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Sample records for immunocompromised rheumatology patients

  1. Herpes zoster infection, vaccination and immunocompromised rheumatology patients.

    LENUS (Irish Health Repository)

    O'Connor, Mortimer B

    2013-01-01

    Varicella is a self-limiting and relatively mild disease of childhood, although it is frequently more severe and complicated among the immunocompromised rheumatology patients on immunomodulator therapies. In addition, future reactivation of the dormant virus in dorsal root ganglia may cause herpes zoster infection, which can be very debilitating. In this manuscript, we discuss the nature of this infection along with its potential vaccine especially among rheumatology patients.

  2. The uptake of influenza and pneumococcal vaccination among immunocompromised patients attending rheumatology outpatient clinics.

    LENUS (Irish Health Repository)

    Haroon, Muhammad

    2011-07-01

    PURPOSE AND OBJECTIVES: The patients using immunosuppressive agents are considered at high risk for acquiring different infections. Accordingly, international guidelines recommend vaccinating such patients against influenza and pneumococcal organisms. The aims of this study were two-fold: (1) to assess the influenza and pneumococcal vaccination uptake among our rheumatology outpatients who are immunosuppressed; (2) to identify the factors influencing immunisation uptake among our sample of patients.

  3. Septic bursitis in immunocompromised patients.

    Science.gov (United States)

    Roschmann, R A; Bell, C L

    1987-10-01

    A retrospective analysis of 29 patients with septic bursitis was undertaken to ascertain if immunocompromised patients differed in their clinical presentations, type of organisms cultured, and outcome when compared with their non-immunocompromised cohorts. Thirty episodes of septic bursitis occurred in 29 patients, 43 percent of which occurred in immunocompromised patients. Despite similar clinical presentations, the bursae of immunocompromised patients took three times longer to sterilize and had a much higher bursal white blood cell count when compared with the bursae of non-immunocompromised patients. The bacteriologic spectrum was essentially identical in both groups; there were no cases in which gram-negative organisms were recovered from infected bursae. No cases of septic bursitis were seen in neutropenic patients. The most common factors contributing to an immunocompromised state were alcoholism or steroid therapy. A successful resolution of septic bursitis was seen in all the patients in the immunocompromised groups.

  4. Pneumoniae in immunocompromised patients

    International Nuclear Information System (INIS)

    Jacobi, Volkmar; Lehnert, Thomas; Thalhammer, Axel

    2009-01-01

    Due to the large surface area, heat, high humidity and high oxygen supply in the lung makes an ideal environment for the propagation of germs. The purpose of the immune system is to establish and maintain the balance between saprophytes and immune defense so as to depress and ultimately kill germs as they infiltrate the body. This usually is achieved by the use of a highly complex immune system. It is a perfect combination of non-specific, cellular and humoral immune mechanisms with very specific immune cells and antibodies, which are specialized on particular pathogens. The specific defenses potentiate the effect of the nonspecific defense in a large extent so as to prevent re-infection and ultimately eliminate recognized pathogens. The causes of immune deficiency can be related to either the cellular or humoral level and affect both the specific and nonspecific defenses. There is a different excitation spectrum depending on the type of immune deficiency. Immune deficiency can prevalently cause complications in the course of infections, decelerate the healing and allow the occurrence of rare pathogens. In particular, the radiological characteristics of typical and atypical pneumonia in immunocompromised patients will be discussed. Particular emphasis is placed on the appearance of bacterial infections, mycobacterioses, PCP, CMV, and laid fungual pneumonia. Even it is not possible to identify certain pathogens radiologically, it is often possible to narrow the spectrum of germs causing pulmonary infections significantly by comparing with other pulmonary complications such as lymphoma or kaposisarcomas. (orig.)

  5. Pulmonary infections in immunocompromised patients

    International Nuclear Information System (INIS)

    Choneva, I.; Abadjieva, D.; Kirilov, R.

    2013-01-01

    Full text: Introduction: The lung is one of the most commonly affected organs in immunocompromised patients. Primary complication is pulmonary infection which is associated with high morbidity and mortality. Although radiography and CT, as main diagnostic tools are reliable and credible methods, often there is difficulty with the correct diagnose. The reasons for this are that immunocompromised patients are potentially susceptible to infection by various microorganisms and that the radiographic findings are rarely specific for detecting a particular pathogen. What you will learn : Our objective is to present general nosological classification of pulmonary infections in immunocompromised patients, and to evaluate and analyze new imaging methods and discuss their correlation with the clinical setting, which aims to facilitate the diagnosis and to take a decision for the treatment. The experience indicates that a clinical environment conducive the immunocompromised patients to infection with certain pathogens, thereby changing the frequency of their occurrence. The most commonly cited fungal infections, cytomegalovirus infections, Pneumocystis carinii pneumonia and Pulmonary tuberculosis (PTB) of which convincing is the Imaging diagnosis primarily in fungal infections, and Pneumocystis carinii pneumonia and less accurate - in bacterial and viral infections. Discussion: The term 'immunocompromised' describes a subject with an increased risk for life-threatening infection as a result of congenital or acquired abnormalities of the immune system. Over the past few decades, the number of immunocompromised patients has grown considerably, reflecting the increased use of immunosuppressive drugs, and the syndrome of acquired immunodeficiency. Given the high incidence of pulmonary infections in immunocompromised patients (lung is one of the most commonly affected organs, such as lung infection is about 75% of pulmonary complications), rapid and accurate diagnosis is important

  6. HPV Carcinomas in Immunocompromised Patients

    Directory of Open Access Journals (Sweden)

    Nicole M. Reusser

    2015-01-01

    Full Text Available Human papillomavirus (HPV infection is the most common sexually transmitted disease worldwide and can result in pre-malignancies or overt malignancies of the skin and mucosal surfaces. HPV-related illnesses are an important personal and public health problem causing physical, mental, sexual and financial detriments. Moreover, this set of malignancies severely affects the immunosuppressed population, particularly HIV-positive patients and organ-transplant recipients. There is growing incidence of HPV-associated anogenital malignancies as well as a decrease in the average age of affected patients, likely related to the rising number of high-risk individuals. Squamous cell carcinoma is the most common type of HPV-related malignancy. Current treatment options for HPV infection and subsequent disease manifestations include imiquimod, retinoids, intralesional bleomycin, and cidofovir; however, primary prevention with HPV vaccination remains the most effective strategy. This review will discuss anogenital lesions in immunocompromised patients, cutaneous warts at nongenital sites, the association of HPV with skin cancer in immunocompromised patients, warts and carcinomas in organ-transplant patients, HIV-positive patients with HPV infections, and the management of cutaneous disease in the immunocompromised patient.

  7. Molecular diagnosis of toxoplasmosis in immunocompromised patients.

    Science.gov (United States)

    Robert-Gangneux, Florence; Belaz, Sorya

    2016-08-01

    Toxoplasmosis in immunocompromised patients is associated with a high mortality rate. Molecular techniques are important tools to diagnose acute disease in immunocompromised patients, but there are various methods with variable efficiency. Some of them have been validated for the diagnosis of congenital toxoplasmosis, but the impact of their use has not been evaluated in immunocompromised patients. Toxoplasmosis is of increasing importance in non-HIV immunocompromised patients. In addition, the picture of disease shows greater severity in South America, both in immunocompetent study participants and in congenitally infected infants. These epidemiological differences could influence the sensitivity of diagnostic methods. This review analyzes recent data on molecular diagnosis and compares them with older ones, in light of progress gained in molecular techniques and of recent epidemiological findings. Most recent studies were conducted in South America and used PCR targeting the B1 gene. PCR on blood could allow diagnosing a significant proportion of patients with ocular toxoplasmosis in Brazil. Quantitative PCR methods with specific probes should be used to improve sensitivity and warrant specificity. Performance of quantitative PCR targeting the repeated 529 bp sequence for the diagnosis of toxoplasmosis in immunocompromised patients needs evaluation in field studies in South America and in western countries.

  8. The patient's role in rheumatology care.

    Science.gov (United States)

    Brady, T J

    1998-03-01

    This article reviews narrative and empiric studies in rheumatology and related literature to explicate the patient's role in rheumatology care. In contrast to early conceptualizations, such as Parsons' sick role that emphasized compliance, current literature describes chronic disease patients as active participants in their care, rather than passive recipients of care. Active patients roles include participant in shared decision making, self-manager, and help and information seeker. All of these roles are colored by the individual's need to preserve a personally defined acceptable lifestyle. Suggestions for strategies that physicians and health professionals can use to engage and support these essential patient roles are also reviewed.

  9. Risk assessment of tuberculosis in immunocompromised patients

    DEFF Research Database (Denmark)

    Sester, Martina; van Leth, Frank; Bruchfeld, Judith

    2014-01-01

    RATIONALE: In the absence of active tuberculosis, a positive tuberculin skin test (TST) or interferon-γ release assay (IGRA) result defines latent infection with Mycobacterium tuberculosis, although test results may vary depending on immunodeficiency. OBJECTIVES: This study compared the performance...... of TST and IGRAs in five different groups of immunocompromised patients, and evaluated their ability to identify those at risk for development of tuberculosis. METHODS: Immunocompromised patients with HIV infection, chronic renal failure, rheumatoid arthritis, solid-organ or stem-cell transplantation......, and healthy control subjects were evaluated head-to-head by the TST, QuantiFERON-TB-Gold in-tube test (ELISA), and T-SPOT.TB test (enzyme-linked immunospot) at 17 centers in 11 European countries. Development of tuberculosis was assessed during follow-up. MEASUREMENTS AND MAIN RESULTS: Frequencies of positive...

  10. Acute hypoxemic respiratory failure in immunocompromised patients

    DEFF Research Database (Denmark)

    Azoulay, Elie; Pickkers, Peter; Soares, Marcio

    2017-01-01

    BACKGROUND: In immunocompromised patients with acute hypoxemic respiratory failure (ARF), initial management aims primarily to avoid invasive mechanical ventilation (IMV). METHODS: To assess the impact of initial management on IMV and mortality rates, we performed a multinational observational.......54-0.87), day-1 SOFA excluding respiratory score (1.12/point, 1.08-1.16), PaO2/FiO2

  11. [Complicated gastroduodenal ulcers in rheumatology patients].

    Science.gov (United States)

    Barashkov, V G; Shemerovskaia, T G; Sergeev, P V; Bokovanov, V E

    1998-01-01

    An analysis of observations of 250 patients with different rheumatological diseases has shown that 18% of the patients had ulcer disease with complications. The greatest risk of bleedings and perforations took place during the first year of treatment with nonsteroidal antiinflammatory drugs. The main risk factors of complications were determined. They are: male sex, high parameters of gastric secretion.

  12. Camembert, Listeria and the immunocompromised patient.

    Science.gov (United States)

    Ries, F; Dicato, M; Hemmer, R; Arendt, F

    1990-01-01

    Listeriosis is a rare but well known infectious complication in pregnant women and immunocompromised patients. Epidemiological studies have shown an association between listeriosis and alimentary contamination by listeria of a variety of foodstuff including soft, ripened cheeses. We describe two case-reports of listeria meningitis with high evidence of food-related illness due to the consumption of contaminated camembert. These observations urged our State Department of Health to formulate a communication about alimentary listeriosis at the intent of all health care professionals, including recommendations for patients at risk.

  13. [Sepsis with Staphylococcus aureus in immunocompromised patients].

    Science.gov (United States)

    Petrache, Simona Magdalena; Miftode, Egidia; Vâţă, A; Petrovici, Cristina Mirela; Dorneanu, Olivia; Luca, V

    2009-01-01

    The aim of our study was to analyze clinical and biological characteristics of immunocompromised patients with staphylococcal sepsis and to compare with the same data in non-immunocompromised patients. The diagnosis of sepsis was made based on Bone criteria. MiniAPI system ID 32 STAPH was used for identification and antibiotic susceptibility was assessed by ATB STAPH method and by E-test for oxacillin and vancomycin. Among the 147 patients with Staphylococcus aureus sepsis--66.67% had concomitant immunosuppressive conditions (diabetes mellitus, liver diseases, renal failure, corticotherapy, etc). We have found a significant correlation between the immunosuppressed status and MRSA (methicillin-resistant Staphylococcus aureus) involvement (p = 0.0018) and also, between this group of patients and treatment failure (p = 0.0012). Because of the high rate of MRSA involvement in systemic infections in the Eastern region of Romania first intention treatment of patients with staphylococcal infections and conditions of immunosuppression must include antibiotics effective against methicillin-resistant strains.

  14. Inhaled medicinal cannabis and the immunocompromised patient.

    Science.gov (United States)

    Ruchlemer, Rosa; Amit-Kohn, Michal; Raveh, David; Hanuš, Lumír

    2015-03-01

    Medicinal cannabis is an invaluable adjunct therapy for pain relief, nausea, anorexia, and mood modification in cancer patients and is available as cookies or cakes, as sublingual drops, as a vaporized mist, or for smoking. However, as with every herb, various microorganisms are carried on its leaves and flowers which when inhaled could expose the user, in particular immunocompromised patients, to the risk of opportunistic lung infections, primarily from inhaled molds. The objective of this study was to identify the safest way of using medicinal cannabis in immunosuppressed patients by finding the optimal method of sterilization with minimal loss of activity of cannabis. We describe the results of culturing the cannabis herb, three methods of sterilization, and the measured loss of a main cannabinoid compound activity. Systematic sterilization of medicinal cannabis can eliminate the risk of fatal opportunistic infections associated with cannabis among patients at risk.

  15. Pasteurella multocida Bacteremia in an Immunocompromised Patient.

    Science.gov (United States)

    Kukrety, Shweta; Parekh, Jai; Townley, Theresa

    2016-01-01

    We present the case of a 61-year-old Caucasian gentleman who presented with a one-day history of fever, chills, and altered mental status. His symptoms were initially thought to be secondary to cellulitis. Blood cultures grew Pasteurella multocida , a rare pathogen to cause bacteremia. Our patient was treated with ciprofloxacin for two weeks and made a complete and uneventful recovery. Our patient's uncontrolled diabetes mellitus and chronic kidney disease put him at a higher risk for developing serious P. multocida infection. The patient's dog licking the wounds on his legs was considered as the possible source of infection. As P. multicoda bacteremia is rare, but severe with a high mortality rate, it is imperative to have a high index of suspicion for this infection especially in the vulnerable immunocompromised population.

  16. Pasteurella multocida Bacteremia in an Immunocompromised Patient

    Directory of Open Access Journals (Sweden)

    Shweta Kukrety

    2016-01-01

    Full Text Available We present the case of a 61-year-old Caucasian gentleman who presented with a one-day history of fever, chills, and altered mental status. His symptoms were initially thought to be secondary to cellulitis. Blood cultures grew Pasteurella multocida, a rare pathogen to cause bacteremia. Our patient was treated with ciprofloxacin for two weeks and made a complete and uneventful recovery. Our patient’s uncontrolled diabetes mellitus and chronic kidney disease put him at a higher risk for developing serious P. multocida infection. The patient’s dog licking the wounds on his legs was considered as the possible source of infection. As P. multicoda bacteremia is rare, but severe with a high mortality rate, it is imperative to have a high index of suspicion for this infection especially in the vulnerable immunocompromised population.

  17. Pulmonary Talcosis in an Immunocompromised Patient

    Directory of Open Access Journals (Sweden)

    Thanh-Phuong Nguyen

    2016-01-01

    Full Text Available The first case of pulmonary talcosis or talc pneumoconiosis related to inhalation of talc during its extraction and processing in mines was described by Thorel in 1896. Pulmonary talcosis is most commonly seen secondary to occupational exposure or intravenous (IV drug abuse and, occasionally, in excessive use of cosmetic talc. Based on literature review, there has been an increase in reported incidents of pulmonary talcosis due to various forms of exposure to the mineral. We report an 82-year-old man who is diagnosed with Philadelphia chromosome positive pre-B cell acute lymphoblastic leukemia (ALL treated with palliative imatinib who presented with chronic hemoptysis and dyspnea shortly after his diagnosis. His symptoms were initially thought to be due to an infectious etiology due to his malignancy, immunocompromised state, and radiographic findings until high-resolution computerized tomographic (HRCT findings showed a diffuse pulmonary fibrosis picture that prompted further questioning and a more thorough history inquiry on his exposure to causative agents of interstitial lung disease. Very often, patients do not recognize their exposure, especially in those whose exposure is unrelated to their occupation. Our case emphasizes the need for thorough and careful history taking of occupational and nonoccupational exposure to known causative agents of interstitial lung disease.

  18. ZYGOMYCOSIS IN IMMUNOCOMPROMISED NON-HAEMATOLOGICAL PATIENTS

    Directory of Open Access Journals (Sweden)

    George Petrikkos

    2011-03-01

    Full Text Available Zygomycoses are rare emerging diseases with a high fatality rate.  The most important risk factors include neutropenia or functional neutropenia, diabetic ketoacidosis, iron overload, major trauma, prolonged use of corticosteroids, illicit intravenous drug use, neonatal prematurity, malnourishment, and pre-exposure to antifungal agents with no activity against zygomycetes, such as voriconazole and caspofungin. A high index of suspicion is crucial for the diagnosis, as prompt and appropriate management can considerably reduce morbidity and mortality. Suspicion index can be increased through recognition of the differential patterns of clinical presentation. In the non- haematological immunocompromised patients, zygomycosis can manifest in various clinical forms, depending on the underlying condition: mostly as rhino-orbital or rhino-cerebral in diabetes patients, pulmonary infection in patients with malignancy or solid organ transplantation, disseminated infection in iron overloaded or deferoxamine treated patients, cerebral - with no sinus involvement - in ID users, gastrointestinal in premature infants or malnourishment, and cutaneous after direct inoculation in immunocompetent individuals with trauma or burns. Treating a patient’s underlying medical condition and reducing immunosuppression are essential to therapy. Rapid correction of metabolic abnormalities is mandatory in cases such as uncontrolled diabetes and corticosteroids or other immunosuppressive drugs should be discontinued where feasible. AmphotericinB or its newer and less toxic lipid formulations are the drugs of choice regarding antifungal chemotherapy, while extensive surgical debridemend is essential to reduce infected and necrotic tissue. A high number of cases could be prevented through measures including diabetes control programmes and proper pre- and post-surgical hygiene.

  19. CT findings of pulmonary tuberculosis in diabetic and immunocompromised patients

    International Nuclear Information System (INIS)

    Takeuchi, Noriyuki; Ikezoe, Junpei; Johkoh, Tsuyoshi

    1992-01-01

    To evaluate the CT features of pulmonary tuberculosis in diabetic or immunocompromised patients, we reviewed CT of the chest in 42 adult patients with active pulmonary tuberculosis. Forty-two had some underlying diseases or immunocompromised conditions (31 diabetes mellitus, 6 malignancies, 2 long-term steroid therapy, 2 pneumoconiosis, and one anorexia nervosa). In diabetic or immunocompromised patients, a high incidence of non-segmental distribution (27%) and multiple small cavities in a cavitary lesion (45%) was observed. Unusual localization of the lesions such as lower lung field disease was observed in 18% of cases (the incidence of unusual localization in patients with no underlying disease was equal to diabetic or immunocompromised patients). (author)

  20. CT findings of pulmonary tuberculosis in diabetic and immunocompromised patients

    Energy Technology Data Exchange (ETDEWEB)

    Takeuchi, Noriyuki; Ikezoe, Junpei; Johkoh, Tsuyoshi (Osaka Univ. (Japan). Faculty of Medicine) (and others)

    1992-01-01

    To evaluate the CT features of pulmonary tuberculosis in diabetic or immunocompromised patients, we reviewed CT of the chest in 42 adult patients with active pulmonary tuberculosis. Forty-two had some underlying diseases or immunocompromised conditions (31 diabetes mellitus, 6 malignancies, 2 long-term steroid therapy, 2 pneumoconiosis, and one anorexia nervosa). In diabetic or immunocompromised patients, a high incidence of non-segmental distribution (27%) and multiple small cavities in a cavitary lesion (45%) was observed. Unusual localization of the lesions such as lower lung field disease was observed in 18% of cases (the incidence of unusual localization in patients with no underlying disease was equal to diabetic or immunocompromised patients). (author).

  1. ZYGOMYCOSIS IN IMMUNOCOMPROMISED NON-HAEMATOLOGICAL PATIENTS

    Directory of Open Access Journals (Sweden)

    George Petrikkos

    2011-01-01

    Full Text Available

    Zygomycoses are rare emerging diseases with a high fatality rate.  The most important risk factors include neutropenia or functional neutropenia, diabetic ketoacidosis, iron overload, major trauma, prolonged use of corticosteroids, illicit intravenous drug use, neonatal prematurity, malnourishment, and pre-exposure to antifungal agents with no activity against zygomycetes, such as voriconazole and caspofungin.

    A high index of suspicion is crucial for the diagnosis, as prompt and appropriate management can considerably reduce morbidity and mortality. Suspicion index can be increased through recognition of the differential patterns of clinical presentation. In the non- haematological immunocompromised patients, zygomycosis can manifest in various clinical forms, depending on the underlying condition: mostly as rhino-orbital or rhino-cerebral in diabetes patients, pulmonary infection in patients with malignancy or solid organ transplantation, disseminated infection in iron overloaded or deferoxamine

  2. International travel in the immunocompromised patient: a cross-sectional survey of travel advice in 254 consecutive patients.

    Science.gov (United States)

    Bialy, C; Horne, K; Dendle, C; Kanellis, J; Littlejohn, G; Ratnam, I; Woolley, I

    2015-06-01

    Our primary aim was to determine the rate of overseas travel in immunocompromised individuals attending appropriate clinics at an Australian tertiary care hospital. We also aimed to characterise health-seeking behaviour prior to travel and investigated sources of pre-travel advice, compared travel patterns and activities between three specific immunosuppressed groups, and examined pre-immunosuppression patient serology. We implemented a cross-sectional survey of patients between February and August 2012. This survey was implemented among three outpatient populations at Monash Medical Centre, an Australian tertiary care hospital. We recruited 254 immunosuppressed adults from three patient populations: human immunodeficiency virus-positive individuals, renal transplant patients and rheumatology patients requiring immunosuppressive therapy. No clinical intervention was performed. In the 10 years preceding the survey, 153 (60.2%) participants reported international travel. Of these, 105 (68.6%) were immunosuppressed at the time of travel. These patients were 47.6% male and 60% Australian born. Forty per cent were visiting friends and relatives as part of their travel. Fifty-four per cent of those immunocompromised at the time of travel were going to high-risk destinations. Pathology files indicated that serological screening was frequently not performed prior to immunosuppression in the renal transplant and rheumatology groups. Immunocompromised patients often travel to high-risk destinations with limited or inadequate pre-travel preparations. Doctors caring for the immunocompromised should be aware of travel risks, suitable vaccination protocols and when to refer to specialist travel clinics. © 2015 Royal Australasian College of Physicians.

  3. Pulmonary fungal infection: Imaging findings in immunocompetent and immunocompromised patients

    International Nuclear Information System (INIS)

    Chong, Semin; Lee, Kyung Soo; Yi, Chin A; Chung, Myung Jin; Kim, Tae Sung; Han, Joungho

    2006-01-01

    Histoplasmosis is the most common endemic mycosis in North America, and is followed by coccidioidomycosis and blastomycosis. Although the majority of these infections in immunocompetent persons are self-limited, some patients can develop severe pneumonitis or various forms of chronic pulmonary infection. Cryptococcoci, Aspergillus, Candidas, and Mucorals are ubiquitous organisms, which may affect immunocompromised patients. Specific imaging findings can be expected, depending on the organisms involved, underlying patients' conditions (immune status), and specific situations after immune depleting procedures

  4. Coronavirus 229E-related pneumonia in immunocompromised patients.

    Science.gov (United States)

    Pene, Frédéric; Merlat, Annabelle; Vabret, Astrid; Rozenberg, Flore; Buzyn, Agnès; Dreyfus, François; Cariou, Alain; Freymuth, François; Lebon, Pierre

    2003-10-01

    Coronaviruses strains 229E and OC43 have been associated with various respiratory illnesses ranging from the self-resolving common cold to severe pneumonia. Although chronic underlying conditions are major determinants of severe respiratory virus infections, few data about coronavirus-related pneumonia in immunocompromised patients are available. Here we report 2 well-documented cases of pneumonia related to coronavirus 229E, each with a different clinical presentation. Diagnosis was made on the basis of viral culture and electron microscopy findings that exhibited typical crown-like particles and through amplification of the viral genome by reverse transcriptase-polymerase chain reaction. On the basis of this report, coronaviruses should be considered as potential causative microorganisms of pneumonia in immunocompromised patients.

  5. Diagnostic accuracy of procalcitonin in critically ill immunocompromised patients

    Directory of Open Access Journals (Sweden)

    Legriel Stéphane

    2011-08-01

    Full Text Available Abstract Background Recognizing infection is crucial in immunocompromised patients with organ dysfunction. Our objective was to assess the diagnostic accuracy of procalcitonin (PCT in critically ill immunocompromised patients. Methods This prospective, observational study included patients with suspected sepsis. Patients were classified into one of three diagnostic groups: no infection, bacterial sepsis, and nonbacterial sepsis. Results We included 119 patients with a median age of 54 years (interquartile range [IQR], 42-68 years. The general severity (SAPSII and organ dysfunction (LOD scores on day 1 were 45 (35-62.7 and 4 (2-6, respectively, and overall hospital mortality was 32.8%. Causes of immunodepression were hematological disorders (64 patients, 53.8%, HIV infection (31 patients, 26%, and solid cancers (26 patients, 21.8%. Bacterial sepsis was diagnosed in 58 patients and nonbacterial infections in nine patients (7.6%; 52 patients (43.7% had no infection. PCT concentrations on the first ICU day were higher in the group with bacterial sepsis (4.42 [1.60-22.14] vs. 0.26 [0.09-1.26] ng/ml in patients without bacterial infection, P 0.5 ng/ml had 100% sensitivity but only 63% specificity for diagnosing bacterial sepsis. The area under the receiver operating characteristic (ROC curve was 0.851 (0.78-0.92. In multivariate analyses, PCT concentrations > 0.5 ng/ml on day 1 independently predicted bacterial sepsis (odds ratio, 8.6; 95% confidence interval, 2.53-29.3; P = 0.0006. PCT concentrations were not significantly correlated with hospital mortality. Conclusion Despite limited specificity in critically ill immunocompromised patients, PCT concentrations may help to rule out bacterial infection.

  6. Diagnostic accuracy of procalcitonin in critically ill immunocompromised patients.

    Science.gov (United States)

    Bele, Nicolas; Darmon, Michael; Coquet, Isaline; Feugeas, Jean-Paul; Legriel, Stéphane; Adaoui, Nadir; Schlemmer, Benoît; Azoulay, Elie

    2011-08-24

    Recognizing infection is crucial in immunocompromised patients with organ dysfunction. Our objective was to assess the diagnostic accuracy of procalcitonin (PCT) in critically ill immunocompromised patients. This prospective, observational study included patients with suspected sepsis. Patients were classified into one of three diagnostic groups: no infection, bacterial sepsis, and nonbacterial sepsis. We included 119 patients with a median age of 54 years (interquartile range [IQR], 42-68 years). The general severity (SAPSII) and organ dysfunction (LOD) scores on day 1 were 45 (35-62.7) and 4 (2-6), respectively, and overall hospital mortality was 32.8%. Causes of immunodepression were hematological disorders (64 patients, 53.8%), HIV infection (31 patients, 26%), and solid cancers (26 patients, 21.8%). Bacterial sepsis was diagnosed in 58 patients and nonbacterial infections in nine patients (7.6%); 52 patients (43.7%) had no infection. PCT concentrations on the first ICU day were higher in the group with bacterial sepsis (4.42 [1.60-22.14] vs. 0.26 [0.09-1.26] ng/ml in patients without bacterial infection, P 0.5 ng/ml had 100% sensitivity but only 63% specificity for diagnosing bacterial sepsis. The area under the receiver operating characteristic (ROC) curve was 0.851 (0.78-0.92). In multivariate analyses, PCT concentrations > 0.5 ng/ml on day 1 independently predicted bacterial sepsis (odds ratio, 8.6; 95% confidence interval, 2.53-29.3; P = 0.0006). PCT concentrations were not significantly correlated with hospital mortality. Despite limited specificity in critically ill immunocompromised patients, PCT concentrations may help to rule out bacterial infection.

  7. Fungal Fourniers Gangrene in an Immunocompromised Patient

    Directory of Open Access Journals (Sweden)

    Winston Crowell

    2016-01-01

    Full Text Available Fournier's Gangrene is a rapidly progressive necrotizing fasciitis of the groin, perianal and perineal region that is often polymicrobial in nature, often averaging 3 species of bacteria per patient. The typical infection can be due to a host of microbes, including gram positive, gram negative and anaerobic species including. Many of the causative organisms are found in the normal microbial flora of the perineum. Therefore, Fourniers is an opportunistic infection most commonly affecting the immunosuppressed. The majority of Fournier's gangrene are bacterial; however there have been cases of fungal Fournier's gangrene reported in the literature.

  8. Current management of parainfluenza pneumonitis in immunocompromised patients: a review

    Directory of Open Access Journals (Sweden)

    Falsey AR

    2012-08-01

    Full Text Available Ann R FalseyUniversity of Rochester, Rochester General Hospital, Rochester, NY, USAAbstract: Parainfluenza viruses (PIV are common respiratory viruses that belong to the Paramyxoviridae family. PIV infection can lead to a wide variety of clinical syndromes ranging from mild upper respiratory illness to severe pneumonia. Severe disease can be seen in elderly or chronically ill persons and may be fatal in persons with compromised immune systems, particularly children with severe combined immunodeficiency disease syndrome and hematopathic stem cell transplant recipients. At present, there are no licensed antiviral agents for the treatment of PIV infection. Aerosolized or systemic ribavirin in combination with intravenous gamma globulin has been reported in small, uncontrolled series and case reports of immunocompromised patients. A number of agents show antiviral activity in vitro and in animals, but none are currently approved for human use.Keywords: parainfluenza virus, antiviral agents, immunocompromised host

  9. [Fungal (Candida) infections in the immunocompromised pediatric patient].

    Science.gov (United States)

    Bruce Diemond, J; Lopez, C; Huerta Romano, F; Montiel Castillo, C

    2008-11-01

    Today, mycotic infections in immunocompromised patients are mainly caused by Candida spp. and Aspergillus spp. The patients most sensitive to these infections are those with some kind of cell-mediated immunity quantitative or qualitative alteration (i.e., blood-related cancer, primary or secondary neutropenia, immunosuppressive disease or therapy, etc.). Candida infection in the immunosupressed patient comprises a wide range of serious diseases such as candidemia, chronic disseminated candididasis, endocarditis, meningitis and endophthalmitis. Therefore, infection by Candida spp. is considered secondary to the technological and medical advances which extend the life of patients with chronic diseases. Copyright 2008 Prous Science, S.A.U. or its licensors. All rights reserved.

  10. [Flesh-eating bacteria infection of an immunocompromised patient].

    Science.gov (United States)

    Slavei, K; Hauser, B; Pénzes, I; Ondrejka, P; Faller, J

    2001-10-01

    After years of steadily declining morbidity and mortality due to group A streptococcal infections, a resurgence of severe, invasive disease has been ongoing since 1980, leading to the recognition of streptococcal shock syndrome (STSS), necrotizing fasciitis, the most severe form of invasive infection. The patients suffer from rapid local deep soft tissue destruction, severe septic shock and multi organ failure. The increased incidence of these infections has been accompanied by remarkable vigor in virulence and severity of the disease. The reason for this impressive change in the epidemiology and clinical manifestation of group A streptococcal infections remains unknown. The possible etiological factor is changing in virulence factor or the lack of protective immunity of the population (immunocompromise) against the invasive strains. We describe a severe necrotizing fasciitis of a 41-year-old previously immunocompromised woman. The patient developed severe septic shock, multi organ failure and perineal and lower abdominal skin, fat and fascia necrosis due to mixed GAS (aerob, anaerob) infection of the perineum and the Bartholini glands. After an aggressive surgical debridement, antibiotic and supportive therapy the generalised and local infection was treated.

  11. Antibody Response against Parvovirus in Patients with Inflammatory Rheumatological Diseases

    Directory of Open Access Journals (Sweden)

    SH Raeisi

    2011-07-01

    Full Text Available Introduction: Some viral infections have been suggested to trigger or cause autoimmune diseases. One of these viruses is parvovirus B19 which can have various rheumatologic manifestations. In this study we investigated the association between parvovirus and rheumatoid arthritis (RA, systemic lupus erythematosis(SLE, systemic sclerosis(SSc and undifferentiated arthritis at the Rheumatological Clinic, Imam Khomeini hospital. Methods: In this sectional case-control study, IgM and IgG antibodies against parvovirus B19 were measured with ELISA in 41 patients with RA, 28 patients with SLE, 13 patients with SSc, 8 patients with undifferentiated arthritis as well as 90 healthy controls. The ELISA kit (DRG, Germany was semi-quantitative and qualititative. Results: Parvovirus B19 IgM was detected in one patient with RA, one with SSc and four in the control group. IgG anti- B19-specific antibody was detected in 58.5% of RA patients, 67.9% of SLE patients, 69. 2% of SSc patients, 87.5% of undifferentiated arthritis patients as compared to 53.3% of controls. The results were compared between the patient and control groups(p>0.05. Conclusion: According to the results, there was no significant correlation for the antibody titer against parvovirus B19 in the patient and control group. The highly positive response of IgG against parvovirus in undifferentiated arthritis implies the need for more research.

  12. Cutaneous Paecilomyces lilacinus infections in immunocompromised and immunocompetent patients

    Directory of Open Access Journals (Sweden)

    Shahindokht Bassiri-Jahromi

    2014-01-01

    Full Text Available Paecilomyces is a genus of saprophytic fungus that has been associated, in rare instances, with human disease. We report two cases in which Paecilomyces lilacinus was isolated from cutaneous and subcutaneous lesions in an immunocompromised and an immunocompetent host. The first case was a subcutaneous infection due to P. lilacinus in a patient with a renal transplant and diabetes mellitus. The second case was an immunocompetent young woman who developed a cutaneous infection, with no identified predisposing factors. A biopsy from each patient provided an initial diagnosis of fungal elements in the tissues under examination and multiple positive fungal cultures were obtained from the tissue biopsy samples. Both microscopic and macroscopic examinations of the biopsy revealed the presence of P. lilacinus. Each of the two cases was successfully treated with oral ketoconazole (200 mg/day and itraconazole. We also review previously reported cases in which the clinical history and response to therapy were noted.

  13. Occult hepatitis B virus infection in immunocompromised patients

    Directory of Open Access Journals (Sweden)

    Ruth Nogueira Cordeiro Moraes Jardim

    Full Text Available Occult hepatitis B infection is characterized by hepatitis B virus (HBV DNA in the serum in the absence of hepatitis B surface antigen (HBsAg. We assessed occult HBV infection prevalence in two groups of immunocompromised patients (maintenance hemodialysis patients and HIV-positive patients presenting HBsAg-negative and anti-HBc positive serological patterns, co-infected or not by HCV. Thirty-four hemodialysis anti-HIV negative patients, 159 HIV-positive patients and 150 blood donors who were anti-HBc positive (control group were selected. HBV-DNA was detected by nested-PCR. Occult hepatitis B infection was not observed in the hemodialysis patients group but was found in 5% of the HIV-patients and in 4% of the blood donors. Immunosuppression in HIV positive patients was not a determining factor for occult HBV infection. In addition, no significant relationship between HBV-DNA and HCV co-infection in the HIV-positive patient group was found. A lack of significant associations was also observed between positivity for HBV-DNA and CD4 count, viral load and previous lamivudine treatment in these HIV-positive patients.

  14. Imaging diagnosis of pulmonary tuberculosis in immunocompromised patients

    International Nuclear Information System (INIS)

    Ma Daqing; Zhao Dawei; Pan Keqin

    2000-01-01

    Objective: To evaluate CT and X-ray features of pulmonary tuberculosis in diabetic patients, patients post kidney transplantation, and patients with acquired immunodeficiency syndrome (AIDS). Methods: The authors reviewed CT scans in 20 patients with diabetic patients, X-ray films in 10 cases after kidney transplantation, and CT scans in 2 patients with AIDS. Results: CT features of pulmonary tuberculosis in diabetic diseases included larger confluent consolidation (10 cases ), multiple small cavities within any given lesion (9 cases ) and non-segmental distribution (2 cases). Satellite lesions were found in most films. The X-ray appearances of pulmonary tuberculosis post kidney transplantation included patch and larger confluent consolidation (6 cases), and miliary tuberculosis(4 cases). The CT findings of pulmonary tuberculosis with AIDS were enlarged mediastinal lymph nodes (1 case), pulmonary infiltration (1 case), and extra chest lesions(2 cases) such as enlarged neck lymph nodes and post-peritoneal lymph nodes. Conclusion: The Main radiological findings of pulmonary tuberculosis in immunocompromised patients appear larger confluent consolidation, multiple small cavities within a given lesion, miliary tuberculosis, enlarged mediastinal lymph nodes, and extra chest enlarged lymph nodes

  15. Rheumatologic complications in a cohort of 227 patients with common variable immunodeficiency.

    Science.gov (United States)

    Azizi, G; Kiaee, F; Hedayat, E; Yazdani, R; Dolatshahi, E; Alinia, T; Sharifi, L; Mohammadi, H; Kavosi, H; Jadidi-Niaragh, F; Ziaee, V; Abolhassani, H; Aghamohammadi, A

    2018-05-01

    Common variable immunodeficiency (CVID) is the most prevalent symptomatic type of human primary immunodeficiency diseases (PID). Clinically, CVID is characterized by increased susceptibility to infections and a wide variety of autoimmune and rheumatologic disorders. All patients with CVID registered in Iranian PID Registry (IPIDR) were enrolled in this retrospective cohort study. We investigated the frequency of rheumatologic diseases and its association with immunological and clinical phenotypes in patients with CVID. A total of 227 patients with CVID were enrolled in this study. The prevalence of rheumatologic disorders was 10.1% with a higher frequency in women than men. Most common rheumatologic manifestations were juvenile idiopathic arthritis (JIA) and adult rheumatoid arthritis (RA) followed by juvenile spondyloarthritis (JSpA) and undifferentiated inflammatory arthritis (UIA). Septic arthritis in patients with CVID with a history of RA and JIA was higher than patients without rheumatologic complication. Patients with CVID with a history of autoimmunity (both rheumatologic and non-rheumatologic autoimmunity) had lower regulatory T cells counts in comparison with patients without autoimmune disorders. There was an association between defect in specific antibody responses and negative serologic test results in patients with rheumatologic manifestations. JIA, RA, JSpA and UIA are the most frequent rheumatologic disorders in patients with CVID. Due to antibody deficiency, serologic tests may be negative in these patients. Therefore, these conditions pose significant diagnostic and therapeutic challenges for immunologists and rheumatologists in charge of the care for these patients. © 2018 The Foundation for the Scandinavian Journal of Immunology.

  16. Digital health: a new dimension in rheumatology patient care.

    Science.gov (United States)

    Kataria, Suchitra; Ravindran, Vinod

    2018-04-30

    The new digital health innovations have opened up several opportunities to help the clinicians, patients and other caregivers of rheumatology healthcare system in maximizing efficiencies resulting in better patient outcomes. In the global context, digital health technology has the potential to bridge the distance gap between all the key stakeholders involved in rheumatology health care. In this review, we update on the recent advances in the field of digital health and highlight unique features of these technologies which would help in routine care. Application of technology in any form to enable, facilitate or enhance the quality of care is the foundation of digitised care. The components could be smartphone apps, sensors, video, social media platforms or messenger platforms, wearables or a combination of these enabling healthcare delivery and overcoming the constraints of distance, location and time. Digital therapeutics have started evolving and an important step in this direction is the involvement of FDA in the approval process. Speciality specific apps, personalised patient education as per disease status, remote specialist consultations or virtual health coach to guide on lifestyle modifications are some of the developments which have been facilitated by increased digitization in all walks of life. Assisted care with the help of robots rendering care in the hospitals or an intelligent robot guiding a patient by voice and visual sense at home are already at the threshold of entering the mainstream of patient care. Wearable devices equipped with powerful sensors are coming handy in keeping a watch on patient symptoms all the time and providing useful insights on disease progression, clinical response or complications. In chronic care such as rheumatology the implications, possibilities and benefits seem unprecedented. Real time data analytics and artificial intelligence are helping the clinicians, healthcare systems and policy makers optimise the resources and

  17. Primary breast lymphoma in an immunocompromised male patient: A case report

    International Nuclear Information System (INIS)

    Yim, Bong Guk; Park, Jeong Seon; Koo, Hye Ryoung; Kim, Soo Yeon; Jang, Ki Seok; Kim, Jin Young; Choi, Yun Young

    2015-01-01

    Primary breast lymphoma in a male patient is extremely rare. We report a case of primary breast lymphoma in an immunocompromised male patient, after renal transplantation. The sonographic and histological features are described in depth

  18. Primary breast lymphoma in an immunocompromised male patient: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Yim, Bong Guk; Park, Jeong Seon; Koo, Hye Ryoung; Kim, Soo Yeon; Jang, Ki Seok [Hanyang University Medical Center, Hanyang University College of Medicine, Seoul (Korea, Republic of); Kim, Jin Young; Choi, Yun Young [Dept. of Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri (Korea, Republic of)

    2015-10-15

    Primary breast lymphoma in a male patient is extremely rare. We report a case of primary breast lymphoma in an immunocompromised male patient, after renal transplantation. The sonographic and histological features are described in depth.

  19. Herpesvirus infections in immunocompromised patients : treatment, treatment failure and antiviral resistance

    NARCIS (Netherlands)

    Beek, Martha Trijntje van der

    2012-01-01

    The research described in this thesis aims to study determinants of the course and outcome of treatment of herpesvirus infections in immunocompromised patients. Both viral factors, such as antiviral resistance, and patient factors, including immunological parameters, were investigated. Techniques to

  20. Virus-Specific T Cells for the Immunocompromised Patient

    Directory of Open Access Journals (Sweden)

    Amy Houghtelin

    2017-10-01

    Full Text Available While progress has been made in the treatment of both hematologic cancers and solid tumors, chemorefractory or relapsed disease often portends a dismal prognosis, and salvage chemotherapy or radiation expose patients to intolerable toxicities and may not be effective. Hematopoietic stem cell transplant offers the promise of cure for many patients, and while mismatched, unrelated or haploidentical donors are increasingly available, the recipients are at higher risk of severe immunosuppression and immune dysregulation due to graft versus host disease. Viral infections remain a primary cause of severe morbidity and mortality in this patient population. Again, many therapeutic options for viral disease are toxic, may be ineffective or generate resistance, or fail to convey long-term protection. Adoptive cell therapy with virus-specific T cells (VSTs is a targeted therapy that is efficacious and has minimal toxicity in immunocompromised patients with CMV and EBV infections in particular. Products have since been generated specific for multiple viral antigens (multi-VST, which are not only effective but also confer protection in 70–90% of recipients when used as prophylaxis. Notably, these products can be generated from either virus-naive or virus-experienced autologous or allogeneic sources, including partially matched HLA-matched third-party donors. Obstacles to effective VST treatment are donor availability and product generation time. Banking of third-party VST is an attractive way to overcome these constraints and provide products on an as-needed basis. Other developments include epitope discovery to broaden the number of viral antigens targets in a single product, the optimization of VST generation from naive donor sources, and the modification of VSTs to enhance persistence and efficacy in vivo.

  1. Virus-Specific T Cells for the Immunocompromised Patient.

    Science.gov (United States)

    Houghtelin, Amy; Bollard, Catherine M

    2017-01-01

    While progress has been made in the treatment of both hematologic cancers and solid tumors, chemorefractory or relapsed disease often portends a dismal prognosis, and salvage chemotherapy or radiation expose patients to intolerable toxicities and may not be effective. Hematopoietic stem cell transplant offers the promise of cure for many patients, and while mismatched, unrelated or haploidentical donors are increasingly available, the recipients are at higher risk of severe immunosuppression and immune dysregulation due to graft versus host disease. Viral infections remain a primary cause of severe morbidity and mortality in this patient population. Again, many therapeutic options for viral disease are toxic, may be ineffective or generate resistance, or fail to convey long-term protection. Adoptive cell therapy with virus-specific T cells (VSTs) is a targeted therapy that is efficacious and has minimal toxicity in immunocompromised patients with CMV and EBV infections in particular. Products have since been generated specific for multiple viral antigens (multi-VST), which are not only effective but also confer protection in 70-90% of recipients when used as prophylaxis. Notably, these products can be generated from either virus-naive or virus-experienced autologous or allogeneic sources, including partially matched HLA-matched third-party donors. Obstacles to effective VST treatment are donor availability and product generation time. Banking of third-party VST is an attractive way to overcome these constraints and provide products on an as-needed basis. Other developments include epitope discovery to broaden the number of viral antigens targets in a single product, the optimization of VST generation from naive donor sources, and the modification of VSTs to enhance persistence and efficacy in vivo .

  2. Challenges and Opportunities in Using Patient-Reported Outcomes in Quality Measurement in Rheumatology

    OpenAIRE

    Wahl, Elizabeth; Yazdany, Jinoos

    2016-01-01

    Use of Patient-reported outcome measures (PROs) in rheumatology research is widespread, but use of PRO data to evaluate the quality of rheumatologic care delivered is less well established. This article reviews the use of PROs in assessing healthcare quality, and highlights challenges and opportunities specific to their use in rheumatology quality measurement. We first explore other countries’ experiences collecting and evaluating national PRO data to assess quality of care. We describe the c...

