risk change was observed between the first and second ODI tertiles. Patients in the highest ODI tertile were younger, predominantly male, more obese, more hypersomnolent, had worse nocturnal and daytime gas exchange, lower prevalence of hypertension, better exercise tolerance, and fewer days hospitalized than patients in the lowest ODI tertile. Conclusions In patients with OHS, the highest OSA severity phenotype was associated with reduced risk of CVM. This finding should guide the design of future clinical trials assessing the impact of interventions aimed at decreasing cardiovascular morbidity and mortality in patients with OHS. Trial Registry Clinicaltrial.gov; No.: NCT01405976 ; URL: www.clinicaltrials.gov
Blood Viscosity in COVID-19 Patients With Sudden Deafness García-Callejo, Francisco Javier; Balaguer-García, Ramón; Lis-Sancerni, María Dolores ...
Acta otorrinolaringológica española,
2022 Mar-Apr, Letnik:
73, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Changes in blood viscoelastic properties have been proposed previosuly as etiopathogenesis for severe complications in COVID-19 and some cases of Sudden Deafness (SD). This is an attempt to verify if ...SD cases in patients admitted for SARS-Cov-2 infection can be correlated.
A prospective follow-up was carried out with COVID-19 patients, monitoring their blood viscosity (BV) at high shear rate (300 s−1) and inquiring them periodically for eventual hearing loss. This measurement was extended to cases bearing of SD in 2019 and 2020 without infection and a control group of healthy normoacoustic subjects.
The normality range was 4,16 ± 0,62 cps. 330 cases admitted for COVID-19 were evaluated from February 24th, 2020 to March 24th, 2021, 85 of them attended in ICU. After anamnesis and Audiometric Tone Thresholds developed as soon as possible, 9 SD were detected, all belonging to ICU group. The mean BV was 4,38 ± 0,43 cps in the ward group, 4,53 ± 0,39 cps in the ICU patients without SD, and 4,85 ± 0,52 cps in the cases with SD, with statistically significant differences. Highest BV elevations in the SD cases were detected between days 6 and 10 of hospital admission. In 2019 four cases consulted with SD, and another two did it in 2020 without a diagnosis of COVID-19, with normal BV values.
During SARS-Cov-2 infection, patients may show high BV and SS, although an inpatients control group and a larger sample volume are necessary to confirm the predisposition to hyperviscosity. The incidence of hearing damage is considerable if its possible appearance is taken into account, within the limitations of critical patients with COVID-19.
La alteración en las propiedades viscoelásticas de la sangre ha sido anteriormente propuesta como etiopatogenia de complicaciones severas por COVID-19 y algunos casos de Sordera Súbita (SS). Pretendemos verificar si la aparición de casos de SSI en pacientes ingresados por infección por SARS-Cov-2 puede correlacionarse de este modo.
Estudio longitudinal prospectivo de pacientes ingresados en nuestro Centro por COVID-19, efectuando monitorización de la viscosidad sanguínea (VS) a alta velocidad de cizallamiento (300 seg−1) y un requerimiento periódico personal sobre hipoacusia. Esta determinación se extendió a casos atendidos por SS sin infección en 2019 y 2020 y un grupo control de sujetos sanos normoacúsicos.
El rango de normalidad se situó en 4,16 ± 0,62 cps. Entre el 24 de Febrero de 2020 y el 24 de Marzo de 2021 se evaluaron 330 casos ingresados por COVID-19, 85 asistidos en UCI. Fueron identificadas tras anamnesis y ATL todo lo inmediata que el status clínico lo permitió hasta 9 casos con SS, todos pertenecientes al grupo de UCI. La VS media fue 4,38 ± 0,43 cps en el grupo de sala, 4,53 ± 0,39 cps en los pacientes en UCI sin SS, y 4,85 ± 0,52 cps en los casos con SS, con diferencias estadísticamente significativas. Las mayores elevaciones de la VS en los casos con SS se detectaron entre los días 6 y 10 del ingreso hospitalario. En 2019 consultaron 4 casos, y otros 2 en 2020 sin diagnóstico de COVID-19, con valores normales de VS.
Durante la infección por SARS-Cov-2 los pacientes pueden presentar elevación en la VS y SS, si bien se hacen necesarios un grupo control hospitalario y un volumen muestral mayor para confirmar la predisposición a la hiperviscosidad. La incidencia del daño auditivo resulta considerable si se tiene en cuenta su posible aparición en pacientes críticos con COVID-19.