  3. Epidemiology and outcome of tuberculosis in immunocompromised patients.

    Science.gov (United States)

    Metry, Abdul Massiah; Al Salmi, Issa; Al-Abri, Seif; Al Ismaili, Faisal; Al Mahrouqi, Yaqoub; Hola, Alan; Shaheen, Faissal A M

    2017-01-01

    The United States Renal Data System showed 1.2% and 1.6% incidences of tuberculosis (TB) in patients on peritoneal dialysis and hemodialysis (HD), respectively. Kidney transplant (KTX) patients have higher rates. We studied the epidemiology and outcome of TB in patients with kidney dysfunction in a tertiary care hospital in the past decade. We examined data of patients with TB with and without kidney dysfunction from 2006 to 2015 through an electronic system. Statistical analysis was completed using Stata software, Chicago, IL, USA. We found 581 patients with active TB of whom 37 had renal dysfunction including chronic kidney disease, HD, and KTX. No difference was found in the prevalence, age, or gender predilection. The age ranged from 1 to 95 with a mean (standard deviation) of 38.6 (21.1) years. The incidence of TB is 3 per 100,000. The number of patients per year with active TB ranges from 52 to 128 and 3 to 4 in the general population and kidney dysfunction group, respectively. Sixty-five percent of patients with kidney dysfunction had pulmonary TB, 5% had pleurisy, and 30% had extrapulmonary TB. Eighty-four percent of patients with kidney dysfunction completed the course of treatment with 16% treatment failure and 0.4% developed multidrug-resistant TB; 8% were lost to follow-up and 8% died during the treatment period. This study showed no gender predilection for TB in the general population and immunocompromised. Duration of symptoms before diagnosis of TB was shorter in kidney dysfunction patients in comparison to the general population. TB cultures were the most positive tests whereas bronchoalveolar lavage and skin test were the least positive for detecting TB in the kidney dysfunction group. Improvement in registries and screening is required to enhance the capturing rate and detection among this group, as well as providing accurate data to health authorities and the public about the magnitude, future trends, treatments, and outcomes regarding TB in

  4. Epidemiology and outcome of tuberculosis in immunocompromised patients

    Directory of Open Access Journals (Sweden)

    Abdul Massiah Metry

    2017-01-01

    Full Text Available The United States Renal Data System showed 1.2% and 1.6% incidences of tuberculosis (TB in patients on peritoneal dialysis and hemodialysis (HD, respectively. Kidney transplant (KTX patients have higher rates. We studied the epidemiology and outcome of TB in patients with kidney dysfunction in a tertiary care hospital in the past decade. We examined data of patients with TB with and without kidney dysfunction from 2006 to 2015 through an electronic system. Statistical analysis was completed using Stata software, Chicago, IL, USA. We found 581 patients with active TB of whom 37 had renal dysfunction including chronic kidney disease, HD, and KTX. No difference was found in the prevalence, age, or gender predilection. The age ranged from 1 to 95 with a mean (standard deviation of 38.6 (21.1 years. The incidence of TB is 3 per 100,000. The number of patients per year with active TB ranges from 52 to 128 and 3 to 4 in the general population and kidney dysfunction group, respectively. Sixty-five percent of patients with kidney dysfunction had pulmonary TB, 5% had pleurisy, and 30% had extrapulmonary TB. Eighty-four percent of patients with kidney dysfunction completed the course of treatment with 16% treatment failure and 0.4% developed multidrug-resistant TB; 8% were lost to follow-up and 8% died during the treatment period. This study showed no gender predilection for TB in the general population and immunocompromised. Duration of symptoms before diagnosis of TB was shorter in kidney dysfunction patients in comparison to the general population. TB cultures were the most positive tests whereas bronchoalveolar lavage and skin test were the least positive for detecting TB in the kidney dysfunction group. Improvement in registries and screening is required to enhance the capturing rate and detection among this group, as well as providing accurate data to health authorities and the public about the magnitude, future trends, treatments, and outcomes

  5. Readability of patient information and consent documents in rheumatological studies

    DEFF Research Database (Denmark)

    Hamnes, Bente; van Eijk-Hustings, Yvonne; Primdahl, Jette

    2016-01-01

    BACKGROUND: Before participation in medical research an informed consent must be obtained. This study investigates whether the readability of patient information and consent documents (PICDs) corresponds to the average educational level of participants in rheumatological studies in the Netherlands......, Denmark, and Norway. METHODS: 24 PICDs from studies were collected and readability was assessed independently using the Gunning's Fog Index (FOG) and Simple Measure of Gobbledygook (SMOG) grading. RESULTS: The mean score for the FOG and SMOG grades were 14.2 (9.0-19.0) and 14.2 (12-17) respectively....... The mean FOG and SMOG grades were 12.7 and 13.3 in the Dutch studies, 15.0 and 14.9 in the Danish studies, and 14.6 and 14.3 in the Norwegian studies, respectively. Out of the 2865 participants, more than 57 % had a lower educational level than the highest readability score calculated in the individual...

  6. Acute hypoxemic respiratory failure in immunocompromised patients : The Efraim multinational prospective cohort study

    NARCIS (Netherlands)

    Azoulay, Elie; Pickkers, Peter; Soares, Marcio; Perner, Anders; Rello, Jordi; Bauer, Philippe R.; van de Louw, Andry; Hemelaar, Pleun; Lemiale, Virginie; Taccone, Fabio Silvio; Loeches, Ignacio Martin; Meyhoff, Tine Sylvest; Salluh, Jorge; Schellongowski, Peter; Rusinova, Katerina; Terzi, Nicolas; Mehta, Sangeeta; Antonelli, Massimo; Kouatchet, Achille; Barratt-Due, Andreas; Valkonen, Miia; Landburg, Precious Pearl; Bruneel, Fabrice; Bukan, Ramin Brandt; Pene, Frederic; Metaxa, Victoria; Moreau, Anne Sophie; Souppart, Virginie; Burghi, Gaston; Girault, Christophe; Silva, Ulysses V. A.; Montini, Luca; Barbier, Francois; Nielsen, Lene B.; Gaborit, Benjamin; Mokart, Djamel; Chevret, Sylvie

    2017-01-01

    Background: In immunocompromised patients with acute hypoxemic respiratory failure (ARF), initial management aims primarily to avoid invasive mechanical ventilation (IMV). Methods: To assess the impact of initial management on IMV and mortality rates, we performed a multinational observational

  7. Acute hypoxemic respiratory failure in immunocompromised patients: the Efraim multinational prospective cohort study

    NARCIS (Netherlands)

    Azoulay, E.; Pickkers, P.; Soares, M.; Perner, A.; Rello, J.; Bauer, P.R.; Louw, A. van de; Hemelaar, P.; Lemiale, V.; Taccone, F.S.; Loeches, I.M.; Meyhoff, T.S.; Salluh, J.; Schellongowski, P.; Rusinova, K.; Terzi, N.; Mehta, S.; Antonelli, M.; Kouatchet, A.; Barratt-Due, A.; Valkonen, M.; Landburg, P.P.; Bruneel, F.; Bukan, R.B.; Pene, F.; Metaxa, V.; Moreau, A.S.; Souppart, V.; Burghi, G.; Girault, C.; Silva, U.V.A.; Montini, L.; Barbier, F.; Nielsen, L.B.; Gaborit, B.; Mokart, D.; Chevret, S.

    2017-01-01

    BACKGROUND: In immunocompromised patients with acute hypoxemic respiratory failure (ARF), initial management aims primarily to avoid invasive mechanical ventilation (IMV). METHODS: To assess the impact of initial management on IMV and mortality rates, we performed a multinational observational

  8. Intractable hiccups due to herpetic esophagitis in an immunocompromised patient

    Directory of Open Access Journals (Sweden)

    John Harris

    2016-01-01

    This case illustrates an exceptionally rare presentation of herpetic esophagitis in an immunocompromised host. As novel immunotherapeutic/suppressive agents continue to emerge, the evolving role of herpes virus prophylaxis and diagnosis of atypical presentations in new host populations is a topic of growing importance.

  9. Computed Tomography Features of Pulmonary Nocardiosis in Immunocompromised and Immunocompetent Patients

    International Nuclear Information System (INIS)

    Mehrian, Payam; Esfandiari, Ehsan; Karimi, Mohammad Ali; Memari, Behzad

    2015-01-01

    Nocardiosis primarily occurs in the setting of immunocompromising conditions. However, it may also occur in immunocompetent patients. We described computed tomography features of pulmonary nocardiosis and compared immunocompetent and immunocompromised patients. CT images of 25 patients (Mean age of 39.5 years; 76% male) with pulmonary nocardiosis proved by bronchoalveolar lavage or biopsy were reviewed by two experienced pulmonary radiologists and detailed findings were reported on. Fourteen patients (56%) were immunocompetent, while 44% had an underlying immunocompromising condition, including chronic granulomatous disease (CGD) (n=4), diabetes mellitus (DM) (n=2), malignancy (n=2), HIV (n=1), concomitant CGD and DM (n=1), and steroid therapy for nephrotic syndrome (n=1). Most patients had bilateral involvement with no zonal predominance. Multiple pulmonary nodules (96%) were the most common CT findings, followed by consolidation (76%) and cavity (52%). Other findings included bronchiectasis (48%), pleural thickening (40%), ground glass opacity (32%), mass-like consolidation (20%), intrathoracic lymphadenopathy (16%), pleural effusion (12%), reticular infiltration (4%), and pericardial effusion (4%). There was no statistically significant difference in the CT findings of immunocompromised and immunocompetent groups. Pulmonary nocardiosis presents mainly as multiple pulmonary nodules, consolidations, and cavity in both immunocompromised and immunocompetent patients. However, these features are more suggestive of nocardiosis in the setting of an underling immunocompromised condition

  10. Pseudomonas aeruginosa Bacteremia among Immunocompetent and Immunocompromised Patients: Relation to Initial Antibiotic Therapy and Survival.

    Science.gov (United States)

    Migiyama, Yohei; Yanagihara, Katsunori; Kaku, Norihito; Harada, Yosuke; Yamada, Koichi; Nagaoka, Kentaro; Morinaga, Yoshitomo; Akamatsu, Norihiko; Matsuda, Junichi; Izumikawa, Koichi; Kohrogi, Hirotsugu; Kohno, Shigeru

    2016-01-01

    Pseudomonas aeruginosa bacteremia occurs mainly in immunocompromised patients. However, P. aeruginosa bacteremia in immunocompetent patients has also been reported. The aim of this study was to evaluate the clinical characteristics of P. aeruginosa bacteremia in relation to the immune status of the patients. The medical records of 126 adult patients with P. aeruginosa bacteremia in Nagasaki University Hospital were retrospectively reviewed between January 2003 and December 2012. Of 126 patients with P. aeruginosa bacteremia, 60 patients (47.6%) were classified as immunocompetent. Mortality in immunocompetent patients tended to be lower than in immunocompromised patients (7-day mortality, 8% vs. 30%, P antibiotic therapy (HR: 0.21, P immunocompromised, but not immunocompetent patients, initial appropriate antibiotic therapy was associated with lower mortality (30-day mortality 20.5% vs. 66.7%, P < 0.01 by log-rank test).

  11. Readability of patient information and consent documents in rheumatological studies.

    Science.gov (United States)

    Hamnes, Bente; van Eijk-Hustings, Yvonne; Primdahl, Jette

    2016-07-16

    Before participation in medical research an informed consent must be obtained. This study investigates whether the readability of patient information and consent documents (PICDs) corresponds to the average educational level of participants in rheumatological studies in the Netherlands, Denmark, and Norway. 24 PICDs from studies were collected and readability was assessed independently using the Gunning's Fog Index (FOG) and Simple Measure of Gobbledygook (SMOG) grading. The mean score for the FOG and SMOG grades were 14.2 (9.0-19.0) and 14.2 (12-17) respectively. The mean FOG and SMOG grades were 12.7 and 13.3 in the Dutch studies, 15.0 and 14.9 in the Danish studies, and 14.6 and 14.3 in the Norwegian studies, respectively. Out of the 2865 participants, more than 57 % had a lower educational level than the highest readability score calculated in the individual study. As the readability level of the PICDs did not match the participants' educational level, consent may not have been valid, as the participants may have had a limited understanding of what they agreed to participate in. There should be more focus on the readability of PICDs. National guidelines for how to write clear and unambiguous PICDs in simple and easily understandable language could increase the focus on the readability of PICD.

  12. Sporotrichoid-Like Spread of Cutaneous Mycobacterium chelonae in an Immunocompromised Patient

    Directory of Open Access Journals (Sweden)

    Daria Marley Kemp

    2017-01-01

    Full Text Available Mycobacterium chelonae is a rapidly growing mycobacterium found in water and soil that can cause local cutaneous infections in immunocompetent hosts but more frequently affects immunocompromised patients. Typically, patients will present with painful subcutaneous nodules of the joints or soft tissues from traumatic inoculation. However, exhibiting a sporotrichoid-like pattern of these nodules is uncommon. Herein, we report a case of sporotrichoid-like distribution of cutaneous Mycobacterium chelonae in a patient with systemic lupus erythematosus on significant immunosuppressive medications. Clinicians treating immunocompromised patients should be cognizant of their propensity to develop unusual infections and atypical presentations.

  13. Prolonged influenza virus shedding and emergence of antiviral resistance in immunocompromised patients and ferrets.

    Directory of Open Access Journals (Sweden)

    Erhard van der Vries

    Full Text Available Immunocompromised individuals tend to suffer from influenza longer with more serious complications than otherwise healthy patients. Little is known about the impact of prolonged infection and the efficacy of antiviral therapy in these patients. Among all 189 influenza A virus infected immunocompromised patients admitted to ErasmusMC, 71 were hospitalized, since the start of the 2009 H1N1 pandemic. We identified 11 (15% cases with prolonged 2009 pandemic virus replication (longer than 14 days, despite antiviral therapy. In 5 out of these 11 (45% cases oseltamivir resistant H275Y viruses emerged. Given the inherent difficulties in studying antiviral efficacy in immunocompromised patients, we have infected immunocompromised ferrets with either wild-type, or oseltamivir-resistant (H275Y 2009 pandemic virus. All ferrets showed prolonged virus shedding. In wild-type virus infected animals treated with oseltamivir, H275Y resistant variants emerged within a week after infection. Unexpectedly, oseltamivir therapy still proved to be partially protective in animals infected with resistant virus. Immunocompromised ferrets offer an attractive alternative to study efficacy of novel antiviral therapies.

  14. Quality of life in rheumatological patients: The impact of personality disorders.

    Science.gov (United States)

    Uguz, Faruk; Kucuk, Adem; Cicek, Erdinc; Kayhan, Fatih; Salli, Ali; Guncu, Hatice; Çilli, Ali Savas

    2015-01-01

    Rheumatological diseases are associated with lower quality of life (QoL) levels. Psychiatric disturbances are frequently observed in these patients. This study examined the impact of personality disorders on the QoL of patients with rheumatological diseases. The study sample consisted of 142 participants including patients suffering from rheumatological disease with a personality disorder (n = 30), without any personality disorder (n = 112), and healthy control participants without physical or psychiatric disorders (n = 60). The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID-I) and the Structured Clinical Interview for DSM, Revised Third Edition Personality Disorders (SCID-II) were used to determine Axis I and Axis II psychiatric disorders, respectively. QoL levels were assessed by means of the World Health Organization QoL Assessment-Brief. The subscale scores of physical health, psychological health, and social relationships were significantly lower in patients with rheumatological disease regardless of the existence of personality disorder compared with the control participants. Rheumatological patients with a personality disorder had significantly lower subscale scores of psychological health (p = 0.003) and social relationships (p personality disorder. Personality disorders seem to be a relevant factor that maybe associated with QoL in patients suffering from rheumatological disease. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  15. Legionella feeleii: an unusual organism associated with cutaneous infection in an immunocompromised patient.

    Science.gov (United States)

    Verykiou, S; Goodhead, C; Parry, G; Meggitt, S

    2018-04-01

    We report a 23-year-old immunocompromised woman who, following cardiac transplantation, presented with an unusual cutaneous eruption. She developed a widespread pustular rash, systemic symptoms and a high temperature with raised inflammatory markers. The diagnosis was reached when a skin biopsy was cultured onto Legionella agar (buffered charcoal yeast extract) and Legionella feeleii was isolated. The patient was treated with 6 weeks of moxifloxacin and her cutaneous lesions gradually resolved. Cutaneous Legionella infections are uncommon and usually affect immunocompromised patients. © 2017 British Association of Dermatologists.

  16. Lesion mimicking perianal abscess in an immunocompromised patient: Report of a case

    Directory of Open Access Journals (Sweden)

    Aranzazu Calero-Lillo

    2014-01-01

    CONCLUSION: Intramuscular administration of drugs should be avoided in patients with thrombocytopenia. Gluteal region is connected to perianal area through the sciatic notch. Usually perianal abscess in immunocompromised patients arise from proctologic origin, but other causes may be taken into account.

  17. Central Nervous System Brucellosis Granuloma and White Matter Disease in Immunocompromised Patient.

    Science.gov (United States)

    Alqwaifly, Mohammed; Al-Ajlan, Fahad S; Al-Hindi, Hindi; Al Semari, Abdulaziz

    2017-06-01

    Brucellosis is a multisystem zoonotic disease. We report an unusual case of neurobrucellosis with seizures in an immunocompromised patient in Saudi Arabia who underwent renal transplantation. Magnetic resonance imaging of the brain showed diffuse white matter lesions. Serum and cerebrospinal fluid were positive for Brucella sp. Granuloma was detected in a brain biopsy specimen.

  18. Impact of healthcare design on patients' perception of a rheumatology outpatient infusion room

    DEFF Research Database (Denmark)

    Bukh, Gunhild; Tommerup, Anne Marie Munk; Madsen, Ole Rintek

    2015-01-01

    Evidence-based healthcare design is a concept aimed at reducing stress factors in the physical environment for the benefit of patients and the medical staff. The objective of this study was to examine the impact of room modifications on patients' perception of an outpatient infusion room used...... the potential to improve patients' perception of outpatient infusion rooms used for treating rheumatologic diseases....

  19. Prevalence of Intestinal Coccidial Infections among Different Groups of Immunocompromised Patients

    Directory of Open Access Journals (Sweden)

    Ghodratollah SALEHI SANGANI

    2016-10-01

    Full Text Available Background: Cryptosporidium and Isospora are known as one of the main cause of diarrhea in both immunocompetent and immunocompromised subjects, all over the world. Incidence of enteropathogens such as Cryptosporidium spp. and Isospora belli considerably has increased, since immunodeficiency virus (HIV rapidly disseminated. In addition, cancer patients are highly susceptible to opportunistic infections. This study aimed to estimate the prevalence of cryptosporidiosis and isosporiasis in immunocompromised patients in Tehran.Methods: This study carried out on patients admitted to Imam Khomeini hospital during 2013-2014. Stool samples collected from 350 immunocompromised patients. Formol-ether concentration was performed for all stool samples. Zeil-Neelsen technique was applied to stain the prepared smears and finally, all slides were examined by light microscope.Results: Out of 350 patients, 195 (55.7% and 155 (44.3% were male and female, respectively. Cryptosporidium oocysts were detected in 3 (0.9% samples including one sample from HIV+/AIDS patients and 2 samples from organ transplant recipients. Isospora oocysts were detected in 4 (1.1% samples consisting 2 HIV+/AIDS patients, one patients suffering from malignancy and one patients with other immunodeficiency diseases.Conclusion: Cryptosporidium sp, and I. belli are the most prevalent gastrointestinal parasitic protozoans that infect a broad range of individuals, particularly those patients who have a suppressed or deficient immunity system.

  20. High-resolution computed tomography (HRCT) of lung infections in non-AIDS immunocompromised patients

    Energy Technology Data Exchange (ETDEWEB)

    Franquet, Tomas [Universitat Autonoma de Barcelona, Department of Radiology, Thoracic Radiology Section, Hospital de Sant Pau, Barcelona (Spain)

    2006-03-15

    Non-AIDS immunocompromised patients are susceptible to infections by a wide range of organisms. In the past several decades, advances in the treatment of cancer, organ transplantation, and immunosuppressive therapy have resulted in large numbers of patients who develop abnormalities in their immune system. Moreover, mildly impaired host immunity as it occurs in chronic debilitating illness, diabetes mellitus, malnutrition, alcoholism, advanced age, prolonged corticosteroid administration, and chronic obstructive lung disease have also been regarded as predisposing factors of pulmonary infections. Imaging plays a crucial role in the detection and management of patients with pulmonary infectious diseases. When pulmonary infection is suspected, knowledge of the varied radiographic manifestations will narrow the differential diagnosis, helping to direct additional diagnostic measures and serving as an ideal tool for follow-up examinations. Combination of pattern recognition with knowledge of the clinical setting is the best approach to pulmonary infection occurring in the immunocompromised patients. (orig.)

  1. Herpes Simplex Virus Infection Mimicking Bullous Disease in an Immunocompromised Patient

    Directory of Open Access Journals (Sweden)

    Anne L.Y. Lecluse

    2010-06-01

    Full Text Available Immunodeficient patients are at risk of developing extended or atypical herpes simplex virus infections, which can be easily misdiagnosed. We present the case of a 79-year-old, treatment-induced (oral corticosteroid, immunocompromised female with an extensive atypical herpes simplex virus infection. This patient presented with multiple erosions and vesicles on the trunk with a subacute onset. The clinical differential diagnosis was herpes simplex infection, herpes zoster infection, pemphigus vulgaris or bullous pemphigoid. Due to the atypical clinical presentation and negative Tzanck test, suspicion of viral infection was low. High-dose steroid treatment was initiated. Subsequent histopathology, however, showed a herpes simplex virus infection. After discontinuing steroid treatment and initiating antiviral treatment, the patient recovered within a week. Emphasis must be placed on the importance of clinical awareness of extended and clinically atypical herpes simplex infections in immunocompromised patients. A negative Tzanck test does not rule out the possibility of a herpes infection.

  2. High-resolution computed tomography (HRCT) of lung infections in non-AIDS immunocompromised patients

    International Nuclear Information System (INIS)

    Franquet, Tomas

    2006-01-01

    Non-AIDS immunocompromised patients are susceptible to infections by a wide range of organisms. In the past several decades, advances in the treatment of cancer, organ transplantation, and immunosuppressive therapy have resulted in large numbers of patients who develop abnormalities in their immune system. Moreover, mildly impaired host immunity as it occurs in chronic debilitating illness, diabetes mellitus, malnutrition, alcoholism, advanced age, prolonged corticosteroid administration, and chronic obstructive lung disease have also been regarded as predisposing factors of pulmonary infections. Imaging plays a crucial role in the detection and management of patients with pulmonary infectious diseases. When pulmonary infection is suspected, knowledge of the varied radiographic manifestations will narrow the differential diagnosis, helping to direct additional diagnostic measures and serving as an ideal tool for follow-up examinations. Combination of pattern recognition with knowledge of the clinical setting is the best approach to pulmonary infection occurring in the immunocompromised patients. (orig.)

  3. Utility of galactomannan antigen detection in bronchoalveolar lavage fluid in immunocompromised patients.

    Science.gov (United States)

    Brownback, Kyle R; Pitts, Lucas R; Simpson, Steven Q

    2013-09-01

    Diagnosis of invasive pulmonary aspergillosis (IPA) is a challenging process in immunocompromised patients. Galactomannan (GM) antigen detection in bronchoalveolar lavage (BAL) fluid is a method to detect IPA with improved sensitivity over conventional studies. We sought to determine the diagnostic yield of BAL GM assay in a diverse population of immunocompromised patients. A retrospective review of 150 fiberoptic bronchoscopy (FOB) with BAL for newly diagnosed pulmonary infiltrate in immunocompromised patients was performed. Patient information, procedural details and laboratory studies were collected. BAL and serum samples were evaluated for GM using enzyme-linked immunoassay. Of 150 separate FOB with BAL, BAL GM was obtained in 143 samples. There were 31 positive BAL GM assays. In those 31 positive tests, 13 were confirmed as IPA, giving a positive predictive value of 41.9%. There was one false negative BAL GM. Of the 18 false positive BAL GM, 4 were receiving piperacillin-tazobactam and 11 were receiving an alternative beta-lactam antibiotic. BAL GM assay shows excellent sensitivity for diagnosing IPA. There was a significant number of false positive BAL GM assays and several of those patients were receiving beta-lactam antibiotics at the time of bronchoscopy. © 2013 Blackwell Verlag GmbH.

  4. Relapse of Legionella longbeachae infection in an immunocompromised patient

    NARCIS (Netherlands)

    van't Hullenaar, N. G.; van Ketel, R. J.; Kuijper, E. J.; Bakker, P. J.; Dankert, J.

    1996-01-01

    We describe the first known case of Legionella longbeachae infection in the Netherlands in a patient with myasthenia gravis. Infection with L. longbeachae relapsed after prolonged therapy with erythromycin. No environmental source of L. longbeachae could be traced

  5. Epidemiology and management of mycobacterial infections in the immunocompromised patient

    Directory of Open Access Journals (Sweden)

    Maximo O Brito

    2015-01-01

    The author will review the epidemiology, clinical presentation, diagnostic methods and principles of treatment of the most common mycobacteria that cause disease in HIV and transplant recipients, and will discuss some of the nuances in the management of these patients.

  6. Framework for Advancing the Reporting of Patient Engagement in Rheumatology Research Projects.

    Science.gov (United States)

    Hamilton, Clayon B; Leese, Jenny C; Hoens, Alison M; Li, Linda C

    2017-07-01

    The term "patient engagement in research" refers to patients and their surrogates undertaking roles in the research process beyond those of study participants. This paper proposes a new framework for describing patient engagement in research, based on analysis of 30 publications related to patient engagement. Over the past 15 years, patients' perspectives have been instrumental in broadening the scope of rheumatology research and outcome measurement, such as evaluating fatigue in rheumatoid arthritis. Recent reviews, however, highlight low-quality reporting of patient engagement in research. Until we have more detailed information about patient engagement in rheumatology research, our understanding of how patients' perspectives are being integrated into research projects remains limited. When authors follow our guidance on the important components for describing patients' roles and function as "research partners," researchers and other knowledge users will better understand how patients' perspectives were integrated in their research projects.

  7. Rhinocerebral Mucor circinelloides infection in immunocompromised patient following yogurt ingestion.

    Science.gov (United States)

    Lazar, Stephen P; Lukaszewicz, Jennifer M; Persad, Kamleish A; Reinhardt, John F

    2014-08-01

    The purpose of this case report is to illustrate the cause of this patient's headache and sinus pain in the setting of a unique environmental exposure: the patient ingested yogurt only days before presentation. This particular brand of yogurt caused controversy in early September 2013 when the manufacturer voluntarily recalled all flavors. The yogurt was found to be contaminated with Mucor circinelloides. The recall was triggered by the FDA, after receiving many complaints from consumers affected by temporary gastrointestinal symptoms such as abdominal cramping, diarrhea, and nausea. This patient was diagnosed with Rhinocerebral mucormycosis through fungal culture of the affected area. He was specifically colonized with Mucor circinelloides, a variant that rarely causes disease in humans. According to a literature review, only eight cases of mucormycosis in adults caused by this strain were documented before 2009.

  8. Fatal sepsis by Bacillus circulans in an immunocompromised patient

    OpenAIRE

    Alebouyeh, M; Gooran Orimi, P; Azimi-rad, M; Tajbakhsh, M; Tajeddin, E; Jahani Sherafat, S; Nazemalhosseini mojarad, E; Zali, MR

    2011-01-01

    An immunosuppressed man was admitted to hospital with diarrhea and a history of urinary tract infection. He was subjected to treatment with antibiotics. The patient died of putative severe sepsis. The etiological agent was a carbapenemase producing isolate of Bacillus circulans with resistance to all prescribed antimicrobial agents.

  9. Septic arthritis by Sphingobacterium multivorum in immunocompromised pediatric patient

    Directory of Open Access Journals (Sweden)

    Maiana Darwich Mendes

    Full Text Available Abstract Objective: To report a case septic arthritis with a rare pathogen in a immunosuppressed child. Case description: Male patient, 6 years old, had liver transplant five and half years ago due to biliary atresia. Patient was using tacrolimus 1mg q.12h. This patient started to have pain in left foot and ankle and had one episode of fever 3 days before hospital admission. Physical examination showed weight 17kg, height 109cm, temperature 36.4°C, with pain, swelling and heat in the left ankle, without other clinical signs. Initial tests: hemoglobin 11.7g/dL hematocrit 36.4%, leukocyte count 17,600µL-1 (7% banded neutrophils, 70% segmented neutrophils, 2% eosinophils, basophils 1%, 13% lymphocytes, 7% monocytes C-reactive protein 170.88mg/L. Joint ultrasound showed moderate effusion in the site. Patient was submitted to surgical procedure and Sphingobacterium multivorum was isolated from the effusion. The germ was susceptible to broad spectrum cephalosporins (ceftriaxone and cefepime and fluoroquinolones (ciprofloxacin and levofloxacin, and it was resistant to carbapenemic antibiotics and aminoglycosides. He was treated intravenously with oxacillin for 15 days and ceftriaxone for 13 days, and orally with ciprofloxacin for 15 days, with good outcome. Comments: The S. multivorum is a gram negative bacillus that belongs to Flavobacteriaceae family and it is considered non-pathogenic. It has rarely been described as a cause of infections in humans, especially in hospital environment and in immunosuppressed patients. This case report is relevant for its unusual etiology and for the site affected, which may be the first case of septic arthritis described.

  10. An isolated tuberculous liver abscess in a non-immunocompromised patient

    International Nuclear Information System (INIS)

    Abeysekera, W.Y.M.; Silva, W.D.D.D.; Pragatheswaran, P.; Banagala, A.S.K.

    2013-01-01

    A liver abscess is an uncommon extra-pulmonary manifestation of a common disease that is tuberculosis. It usually follows primary infection in the lung or the gut. Tuberculous liver abscess in a non-immunocompromised patient in the absence of primary disease elsewhere is an extremely rare occurrence. We report here a case of a tuberculous liver abscess in a 30 years old female who presented a considerable diagnostic challenge. (author)

  11. Pathogens Causing Blood Stream Infections and their Drug Susceptibility Profile in Immunocompromised Patients

    International Nuclear Information System (INIS)

    Fayyaz, M.; Mirza, I.A.; Ikram, A.; Hussain, A.; Ghafoor, T.; Shujat, U.

    2013-01-01

    Objective: To determine the types of pathogens causing blood stream infections and their drug susceptibility profile in immunocompromised patients. Study Design: Cross-sectional, observational study. Place and Duration of Study: Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi, from January to September 2012. Methodology: Blood culture bottles received from immunocompromised patients were dealt by two methods, brain heart infusion (BHI) broth based manual method and automated BACTEC system. The samples yielding positive growth from either of two methods were further analyzed. The identification of isolates was done with the help of biochemical reactions and rapid tests. Antimicrobial susceptibility of the isolates was carried out as per recommendations of Clinical and Laboratory Standards Institute (CLSI). Results: Out of the 938 blood culture specimens received from immunocompromised patients, 188 (20%) yielded positive growth. Out of these, 89 (47.3%) isolates were Gram positive and Gram negative each, while 10 (5.3%) isolates were fungi (Candida spp.). In case of Gram positive isolates, 75 (84.3%) were Staphylococcus spp. and 51 (67%) were Methicillin resistant. Amongst Gram negative group 49 (55.1%) isolates were of enterobacteriaceae family, while 40 (44.9%) were non-lactose fermenters (NLF). In vitro antimicrobial susceptibility of Staphylococci revealed 100% susceptibility to vancomycin and linezolid. The enterobacteriaceae isolates had better susceptibility against amikacin 85.7% compared to tigecycline 61.2% and imipenem 59.2%. For NLF, the in vitro efficacy of aminoglycosides was 72.5%. Conclusion: The frequency of Gram positive and Gram negative organisms causing blood stream infections in immunocompromised patients was equal. Vancomycin in case of Gram positive and amikacin for Gram negative organisms revealed better in vitro efficacy as compared to other antibiotics. (author)

  12. Pathogens causing blood stream infections and their drug susceptibility profile in immunocompromised patients.

    Science.gov (United States)

    Fayyaz, Muhammad; Mirza, Irfan Ali; Ikram, Aamer; Hussain, Aamir; Ghafoor, Tahir; Shujat, Umer

    2013-12-01

    To determine the types of pathogens causing blood stream infections and their drug susceptibility profile in immunocompromised patients. Cross-sectional, observational study. Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi, from January to September 2012. Blood culture bottles received from immunocompromised patients were dealt by two methods, brain heart infusion (BHI) broth based manual method and automated BACTEC system. The samples yielding positive growth from either of two methods were further analyzed. The identification of isolates was done with the help of biochemical reactions and rapid tests. Antimicrobial susceptibility of the isolates was carried out as per recommendations of Clinical and Laboratory Standards Institute (CLSI). Out of the 938 blood culture specimens received from immunocompromised patients, 188 (20%) yielded positive growth. Out of these, 89 (47.3%) isolates were Gram positive and Gram negative each, while 10 (5.3%) isolates were fungi (Candida spp.). In case of Gram positive isolates, 75 (84.3%) were Staphylococcus spp. and 51 (67%) were Methicillin resistant. Amongst Gram negative group 49 (55.1%) isolates were of enterobacteriaceae family, while 40 (44.9%) were non-lactose fermenters (NLF). In vitro antimicrobial susceptibility of Staphylococci revealed 100% susceptibility to vancomycin and linezolid. The enterobacteriaceae isolates had better susceptibility against amikacin 85.7% compared to tigecycline 61.2% and imipenem 59.2%. For NLF, the in vitro efficacy of aminoglycosides was 72.5%. The frequency of Gram positive and Gram negative organisms causing blood stream infections in immunocompromised patients was equal. Vancomycin in case of Gram positive and amikacin for Gram negative organisms revealed better in vitro efficacy as compared to other antibiotics.

  13. Nutritive and safe meals, microbiologically treated by gamma irradiation, for immunocompromised patients. Part 2

    International Nuclear Information System (INIS)

    Veronesi, Paola; Cossani, Elena; Lound, Liliana; Gasparovich, Alejandra; Narvaiz, Patricia

    2005-01-01

    Immunocompromised people have diminished immune response , being more vulnerable to food borne infections. Ionizing radiation has been proved to be effective in controlling pathogenic microorganisms in food with negligible temperature raise , which leads it to be called 'cold pasteurization'. Nutritional losses and sensory changes due to this treatment are minimal. In this work a whole gamma irradiated lunch composed of three dishes was tasted by 44 immunocompromised patients at the Clinical Hospital 'Jose de San Martin', Buenos Aires, to evaluate sensory acceptability. The packaged meals were irradiated in the cobalt-60 industrial facility of the Ezeiza Atomic Center at doses sufficient to reduce 6 log cycles of Salmonella enteritidis and stored under refrigeration for one week. Microbiological and sensory analysis (consumer panel of 50 healthy members) were carried out previously to the experience with patients. Experimental work is depicted as related to meals selection, elaboration, packaging, irradiation , storage, microbiological challenge tests, microbiological analysis according to Argentine Alimentary Code specifications, sensory trials with both healthy and immunocompromised consumer panels along storage time. Results showed very good sensory acceptability of the irradiated meals. Nutritional and psychological benefits to the patients, further applications and scope are discussed. (author)

  14. Hepatitis From Spiroplasma sp. in an Immunocompromised Patient.

    Science.gov (United States)

    Mueller, N J; Tini, G M; Weber, A; Gaspert, A; Husmann, L; Bloemberg, G; Boehler, A; Benden, C

    2015-09-01

    A 70-year-old lung transplant recipient patient was admitted with fever, nausea, abdominal pain, peripheral edema and pronounced weakness. An initial work-up for presumed infection revealed cholestatic hepatitis, leukocytosis and thrombocytopenia, but failed to detect a pathogen. An increased glucose uptake exclusively in the liver was demonstrated by positron emission tomography. Liver biopsy showed basophilic inclusions in the cytoplasm of hepatocytes. Broad- range 16S rRNA gene PCR followed by sequence analysis yielded Spiroplasma sp. in two independent blood samples and the liver biopsy, confirming Spiroplasma sp. as the causative agent. Antibiotic treatment with doxycycline and azithromycin led to complete recovery. © Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.

  15. Intracranial toxoplasmosis presenting as panhypopituitarism in an immunocompromised patient.

    Science.gov (United States)

    Hamdeh, Shadi; Abbas, Anum; Fraker, Jessica; Lambrecht, J E

    2015-12-01

    A 37-year-old man presented with worsening headache, vomiting, and right-sided weakness over the last few weeks. A head computed tomography showed a left hemispheric posterior medial parietal lobe lesion with surrounding edema. Further imaging with magnetic resonance imaging showed multiple enhancing mass lesions. The largest lesion measured 2.4 cm within the left occipital parietal region (Figure A and B). Laboratory data showed reactive HIV antibodies, confirmed by Western blot. An absolute CD4 count was 22 cells/μL. Other laboratory test results showed low sodium, thyrotropin, FT4, FT3, cortisol levels, corticotropin, luteinizing hormone, and testosterone. Based on these findings, the brain lesions were believed to be causing his panhypopituitarism. A brain biopsy confirmed the presence of Toxoplasma gondii by polymerase chain reaction. The patient was started on pyrimethamine and clindamycin for toxoplasmosis treatment, and azithromycin and sulfamethoxazole/trimethoprime for appropriate prophylaxis. He was also started on hormone supplementation. His symptoms were completely resolved at the time of discharge.

  16. First case of bacteraemia due to Acinetobacter schindleri harbouring blaNDM-1 in an immunocompromised patient

    Directory of Open Access Journals (Sweden)

    S. Montaña

    2018-01-01

    Full Text Available Clinically significant NDM-1-producing Acinetobacter schindleri has not yet been described in the literature. We report the first case of bacteraemia due to an A. schindleri strain harbouring blaNDM-1 recovered from an immunocompromised patient. Our report reinforces the fact that NDM-1 can easily be acquired by Acinetobacter species. Keywords: Acinetobacter schindleri, bacteraemia, blaNDM-1, clinically significant isolate, immunocompromised patient

  17. Impact of Fluoroquinolone Exposure Prior to Tuberculosis Diagnosis on Clinical Outcomes in Immunocompromised Patients.

    Science.gov (United States)

    Lee, Ju Young; Lee, Hyun Jung; Kim, Yong Kyun; Yu, Shinae; Jung, Jiwon; Chong, Yong Pil; Lee, Sang-Oh; Choi, Sang-Ho; Shim, Tae Sun; Kim, Yang Soo; Woo, Jun Hee; Kim, Sung-Han

    2016-07-01

    There have been concerns about an association of fluoroquinolone (FQ) use prior to tuberculosis (TB) diagnosis with adverse outcomes. However, FQ use might prevent clinical deterioration in missed TB patients, especially in those who are immunocompromised, until they receive definitive anti-TB treatment. All adult immunocompromised patients with smear-negative and culture-positive TB at a tertiary care hospital in Korea over a 2-year period were included in this study. Long-term FQ (≥7 days) use was defined as exposure to FQ for at least 7 days prior to TB diagnosis. A total of 194 patients were identified: 33 (17%) in the long-term FQ group and 161 (83%) in the comparator, including a short-term FQ group (n = 23), non-FQ group (n = 78), and a group receiving no antibiotics (n = 60). Patients in the long-term FQ group presented with atypical chest radiologic pattern more frequently than those in the comparator (77% [24/31] versus 46% [63/138]; P = 0.001). The median time from mycobacterial test to positive mycobacterial culture appeared to be longer in the long-term FQ group (8.1 weeks versus 7.7 weeks; P = 0.09), although the difference was not statistically significant. Patients in the long-term FQ group were less likely to receive empirical anti-TB treatment (55% versus 74%; P = 0.03). The median time from mycobacterial test to anti-TB therapy was longer in the long-term FQ group (4.6 weeks versus 2.2 weeks; P 0.99) or in the 30-day (6% versus 6%; P > 0.99) or 90-day (12% versus 12%; P > 0.99) mortality rate between the two groups. FQ exposure (≥7 days) prior to TB diagnosis in immunocompromised patients appears not to be associated with adverse outcomes. Copyright © 2016, American Society for Microbiology. All Rights Reserved.

  18. Prophylaxis for Pneumocystis pneumonia (PCP) in non-HIV immunocompromised patients.

    Science.gov (United States)

    Stern, Anat; Green, Hefziba; Paul, Mical; Vidal, Liat; Leibovici, Leonard

    2014-10-01

    Pneumocystis pneumonia (PCP) is a disease affecting immunocompromised patients. PCP among these patients is associated with significant morbidity and mortality. To assess the effectiveness of PCP prophylaxis among non-HIV immunocompromised patients; and to define the type of immunocompromised patient for whom evidence suggests a benefit for PCP prophylaxis. Electronic searches of the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 1), MEDLINE and EMBASE (to March 2014), LILACS (to March 2014), relevant conference proceedings; and references of identified trials. Randomised controlled trials (RCTs) or quasi-RCTs comparing prophylaxis with an antibiotic effective against PCP versus placebo, no intervention, or antibiotic(s) with no activity against PCP; and trials comparing different antibiotics effective against PCP among immunocompromised non-HIV patients. We only included trials in which Pneumocystis infections were available as an outcome. Two review authors independently assessed risk of bias in each trial and extracted data from the included trials. We contacted authors of the included trials to obtain missing data. The primary outcome was documented PCP infections. Risk ratios (RR) with 95% confidence intervals (CI) were estimated and pooled using the random-effects model. Thirteen trials performed between the years 1974 and 2008 were included, involving 1412 patients. Four trials included 520 children with acute lymphoblastic leukemia and the remaining trials included adults with acute leukemia, solid organ transplantation or autologous bone marrow transplantation. Compared to no treatment or treatment with fluoroquinolones (inactive against Pneumocystis), there was an 85% reduction in the occurrence of PCP in patients receiving prophylaxis with trimethoprim/sulfamethoxazole, RR of 0.15 (95% CI 0.04 to 0.62; 10 trials, 1000 patients). The evidence was graded as moderate due to possible risk of bias. PCP

  19. Safer prepared meals for immunocompromised patients and the general consumer by gamma irradiation

    International Nuclear Information System (INIS)

    Narvaiz, P.; Horak, C.; Campos, M.; Veronesi, P.; Cossani, E.; Lound, L.; Gasparovich, A.; Liendo, G.; Hovsepian, J.; Mengoni, G.

    2009-01-01

    Ready-to-eat meals are commonplace nowadays in urban life. Many of them, minimally processed, could convey foodborne pathogens likely to cause diseases in the consumer, which is of concern to the normal population and even more so to immunocompromised patients. The feasibility of attaining microbiological decontamination at pasteurization levels of such foods by gamma irradiation was studied. Typical Argentine dishes were chosen after market surveys: cannelloni in tomato sauce, tomato and carrot salad with boiled egg, empanada, fruit salad in gelatin jelly with white cheese, ham and cheese sandwich, chicken and vegetable pie, custard, and bread pudding, in different packaging. Microbiological profiles of the meals were obtained and challenge tests with Listeria innocua or Salmonella enteritidis were performed to determine the minimum radiation dose to be applied in each food so as to attain a 6 log cycle reduction of pathogen counts. Preliminary sensory evaluations, out of panel, were carried out to determine possible evident sensory alterations due to the irradiation treatment. Then, a greater number of samples were irradiated at the minimum radiation dose and at a maximum dose equal to or less than twice the minimum, at the 60 Co semi-industrial facility of the Ezeiza Atomic Center. Microbiological and sensory analyses by a consumer panel were performed on control and irradiated samples throughout storage life at refrigeration temperatures. A whole irradiated lunch, composed of salad, empanadas and fruit salad, was sampled by 44 immunocompromised patients at a hospital. The composition and adequacy of this lunch was designed by nutritionists. Results showed that it was feasible to attain the proposed decontamination goal without significantly impairing the sensory quality. Shelf life was almost tripled in irradiated samples. Immunocompromised patients enjoyed the irradiated lunch and requested it and other dishes to be made commercially available. (author)

  20. Profile of rheumatology patients willing to report adverse drug reactions: bias from selective reporting

    Directory of Open Access Journals (Sweden)

    Protić D

    2016-02-01

    Full Text Available Dragana Protić,1 Nada Vujasinović-Stupar,2 Zoran Bukumirić,3 Slavica Pavlov-Dolijanović,4 Snežana Baltić,5 Slavica Mutavdžin,6 Ljiljana Markovic-Denić,7 Marija Zdravković,8 Zoran Todorović1 1Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 2Department 2, Institute of Rheumatology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 3Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 4Department 5, Institute of Rheumatology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 5Department 5, Institute of Rheumatology, Belgrade, Serbia; 6Institute of Physiology “Rihard Burjan”, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 7Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 8Department of Cardiology, Medical Center “Bežanijska kosa”, Faculty of Medicine, University of Belgrade, Belgrade, Serbia Background: Adverse drug reactions (ADRs have a significant impact on human health and health care costs. The aims of our study were to determine the profile of rheumatology patients willing to report ADRs and to identify bias in such a reporting system. Methods: Semi-intensive ADRs reporting system was used in our study. Patients willing to participate (N=261 completed the questionnaire designed for the purpose of the study at the hospital admission. They were subsequently classified into two groups according to their ability to identify whether they had experienced ADRs during the previous month. Group 1 included 214 out of 261 patients who were able to identify ADRs, and group 2 consisted of 43 out of 261 patients who were not able to identify ADRs in their recent medical history. Results: Group 1 patients were more significantly aware of their diagnosis than the patients from group 2. Marginal significance was found

  1. Nocardia yamanashiensis in an immunocompromised patient presenting as an indurated nodule on the dorsal hand.

    Science.gov (United States)

    Anzalone, C Lane; Cohen, Philip R; Tarrand, Jeffrey J; Diwan, Abdul H; Prieto, Victor G

    2013-01-01

    Nocardia are ubiquitous, aerobic, gram-positive actinomycetes. Nocardiosis typically occurs in immunocompromised patients, although immunocompetent individuals can also be affected. The purpose of this case study is to review the clinical characteristics and treatments of a unique form of cutaneous nocardiosis. We retrospectively reviewed the medical literature using PubMed, searching the terms cutaneous, host, immunocompromised, Nocardia, primary, yamanashiensis. Patient reports and previous reviews of the subject were critically assessed and the salient features are presented. Cutaneous nocardiosis typically presents as pustular nodules and the lesions may progress to become abscesses, cellulitis, granulomas or keloid-like tumors. N. brasiliensis is the predominant species involved in primary cutaneous nocardiosis; other common Nocardia species involved in human disease are N. farcinica, N. abscessus, N. cyriacigeorgica, and N. nova. Only two individuals (including the patient presented here) with primary cutaneous infection by N. yamanashiensis have been described in the literature; a third clinical isolate was recovered from a lung biopsy. Nocardia yamanashiensis is a rare clinical form of primary cutaneous nocardiosis. 16S ribosomal gene sequencing, as well as Gram stain and modified Fite acid-fast stain, play a vital role in identifying this clinical variant.

  2. PERICARDIAL FEATURES OF IN-HOSPITAL RHEUMATOLOGY PATIENTS: AN OBSERVATIONAL STUDY.

    Science.gov (United States)

    Bakalli, Aurora; Rexhepi, Mjellma; Rexhepi, Blerta; Koçinaj, Dardan

    Rheumatic disorders can be associated with pericarditis, but severe forms of pericarditis are rare. The aim of this observational study was to evaluate pericardial features in patients with different rheumatic diseases. Thirty-five patients hospitalized at the Clinic of Rheumatology, University Clinical Center of Kosovo, from October 1 to October 21, 2014 were included in the study. Demographic data, history, laboratory, ECG, and echocardiography data, with special emphasis on the analysis of the pericardium, were obtained from each patient. Echocardiography was especially focused on the amount of pericardial fluid and pericardial thickness in the posterior wall of the heart. Mean patient age was 51.5 ± 13.8 years. 65.7% of the patients were women. Out of the patients that we analyzed, 88.6% had an inflammatory rheumatologic disease. 11.3% of the patients had mild symptoms, in 68.7% the symptoms were moderate, and in 20% severe. In all patients, pericardial hyperechogenicity was marked, with a mean pericardial thickness of 4.68 ± 1.66 mm. Pericardial effusion in a small amount was present in 57.1% of patients, with a mean pericardial fluid amount of 3.3 ± 1.9 mm. The severity of rheumatic disease had a positive and significant correlation with the presence of pericardial effusion (r= 0.29, p=0.04) and its amount (r= 0.28, p=0.05). The patients had not been aware of the pericardial involvement and did not have any clinical symptoms. In conclusion, in this short-term small observational study pericardial changes were a frequent finding in the rheumatology patients. In general, the pericarditis was subclinical and with small amounts of effusion. The disease activity of rheumatic disorders can be associated with pericarditis. Further studies with larger samples of patients and of longer duration are needed to further explore this issue.

  3. Viewpoints of dentists on the use of bisphosphonates in rheumatology patients.

    Science.gov (United States)

    Daron, Coline; Deschaumes, Christophe; Soubrier, Martin; Mathieu, Sylvain

    2018-02-15

    Alhough typically prescribed in oncology, bisphosphonates (BPs) are also employed in rheumatology, particularly for the treatment of osteoporosis, sometimes resulting in complications, such as osteonecrosis of the jaw. Because of different opinions between rheumatologists and dentists on BP use, this study aimed to assess the views of dentists regarding administration of BPs in rheumatology. A questionnaire was sent to 880 dentists from the Auvergne region of France to determine their views on BP treatment. We obtained 382 (43.4%) responses and analysed 376 (58.7% men). In total, 156 (41.5%) of the responders analysed had attended an in-service training course (ISTC) on the topic. A total of 237 (63.0%) systematically inquired as to whether their patients were undergoing BP treatment; this proportion was higher among those who had been practicing for fewer than 10 years (P ISTC (62.6% vs. 50.7%; P < 0.03). Dentists feel ill at ease providing dental surgery to patients receiving BPs. Closer collaboration and better information-sharing between rheumatologists and dentists is necessary to facilitate the administration of BPs in rheumatology. © 2018 FDI World Dental Federation.

  4. Evaluation of instant cup noodle, irradiated for immuno-compromised patients

    International Nuclear Information System (INIS)

    Lee, Ji-Hye; Kim, Jae-Kyung; Park, Jae-Nam; Yoon, Young-Min; Sung, Nak-Yun; Kim, Jae-Hun; Song, Beom-Seok; Yook, Hong-Sun; Kim, Byeong-Keun; Lee, Ju-Woon

    2012-01-01

    In the present study, initial microbial load of instant cup noodle (ICN) was investigated and gamma irradiation applied to develop immuno-compromised patients food for their safe consumption. The initial microbial population of dried vegetable and meat, and noodle was below the detection limit (1 log CFU/g); however, that of seasoning powder was just above 4 log CFU/g. Moreover, rehydrated-ICN with water at 100 °C still show above 3 log CFU/g of microbial load, which indicates the need for an additional process to control microbial safety of the seasoning powder. The total aerobic bacteria in seasoning powder and rehydrated-ICN could be controlled with 17 kGy gamma irradiation. This result referred 17 kGy gamma irradiation could reach ‘practical sterility’ of ICN. The overall difference in sensory properties between the non-irradiated and irradiated ICN was insignificant. Thus, gamma irradiation could improve the microbial quality of ICN, and reduce the risk of infection posed by the seasoning powder, without any adverse effects on their sensory quality. These results suggest that gamma-irradiated ICN can be used as a snack food for immuno-compromised patients.

  5. Stenotrophomonas maltophila cellulitis in an immunocompromised patient presenting with purpura, diagnosed on skin biopsy.

    Science.gov (United States)

    Gao, Yi; Minca, Eugen C; Procop, Gary W; Bergfeld, Wilma F

    2016-11-01

    Stenotrophomas maltophilia is an opportunistic Gram-negative bacillus and an important cause of nosocomial infections, particularly in immunosuppressed individuals. Although infections with this organism are most often in the form of pneumonia, bacteremia and endocarditis, awareness of the impact of S. maltophilia skin infections has been increasing. Here we describe a case of S. maltophilia cellulitis in a 65-year-old man with severe neutropenia and purpuric skin lesions to highlight the critical histopathological findings and correlate them with the clinical manifestations of the skin infection with this organism. Because identification of S. maltophilia can be challenging and infections are difficult to manage, this case illustrates essential considerations regarding the multifaceted histopathological, dermatological, clinical and microbiological aspects of the diagnosis and treatment of S. maltophilia cellulitis in a severely immunocompromised patient. Cognizance of the increasing incidence of nosocomial infections with uncommon microorganisms such as S. maltophilia is necessary when presented with atypical cutaneous manifestations, particularly in immunocompromised patients. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  6. Sterilization of freeze dried manila clam (Ruditapea philippinarum) porridge for immuno-compromised patients

    International Nuclear Information System (INIS)

    Song, Beom Seok; Park, Jae Nam

    2017-01-01

    This study was conducted to evaluate the combined effect of gamma irradiation and different conditions (vacuum packaging, antioxidant and freezing) on the microbiological and sensory characteristics of freeze dried Manila clam porridge (MCP) for immuno-compromised patient food. McP can be sterilized at 1 kGy to 10 kGy. the initial counts of total aerobic bacteria and yeast molds in the non-irradiated MCP were 2.4±0.5 and 1.2±0.3 log CFU g"-'1, respectively, but gamma irradiation significantly decreased the total aerobic bacteria to below the detection limit (1 log CFU g"-"1) (5 kGy). Moreover, gamma irradiation effectively eliminated yeasts/molds at dose below than 1 kGy. However, gamma irradiation accelerated the increase of lipid oxidation and therefore, decreased the sensory characteristics of MCP as irradiation dose increased. to improve the sensory qualities of gamma irradiated MCP, combination treatment (vacuum packaging, 0.1% vitamin c) were applied. there was no significant difference in the overall acceptance scores between the combined-treatment sample (5.6 points) and the non-irradiated samples (6.0). the results indicate that combination treatment (vacuum packaging, 0.1% vitamin c) may help to maintain the quality of MCP. therefore, it considered that irradiation of MCP with combined treatment and this is an effective method for the consumption as a special purpose food such as for space travel or immuno-compromised patients

  7. Nutritive and safe meals, microbiologically treated by gamma irradiation, for immunocompromised patients. Part 1

    International Nuclear Information System (INIS)

    Veronesi, Paola; Cossani, Elena; Lound, Liliana; Gasparovich, Alejandra; Narvaiz, Patricia

    2004-01-01

    Immunocompromised people have diminished immune response , being more vulnerable to food borne infections. Ionizing radiation has been proved to be effective in controlling pathogenic microorganisms in food with negligible temperature raise , which leads it to be called 'cold pasteurization'. Nutritional losses and sensory changes due to this treatment are minimal. In this work a whole gamma irradiated lunch composed of three dishes was tasted by 44 immunocompromised patients at the Clinical Hospital 'Jose de San Martin', Buenos Aires, to evaluate sensory acceptability. The packaged meals were irradiated in the cobalt-60 industrial facility of the Ezeiza Atomic Center at doses sufficient to reduce 6 log cycles of Salmonella enteritidis and stored under refrigeration for one week. Microbiological and sensory analysis (consumer panel of 50 healthy members) were carried out previously to the experience with patients. The immuno compromise condition is described as related to causes, treatment and nutritional requirements. Food irradiation is discussed regarding feasible applications, biological and chemical effects, wholesomeness, facilities , dosimetry, packaging, legislation, consumer attitude and commercialization. (author)

  8. Evaluation of instant cup noodle, irradiated for immuno-compromised patients

    Science.gov (United States)

    Lee, Ji-Hye; Kim, Jae-Kyung; Park, Jae-Nam; Yoon, Young-Min; Sung, Nak-Yun; Kim, Jae-Hun; Song, Beom-Seok; Yook, Hong-Sun; Kim, Byeong-Keun; Lee, Ju-Woon

    2012-08-01

    In the present study, initial microbial load of instant cup noodle (ICN) was investigated and gamma irradiation applied to develop immuno-compromised patients food for their safe consumption. The initial microbial population of dried vegetable and meat, and noodle was below the detection limit (1 log CFU/g); however, that of seasoning powder was just above 4 log CFU/g. Moreover, rehydrated-ICN with water at 100 °C still show above 3 log CFU/g of microbial load, which indicates the need for an additional process to control microbial safety of the seasoning powder. The total aerobic bacteria in seasoning powder and rehydrated-ICN could be controlled with 17 kGy gamma irradiation. This result referred 17 kGy gamma irradiation could reach 'practical sterility' of ICN. The overall difference in sensory properties between the non-irradiated and irradiated ICN was insignificant. Thus, gamma irradiation could improve the microbial quality of ICN, and reduce the risk of infection posed by the seasoning powder, without any adverse effects on their sensory quality. These results suggest that gamma-irradiated ICN can be used as a snack food for immuno-compromised patients.

  9. Prevalence of adenovirus and rotavirus infection in immunocompromised patients with acute gastroenteritis in Portugal.

    Science.gov (United States)

    Ribeiro, Joana; Ferreira, Delfim; Arrabalde, Célia; Almeida, Sandra; Baldaque, Inês; Sousa, Hugo

    2015-11-12

    To characterize the prevalence of rotavirus (RV) and adenovirus (AdV) infections in immunocompromised patients with acute gastroenteritis. The presence of RV and AdV (serotypes 40 and 41) was evaluated in 509 stool samples obtained between January 2009 and December 2010 from 200 immunocompromised patients (83 females and 117 males; median age 21 years old, range 0-72. The diagnosis of infection was performed as a routine procedure and the presence of RV and AdV (serotypes 40 and 41) was determined by immunochromatography using the RIDA(®) Quick Rota-Adeno-Kombi kit (r-Biopharm, Darmstadt, Germany). The data analysis and description of seasonal frequencies were performed using computer software IBM(®) SPSS(®) (Statistical Package for Social Sciences) Statistics version 20.0 for Mac. The frequencies of infection were compared into different age and gender groups by χ(2) test. The study revealed 12.4% AdV positive samples and 0.8% RV positive samples, which correspond to a prevalence of 6.5% and 1.5%, respectively. AdV was more frequent between October 2009 and April 2010, while RV was identified in April 2010 and July 2010. The stool analysis revealed that from the 509 samples, 63 (12.4%) were positive for AdV and 4 (0.8%) positive for RV, which by resuming the information of each patient, lead to an overall prevalence of AdV and RV of 6.5% (13/200 patients) and 1.5% (3/200 patients), respectively. The stratification of the analysis regarding age groups showed a tendency to an increased prevalence of infection in paediatric patients between 0-10 years old. Considering the seasonal distribution of these infections, our study revealed that AdV infection was more frequent between October 2009 and April 2010, while RV infection was characterized by two distinct peaks (April 2010 and July 2010). The overall prevalence of AdV and RV infection in immunocompromised patients with acute gastroenteritis was 8% and AdV was the most prevalent agent.

  10. Patient involvement in rheumatology outpatient service design and delivery: a case study.

    Science.gov (United States)

    de Souza, Savia; Galloway, James; Simpson, Carol; Chura, Radka; Dobson, Joanne; Gullick, Nicola J; Steer, Sophia; Lempp, Heidi

    2017-06-01

    Patient involvement is increasingly recognized as important within the UK National Health Service to ensure that services delivered are relevant to users' needs. Organizations are encouraged to work with service users to achieve excellence in care. Patient education can improve health outcomes and reduce health-care costs. Mobile technologies could play a vital role in this. Patient-centred development of innovative strategies to improve the experience of rheumatology outpatients. The Group Rheumatology Initiative Involving Patients (GRIIP) project was set up in 2013 as a joint venture between patients, clinicians, academics and management at a London hospital. The project saw (i) the formation of an independent patient group which provided suggestions for service improvement - outcomes included clearer signs in the outpatient waiting area, extended phlebotomy opening hours and better access to podiatry; (ii) a rolling patient educational evening programme initiated in 2014 with topics chosen by patient experts - feedback has been positive and attendance continues to grow; and (iii) a mobile application (app) co-designed with patients launched in 2015 which provides relevant information for outpatient clinic attendees and data capture for clinicians - downloads have steadily increased as users adopt this new technology. Patients can effectively contribute to service improvement provided they are supported, respected as equals, and the organization is willing to undergo a cultural change. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

  11. The prevalence of medical nomadism of the followed patients in rheumatology.

    Science.gov (United States)

    Boudali, Aziza; Bahiri, Rachid; Hmamouchi, Ihssane; Abouqal, Redouane; Abouqual, Redouane; Hajjaj Hassouni, Najia

    2012-06-01

    The nomads are defined as patients related to multiple practicians of the same speciality or different specialities for the same symptomatology during a certain period. The objectives of this investigation were to evaluate the prevalence of medical nomadism of the followed patients in rheumatology and compare their profile with those patients followed in neurology and gastroenterology. A multicentric transverse study (September 2009-March 2010) was conducted in three departments of CHU Ibn Sina Rabat-Salé, Morocco; rheumatology, gastroenterology and neurology. Only patients seen in external consultations were included. Patients' socio-economic and demographic background (familial status, instruction level, monthly revenue, social assistance) were recorded, as well as the clinical parameters related to the pathology (pathology, duration of the illness, diagnosis final time). A questionnaire containing variables on the patients' state concerning diagnosis, satisfaction degree of the patients and other variables evaluated the notion of taking medication and the practice of alternative medicine. Medical nomadism has been defined by the consultation for the same symptomatology of three different practicians, either of the same speciality or of different specialities during the study period of 6 months. There were 250 patients included in this study (150 patients in rheumatology, 50 in gastroenterology and 50 in neurology), the mean age was 46 ± 13 years and females dominated (65.6%). The average duration of the evolution was 7 ± 5 years, 35% of the patients were illiterate, 30% had a primary school education, 22% had a secondary school education and 13% had a university-level education. Sixty-two percent of the patients were jobless, 27% were workers, 9% were the functionary and 2% were the based liberal. Fifty-six percent had no social assistance. Rheumatoid arthritis and degenerative pathology were the most frequent diagnoses in rheumatology, being 20% and

  12. Safety and immunogenicity of HIV-1 Tat toxoid in immunocompromised HIV-1-infected patients.

    Science.gov (United States)

    Gringeri, A; Santagostino, E; Muça-Perja, M; Mannucci, P M; Zagury, J F; Bizzini, B; Lachgar, A; Carcagno, M; Rappaport, J; Criscuolo, M; Blattner, W; Burny, A; Gallo, R C; Zagury, D

    1998-01-01

    To antagonize the deleterious effects of the HIV-1 toxin extracellular Tat on uninfected immune cells, we developed a new strategy of anti-HIV-1 vaccine using an inactivated but immunogenic Tat (Tat toxoid). Tat toxoid has been assayed for safety and immunogenicity in seropositive patients. The phase I vaccine clinical trial testing Tat toxoid preparation in Seppic Isa 51 oil adjuvant was performed on 14 HIV-1-infected asymptomatic although biologically immunocompromised individuals (500-200 CD4+ cells/mm3). Following as many as 8 injections, no clinical defects were observed. All patients exhibited an antibody (Ab) response to Tat, and some had cell-mediated immunity (CMI) as evaluated by skin test in vivo and T-cell proliferation in vitro. These results provide initial evidence of safety and potency of Tat toxoid vaccination in HIV-1-infected individuals.

  13. Patients' Perspectives on Information and Communication About Sexual and Relational Issues in Rheumatology Health Care.

    Science.gov (United States)

    Helland, Ylva; Dagfinrud, Hanne; Haugen, Mona-Iren; Kjeken, Ingvild; Zangi, Heidi

    2017-06-01

    Men and women with rheumatic diseases report a significantly negative impact on multiple areas of life, including sexuality. Research indicates that patients want to discuss sexual issues with health professionals (HPs) in rheumatology care but these issues are rarely addressed in consultations. The objective of the present study was to explore patients' experiences of communication with HPs about disease-related sexual issues, their perceptions of the relevance of these issues in rheumatology care and their preferences for how these topics should be handled. A qualitative design was used and 18 semi-structured interviews were performed, including eight women and ten men with inflammatory rheumatic joint diseases, aged 29-62 years. The interviews were recorded and transcribed verbatim. Data were analysed thematically. Four main themes were derived from the interviews: (i) relevance of sexual issues; (ii) vital conditions for communication; (iii) individual preferences in mode and timing of information and communication; and (iv) benefits of information and communication. The participants expressed that, although sexual issues are relevant, necessary conditions for good communication are largely lacking. HPs' knowledge, experience and personal skills, as well as having sufficient time were essential. HPs lack of initiating sexual topics contributed to uncertainty about whether their sexual challenges were disease related and whether it was a legitimate topic to discuss in rheumatology care. Patients wanted HPs to possess knowledge about possible disease-related challenges in sexual life and intimate relationships, and to facilitate communication about these aspects. There is a need to develop practice guidelines to enable HPs to integrate sexual issues as an aspect of healthcare delivery in a patient-friendly manner. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  14. Patient's Knowledge and Perception Towards the use of Non-steroidal Anti-Inflammatory Drugs in Rheumatology Clinic Northern Malaysia.

    Science.gov (United States)

    Sulaiman, Wahinuddin; Seung, Ong Ping; Ismail, Rosli

    2012-11-01

    In Rheumatology, non-steroidal anti-inflammatory drugs (NSAIDs) has been widely prescribed and used. However, despite their clinical benefits in the management of inflammatory and degenerative joint disease, NSAIDs have considerable side effects, mostly affecting the upper gastrointestinal system, which therefore, limit their use. This study was conducted to determine the patients' knowledge and perception regarding the used of NSAIDS. A total of 120 patients who attended the rheumatology clinic Hospital, Raja Permaisuri Bainun, Malaysia, and received NSAIDs more than 3 months were interviewed irrespective of their rheumatological conditions. Patient's knowledge and perception on the side effects of NSAIDs were recorded. Fifty-four percent of the patients obtained information regarding the side effect of NSAIDs either from the rheumatologist, rheumatology staff nurse or other medical staffs (75.4%). The remaining 45.8% were naive of such knowledge. Fifteen percent obtained the information by surfing the internet and 9.2% from printed media. Twenty-four (24.2%) patients, experienced indigestion and/or stomach discomfort attributed to NSAIDs used. Two patients (1.7%) had hematemesis and malena once. This study shows that half of the patients who attended the rheumatology clinic were unaware of the side effect of NSAIDs. Available data showed that most of the knowledgeable patients are more conscience and self-educated. This study also reveals the important roles of clinicians, trained staff nurses as well as the pharmacist in providing the guidance and knowledge of any medication taken by patients.

  15. Lifestyle and dietary habits of patients with gout followed in rheumatology settings.

    Science.gov (United States)

    Manara, M; Carrara, G; Scirè, C A; Cimmino, M A; Govoni, M; Montecucco, C; Matucci-Cerinic, M; Minisola, G; Study Group, The King

    2015-12-23

    Diet and lifestyles modification are core aspects of the non-pharmacological management of gout, but a poor consistency with suggested guidelines is reported. This study aimed to investigate dietary and lifestyle habits of patients with gout followed in rheumatology settings. Data were retrieved from the baseline dataset of the KING study, a multicentre cohort study of patients with gout followed in rheumatology settings. Dietary habits were assessed with the Italian National Institute of Statistics (ISTAT) food-frequency questionnaire and compared with reported data about general population. The relative increase of exposure was estimated by standardized prevalence ratios adjusted for gender, age and geographical distribution. The study population included 446 patients, with a mean age of 63.9 years and a M/F ratio of 9:1. Compared to the Italian population, gouty patients showed a higher prevalence of obesity [1.82 (1.52-2.18)] and a higher consumption of wine [1.85 (1.48-2.32)] and beer [2.21 (1.68-2.90)], but a lower prevalence of smoking and a lower intake of liquor. They showed a lower intake of red meat [0.80 (0.71-0.91)], but a similar intake of other tested dietary factors. Gouty patients' lifestyle is still partially different from the recommended.

  16. Sterilization of freeze dried manila clam (Ruditapea philippinarum) porridge for immuno-compromised patients

    Energy Technology Data Exchange (ETDEWEB)

    Song, Beom Seok; Park, Jae Nam [Team for Radiation Food Science and Biotechnology, Advanced Radiation Technology Institute, Korea Atomic Energy Research Institute, Jeongeup (Korea, Republic of)

    2017-02-15

    This study was conducted to evaluate the combined effect of gamma irradiation and different conditions (vacuum packaging, antioxidant and freezing) on the microbiological and sensory characteristics of freeze dried Manila clam porridge (MCP) for immuno-compromised patient food. McP can be sterilized at 1 kGy to 10 kGy. the initial counts of total aerobic bacteria and yeast molds in the non-irradiated MCP were 2.4±0.5 and 1.2±0.3 log CFU g{sup -}'1, respectively, but gamma irradiation significantly decreased the total aerobic bacteria to below the detection limit (1 log CFU g{sup -1}) (5 kGy). Moreover, gamma irradiation effectively eliminated yeasts/molds at dose below than 1 kGy. However, gamma irradiation accelerated the increase of lipid oxidation and therefore, decreased the sensory characteristics of MCP as irradiation dose increased. to improve the sensory qualities of gamma irradiated MCP, combination treatment (vacuum packaging, 0.1% vitamin c) were applied. there was no significant difference in the overall acceptance scores between the combined-treatment sample (5.6 points) and the non-irradiated samples (6.0). the results indicate that combination treatment (vacuum packaging, 0.1% vitamin c) may help to maintain the quality of MCP. therefore, it considered that irradiation of MCP with combined treatment and this is an effective method for the consumption as a special purpose food such as for space travel or immuno-compromised patients.

  17. Impact of the 2012 London Olympic and Paralympic Games on physical activity of rheumatology patients.

    Science.gov (United States)

    Müther, Michael; Williamson, Marie; Williamson, Lyn

    2014-10-01

    Lack of physical activity in the general population is one of the biggest health challenges we face. For rheumatology patients, and other patients with chronic disease, exercise is an essential part of disease management. However, very few patients exercise effectively.One of the aspirations of the London 2012 Olympic/Paralympic Games was to catalyze people into long-term physical activity. We surveyed our rheumatology patients at 3 high-profile times in the year after the Olympics. Two hundred fifty-three patients were enrolled within the study; the largest diagnosis subgroup being rheumatoid arthritis (36%). Ninety-five percent of our patients regard exercise as beneficial; 36% still think it does harm. Most common barriers to exercise were pain (53%), tiredness (44%), and lack of time (36%). Forty-five percent exercise daily, mostly just walking. Twnety-seven patients (16%) were motivated by the 2012 Olympic and Paralympic Games toward physical activity. They were mostly motivated by athletics' individual stories (67%), taking part in a big sports festival (11%) and demonstration of top sporting levels (4%). Eighteen patients in total (7%) increased their amount of exercise in response to the London 2012 Olympic and Paralympic Games. There was no difference between patient diagnostic groups. Only a small minority of patients increased their amount of exercise in response to the 2012 Olympic and Paralympic Games. The message about the importance of physical exercise to health needs to be clear, unambiguous, and consistent, because a significant number of patients still think that physical activity does harm. Big sporting events such as the London 2012 Olympic and Paralympic Games can be used as an opportunity to remind patients that physical activity does good and is not harmful. Athletes' individual stories could be used in future as part of a strategy to encourage exercise for all patients.

  18. Non-invasive mechanical ventilation and mortality in elderly immunocompromised patients hospitalized with pneumonia: a retrospective cohort study.

    Science.gov (United States)

    Johnson, Christopher S; Frei, Christopher R; Metersky, Mark L; Anzueto, Antonio R; Mortensen, Eric M

    2014-01-27

    Mortality after pneumonia in immunocompromised patients is higher than for immunocompetent patients. The use of non-invasive mechanical ventilation for patients with severe pneumonia may provide beneficial outcomes while circumventing potential complications associated with invasive mechanical ventilation. The aim of our study was to determine if the use of non-invasive mechanical ventilation in elderly immunocompromised patients with pneumonia is associated with higher all-cause mortality. In this retrospective cohort study, data were obtained from the Department of Veterans Affairs administrative databases. We included veterans age ≥65 years who were immunocompromised and hospitalized due to pneumonia. Multilevel logistic regression analysis was used to determine the relationship between the use of invasive versus non-invasive mechanical ventilation and 30-day and 90-day mortality. Of 1,946 patients in our cohort, 717 received non-invasive mechanical ventilation and 1,229 received invasive mechanical ventilation. There was no significant association between all-cause 30-day mortality and non-invasive versus invasive mechanical ventilation in our adjusted model (odds ratio (OR) 0.85, 95% confidence interval (CI) 0.66-1.10). However, those patients who received non-invasive mechanical ventilation had decreased 90-day mortality (OR 0.66, 95% CI 0.52-0.84). Additionally, receipt of guideline-concordant antibiotics in our immunocompromised cohort was significantly associated with decreased odds of 30-day mortality (OR 0.31, 95% CI 0.24-0.39) and 90-day mortality (OR 0.41, 95% CI 0.31-0.53). Our findings suggest that physicians should consider the use of non-invasive mechanical ventilation, when appropriate, for elderly immunocompromised patients hospitalized with pneumonia.

  19. In Vitro Activity of the Histatin Derivative P-113 against Multidrug-Resistant Pathogens Responsible for Pneumonia in Immunocompromised Patients

    OpenAIRE

    Giacometti, Andrea; Cirioni, Oscar; Kamysz, Wojciech; D'Amato, Giuseppina; Silvestri, Carmela; Prete, Maria Simona Del; Licci, Alberto; Riva, Alessandra; Łukasiak, Jerzy; Scalise, Giorgio

    2005-01-01

    The in vitro activity of the histatin derivative P-113, alone or combined with eight antibiotics, was investigated against multidrug-resistant strains isolated from clinical specimens of immunocompromised patients with pneumonia. The gram-negative isolates were susceptible to P-113. S. aureus showed less susceptibility. Synergy was demonstrated when P-113 was combined with beta-lactams against gram-negative organisms.

  20. Antifungal susceptibility testing of Candida species isolated from the immunocompromised patients admitted to ten university hospitals in Iran

    NARCIS (Netherlands)

    Badiee, P.; Badali, H.; Boekhout, T.; Diba, K.; Moghadam, A.G.; Hossaini Nasab, A.; Jafarian, H.; Mohammadi, R.; Mirhendi, H.; Najafzadeh, M.J.; Shamsizadeh, A.; Soltani, J.

    2017-01-01

    Background Antifungal susceptibility testing is a subject of interest in the field of medical mycology. The aim of the present study were the distributions and antifungal susceptibility patterns of various Candida species isolated from colonized and infected immunocompromised patients admitted to

  1. Molecular diagnosis of toxoplasmosis in immunocompromised patients: a 3-year multicenter retrospective study.

    Science.gov (United States)

    Robert-Gangneux, Florence; Sterkers, Yvon; Yera, Hélène; Accoceberry, Isabelle; Menotti, Jean; Cassaing, Sophie; Brenier-Pinchart, Marie-Pierre; Hennequin, Christophe; Delhaes, Laurence; Bonhomme, Julie; Villena, Isabelle; Scherer, Emeline; Dalle, Frédéric; Touafek, Feriel; Filisetti, Denis; Varlet-Marie, Emmanuelle; Pelloux, Hervé; Bastien, Patrick

    2015-05-01

    Toxoplasmosis is a life-threatening infection in immunocompromised patients (ICPs). The definitive diagnosis relies on parasite DNA detection, but little is known about the incidence and burden of disease in HIV-negative patients. A 3-year retrospective study was conducted in 15 reference laboratories from the network of the French National Reference Center for Toxoplasmosis, in order to record the frequency of Toxoplasma gondii DNA detection in ICPs and to review the molecular methods used for diagnosis and the prevention measures implemented in transplant patients. During the study period, of 31,640 PCRs performed on samples from ICPs, 610 were positive (323 patients). Blood (n = 337 samples), cerebrospinal fluid (n = 101 samples), and aqueous humor (n = 100 samples) were more frequently positive. Chemoprophylaxis schemes in transplant patients differed between centers. PCR follow-up of allogeneic hematopoietic stem cell transplant (allo-HSCT) patients was implemented in 8/15 centers. Data from 180 patients (13 centers) were further analyzed regarding clinical setting and outcome. Only 68/180 (38%) patients were HIV(+); the remaining 62% consisted of 72 HSCT, 14 solid organ transplant, and 26 miscellaneous immunodeficiency patients. Cerebral toxoplasmosis and disseminated toxoplasmosis were most frequently observed in HIV and transplant patients, respectively. Of 72 allo-HSCT patients with a positive PCR result, 23 were asymptomatic; all were diagnosed in centers performing systematic blood PCR follow-up, and they received specific treatment. Overall survival of allo-HSCT patients at 2 months was better in centers with PCR follow-up than in other centers (P toxoplasmosis in HIV-negative ICPs and suggests that regular PCR follow-up of allo-HSCT patients could guide preemptive treatment and improve outcome. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

  2. Giving rheumatology patients online home access to their electronic medical record (EMR): advantages, drawbacks and preconditions according to care providers

    NARCIS (Netherlands)

    van der Vaart, R.; Drossaert, Constance H.C.; Taal, Erik; van de Laar, Mart A F J

    2013-01-01

    Technology enables patients home access to their electronic medical record (EMR), via a patient portal. This study aims to analyse (dis)advantages, preconditions and suitable content for this service, according to rheumatology health professionals. A two-phase policy Delphi study was conducted.

  3. Comparison of chest-CT findings of Influenza virus-associated pneumonia in immunocompetent vs. immunocompromised patients

    Energy Technology Data Exchange (ETDEWEB)

    Kloth, C., E-mail: christopher.kloth@med.uni-tuebingen.de [Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tübingen (Germany); Forler, S.; Gatidis, S. [Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tübingen (Germany); Beck, R. [Institute of Medical Virology and Epidemiology of Viral Diseases, Eberhard-Karls-University, Elfriede-Aulhorn-Straße 6, 72076 Tübingen (Germany); Spira, D.; Nikolaou, K.; Horger, M. [Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tübingen (Germany)

    2015-06-15

    Highlights: • Patterns of pulmonary infiltration caused by Influenza viruses do not significantly differ between immunocompetent and immunocompromised patients or between different types and subtypes of Influenza virus. • Patterns of pulmonary infiltration caused by Influenza viruses seem to be interchangeable which might in part explain the great overlap in CT-imaging findings that has been reported in the past. • Interestingly, pattern transition from interstitial into airway-centric pattern seems to be frequent in immunocompromised patients receiving specific antiviral therapy, whereas the conversion of the airway-centric pattern into an interstitial pattern was observed more frequent in immunocompetent patients developing ARDS. - Abstract: Purpose: To retrospectively compare CT-patterns of pulmonary infiltration caused by different Influenza virus types and subtypes in immunocompetent and immunocompromised patients for possible discrimination. Materials and methods: Retrospective database search at our institution yielded 237 patients who were tested positive for Influenza virus type A or type B by bronchoalveolar lavage between January 2009 and April 2014. Fifty-six of these patients (female 26; male 30; median age 55.8 y, range 17–86 y; SD ± 14.4 y) underwent chest-HRCT due to a more severe clinical course of pulmonary infection. We registered all CT-findings compatible with pulmonary infection classifying them as airway predominant (tree-in-bud, centrilobular nodules, bronchial wall thickening ± peribronchial ground-glass opacity and consolidation) vs. interstitial-parenchymal predominant (bilateral, symmetrical GGO, consolidation, crazy paving and/or interlobular septal thickening). Twenty-six patients (46.4%) had follow-up CT-studies (0.78 mean, SD ± 5.8 scans). Results: Thirty-six patients were immunocompromised (group I) whereas 20 patients were immunocompetent (group II). An airway-centric pattern of infection was found in 15 patients (group

  4. Non-lethal Clostridium sordellii bacteraemia in an immunocompromised patient with pleomorphic sarcoma.

    Science.gov (United States)

    Bonnecaze, Alex K; Stephens, Sarah Ellen Elza; Miller, Peter John

    2016-08-03

    Clostridium sordellii is a spore-forming anaerobic Gram-positive rod that has rarely been reported to cause disease in humans. Resultant mortality from infection is estimated at nearly 70% and is most often correlated with gynaecological procedures, intravenous drug abuse or trauma. C. sordellii infection often presents similarly to toxic shock syndrome (TSS); notable features of infection include refractory hypotension, haemoconcentration and marked leucocytosis. Although clinically similar to TSS, a notable difference is C. sordellii infections rarely involve fever. The organism's major toxins include haemorrhagic (TcsH) and lethal factor (TcsL), which function to disrupt cytoskeletal integrity. Current literature suggests treating C. sordelli infection with a broad-spectrum penicillin, metronidazole and clindamycin. We present a case of C. sordellii bacteraemia and septic shock in an immunocompromised patient who was recently diagnosed with pleomorphic gluteal sarcoma. Despite presenting in critical condition, the patient improved after aggressive hemodynamic resuscitation, source control and intravenous antibiotic therapy. 2016 BMJ Publishing Group Ltd.

  5. New US and CT patterns of hepatic and spienic candidiasis in immunocompromised patients

    International Nuclear Information System (INIS)

    Pastakia, B.; Shawker, T.H.; Thaler, M.; Pizzo, P.A.

    1986-01-01

    Nine immunocompromised cancer patients with tissue-proved candidiasis underwent a total of eight serial abdominal US studies and 53 CT examinations. Four US patterns of hepatic and splenic candidiasis were recognized. Type 1 was a ''wheel within a wheel'', or a central hypoechoic nidus surrounded by a dense band, in turn surronded by a rim of hypoechoic tissue. Type 2 was the classic ''bull's eye'' lesion. Type 3, the most common, was a uniformly hypoechoic lesion, 1-4 cm in diameter. Type 4 was a small, dense, echogenic focus with no surrounding lucency and varying amounts of posterior shadowing. Types 1,2 and 3 were seen early in infection; types 3 and 4 were present later. Lesion types 2,3 and 4 were also identified on CT scans. In addition, periportal linear areas of increased attenuation, possibly calcified, were identified on follow-up, non-contrast-enhanced CT. Some abscesses were better seen on non-contrast-enhanced CT scans, while others became visible only after iodinated contrast medium was administered intravenously. Although lesions not seen on US were often seen on CT, the opposite was also true. In two cases pathologic proof of candidiasis was established even when all imaging studies were negative. Patients should be studied by US and by CT before and after contrast agent administration for maximum sensitivity. Even when both US and CT are negative, if there is a strong clinical suspicion of candidiasis, open biopsy is recommended

  6. [Invasive fungal infections in immunocompromised patients with focus on aspergillosis and its causative agents].

    Science.gov (United States)

    Paloušová, Dita; Lengerová, Martina; Volfová, Pavlína; Bejdák, Petr; Kocmanová, Iva; Mayer, Jiří; Ráčil, Zdeněk

    2012-08-01

    Invasive fungal diseases (IFD) are a life-threatening infectious complications in immunocompromised patients and are associated with high rate of morbidity and mortality. The most common invasive mycosis in patients who underwent an allogeneic hematopoietic stem cell transplantation is invasive aspergilosis (IA), most frequently caused by the clinically dominant species Aspergillus fumigatus and, rarely, also by Aspergillus flavus, Aspergillus terreus and Aspergillus niger. In recent years, other related Aspergillus species were also reported to cause IFD, phenotypically similar to A. fumigatus and moreover, frequently exhibiting resistance towards various antifungals. For example, it is Aspergillus lentulus, Aspergillus viridinutans, Neosartoya fischeri, etc. Classical microbiological methods such as direct microscopy or culture are usually used for the identification of Aspergillus species. The application of PCR-based molecular techniques and monitoring of secondary metabolites production enable detection and identification of species, which are not distinguishable solely by their morphology. PCR methods are also useful for molecular strain typing of aspergilli and can reveal the genetic diversity of isolates.

  7. Phylogenetic analysis reveals two genotypes of the emerging fungus Mucor indicus, an opportunistic human pathogen in immunocompromised patients.

    Science.gov (United States)

    Taj-Aldeen, Saad J; Almaslamani, Muna; Theelen, Bart; Boekhout, Teun

    2017-07-12

    Mucormycosis is a rare fungal infection caused by Mucor indicus. Phylogenetic analysis of many M. indicus isolates, mainly sampled from different clinical and environmental specimens collected worldwide, revealed two genotypes, I and II, based on ITS and D1/D2 LSU rDNA sequences. A retrospective review of the literature revealed 13 cases. Eight (76.9%) patients had disseminated infections, and the overall mortality rate was 30.7%. A pulmonary infection caused by M. indicus genotype I in a liver transplant recipient was disseminated to include the skin and was successfully treated with liposomal amphotericin B and aggressive surgery. M. indicus can infect a wide variety of patients with no real preference for the site of infection. We concluded that M. indicus has emerged as a significant cause of invasive mycosis in severely immunocompromised patients worldwide. Early diagnosis and initiation of appropriate therapy could enhance survival in these immunocompromised patient populations.

  8. Prevalence of Cryptosporidium Infection in Immunocompromised Pa-tients, In South-West of Iran, 2009-10

    Directory of Open Access Journals (Sweden)

    A Balouty Dehkordy

    2010-12-01

    Full Text Available Background: Cryptosporidium is a protozoan parasite with worldwide distribution. The aim of this study was to estimate the prevalence of Cryptosporidium infection by antigen detection in faeces among immunocompromised patients referred to educational hospitals of Ahvaz City, South-West of Iran, 2009-2010.Methods: Fecal samples from 176 immunocompromised patients were collected and Cryptosporid­ium coproantigen test was performed using ELISA method (DRG kit, Germany. A questionnaire was completed for each case and the results were analyzed using descriptive and Chi-Square tests, by SPSS statistical software (15th version.Results: Our study indicated 5.1% Cryptosporidium infection prevalence in the immunocompro­mised participated population. Furthermore, 4.2 %, 4%, 4.5 % and 9.1% infection rates were identi­fied in children suffered from hematopoietic malignancy, adult cancer patients, renal trans­plant recipients, and HIV+ cases, respectively. There was not significant correlation between the infection and age and gender (P>0.05. Infection was most frequent among HIV+ patients.Conclusion: The present study confirmed the high prevalence of Cryptosporidium antigen in fe­cal samples of immunocompromised patients in the region. As no chemotherapeutic agents have yet proven, especially in immunosuppressed patients, therefore our results highlight the impor­tance of preventive intervention in these groups.

  9. Aspergillus Spondylitis involving the Cervico-Thoraco-Lumbar Spine in an Immunocompromised Patient: a Case Report

    International Nuclear Information System (INIS)

    Son, Jeong-Min; Jee, Won-Hee; Jung, Chan-Kwon; Kim, Sang-Il; Ha, Kee-Yong

    2007-01-01

    Aspergillosis is a rare cause of spondylitis. Moreover, early diagnosis by MR imaging and adequate treatment can prevent the serious complications of fungal infection. To our knowledge, the MR findings of multilevel aspergillus spondylitis in the cervico-thoraco-lumbar spine have not been previously described. Here, we report the MR findings of aspergillus spondylitis involving the cervical, thoracic, and lumbar spine in a liver transplant recipient. spergillosis is a rare cause of spondylitis, and early diagnosis by MR imaging and adequate treatment are essential for a good outcome. Although the MR findings of bacterial spondylitis have been fully described, the findings of aspergillus spondylitis have been rarely described, and to the best of our knowledge multilevel involvement of cervico-thoraco-lumbar spine has not been previously reported. Here, we report the MR imaging findings of aspergillus spondylitis involving the cervico-thoraco-lumbar spine in a liver transplant recipient. In conclusion, aspergillus spondylitis should be considered in the differential diagnosis of immunocompromised patients with MR findings resembling those of tuberculous spondylitis

  10. Varicella-zoster virus infections in immunocompromised patients - a single centre 6-years analysis

    Directory of Open Access Journals (Sweden)

    Liese Johannes

    2011-05-01

    Full Text Available Abstract Background Infection with varicella-zoster virus (VZV contemporaneously with malignant disease or immunosuppression represents a particular challenge and requires individualized decisions and treatment. Although the increasing use of varicella-vaccines in the general population and rapid initiation of VZV-immunoglobulins and acyclovir in case of exposure has been beneficial for some patients, immunocompromised individuals are still at risk for unfavourable courses. Methods In this single center, 6-year analysis we review incidence, hospitalization and complication rates of VZV-infections in our center and compare them to published data. Furthermore, we report three instructive cases. Results Hospitalization rate of referred children with VZV-infections was 45%, among these 17% with malignancies and 9% under immunosuppressive therapy. Rate of complications was not elevated in these two high-risk cohorts, but one ALL-patient died due to VZV-related complications. We report one 4-year old boy with initial diagnosis of acute lymphoblastic leukemia who showed a rapidly fatal outcome of his simultaneous varicella-infection, one 1.8-year old boy with an identical situation but a mild course of his disease, and an 8.5-year old boy with a steroid-dependent nephrotic syndrome. This boy developed severe hepatic involvement during his varicella-infection but responded to immediate withdrawl of steroids and administration of acyclovir plus single-dose cidofovir after nonresponse to acyclovir after 48 h. Conclusion Our data show that patients with malignant diseases or immunosuppressive therapy should be hospitalized and treated immediately with antiviral agents. Despite these measures the course of VZV-infections can be highly variable in these patients. We discuss aids to individual decision-making for these difficult situations.

  11. Influenza vaccination for immunocompromised patients: systematic review and meta-analysis from a public health policy perspective.

    Directory of Open Access Journals (Sweden)

    Charles R Beck

    Full Text Available Immunocompromised patients are vulnerable to severe or complicated influenza infection. Vaccination is widely recommended for this group. This systematic review and meta-analysis assesses influenza vaccination for immunocompromised patients in terms of preventing influenza-like illness and laboratory confirmed influenza, serological response and adverse events.Electronic databases and grey literature were searched and records were screened against eligibility criteria. Data extraction and risk of bias assessments were performed in duplicate. Results were synthesised narratively and meta-analyses were conducted where feasible. Heterogeneity was assessed using I(2 and publication bias was assessed using Begg's funnel plot and Egger's regression test. Many of the 209 eligible studies included an unclear or high risk of bias. Meta-analyses showed a significant effect of preventing influenza-like illness (odds ratio [OR]=0.23; 95% confidence interval [CI]=0.16-0.34; p<0.001 and laboratory confirmed influenza infection (OR=0.15; 95% CI=0.03-0.63; p=0.01 through vaccinating immunocompromised patie nts compared to placebo or unvaccinated controls. We found no difference in the odds of influenza-like illness compared to vaccinated immunocompetent controls. The pooled odds of seroconversion were lower in vaccinated patients compared to immunocompetent controls for seasonal influenza A(H1N1, A(H3N2 and B. A similar trend was identified for seroprotection. Meta-analyses of seroconversion showed higher odds in vaccinated patients compared to placebo or unvaccinated controls, although this reached significance for influenza B only. Publication bias was not detected and narrative synthesis supported our findings. No consistent evidence of safety concerns was identified.Infection prevention and control strategies should recommend vaccinating immunocompromised patients. Potential for bias and confounding and the presence of heterogeneity mean the evidence

  12. Role of bronchoalveolar lavage in immunocompromised patients with pneumonia treated with a broad spectrum antibiotic and antifungal regimen

    Science.gov (United States)

    Hohenadel, I; Kiworr, M; Genitsariotis, R; Zeidler, D; Lorenz, J

    2001-01-01

    BACKGROUND—In a retrospective study the value of bronchoalveolar lavage (BAL) in the diagnosis of pneumonia was investigated in 95 immunocompromised patients suffering from haematological disorders and receiving a regimen of broad spectrum antibiotics and antifungal agents (BSAR).
METHODS—With the exception of four afebrile patients, all had fever, raised C reactive protein (CRP) levels, and new infiltrates visible on chest radiography. All patients underwent BAL to identify the organism causing the pneumonia and surveillance cultures were performed regularly for pathogens at different sites. Following classification of the isolates, patients with positive cultures were subdivided into two groups, pathogenic or contaminated. We investigated whether relevant pathogens were cultured only from the BAL fluid and whether they were susceptible to BSAR.
RESULTS—Although 77 of the 95 patients were thrombocytopenic, bleeding during BAL occurred in only 15% of all patients. Ten days after the procedure the fever improved in 88% of patients, radiographic findings improved in 71%, and CRP levels improved in 75% of patients; 22% of patients died within 28 days. Pathologically relevant isolates were found in 65% of all patients. Respiratory pathogens were detected only in the BAL fluid of 29 of the 95 patients (35% Gram positive species, 40% Gram negative species, 11% Mycobacterium, 11% fungi, and 3% cytomegalovirus). In 16 of these 29 patients (55%) the pathogens cultured only from the BAL fluid were resistant to treatment. Pathogens detected only in the BAL fluid were not susceptible to a standard broad spectrum antibiotic and antifungal regimen including teicoplanin, ceftriaxon, tobramycin, and amphotericin B in 12 of the 29 patients (41%).
CONCLUSIONS—Our data suggest that 12 patients were treated with broad spectrum antimicrobial agents which were not directed at the appropriate organism on in vitro sensitivity tests without BAL. BAL is a relatively safe

  13. Successful Treatment of Liver Aspergilloma by Caspofungin Acetate First-Line Therapy in a Non-Immunocompromised Patient

    Directory of Open Access Journals (Sweden)

    Hong-Juan Dong

    2012-09-01

    Full Text Available Aspergillosis remains to be a life-threatening complication in immunocompromised patients. However, Aspergillus infection can be observed in non-immunocompromised individuals in rare cases. We report a case of liver aspergilloma in a chronic aplastic anemia patient under relatively intact immune status. Therapeutic strategy for this rare condition was extensively discussed and caspofungin acetate single agent first-line therapy was applied after careful consideration. Encouraging clinical and radiologic improvements were achieved in response to the antifungal salvage. Our long-term follow-up study also revealed a favorable prognosis. Based on this experience, we suggest caspofungin acetate as first-line therapy for treatment plans of liver aspergilloma.