Different lines of evidence have highlighted the role of IL-17A in the inflammatory process occurring in giant cell arteritis (GCA). The aim of the present study was to assess whether the IL17A locus ...influences GCA susceptibility and its clinical subphenotypes.
We carried out a large meta-analysis including a total of 1266 biopsy-proven GCA patients and 3779 healthy controls from four European populations (Spain, Italy, Germany and Norway). Five IL17A polymorphisms (rs4711998, rs8193036, rs3819024, rs2275913 and rs7747909) were selected by tagging and genotyped using TaqMan assays. Allelic combination and dependency tests were also performed.
In the pooled analysis, two of the five analysed polymorphisms showed evidence of association with GCA (rs2275913: PMH=1.85E-03, OR=1.17 (1.06-1.29); rs7747909: PMH=8.49E-03, OR=1.15 (1.04-1.27)). A clear trend of association was also found for the rs4711998 variant (PMH=0.059, OR=1.11 (1.00-1.23)). An independent effect of rs2275913 and rs4711998 was evident by conditional regression analysis. In addition, the haplotype harbouring the risk alleles better explained the observed association than the polymorphisms independently (likelihood p value <10(-05)).
Polymorphisms within the IL17A locus show a novel association with GCA. This finding supports the relevant role of the Th17 cells in this vasculitis pathophysiology.
Mayor urological complications, fistulae and stenosis, mainly affect the vesicoureteral anastomosis and present in the early post-transplant period. The systematic use of ureteral catheters keeps ...selecbeing controversial with many groups using them only selectively depending on the existence of pretransplant or intraoperative risk factors.
We performed a bibliographic review through automatized search in the Medline bibliographic database, as the main bibliographic source, and also in Clinical Key. The search strategy included the following terms: "stent" AND "kidney transplantation".
The bibliographic search revealed the protective effect of the use of ureteral catheters in the transplant ureteroneocystostomy for both development of fistulae (RR 0.29, 0.12 to 0.74, p=0.009) and stenosis (RR 0.27, 0.09 to 0.81, p=0.02). The use of catheters in immunosuppressed patients was associated with significant increase of the incidence of post-transplant urinary tract infections (RR 1.49 IC 95% 1.04 to 2.15, p=0.03) that was prevented by antibiotic prophylaxis with cotrimoxazole directed against pneumocistis carinii. The rates of permeability of self-expandable metallic stents and extra-anatomic bypasses in the treatment of ureteral stenosis after renal transplantation in high surgical risk patients or after the failure of previous surgery, has varied from 50% to 100%, with a limited number of patients included.
The use of ureteral catheters in the extravesical ureteroneocystostomy reduces the incidence of anastomotic complications. Surgery is the treatment of choice of post-transplant ureteral stenosis. The use of metallic stents and extra-anatomic bypasses should be limited to complex ureteral stenosis when primary therapy has failed, in high surgical risk patients or chronic graft dysfunction.
We provide new experimental results on studies of composites with glass-coated ferromagnetic microwires aligned with the requirements of carbon composites. This work focuses on the free space ...microwave measurements of composites made from carbon fibers and ferromagnetic microwires inclusion focusing on the electromagnetic properties. We prepared several glass-coated microwires and selected Co-based microwires with optimum soft magnetic properties and high magnetoimpedance effect for composite fabrication. We observed that by using a low-frequency modulating ac magnetic field parallelly oriented to the ferromagnetic microwires allows us to distinguish the microwave signals originated from the ferromagnetic microwires inclusions from the response generated by the carbon fibers. The location of carbon fibers near magnetic microwires has a critical effect on the response signals (parameters S amplitude) obtained from such composites.
ABSTRACT Air pollution is a threat to cultural heritage because it accelerates the natural deterioration of monuments, palaces, churches, and archaeological ruins, which have an irreplaceable value. ...In the Mexico City Metropolitan Area (MCMA), there are 19 968 buildings registered as archaeological, historic, or artistic monuments. Some are built with calcareous rocks (limestone and marble) but many of them are made with andesite, tezontle and tuff stone. This paper reports for the first time the spatial distribution of the potential risk of deterioration on calcareous rocks in terms of surface recession with regard to Mexican cultural heritage in the MCMA for the base year 2007. The risk estimate was performed using Lipfert’s damage function, only applicable to carbonate stones of medium and low porosity. These include mainly medium/high density limestone and marble. Carrara white marble has a density of 2.69 g cm-3 and a porosity of 0.37%, and limestone has a density of 2.2-2.6 g cm-3 and a porosity of 5-20%. For high porosity (low density) limestone the function would be applicable with a potential under-estimation. In this function, annual recession rate is a function of annual averages of precipitation, pH, and dry deposition of SO2 and HNO3. Data from several meteorological monitoring networks, the MCMA air quality and acid deposition monitoring networks, and a 3D air quality model (MCCM) were interpolated in a GIS in order to obtain map layers for these variables. These overlaid maps were used to apply the Lipfert functions at the specific coordinates of a small sample of relevant historic or artistic monuments. The complexity of climate gradients, wind patterns, and emissions distribution within the Mexico Megacity leads to gradients as large as 50% in estimated recession rates using the Lipfert function at nearby sites made of the same type of building materials. The Comisión Ambiental de la Megalópolis (Environmental Commission of the Megacity) divides the MCMA into five sectors. Differences in recession rates between them were, in 1990, as large as those between estimated values for Oviedo, Paris, and Prague in Europe for the period 1980-2000. Recession rates decreased by about 50% from 1990 to 2007, the base year for this report, due to the success of air pollution control actions focused on the protection of public health. Nevertheless, strong recession gradients are still expected for carbonate stone within the MCMA. The recession values reported in this work must be taken as conservative estimates due to the not yet optimal performance of 3D air quality models in urban meteorology and the high degree of uncertainty in modeling emissions inventories. Most notable is the SO2 emissions inventory. These maps call for a program of experimental determination of recession rates for building materials that comprise a very large part of Mexico’s unique cultural heritage. These maps should also be added to the critical level maps obtained for human exposure, crops, and ecosystems in order to properly estimate the actual cost of air pollution in the MCMA and the area under its influence.
Pyogenic arthritis of native joints due to Bacteroides fragilis seems to be an infrequent disease. We analyzed the cases diagnosed in a tertiary hospital during a 22-year period and reviewed the ...literature to summarize the experience with this infectious entity.In our institution, of 308 patients with pyogenic arthritis of native joints, B fragilis was the causative organism in 2 (0.6%) cases. A MEDLINE search (1981-2015) identified 19 additional cases.Of the 21 patients available for review (13 men and 8 women, with a mean age, of 54.4 ± 17 years), 19 (90%) presented a systemic predisposing factor for infection; the most common associated illness was rheumatoid arthritis (8 patients). Bacteremia was documented in 65% (13/20) of cases. In 5 patients (24%), 1 or more concomitant infectious process was found. Metronidazole was the most frequently used antibiotic. Surgical drainage was performed in 11 cases (52%). The overall mortality rate was 5%.Pyogenic arthritis of native joints due to B fragilis is an infrequent disease that mainly affects elderly patients with underlying medical illnesses and in whom bacteremia and the presence of a concomitant infectious process are frequent conditions.
ABSTRACTThe thyroid gland is an uncommon location for metastasis. We report a 59-year-old woman with a history of cutaneous malignant melanoma. A unique hypermetabolic mass on the left thyroid lobe ...was identified by control F-FDG PET/CT scan, leading to dysphagia and stridor clinic. Total thyroidectomy and lymphadenectomy were performed with histopathological results concordant with metastasis from melanoma. Despite its rarity, finding focal thyroid lesions in patients with an oncological history should alert us, recommending that its metastatic etiology be ruled out.
El tránsito de la educación secundaria a la enseñanza universitaria se ha convertido en un momento crítico para el estilo de vida de los jóvenes, especialmente para la práctica de actividad física. ...Por ello, el principal objetivo del presente estudio fue valorar los niveles de actividad física en universitarios, mediante la correlación entre los resultados del IPAQ-SF y las distintas variables de condición física (Eurofit). La muestra estuvo conformada por 194 estudiantes del Grado de Educación Primaria, con una edad media de 21,37 ± 2,66 años. Los principales resultados obtenidos reflejan la relación directa entre la práctica de actividad física en general, y la actividad física vigorosa en particular y una óptima aptitud física de los estudiantes universitarios, vinculada sobre todo con el componente fuerza. En cuanto a la comparación entre los universitarios del curso prepandémico (18/19) y el curso pospandémico (21/22), el aumento de la actividad física tras la pandemia no reportó diferencias sustanciales en los componentes de la condición física. A modo de conclusión, estos resultados deben conducirnos a una reflexión sobre la influencia de un estilo de vida activo en la aptitud física, la cual tiene repercusión en el estado de salud general y la calidad de vida.
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