  14. Prevalence and fungal profile of pulmonary aspergillosis in immunocompromised and immunocompetent patients of a tertiary care hospital

    OpenAIRE

    Prakash Ved, Mishra Prem P, Verma Shashi K, Sinha Shivani, Sharma Mahendra

    2014-01-01

    Background: Aspergillus is a fungus which may present an array of pulmonary manifestations, depending on the patient’s immunological and physiological state. Although the incidence of pulmonary aspergillosis occurs primarily in immunocompromised patients but the incidence is also rising in immunocompetent individuals, especially in developing countries. Aim: The objective of the study was to determine the prevalence and predisposing factors of pulmonary aspergillosis along with species identi...

  15. Rhino-oculo-cerebral aspergillus and mucor co-infections in an immunocompromised patient with type 2 diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Kalidas Rit

    2014-01-01

    Full Text Available Mucormycosis are pathogenic moulds of the mucorales species usually occurring in immunocompromised patients or in patients with uncontrolled diabetes mellitus. Aspergillosis is the clinical condition caused by Aspergillus species and may cause an invasive disease with high case fatality rate, especially in immunosuppressed patients. A 46-year-old male patient with Type 2 diabetes mellitus with underlying malignancy presented with proptosis of left eye. Combined infections of Mucor and Aspergillus were diagnosed by means of computed tomography (CT scan and biopsy. Treatment with Amphotericin B and Voriconazole was started, the patient died within 3 months, from multi-organ failure.

  16. Travel-related health risks in moderately and severely immunocompromised patients: a case-control study.

    Science.gov (United States)

    Dekkiche, Souad; de Vallière, Serge; D'Acremont, Valérie; Genton, Blaise

    2016-03-01

    The number of immunocompromised persons travelling to tropical countries is increasing. The hypothesis is that this population is at increased risk of travel-related health problems but there are few data to support it. The objective was to assess the risk of travel-related health problems in immunocompromised persons when compared with the general population of travellers. A retrospective matched case-control study was performed. Cases were moderately or severely immunocompromised persons travelling to tropical countries and controls were non-immunocompromised persons, matched for demographic and travel characteristics. All participants responded to a phone questionnaire, asking them about any health problem they may have encountered while travelling or during the month following their return. The primary outcome was the incidence of a significant clinical event defined as repatriation, hospitalization during the travel or during the month following the return if due to a travel-related health problem and medical consultations during the trip. One hundred and sixteen moderately or severely immunocompromised cases [HIV infection (15), active cancer (25), splenectomized (20), solid organ transplant recipients (4) and use of systemic immunosuppressive medication (52)] and 116 controls were included. Incidence rates of significant clinical events were higher in immunocompromised travellers (9/116, 7.8%) than in controls (2/116, 1.7%) [OR = 4.8 , 95% CI 1.01-22.70; P = 0.048]. Most cases were related to infectious diseases (5/9, 55.5%), others were pulmonary embolism (2/9, 22%), inflammatory disease and trauma (1/9, 11.1% each). There was no significant difference between the two groups regarding common health problems. Moderately and severely immunocompromised travellers are at increased risk of developing a serious health problem during or after a trip in a tropical country. They should be well informed about the specific risks they are particularly prone to

  17. Rotavirus disease course among immunocompromised patients : 5-year observations from a tertiary care medical centre

    NARCIS (Netherlands)

    Bruijning-Verhagen, P; Nipshagen, M D; Graaf, H.; Bonten, M J M

    2017-01-01

    Rotavirus (RV) is highly endemic inside and outside hospital-settings. Immunocompromised children and adults are at risk of complicated rotavirus gastroenteritis (RVGE), but general rotavirus disease severity in this group remains poorly described and rotavirus testing is not routinely performed

  18. Pneumocystis jirovecii dihydropteroate synthase (DHPS) genotypes in non-HIV-immunocompromised patients: a tertiary care reference health centre study.

    Science.gov (United States)

    Tyagi, A K; Mirdha, B R; Luthra, K; Guleria, R; Mohan, A; Singh, U B; Samantaray, J C; Dar, L; Iyer, V K; Sreenivas, V

    2011-02-01

    Studies on Pneumocystis jirovecii dihydropteroate synthase (DHPS) genotypes among non-HIV immunocompromised patients from developing countries are rare. In the present prospective investigation, 24 (11.8%) cases were found to be positive for Pneumocystis jirovecii out of 203 non-HIV patients with a clinical suspicion of Pneumocystis pneumonia (PCP). Dihydropteroate synthase (DHPS) genotype 1 (Thr55+Pro57) was noted in 95.8% P. jirovecii isolates in the present study in contrast to only 4.1% of patients with DHPS genotype 4 (Thr55Ala + Pro57Ser).

  19. Medication use in juvenile uveitis patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance Registry.

    Science.gov (United States)

    Henderson, Lauren A; Zurakowski, David; Angeles-Han, Sheila T; Lasky, Andrew; Rabinovich, C Egla; Lo, Mindy S

    2016-02-16

    There is not yet a commonly accepted, standardized approach in the treatment of juvenile idiopathic uveitis when initial steroid therapy is insufficient. We sought to assess current practice patterns within a large cohort of children with juvenile uveitis. This is a cross-sectional cohort study of patients with uveitis enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRAnet) registry. Clinical information including, demographic information, presenting features, disease complications, and medications were collected. Chi-square and Fisher's exact tests were used to assess for associations between medications and clinical characteristics. Ninety-two children with idiopathic and 656 with juvenile idiopathic arthritis (JIA)-associated uveitis were identified. Indication (arthritis or uveitis) for medication use was not available for JIA patients; therefore, detailed analysis was limited to children with idiopathic uveitis. In this group, 94 % had received systemic steroids. Methotrexate (MTX) was used in 76 % of patients, with oral and subcutaneous forms given at similar rates. In multivariable analysis, non-Caucasians were more likely to be treated initially with subcutaneous MTX (P = 0.003). Of the 53 % of patients treated with a biologic DMARD, all received a tumor necrosis factor (TNF) inhibitor. TNF inhibitor use was associated with a higher frequency of cataracts (52 % vs 21 %; P = 0.001) and antinuclear antibody positivity (49 % vs 29 %; P = 0.04), although overall complication rates were not higher in these patients. Among idiopathic uveitis patients enrolled in the CARRAnet registry, MTX was the most commonly used DMARD, with subcutaneous and oral forms equally favored. Patients who received a TNF inhibitor were more likely to be ANA positive and have cataracts.

  20. Retrospective review of cerebral mycotic aneurysms in 26 patients: focus on treatment in strongly immunocompromised patients with a brief literature review.

    Science.gov (United States)

    Allen, L M; Fowler, A M; Walker, C; Derdeyn, C P; Nguyen, B V; Hasso, A N; Ghodke, B V; Zipfel, G J; Cross, D T; Moran, C J

    2013-04-01

    Cerebral mycotic aneurysms are a rare and deadly type of aneurysm that have no definitive treatment guidelines. Our purpose was to retrospectively review known or suspected cases of CMA in order to identify patient populations that may be associated with higher morbidity and mortality. We hope that the identification of patients with these risk factors will lead to early stratification upon presentation, and more urgent treatment of their CMAs. We also hoped to identify any benefit or complication that was specific to either the endovascular or neurosurgical repair of CMAs. A retrospective multi-institutional study was performed examining cases of CMA during a 15-year period. Patients were considered strongly immunocompromised if there were long-term severely immunocompromised states: AIDS, chemotherapy, or steroid immunosuppression. Patients were excluded if angiographic findings suggested an alternative diagnosis or if an infectious etiology was unknown. Antibiotics were considered "noninvasive treatment." Endovascular and neurosurgical repair were considered "invasive treatment." Data were recorded by reviewing electronic medical records and imaging reports. Twenty-six patients with 40 CMAs were included. Three patients were considered strongly immunocompromised and presented with 4 CMAs, which demonstrated larger average size and more rapid growth; 3 of these patients' aneurysms were treated invasively in the acute period, with the one that was not ruptured causing death. Technical success (aneurysm occlusion without rupture or recanalization) and clinical success (no neurologic complication attributable to the intervention) were obtained equally endovascularly and neurosurgically. Clipping was aborted in favor of coiling for 1 patient. Anticoagulation needed reversal before 2 patients underwent craniotomy for clipping after valve replacement. For CMAs treated with antibiotics alone with angiographic follow-up (n=11), initial aneurysm size was unrelated to

  1. Infectious uveitis in immunocompromised patients and the diagnostic value of polymerase chain reaction and Goldmann-Witmer coefficient in aqueous analysis.

    Science.gov (United States)

    Westeneng, Arnaud C; Rothova, Aniki; de Boer, Joke H; de Groot-Mijnes, Jolanda D F

    2007-11-01

    To establish the causes of uveitis in immunocompromised patients and to determine the contribution of polymerase chain reaction (PCR) and Goldmann-Witmer coefficient (GWC) analysis of aqueous humor in patients with an infectious etiology. Retrospective case series of 56 consecutive immunocompromised patients with uveitis. All patients underwent full ophthalmologic examination and laboratory blood analysis for uveitis. Aqueous humor analyses were performed using PCR and GWC for cytomegalovirus (CMV), herpes simplex virus (HSV), varicella zoster virus (VZV), and Toxoplasma gondii. Of 56 immunocompromised patients, 43 (77%), all posterior and panuveitis, had intraocular infections. Twenty-one (49%) had CMV, three (7%) had VZV, 11 (26%) had T. gondii, six (14%) had Treponema pallidum, and one (2%) each had Aspergillus and Candida. In AIDS patients, CMV was the most common cause. A strong correlation between AIDS and ocular syphilis was also observed (P = .007). In nonAIDS immunocompromised patients, T. gondii was most frequently detected. Twenty-seven patients were examined by both PCR and GWC; five (18.5%) were positive by both assays, 15 (55.5%) were positive by PCR alone and seven (26%) by GWC alone. Viral infections were detected by PCR in 16 of 17 (94%) cases; T. gondii in four of 10 (40%) patients. Using GWC, a viral infection was diagnosed in three of 17 (18%) and T. gondii in nine of 10 (90%) cases. In immunocompromised patients, PCR is superior in diagnosing viral infections. Analysis of intraocular antibody production played a decisive role in the diagnosis of ocular toxoplasmosis.

  2. Redesign of the Attention Process of Patients with Rheumatologic Diseases: Assessing the Performance with Analytic Hierarchy Process

    OpenAIRE

    Gorbanev, Iouri; Cortes, Ariel; Agudelo-Londoño, Sandra

    2017-01-01

    Objective. To compare the Business process management and the analytic hierarchy process as the tools of process performance assessment. Instruments and Methods. Case study of the attention process of rheumatology patients. Business process management and analytic hierarchy process were applied to assess the redesign of the attention process. The two methods were compared. The data were obtained through personal observations, an interview with a Colombian health insurer’s senior executive, an...

  3. Use of combined treatments involving gamma irradiation for the sterilization of a carrot puree intended to immunocompromised patients

    International Nuclear Information System (INIS)

    Gharbi Yahyaoui, Asma

    2010-01-01

    In this study, we were interested to the application of a series of combined physical treatments (blanching, vacuum packaging and irradiation) on carrot puree. The results showed that with sub-lethal dose of 3 kGy in combination with moderate heat treatment and moderate pressure vacuum we can achieve an undetectable level of bacteria while preserving the antioxidant activity and the phenolic content. The combination of mild irradiation doses with other physical or biological preservation methods can be used to provide more dietary variety for immunocompromised patients and other groups since it ensures stable sterile foods.

  4. Bases and principles of rheumatology. Book

    International Nuclear Information System (INIS)

    Vidal, L.; Chavez, J.; Quevedo, H.; Castaneda, L.

    1993-01-01

    This book describes in 7 sections (42 chapters) the bases and principles of rheumatology. Section I bases and principles of rheumatology, Section II diffuse disorders of conjunctive tissue, Section III serum negatives spondyloarthropathies, Section IV arthropathies associated to infectious agents, Section V osteoarthritis diseases and different disorders, Section VI rational management rheumatic patients, Section VII therapeutics in rheumatology. In the chapter 34, the uses of radioisotope scanning in rheumatology are described. Every chapter contains also references, figures and tables

  5. Fusariose em paciente imunocomprometido: sucesso terapêutico com voriconazol Fusariosis in an immunocompromised patient: therapeutic success with voriconazole

    Directory of Open Access Journals (Sweden)

    Thaís Prota Hussein Pincelli

    2008-08-01

    Full Text Available A infecção por Fusarium solani é afecção fúngica potencialmente grave em pacientes imunocomprometidos, sobretudo naqueles portadores de neoplasias hematológicas. A mortalidade é alta,sendo limitadas as opções terapêuticas devido às condições da imunidade do doente e à relativa resistência do fungo aos antifúngicos utilizados de rotina. O voriconazol tem-se mostrado boa alternativa terapêutica em pacientes neutropênicos que apresentam fusariose refratária ou pouco responsiva à anfotericina B. Neste artigo relata-se caso de fusariose em doente imunocomprometido tratado com sucesso com voriconazol.Fusarium infection is known to be potentially severe in immunocompromised patients, especially those with hematologic malignancies. Mortality rates are high and there are few therapeutic options, due to the severe underlying condition of this group of patients and the relative resistance of Fusarium to conventional antifungal therapy. Voriconazole has been shown to be an effective antifungal agent for neutropenic patients with fusariosis that are refractory or unresponsive to amphotericin B. We report the successful treatment of disseminated Fusarium infection in an immunocompromised host.

  6. HRCT findings of pulmonary complications in non-AIDS immunocompromised patients. Are they useful in differential diagnosis?

    International Nuclear Information System (INIS)

    Emoto, Takuya; Matsumoto, Tsuneo; Tanaka, Nobuyuki; Miura, Gouji; Kawamura, Takeo; Matsunaga, Naofumi

    2003-01-01

    This study was designed to evaluate the diagnostic value of characteristic high-resolution CT (HRCT) findings in the differential diagnosis of acute pulmonary complications (APCs) in immunocompromised patients and to investigate how to improve diagnostic accuracy. We reviewed the chest CT images of 103 consecutive immunocompromised non-acquired immunodeficiency syndrome (AIDS) patients with APCs. The presence, extent, and anatomical distribution of the CT findings were assessed by two radiologists. The sensitivity and positive predictive value (PPV) of each criterion determined by the combination of CT findings that were characteristic in previous studies were calculated. The average sensitivity of each criterion was 0.50 in the total cases. There were many false positives, and the PPVs of some criteria were low. Among the significantly less frequent CT findings, the frequency of bronchovascular bundle thickening was 0% in cytomegaloviral pneumonia (CMV P). The absence of this finding improved the diagnostic accuracy of CMV P. Because the combination of only characteristic HRCT findings in each disease was of relatively limited value in making a diagnosis, infrequent findings should be also added to the CT criteria to improve accuracy. (author)

  7. Initial CT manifestations of invasive pulmonary aspergillosis in 45 non-HIV immunocompromised patients: association with patient outcome?

    International Nuclear Information System (INIS)

    Horger, Marius; Hebart, Holger; Einsele, Hermann; Lengerke, Claudia; Claussen, C.D.; Vonthein, Reinhard; Pfannenberg, Christina

    2005-01-01

    Purpose: To assess early high-resolution computer tomographic (CT) signs of invasive pulmonary aspergillosis (IPA) in non-HIV immunosuppressed patients and their potential association with patient's outcome, including frequency and severity of pulmonary hemorrhage, taking also in consideration the impact of other known risk factors contributory to IPA. Material and methods: A retrospective review of serial CT scans was performed in 45 immunocompromised patients with a total of 46 episodes of invasive pulmonary aspergillosis. All patients underwent CT beginning with the day they showed clinical or laboratory signs of infection. Serial follow-up CT included more than two, up to 12 CT examinations. Patient's outcome was judged by clinical and radiological follow-up and classified as survival, death by IPA, or death unrelated to IPA. The influence of patient's age, underlying disease, hematopoietic stem cell transplantation, neutropenia, graft versus host disease, and antifungal therapy onset was also statistically considered. Results: Three main CT findings were identified: small nodules (<1 cm) 43% (20/46), large nodules 21% (10/46) and consolidations, either in patchy ± segmental 26% (12/46), or peribronchial distribution ± tree in bud 9% (4/46). In 11 patients (24%) we found a combination of two or more of these signs: 9 (19%) patients presented concurrent small nodules accompanied by reticulation, tree in bud or peribronchial infiltrates, while 2 (4%) patients showed large pulmonary nodules accompanied by large consolidations. An accompanying 'halo' sign was observed in 38 patients (82%). Crescent sign followed by cavitation was encountered in 29 patients (63%). Two patients succumbed to massive pulmonary bleeding caused by IPA. Twenty-one patients (15/46) deceased in this series, 12 of them succumbed to IPA, 1 died from cerebral invasive aspergillosis, while in 9 patients the cause of death was not primarily IPA. Manifest pulmonary hemorrhage occurred in 19% (9

  8. The prevalence of vitamin D deficiency in consecutive new patients seen over a 6-month period in general rheumatology clinics.

    LENUS (Irish Health Repository)

    Haroon, Muhammad

    2012-02-01

    The objectives of this study are to assess: (a) the prevalence of vitamin D deficiency among new patients attending rheumatology outpatient departments, (b) the age profile of these low vitamin D patients and (c) whether any diagnostic category had a particularly high number of vitamin D-deficient patients. All new patients seen consecutively in general rheumatology clinics between January to June 2007 inclusive were eligible to partake in this study, and 231 out of 264 consented to do so. Parathyroid hormone, 25-hydroxyvitamin D, creatinine, calcium, phosphate, albumin and alkaline phosphatase levels were measured. We defined vitamin D deficiency as <\\/=53 nmol\\/l and severe deficiency as <\\/=25 nmol\\/l. Overall, 70% of 231 patients had vitamin D deficiency, and 26% had severe deficiency. Sixty-five percent of patients aged >\\/=65 and 78% of patients aged <\\/=30 years had low vitamin D levels. Vitamin D deficiency in each diagnostic category was as follows: (a) inflammatory joint diseases\\/connective tissue diseases (IJD\\/CTD), 69%; (b) soft tissue rheumatism, 77%; (c) osteoarthritis, 62%; (d) non-specific musculoskeletal back pain, 75% and (e) osteoporosis, 71%. Seasonal variation of vitamin D levels was noted in all diagnostic groups apart from IJD\\/CTD group, where the degree of vitamin D deficiency persisted from late winter to peak summer. Very high prevalence of vitamin D deficiency was noted in all diagnostic categories (p = 0.006), and it was independent of age (p = 0.297). The results suggest vitamin D deficiency as a possible modifiable risk factor in different rheumatologic conditions, and its role in IJD\\/CTD warrants further attention.

  9. Pulmonary infiltrates in non-HIV immunocompromised patients: a diagnostic approach using non-invasive and bronchoscopic procedures

    Science.gov (United States)

    Rano, A; Agusti, C; Jimenez, P; Angrill, J; Benito, N; Danes, C; Gonzalez, J; Rovira, M; Pumarola, T; Moreno, A; Torres, A

    2001-01-01

    BACKGROUND—The development of pulmonary infiltrates is a frequent life threatening complication in immunocompromised patients, requiring early diagnosis and specific treatment. In the present study non-invasive and bronchoscopic diagnostic techniques were applied in patients with different non-HIV immunocompromised conditions to determine the aetiology of the pulmonary infiltrates and to evaluate the impact of these methods on therapeutic decisions and outcome in this population.
METHODS—The non-invasive diagnostic methods included serological tests, blood antigen detection, and blood, nasopharyngeal wash (NPW), sputum and tracheobronchial aspirate (TBAS) cultures. Bronchoscopic techniques included fibrobronchial aspirate (FBAS), protected specimen brush (PSB), and bronchoalveolar lavage (BAL). Two hundred consecutive episodes of pulmonary infiltrates were prospectively evaluated during a 30 month period in 52 solid organ transplant recipients, 53 haematopoietic stem cell transplant (HSCT) recipients, 68 patients with haematological malignancies, and 27 patients requiring chronic treatment with corticosteroids and/or immunosuppressive drugs.
RESULTS—An aetiological diagnosis was obtained in 162 (81%) of the 200 patients. The aetiology of the pulmonary infiltrates was infectious in 125 (77%) and non-infectious in 37 (23%); 38 (19%) remained undiagnosed. The main infectious aetiologies were bacterial (48/125, 24%), fungal (33/125, 17%), and viral (20/125, 10%), and the most frequent pathogens were Aspergillus fumigatus (n=29), Staphylococcus aureus (n=17), and Pseudomonas aeruginosa (n=12). Among the non-infectious aetiologies, pulmonary oedema (16/37, 43%) and diffuse alveolar haemorrhage (10/37, 27%) were the most common causes. Non-invasive techniques led to the diagnosis of pulmonary infiltrates in 41% of the cases in which they were used; specifically, the diagnostic yield of blood cultures was 30/191 (16%); sputum cultures 27/88 (31%); NPW 9/50 (18

  10. High-dose continuous infusion beta-lactam antibiotics for the treatment of resistant Pseudomonas aeruginosa infections in immunocompromised patients.

    Science.gov (United States)

    Moriyama, Brad; Henning, Stacey A; Childs, Richard; Holland, Steven M; Anderson, Victoria L; Morris, John C; Wilson, Wyndham H; Drusano, George L; Walsh, Thomas J

    2010-05-01

    To report a case series of high-dose continuous infusion beta-lactam antibiotics for the treatment of resistant Pseudomonas aeruginosa infections. Continuous infusion ceftazidime or aztreonam was administered to achieve target drug concentrations at or above the minimum inhibitory concentration, when possible, in 3 patients with P. aeruginosa infections. The maximal calculated target drug concentration was 100 mg/L. In the first patient, with primary immunodeficiency, neutropenia, and aggressive cutaneous T-cell lymphoma/leukemia, continuous infusion ceftazidime (6.5-9.6 g/day) was used to successfully treat multidrug-resistant P. aeruginosa bacteremia. In the second patient, with leukocyte adhesion deficiency type 1, continuous infusion aztreonam (8.4 g/day) was used to successfully treat multidrug-resistant P. aeruginosa wound infections. In the third patient, with severe aplastic anemia, continuous infusion ceftazidime (7-16.8 g/day) was used to treat P. aeruginosa pneumonia and bacteremia. In each patient, bacteremia cleared, infected wounds healed, and pneumonia improved in response to continuous infusion ceftazidime or aztreonam. Treatment strategies for multidrug-resistant P. aeruginosa infections are limited. A novel treatment strategy, when no other options are available, is the continuous infusion of existing beta-lactam antibiotics to maximize their pharmacodynamic activity. High-dose continuous infusion ceftazidime or aztreonam was used for the successful treatment of resistant systemic P. aeruginosa infections in 3 chronically immunocompromised patients. Continuous infusion beta-lactam antibiotics are a potentially useful treatment strategy for resistant P. aeruginosa infections in immunocompromised patients.

  11. Infective endocarditis caused by multidrug-resistant Streptococcus mitis in a combined immunocompromised patient: an autopsy case report.

    Science.gov (United States)

    Matsui, Natsuko; Ito, Makoto; Kuramae, Hitoshi; Inukai, Tomomi; Sakai, Akiyoshi; Okugawa, Masaru

    2013-04-01

    An autopsy case of infective endocarditis caused by multidrug-resistant Streptococcus mitis was described in a patient with a combination of factors that compromised immune status, including autoimmune hemolytic anemia, post-splenectomy state, prolonged steroid treatment, and IgA deficiency. The isolated S. mitis strain from blood culture was broadly resistant to penicillin, cephalosporins, carbapenem, macrolides, and fluoroquinolone. Recurrent episodes of bacterial infections and therapeutic use of several antibiotics may underlie the development of multidrug resistance for S. mitis. Because clinically isolated S. mitis strains from chronically immunocompromised patients have become resistant to a wide spectrum of antibiotics, appropriate antibiotic regimens should be selected when treating invasive S. mitis infections in these compromised patients.

  12. Prevalence and fungal profile of pulmonary aspergillosis in immunocompromised and immunocompetent patients of a tertiary care hospital

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    Prakash Ved, Mishra Prem P, Verma Shashi K, Sinha Shivani, Sharma Mahendra

    2014-03-01

    Full Text Available Background: Aspergillus is a fungus which may present an array of pulmonary manifestations, depending on the patient’s immunological and physiological state. Although the incidence of pulmonary aspergillosis occurs primarily in immunocompromised patients but the incidence is also rising in immunocompetent individuals, especially in developing countries. Aim: The objective of the study was to determine the prevalence and predisposing factors of pulmonary aspergillosis along with species identification. Materials and Methods: One hundred and three patients admitted to the Department of Chest and Tuberculosis and in the Department of Medicine from Jan 2012 to Jan 2013 were included in this study. The patients were epitomized on the basis of clinical signs and symptoms, physical examination, chest radiography, CT scans, histopathological examination, bronchoscopy and fungal examination including potassium hydroxide mount, fungal culture of sputum and bronchoalveolar lavage. Species identification was done by colony characteristics, slide culture and Lactophenol Cotton blue mount. Results: Out of the 103 patients, (63 males and 40 females Aspergillus species has been isolated from 17 (16.5% males and 07 (6.79% females. Various predisposing factors of pulmonary aspergillosis have been identified in which pulmonary tuberculosis, chronic smoking and environmental exposure to asbestos, cement its tops the list. Many of the patients had multiple predisposing factors. Aspergillus species were isolated in 24 (23.3% cases. Aspergillus fumigatus was the predominant species isolated in 13 (54.16% cases followed by Aspergillus flavus in 07 (29.16% cases, Aspergillus niger in 03 (12.5 % and Aspergillus terrus in 1 (4.16% cases. Conclusion: It is concluded that the prevalence of pulmonary Aspergillosis is quite high in immunocompromised individuals and low in immunocompetent individuals. An adequate and efficient evaluation of the etiological agents has a

  13. The "Knife-Cut Sign" Revisited: A Distinctive Presentation of Linear Erosive Herpes Simplex Virus Infection in Immunocompromised Patients.

    Science.gov (United States)

    Cohen, Philip R

    2015-10-01

    The "knife-cut sign" is a distinctive presentation of linear erosive herpes simplex virus infection in immunocompromised patients. To describe a man whose herpes simplex virus infection-related skin lesions demonstrated the "knife-cut sign" and to review the characteristics of reported immunosuppressed individuals with "knife-cut" cutaneous herpes simplex virus lesions. A man with multiple myeloma and post-stem cell transplant cutaneous graft-versus-host disease managed with systemic prednisone and sirolimus developed disseminated cutaneous herpes simplex virus infection with virus-associated linear ulcers of the inguinal folds and the area between his ear and scalp; the lesions at both sites had a distinctive "knife-cut" appearance. Using the PubMed database, an extensive literature search was performed on herpes simplex virus, immunocompromised patient, and "knife-cut sign". Herpes simplex virus infection-associated skin lesions that demonstrate the "knife-cut sign" present in patients who are immunosuppressed secondary to either an underlying medical condition or a systemic therapy or both. The distinctive virus-related cutaneous lesions appear as linear ulcers and fissures in intertriginous areas, such as the folds in the inguinal area, the vulva, and the abdomen; in addition, other sites include beneath the breast, within the gluteal cleft, and the area between the ear and the scalp. Not only herpes simplex virus-2, but also herpes simplex virus-1 has been observed as the causative viral serotype; indeed, herpes simplex virus-1 has been associated with genital and inframammary lesions in addition to those above the neck. Direct fluorescent antibody testing is a rapid method for confirming the clinically suspected viral infection; however, since false-negative direct fluorescent antibody testing occurred in some of the patients, it may be prudent to also perform viral cultures and possibly lesional skin biopsies to establish the diagnosis. The herpes simplex

  14. A rare cause of drug-induced hepatitis in an immunocompromised patient and the role of glutathione.

    Science.gov (United States)

    Senadhi, Viplove; Arora, Deepika; Arora, Manish; Marsh, Franklin

    2012-08-27

    The Food and Drug Administration (FDA) has issued a warning on numerous herbal drugs, including many popular products at General Nutrition Centers (GNC), regarding unstudied hepatotoxicity. There have been recent reports of GNC products such as hydroxycut and herbalife, causing drug-induced hepatitis. Herbal medications are over-the-counter products and are not investigated thoroughly by the FDA. Given that the most common outpatient laboratory abnormality is elevated liver transaminases, a sign of hepatocellular toxicity; it is not surprising that some of these products end up causing hepatic dysfunction, especially when taken in large volume. There are numerous herbal supplements that are hepatotoxic, however, these medications have a much more significant effect in human immunodeficiency virus (HIV)/ acquired immune deficiency syndrome patients, which is secondary to depleted glutathione. We present a rare case of drug induced hepatitis secondary to herbal medications used to treat HIV and elucidate the role of glutathione depletion in immunocompromised patients.

  15. [Rehabilitation in rheumatology].

    Science.gov (United States)

    Luttosch, F; Baerwald, C

    2010-10-01

    Rehabilitation in rheumatology focuses on prevention of functional disorders of the musculoskeletal system, maintenance of working ability and prevention of care dependency. Drug treatment alone rarely results in long-term remission, therefore rehabilitative measures must be integrated into rheumatic care. Rehabilitative therapy in rheumatology includes physiotherapy, patient education and occupational therapy. Positive effects of physical therapy methods have been proven by various studies. Patient education and occupational therapy are important tools for stabilizing the course of the disease. To maintain positive rehabilitative results patients have to be involved in the selection of treatment measures and should take an active part in the long-term treatment process. Despite proven efficacy of physical measures there is evidence for a lack of utilization of rehabilitative therapy due to increasing cost pressure in the health care system which will further increase over time.

  16. Transthoracic ultrasonography for the immunocompromised patient. A pilot project that introduces transthoracic ultrasonography for the follow-up of hematological patients in Romania.

    Science.gov (United States)

    Frinc, Ioana; Ilies, Petru; Zaharie, Florin; Dima, Delia; Tanase, Alina; Petrov, Ljubomir; Irimie, Alexandru; Berce, Cristian; Lisencu, Cosmin; Berindan-Neagoe, Ioana; Tomuleasa, Ciprian; Bojan, Anca

    2017-06-01

    In the past decade, there has been significant progress in clinical hematology with the discovery of targeted molecules and thus the achievement of both hematologic and molecular responses. Nevertheless, chemotherapy remains the treatment of choice for many types of hematological malignancies. Aggressive chemotherapy leads to immunosuppression, accompanied by a high rate of infections and an increased rate of treatment-related mortality. Invasive fungal infections as well as more common bacterial and viral infections are frequent in immunocompromised patients as they are difficult to diagnose and treat. Pleuropulmonary infections in immunocompromised patients are diagnosed using clinical examination, imaging and laboratory tests. Many laboratory tests are run for several days before a final result is given and are expensive. Computer tomography is a reliable technique, but it is encumbered by high irradiation and high cost, and can assess lesions larger than 1 cm. Transthoracic ultrasound is a modern method, used in the diagnostic algorithm of pleuropulmonary pathology. It allows the diagnosis of small lesions, can be performed at the patients' bedside, with acceptable costs and no irradiation. A fast, informed and accurate medical decision is essential for a favorable outcome in immunosuppressed patients with an adjacent infection. In the current case series we present the implementation of a new protocol for the follow-up of immunocompromised patients using transthoracic ultrasonography, of great potential use in the clinic.

  17. Cardiac Aspergilloma: A Rare Case of a Cardiac Mass Involving the Native Tricuspid Valve, Right Atrium, and Right Ventricle in an Immunocompromised Patient

    Directory of Open Access Journals (Sweden)

    Christina S. Chen-Milhone

    2018-01-01

    Full Text Available Aspergillus can cause devastating opportunistic infections in immunocompromised patients. Rarely does this fungus invade the heart, and when it does, survival is especially poor despite optimal medical and surgical treatment. We report a case of cardiac aspergilloma with involvement of the tricuspid valve and both the right atrium and ventricle found on a transthoracic echocardiogram in an immunocompromised patient after developing atrial fibrillation with rapid ventricular rate. The findings from this case suggest that early clinical suspicion is critical in early diagnosis and thus early treatment.

  18. Transthoracic ultrasonography for the immunocompromised patient. A pilot project that introduces transthoracic ultrasonography for the follow-up of hematological patients in Romania

    Directory of Open Access Journals (Sweden)

    Frinc Ioana

    2017-06-01

    Full Text Available In the past decade, there has been significant progress in clinical hematology with the discovery of targeted molecules and thus the achievement of both hematologic and molecular responses. Nevertheless, chemotherapy remains the treatment of choice for many types of hematological malignancies. Aggressive chemotherapy leads to immunosuppression, accompanied by a high rate of infections and an increased rate of treatment-related mortality. Invasive fungal infections as well as more common bacterial and viral infections are frequent in immunocompromised patients as they are difficult to diagnose and treat. Pleuropulmonary infections in immunocompromised patients are diagnosed using clinical examination, imaging and laboratory tests. Many laboratory tests are run for several days before a final result is given and are expensive. Computer tomography is a reliable technique, but it is encumbered by high irradiation and high cost, and can assess lesions larger than 1 cm. Transthoracic ultrasound is a modern method, used in the diagnostic algorithm of pleuropulmonary pathology. It allows the diagnosis of small lesions, can be performed at the patients’ bedside, with acceptable costs and no irradiation. A fast, informed and accurate medical decision is essential for a favorable outcome in immunosuppressed patients with an adjacent infection. In the current case series we present the implementation of a new protocol for the follow-up of immunocompromised patients using transthoracic ultrasonography, of great potential use in the clinic.

  19. EULAR task force recommendations on annual cardiovascular risk assessment for patients with rheumatoid arthritis: an audit of the success of implementation in a rheumatology outpatient clinic.

    Science.gov (United States)

    Ikdahl, Eirik; Rollefstad, Silvia; Olsen, Inge C; Kvien, Tore K; Hansen, Inger Johanne Widding; Soldal, Dag Magnar; Haugeberg, Glenn; Semb, Anne Grete

    2015-01-01

    EULAR recommendations for cardiovascular disease (CVD) risk management include annual CVD risk assessments for patients with rheumatoid arthritis (RA). We evaluated the recording of CVD risk factors (CVD-RF) in a rheumatology outpatient clinic, where EULAR recommendations had been implemented. Further, we compared CVD-RF recordings between a regular rheumatology outpatient clinic (RegROC) and a structured arthritis clinic (AC). In 2012, 1142 RA patients visited the rheumatology outpatient clinic: 612 attended RegROC and 530 attended AC. We conducted a search in the patient journals to ascertain the rate of CVD-RF recording. The overall CVD-RF recording rate was 40.1% in the rheumatology outpatient clinic, reflecting a recording rate of 59.1% in the AC and 23.6% in the RegROC. The odds ratios for having CVD-RFs recorded for patients attending AC compared to RegROC were as follows: blood pressure: 12.4, lipids: 5.0-6.0, glucose: 9.1, HbA1c: 6.1, smoking: 1.4, and for having all the CVD-RFs needed to calculate the CVD risk by the systematic coronary risk evaluation (SCORE): 21.0. The CVD-RF recording rate was low in a rheumatology outpatient clinic. However, a systematic team-based model was superior compared to a RegROC. Further measures are warranted to improve CVD-RF recording in RA patients.

  20. EULAR Task Force Recommendations on Annual Cardiovascular Risk Assessment for Patients with Rheumatoid Arthritis: An Audit of the Success of Implementation in a Rheumatology Outpatient Clinic

    Directory of Open Access Journals (Sweden)

    Eirik Ikdahl

    2015-01-01

    Full Text Available Objective. EULAR recommendations for cardiovascular disease (CVD risk management include annual CVD risk assessments for patients with rheumatoid arthritis (RA. We evaluated the recording of CVD risk factors (CVD-RF in a rheumatology outpatient clinic, where EULAR recommendations had been implemented. Further, we compared CVD-RF recordings between a regular rheumatology outpatient clinic (RegROC and a structured arthritis clinic (AC. Methods. In 2012, 1142 RA patients visited the rheumatology outpatient clinic: 612 attended RegROC and 530 attended AC. We conducted a search in the patient journals to ascertain the rate of CVD-RF recording. Results. The overall CVD-RF recording rate was 40.1% in the rheumatology outpatient clinic, reflecting a recording rate of 59.1% in the AC and 23.6% in the RegROC. The odds ratios for having CVD-RFs recorded for patients attending AC compared to RegROC were as follows: blood pressure: 12.4, lipids: 5.0-6.0, glucose: 9.1, HbA1c: 6.1, smoking: 1.4, and for having all the CVD-RFs needed to calculate the CVD risk by the systematic coronary risk evaluation (SCORE: 21.0. Conclusion. The CVD-RF recording rate was low in a rheumatology outpatient clinic. However, a systematic team-based model was superior compared to a RegROC. Further measures are warranted to improve CVD-RF recording in RA patients.

  1. Antifungal susceptibility testing of Candida species isolated from the immunocompromised patients admitted to ten university hospitals in Iran : comparison of colonizing and infecting isolates

    NARCIS (Netherlands)

    Badiee, Parisa; Badali, Hamid; Boekhout, Teun; Diba, Kambiz; Moghadam, Abdolkarim Ghadimi; Hossaini Nasab, Ali; Jafarian, Hadis; Mohammadi, Rasoul; Mirhendi, Hossein; Najafzadeh, Mohammad Javad; Shamsizadeh, Ahmad; Soltani, Jafar

    2017-01-01

    BACKGROUND: Antifungal susceptibility testing is a subject of interest in the field of medical mycology. The aim of the present study were the distributions and antifungal susceptibility patterns of various Candida species isolated from colonized and infected immunocompromised patients admitted to

  2. Percutaneous treatment with amphotericin B of mycotic lung lesions from invasive aspergillosis: results in 10 immunocompromised patients

    International Nuclear Information System (INIS)

    Veltri, A.; Anselmetti, G.C.; Bartoli, G.; Martina, M.C.; Galli, J.; Regge, D.; Bertini, M.

    2000-01-01

    The aim of this study was to evaluate the efficacy of percutaneous treatment of pulmonary lesions from invasive aspergillosis in immunocompromised patients. From 1992 to 1998, ten patients (seven men and three women; mean age 56 years) affected by hematological neoplasms (8 acute myeloid leukemias, 2 non-Hodgkin's lymphomas) and post-chemotherapy prolonged neutropenia developed pulmonary lesions from invasive aspergillosis. A total of 13 lesions (diameter 2-7 cm, median 5 cm) were treated percutaneously due to insufficiency of the high-dose i. v. therapy; under CT guidance, a median of 10 cm 3 per session of a 1 mg/cm 3 diluted solution of amphotericin B was injected through a fine needle (21-22 G); 45 sessions overall were performed (one to five per lesion, median four), according to the volume of the nodules, tolerance, and complications. The results were retrospectively evaluated either radiologically or clinically. Complications were cough, mild hemoptysis, and small pneumothorax and/or pleural effusion. No major complications occurred. One month after the beginning of treatment, 8 lesions completely resolved, 4 greatly improved, and 1 was not significantly reduced. In all ten patients symptoms improved (eight of ten could restart chemotherapy as scheduled). After antiblastic retreatment, 1 patient had mycotic recurrence. In our experience transthoracic topical treatment with amphotericin B of single or few lung lesions from invasive aspergillosis was effective, affording a rapid improvement of the lesions and symptoms, and allowing continuation of chemotherapy as scheduled, thereby reducing the risk of recurrences. (orig.)

  3. [Proteinase activity in Candida albicans strains isolated from the oral cavity of immunocompromised patients, with oral candidiasis and in healthy subjects].

    Science.gov (United States)

    Hernández-Solís, Sandra E; Rueda-Gordillo, Florencio; Rojas-Herrera, Rafael A

    2014-01-01

    Candida albicans has a variety of virulence factors, including secreted aspartyl proteases, which are determinant factors in the pathogenesis of this yeast in immunocompromised patients. Proteinase activity was identified in C. albicans strains isolated from the oral cavity of immunocompromised patients with cancer, diabetes and HIV+, with oral candidiasis and in healthy subjects. Two hundred and fifty C. albicans strains were analyzed, distributed in 5 different groups: patients with cancer, diabetes, HIV+, with oral candidiasis and healthy subjects. Proteolytic activity was identified in 46% of the strains from cancer patients, 54% from HIV+ patients, 60% from diabetics, 70% from oral candidiasis patients, and 42% from healthy subjects. Activity was higher in strains from immunocompromised and oral candidiasis patients than in healthy subjects. Differences were observed between the candidiasis-healthy, candidiasis-HIV+, and diabetic-healthy groups. No differences were observed between the oral candidiasis, diabetes and cancer patients, between the diabetes and HIV+ patients, or between the cancer patients, HIV+ patients and healthy subjects. The present results suggest that although secreted aspartyl proteases are important in the pathogenesis of C. albicans, their activity depends on host conditions. Copyright © 2012 Revista Iberoamericana de Micología. Published by Elsevier Espana. All rights reserved.

  4. Detection of low frequency multi-drug resistance and novel putative maribavir resistance in immunocompromised paediatric patients with cytomegalovirus

    Directory of Open Access Journals (Sweden)

    Charlotte Jane Houldcroft

    2016-09-01

    Full Text Available Human cytomegalovirus (HCMV is a significant pathogen in immunocompromised individuals, with the potential to cause fatal pneumonitis and colitis, as well as increasing the risk of organ rejection in transplant patients. With the advent of new anti-HCMV drugs there is therefore considerable interest in using virus sequence data to monitor emerging resistance to antiviral drugs in HCMV viraemia and disease, including the identification of putative new mutations. We used target-enrichment to deep sequence HCMV DNA from 11 immunosuppressed paediatric patients receiving single or combination anti-HCMV treatment, serially sampled over 1-27 weeks. Changes in consensus sequence and resistance mutations were analysed for three ORFs targeted by anti-HCMV drugs and the frequencies of drug resistance mutations monitored. Targeted-enriched sequencing of clinical material detected mutations occurring at frequencies of 2%. Seven patients showed no evidence of drug resistance mutations. Four patients developed drug resistance mutations a mean of 16 weeks after starting treatment. In two patients, multiple resistance mutations accumulated at frequencies of 20% or less, including putative maribavir and ganciclovir resistance mutations P522Q (UL54 and C480F (UL97. In one patient, resistance was detected 14 days earlier than by PCR. Phylogenetic analysis suggested recombination or superinfection in one patient. Deep sequencing of HCMV enriched from clinical samples excluded resistance in 7 of eleven subjects and identified resistance mutations earlier than conventional PCR-based resistance testing in 2 patients. Detection of multiple low level resistance mutations was associated with poor outcome.

  5. Association of bronchoalveolar lavage yield with chest computed tomography findings and symptoms in immunocompromised patients

    Directory of Open Access Journals (Sweden)

    Kyle R Brownback

    2013-01-01

    Conclusion: CT findings of reticular and nodular infiltrates portend a worse diagnostic yield from BAL than those that are alveolar in nature. Symptomatic patients are more likely to have diagnostic FOB with BAL than asymptomatic patients.

  6. Discordant results obtained on testing sera from immunocompromised patients for cytomegalovirus IgG by enzyme-linked immunosorbent assay and radioimmunoassay

    Energy Technology Data Exchange (ETDEWEB)

    Booth, J C; El Mohandes, L; Tryhorn, Y S [London University (United Kingdom). St. George' s Hospital Medical School, Department of Medical Microbiology; Kangro, H O; Liu, K M [Saint Bartholomew' s Hospital, London (UK)

    1989-10-01

    The investigation of sera from immunocompromised patients for antibody to CMV by ELISA, RIA, immunofluorescence (IF) and complement-fixation (CF) revealed discrepancies that reflected differences in test specificity rather than sensitivity and suggested that for the long-term serological follow-up of such patients it would be advisable not to rely on only a single assay procedure. (author). 12 refs.; 8 figs.; 1 tab.

  7. Characterization of Streptococcus constellatus strains recovered from a brain abscess and periodontal pockets in an immunocompromised patient.

    Science.gov (United States)

    Marques da Silva, Rafael; Caugant, Dominique A; Josefsen, Roger; Tronstad, Leif; Olsen, Ingar

    2004-12-01

    There have been a number of reports of brain abscesses suggesting an odontogenic etiology. However, no efforts have been made to compare brain abscess isolates with isolates from the oral cavity using highly discriminative methods. We report a brain abscess caused by Streptococcus constellatus in an immunocompromised patient where oral infection (periodontitis) was suspected to be implicated. The brain abscess and oral isolates were compared by means of one phenotypic and three genetic (restriction fragment length polymorphism [RFLP], ribotyping, and random amplified polymorphic DNA [RAPD]) fingerprinting techniques. The phenotypic method and RFLP showed identical profiles between brain and periodontal isolates, while ribotyping and RAPD showed very close similarity, with only one band difference in one of the three ribotypes and in one of the three polymorphic RAPD. Gene transfer by genetic recombinational events in the periodontal pocket might have been responsible for the emergence of a strain variant of S. constellatus that had the potential to cause an abscess at a distant site (brain). The importance of odontogenic sources as potential foci of infection for brain abscesses is discussed.

  8. Pulmonary toxoplasmosis in immunocompromised patients with interstitial pneumonia: a single-centre prospective study assessing PCR-based diagnosis.

    Science.gov (United States)

    Desoubeaux, Guillaume; Cabanne, Églantine; Franck-Martel, Claire; Gombert, Martin; Gyan, Emmanuel; Lissandre, Séverine; Renaud, Marc; Monjanel, Hélène; Dartigeas, Caroline; Bailly, Éric; Van Langendonck, Nathalie; Chandenier, Jacques

    2016-08-01

    Pulmonary toxoplasmosis has become a very rare parasitic infection since the advent of highly active antiretroviral therapies. It is generally diagnosed by the direct microscopic observation of Toxoplasma gondii tachyzoites in bronchoalveolar lavage fluid (BALF). The aim of this study was to assess possible improvements in diagnostic performance associated with the use of real-time PCR. This prospective study was carried out on BALFs obtained from immunocompromised patients over a 2-year period. We systematically compared the results of conventional staining with those of molecular detection. Two cases of pulmonary toxoplasmosis were diagnosed for a total of 336 samples. PCR did not detect any additional cases and was more time-consuming than conventional staining. Conventional staining is a reliable technique and is probably the most appropriate method for experienced microbiology laboratories, whereas T. gondii-specific PCR may be useful for laboratories with less experience in parasitology. 2015_030, May 27th 2015. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  9. A real time PCR assay on blood for diagnosis of invasive candidiasis in immunocompromised patient

    Directory of Open Access Journals (Sweden)

    Mohsen Ashrafi

    2015-01-01

    Results: From 2009 to 2011, 72 patients with hematologic malignancies and bone marrow transplant recipients were evaluated for IC. The female to male ratio was 27:45; the mean age was 32.1 years. The most common malignancy in this patient was acute myeloid leukemia (AML (27.8% and acute lymphoblastic leukemia (ALL (26.4%. Out of 72 patients, 11 patients (15.3% had positive real time PCR /probe results. Based on the melting temperature (Tm analysis, 5 (45.4% C. krusei, 3 (27.2% C. tropicalis, 2 (18.1% C. parapsilosis and 1 C. albicans (9% were identified. According to the revised EORTC / MSG, 1 patient (9% and 10 patients (91% were defined as proven and possible groups of IC, respectively. The mortality rate in proven and possible IC patient was found 54.5%. Conclusion: The established Real-time PCR/FRET probe assay is an appropriate diagnostic tool for the detection of Candida species DNA and the management of patients suffering from hematologic malignancies and bone marrow recipient are at risk for IC.

  10. Percutaneous treatment with amphotericin B of mycotic lung lesions from invasive aspergillosis: results in 10 immunocompromised patients

    Energy Technology Data Exchange (ETDEWEB)

    Veltri, A.; Anselmetti, G.C.; Bartoli, G.; Martina, M.C.; Galli, J. [Sezione di Scienze Radiologiche, DiUniv. Torino (Italy); Regge, D. [Servizio di Radiodiagnostica, Istituto di Ricerca e Cura per il Cancro, Ordine Mauriziano, Candiolo (Italy); Bertini, M. [U.O.A. Ematologia, Azienda Ospedaliera San Giovanni Battista, Torino (Italy)

    2000-12-01

    The aim of this study was to evaluate the efficacy of percutaneous treatment of pulmonary lesions from invasive aspergillosis in immunocompromised patients. From 1992 to 1998, ten patients (seven men and three women; mean age 56 years) affected by hematological neoplasms (8 acute myeloid leukemias, 2 non-Hodgkin's lymphomas) and post-chemotherapy prolonged neutropenia developed pulmonary lesions from invasive aspergillosis. A total of 13 lesions (diameter 2-7 cm, median 5 cm) were treated percutaneously due to insufficiency of the high-dose i. v. therapy; under CT guidance, a median of 10 cm{sup 3} per session of a 1 mg/cm{sup 3} diluted solution of amphotericin B was injected through a fine needle (21-22 G); 45 sessions overall were performed (one to five per lesion, median four), according to the volume of the nodules, tolerance, and complications. The results were retrospectively evaluated either radiologically or clinically. Complications were cough, mild hemoptysis, and small pneumothorax and/or pleural effusion. No major complications occurred. One month after the beginning of treatment, 8 lesions completely resolved, 4 greatly improved, and 1 was not significantly reduced. In all ten patients symptoms improved (eight of ten could restart chemotherapy as scheduled). After antiblastic retreatment, 1 patient had mycotic recurrence. In our experience transthoracic topical treatment with amphotericin B of single or few lung lesions from invasive aspergillosis was effective, affording a rapid improvement of the lesions and symptoms, and allowing continuation of chemotherapy as scheduled, thereby reducing the risk of recurrences. (orig.)

  11. Low sensitivity of fecal toxin A/B enzyme immunoassay for diagnosis of Clostridium difficile infection in immunocompromised patients.

    Science.gov (United States)

    Erb, S; Frei, R; Strandén, A M; Dangel, M; Tschudin-Sutter, S; Widmer, A F

    2015-11-01

    The optimal approach in laboratory diagnosis of Clostridium difficile infection (CDI) is still not well defined. Toxigenic culture (TC) or alternatively fecal toxin assay by cell cytotoxicity neutralization assay are considered to be the reference standard, but these methods are time-consuming and labor intensive. In many medical centers, diagnosis of CDI is therefore still based on fecal toxin A/B enzyme immunoassay (EIA) directly from stool alone, balancing cost and speed against limited diagnostic sensitivity. The aim of the study was to assess in which patient population the additional workload of TC is justified. All consecutive stool specimens submitted for diagnosis of suspected CDI between 2004 and 2011 at a tertiary-care center were examined by toxin EIA and TC. Clinical data of patients with established diagnosis of CDI were collected in a standardized case-report form. From 12,481 stool specimens submitted to the microbiologic laboratory, 480 (3.8%) fulfilled CDI criteria; 274 (57.1%) were diagnosed by toxin EIA; and an additional 206 (42.9%) were diagnosed by TC when toxin EIA was negative. Independent predictors for negative toxin EIA but positive TC were high-dose corticosteroids (odds ratio (OR) 2.97, 95% confidence interval (CI) 1.50-5.90, p 0.002), leukocytopenia <1000/μL (OR 2.52, 95% CI 1.22-5.23, p 0.013) and nonsevere CDI (OR 2.21, 95% CI 1.39-3.50, p 0.001). There was no difference in outcomes such as in-hospital mortality and recurrence between both groups. In conclusion, negative toxin EIA does not rule out CDI in immunocompromised patients in the setting of relevant clinical symptoms. Methods with improved sensitivity such as TC or PCR should be used, particularly in this patient population. Copyright © 2015 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  12. CLINICAL AND IMMUNOLOGICAL EFFECT OF PNEUMOCOCCAL CONJUGATED VACCINES IN IMMUNOCOMPROMISED PATIENTS

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    A.A. Tarasova

    2010-01-01

    Full Text Available Invasive pneumococcal infection is the most frequent cause of death in patients with immunodeficiences. The antibiotics used previously for prevention purposes are not efficient enough due to the developing antibiotic resistance. Polysaccharide pneumococcal vaccines create short-lived immunity. The overview summarizes the experience of applying conjugated pneumococcal vaccines in patients with primary immunodeficiences, HIV infection, oncological and rheumatic diseases. Key words: pneumococcal infection, pneumococcal conjugated vaccines, children, immunosuppression. (Pediatric Pharmacology. – 2010; 7(5:18-23

  13. Concurrent central nervous system infective pathology in a severely immunocompromised patient

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    Thein Swe

    2016-01-01

    Full Text Available To our knowledge and literature search, concurrent cryptococcal meningitis and neurosyphilis in a patient have rarely been reported. Here, we report a 37-year-old male with HIV infection presented with headache and dizziness for 5 days along with memory difficulty and personality changes for about 1 week. During the hospital stay, cryptococcal meningitis was confirmed with positive cerebral spinal fluid (CSF cryptococcal antigen titer (1:320 and positive CSF culture. Diagnosis of neurosyphilis was made based upon CSF white blood cell count of 85 cells/mL, with CSF total protein of 87 mg/dL, reactive CSF treponemal antibody, and fluorescent treponemal antibody. The patient was treated with amphotericin B, flucytosine, fluconazole, and benzathine penicillin G, and the patient was recovered and discharged. HIV patients are at high risk of developing severe infections of the central nervous system. Awareness should be made not only to single infection but also for dual pathology for a better and life-saving management.

  14. Disseminated Strongyloidiasis in an Iranian Immunocompro-mised Patient: A Case Report

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    Narges NAJAFI

    2016-10-01

    Full Text Available Strongyloides stercoralis is a soil-transmitted helminth (STH widespread in various part of the world. A 78-yr-old peasant diabetic female from Mazandaran Province northern Iran, was admitted to Infection Department of the Razi Hospital in city of Qaemshahr, north of Iran complaining about abdominal skin rash, pruritus, itching, anorexia, nausea, vomiting, dysuria and cough. This patient had cutaneous migration effects of S. stercoralis larvae in her abdominal skin (larva currents and urticaria. Lung CT without contrast demonstrates bilateral diffuse ground glass opacity draws attention. Upper gastrointestinal endoscopy revealed gastro esophageal reflux with antral gastritis. Duodenal endoscopy showed unusual mucosa and a biopsy from it sent to the pathology laboratory. Histopathology of duodenal bulb and duodenum biopsy showed mild villous atrophy and S. stercoralis infection. The patient was treated with albendazole and clinical sings improved completely after treatment. Strongyloidiasis should be care­fully considered by clinicians who practice in endemic areas. Clinicians must keep a high level of skepticism for patients from endemic area.

  15. Economic Comparison of an Empirical Versus Diagnostic-Driven Strategy for Treating Invasive Fungal Disease in Immunocompromised Patients.

    Science.gov (United States)

    Barnes, Rosemary; Earnshaw, Stephanie; Herbrecht, Raoul; Morrissey, Orla; Slavin, Monica; Bow, Eric; McDade, Cheryl; Charbonneau, Claudie; Weinstein, David; Kantecki, Michal; Schlamm, Haran; Maertens, Johan

    2015-06-01

    Patients with persistent or recurrent neutropenic fevers at risk of invasive fungal disease (IFD) are treated empirically with antifungal therapy (AFT). Early treatment using a diagnostic-driven (DD) strategy may reduce clinical and economic burdens. We compared costs and outcomes of both strategies from a UK perspective. An empirical strategy with conventional amphotericin B deoxycholate (C-AmB), liposomal amphotericin B (L-AmB), or caspofungin was compared with a DD strategy (initiated based on positive ELISA results for galactomannan antigen) and/or positive results for Aspergillus species on polymerase chain reaction assay) using C-AmB, voriconazole, or L-AmB in a decision-analytic model. Rates of IFD incidence, overall mortality, and IFD-related mortality in adults expected to be neutropenic for ≥10 days were obtained. The empirical strategy was assumed to identify 30% of IFD and targeted AFT to improve survival by a hazard ratio of 0.589. AFT-specific adverse events were obtained from a summary of product characteristics. Resource use was obtained, and costs were estimated by using standard UK costing sources. All costs are presented in 2012 British pounds sterling. Total costs were 32% lower for the DD strategy (£1561.29) versus the empirical strategy (£2301.93) due to a reduced incidence of adverse events and decreased use of AFT. Administration of AFT was reduced by 41% (DD strategy, 74 of 1000; empirical strategy, 125 of 1000), with similar survival rates. This study suggests that a DD strategy is likely to be cost-saving versus empirical treatment for immunocompromised patients with persistent or recurrent neutropenic fevers. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

  16. A fatal case of empyema thoracis by Nocardia farcinica in an immunocompromised patient

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    Parande M

    2010-01-01

    Full Text Available Empyema thoracis by Nocardia farcinica infection is uncommon. Here we report a rare and fatal infection in a 27-year-old HIV- seropositive male who presented with cough, expectoration, and breathlessness. Nocardia farcinica was isolated from sputum and pus from the pleural cavity. Confirmation of the isolate and minimum inhibitory concentrations (MIC for various antibiotics was done at the Aerobic Actinomycetes Reference Laboratory, Centres for Disease Control and Prevention (CDC, Atlanta. Patient was treated with suitable antibiotics and antiretroviral drugs in spite of which he eventually succumbed to the disease.

  17. Nocardia transvalensis Disseminated Infection in an Immunocompromised Patient with Idiopathic Thrombocytopenic Purpura

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    Jorge García-Méndez

    2016-01-01

    Full Text Available Nocardia transvalensis complex includes a wide range of microorganisms with specific antimicrobial resistance patterns. N. transvalensis is an unusual Nocardia species. However, it must be differentiated due to its natural resistance to aminoglycosides while other Nocardia species are susceptible. The present report describes a Nocardia species involved in an uncommon clinical case of a patient with idiopathic thrombocytopenic purpura and pulmonary nocardiosis. Microbiological and molecular techniques based on the sequencing of the 16S rRNA gene allowed diagnosis of Nocardia transvalensis sensu stricto. The successful treatment was based on trimethoprim-sulfamethoxazole and other drugs. We conclude that molecular identification of Nocardia species is a valuable technique to guide good treatment and prognosis and recommend its use for daily bases diagnosis.

  18. Invasive Mucormycosis Induced Pneumopericardium: A Rare Cause of Pneumopericardium in an Immunocompromised Patient

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    Sana Khan

    2017-01-01

    Full Text Available Mucor and Rhizopus cause life-threatening infections primarily involving the lungs and sinuses, which disseminate very rapidly by necrosis and infarction of the contiguous tissues. We present a case of a 64-year-old African American posttransplant patient who presented with a productive cough and weight loss. He had a past surgical history of renal transplant for renal cell carcinoma and was on dual immunosuppressive therapy, that is, mycophenolate and tacrolimus. During his hospital stay, he developed a pneumopericardium due to the direct extension of a lung lesion. The diagnosis was made by radiological imaging and PCR result which was consistent with Mucor species. He was treated with antifungal therapy. The purpose of this report is to highlight the unusual association of mucormycosis with pneumopericardium.

  19. A CASE OF SUBCUTANEOUS PHAEOHYPHOMYCOSIS CAUSED BY EXSEROHILUM SPECIES IN AN IMMUNOCOMPROMISED PATIENT

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    Koppada Rajasekhar

    2013-10-01

    Full Text Available Phaeohyphomycoses are rare fungal infections, caused by dematiaceous fungi, manifested as cutaneous and subcutaneous infections, meningitis, sinusitis, keratitis, osteomyelitis and disseminated infection. This is a case report of a 45year old immuno compromised female on ART (Anti Retroviral therapy presented with fever and generalized nodular lesions draining pus on face, hands, axilla, groin and labia majora since one month. Biopsy of the subcutaneous nodule on the lateral aspect of the thigh revealed septate fungal hyphae on 10% KOH (10% Potassium Hydroxide mount. Fungal culture of the biopsy material on SDA (Sabouraud’s Dextrose Agar at 250C showed cotton wooly, dark gray to olivaceous black growth with black reverse and identified as dematiaceous fungi belonging to Exserohilum species by microscopy. The patient was put on Itraconazole 200mg BD in combination with Terbinafine 250mg BD for which she responded with healing of pustular lesions in two weeks and complete remission in two months..

  20. Population pharmacokinetics and dosing simulations of imipenem in serious bacteraemia in immunocompromised patients with febrile neutropenia.

    Science.gov (United States)

    Jaruratanasirikul, Sutep; Wongpoowarak, Wibul; Jullangkoon, Monchana; Samaeng, Maseetoh

    2015-02-01

    The aims of this study were to i) reveal the population pharmacokinetics; and ii) assess the probability of target attainment (PTA) and cumulative fraction of response (CFR) (defined as the expected population PTA for a specific drug dose and a specific population of microorganisms) of imipenem in febrile neutropenic patients with bacteraemia. Ten patients were randomised into two groups: Group I received a 0.5-h infusion of 0.5 g of imipenem every 6 h (q6h) for 8 doses; and Group II received a 4-h infusion of 0.5 g q6h for 8 doses. A Monte Carlo simulation was performed to determine the PTA. The volume of distribution and total clearance of imipenem were 20.78 ± 1.35 l and 23.19 ± 1.34 l/h, respectively. Only a 4-h infusion of 1 g q6h regimen achieved a PTA >93% for 80% T>MIC for a MIC of 2 μg/ml. A 4-h infusion of all simulated regimens and a 0.5-h infusion of 0.5 g q6h and 1 g q6h achieved targets (CFR ≥ 90%) against Escherichia coli and Klebsiella spp. However, against Pseudomonas aeruginosa and Acinetobacter spp., no regimens achieved their targets. In conclusion, the results indicate that a higher than manufacturer's dosage recommendation is required to maximize the activity of imipenem. Copyright © 2014 Japanese Pharmacological Society. Production and hosting by Elsevier B.V. All rights reserved.

  1. Retroperitoneal Necrotizing Fasciitis from Fournier’s Gangrene in an Immunocompromised Patient

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    Samuel B. Weimer

    2017-01-01

    Full Text Available Introduction. Necrotizing fasciitis (NF is a devastating soft tissue disease causing fulminant clinical deterioration, and extension into the retroperitoneum has a high mortality rate. This disease process demands a strong clinical suspicion for early identification which must be coupled with frequent wide surgical debridements and intravenous antibiotics for improved outcomes. Various clinical risk factors may render a weakness in the patient’s immune status including diabetes mellitus, chronic renal failure, obesity, and autoimmune disorders, such as a human immunodeficiency virus (HIV infection. Case Report. A 55-year-old male presented with hypotension requiring a large intravenous fluid resuscitation and vasopressors. He was diagnosed with the human immunodeficiency virus upon presentation. A computerized tomographic scan revealed air and fluid in the perineum and pelvis, ascending into the retroperitoneum. Multiple surgical debridements to his perineum, deep pelvic structures, and retroperitoneum were completed. After colostomy placement, antibiotic administration, and wound care, he was closed using split-thickness skin grafting. Conclusion. NF is a sinister and fulminant disease requiring prompt diagnosis and surgical intervention. The best chance for survival occurs with emergent surgical debridement and appropriate intravenous antibiotics. While retroperitoneal NF is consistent with uniformly poor outcomes, patients are best treated in an American Burn Association-verified burn center.

  2. Bacteremia caused by Achromobacter species in an immunocompromised host.

    Science.gov (United States)

    Kish, M A; Buggy, B P; Forbes, B A

    1984-01-01

    A case of bacteremia caused by Achromobacter species in an immunocompromised patient is described. The patient responded to antibiotic therapy. Detailed antibiotic susceptibility data are presented. PMID:6332118

  3. Diagnosis of pulmonary infection with Toxoplasma gondii in immunocompromised HIV-positive patients by real-time PCR

    DEFF Research Database (Denmark)

    Petersen, E; Edvinsson, B; Lundgren, B

    2006-01-01

    The aim of the study presented here was to evaluate the use of PCR for improving the diagnosis of Toxoplasma gondii infection in immunocompromised hosts. Three hundred thirty-two bronchoalveolar lavage (BAL) fluid samples were analyzed by real-time PCR targeting a 529 bp element of T. gondii. In ...

  4. Ankylosing Spondylitis Patients Commencing Biologic Therapy Have High Baseline Levels of Comorbidity: A Report from the Australian Rheumatology Association Database

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    John Oldroyd

    2009-01-01

    Full Text Available Aims. To compare the baseline characteristics of a population-based cohort of patients with ankylosing spondylitis (AS commencing biological therapy to the reported characteristics of bDMARD randomised controlled trials (RCTs participants. Methods. Descriptive analysis of AS participants in the Australian Rheumatology Association Database (ARAD who were commencing bDMARD therapy. Results. Up to December 2008, 389 patients with AS were enrolled in ARAD. 354 (91.0% had taken bDMARDs at some time, and 198 (55.9% completed their entry questionnaire prior to or within 6 months of commencing bDMARDs. 131 (66.1% had at least one comorbid condition, and 24 (6.8% had a previous malignancy (15 nonmelanoma skin, 4 melanoma, 2 prostate, 1 breast, cervix, and bowel. Compared with RCT participants, ARAD participants were older, had longer disease duration and higher baseline disease activity. Conclusions. AS patients commencing bDMARDs in routine care are significantly different to RCT participants and have significant baseline comorbidities.

  5. Update on rheumatology: part 1.

    Science.gov (United States)

    Neal-Boylan, Leslie

    2009-05-01

    There are many rheumatic diseases. Part 1 of this 2 part series on rheumatology presented a few of those most commonly seen in the community. Home health clinicians can be helpful in managing these diseases and preventing progression by watching for new symptoms or acute attacks of pain or disability, ensuring that patients take their medications appropriately, reminding patients to see their rheumatology providers and have their lab work done regularly, and reporting adverse effects to medications promptly. Additionally, as with most home health patients, an interdisciplinary approach that includes physical and occupational therapy, social work, nursing, nutrition, and other disciplines as needed should be implemented so that all patient needs are met and the patient is discharged at the highest level of self-care that is possible. Part 2 of this series will discuss the care of the patient with rheumatic disease at home and will provide a more in-depth look at lab diagnosis of rheumatic diseases.

  6. Combination liposomal amphotericin B, posaconazole and oral amphotericin B for treatment of gastrointestinal Mucorales in an immunocompromised patient

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    Anthony Anderson

    2017-09-01

    Full Text Available Mucormycosis is a life threatening infection caused by fungi in the order Mucorales. Mucormycosis can affect any organ system with rhino-orbital-cerebral and pulmonary infections being the most predominant infection types. Gastrointestinal mucormycosis is rare and accounts for only 4–7% of all cases. Here, we present a case of invasive gastrointestinal mucormycosis in an immunocompromised host treated with systemic and topical anti-mold therapy.

  7. Combination liposomal amphotericin B, posaconazole and oral amphotericin B for treatment of gastrointestinal Mucorales in an immunocompromised patient.

    Science.gov (United States)

    Anderson, Anthony; McManus, Dayna; Perreault, Sarah; Lo, Ying-Chun; Seropian, Stuart; Topal, Jeffrey E

    2017-09-01

    Mucormycosis is a life threatening infection caused by fungi in the order Mucorales. Mucormycosis can affect any organ system with rhino-orbital-cerebral and pulmonary infections being the most predominant infection types. Gastrointestinal mucormycosis is rare and accounts for only 4-7% of all cases. Here, we present a case of invasive gastrointestinal mucormycosis in an immunocompromised host treated with systemic and topical anti-mold therapy.

  8. Cardiovascular risk of patients with gout seen at rheumatology clinics following a structured assessment.

    Science.gov (United States)

    Andrés, Mariano; Bernal, José Antonio; Sivera, Francisca; Quilis, Neus; Carmona, Loreto; Vela, Paloma; Pascual, Eliseo

    2017-07-01

    Gout-associated cardiovascular (CV) risk relates to comorbidities and crystal-led inflammation. The aim was to estimate the CV risk by prediction tools in new patients with gout and to assess whether ultrasonographic carotid changes are present in patients without high CV risk. Cross-sectional study. Consecutive new patients with crystal-proven gout underwent a structured CV consultation, including CV events, risk factors and two risk prediction tools-the Systematic COronary Evaluation (SCORE) and the Framingham Heart Study (FHS). CV risk was stratified according to current European guidelines. Carotid ultrasound (cUS) was performed in patients with less than very high CV risk. The presence of carotid plaques was studied depending on the SCORE and FHS by the area under the curve (AUC) of receiver operating curves. 237 new patients with gout were recruited. CV stratification by scores showed a predominance of very high (95 patients, 40.1%) and moderate (72 patients, 30.5%) risk levels. cUS was performed in 142 patients, finding atheroma plaques in 66 (46.5%, 95% CI 37.8 to 54.2). Following cUS findings, patients classified as very high risk increased from 40.1% up to 67.9% (161/237 patients). SCORE and FHS predicted moderately (AUC 0.711 and 0.683, respectively) the presence of atheroma plaques at cUS. The majority of patients presenting with gout may be at very high CV risk, indicating the need for initiating optimal prevention strategies at this stage. Risk prediction tools appear to underestimate the presence of carotid plaque in patients with gout. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  9. PROCALCITONIN TESTING IN RHEUMATOLOGY

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    D. V. Bukhanova

    2017-01-01

    Full Text Available Currently, differential diagnosis of systemic bacterial infection and active rheumatic process remains a challenging problem in rheumatology. In the review, current data on the role of procalcitonin biomarker in diagnosis and differential diagnosis of rheumatic diseases (RD and infectious pathology are presented. In particular, some authors recommend procalcitonin (PCT test as a marker of bacterial infection in bones and joints at levels above 0.5 ng/ml; at PCT level below 0.3 ng/ml, infection can be ruled out. In patients with microcrystalline arthritis, data on the significance of PCT for differential diagnosis are contradictory. PCT level doesn’t correlate with systemic lupus erythematosus activity and is elevated only during bacterial infection proportionally to its systematicity. In some studies, elevated PCT level was observed in ANCA-associated vasculitis with high activity without bacterial infection. It was shown that in 80 % of adults with Still’s disease, PCT level was higher than the threshold value even without infection. For patients with RD hospitalized in intensive care units, PCT clearance is a more informative predictive characteristic than its level, regardless of the cause of PCT elevation (infection, injury, severe organ damage, etc.; slowdown of its decrease is a factor of poor prognosis and is associated with higher mortality. At the same time, PCT level positively correlates with the SOFA score in presence of bacterial infection. For some rheumatic diseases, the threshold PCT value at which the test has optimal sensitivity and specificity is yet to be established. Nonetheless, PCT should be evaluated in relation to the clinical picture and data of additional examinations. The effect of various therapy methods used in rheumatology on PCT level requires further research.

  10. Demographic, clinical and radiological characteristics of seronegative spondyloarthritis Egyptian patients: A rheumatology clinic experience in Mansoura

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    Adel Abdelsalam

    2017-04-01

    Conclusion: The demographic, clinical and radiological characteristics of Egyptian SpA patients are comparable to those from other countries except for the lower prevalence of extra-articular manifestations.

  11. Wait times to rheumatology care for patients with rheumatic diseases: a data linkage study of primary care electronic medical records and administrative data.

    Science.gov (United States)

    Widdifield, Jessica; Bernatsky, Sasha; Thorne, J Carter; Bombardier, Claire; Jaakkimainen, R Liisa; Wing, Laura; Paterson, J Michael; Ivers, Noah; Butt, Debra; Lyddiatt, Anne; Hofstetter, Catherine; Ahluwalia, Vandana; Tu, Karen

    2016-01-01

    The Wait Time Alliance recently established wait time benchmarks for rheumatology consultations in Canada. Our aim was to quantify wait times to primary and rheumatology care for patients with rheumatic diseases. We identified patients from primary care practices in the Electronic Medical Record Administrative data Linked Database who had referrals to Ontario rheumatologists over the period 2000-2013. To assess the full care pathway, we identified dates of symptom onset, presentation in primary care and referral from electronic medical records. Dates of rheumatologist consultations were obtained by linking with physician service claims. We determined the duration of each phase of the care pathway (symptom onset to primary care encounter, primary care encounter to referral, and referral to rheumatologist consultation) and compared them with established benchmarks. Among 2430 referrals from 168 family physicians, 2015 patients (82.9%) were seen by 146 rheumatologists within 1 year of referral. Of the 2430 referrals, 2417 (99.5%) occurred between 2005 and 2013. The main reasons for referral were osteoarthritis (32.4%) and systemic inflammatory rheumatic diseases (30.6%). Wait times varied by diagnosis and geographic region. Overall, the median wait time from referral to rheumatologist consultation was 74 (interquartile range 27-101) days; it was 66 (interquartile range 18-84) days for systemic inflammatory rheumatic diseases. Wait time benchmarks were not achieved, even for the most urgent types of referral. For systemic inflammatory rheumatic diseases, most of the delays occurred before referral. Rheumatology wait times exceeded established benchmarks. Targeted efforts are needed to promote more timely access to both primary and rheumatology care. Routine linkage of electronic medical records with administrative data may help fill important gaps in knowledge about waits to primary and specialty care.

  12. What do patients in rheumatologic care know about the risks of NSAIDs?

    DEFF Research Database (Denmark)

    Ornbjerg, Lykke; Andersen, Henning Boje; Kryger, Peter

    2008-01-01

    drugs than the prescribed drugs (P = 0.002, Mann-Whitney). Factors recognized to increase the risk of side effects were: higher dose (81% of patients), long-term treatment (68%), previous side effects (57%), combination of NSAIDs (49%), and old age (31 %). Twenty-three percent assumed that acetaminophen...

  13. Management of infections in rheumatic patients receiving biological therapies. The Portuguese Society of Rheumatology recommendations.

    Directory of Open Access Journals (Sweden)

    Teixeira L

    2016-12-01

    Full Text Available Introduction: Infections are a major cause of morbi dity and mortality in systemic inflammatory rheumatic di - seases and the management of infectious complications in patients under biological therapies deserves parti - cular attention. Objective: Develop evidence-based recommendations for the management of infections in rheumatic patients receiving biological therapies. Methods: A search in PubMed (until 10 November 2014 and EMBASE (until 20 December 2014 databases was performed. Patients with systemic inflammatory rheumatic diseases treated with approved biologics in whom infections occurred were included. Search results were submitted to title and abstract selection, followed by detailed review of suitable studies. Information regarding presentation of the infectious complication, its diagnosis, treatment, and outcome, as well as maintenance or discontinuation of the biological agent was extracted and subsequently pooled according to the type of infection considered. Results of literature review were presented and critically reviewed in a dedi - cated meeting by a multidisciplinary panel. Recommendations were then formulated using the Delphi method. Finally, the level of agreement among rheumatologists was voted using an online survey. Results: Fifteen recommendations were issued. Nine general recommendations concerned the assessment of infectious risk before and while on biologics, the procedures in case of suspected infection and the mana - gement of biologics during infectious complications. Six specific recommendations were developed for respiratory, urinary, gastrointestinal, skin, osteoarticular and disseminated infections. Conclusion: These fifteen recommendations are intended to help rheumatologists in the management of infections in patients on biological therapy. They integrate an extensive literature review, expert opinion and inputs from Portuguese rheumatologists.

  14. Attitudes and Self-Care Behaviors of Patients with Knee Osteoarthritis Referred to Rheumatology Clinical Centers in Yazd

    Directory of Open Access Journals (Sweden)

    MA Morowatisharifabad

    2016-01-01

    Full Text Available Abstract Introduction: Knee Osteoarthritis is the most common age-related causes of knee pain which can induce disability, disablement and reduced quality of life. Therefore, the present study aimed to determine attitudes and self-care behaviors of knee osteoarthritis patients referred to three Rheumatology Clinical Centers in Yazd. Methods: This descriptive-analytical study was carried out on 235 patients referred to Health Care Centers of Yazd who were selected randomly. In order to glean the study data, a researcher-designed questionnaire was utilized probing into demographic variables as well as patients' attitudes and self-care behaviors. The reliability and validity of the questionnaire were approved, as well. The study data were analyzed applying SPSS software (ver. 18 via T-Test, ANOVA, Pearson correlation coefficient at 0.05 of the significant level. Results: The participants' mean age and Mean BMI were reported 54.90±9.15 and 28.8±4.61, respectively. Mean score of patients' attitude toward self-care was 47.4±3.95 out of 55 and the mean score of their self-care behaviors was 43.11±5.75 out of 60, which the both scores were at a moderate level. Furthermore, a positive significant correlation was detected between attitude and self-care behaviors (p=0.01. Within different self-care behaviors, participants' attitude towards the positive effect of using crutches while walking was at the lowest level. Meanwhile, according to the patients' attitude, using crutches was demonstrated to have the least performance within the self-care behaviors. Conclusion: Based on the findings of the present study, the attitude level can cause an increase in the patients' self-care behaviors. Moreover, since the participants' attitude towards such behaviors as using crutches, using pool and weight loss were at a low level, interventional programs are recommended to emphasize the mentioned issues. Keywords: Attitude; Knee osteoarthritis; Performance; Self

  15. Escherichia coli pyomyositis in an immunocompromised host.

    Science.gov (United States)

    Sharma, Umesh; Schwan, William R; Agger, William A

    2011-08-01

    Pyomyositis due to Escherichia coli (E. coil) is rarely reported in immunocompromised patients with hematological malignancy. We present a case report of a 34-year-old man who developed E. coli pyomyositis as a complication of acute myelogenous leukemia (AML). Magnetic resonance imaging (MRI) of the right hip suggested myofascial infection of the gluteal muscles, and a needle muscle aspiration grew E. coli phylogenetic group B2. The patient responded to intravenous piperacillin/tazobactam followed by prolonged oral levofloxacin. Pyomyositis should be suspected in all immunocompromised patients complaining of muscle pain and may exhibit signs of localized muscle infection. Appropriate antibiotic therapy targeting fluoroquinolone-resistant E. coli should be considered for initial empiric therapy of pyomyositis in immunocompromised patients.

  16. ERGOTHERAPY IN RHEUMATOLOGY

    OpenAIRE

    Tat’yana Vladimirovna Dubinina; M L Sukhareva; Sh F Erdes

    2014-01-01

    The article reports one of the most affordable rehabilitation methods, i.e. occupational therapy. The issues related to the history of occupational therapy as a treatment method, its application in rheumatology and promising directions of development are covered.

  17. Sjögren SER: National registry of the Spanish Society of Rheumatology of patients with primary Sjögren syndrome: Objectives and methodology.

    Science.gov (United States)

    Fernández Castro, Mónica; Andreu, Jose Luis; Sánchez-Piedra, Carlos; Martínez Taboada, Víctor; Olivé, Alejandro; Rosas, José; Sánchez-Alonso, Fernando

    2016-01-01

    To describe the objectives and methods of the Spanish Society of Rheumatology primary Sjögren syndrome (pSS) registry (SJOGREN-SER) METHODS: This is a multicenter descriptive transversal study of a cohort of pSS patients fulfilling European/American consensus criteria collected from Rheumatology clinics all over Spain. Patients were included by randomisation from an anonymised list provided by every department. Data were collected by reviewing clinical records and an interviewing the patients. Two hundred and ninety eight variables were investigated: epidemiological, clinical, serological characteristics, treatments and complications. Informed consent was obtained and local ethics committees approved the study. Variables were analysed by descriptive statistical methods, using means, medians, and rates, with their deviations and interquartile ranges (p25-p75). A total of 3 rheumatology departments participated in the registry. A total of 437 patients were included. And 95% of them were women, with a median age of 58. Median age at pSS 's diagnosis was 50 years. Dryness symptoms (95%) were the most frequent complaint and anti-Ro/SS-A were present in 94% of the cases. Only 27% of the patients fulfilled the new 2012 SICCA-ACR classification criteria. SJOGREN-SER has been designed in order to characterize a representative pSS Spanish cohort, in clinical daily practice, to analyze the magnitude and distribution of its manifestations, activity, accumulated damage and therapeutic management of the disease. This will allow broadening the knowledge of this disease and plan strategies of action in pSS. Copyright © 2015 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  18. VACCINATION IN RHEUMATOLOGY: CURRENT ASPECTS

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    B. S. Belov

    2014-01-01

    Full Text Available Infectious diseases still remain a serious social and medical problem. The importance of comorbid infections in rheumatology has increased substantially in recent years, particularly due to the clinical introduction of biologicals. The investigation and active use of different vaccines are one of the ways to solve the above problem. This review considers the issues concerning the use of vaccines against influenza, infections caused by pneumococci, herpesviruses, human papillomavirus, and hepatitis B virus in rheumatology patients. It discusses the safety and immunogenicity of vaccination associated with the prevention of airway infections as the most common cause of a poor outcome in rheumatic diseases. The main areas of future investigations in the problem under consideration are defined.

  19. Complications encountered in patients bearers with crest syndrome in rheumatological service of the Hospital San Juan de Dios until September 2009

    International Nuclear Information System (INIS)

    Mendez Rodriguez, Alexis

    2010-01-01

    Systematic sclerosis is a disease that has caused much morbidity and dependence in patients. Despite not being the disease most prevalent in rheumatological practice, it has been perhaps one that has generated more interest in the complex pathophysiology; but, also a great sense of frustration with the great therapeutic limitations especially when is diagnosed in advanced stages. The research was conducted in order to motivate early clinical search of the major complications found in patients CREST syndrome, in rheumatological service of the Hospital San Juan de Dios until September 2009 the total of cases with a diagnosis of CREST were reviewed in outpatient records, the study population have been of 41 patients. The different clinical manifestations of the patient were taken into account, among other aspects: immunological studies, established treatments and diagnosis methods as conventional radiology, endoscopic studies, echocardiogram, capillaroscopy. This job has determined among other things, that the majority of patients with CREST come from Desamparados and the Southern Zone, representing 31.7 and 29.2%, respectively, 98% are women and 76% of patients engaged in domestic chores and no mortality case was found in relation to CREST [es

  20. Diarrhea due to Cryptosporidium parvum in immunocompromised ...

    African Journals Online (AJOL)

    Objective: The objective of this study is to search for Cryptosporidium parvum in Sudanese immunocompromised and immunocompetent patients presenting with diarrhea. Methods: Two hundred and thirteen stool specimens were collected from different groups of patients presenting with diarrhea and healthy control ...

  1. Management of infections in critically ill returning travellers in the intensive care unit—II: clinical syndromes and special considerations in immunocompromised patients

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    Jordi Rello

    2016-07-01

    Full Text Available This position paper is the second ESCMID Consensus Document on this subject and aims to provide intensivists, infectious disease specialists, and emergency physicians with a standardized approach to the management of serious travel-related infections in the intensive care unit (ICU or the emergency department. This document is a cooperative effort between members of two European Society of Clinical Microbiology and Infectious Diseases (ESCMID study groups and was coordinated by Hakan Leblebicioglu and Jordi Rello for ESGITM (ESCMID Study Group for Infections in Travellers and Migrants and ESGCIP (ESCMID Study Group for Infections in Critically Ill Patients, respectively. A relevant expert on the subject of each section prepared the first draft which was then edited and approved by additional members from both ESCMID study groups. This article summarizes considerations regarding clinical syndromes requiring ICU admission in travellers, covering immunocompromised patients.

  2. Microbiological, physicochemical and sensory evaluation of cabbage and carrot minimally processed salad after radiation treatment intended to immunocompromised patients or with special diets

    International Nuclear Information System (INIS)

    Nunes, Thaise Cristine Fernandes

    2015-01-01

    During and after the treatment of cancer, people with HIV or transplants, the food intake can offer a well-being to the patient, because the action of eating right helps people to feel strong. Healthy people have their immune system working properly and can tolerate small amounts of bacteria. However, immunocompromised persons may not be able to and however immunocompromised people cannot fight this small amount of microorganisms and require a diet with very low microbiological count to avoid contact with potentially harmful bacteria. This is called neutropenic diet. These patients are susceptible to food contamination, so that it's not advisable the ingestion of raw products. The vegetable irradiation with low doses has the purpose of reducing the microbial load. The aim of this study was to obtain data on microbiological, sensorial e physicochemical aspects in minimally processed 'Primavera' salad irradiated with different doses of gamma radiation designed to immunocompromised patients. It were used doses of 1.0kGy, 2.0kGy, 3.0kGy and 4.0kGy irradiated in the Multipurpose Irradiator 60 Co located in Radiation Technology Center. Microbiological analyzes were performed (n=25) using Petrifilm, sensory analysis using the sensory acceptance test (n=30) and triangular (n=15) and texture analysis (n=90) in the Food Microbiology Laboratory located at the Radiation Technology Center. The texture analysis was performed with the aid of a texturometer equipped with 5 kg load cell using a triangular cutting Warner-Bratzler Knife blade probe with the descent speed of 2mm/sec. All results were expressed in Newtons (N). The results showed that for microbiological analyzes the standards were followed according to the RDC 12/01 ANVISA. For the sensory test of acceptation no difference was found among the samples, however in the triangular test could be found slight differences between samples irradiated with 4.0kGy and control and there was significant difference

  3. History of rheumatology

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    Shrikant Deshpande

    2014-01-01

    Full Text Available This article describes the history and various milestones of rheumatology from ancient to modern times. The origin of rheumatology can be traced to ancient times. Diseases such as gout and osteoarthritis were prevalent in ancient people. Many ancient skeletons show signs of gout and osteoarthritis. The ancient book on Indian Medicine, Charaka Samhita, gives a vivid description of many variants of arthritis. Charaka, an eminent Ayurvedic physician, described rheumatoid arthritis (RA in Charaka Samhitha as "Vishkantha," meaning painful joints. The word rheumatology has its origin in the word "rheuma," which means flowing, and is mentioned in Hippocratic corpus. Hippocrates made several observations about gout, popularly known as "aphorisms of gout." Many famous paintings in the medieval era depict joint diseases. Hand lesions resembling those of RA are found in paintings of the Flemish school. "The virgin with canon van der paele," a painting by Jan Van Eyck (1436, shows thickened arteries in the temple, suggestive of temporal arthritis. The famous portrait of Federigo de Montefeltre, thought to have been painted by Joos (Justus van Gent, shows arthritis of the proximal interphalangeal joint of the left index finger. Rheumatology developed as a well-recognized specialty of medicine in the 20th century. American Physicians Bernard Comroe and Joseph Lee Hollander coined the term rheumatologist in 1940. Rheumatology has rapidly advanced during the last 50 years due to improved diagnosis as a result of progress in immunology, molecular biology, genetics and imaging.

  4. Antifungal susceptibility testing of Candida species isolated from the immunocompromised patients admitted to ten university hospitals in Iran: comparison of colonizing and infecting isolates

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    Parisa Badiee

    2017-11-01

    Full Text Available Abstract Background Antifungal susceptibility testing is a subject of interest in the field of medical mycology. The aim of the present study were the distributions and antifungal susceptibility patterns of various Candida species isolated from colonized and infected immunocompromised patients admitted to ten university hospitals in Iran. Methods In totally, 846 Candida species were isolated from more than 4000 clinical samples and identified by the API 20 C AUX system. Antifungal susceptibility testing was performed by broth microdilution method according to CLSI. Results The most frequent Candida species isolated from all patients was Candida albicans (510/846. The epidemiological cutoff value and percentage of wild-type species for amphotericin B and fluconazole in Candida albicans, Candida tropicalis, Candida glabrata and Candida krusei were 0.5 μg/ml (95% and 4 μg/ml (96%; 1 μg/ml (95% and 8 μg/ml (95%; 0.5 μg/ml (99% and 19 μg/ml (98%; and 4 μg/ml (95% and 64 μg/ml (95%, respectively. The MIC90 and epidemiological cutoff values to posaconazole in Candida krusei were 0.5 μg/ml. There were significant differences between infecting and colonizing isolates of Candida tropicalis in MIC 90 values of amphotericin B, and isolates of Candida glabrata in values of amphotericin B, caspofungin, and voriconazole (P < 0.05. Conclusions Our findings suggest that the susceptibility patterns of Candida species (colonizing and infecting isolates in immunocompromised patients are not the same and acquired resistance was seen in some species.

  5. Antifungal susceptibility testing of Candida species isolated from the immunocompromised patients admitted to ten university hospitals in Iran: comparison of colonizing and infecting isolates.

    Science.gov (United States)

    Badiee, Parisa; Badali, Hamid; Boekhout, Teun; Diba, Kambiz; Moghadam, Abdolkarim Ghadimi; Hossaini Nasab, Ali; Jafarian, Hadis; Mohammadi, Rasoul; Mirhendi, Hossein; Najafzadeh, Mohammad Javad; Shamsizadeh, Ahmad; Soltani, Jafar

    2017-11-21

    Antifungal susceptibility testing is a subject of interest in the field of medical mycology. The aim of the present study were the distributions and antifungal susceptibility patterns of various Candida species isolated from colonized and infected immunocompromised patients admitted to ten university hospitals in Iran. In totally, 846 Candida species were isolated from more than 4000 clinical samples and identified by the API 20 C AUX system. Antifungal susceptibility testing was performed by broth microdilution method according to CLSI. The most frequent Candida species isolated from all patients was Candida albicans (510/846). The epidemiological cutoff value and percentage of wild-type species for amphotericin B and fluconazole in Candida albicans, Candida tropicalis, Candida glabrata and Candida krusei were 0.5 μg/ml (95%) and 4 μg/ml (96%); 1 μg/ml (95%) and 8 μg/ml (95%); 0.5 μg/ml (99%) and 19 μg/ml (98%); and 4 μg/ml (95%) and 64 μg/ml (95%), respectively. The MIC90 and epidemiological cutoff values to posaconazole in Candida krusei were 0.5 μg/ml. There were significant differences between infecting and colonizing isolates of Candida tropicalis in MIC 90 values of amphotericin B, and isolates of Candida glabrata in values of amphotericin B, caspofungin, and voriconazole (P Candida species (colonizing and infecting isolates) in immunocompromised patients are not the same and acquired resistance was seen in some species.

  6. [Prophylactic antibiotics for immunocompromised children].

    Science.gov (United States)

    Poirée, M; Picard, C; Aguilar, C; Haas, H

    2013-11-01

    Infections are the most common cause of morbidity and mortality in pediatric immunocompromised children. The emergence of pan-drug resistant bacteria is particularly concerning for these patients. The risk of infection can be reduced by educational rules, immunizing these patients and sometimes antibiotic prophylaxis. But the individual level of risk is very difficult to assess. Using antibiotics may lead to adverse effects such as allergic reactions, cross-reactions with other drugs, development of super-infections, pseudomembranous colitis and overall development of antibioticresistant bacterial strains. Recommendations for preventing infections in these patients exist for specific case such as inherited disorder or stem cell transplantation. In others cases it depends on physicians' habits: the increase of bacterial resistance could lead to reduce the prescriptions non evidence based and not included in official guidelines. Pneumococcal and meningococcal vaccinations might change guidelines and habits. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  7. Ocular bacillary angiomatosis in an immunocompromised man.

    Science.gov (United States)

    Murray, Meltzer A; Zamecki, Katherine J; Paskowski, Joseph; Lelli, Gary J

    2010-01-01

    An immunocompromised man presented with an inflammatory eyelid lesion. Biopsy was performed; histopathology and special staining confirmed a diagnosis of bacillary angiomatosis. The man was treated with oral erythromycin, and the lesion resolved. The etiologic agents of bacillary angiomatosis are Bartonella henselae and Bartonella quintana, Gram-negative coccobacilli. The organisms stain positively with the Warthin-Starry silver stain. Lesions can be cutaneous or visceral and have been commonly described in immunocompromised patients. Histopathologic examination of lesions reveals angiogenesis and cellular proliferation. Bacillary angiomatosis can be treated with oral antibiotics.

  8. Evaluation of rheumatoid factor and anti-citrullinated peptide antibodies in relation to rheumatological manifestations in patients with leprosy from Southern Brazil.

    Science.gov (United States)

    Dionello, Carla Fontoura; Rosa Utiyama, Shirley Ramos; Radominski, Sebastião Cézar; Stahlke, Ewalda; Stinghen, Servio Tulio; de Messias-Reason, Iara Jose

    2016-10-01

    Leprosy patients may present several osteoarticular complaints, which require further evaluation of inflammatory diseases, such as rheumatoid arthritis (RA). Therefore, an adequate clinical assessment in addition to testing for rheumatoid factors (RF) and anticyclic citrullinated peptide antibodies (anti-CCP), can be useful in order to establish the correct diagnosis. In this study, the relation of RF and anti-CCP with rheumatological manifestations was evaluated in 97 leprosy patients from Southern Brazil. The results were compared to RA patients and healthy controls from the same geographical area and ethnic background. Neuropathy was observed in 71.1% and arthritis in 35.1% of the leprosy patients. A high frequency of RF positivity was observed among the leprosy patients (41.2%, 40/97), with RF immunoglobulin A (IgA) significantly associated with arthritis (OR = 7.9, 95% CI = 1.5-40.6 P = 0.008). Anti-CCP was observed in 9.3% (9/97) of the patients, with anti-CCP2 being the most frequent subtype. Only 4.1% (4/97) of the patients were RF and anti-CCP concomitantly positive. RF IgM showed a significant association with leprosy when compared to healthy controls (P leprosy in patients from the same geographical area and ethnic background (anti-CCP2 OR = 38.6; 95% CI = 16.49-90.26; P leprosy with other inflammatory diseases, such as RA, clinical and laboratorial evaluation of affected patients must be carefully assessed in order to achieve proper diagnosis and treatment. © 2015 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.

  9. Etoricoxib (arcoxia in rheumatology

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    Fatima Magomedovna Kudaeva

    2011-06-01

    Full Text Available The paper gives information on the selective COX-2 inhibitor etoricoxib registered for use in many countries of the world. It gives a brief description of a few key trials of the efficacy and tolerability of etoricoxib in rheumatology

  10. Etoricoxib (arcoxia in rheumatology

    Directory of Open Access Journals (Sweden)

    Fatima Magomedovna Kudaeva

    2011-01-01

    Full Text Available The paper gives information on the selective COX-2 inhibitor etoricoxib registered for use in many countries of the world. It gives a brief description of a few key trials of the efficacy and tolerability of etoricoxib in rheumatology

  11. African Journal of Rheumatology

    African Journals Online (AJOL)

    The journal aims to publish papers on basic and clinical research in rheumatology and be a vessel of sharing knowledge across the globe. Original research work, reviews, case reports and other relevant scientific work will be published in the journal. The readers of the journal are mainly practicing rheumatologists, ...

  12. Educational issues in Rheumatology

    NARCIS (Netherlands)

    Rasker, Johannes J.; Dequeker, Jan; Woolf, Anthony D.

    2000-01-01

    Musculoskeletal conditions are the most common cause of severe long-term pain and physical disability, affecting hundreds of millions of people around the world. Nearly a quarter of all consultations in primary care are concerned with rheumatic disease, yet undergraduate education in rheumatology is

  13. ERGOTHERAPY IN RHEUMATOLOGY

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    Tat’yana Vladimirovna Dubinina

    2014-01-01

    Full Text Available The article reports one of the most affordable rehabilitation methods, i.e. occupational therapy. The issues related to the history of occupational therapy as a treatment method, its application in rheumatology and promising directions of development are covered.

  14. Textbook of rheumatology

    International Nuclear Information System (INIS)

    Turner, R.A.; Wise, C.M.

    1986-01-01

    This book contains 23 papers. Some of the titles are: Diagnostic Radiology in the Rheumatic Diseases; Laboratory Testing in Rheumatology; Arthritis Nursing and the Team Approach in the Management of Rheumatic Disease; The Surgical Management of Arthritis; Vasculities; Neoplasms of Bone and Joints; and Rheumatic Disease of Childhood

  15. Study of the functional state of peripheral vessels in fingers of rheumatological patients by means of laser Doppler flowmetry and cutaneous thermometry measurements

    Science.gov (United States)

    Zherebtsova, Angelina I.; Zherebtsov, Evgeny A.; Dunaev, Andrey V.; Podmasteryev, Konstantin V.; Pilipenko, Olga V.; Krupatkin, Alexander I.; Khakhicheva, Lyudmila S.; Muradyan, Vadim F.

    2016-04-01

    Vasospastic disorders are a common class of rheumatic disease. These include syndromes such as vegetative dystonia, Raynaud's syndrome, vibration disease and rheumatoid arthritis among others. The aim of this work is to develop an original method of diagnosing the functional state of peripheral vessels of the fingers, based on the simultaneous recording of LDF- and thermograms during the occlusion test, for determining vascular disorders of rheumatological patients. A diagnostic method was developed for assessing the functional state of the peripheral vessels of fingers, based on carrying out occlusion test in a thermally stabilized environment, with simultaneous recording of signals of laser Doppler flowmetry and skin thermometry. To verify the diagnostic value of the proposed method, a series of experiments were carried out on 41 rheumatological patients: 5 male and 36 females (average age 56.0+/-12.2 years). The most common diagnoses in the patient group were rheumatoid arthritis, arthrosis, gout and systemic lupus erythematosus. The laser analyser of blood microcirculation "LAKK-02" (SPE "LAZMA" Ltd, Russia) and a custom developed multi-channel thermometry device for low inertia thermometry were used for experimental measurements. The measurements of cutaneous temperature and the index of microcirculation were performed on the distal phalanx of the third finger of the right hand. Occlusion tests were performed with water baths at 25 and 42 °C and a tonometer cuff with a pressure of 200-220 mmHg for 3 min on the upper arm. The results of experimental studies are presented and interpreted. These data indicate a violation of the blood supply regulation in the form of a pronounced tendency towards microvascular vasoconstriction in the fingers. Thus, the response displaying a tendency toward angiospasm among patients in the rheumatological diseases profile group was observed mainly in the most severe cases (49 % of this group). The prospects of the developed

  16. An insight into rheumatology in Thailand.

    Science.gov (United States)

    Louthrenoo, Worawit

    2015-01-01

    Despite the fact that rheumatic diseases constitute a common health care problem in Thailand, improvements in rheumatology education, research and health care are still required. Low numbers of rheumatologists, their uneven distribution, lack of time to perform both clinical and basic research, lack of patient compliance and restricted access to effective medication comprise some of the barriers that need to be overcome to establish rheumatology education, research and care with a Western-country benchmark. The annual academic activities provided by the Thai Rheumatism Association for rheumatologists, general practitioners, allied health professionals and patients can advance only some forms of education and health care. Better cooperation between the Thai Rheumatism Association, the Royal College of Physicians of Thailand, the Ministry of Public Health and the Thai government is needed to improve rheumatology training, care and research in the country.

  17. Comparison of Anti-Saccharomyces Cerevisiae Antibodies (ASCA in Behcet’s Disease Patients with Three Groups of Oral Aphthosis, other Rheumatologic Diseases and Healthy Volunteers

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    Saeed Kerdari

    2015-07-01

    Full Text Available Introduction: Behcet’s Disease (BD is a general and progressive vasculitis and involves various organs. Its main etiology is not yet understood; however, immunologic and infectious causes and genetic predisposition have been proposed. Saccharomyces Cerevisiae is a type of yeast which is used in the bread and wine industries. Antibodies against this yeast have a well-proven role in inflammatory bowel diseases. The aim of the present study was to assess the frequency of Anti-Saccharomyces Cerevisiae Antibody (ASCA and its relation to clinical symptoms and disease activity index in patients afflicted by BD. Materials and Methods: Serum ASCA levels, determined by ELISA, were Studied in Behcet’s disease along with oral aphthosis, other rheumatologic diseases and healthy volunteers (n=30 in each group. In the BD group the disease activity index and different clinical symptoms were recorded during the study course. Results:Serum level of ASCA in the four studied groups of BD, oral aphthosis, other rheumatologic disease and healthy volunteers was 9.18±9.69, 10.90±10.40, 11.29±17.96 and 8.86±5.31IU/ml, respectively;  indicating no meaningful difference (p=0.811. The ASCA titer was not related to Behcet’s disease severity (p=0.399. Serum level of ASCA in BD patients with oral aphthosis or with gastrointestinal symptoms was significantly higher than the other Behcet’s Disease patients (p=0.012, p=0.014. Conclusion: ASCS is not a valuable test for distinguishing BD from recurrent oral aphthosis or other connective tissue disorders. It also cannot be used for determining disease severity. However, it has a higher level in BD patients with oral aphthous ulcers and gastrointestinal symptoms.

  18. Association between periodontal disease temporomandibular disorders and rheumatoid arthritis among patients visiting rheumatology centers in Bengaluru City: A cross-sectional study

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    Vijay Kumar

    2017-01-01

    Full Text Available Introduction: Association between rheumatoid arthritis (RA, periodontitis and temporomandibular disorder (TMD can be an outcome of the existing inflammatory conditions or involvement of joints at a different level of severity. Aim: This study aims to find an association between periodontal disease and TMDs and RA among patients visiting various Rheumatology centers in Bengaluru city. Materials and Methods: A total of 100 RA patients and age- and gender-matched comparison group were recruited from various Rheumatology centers in Bengaluru city. Periodontal status and loss of attachment (LOA were measured from the World Health Organization (2013 criteria and TMDs and severity were assessed using Helkimo index (1987. Data were analyzed and comparisons were done using Chi-square test and independent t-test (P < 0.05. Correlation and association are measured through spearman's correlation and logistic regression analysis. Results: There was a significant difference regarding shallow and deep periodontal pocket depth among RA (4.62 ± 2.33, 1.48 ± 1.7 and comparison (3.48 ± 2.53, 0.83 ± 1.05 groups (P = 0.01. Impaired mobility (P = 0.012, altered function (P = 0.032, painful function (P = 0.023, muscle pain (P = 0.028, and temporomandibular joint pain (P = 0.048 differed significantly between RA group and comparison group. RA patients were more likely to suffer from TMD (OR = 4.88 and LOA (OR = 2.16 than the comparison group. Conclusion: Periodontitis and TMD are found to be associated with RA. A dental check-up for patients suffering from RA should be part of the routine RA assessment.

  19. Prevalence of the American College of Rheumatology hematological classification criteria and associations with serological and clinical variables in 460 systemic lupus erythematosus patients

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    Thelma Skare

    2015-04-01

    Full Text Available Objective: To study systemic lupus erythematosus in a Brazilian population using the American College of Rheumatology hematological classification criteria and report associations of the disease with serological and clinical profiles. Methods: This is a retrospective study of 460 systemic lupus erythematosus patients followed in a single rheumatologic center during the last 10 years. Hematological manifestations considered for this study were hemolysis, leukopenia, lymphocytopenia and thrombocytopenia. Results: The cumulative prevalences of leukopenia, thrombocytopenia, lymphocytopenia and hemolytic anemia were 29.8%, 21.08%, 17.7% and 8.4%, respectively. A higher percentage of patients with hemolysis had anticardiolipin IgM (p-value = 0.002. Those with leukopenia had more lymphopenia (p-value = 0.02, psychosis (p-value = 0.01, thrombocy- topenia (p-value <0.0001 and anti-double stranded DNA antibodies (p-value = 0.03. Patients with lymphopenia had more leukopenia (OR = 1.8; 95% CI = 1.01-3.29 and lupus anticoagulant antibodies (OR = 2.2; 95% CI = 1.16-4.39 and those with thrombocytopenia had more leukopenia (OR = 3.1; 95% CI = 1.82-5.44 and antiphospholipid syndrome (OR = 3.1; 95% CI = 1.28-7.87. Conclusion: The most common hematological finding was leukopenia and the least common was hemolysis. Associations of low platelet count and hemolysis were found with antiphospholipid syndrome and anticardiolipin IgM positivity, respectively. Leukopenia and lymphocytopenia are correlated and leukopenia is more common in systemic lupus erythe- matosus patients with psychosis, thrombocytopenia and anti-double stranded DNA.

  20. FlindersTechnology Associates (FTA) filter paper-based DNA extraction with polymerase chain reaction (PCR) for detection of Pneumocystis jirovecii from respiratory specimens of immunocompromised patients.

    Science.gov (United States)

    Nuchprayoon, Surang; Saksirisampant, Wilai; Jaijakul, Siraya; Nuchprayoon, Issarang

    2007-01-01

    We evaluated the diagnostic value of Flinders Technology Associates (FTA) filter paper together with polymerase chain reaction (PCR) for detection of Pneumocystis jirovecii (carinii) from induced sputum (IS) and bronchoalveolar lavage fluid (BALF) samples. The study involved 162 patients with clinical diagnosis of pneumocystis pneumonia (PcP) of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) patients and other immunocompromised patients. P. jirovecii cysts or trophozoites were detected in IS and BALF by cytological method. The mitochondrial 5S ribosomal ribonucleic acid (rRNA) gene of P. jirovecii was amplified from these samples by using FTA filters together with a one-step PCR method (FTA-PCR). With the FTA-PCR method, the sensitivity and specificity of the test compared to microscopic examination were 67% and 90% for IS, while they were 67% and 91% for BALF, respectively. The sensitivity and specificity of the FTA-PCR test was also comparable to PCR with the conventional deoxyribonucleic acid (DNA) extraction method. We concluded that FTA-PCR is useful to detect P. jirovecii in noninvasive IS.

  1. BIOSIMILARS IN RHEUMATOLOGY

    Directory of Open Access Journals (Sweden)

    E. L. Nasonov

    2016-01-01

    Full Text Available One of the most striking achievements in the pharmacotherapy of rheumatoid arthritis (RA and other human immunoinflammatory diseases (IIDs late in the 20th century is associated with the design of a fundamentally new group of medications that received the name biological agents (BAs. However, the introduction of innovative BAs into clinical practice not only could enhance the efficiency of therapy and improve prognosis in patients with the most severe forms of IIDs, but has also led to a dramatic increase in the cost of treatment. Progress in the design of biosimilars is related to many factors, including expiry of the term of patents for many brand-name BAs, such as infliximab, adalimumab, etanercept, and rituximab. Over the last 5 years, a large number of biosimilars have been designed and their design is being continued. The European Medicines Agency, the World Health Organization, and the U.S. Food and Drug Administration have developed a regulatory framework and general requirements for the manufacture and characteristics of biosimilars. Federal Law No. 429-FZ «On Amendments to the Federal Law "On Circulation of Medicines"» dated December 22, 2014 defines a biosimilar drug as a biological medicine product that is similar to the parameters of quality, efficiency, and safety with the reference biologic drug in the same formulation, and the same route of administration. The review presents an update on the requirements for biosimilars used to treat IIDs, their interchangeability and promises in further clinical application. Particular emphasis is laid on the chimeric monoclonal antibodies to tumor necrosis factor-α infliximab biosimilar Flammegis (Egis Pharmaceuticals, Hungary, that has been registered in Russia for the treatment of RA, ankylosing spondylitis and other IIDs, as well as the chimeric monoclonal antibodies to B-lymphocytes rituximab biosimilar Acellbia in a phase III clinical trial that is in the closing

  2. Limitations of the QuantiFERON-TB Gold test in detecting Mycobacterium tuberculosis infection in immunocompromised patients

    DEFF Research Database (Denmark)

    Hornum, M.; Mortensen, K.L.; Kamper, Anne-Lise

    2008-01-01

    Four cases are presented, immunosuppressed by at least three different mechanisms: one HIV-positive patient with a CD4 count of 0.29 x 10(6)/ml, one malnourished patient, and two kidney-transplanted patients. All patients had a negative interferon (IFN)-gamma test for suspected tuberculosis (TB),...

  3. Limitations of the QuantiFERON-TB Gold test in detecting Mycobacterium tuberculosis infection in immunocompromised patients

    DEFF Research Database (Denmark)

    Hornum, Mads; Mortensen, Klaus Leth; Kamper, Anne-Lise

    2008-01-01

    Four cases are presented, immunosuppressed by at least three different mechanisms: one HIV-positive patient with a CD4 count of 0.29 x 10(6)/ml, one malnourished patient, and two kidney-transplanted patients. All patients had a negative interferon (IFN)-gamma test for suspected tuberculosis (TB...

  4. Usefulness of molecular biology performed with formaldehyde-fixed paraffin embedded tissue for the diagnosis of combined pulmonary invasive mucormycosis and aspergillosis in an immunocompromised patient

    Directory of Open Access Journals (Sweden)

    Vénissac Nicolas

    2010-01-01

    Full Text Available Abstract Immunocompromised patients who develop invasive filamentous mycotic infections can be efficiently treated if rapid identification of the causative fungus is obtained. We report a case of fatal necrotic pneumonia caused by combined pulmonary invasive mucormycosis and aspergillosis in a 66 year-old renal transplant recipient. Aspergillus was first identified during the course of the disease by cytological examination and culture (A. fumigatus of bronchoalveolar fluid. Hyphae of Mucorales (Rhizopus microsporus were subsequently identified by culture of a tissue specimen taken from the left inferior pulmonary lobe, which was surgically resected two days before the patient died. Histological analysis of the lung parenchyma showed the association of two different filamentous mycoses for which the morphological features were evocative of aspergillosis and mucormycosis. However, the definitive identification of the associative infection was made by polymerase chain reaction (PCR performed on deparaffinized tissue sections using specific primers for aspergillosis and mucormycosis. This case demonstrates that discrepancies between histological, cytological and mycological analyses can occur in cases of combined mycotic infection. In this regard, it shows that PCR on selected paraffin blocks is a very powerful method for making or confirming the association of different filamentous mycoses and that this method should be made available to pathology laboratories.

  5. Rheumatology training in Poland vs. United Kingdom

    Directory of Open Access Journals (Sweden)

    Karina Lazarewicz

    2017-07-01

    Full Text Available When evaluating the quality of Rheumatology specialty training, it can be useful to explore similarities and differences between countries. In this article we compare the training in the UK and Poland. The two training programmes are similar in length and in the competencies that must be achieved, although they do have significant differences in the way the training is structured. The UK-based system is more out-patient based, which can be advantageous, as after completion of training the doctor is more confident in treating common rheumatological problems. On the other hand, having exposure to paediatric rheumatology and orthopaedics like one has in Polish-based training, despite a short placement time, is definitely beneficial for the trainee in gaining all-round knowledge. In conclusion, each system has its merits and can be further enhanced by observing how junior doctors are sub-speciality trained in different countries.

  6. Most patients who reach disease remission following anti-TNF therapy continue to report fatigue: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis.

    Science.gov (United States)

    Druce, Katie L; Bhattacharya, Yagnaseni; Jones, Gareth T; Macfarlane, Gary J; Basu, Neil

    2016-10-01

    RA-related fatigue is common and debilitating, but does not always respond to immunotherapy. In the context of anti-TNF therapy, we aimed to examine whether patients achieving disease remission experienced remission of fatigue. Data from the British Society for Rheumatology Biologics Register for RA were used. In participants with severe baseline fatigue [36-item Short Form Health Survey (SF-36) vitality score ⩽12.5], we identified those in disease remission [28-joint DAS (DAS28) 12.5) and complete remission (SF-36 vitality score >50) at follow-up. Demographic (e.g. sex, age), clinical (e.g. inflammation, joint erosion and co-morbidities) and psychosocial (e.g. SF-36 domains and HAQ) characteristics were compared between responder and non-responder groups. Severe baseline fatigue was reported by 2652 participants, of whom 271 (10%) achieved a DAS28 <2.6 by 6 months. In total, 225 participants (83%) reported partial remission and were distinguished from those who did not by better health status on all psychosocial domains. Far fewer [n = 101 (37.3%)] reported full fatigue remission. In addition to reporting clinically poorer health status, they were distinguished on the basis of a history of hypertension, depression and stroke as well as baseline treatment use of steroids and antidepressants. Despite achieving clinical remission, many RA patients do not achieve complete remission of their fatigue. Therefore, despite being important in overall disease control, reductions in disease activity are not always sufficient to ameliorate fatigue, so other symptom-specific management approaches must be considered for those for whom fatigue does not resolve. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  7. Aspergillus tracheobronchitis in a mild immunocompromised host.

    Science.gov (United States)

    Cho, Byung Ha; Oh, Youngmin; Kang, Eun Seok; Hong, Yong Joo; Jeong, Hye Won; Lee, Ok-Jun; Chang, You-Jin; Choe, Kang Hyeon; Lee, Ki Man; An, Jin-Young

    2014-11-01

    Aspergillus tracheobronchitis is a form of invasive pulmonary aspergillosis in which the Aspergillus infection is limited predominantly to the tracheobronchial tree. It occurs primarily in severely immunocompromised patients such as lung transplant recipients. Here, we report a case of Aspergillus tracheobronchitis in a 42-year-old man with diabetes mellitus, who presented with intractable cough, lack of expectoration of sputum, and chest discomfort. The patient did not respond to conventional treatment with antibiotics and antitussive agents, and he underwent bronchoscopy that showed multiple, discrete, gelatinous whitish plaques mainly involving the trachea and the left bronchus. On the basis of the bronchoscopic and microbiologic findings, we made the diagnosis of Aspergillus tracheobronchitis and initiated antifungal therapy. He showed gradual improvement in his symptoms and continued taking oral itraconazole for 6 months. Physicians should consider Aspergillus tracheobronchitis as a probable diagnosis in immunocompromised patients presenting with atypical respiratory symptoms and should try to establish a prompt diagnosis.

  8. Risk of Serious Infection in Juvenile Idiopathic Arthritis Patients Associated With Tumor Necrosis Factor Inhibitors and Disease Activity in the German Biologics in Pediatric Rheumatology Registry.

    Science.gov (United States)

    Becker, Ingrid; Horneff, Gerd

    2017-04-01

    To examine the effects of tumor necrosis factor inhibitors on the risk for serious infections and other influencing factors in a registry. Patients exposed for the first time to etanercept, adalimumab, or methotrexate and serious infections were identified in the German Biologic Registry for Pediatric Rheumatology (BIKER) registry. Serious infection rates per 1,000 observation-years and relative risks were calculated. Cox regression identified risk factors and provided hazard ratios (HRs) for occurrence of infections. A total of 3,350 patients with 5,919 observation-years fulfilled the inclusion criteria for the study. The first biologic agents were etanercept (1,720 cases) and adalimumab (177 cases). A total of 1,453 patients were treated with methotrexate and no biologic agent. In total, 28 serious infections were reported in 26 patients (4.7 per 1,000 patient-years), 5 with methotrexate (1.6 per 1,000 patient-years), 21 with etanercept (8.1 per 1,000 patient-years), and 2 with adalimumab (9.7 per 1,000 patient-years). Significant univariate risk factors for infection were therapy with biologic agents, disease duration before therapy start, corticosteroid medication, nonbiologic premedications, higher clinical Juvenile Arthritis Disease Activity Score including maximal 10 joints (cJADAS10) at therapy start, and higher mean cJADAS10 during therapy. In multivariate Cox regression, only biologic therapy and cJADAS10 at therapy start remained significant. Risk for infection was increased by etanercept (univariate HR 6.0 [95% confidence interval (95% CI) 2.0-17.5]) or adalimumab (HR 7.3 [95% CI 1.3-40.0]) compared to methotrexate as well as by an elevated cJADAS10 at therapy start (HR 1.1 [95% CI 1.0-1.2] per unit increase). The total rate of serious infections reported in the BIKER registry seems low. Treatment with etanercept or adalimumab increases the risk for serious infection slightly, compared to methotrexate. Disease activity expressed by cJADAS10 appears to

  9. Disseminated Acanthamoeba Infection Presenting With Cutaneous Lesions in an Immunocompromised Patient: A Case Report, Review of Histomorphologic Findings, and Potential Diagnostic Pitfalls.

    Science.gov (United States)

    Morrison, Annie O; Morris, Robert; Shannon, Amie; Lauer, Scott R; Guarner, Jeannette; Kraft, Colleen S

    2016-02-01

    Free-living amoebas are exceedingly rare causes of cutaneous infections and present unique diagnostic and therapeutic challenges. We describe a case of disseminated acanthamoebiasis with cutaneous manifestations and summarize additional diagnostic, prognostic, and therapeutic highlights. A 58-year-old man with relapsed chronic lymphocytic leukemia had several weeks of progressive, painful ulcerations on the forehead, arms, abdomen, and thighs. A biopsy was performed for histopathologic evaluation. The biopsy specimen showed inflammatory infiltrate with abscess formation involving the epidermis, dermis, and subcutis. Scattered cells showed nuclei with a prominent central karyosome, dispersed chromatin, and either abundant foamy basophilic cytoplasm or two well-demarcated cytoplasmic walls. Acanthamoeba species was confirmed by polymerase chain reaction from the formalin-fixed, paraffin-embedded tissue. Cutaneous lesions from acanthamoebiasis are exceptionally rare but should be included in the differential diagnosis of necrotic cutaneous lesions in immunocompromised patients. Although infrequently encountered, pathologists need to be aware of the morphologic features of free-living amoebas. Immunohistochemical and molecular studies can confirm the diagnosis. Multiagent treatment regimens, when initiated empirically, have been more successful than single-agent regimens, but infections involving the central nervous system are almost universally fatal. © American Society for Clinical Pathology, 2016. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  10. Identification of patients at risk of non-adherence to oral antirheumatic drugs in rheumatoid arthritis using the Compliance Questionnaire in Rheumatology: an ARCO sub-study.

    Science.gov (United States)

    Marras, Carlos; Monteagudo, Indalecio; Salvador, Georgina; de Toro, Francisco J; Escudero, Alejandro; Alegre-Sancho, Juan J; Raya, Enrique; Ortiz, Ana; Carmona, Loreto; Mestre, Yvonne; Cea-Calvo, Luis; Calvo-Alén, Jaime

    2017-07-01

    The ARCO study (Study on Adherence of Rheumatoid Arthritis patients to SubCutaneous and Oral Drugs), a multicenter, non-interventional retrospective study, was primarily designed to assess the percentage of patients [aged ≥18 years with an established rheumatoid arthritis (RA) diagnosis] with non-adherence to prescribed subcutaneous biologicals. This paper reports data for the secondary objective from a subset of patients, namely to evaluate non-adherence to prescribed oral antirheumatic drugs in RA patients in Spain using the validated Compliance Questionnaire Rheumatology (CQR). Patients also completed the Morisky-Green Medication Adherence Questionnaire, Beliefs about Medicines Questionnaire, and a questionnaire (developed and validated in Spain) on patient satisfaction with RA treatment and preferences. A total of 271 patients (76.7% females; mean age 55.6 years) were being treated with oral drugs for RA, of which 234 completed the CQR questionnaire. Non-adherence was reported in 49/234 (20.9%) patients. The proportion of non-adherence in younger patients (aged ≤48 years; 37.5%) was double that recorded in patients aged >48 years (p = 0.006). Patients with a perception of lower efficacy also had a higher risk of non-adherence (p = 0.012). Multivariable analysis showed that younger age and male gender were independently associated with risk of non-adherence. There was only slight agreement between the CQR and Morisky-Green assessment tools (kappa coefficient = 0.186), possibly reflecting the fact that both questionnaires measure slightly different aspects of medication adherence. In conclusion, one out of five RA patients was identified as at risk for non-adherence with the CQR, and this was more frequent in younger patients and in males.

  11. The clinical benefits of antiretroviral therapy in severely immunocompromised HIV-1-infected patients with and without complete viral suppression

    DEFF Research Database (Denmark)

    Mocroft, Amanda; Bannister, Wendy P; Kirk, Ole

    2012-01-01

    The aim of this study was to determine whether there is a protective effect of combination antiretroviral therapy (cART) on the development of clinical events in patients with ongoing severe immunosuppression.......The aim of this study was to determine whether there is a protective effect of combination antiretroviral therapy (cART) on the development of clinical events in patients with ongoing severe immunosuppression....

  12. Quantitative polymerase chain reaction detection of circulating DNA in serum for early diagnosis of mucormycosis in immunocompromised patients.

    Science.gov (United States)

    Millon, Laurence; Larosa, Fabrice; Lepiller, Quentin; Legrand, Faezeh; Rocchi, Steffi; Daguindau, Etienne; Scherer, Emeline; Bellanger, Anne-Pauline; Leroy, Joel; Grenouillet, Frederic

    2013-05-01

    The aim of our study was to assess the detection of circulating DNA from the most common species of Mucorales for early diagnosis of mucormycosis in at-risk patients. We retrospectively evaluated a combination of 3 quantitative polymerase chain reaction (qPCR) assays using hydrolysis probes targeting Mucor/Rhizopus, Lichtheimia (formerly Absidia), and Rhizomucor for circulating Mucorales detection. Serial serum samples from 10 patients diagnosed with proven mucormycosis (2-9 samples per patient) were analyzed. No cross-reactivity was detected in the 3 qPCR assays using 19 reference strains of opportunistic fungi, and the limit of detection ranged from 3.7 to 15 femtograms/10 µL, depending on the species. DNA from Mucorales was detected in the serum of 9 of 10 patients between 68 and 3 days before mucormycosis diagnosis was confirmed by histopathological examination and/or positive culture. All the qPCR results were concordant with culture and/or PCR-based identification of the causing agents in tissue (Lichtheimia species, Rhizomucor species, and Mucor/Rhizopus species in 4, 3, and 2 patients, respectively). Quantitative PCR was negative in only 1 patient with proven disseminated mucormycosis caused by Lichtheimia species. Our study suggests that using specific qPCR targeting several species of Mucorales according to local ecology to screen at-risk patients could be useful in a clinical setting. The cost and efficacy of this strategy should be evaluated. However, given the human and economic cost of mucormycosis and the need for rapid diagnosis to initiate prompt directed antifungal therapy, this strategy could be highly attractive.

  13. Three novel, multiple recombinant types of species of human mastadenovirus D (HAdV-D 73, 74 & 75) isolated from diarrhoeal faeces of immunocompromised patients.

    Science.gov (United States)

    Hage, Elias; Dhingra, Akshay; Liebert, Uwe G; Bergs, Sandra; Ganzenmueller, Tina; Heim, Albert

    2017-11-02

    Species D is the largest of the seven species of human mastadenoviruses (HAdV), but few of its multiple types are associated with asevere disease, e.g. epidemic keratoconjunctivitis. Many other types are hardly ever associated with significant diseases in immunocompetent patients, but have been isolated from the diarrhoeal faeces of terminal AIDS patients suggesting their role as opportunistic pathogens. Three novel HAdV-D strains were isolated from the faeces of three immunocompromised adult patients (clinical diagnoses: lymphoma, myelodysplastic syndrome and AIDS CDC3B, respectively). These strains were not typeable by imputed serology of the hexon and fibre gene and therefore complete genomic sequences were generated by next-generation sequencing (NGS). All three strains were multiple recombinants and fulfilled the criteria for designation as types 73, 74 and 75 with the penton/hexon/fibre genotype codes P67H45F27, P70H74F51 and P75H26F29, respectively. A novel genomic backbone and also a novel hexon neutralization epitope sequence were discovered in type 74, and a novel penton sequence in type 75. At the complete genome level, types 73, 74 and 75 were closely related neither to each other nor to type 70, which was previously isolated in the same region. However, these four HAdV-D types were closely related to each other in single genes and gene regions, e.g. penton, E1 and E4 due to recombination events in their phylogeny. In conclusion, regional co-circulation of opportunistic HAdV-D types facilitated co- and super-infections, which are essential for homologous recombination, and thus resulted in the evolution of novel genotypes by lateral gene transfer.

  14. HRCT-features of Pneumocystis jiroveci pneumonia and their evolution before and after treatment in non-HIV immunocompromised patients

    International Nuclear Information System (INIS)

    Vogel, M.N.; Vatlach, M.; Weissgerber, P.; Goeppert, B.; Claussen, C.D.; Hetzel, J.; Horger, M.

    2012-01-01

    Objective: This study retrospectively analyzes the characteristics and kinetics of pulmonary changes in Pneumocystis jiroveci pneumonia (PJP) before and after treatment as depicted by thin-section-CT in HIV-negative patients. Materials and methods: Serial CT scans of 84 consecutive HIV-negative PJP patients were reviewed retrospectively encompassing a median follow-up of 76 (range, 37–506) days. Along with underlying disease and time span between the onset of symptoms and specific antimicrobial therapy, early and late pulmonary CT-findings were evaluated. Results: Imaging findings at initial diagnosis differed from those in the posttherapeutic setting. In the acute (initial) PJP-phase, most frequent finding was symmetric, apically distributed ground glass opacities (GGO) with peripheral sparing 43% (n = 36). These initial changes resolved up to 1st follow-up-examination in 57% (n = 48), and finally in all except for two patients after a median period of 13 (mean 26, range 1–58) days following application of specific therapy. In 42% (n = 35) architectural distortions occurred, but they resolved after a median period of 27 (mean 60, range 11–302) days. Only in 9 patients, complete resolution could not be documented. Significant correlations of the underlying disease or the time span between the onset of symptoms and specific antibiotic therapy and morphologic kinetic could not be found. Conclusion: Thin-section CT-findings of PJP usually resolve soon after onset of specific therapy. Postinfectious fibrosis rarely occurs following PJP in HIV-negative patients.

  15. Role of advanced magnetic resonance imaging techniques in diagnosis of cerebral toxoplasmosis in immunocompromised patients: A case report

    Directory of Open Access Journals (Sweden)

    Inderpreet Singh

    2014-01-01

    Full Text Available Cerebral toxoplasmosis commonly affects patients with advanced HIV infection. Toxoplasmosis can be severe and debilitating in patients with Central Nervous System (CNS involvement and the condition may be fatal in patients if not suspected and treated early and adequately. Hence, imaging plays an important role in diagnosis and following during treatment in cases of suspected toxoplasmosis. We report a case of a 51-years-old man who was a known sero-positive since 2 years and presented with altered sensorium. Magnetic Resonance Imaging (MRI scan of the brain showed multiple heterogeneously enhancing lesions in bilateral cerebral as well as cerebellar hemispheres and some of them showed "eccentric target sign." MR spectroscopy showed features of reduced NAA, mildly increased choline, and lipid lactate peak. MR perfusion study showed reduced perfusion favoring diagnosis of cerebellar toxoplasmosis. Patient was started on a combination of pyrimethamine plus sulfadiazine for toxoplasmosis. Follow up MRI after 20 days and 45 days from start of treatment showed significant resolution of the lesions supporting our radiological diagnosis.

  16. Diagnosis of Cellulitis in the Immunocompromised Host

    Directory of Open Access Journals (Sweden)

    Charles F Carey

    1990-01-01

    Full Text Available A prospective study of diagnostic techniques in cellulitis was performed on 28 patients with malignancy. Twenty-two (78% of the fine needle aspiration cultures and 10 (35% of the blood cultures were positive in this immunocompromised population. The incidence of positive fine needle aspiration cultures (P<0.005 or bacteremia (P<0.0005 was significantly higher than results obtained in an immunocompetent population with cellulitis at the same institution. Staphylococci or streptococci were recovered in 59% of positive cultures, while aerobic Gram-negative bacilli grew in 33%. This study indicates that in the immunocompromised population with cellulitis, fine needle aspiration and blood cultures should be obtained, and the antibiotic regimen should cover Gram-positive cocci and Gram-negative bacilli pending the results of cultures.

  17. Promoting transparent and accurate reporting of research studies in rheumatology: endorsement of reporting guidelines in rheumatology journals.

    Science.gov (United States)

    Marušić, Ana; Gasparyan, Armen Yuri; Kitas, George D

    2013-10-01

    To adequately translate research into practice, research results should be reported in a way that is useful to practicing clinicians and policymakers. Based on evidence from systematic reviews, the implementation of reporting guidelines, such as CONSORT for randomized controlled trials, may improve the quality of research reporting. We assessed the endorsement of reporting guidelines in rheumatology journals. We analyzed guidelines for authors of all (n = 28) journals indexed in the "Rheumatology" Subject Category of the Journal Citation Reports published in 2012. Journal websites were reviewed for information relevant to reporting guidelines. Out of 28 indexed journals, only about a third (n = 10) endorsed 1 or more reporting guidelines, most commonly CONSORT. General editorial policies, such as those from the International Committee of Medical Journal editors (ICMJE), were endorsed by 19 journals (all 10 journals with and 9 out of 18 without reporting guidelines). Two rheumatology journals introduced specific reporting guidelines about economic studies and genetic association studies. The endorsement of reporting guidelines is low in rheumatology journals. To continue to serve their research community, rheumatology journals should provide the platform for the discussion on most relevant reporting guidelines and adopt them as a group, especially those specific for rheumatology research. Coordinated action of journals and other stakeholders in rheumatology research in the promotion of accurate and transparent reporting of health research studies would be an important part of knowledge translation into practice and well-being of rheumatology patients. Copyright © 2013 Elsevier Inc. All rights reserved.

  18. Dose reduction in high-resolution MSCT. Examinations of the chest for early detection of pneumonia in immunocompromised patients

    International Nuclear Information System (INIS)

    Yamamura, J.; Adam, G.; Wedegaertner, U.; Wildberger, J.E.; Dichtl, D.; Nagel, H.D.

    2009-01-01

    Purpose: the purpose of this study was to optimize high-resolution MSCT chest protocols for the evaluation of symptomatic immunosuppressed patients with suspected pneumonia using a dose-simulating program. Materials and methods: using the MSCT (Siemens, Erlangen, Germany), 30 immunosuppressed patients with suspected pneumonia were examined with a low-dose HRCT of the chest (120 kV, 100 eff.mAs and collimation of 4 x 1 mm). A dose-simulating program was used to reconstruct the raw data at four different dose levels (70, 50, 35 und 25 mAs). For dose simulation for each mAs product, the correspondent noise level was added to the data. Images were generated with a slice thickness of 1 mm and 5 mm in the lung window. The images were then evaluated independently by two radiologists and graded on a scale of 1 to 3 points: 1 = no pneumonia, 2 = unclear, 3 = pneumonia. A receiver operating curve (ROC) analysis was performed to calculate the area under the curve (AUC). The actual dosage in mSv was calculated. The sensitivity and specificity were evaluated. Results: out of 30 patients, 7 had a normal chest finding and 23 had pneumonia. The area under the ROC curve (AUC) was 1.0 for every dosage and slice thickness. Infiltrates were detected correctly for all dosage levels. The sensitivity was 100% for all dose levels and slice thicknesses. There was one false positive finding at 35 mAs and 1 mm slice thickness. At this dose level the specificity was reduced to 93%. A reduction to 25 mAs had no influence on the detection of pneumonia. Thus, MSCT examinations of the chest can be performed with 25 mAs without missing the right diagnosis, resulting in an effective dose of 1.15 mSv (men), 1.5 mSv (women) and a CTDIvol of 2.5 mGy. (orig.)

  19. Home Environment as a Source of Life-Threatening Azole-Resistant Aspergillus fumigatus in Immunocompromised Patients.

    Science.gov (United States)

    Lavergne, Rose-Anne; Chouaki, Taieb; Hagen, Ferry; Toublanc, Bénédicte; Dupont, Hervé; Jounieaux, Vincent; Meis, Jacques F; Morio, Florent; Le Pape, Patrice

    2017-01-01

    A case of fatal aspergillosis due to a TR 46 /Y121F/T289A azole-resistant Aspergillus fumigatus is reported. Environmental investigations at the patient's residence led to the recovery of TR 46 /Y121F/T289A isolates, genotypically indistinguishable from the clinical isolate, supporting for the first time the direct role of household as potential source of azole-resistant invasive aspergillosis. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  20. Diagnosis of pulmonary infection with Toxoplasma gondii in immunocompromised HIV-positive patients by real-time PCR

    DEFF Research Database (Denmark)

    Petersen, E.; Edvinsson, B.; Lundgren, Bettina

    2006-01-01

    . In positive samples, the genotype of the parasite was determined by sequence analysis of the GRA6 gene. Positive results were achieved for 2% (7/332) of the samples tested. Genotyping was possible in two samples and revealed GRA6 type II T. gondii. PCR for detecting T. gondii in BAL samples should...... be performed in all immunosuppressed HIV-positive patients with symptoms of a systemic infection of unknown etiology. Trimethoprim-sulfamethoxazole prophylaxis does not exclude concomitant infection with T. gondii....

  1. Estudio de sensibilidad antiviral de Virus Herpes simplex en pacientes trasplantados Antiviral sensitivity of Herpes simplex virus in immunocompromised patients

    Directory of Open Access Journals (Sweden)

    H. Illán

    2004-06-01

    Full Text Available La resistencia de virus Herpes simplex (VHS a Aciclovir (ACV ocurre en aproximadamente un 5% de los pacientes inmunocomprometidos. El tratamiento con análogos de nucleósidos, provoca la aparición de cepas VHS-ACV resistentes (ACVr. El mecanismo responsable de la resistencia a ACV son las mutaciones en los genes que codifican las enzimas timidina quinasa y/o ADN- polimerasa. En un estudio de aislamientos clinicos de pacientes inmunodeficientes, se encontró que el 96% de los VHS ACVr son debidos a una baja producción o ausencia de la enzima y un4% son cepas con alteración de la especificidad por el sustrato, casi no se obtuvieron cepas mutantes en la ADN-polimerasa (15. Los análogos de Pirofosfatos generan resistencia por mutación en el gen de la ADN-polimerasa. En este trabajo se presenta la metodología empleada para el estudio de los perfiles de sensibilidad a ACV y a Foscarnet (PFA en una población de inmunosuprimidos. Se estudiaron 46 aislamientos de VHS en fibroblastos humanos, provenientes de muestras de trasplantados con lesiones vesiculares. De los 46 aislamientos, 26 resultaron VHS-1 y 20 VHS-2, tipificados por Inmunofluorescencia (IF con anticuerpos monoclonales. Posteriormente se amplificaron y se les determinó su perfíl de sensibilidad en células Vero, utilizando 100 Dosis infectivas en cultivo de tejidos 50% (DICT50 de cada cepa viral y las drogas antivirales en diferentes concentraciones. La concentración inhibitoria 50%(CI50 se calculó a partir del porcentaje de inhibición del efecto citopático en función de la concentración de la droga. Ninguno de los aislamientos resultó resistente al PFA y solo dos de ellos, uno de VHS-1 y uno de VHS-2, fueron resistentesa ACV.The Herpes simplex Virus (HSV resistance to acyclovir (ACV occurs in a 5% of the inmunocompromised patients, approximately. The treatment with analogs of nucleosides, causes the appearance of resistent HSV-ACV stocks(ACVr which can be produced by

  2. Capítulo 8 - Infecções fúngicas em imunocomprometidos Chapter 8 - Fungal infections in immunocompromised patients

    Directory of Open Access Journals (Sweden)

    Rodney Frare e Silva

    2010-02-01

    Full Text Available As complicações pulmonares se constituem na maior causa de morbidade e mortalidade no hospedeiro imunocomprometido, devido à deficiência nos mecanismos básicos de defesa. Independente da causa da imunodepressão, infecções bacterianas, virais e fúngicas são as mais frequentes. Entre as infecções fúngicas, a aspergilose é a mais comum (incidência de 1-9% e mortalidade de 55-92% nos diferentes tipos de transplantados. Embora a forma pneumônica seja a mais frequente, lesões do sistema nervoso central e sinusite não são raras. O sinal do halo em TC de tórax representa uma área de baixa atenuação em volta do nódulo, revelando edema ou hemorragia. O padrão ouro para o diagnóstico é a identificação do fungo por cultura de escarro, amostras de LBA ou biópsia. Na falta dessa identificação, a detecção de galactomanana, um dos componentes da parede celular de Aspergillus sp., tem mostrado sensibilidade e especificidade de 89% e 98%, respectivamente. Anfotericina B, anfotericina B lipossomal, caspofungina e voriconazol têm efeito sobre o fungo, com destaque para esse último. A pneumonia por Pneumocystis jirovecii, que pode ser fatal, teve sua incidência reduzida pelo uso preventivo de sulfametoxazol/trimetoprima. Dispneia e hipoxemia em pacientes imunodeprimidos indicam a necessidade da pesquisa de fungos. O uso de sulfametoxazol/trimetoprima por 14-21 dias associado com corticosteroides costuma ser eficaz. A candidíase disseminada é outra rara enfermidade fúngica causada por Candida spp.Pulmonary complications are the most common cause of morbidity and mortality in immunocompromised patients, who lack of the basic mechanisms of cellular defense. Regardless of the cause of the immunodeficiency, the most common complications are infections (bacterial, viral or fungal. Among the fungal infections, aspergillosis is the most common (incidence, 1-9%; mortality, 55-92% following organ transplant. Although pulmonary

  3. Patients receiving anti-TNF therapies experience clinically important improvements in RA-related fatigue: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis.

    Science.gov (United States)

    Druce, Katie L; Jones, Gareth T; Macfarlane, Gary J; Basu, Neil

    2015-06-01

    Pro-inflammatory cytokines such as TNF-α are important in the pathogenesis of fatigue in conditions such as RA. This study aimed to determine whether fatigue improved in a cohort of RA patients with clinically relevant fatigue commencing anti-TNF-α therapy and, if so, to identify predictors of improvement. Participants recruited to a long-term observational cohort study (the British Society for Rheumatology Biologics Register for RA) provided information on fatigue using the 36-item Short Form Health Survey (SF-36) vitality subscale. The prevalence of severe baseline fatigue (SF-36 vitality ≤12.5) was calculated and improvements, considered as (i) absolute values and (ii) improvement from severe to non-severe fatigue (SF-36 vitality >12.5), were examined 6 months subsequently. A comprehensive set of putative predictors of fatigue improvement were evaluated using multivariable logistic regression. In 6835 participants the prevalence of severe baseline fatigue was 38.8%. Of those with severe fatigue, 70% reported clinically relevant improvement and 66% moved to the non-severe fatigue category (i.e. improvers). The mean change for improvers was three times the minimum clinically important difference for improvement (33.0 U). Independent baseline predictors of improvement were female sex [odds ratio (OR) 1.3 (95% CI 1.1, 1.7)], not being unemployed due to ill health [OR 1.5 (95% CI 1.2, 1.7)], low disability [OR 1.2 (95% CI 1.001, 1.5)], seropositivity [OR 1.2 (95% CI 0.98, 1.4)], not using steroids [OR 1.2 (95% CI 1.03, 1.5)], no history of hypertension [OR 1.4 (95% CI 1.1, 1.6)] or depression [OR 1.3 (95% CI 1.1, 1.5)] and good mental health [SF-36 mental health subscale >35; OR 1.4 (95% CI 1.2, 1.7)]. Fatigued RA patients reported substantial improvement in their fatigue after commencing anti-TNF-α therapy. Further, a number of clinical and psychosocial baseline factors identified those most likely to improve, supporting future stratified approaches to RA

  4. Response to Hepatitis A Vaccination in Immunocompromised Travelers.

    Science.gov (United States)

    Garcia Garrido, Hannah M; Wieten, Rosanne W; Grobusch, Martin P; Goorhuis, Abraham

    2015-08-01

    Hepatitis A vaccines are highly immunogenic in healthy patients, but there is uncertainty about their immunogenicity in immunocompromised patients. Our study included immunocompromised patients who received 1 or 2 hepatitis A vaccinations between January 2011 and June 2013. We assessed factors that influenced the serologic response to vaccination. We performed a literature review of previous studies on hepatitis A vaccination in immunocompromised patients. Of 85 immunocompromised patients, 65 used immunosuppressive drugs, 13 had received stem cell transplants, and 7 were infected with human immunodeficiency virus. After vaccination, 65 of 85 (76.5%) developed antibodies. Tumor necrosis factor α blocker use was associated with better serologic responses than other immunosuppressive drugs. Female patients were more compliant than male patients with postvaccination antibody titer measurements. In 11 relevant studies, antibody responses after the first and second vaccination averaged 37% and 82%, respectively. Factors that negatively influenced serologic response rates were high doses of immunosuppressive drugs, fewer hepatitis A vaccinations, and a short interval between vaccination and antibody measurement. Immunocompromised patients showed moderate to good serologic responses to hepatitis A vaccination, but may need more time to develop immunity. Tumor necrosis factor α blocker use was associated with better antibody responses than other drugs. Specifically, male patients should be motivated to return for antibody titer measurements. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  5. Semiconductor lasers in rheumatological treatment

    Science.gov (United States)

    Pascu, Mihail-Lucian; Suteanu, S.; Ignat, P.; Pruna, Simion; Chitu, A.

    1995-03-01

    A computer controlled equipment, containing 6 lasers (HeNe and 5 diode lasers--DL) conceived to be used in rheumatological treatment is reported. DL emit at 895 nm and for typical applications, their expanded spots are superposed within the irradiation plane, on the HeNE defocused spot used to define the surface to be irradiated. DL emit 100 nsec pulses between 0.5 KHz and 1.5 KHz repetition rate and 0.5 mW average power (measured at 1 KHz). 150 patients with rheumathologic diseases were treated: lumbar spondylosis (75), gonarthrosis (30), cervical spondylosis (21), coxarthrosis (15), Heberden and Bouchard (9). The treatment consisted of: group I, 50 patients--laser therapy, 10 min/day, 10 days; group II, 50 patients--classical antirheumatic treatment; group III, 50 patients--mixed treatment. Assessment of sympathetic skin activity made using reactometry measurements, shows that latency time was longer before irradiation, 1867 +/- 289) msec then after, (1234 +/- 321) msec. Pain rating indexes decreasing for all three groups of patients were measured. Better results for more superficial diseases were obtained and best results were observed after irradiation with 1 KHz - 1.5 KHz repetition rate IR pulses. Better results were obtained when spot irradiation in a few points combined with zone irradiations was used.

  6. The new Childhood Arthritis and Rheumatology Research Alliance (CARRA) registry: design, rationale, and characteristics of patients enrolled in the first 12 months.

    Science.gov (United States)

    Beukelman, Timothy; Kimura, Yukiko; Ilowite, Norman T; Mieszkalski, Kelly; Natter, Marc D; Burrell, Grendel; Best, Brian; Jones, Jason; Schanberg, Laura E

    2017-04-17

    Herein we describe the history, design, and rationale of the new Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry and present the characteristics of patients with juvenile idiopathic arthritis (JIA) enrolled in the first 12 months of operation. The CARRA Registry began prospectively collecting data in the United States and Canada in July 2015 to evaluate the safety of therapeutic agents in persons with childhood-onset rheumatic disease, initially restricted to JIA. Secondary objectives include the evaluation of disease outcomes and their associations with medication use and other factors. Data are collected every 6 months and include clinical assessments, detailed medication use, patient-reported outcomes, and safety events. Follow-up is planned for at least 10 years for each participant and is facilitated by a telephone call center. As of July 2016, 1192 patients with JIA were enrolled in the CARRA Registry at 49 clinical sites. At enrollment, their median age was 12.4 years old and median disease duration was 2.6 years. Owing to preferential enrollment, patients with systemic JIA (13%) and with a polyarticular course (75%) were over-represented compared to patients in typical clinical practice. Approximately 49% were currently using biologic agents and ever use of oral glucocorticoids was common (47%). The CARRA Registry provides safety surveillance data to pharmaceutical companies to satisfy their regulatory requirements, and several independently-funded sub-studies that use the Registry infrastructure are underway. The new CARRA Registry successfully enrolled nearly 1200 participants with JIA in the first 12 months of its operation. Sustainable funding has been secured from multiple sources. The CARRA Registry may serve as a model for the study of other uncommon diseases.

  7. Bacterial meningitis in immunocompromised patients

    NARCIS (Netherlands)

    van Veen, K.E.B.

    2018-01-01

    Bacterial meningitis is an acute infection of the meninges, in The Netherlands most commonly caused by Streptococcus pneumoniae and Neisseria meningitides. Risk factors for acquiring bacterial meningitis include a decreased function of the immune system. The aim of this thesis was to study

  8. A Composite Indicator to Assess the Quality of Care in the Management of Patients With Rheumatoid Arthritis in Outpatient Rheumatology Clinics.

    Science.gov (United States)

    Martín-Martínez, María Auxiliadora; Andreu-Sanchez, Jose Luis; Sanchez-Alonso, Fernando; Corominas, Hector; Perez-Venegas, Jose Javier; Roman-Ivorra, Jose Andres; Alperi, Mercedes; Blanco-Alonso, Ricardo; Caliz, Rafael; Chamizo-Carmona, Eugenio; Graña-Gil, Jenaro; Hernández, Blanca; Marras, Carlos; Mazzucchelli, Ramon; Medina Luezas, Julio Antonio; Naranjo-Hernández, Antonio; Ortiz, Ana; Roselló, Rosa; Sanchez-Nievas, Ginés; Sanmartí, Raimon; Vela-Casasempere, Paloma

    2017-08-05

    The current guidelines in the treatment of rheumatoid arthritis (RA) include the early diagnosis and early use of disease modifying drugs to achieve remission or low disease activity level, known as "Treat to Target" (T2T). The objective of this study is to develop a composite indicator (CI) to evaluate the quality of care in the management of patients with RA, according to the T2T strategy and other general recommendations concerning the management of these patients. The phases of the construction of the CI were: 1) selection of quality criteria through expert judgment; 2) prioritization of the criteria, according to relevance and feasibility, applying the Delphi methodology (two rounds) involving 20 experts; 3) design of quality indicators; and 4) calculation of the weighted CI, using the mean value in relevance and feasibility granted by the experts. The source of information for the calculation of the CI are the medical records of patients with RA. Twelve criteria out of 37 required a second Delphi round. Thirty-one criteria were prioritized. These criteria presented a median in relevance and feasibility greater than or equal to 7.5, with an interquartile range of less than 3.5, and a level of agreement (score greater than or equal to 8) greater than or equal to 80%. The constructed CI allows us to evaluate the quality of care of patients with RA following the T2T strategy in the rheumatology units of Spanish hospitals, offering a valid and easily interpretable summary measure. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  9. An assessment of the current treatment landscape for rheumatology patients in Qatar: Recognising unmet needs and moving towards solutions.

    Science.gov (United States)

    Emadi, Samar Al; Hammoudeh, Mohammed; Mounir, Mohamed; Mueller, Ruediger B; Wells, Alvin F; Sarakbi, Housam Aldeen

    2017-04-01

    Objective This study assessed the mode of application (oral, intravenous or subcutaneous (SC)) currently employed in the treatment of rheumatoid arthritis (RA) in patients from Qatar in comparison with patients' individual preferences for the mode of application of their treatment. Methods This study included 294 RA patients visiting three clinics at the main referral hospital in Qatar who were interviewed using a standard questionnaire to determine their preference of mode of application for their disease-modifying antirheumatic drug (DMARD) treatment in relation to their currently employed mode of application. Results The majority of patients were female (76%), and 93% of male patients and 61% of female patients in the study clinics were of a nationality other than Qatari. The highest patient preference recorded was for an oral therapy (69%), compared with injection (23%) and intravenous (8%) therapy. In total, 85% of patients expressed a preference to remain on oral therapy compared with 63% and 58% of intravenous and SC injection patients indicating a preference to remain on their current method of administration. Conclusions This high preference for oral therapies highlights the considerable need for incorporation of new oral targeted synthetic DMARD therapies into clinical practice within the region.

  10. Usability and Workflow Evaluation of "RhEumAtic Disease activitY" (READY). A Mobile Application for Rheumatology Patients and Providers.

    Science.gov (United States)

    Yen, Po-Yin; Lara, Barbara; Lopetegui, Marcelo; Bharat, Aseem; Ardoin, Stacy; Johnson, Bernadette; Mathur, Puneet; Embi, Peter J; Curtis, Jeffrey R

    2016-11-02

    RhEumAtic Disease activitY (READY) is a mobile health (mHealth) application that aims to create a shared platform integrating data from both patients and physicians, with a particular emphasis on arthritis disease activity. We made READY available on an iPad and pilot implemented it at a rheumatology outpatient clinic. We conducted 1) a usability evaluation study to explore patients' and physicians' interactions with READY, and 2) a time motion study (TMS) to observe the clinical workflow before and after the implementation. A total of 33 patients and 15 physicians participated in the usability evaluation. We found usability problems in navigation, data entry, pain assessment, documentation, and instructions along with error messages. Despite these issues, 25 (75,76%) patients reported they liked READY. Physicians provided mixed feedback because they were concerned about the impact of READY on clinical workflow. Six physicians participated in the TMS. We observed 47 patient visits (44.72 hours) in the pre-implementation phase, and 42 patient visits (37.82 hours) in the post-implementation phase. We found that patients spent more time on READY than paper (4.39mins vs. 2.26mins), but overall, READY did not delay the workflow (pre = 52.08 mins vs. post = 45.46 mins). This time difference may be compensated with READY eliminating a workflow step for the staff. Patients preferred READY to paper documents. Many found it easier to input information because of the larger font size and the ease of 'tapping' rather than writing-out or circling answers. Even though patients spent more time on READY than using paper documents, the longer usage of READY was mainly due to when troubleshooting was needed. Most patients did not have problems after receiving initial support from the staff. This study not only enabled improvements to the software but also serves as good reference for other researchers or institutional decision makers who are interested in implementing such a

  11. Imaging manifestations of neck masses in the immunocompromised host

    International Nuclear Information System (INIS)

    Taylor, N.; Scarsbrook, A.F.; Conlon, C.P.; Anslow, P.A.; Phillips, R.R.

    2007-01-01

    Human immunodeficiency virus (HIV) infection, haematological malignancy, and immunosuppression for transplantation and autoimmune disorders have led to a large increase in immunocompromised patients. Neck masses are relatively common in this patient group and include both opportunistic and severe manifestations of common infections, benign hyperplasia, and primary or secondary malignancies. Although biopsy may be necessary for definitive diagnosis, features on cross-sectional imaging may suggest a specific diagnosis or limit the differential diagnosis and facilitate optimal patient management. This article will review critical aspects of neck anatomy, illustrate the spectrum of imaging features, and discuss the interpretative pearls and pitfalls when evaluating neck masses in immunocompromised patients

  12. Radioisotope binding capacity of serum for folic acid, vitamin B12 and ferritin in hematologic and rheumatologic patients

    International Nuclear Information System (INIS)

    Ringelhann, B.; Revicky, A.; Arvai, I.; Megyeri, A.; Goemoer, B.; Josfay, L.; Csak, E.

    1980-01-01

    Folic acid, vitamin B 12 and ferritin levels were determined by radioimmunoassay in patients suffering from hemic and rheumatic diseases, resp. Compared to the controls the folic acid levels were lower in some cases, the deficiency of folic acid absorption and distribution possibly being caused by the disease. Vitamin B 12 was only slightly decreased. In ankylosing spondylitis the transferrin level was similar to that of the controls, but in rheumatoid arthritis and in patients suffering from various diseases it was increased

  13. Gout treatment: survey of Brazilian rheumatology residents.

    Science.gov (United States)

    Amorim, Rodrigo Balbino Chaves; Vargas-Santos, Ana Beatriz; Pereira, Leticia Rocha; Coutinho, Evandro Silva Freire; da Rocha Castelar-Pinheiro, Geraldo

    2017-05-01

    To assess the current practices in gout management among Brazilian rheumatology residents. We performed a cross-sectional online survey among all the rheumatology residents and those rheumatologists who had just completed their training (post-residency (PR)) regarding their approach to gout management. Results were compared with the 2012 American College of Rheumatology (ACR) gout guidelines and with the responses of a previous survey with a representative sample of practicing Brazilian rheumatologists (RHE). We received 224 responses (83%) from 271 subjects. Among all respondents, the first-choice treatment for gout flares was the combination of a nonsteroidal anti-inflammatory drug + colchicine for otherwise healthy patients. A target serum urate 75%. Less than 70% reported starting allopurinol at low doses (≤100 mg/day) for patients with normal renal function and gout guidelines, especially among PR. However, some important aspects of gout management need improvement. These results will guide the development of a physician education program to improve the management of gout patients in Brazil.

  14. Expanding access to rheumatology care: the rheumatology general practice toolbox.

    LENUS (Irish Health Repository)

    Conway, R

    2015-02-01

    Management guidelines for many rheumatic diseases are published in specialty rheumatology literature but rarely in general medical journals. Musculoskeletal disorders comprise 14% of all consultations in primary care. Formal post-graduate training in rheumatology is limited or absent for many primary care practitioners. Primary care practitioners can be trained to effectively treat complex diseases and have expressed a preference for interactive educational courses. The Rheumatology General Practice (GP) Toolbox is an intensive one day course designed to offer up to date information to primary care practitioners on the latest diagnostic and treatment guidelines for seven common rheumatic diseases. The course structure involves a short lecture on each topic and workshops on arthrocentesis, joint injection and DXA interpretation. Participants evaluated their knowledge and educational experience before, during and after the course. Thirty-two primary care practitioners attended, who had a median of 13 (IQR 6.5, 20) years experience in their specialty. The median number of educational symposia attended in the previous 5 years was 10 (IQR-5, 22.5), with a median of 0 (IQR 0, 1) in rheumatology. All respondents agreed that the course format was appropriate. Numerical improvements were demonstrated in participant\\'s confidence in diagnosing and managing all seven common rheumatologic conditions, with statistically significant improvements (p < 0.05) in 11 of the 14 aspects assessed. The Rheumatology Toolbox is an effective educational method for disseminating current knowledge in rheumatology to primary care physicians and improved participant\\'s self-assessed competence in diagnosis and management of common rheumatic diseases.

  15. 2015 American College of Rheumatology Workforce Study: Supply and Demand Projections of Adult Rheumatology Workforce, 2015-2030.

    Science.gov (United States)

    Battafarano, Daniel F; Ditmyer, Marcia; Bolster, Marcy B; Fitzgerald, John D; Deal, Chad; Bass, Ann R; Molina, Rodolfo; Erickson, Alan R; Hausmann, Jonathan S; Klein-Gitelman, Marisa; Imundo, Lisa F; Smith, Benjamin J; Jones, Karla; Greene, Kamilah; Monrad, Seetha U

    2018-04-01

    To describe the character and composition of the 2015 US adult rheumatology workforce, evaluate workforce trends, and project supply and demand for clinical rheumatology care for 2015-2030. The 2015 Workforce Study of Rheumatology Specialists in the US used primary and secondary data sources to estimate the baseline adult rheumatology workforce and determine demographic and geographic factors relevant to workforce modeling. Supply and demand was projected through 2030, utilizing data-driven estimations regarding the proportion and clinical full-time equivalent (FTE) of academic versus nonacademic practitioners. The 2015 adult workforce (physicians, nurse practitioners, and physician assistants) was estimated to be 6,013 providers (5,415 clinical FTE). At baseline, the estimated demand exceeded the supply of clinical FTE by 700 (12.9%). By 2030, the supply of rheumatology clinical providers is projected to fall to 4,882 providers, or 4,051 clinical FTE (a 25.2% decrease in supply from 2015 baseline levels). Demand in 2030 is projected to exceed supply by 4,133 clinical FTE (102%). The adult rheumatology workforce projections reflect a major demographic and geographic shift that will significantly impact the supply of the future workforce by 2030. These shifts include baby-boomer retirements, a millennial predominance, and an increase of female and part-time providers, in parallel with an increased demand for adult rheumatology care due to the growing and aging US population. Regional and innovative strategies will be necessary to manage access to care and reduce barriers to care for rheumatology patients. © 2018, American College of Rheumatology.

  16. Is phage therapy acceptable in the immunocompromised host?

    Science.gov (United States)

    Borysowski, Jan; Górski, Andrzej

    2008-09-01

    Over the last decade, bacteriophages (bacterial viruses) have emerged as the major alternative to antibiotics in the treatment of antibiotic-resistant infections. While a considerable body of evidence has accumulated for the efficacy and safety of phage therapy in immunocompetent patients, data remain relatively scarce regarding its use in the immunocompromised host. To our knowledge, the present article is the first to summarize all findings, of both experimental and clinical studies, that may be relevant to the employment of phage therapy in immunocompromised patients. The available data suggest that bacteriophages could also be an efficacious and safe therapeutic modality in such patients.

  17. Disseminated strongyloidiasis in a immunocompromised host.

    Science.gov (United States)

    Mundkur, Suneel C; Aroor, Shrikiran; Jayashree, K

    2011-12-01

    Strongyloidiasis in an immunocompromised patient has the potential to be life threatening. We describe a boy who was on steroids for acute demyelinating myelitis and receiving antibiotics for E. coli UTI and meningitis. He developed anasarca, malabsorption, malnutrition and left ventricular failure. Duodenal biopsy revealed abundant rhabditiform larvae of Strongyloides stercoralis. The diagnosis went unsuspected and proved fatal. This emphasizes the need to have a high index of suspicion and early intervention for S. stercoralis in immunosuppressed persons who present with refractory gastrointestinal symptoms.

  18. Indicadores del estrés oxidativo en pacientes afectados por VIH/sida con manifestaciones reumatológicas Oxidative stress indicators for HIV/AIDS patients with rheumatologic manifestations

    Directory of Open Access Journals (Sweden)

    Olga Pomier Suárez

    2012-09-01

    Full Text Available Introducción: el estrés oxidativo se ha reconocido como cofactor en la progresión de la infección por el virus de la inmunodeficiencia humana (VIH y en las manifestaciones reumatológicas. Objetivo: valorar los indicadores del estrés oxidativo en los pacientes afectados por VIH con manifestaciones reumatológicas. Métodos: se estudiaron 31 pacientes VIH con manifestaciones reumatológicas y se compararon los índices evaluados con un grupo control, 31 individuos aparentemente sanos. Los pacientes fueron clasificados según los siguientes criterios de actividad: escala de actividad de la enfermedad para manifestaciones reumatológicas, e índice de actividad de enfermedad y la escala visual analógica de dolor nocturno para manifestaciones reumatológicas. Las concentraciones plasmáticas de los indicadores de estrés oxidativo fueron cuantificadas mediante técnicas espectrofotométricas y el análisis estadístico realizado, mediante el programa estadístico SPSS 13. Resultados: los pacientes VIH evaluados presentaron un estrés oxidativo de moderado a severo, caracterizado por aumento significativo de los parámetros indicadores de daño oxidativo y disminución de los sistemas antioxidantes (pIntroduction: the oxidative stress has been recognized as a cofactor in the progression of the human immunodeficiency virus (HIV infection and in the rheumatologic manifestations. Objective: to assess the oxidative stress indicators in those HIV patients with rheumatologic manifestations. Methods: thirty one HIV patients with rheumatologic manifestations were studied and the evaluated indexes were compared to those of a control group made up of 31 apparently healthy individuals. The patients were classified according to the following activity criteria: scale of the disease activity for the rheumatologic manifestations, and index of disease activity and the analogical visual scale of pain at night in terms of the rheumatologic manifestations. The

  19. Use of prophylactic antifungals in the immunocompromised host

    NARCIS (Netherlands)

    Ship, Jonathan A.; Vissink, Arjan; Challacombe, Stephen J.

    This literature review assessed the effectiveness of interventions for the prevention of oral candidiasis in immunocompromised patients and in cancer patients treated with radiotherapy and/or chemotherapy. The studies reviewed provide strong evidence that oral candidiasis is associated with greater

  20. A preliminary study of the prevalence of intestinal parasites in immunocompromised patients with and without gastrointestinal manifestations Frequência de parasitas intestinais em pacientes imunocomprometidos com e sem manifestações gastrointestinais: estudo preliminar

    Directory of Open Access Journals (Sweden)

    Jorge Humberto Botero

    2003-08-01

    Full Text Available The objective of the present study was to determine the prevalence of the intestinal parasites most commonly found in immunocompromised patients. A group of 111 individuals with acute lymphoid leukaemia (ALL, chronic myeloid leukaemia (CML, human immunodeficiency virus (HIV and other immunocompromised conditions (principally haematological disorders was selected. A battery of tests was performed on each individual to identify the presence of parasites (three stool specimens with saline solution and Lugol both directly and by concentration, culture and special staining. No significant differences were found among the frequencies of the different parasites with the several types of immunocompromised conditions. The overall frequencies of potentially pathogenic and opportunistic parasites were 32.4% (36/111 and 9% (10/111 respectively, the most frequently encountered among the latter being Cryptosporidium sp., Microsporidia spp. and Strongyloides stercoralis.O objetivo do presente estudo é avaliar a frequência de parasitas intestinais em pacientes com alterações imunológicas. Foram analisadas 111 pessoas com leucemia linfóide aguda (LLA, leucemia mieloide crônica, virus da imunodeficiência humana (VIH e outras doenças, principalmente alterações sanguíneas. Para cada indivíduo foram realizados exames seriados de fezes tanto com solução salina quanto com lugol #3, direto e por concentração, culturas de fezes e colorações específicas. Não houve diferenças significativas na frequência de parasitoses nos distintos grupos avaliados. A frequência de parasitas potencialmente patogênicos foi de 32.4% (36/111 enquanto a de parasitas oportunistas foi de 9.0% (10/111. As espécies mais observadas foram C. parvum, microsporídios spp. e S. stercoralis.

  1. Methodology for clinical trials involving patients with cancer who have febrile neutropenia: updated guidelines of the Immunocompromised Host Society/Multinational Association for Supportive Care in Cancer, with emphasis on outpatient studies.

    Science.gov (United States)

    Feld, Ronald; Paesmans, Marianne; Freifeld, Alison G; Klastersky, Jean; Pizzo, Philip A; Rolston, Kenneth V I; Rubenstein, Edward; Talcott, James A; Walsh, Thomas J

    2002-12-15

    Two multinational organizations, the Immunocompromised Host Society and the Multinational Association for Supportive Care in Cancer, have produced for investigators and regulatory bodies a set of guidelines on methodology for clinical trials involving patients with febrile neutropenia. The guidelines suggest that response (i.e., success of initial empirical antibiotic therapy without any modification) be determined at 72 h and again on day 5, and the reasons for modification should be stated. Blinding and stratification are to be encouraged, as should statistical consideration of trials specifically designed for showing equivalence. Patients enrolled in outpatient studies should be selected by use of a validated risk model, and patients should be carefully monitored after discharge from the hospital. Response and safety parameters should be recorded along with readmission rates. If studies use these guidelines, comparisons between studies will be simpler and will lead to further improvements in patient therapy.

  2. Measuring (1,3)-β-D-glucan in tracheal aspirate, bronchoalveolar lavage fluid, and serum for detection of suspected Candida pneumonia in immunocompromised and critically ill patients: a prospective observational study.

    Science.gov (United States)

    Su, Kang-Cheng; Chou, Kun-Ta; Hsiao, Yi-Han; Tseng, Ching-Min; Su, Vincent Yi-Fong; Lee, Yu-Chin; Perng, Diahn-Warng; Kou, Yu Ru

    2017-04-08

    While Candida pneumonia is life-threatening, biomarker measurements to early detect suspected Candida pneumonia are lacking. This study compared the diagnostic values of measuring levels of (1, 3)-β-D-glucan in endotracheal aspirate, bronchoalveolar lavage fluid, and serum to detect suspected Candida pneumonia in immunocompromised and critically ill patients. This prospective, observational study enrolled immunocompromised, critically ill, and ventilated patients with suspected fungal pneumonia in mixed intensive care units from November 2010 to October 2011. Patients with D-glucan confounding factors or other fungal infection were excluded. Endotracheal aspirate, bronchoalveolar lavage fluid and serum were collected from each patient to perform a fungal smear, culture, and D-glucan assay. After screening 166 patients, 31 patients completed the study and were categorized into non-Candida pneumonia/non-candidemia (n = 18), suspected Candida pneumonia (n = 9), and non-Candida pneumonia/candidemia groups (n = 4). D-glucan levels in endotracheal aspirate or bronchoalveolar lavage were highest in suspected Candida pneumonia, while the serum D-glucan level was highest in non-Candida pneumonia/candidemia. In all patients, the D-glucan value in endotracheal aspirate was positively correlated with that in bronchoalveolar lavage fluid. For the detection of suspected Candida pneumonia, the predictive performance (sensitivity/specificity/D-glucan cutoff [pg/ml]) of D-glucan in endotracheal aspirate and bronchoalveolar lavage fluid was 67%/82%/120 and 89%/86%/130, respectively, accounting for areas under the receiver operating characteristic curve of 0.833 and 0.939 (both P pneumonia in the absence of concurrent candidemia. D-glucan levels in both endotracheal aspirate and bronchoalveolar lavage, but not in serum, provide good diagnostic values to detect suspected Candida pneumonia and to serve as potential biomarkers for early detection in this patient population.

  3. Hot topics in modern rheumatology

    Directory of Open Access Journals (Sweden)

    D. E. Karateev

    2014-01-01

    Full Text Available The Expert Council for Tofacitinib (TOFA and two symposiums on New Possibilities for Targeted Therapy of Rheumatoid Arthritis and on Success Factor of Biological Therapy for Rheumatic Diseases were held within the annual scientific-and-practical conference of the V.A. Nasonova Research Institute of Rheumatology on Comorbidity in Rheumatic Diseases in Moscow on 14–15 October 2014.

  4. Transmission of human respiratory syncytial virus in the immunocompromised ferret model

    NARCIS (Netherlands)

    de Waal, L. (Leon); S.L. Smits (Saskia); E.J.B. Veldhuis Kroeze (Edwin); G. van Amerongen (Geert); Pohl, M.O. (Marie O.); Osterhaus, A.D.M.E. (Albert D. M. E.); K.J. Stittelaar (Koert)

    2018-01-01

    textabstractHuman respiratory syncytial virus (HRSV) causes substantial morbidity and mortality in vulnerable patients, such as the very young, the elderly, and immunocompromised individuals of any age. Nosocomial transmission of HRSV remains a serious challenge in hospital settings, with

  5. Colostomy for Perianal Sepsis With Ecthyma Gangrenosum in Immunocompromised Children.

    Science.gov (United States)

    Vuille-dit-Bille, Raphael N; Berger, Christoph; Meuli, Martin; Grotzer, Michael A

    2016-01-01

    Perianal sepsis with ecthyma gangrenosum is a severe and potentially mutilating complication in immunocompromised children. Therapies include antimicrobial treatment, incision and drainage, generous tissue debridement, and skin transplantation. We describe 3 children with acute lymphoblastic leukemia having sepsis with Pseudomonas aeruginosa in febrile neutropenia and severe perianal infections treated relatively early with a protective colostomy. Indications for colostomy were nonhealing wounds, and ceaseless pain. All patients showed a rapid reduction of pain. Complete wound healing was seen in 2 patients, and considerable pain reduction and increased quality of life were seen in a third patient during palliative care. These results suggest that a protective colostomy should be considered early in the management of immunocompromised children with ecthyma gangrenosum.

  6. 2017 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty.

    Science.gov (United States)

    Goodman, Susan M; Springer, Bryan; Guyatt, Gordon; Abdel, Matthew P; Dasa, Vinod; George, Michael; Gewurz-Singer, Ora; Giles, Jon T; Johnson, Beverly; Lee, Steve; Mandl, Lisa A; Mont, Michael A; Sculco, Peter; Sporer, Scott; Stryker, Louis; Turgunbaev, Marat; Brause, Barry; Chen, Antonia F; Gililland, Jeremy; Goodman, Mark; Hurley-Rosenblatt, Arlene; Kirou, Kyriakos; Losina, Elena; MacKenzie, Ronald; Michaud, Kaleb; Mikuls, Ted; Russell, Linda; Sah, Alexander; Miller, Amy S; Singh, Jasvinder A; Yates, Adolph

    2017-08-01

    This collaboration between the American College of Rheumatology and the American Association of Hip and Knee Surgeons developed an evidence-based guideline for the perioperative management of antirheumatic drug therapy for adults with rheumatoid arthritis (RA), spondyloarthritis (SpA) including ankylosing spondylitis and psoriatic arthritis, juvenile idiopathic arthritis (JIA), or systemic lupus erythematosus (SLE) undergoing elective total hip (THA) or total knee arthroplasty (TKA). A panel of rheumatologists, orthopedic surgeons specializing in hip and knee arthroplasty, and methodologists was convened to construct the key clinical questions to be answered in the guideline. A multi-step systematic literature review was then conducted, from which evidence was synthesized for continuing versus withholding antirheumatic drug therapy and for optimal glucocorticoid management in the perioperative period. A Patient Panel was convened to determine patient values and preferences, and the Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of evidence and the strength of recommendations, using a group consensus process through a convened Voting Panel of rheumatologists and orthopedic surgeons. The strength of the recommendation reflects the degree of certainty that benefits outweigh harms of the intervention, or vice versa, considering the quality of available evidence and the variability in patient values and preferences. The guideline addresses the perioperative use of antirheumatic drug therapy including traditional disease-modifying antirheumatic drugs, biologic agents, tofacitinib, and glucocorticoids in adults with RA, SpA, JIA, or SLE who are undergoing elective THA or TKA. It provides recommendations regarding when to continue, when to withhold, and when to restart these medications, and the optimal perioperative dosing of glucocorticoids. The guideline includes 7 recommendations, all of which are conditional

  7. Cutaneous Erysipelothrix rhusiopathiae (erysipeloid) infection in an immunocompromised child.

    Science.gov (United States)

    Boyd, Alan S; Ritchie, Coleman; Fenton, Jeremy S

    2014-01-01

    Erysipeloid, a cutaneous infection with the gram-positive bacillus Erysipelothrix rhusiopathiae, is typically an occupational dermatosis seen in persons working with livestock or involved in commercial fishing (fishmongers). Other more-generalized forms of infection with this organism also exist, including a septic form usually associated with endocarditis. Many infections may be self-limited. They have rarely been reported in children or in immunocompromised patients. This microbe is sensitive to many mainstream antibiotic agents. © 2012 Wiley Periodicals, Inc.

  8. The changing landscape of biosimilars in rheumatology

    Science.gov (United States)

    Dörner, Thomas; Strand, Vibeke; Cornes, Paul; Gonçalves, João; Gulácsi, László; Kvien, Tore K; Tanaka, Yoshiya; Burmester, Gerd R

    2016-01-01

    Biosimilars remain a hot topic in rheumatology, and some physicians are cautious about their application in the real world. With many products coming to market and a wealth of guidelines and recommendations concerning their use, there is a need to understand the changing landscape and the real clinical and health-economic potential offered by these agents. Notably, rheumatologists will be at the forefront of the use of biosimilar monoclonal antibodies/soluble receptors. Biosimilars offer cost savings and health gains for our patients and will play an important role in treating rheumatic diseases. We hope that these lower costs will compensate for inequities in access to therapy based on economic differences across countries. Since approved biosimilars have already demonstrated highly similar efficacy, it will be most important to establish pharmacovigilance databases across countries that are adequate to monitor long-term safety after marketing approval. PMID:26964144

  9. Rheumatology outpatient nurse clinics: a valuable addition?

    NARCIS (Netherlands)

    Temmink, D.; Hutten, J.B.F.; Francke, A.L.; Rasker, J.J.; Huijer Abu-Saad, H.; Zee, J. van der

    2001-01-01

    Objectives: "Transmural rheumatology nurse clinics," where nursing care is provided under the joint responsibility of a home care organization and a hospital, were recently introduced into Dutch health care. This article gives insight into outcomes of the transmural rheumatology nurse clinics.

  10. Rheumatology outpatient nurse clinics: a valuable addition?

    NARCIS (Netherlands)

    Temmink, Denise; Hutten, Jack B.F.; Francke, Anneke L.; Rasker, Johannes J.; Abu-Saad, Huda Huijer

    2001-01-01

    Objectives: Transmural rheumatology nurse clinics, where nursing care is provided under the joint responsibility of a home care organization and a hospital, were recently introduced into Dutch health care. This article gives insight into outcomes of the transmural rheumatology nurse clinics. -

  11. AUTOINFLAMMATORY DISEASES IN RHEUMATOLOGY: RUSSIAN EXPERIENCE

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    S. O. Salugina

    2016-01-01

    Full Text Available Autoinflammatory diseases (AIDs are characterized by periodic, sometimes self-limiting attacks that appear as fever and clinical symptoms resembling rheumatic ones, in the absence of autoimmune or infectious diseases. The group of AIDs encompasses a broad spectrum of nosological entities; some of them have been recently dealt with by rheumatologists.Objective: to define the spectrum of AIDs in the practice of a pediatric rheumatologist from the results of visits to the Russian Federal Rheumatology Center.Subjects and methods. The investigation enrolled patients who had visited the V.A. Nasonova Research Institute of Rheumatology in 2007 to 2015 for fever and other signs of a systemic inflammatory process in order to specify their diagnosis and to rule out infections, blood cancer, and other diseases. All underwent conventional rheumatologic examination, HLA Class A typing, and molecular genetic testing.Results and discussion. 101 patients aged 6.5 months to 60 years with AIDs were identified over 9 years and diagnosed as having the following diseases. Familial Mediterranean fever (FMF was detected in 17 patients (the female to male (M/F ratio was 6:11; Behсet's disease (BD in 25 children (M/F, 14:11, cryopyrin-associated periodic syndromes (CAPS in 17 patients, including Muckle–Wells syndrome in 13 (M/F, 4:9; chronic infantile neurologic cutaneous articular and neonatal onset multisystem inflammatory disease (CINCA/NOMID syndrome in 4 (M/F, 3:1, periodic fever, aphthous stomatitis, pharyngitis, cervical adenitis (PFAPA syndrome in 17 (M/F, 10:7, hyper-IgD syndrome/mevalonate kinase deficiency syndrome in 3 (M/F, 0:3, tumor necrosis factor receptor periodic syndrome (TRAPS in 7 (M/F, 4:3, undifferentiated AID in 14, and Blau syndrome in one patient. The patients with BD were rather ethnically diverse: among them, there were representatives of North Caucasian peoples, Tatars, Uzbeks, Moldavians, and others; there were 7 ethnic Russians. There

  12. Antibiotic-Resistant Infections and Treatment Challenges in the Immunocompromised Host.

    Science.gov (United States)

    Dumford, Donald M; Skalweit, Marion

    2016-06-01

    This article reviews antibiotic resistance and treatment of bacterial infections in the growing number of patients who are immunocompromised: solid organ transplant recipients, the neutropenic host, and persons with human immunodeficiency virus and AIDS. Specific mechanisms of resistance in both gram-negative and gram-positive bacteria, as well as newer treatment options are addressed elsewhere, and are only briefly discussed in the context of the immunocompromised host. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. [INTERNATIONAL COOPERATION IN PEDIATRIC RHEUMATOLOGY: THE SHARE PROJECT].

    Science.gov (United States)

    Uziel, Yosef

    2017-07-01

    The SHARE initiative is a project initiated by the European Society of Pediatric Rheumatology for the purpose of improving clinical care in the field of pediatric rheumatology. Towards this goal numerous working plans and surveys were conducted. All pediatric rheumatology centers were mapped in terms of staff members, quality and types of treatments in each country, in order to improve and plan the best way for the diagnosis and treatment of rheumatic disease in children. After termination of the optimal clinical approach and care, position papers were written including all recommendations based on the scientific literature in the field. In addition, recommendations were set regarding the encouragement of international research, especially in light of the major advances achieved in the genetic aspects of pediatric rheumatology diseases, and the need for sharing biological samples between researchers from different countries and continents. Information for patients became more available regarding the diseases and the medical centers in each country. Futhermore, educational programs for interns and young fellows were written for the promotion of higher and identical academic levels in different countries.

  14. Musculoskeletal ultrasound in pediatric rheumatology

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    Özçakar Levent

    2011-09-01

    Full Text Available Abstract Although musculoskeletal ultrasound (MSUS has emerged as an indispensible tool among physicians involved in musculoskeletal medicine in the last two decades, only recently has it become more attractive to pediatric rheumatologists. Thereafter, the use of MSUS in pediatric rheumatology has started to increase. Yet, an ever-growing body of literature shows parity and even superiority of MSUS when compared to physical examination and other imaging modalities. MSUS is suitable for examination of children of all ages and it has certain advantages over other imaging modalities; as it is cheaper, mobile, instantly accessible bedside, easy to combine with clinical assessment (interactivity and non-invasive. It does not require sedation, which facilitates repetitive examinations. Assessment of multiple locations is possible during the same session. Agitation is rarely a problem and small children can be seated in their parents' lap or they can even play while being examined.

  15. Autoimmune thyroiditis in antinuclear antibody positive children without rheumatologic disease

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    Arkachaisri Thaschawee

    2010-05-01

    Full Text Available Abstract Background Children are commonly referred to a pediatric rheumatology center for the laboratory finding of an Anti-nuclear antibody (ANA of undetermined significance. Previous studies regarding adult rheumatology patients have supported an association between ANA and anti-thyroid antibodies, with the prevalence of thyroid antibodies being significantly higher in patients referred to a rheumatology center for an ANA without evidence of connective tissue disease compared to the general population. The purpose of the present study was to determine the frequency of thyroid antibodies in children referred to a pediatric rheumatology center for a positive ANA without evidence of a connective tissue disease. Methods A retrospective chart review was performed on children who were referred to our pediatric rheumatology center between August 2003 and March 2007 for positive ANA with concurrent thyroid antibody and thyroid function tests performed who did not fulfill criteria for a specific connective tissue disease. Laboratory and clinical features were recorded and analyzed. Mean and standard deviation were used to describe continuous data. Chi-square or Fisher's exact tests were used to compare proportions between variables. Results One-hundred and four ANA-positive patients with concurrent thyroid studies were evaluated (88% female, 93% Caucasian, mean age 11.9 ± 4.0 years. Half of patients had an ANA titer ≥ 1:320. The ANA pattern was speckled in 60% of the patients. Thyroid antibodies were detected in 30% of the patients. Anti-Thyroglobulin (ATG was detected in 29% and Anti-thyroid peroxidase (ATPO in 21% of the patients; of these children, 14% had hypothyroidism. ANA pattern and titer were not associated with anti-thyroid antibody positivity. Conclusion Thyroid antibodies associated with chronic lymphocytic thyroiditis, ATG and ATPO, were detected significantly higher in ANA-positive children without a rheumatologic condition (30% as

  16. An audit of influenza and pneumococcal vaccination in rheumatology outpatients

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    Mitchell William S

    2007-07-01

    Full Text Available Abstract Background Influenza and pneumococcal vaccination are recommended for a number of clinical risk groups including patients treated with major immunosuppressant disease modifying anti-rheumatic drugs. Such immunisation is not only safe but immunogenic in patients with rheumatic diseases. We sought to establish dual vaccination rates and significant influencing factors amongst our hospital rheumatology outpatients. Method We audited a sample of 101 patients attending hospital rheumatology outpatient clinics on any form of disease modifying treatment by clinical questionnaire and medical record perusal. Further data were collected from the local immunisation coordinating agency and analysed by logistic regression modelling. Results Although there was a high rate of awareness with regard to immunisation, fewer patients on major immunosuppressants were vaccinated than patients with additional clinical risk factors against influenza (53% vs 93%, p Conclusion Influenza and pneumococcal immunisation is suboptimal amongst patients on current immunosuppressant treatments attending rheumatology outpatient clinics. Raising awareness amongst patients may not be sufficient to improve vaccination rates and alternative strategies such as obligatory pneumococcal vaccination prior to treatment initiation and primary care provider education need to be explored.

  17. Utility of the American-European Consensus Group and American College of Rheumatology Classification Criteria for Sjögren's syndrome in patients with systemic autoimmune diseases in the clinical setting.

    Science.gov (United States)

    Hernández-Molina, Gabriela; Avila-Casado, Carmen; Nuñez-Alvarez, Carlos; Cárdenas-Velázquez, Francisco; Hernández-Hernández, Carlos; Luisa Calderillo, María; Marroquín, Verónica; Recillas-Gispert, Claudia; Romero-Díaz, Juanita; Sánchez-Guerrero, Jorge

    2015-03-01

    The aim of this study was to evaluate the feasibility and performance of the American-European Consensus Group (AECG) and ACR Classification Criteria for SS in patients with systemic autoimmune diseases. Three hundred and fifty patients with primary SS, SLE, RA or scleroderma were randomly selected from our patient registry. Each patient was clinically diagnosed as probable/definitive SS or non-SS following a standardized evaluation including clinical symptoms and manifestations, confirmatory tests, fluorescein staining test, autoantibodies, lip biopsy and medical chart review. Using the clinical diagnosis as the gold standard, the degree of agreement with each criteria set and between the criteria sets was estimated. One hundred fifty-four (44%) patients were diagnosed with SS. The AECG criteria were incomplete in 36 patients (10.3%) and the ACR criteria in 96 (27.4%; P vs 62.3 and a specificity of 94.3 vs 91.3, respectively. Either set of criteria was met by 123 patients (80%); 95 (61.7%) met the AECG criteria and 96 (62.3%) met the ACR criteria, but only 68 (44.2%) patients met both sets. The concordance rate between clinical diagnosis and AECG or ACR criteria was moderate (k statistic 0.58 and 0.55, respectively). Among 99 patients with definitive SS sensitivity was 83.3 vs 77.7 and specificity was 90.8 vs 85.6, respectively. A discrepancy between clinical diagnosis and criteria was seen in 59 patients (17%). The feasibility of the SS AECG criteria is superior to that of the ACR criteria, however, their performance was similar among patients with systemic autoimmune diseases. A subset of SS patients is still missed by both criteria sets. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  18. Pure analgesics in a rheumatological outpatient clinic

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    M.A. Cimmino

    2011-09-01

    Full Text Available Objective: Pure analgesics are only rarely used by Italian clinicians and this holds true also for rheumatologists. This work is concerned with an evaluation of the use of analgesics in a rheumatological outpatient clinic during the period 1989-1999. Methods: The records of 1705 patients consecutively seen at the clinic were downloaded on a specifically built website. Results: 4469 visits were considered. In 260 of them (5.8%, analgesics were prescribed to 234 (13.7% patients. The number of patients with a prescription of analgesics steadily increased during the years 1989-1999. The diagnoses in patients assuming analgesics were: osteoarthritis (47.1%, inflammatory arthritis (24.2%, soft tissue rheumatisms (13.7%, nonspecific arthralgia/myalgia (7.5%, and connective tissue diseases (2.6%. Peripheral analgesics were used in 188 (82.5% patients and central analgesics were used in the remaining 40 patients (17.5%. Analgesic drugs were used mainly in degenerative joint conditions. The indications for analgesics in the 55 patients with inflammatory arthrits were: (a partial or total remission of arthritis; for this reason non-steroidal anti-inflammatory drugs were no longer required in 18 patients; (b to increase the analgesic effect of NSAIDs in 23 patients; (c contraindications to NSAIDs in 14 patients (renal failure in 2 patients, gastritis in 10, allergy and bleeding in the remaining two. Conclusions: About 14% of our outpatients were treated with analgesics with an increasing trend in the examined period. The main indications for analgesics are degenerative conditions but they can be used also in selected patients with arthritis.

  19. Management of patients with rheumatoid arthritis in Latin America: a consensus position paper from Pan-American League of Associations of Rheumatology and Grupo Latino Americano De Estudio De Artritis Reumatoide.

    Science.gov (United States)

    Massardo, Loreto; Suárez-Almazor, María E; Cardiel, Mario H; Nava, Arnulfo; Levy, Roger A; Laurindo, Ieda; Soriano, Enrique R; Acevedo-Vázquez, Eduardo; Millán, Alberto; Pineda-Villaseñor, Carlos; Galarza-Maldonado, Claudio; Caballero-Uribe, Carlo V; Espinosa-Morales, Rolando; Pons-Estel, Bernardo A

    2009-06-01

    A consensus meeting of representatives of 18 Latin-American and Caribbean countries gathered in Reñaca, Chile, for 2 days to identify problems and provide recommendations for the care of patients with rheumatoid arthritis (RA) in Latin America, a region where poverty and other health priorities make the efforts to provide effective and high quality care difficult. This report includes recommendations for health professionals, patients, and health authorities in Latin America, with an emphasis on education and therapeutic issues. Fifty-one rheumatologists (list available only online on the JCR website) from 18 Latin-American and Caribbean countries with a special interest in RA participated in the consensus meeting. Participants were experts identified and appointed by the National Societies of Rheumatology affiliated with the Pan-American League of Associations for Rheumatology (PANLAR) and by the Grupo Latino Americano De Estudio de Artritis Reumatoide (GLADAR)-an independent group of Latin American rheumatologist researchers were also invited to the meeting. Eight topics were identified as priorities: patient, community and allied health professional education, health policy and decision making, programs for early detection and appropriate treatment of RA, role of classic disease modifying antirheumatic drugs (DMARDs), role of biologic therapy, and drug safety surveillance. To reach consensus, a survey with questions relevant to the topic of interest was sent to all participants before the meeting. During a 2 day meeting, the answers of the survey were reviewed and discussed by each group, with final recommendations on action items. The specific topic of the survey was answered by 86% of the participants and 68% of them answered the entire survey. It was agreed that RA and rheumatic diseases which are currently not but should be public health priorities in Latin America, because of their prevalence and impact on quality of life. Strategic areas identified as

  20. On-spot rheumatology consultations in a multilevel geriatric hospital.

    Science.gov (United States)

    Lubart, Emily; Leibovitz, Arthur; Shapir, Vadim; Segal, Refael

    2014-01-01

    Musculoskeletal and joint disorders are extremely common in the elderly. They directly affect mobility, gait stability, quality of life, and independence. To assess the nature of joint problems encountered in a geriatric inpatient population and evaluate the contribution of a rheumatologist. We reviewed the rheumatology consultation records that were conducted in a geriatric medical center over a 10 year period. A total of 474 consultations were held; most of these patients (86%) were hospitalized in the acute geriatric departments, 10% in the rehabilitation ward and 4% in the long-term care wards. Some patients were seen more than once. A rheumatologic joint problem was the main reason for hospitalization in 53% of these patients. Monoarthritis was the most frequent complaint (50%), followed by pauciarticular arthritis (two to five joints) in 30% of patients. Arthrocentesis, diagnostic and therapeutic, was performed in 225 patients, most of them in knee joints (81%). The most frequent diagnosis was osteoarthritis with acute exacerbation (28%), followed by gout (18%), pseudo-gout (9%) and rheumatoid arthritis (9%). In 86 cases (18%) the diagnosis was a non-specific rheumatologic problem: arthralgia, nonspecific generalized pain, or fibromyalgia. Prompt and appropriate evaluation, as well as arthrocentesis and treatment initiation, including local injections, were made possible by the presence of an in-house rheumatologist.

  1. Role of Tai Chi in the treatment of rheumatologic diseases.

    Science.gov (United States)

    Wang, Chenchen

    2012-12-01

    Rheumatologic diseases (e.g., fibromyalgia, osteoarthritis, and rheumatoid arthritis) consist of a complex interplay between biologic and psychological aspects, resulting in therapeutically challenging chronic conditions to control. Encouraging evidence suggests that Tai Chi, a multi-component Chinese mind-body exercise, has multiple benefits for patients with a variety of chronic disorders, particularly those with musculoskeletal conditions. Thus, Tai Chi may modulate complex factors and improve health outcomes in patients with chronic rheumatologic conditions. As a form of physical exercise, Tai Chi enhances cardiovascular fitness, muscular strength, balance, and physical function. It also appears to be associated with reduced stress, anxiety, and depression, as well as improved quality of life. Thus, Tai Chi can be safely recommended to patients with fibromyalgia, osteoarthritis, and rheumatoid arthritis as a complementary and alternative medical approach to improve patient well-being. This review highlights the current body of knowledge about the role of this ancient Chinese mind-body medicine as an effective treatment of rheumatologic diseases to better inform clinical decision-making for our patients.

  2. 2017 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty.

    Science.gov (United States)

    Goodman, Susan M; Springer, Bryan; Guyatt, Gordon; Abdel, Matthew P; Dasa, Vinod; George, Michael; Gewurz-Singer, Ora; Giles, Jon T; Johnson, Beverly; Lee, Steve; Mandl, Lisa A; Mont, Michael A; Sculco, Peter; Sporer, Scott; Stryker, Louis; Turgunbaev, Marat; Brause, Barry; Chen, Antonia F; Gililland, Jeremy; Goodman, Mark; Hurley-Rosenblatt, Arlene; Kirou, Kyriakos; Losina, Elena; MacKenzie, Ronald; Michaud, Kaleb; Mikuls, Ted; Russell, Linda; Sah, Alexander; Miller, Amy S; Singh, Jasvinder A; Yates, Adolph

    2017-09-01

    This collaboration between the American College of Rheumatology and the American Association of Hip and Knee Surgeons developed an evidence-based guideline for the perioperative management of antirheumatic drug therapy for adults with rheumatoid arthritis (RA), spondyloarthritis (SpA) including ankylosing spondylitis and psoriatic arthritis, juvenile idiopathic arthritis (JIA), or systemic lupus erythematosus (SLE) undergoing elective total hip (THA) or total knee arthroplasty (TKA). A panel of rheumatologists, orthopedic surgeons specializing in hip and knee arthroplasty, and methodologists was convened to construct the key clinical questions to be answered in the guideline. A multi-step systematic literature review was then conducted, from which evidence was synthesized for continuing versus withholding antirheumatic drug therapy and for optimal glucocorticoid management in the perioperative period. A Patient Panel was convened to determine patient values and preferences, and the Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of evidence and the strength of recommendations, using a group consensus process through a convened Voting Panel of rheumatologists and orthopedic surgeons. The strength of the recommendation reflects the degree of certainty that benefits outweigh harms of the intervention, or vice versa, considering the quality of available evidence and the variability in patient values and preferences. The guideline addresses the perioperative use of antirheumatic drug therapy including traditional disease-modifying antirheumatic drugs, biologic agents, tofacitinib, and glucocorticoids in adults with RA, SpA, JIA, or SLE who are undergoing elective THA or TKA. It provides recommendations regarding when to continue, when to withhold, and when to restart these medications, and the optimal perioperative dosing of glucocorticoids. The guideline includes 7 recommendations, all of which are conditional

  3. Comparison of serum PCR assay and histopathology for the diagnosis of invasive aspergillosis and mucormycosis in immunocompromised patients with sinus involvement

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    Shervin Shokouhi

    2016-12-01

    Conclusion: Using serum PCR, we detected Aspergillus and Mucoralean species in patients with suspected fungal sinus infection. While this test may have utility in diagnosis directly from biopsy site, it appears unreliable for use as a noninvasive blood test.  

  4. Autopsy-proven causes of death in lungs of patients immunocompromised by secondary interstitial pneumonia Causas de óbito por pneumonia intersticial secundária em autópsias pulmonares de pacientes imunocomprometidos

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    Alberto Antonio Terrabuio Junior

    2007-02-01

    Full Text Available PURPOSE: To present the more frequent associations found in autopsies of immunocompromised patients who developed secondary interstitial pneumonia as well as the risk of death (odds ratio in having specific secondary interstitial pneumonia according to the cause of immunocompromise. METHOD: From January 1994 to March 2004, 17,000 autopsies were performed at Hospital das Clínicas, São Paulo University Medical School. After examining the pathology report review, we selected 558 of these autopsies (3.28% from patients aged 15 years or more with primary underlying diseases who developed radiologically diffuse infiltrates of the lung during their hospital course and died after secondary interstitial pneumonia (bronchopneumonia, lobar pneumonia, interstitial pneumonia, diffuse alveolar damage, pulmonary recurrence of underlying disease, drug-induced lung disease, cardiogenic pulmonary edema, or pulmonary embolism. Histology slides were reviewed by experienced pathologists to confirm or not the presence of secondary interstitial pneumonia. Statistical analysis included the Fisher exact test to verify any association between histopathology and the cause of immunocompromise; a logistic regression was used to predict the risk of death for specific histological findings for each of the independent variables in the model. RESULTS: Secondary interstitial pneumonia was histologically represented by diffuse interstitial pneumonitis ranging from mild nonspecific findings (n = 213 to a pattern of diffuse alveolar damage (n = 273. The principal causes of immunocompromise in patients with diffuse alveolar damage were sepsis (136 cases, neoplasia (113 cases, diabetes mellitus (37 cases, and transplantation (48 cases. A high risk of death by pulmonary edema was found for patients with carcinoma of colon. Similarly, in patients with lung cancer or cachexia, A high risk of death by bronchopneumonia (OR = 3.6; OR = 2.6, respectively was found. Pulmonary

  5. [Pain in Spanish rheumatology outpatient offices: EPIDOR epidemiological study].

    Science.gov (United States)

    Gamero Ruiz, F; Gabriel Sánchez, R; Carbonell Abello, J; Tornero Molina, J; Sánchez-Magro, I

    2005-04-01

    To establish the prevalence and characteristics of rheumatologic pain in Spanish adult population cared in specialized rheumatology offices. Cross selection study in a population of patients cared in rheumatology offices of public Spanish hospitals. 1,134 patients selected through random sampling based on waiting lists of patients, during a period of 1 week, in rheumatology offices of each participating hospital. MAIN OUTCOMES OF THE STUDY: Reason behind the consultation (a new patient [NP] or a patient for revision [RP]), characteristics of the patient (sex, age, habits [alcohol/tobacco], marital status), location, type, intensity, duration, tolerance and management of pain; treatment (pharmacological or non-pharmacological) carried out; satisfaction with the treatment; and association with fibromyalgia. The prevalence of pain in NP was 98.6% and in RP 95.1%, with a global prevalence of 96%, predominating mainly in adult sedentary women with fibromyalgia. The frequency of acute pain was 20.9% and this of chronic pain 79.1% [corrected] The prevalence of fibromyalgia was 12% (2.2% in men, and 15.5% in women). The most prevalent pattern of current dominant pain was this of the mechanical type. More frequent associated pathologies were: hypertension (21.7%), depression (14.4%), gastrointestinal diseases (13.8%) and anxiety (13.4%). All variables analyzed in the study showed changes according to age, sex, and type of patient (NP or RP). Most used treatment was pharmacological; more than 57.6% of patients were receiving NSAIDs. In NP, medical prescriber of the treatment was first the general practitioner (56.1%) followed by the rheumatologist (14.1%); in PR the first one was the rheumatologist (69.9%) followed by the general practitioner (16.5%). Our results show that the prevalence of the rheumatologic pain is very high, predominating mainly in adult women with fibromyalgia. Pain location, intensity, and type, associated pathology, and treatment vary according to age

  6. Pets and the immunocompromised person

    Science.gov (United States)

    ... marrow transplant patients and pets; Chemotherapy patients and pets ... Centers for Disease Control and Prevention website. Healthy pets healthy people. www.cdc.gov/healthypets . Updated July 19, 2016. ...

  7. Clostridium difficile infection among immunocompromised patients in Rio de Janeiro, Brazil and detection of moxifloxacin resistance in a ribotype 014 strain.

    Science.gov (United States)

    Secco, Danielle Angst; Balassiano, Ilana Teruszkin; Boente, Renata Ferreira; Miranda, Karla Rodrigues; Brazier, Jon; Hall, Val; dos Santos-Filho, Joaquim; Lobo, Leandro Araujo; Nouér, Simone Aranha; Domingues, Regina Maria Cavalcanti Pilotto

    2014-08-01

    Clostridium difficile is a Gram-positive spore forming anaerobic bacterium, often associated with nosocomial diarrhea and pseudomembranous colitis. The acquisition of this organism occurs primarily in hospitals through accidental ingestion of spores, and its establishment and proliferation in the colon results from the removal of members of the normal intestinal flora during or after antibiotic therapy. In this study, stool samples from patients admitted to the University Hospital Clementino Fraga Filho (HUCCF/UFRJ) were screened for C. difficile toxins with an ELISA test and cultured with standard techniques for C. difficile isolation. A total of 74 stool samples were collected from patients undergoing antibiotic therapy between August 2009 and November 2010, only two (2.7%) were positive in the ELISA test and culture. A third isolate was obtained from a negative ELISA test sample. All cases of CDI were identified in patients with acute lymphoid or myeloid leukemia. Genotypic and phenotypic characterization showed that all strains carried toxins A and B genes, and belonged to PCR-ribotypes 014, 043 and 046. The isolated strains were sensitive to metronidazole and vancomycin, and resistant to ciprofloxacin and levofloxacin. Resistance to moxifloxacin, was present in the strain from PCR-ribotype 014, that showed an amino acid substitution in gyrB gene (Asp 426 → Asn). This is the first time that this mutation in a PCR-ribotype 014 strain has been described in Brazil. Copyright © 2014 Elsevier Ltd. All rights reserved.

  8. A brief history of ultrasound in rheumatology

    DEFF Research Database (Denmark)

    D'Agostino, Maria Antonietta; Terslev, Lene

    2014-01-01

    Musculoskeletal ultrasound is an evolving technique widely used in rheumatology thanks to the numerous advances and the improved work on standardisation. This article deals with the new developments in terms of technology and validation.......Musculoskeletal ultrasound is an evolving technique widely used in rheumatology thanks to the numerous advances and the improved work on standardisation. This article deals with the new developments in terms of technology and validation....

  9. Rheumatology training experience across Europe: analysis of core competences.

    Science.gov (United States)

    Sivera, Francisca; Ramiro, Sofia; Cikes, Nada; Cutolo, Maurizio; Dougados, Maxime; Gossec, Laure; Kvien, Tore K; Lundberg, Ingrid E; Mandl, Peter; Moorthy, Arumugam; Panchal, Sonia; da Silva, José A P; Bijlsma, Johannes W

    2016-09-23

    The aim of this project was to analyze and compare the educational experience in rheumatology specialty training programs across European countries, with a focus on self-reported ability. An electronic survey was designed to assess the training experience in terms of self-reported ability, existence of formal education, number of patients managed and assessments performed during rheumatology training in 21 core competences including managing specific diseases, generic competences and procedures. The target population consisted of rheumatology trainees and recently certified rheumatologists across Europe. The relationship between the country of training and the self-reported ability or training methods for each competence was analyzed through linear or logistic regression, as appropriate. In total 1079 questionnaires from 41 countries were gathered. Self-reported ability was high for most competences, range 7.5-9.4 (0-10 scale) for clinical competences, 5.8-9.0 for technical procedures and 7.8-8.9 for generic competences. Competences with lower self-reported ability included managing patients with vasculitis, identifying crystals and performing an ultrasound. Between 53 and 91 % of the trainees received formal education and between 7 and 61 % of the trainees reported limited practical experience (managing ≤10 patients) in each competence. Evaluation of each competence was reported by 29-60 % of the respondents. In adjusted multivariable analysis, the country of training was associated with significant differences in self-reported ability for all individual competences. Even though self-reported ability is generally high, there are significant differences amongst European countries, including differences in the learning structure and assessment of competences. This suggests that educational outcomes may also differ. Efforts to promote European harmonization in rheumatology training should be encouraged and supported.

  10. Comparison of Two Molecular Assays for Detection and Characterization of Aspergillus fumigatus Triazole Resistance and Cyp51A Mutations in Clinical Isolates and Primary Clinical Samples of Immunocompromised Patients

    Directory of Open Access Journals (Sweden)

    Patricia Postina

    2018-03-01

    Full Text Available In hematological patients, the incidence of invasive aspergillosis (IA caused by azole resistant Aspergillus fumigatus (ARAf is rising. As the diagnosis of IA is rarely based on positive culture in this group of patients, molecular detection of resistance mutations directly from clinical samples is crucial. In addition to the in-house azole resistance ARAf polymerase chain reaction (PCR assays detecting the frequent mutation combinations TR34/L98H, TR46/Y121F/T289A, and M220 in the Aspergillus fumigatus (A. fumigatus Cyp51A gene by subsequent DNA sequence analysis, we investigated in parallel the commercially available AsperGenius® real time PCR system in detecting the Cyp51A alterations TR34/L98H and Y121F/T289A directly from 52 clinical samples (15 biopsies, 22 bronchoalveolar lavage (BAL, 15 cerebrospinal fluid (CSF samples and ARAf isolates (n = 3 of immunocompromised patients. We analyzed DNA aliquots and compared both methods concerning amplification and detection of Aspergillus DNA and Cyp51A alterations. As positive control for the feasibility of our novel Y121F and T289A PCR assays, we used two A. fumigatus isolates with the TR46/Y121F/T289A mutation combination isolated from hematological patients with known Cyp51A alterations and a lung biopsy sample of a patient with acute myeloid leukemia (AML. The rate of positive ARAf PCR results plus successful sequencing using the ARAf PCR assays was 61% in biopsies, 29% in CSF, 67% in BAL samples and 100% in isolates. In comparison the amount of positive PCRs using the AsperGenius® assays was 47% in biopsies, 42% in CSF, 59% in BAL samples and 100% in isolates. Altogether 17 Cyp51A alterations were detected using our ARAf PCRs plus DNA sequencing and therefrom 10 alterations also by the AsperGenius® system. The comparative evaluation of our data revealed that our conventional PCR assays are more sensitive in detecting ARAf in BAL and biopsy samples, whereby differences were not significant

  11. Bacteriemia por Campylobacter fetus aislado mediante métodos convencionales de una paciente inmunocomprometida Bacteremia due to Campylobacter fetus isolated by conventional methods from an immunocompromised patient

    Directory of Open Access Journals (Sweden)

    G. Epifane

    2007-03-01

    Full Text Available Las bacterias del género Campylobacter son bacilos gram-negativos móviles, helicoidales, que presentan morfologías características. Estos microorganismos requieren una baja tensión de oxígeno y un nivel aumentado de CO2 para su desarrollo. Se presenta un caso de bacteriemia por Campylobacter fetus en una paciente con diagnóstico previo de cáncer de mama, metástasis en columna dorso-lumbar y leucemia promielocítica aguda M3 variante de la clasificación FAB. La paciente ingresó al Hospital Italiano de Córdoba por pérdida de conocimiento y proctorragia de 48 h de evolución. Debido a su pancitopenia severa se le realizaron sucesivas transfusiones de sangre. A los 13 días de internación presentó fiebre permanente. Se tomaron muestras para hemocultivo y urocultivo y se comenzó el tratamiento antibiótico con clindamicina y ciprofloxacina. Los hemocultivos se subcultivaron a las 48 h en agar chocolate. A las 24 h de incubación a 35 °C en atmósfera con 5% de CO2 desarrollaron colonias diminutas. La coloración de Gram reveló en ambas muestras bacilos gram-negativos espirilados, posteriormente identificados como Campylobacter fetus por medio de pruebas bioquímicas convencionales. El esquema antibiótico fue rotado a gentamicina más clindamicina. La paciente evolucionó favorablemente y los hemocultivos resultaron negativos luego de 5 días de tratamiento.The genus Campylobacter includes gram-negative, motile, curved rods that can evidence characteristic morphologies. These microorganisms require low oxygen tension and an increased level of CO2 for growing. A case of bacteremia due to Campylobacter fetus in a patient with a previous diagnosis of breast cancer with metastases in dorso-lumbar column and acute promyelocytic leukemia (FAB-M3 variant is presented. The patient was admitted to our institution due to loss of consciousness and a 2 day - history of bloody diarrhea. She received successive blood transfusions on account of

  12. Diagnóstico rápido de citomegalovirus (CMV en pacientes inmunocomprometidos mediante anticuerpos monoclonales que reconocen proteinas precoces virales Rapid diagnosis of cytomegalovirus infection in immunocompromised patients by using monoclonal antibodies against early viral antigens

    Directory of Open Access Journals (Sweden)

    Maritza Alvarez

    1989-06-01

    Full Text Available Se aplicó la técnica de detección de antigenos precoces fluorescentes (DAPF usando el anticuerpo monoclonal E-13 McAb, mediante el cual se lograron detectar 15 casos positivos a CMV de 75 muestras de orina o sangre ("buffy coat" tomadas de 52 pacientes inmunocomprometidos ingresados en el Instituto de Nefrología de ciudad Habana. Aplicando las técnicas clásicas de aislamiento en fibroblastos humanos diploides (MRC-5, se lograron aislar 12 cepas de CMV de casos previamente positivos por DAPF; lográndose además un aislamiento en una muestra reportada negativa por fluorescencia. Se observó una coincidencia de un 80% entre ambas técnicas. Se detectó la presencia de anticuerpos IgG contra CMV en todos los casos estudiados, utilizando para ello la técnica ELISA.A technique was applied to detect early fluorescent antigens (DEFA of cytomegalovirus (CMV using the E13 monoclonal antibodies in 52 immunocompromised patients hospitalized in the Nephrology Institute of Havana. Of the 75 urine or blood (buffy coat samples taken, 15 were found positive to CMV. Using classical diploide human fibroblast isolation technique, 12 CMV strains were isloation of previously detected positive samples by DEFA. In addition, CMV was isolated from one sample reported to be negative by DEFA. A coincidence of 80% was found between both techniques. With the ELISA test, all the sample studied have IgG antibodies to CMV.

  13. A brief history of ultrasound in rheumatology: where we were.

    Science.gov (United States)

    Grassi, Walter; Filippucci, Emilio

    2014-01-01

    Ultrasonography in the '70s was a well-known and widely used method within several medical specialties but not in rheumatology. Initial development of the field was led by radiologists who mainly investigated the potential of ultrasound in the assessment of large joints. In the late '80s, the first studies supporting the role of ultrasound in the detection of soft tissue changes and bone erosions in the hands of patients with rheumatoid arthritis were published. In the '90s, the dramatic improvement of spatial resolution due to the new generation high frequency probes opened up new avenues for the exploration of otherwise undetectable anatomical details. Ultrasound research during this period was enhanced by the growing use of colour Doppler and power Doppler and by the first prototypes of three dimensional ultrasound. Over the last 10 years, the buzz words in ultrasound research in rheumatology have been standardisation, early diagnosis and therapy monitoring.

  14. Mental health care for youth with rheumatologic diseases - bridging the gap.

    Science.gov (United States)

    Davis, Alaina M; Rubinstein, Tamar B; Rodriguez, Martha; Knight, Andrea M

    2017-12-28

    Youth with rheumatologic diseases have a high prevalence of comorbid mental health disorders. Individuals with comorbid mental health disorders are at increased risk for adverse outcomes related to mental health as well as their underlying rheumatologic disease. Early identification and treatment of mental health disorders has been shown to improve outcomes, but current systems of care fall short in providing adequate mental health services to those in need. Pediatric rheumatologists are uniquely positioned to provide mental health screening and intervention for youth with rheumatologic diseases due to the frequency of patient encounters and ongoing therapeutic relationship with patients and families. However, additional training is likely required for pediatric rheumatologists to provide effective mental health care, and focusing efforts on providing trainees with mental health education is key to building competency. Potential opportunities for improved mental health education include development of clinical guidelines regarding mental health screening and management within pediatric rheumatology settings and incorporation of mental health didactics, workshops, and interdisciplinary clinic experiences into pediatric rheumatology fellowship curricula. Additional steps include mental health education for patients and families and focus on system change, targeting integration of medical and mental health care. Research is needed to better define the scope of the problem, determine effective strategies for equipping pediatric rheumatologists with skills in mental health intervention, and develop and implement sustainable systems for delivery of optimal mental health care to youth with rheumatologic diseases.

  15. Musculoskeletal ultrasound in rheumatology in Korea: targeted ultrasound initiative survey.

    Science.gov (United States)

    Kang, Taeyoung; Wakefield, Richard J; Emery, Paul

    2016-04-01

    In collaboration with the Targeted Ultrasound Initiative (TUI), to conduct the first study in Korea to investigate current practices in ultrasound use among Korean rheumatologists. We translated the TUI Global Survey into Korean and added questions to better understand the specific challenges facing rheumatologists in Korea. To target as many rheumatologists in Korea as possible, we created an on-line version of this survey, which was conducted from March to April 2013. Rheumatologists are in charge of ultrasound in many Korean hospitals. Rheumatologists in hospitals and private clinics use ultrasound to examine between one and five patients daily; they use ultrasound for diagnosis more than monitoring and receive compensation of about US$30-50 per patient. There are marked differences in the rates of ultrasound usage between rheumatologists who work in private practice compared with tertiary hospitals. Korean rheumatologists not currently using ultrasound in their practice appear eager to do so. This survey provides important insights into the current status of ultrasound in rheumatology in Korea and highlights several priorities; specifically, greater provision of formal training, standardization of reporting and accrual of greater experience among ultrasound users. If these needs are addressed, all rheumatology departments in Korea are likely to use ultrasound or have access to it in the future. © 2014 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.

  16. [Amendment of the structural quality for inpatient rheumatology. A forward-looking concept].

    Science.gov (United States)

    Lakomek, H-J; Braun, J; Gromnica-Ihle, E; Fiehn, C; Claus, S; Specker, C; Jung, J; Krause, A; Lorenz, H-M; Robbers, J

    2011-09-01

    In 2010 a total of 9 guidelines on structural quality were endorsed by the Association of Rheumatology Clinics in Germany (VRA). These 9 structural criteria replace the regulations published in 2002 and were elaborated with the support of the German Rheumatology League. With guideline number 9 even the structural requirements for university hospitals are defined for the first time.Along with taking part in the quality project "Kobra" (continuous outcome benchmarking in rheumatology inpatient treatment) compliance with the new structural criteria constitutes a prerequisite for acquiring a quality certificate, which is awarded by an external institution.By this means the VRA sets the stage for its members to be prepared for future challenges and quality competition among hospitals. Furthermore, the provision of a high quality treatment for chronically diseased patients in rheumatology clinics will be effectively supported.

  17. Irradiated food for immunocompromised people

    International Nuclear Information System (INIS)

    Narvaiz, Patricia

    2005-01-01

    Immune-compromise is a condition in which the natural defenses against diseases are dimished; several situations can be cited as examples, including mis nourishment, pregnancy, young and old age. This enhances the probability of suffering microbial diseases, caused by food borne pathogens. Traditionally, immune-suppressed patients in hospitals were isolated from the environment, being their food sterilized by different treatments, including irradiation. At present the medical opinion differs from this approach due to the costs and specialized requirements, uncertainties about the clinical benefits, and psychological convenience. So, the tendency nowadays seems to move, when the patient's condition allows it, from 'sterile diets' to 'low microbe diets' (or 'clean diets'). At the National Atomic Energy Commission, Argentina, under Coordinated Research Programmes of the Food and Environmental Preservation Section, International Atomic Energy Agency, in which 14 countries participated, treatments at pasteurizing doses were studied to widen the meals availability for vulnerable persons, to include some products usually considered as 'high risk' , but nutritionally or psychologically adequate. In a first experience, nutritionists working at the corresponding Service in a Buenos Aires hospital elaborated diets suitable for patients with different immune-compromise degrees, and advised on the interesting meal types to be studied. In a second experience, advanced nutrition students of the Entre Rios University performed a sensory evaluation in which 44 immune- compromised patients at the Jose de San Martin Clinical School Hospital, Buenos Aires, tasted a whole irradiated lunch composed of meals usually forbidden due to high microbial risk, though highly desired. The patients evaluated this lunch with high scores and showed enthusiastic towards the irradiation treatment. This preservation treatment could not only be useful to supply hospitals but also supermarkets. (author)

  18. [Helping reintegration of patients suffering from chronic musculoskeletal diseases with decreased working ability in the National Institute of Rheumatology and Physiotherapy, Budapest, Hungary].

    Science.gov (United States)

    Sallai, Julianna Rozália; Hunka, Aniella; Héjj, Gábor; Bálint, Géza; Poór, Gyula

    2017-04-01

    An important task of our institute is to support social reintegration: including occupational rehabilitation of patients suffering from chronic musculoskeletal diseases with decreased working ability. The aim of the authors was to provide informations of their daily practice, how they perform patient education, giving information for their patients about their disease, the rehabilitation possibilities, how they support the patients with decreased working ability to take part in their own rehabilitation. Patients taking part in in-patient rehabilitation received teaching and education about their disease and rehabilitation options in groups. Patients interested in part-time jobs were individually interviewed by a 30-120 minutes talk about their educational level and training, social conditions and about the available part time jobs. The part time jobs were available with the help of the Motivation Foundation of the National Association of the Societies of Motion Disabled, and the Alfa Rehabilitation Nonprofit Rt. The data of patients receiving in-patient rehabilitation betwen the 1st of January 2009 and 31st of December 2014 were analyzed. Out of the 230 patients seeking our help for part time job, our social service could organise jobs for 180 disabled persons, all town-inhabitants, but was unsuccesful in getting jobs for patients living in villages and separated farms. Part time jobs can be organized for musculoskeletal disabled living in cities and towns. For village-dwellers there are no suitable jobs and working places. It is necessary to organize rehabilitation working possibitities for musculoskeletal disabled patients living in villages. Orv Hetil. 2017; 158(17): 662-667.

  19. Zosteriform impetigo: Wolf's isotopic response in a cutaneous immunocompromised district.

    Science.gov (United States)

    Cohen, Philip R

    2015-07-01

    Impetigo can result from Staphylococcus aureus (S. aureus). Wolf's isotopic response is the occurrence of a new cutaneous disorder at the site of a previously healed disease. A cutaneous immunocompromised district is an area of skin that is more vulnerable than the rest of the individual's body. To describe a man with impetigo localized to a unilateral dermatome and review the clinical features of other patients with zosteriform Staphylococcus aureus cutaneous infection. PubMed was used to search the following terms, separately and in combination: cutaneous, dermatome, dermatomal, district, herpes, immunocompromised, impetigo, infection, isotopic, response, skin, staphylococcal, Staphylococcus aureus, Wolf, zoster, zosteriform. All papers were reviewed and relevant manuscripts, along with their reference citations, were evaluated. Crusted, eroded and intact, erythematous papules and nodules acutely presented localized to the mandibular branch of the left trigeminal nerve on the face of a 66-year-old man; he did not recall a prior episode of varicella-zoster virus infection in that area. A bacterial culture isolated methicillin-susceptible S. aureus. Viral cultures and direct fluorescent absorption studies were negative for herpes simplex and herpes zoster virus. All of the lesions resolved after oral treatment with cefdinir. Impetigo and/or furunculosis in a zosteriform distribution have also been described in 3 additional patients. The bacterial culture showed either methicillin-susceptible or methicillin-resistant S. aureus; the skin infection resolved after treatment with oral antibiotics; however one man experienced 2 recurrences in the same area. Zosteriform cutaneous staphylococcal impetigo may be an example of Wolf's isotopic response in a cutaneous immunocompromised district.

  20. An audit of influenza and pneumococcal vaccination in rheumatology outpatients.

    Science.gov (United States)

    Sowden, Evin; Mitchell, William S

    2007-07-04

    Influenza and pneumococcal vaccination are recommended for a number of clinical risk groups including patients treated with major immunosuppressant disease modifying anti-rheumatic drugs. Such immunisation is not only safe but immunogenic in patients with rheumatic diseases. We sought to establish dual vaccination rates and significant influencing factors amongst our hospital rheumatology outpatients. We audited a sample of 101 patients attending hospital rheumatology outpatient clinics on any form of disease modifying treatment by clinical questionnaire and medical record perusal. Further data were collected from the local immunisation coordinating agency and analysed by logistic regression modelling. Although there was a high rate of awareness with regard to immunisation, fewer patients on major immunosuppressants were vaccinated than patients with additional clinical risk factors against influenza (53% vs 93%, p risk factors was confirmed as significant in determining vaccination status by logistic regression for both influenza (OR 10.89, p < 0.001) and streptococcus pneumoniae (OR 4.55, p = 0.002). The diagnosis of rheumatoid arthritis was also found to be a significant factor for pneumococcal vaccination (OR 5.1, p = 0.002). There was a negative trend suggesting that patients on major immunosuppressants are less likely to be immunised against pneumococcal antigen (OR 0.35, p = 0.067). Influenza and pneumococcal immunisation is suboptimal amongst patients on current immunosuppressant treatments attending rheumatology outpatient clinics. Raising awareness amongst patients may not be sufficient to improve vaccination rates and alternative strategies such as obligatory pneumococcal vaccination prior to treatment initiation and primary care provider education need to be explored.

  1. Current provision of rheumatology education for undergraduate nursing, occupational therapy and physiotherapy students in the UK.

    Science.gov (United States)

    Almeida, C; Clarke, B; O'Brien, A; Hammond, A; Ryan, S; Kay, L; Hewlett, S

    2006-07-01

    Rheumatological conditions are common and all health professionals (HPs) therefore need sufficient knowledge and skills to manage patients safely and effectively. The aim of this study was to examine current undergraduate education in rheumatology for HPs in the UK. A questionnaire was sent to curriculum organizers and clinical placement officers for all undergraduate courses in adult nursing, occupational therapy (OT) and physiotherapy (PT) in the UK to ascertain the nature and amount of rheumatology theory and clinical exposure provided. Of the 47 adult nursing, 26 OT and 30 PT undergraduate courses surveyed, 85-90% responded. Overall, rheumatology teaching is 5-10 h over 3 yr. Nursing students receive moderate/in-depth teaching on rheumatoid arthritis (RA) in only 52% of courses (OT 91%, PT 96%) and on osteoarthritis (OA) in 63% (OT 91%, PT 92%). Clinical experience of RA is probably/definitely available in only 56% of nursing courses (OT 72%, PT 88%), with similar results in OA. Overall, nursing students receive the least rheumatology exposure, particularly in psychosocial issues and symptom management, while PT students receive the most. OT students have limited opportunities for clinical exposure to psychosocial and joint protection issues. Use of local rheumatology clinical HP experts is variable (18-93%) and cross-disciplinary exposure is limited (0-36%). Many educators consider their rheumatology training to be insufficient (nursing 50%, PT 42%, OT 24%). Rheumatology training for undergraduate HPs is limited in key areas and often fails to take advantage of local clinical expertise, with nursing students particularly restricted. Clinical HP experts should consider novel methods of addressing these shortfalls within the limited curriculum time available.

  2. Etiological factors and clinical profile of adhesive capsulitis in patients seen at the Rheumatology clinic of a tertiary care hospital in India

    International Nuclear Information System (INIS)

    Rauoof, Malik A.; Lone, Nazir A.; Bhat, Bashir A.; Habib, Shahida

    2004-01-01

    This study was conducted to examine the clinical profile of patients with adhesive capsulitis (AC) and evaluate various possible etiological factors. The study was conducted in the Department of Physical Medicine and Rehabilitation, Sher-I-Kashmir Institute of Medical Sciences, Soure, Srinagar, Kashmir, India.100 patients fulfilling the criteria for the diagnosis of AC were studied for the severirty of shoulder pain and range of shoulder movements, The patients were also examined for the presence of various etiological factors for AC. Age of the subjects ranged from 25-70 years and duration of symptoms averaged 3.66+-2.36 months; left shoulder was more commonly involved (54%), 2% had bilateral involvement and 63% of subject were sedentary workers. Disease was seen most commonly in patients with diabetes mellitus (27%). Other identifiable risk factors included previous myocardial infarction (5%), immobilization (5%), stroke and chronic bronchitis (4%) each. 56% of the patients with AC had radiological evidence of cervical spondylisis. We conclude that AC mostly affects people in the 5-7 decade. The majority of the affected individuals are sedentary at time of sickness and the subjects with diabetes mellitus are the particular risk. (author)

  3. Recommendations by the Spanish Society of Rheumatology for the management of patients diagnosed with rheumatoid arthritis who cannot be treated with methotrexate.

    Science.gov (United States)

    García-Vicuña, Rosario; Martín-Martínez, María Auxiliadora; Gonzalez-Crespo, María Rosa; Tornero-Molina, Jesús; Fernández-Nebro, Antonio; Blanco-García, Francisco Javier; Blanco-Alonso, Ricardo; Marsal-Barril, Sara

    To establish a set of recommendations for the management of patients diagnosed with rheumatoid arthritis (RA) who cannot be treated with methotrexate (MTX) due to contraindications, drug toxicity or lack of adherence, and to establish therapeutic strategies more effective and safer in these RA patients. A qualitative analysis of the scientific evidence available to June 2015. The 2-round Delphi technique of consensus was used to collect and establish expert opinion based on the participants' clinical experience when only low quality evidence was available. A total of eighteen recommendations were developed for the management of this patient profile. Fourteen of these recommendations were related to drug safety aspects. Recommendations on contraindication and toxicity of MTX have been updated. The experts recommend the use of biological monotherapy, a preferred treatment option, in patients whose profiles reveal a contraindication, intolerance or circumstances that prevent us against the use of MTX. There is some high-quality scientific evidence that supports contraindication and establishes certain conditions of MTX use in RA patients with specific clinical profiles. Copyright © 2016. Publicado por Elsevier España, S.L.U.

  4. Case mix in paediatric rheumatology: implications for training in Australia.

    Science.gov (United States)

    Lim, Sern Chin; Allen, Roger C; Munro, Jane E; Akikusa, Jonathan D

    2012-05-01

    Despite a move towards the provision of specialist training in Australia in settings that extend beyond the public hospital system, formal comparisons of case mix between public and private specialty clinics have rarely been performed. It is therefore unclear for many specialties how well training in one setting prepares trainees for practice in the other. This study aims to compare the case mix of paediatric rheumatology patients seen in public and private settings and the referral sources of patients in each. An audit of all new patients seen in the public and private paediatric rheumatology clinics on campus at Royal Children's Hospital between June 2009 and January 2011. Data related to demographics, primary diagnosis, referral source and location seen were abstracted and compared. Eight hundred and seventy-six new patients were seen during the period of interest. Of these, 429 patients (48.9%) were seen in private clinics. The commonest diagnostic categories for both type of clinics were non-inflammatory musculoskeletal pain/orthopaedic conditions (public 39.4%, private 33.6%) followed by juvenile idiopathic arthritis (public 16.6%, %, private 18.6%), other skin/soft tissue disorders (public 8.7%, private 9.6%) and pain syndromes (public 4.9%, private 11.4%). Patients with haematological and vasculitic disorders were predominantly seen in public clinics. The commonest source of referrals to both clinics was general practitioners (public 40.6%, private 53.1%). The case mix in private paediatric rheumatology clinics closely mirrors that of public clinics at our centre. Training in either setting would provide sufficient case-mix exposure to prepare trainees for practice in the other. © 2011 The Authors. Journal of Paediatrics and Child Health © 2011 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  5. Ananyeva Rational antibiotic use in rheumatology

    Directory of Open Access Journals (Sweden)

    Boris Sergeyevich Belov

    2012-06-01

    Full Text Available To control infections and infectious complications is one of the most urgent challenges in medicine under present-day conditions. At the same time, rational therapy with anti-infective drugs occupies a highly importance place. In rheumatology, the necessity of using antibiotics is associated with at least two factors, such as eradication of a pathogen trigger (an infectious agent that triggers the immunopathological mechanisms of inflammation and treatment of comorbid infection. The paper gives information on etiological agents and detailed antimicrobial therapy regimens for the major infections observed in modern rheumatology.

  6. Ananyeva Rational antibiotic use in rheumatology

    Directory of Open Access Journals (Sweden)

    Boris Sergeyevich Belov

    2012-01-01

    Full Text Available To control infections and infectious complications is one of the most urgent challenges in medicine under present-day conditions. At the same time, rational therapy with anti-infective drugs occupies a highly importance place. In rheumatology, the necessity of using antibiotics is associated with at least two factors, such as eradication of a pathogen trigger (an infectious agent that triggers the immunopathological mechanisms of inflammation and treatment of comorbid infection. The paper gives information on etiological agents and detailed antimicrobial therapy regimens for the major infections observed in modern rheumatology.

  7. Modern psychometrics applied in rheumatology--a systematic review.

    Science.gov (United States)

    Siemons, Liseth; Ten Klooster, Peter M; Taal, Erik; Glas, Cees Aw; Van de Laar, Mart Afj

    2012-10-31

    Although item response theory (IRT) appears to be increasingly used within health care research in general, a comprehensive overview of the frequency and characteristics of IRT analyses within the rheumatic field is lacking. An overview of the use and application of IRT in rheumatology to date may give insight into future research directions and highlight new possibilities for the improvement of outcome assessment in rheumatic conditions. Therefore, this study systematically reviewed the application of IRT to patient-reported and clinical outcome measures in rheumatology. Literature searches in PubMed, Scopus and Web of Science resulted in 99 original English-language articles which used some form of IRT-based analysis of patient-reported or clinical outcome data in patients with a rheumatic condition. Both general study information and IRT-specific information were assessed. Most studies used Rasch modeling for developing or evaluating new or existing patient-reported outcomes in rheumatoid arthritis or osteoarthritis patients. Outcomes of principle interest were physical functioning and quality of life. Since the last decade, IRT has also been applied to clinical measures more frequently. IRT was mostly used for evaluating model fit, unidimensionality and differential item functioning, the distribution of items and persons along the underlying scale, and reliability. Less frequently used IRT applications were the evaluation of local independence, the threshold ordering of items, and the measurement precision along the scale. IRT applications have markedly increased within rheumatology over the past decades. To date, IRT has primarily been applied to patient-reported outcomes, however, applications to clinical measures are gaining interest. Useful IRT applications not yet widely used within rheumatology include the cross-calibration of instrument scores and the development of computerized adaptive tests which may reduce the measurement burden for both the patient

  8. Rheumatologic care of nursing home residents with rheumatoid arthritis: a comparison of the year before and after nursing home admission.

    Science.gov (United States)

    Luque Ramos, Andres; Albrecht, Katinka; Zink, Angela; Hoffmann, Falk

    2017-12-01

    The purpose of this study was to investigate health care for patients with rheumatoid arthritis (RA) before and after admission to nursing homes. Data of a German health insurance fund from persons with diagnostic codes of RA, aged ≥65 years, admitted to a nursing home between 2010 and 2014 and continuously insured 1 year before and after admission were used. The proportion of patients with ≥1 rheumatologist visit and ≥1 prescription of biologic or conventional synthetic disease-modifying antirheumatic drugs (bDMARDs or csDMARDs), glucocorticoids and non-steroidal anti-inflammatory drugs (NSAIDs) in the year before and after admission were calculated. Predictors of rheumatologic care after admission were analyzed by multivariable logistic regression. Of 75,697 nursing home residents, 2485 (3.3%) had RA (90.5% female, mean age 83.8). Treatment by rheumatologists and prescription of antirheumatic drugs decreased significantly in the year after admission (rheumatologic visits: 17.6 to 9.1%, bDMARDs: 2.1 to 1.5%, csDMARDs: 22.5 to 16.5%, glucocorticoids: 46.5 to 43.1%, NSAIDs: 47.4 to 38.5%). 60.2% of patients in rheumatologic care received csDMARDs compared with 14.5% without rheumatologic care. Rheumatologic care before admission to a nursing home strongly predicted rheumatologic care thereafter (OR 33.8, 95%-CI 23.2-49.2). Younger age and lower care level (reflecting need of help) were also associated with a higher chance of rheumatologic care. Rheumatologic care is already infrequent in old patients with RA and further decreases after admission to a nursing home. Patients without rheumatologic care are at high risk of insufficient treatment for their RA. Admission to a nursing home further increases this risk.

  9. Progress on incorporating the patient perspective in outcome assessment in rheumatology and the emergence of life impact measures at OMERACT 9.

    LENUS (Irish Health Repository)

    Kirwan, John R

    2009-09-01

    The Patient Perspective Workshop included over 100 researchers and 18 patient participants from 8 countries. Following preconference reading and short plenary presentations, breakout groups considered work undertaken on measurement of sleep, assessing interventions to develop the effective consumer, and assessing psychological and educational interventions. The workshop explored the best way to identify other outcome domains (and instruments) that should be measured in observational or interventional studies with broader intentions than simply altering outcomes captured in the traditional "core set" plus fatigue. Four sleep questionnaires showed promise and will be the subject of further study. The Effective Consumer scale (EC-17) was reviewed and the concept Effective Consumer was well received. Participants thought it worthwhile to measure the skills and attributes of an effective consumer and develop an intervention that would include education in all of the scale\\'s categories. Assessment of educational and psychological interventions requires a wider set of instruments than is currently used; these should relate to the purpose of the intervention. This principle was extended to include wider measures of the impact of disease on life, as indicated in the International Classification of Functioning, Disability and Health. Life impact measure sets covering domains appropriate to different rheumatic conditions and focused on different interventions might be defined by future OMERACT consensus. Measurement instruments within these domains that are valid for use in rheumatic conditions can then be identified and, in the case of psychological and educational interventions, chosen to fit with the purpose of the intervention.

  10. Fever, petechiae, and pulmonary infiltrates in an immunocompromised Peruvian man.

    Science.gov (United States)

    Berenson, C. S.; Dobuler, K. J.; Bia, F. J.

    1987-01-01

    The diagnostic considerations raised by immunocompromised patients with opportunistic infection continue to expand. When such patients harbor latent or persistent infection acquired in a tropical environment, the diagnostic challenge is even greater. The Infectious Disease Service at Yale-New Haven Hospital was asked to see a middle-aged man from Peru with known T-cell lymphoma who had recently completed a course of chemotherapy. He presented to the hospital with fever, petechial skin rash, pulmonary infiltrates, and neutropenia. Ultimately this case illustrated the necessity for careful evaluation of such patients, looking, in particular, for evidence of opportunistic parasitic infection. Images FIG. 1 FIG. 2 FIG. 3 FIG. 4 FIG. 5 PMID:3424876

  11. Uso de infliximab en pacientes de un centro reumatológico Use of infliximab in patients of a rheumatologic center

    Directory of Open Access Journals (Sweden)

    Ingrid Strusberg

    2005-03-01

    ún las necesidades clínicas.The objective of this study was to obtain post-marketing information about the use of infliximab in an ambulatory setting. We studied–retrospectively and prospectively - the case records of patients with rheumatoid arthritis (n=37, psoriatic arthritis (n=5, mixed connective tissue disease (n=1, and ankylosing spondylitis (n=2 who received infliximab (3 mg/kg from August 2000 to January 2003. Descriptive values were given as percentage, mean or median, and standard deviation or interquartile range. Wilcoxon test was used for paired analysis of pre/post doses of corticosteroids, non-steroidal anti-inflammatory drugs, and methotrexate therapy. A p value £ 0.05 was considered significant. Forty-five patients were included. A total of 207 infusions were administered. In 4 patients the treatment was permanently discontinued due to severe back pain during the infusion (2 cases and serious anaphylactic reactions (2 cases. Other adverse reactions occurring during infusions were mild and successfully managed with standard treatment. A case of staphylococcal septic arthritis resolved with standard antibiotic treatment. No patient had evidence of active tuberculosis. One patient with rheumatoid arthritis and chronic renal insufficiency, received treatment with infliximab 1.9 mg/kg, every 30 days, with no changes in renal function. Due to improvement of symptoms, 14/39 (35.9% patients could decrease the doses of corticosteroids, 15/43 (34.8% decreased the doses of antiinflammatory drugs and 12/34 (35.3% decreased methotrexate dosage. Although some questions remain to be elucidated, this case series shows the drug safety profile, the possibility to reduce concomitant drug doses, as well as individual approaches for situations where there are not yet guidelines available, so that rheumatologists have to make decisions based on clinical needs.

  12. Systematic review and network meta-analysis of combination and monotherapy treatments in disease-modifying antirheumatic drug-experienced patients with rheumatoid arthritis: analysis of American College of Rheumatology criteria scores 20, 50, and 70

    Science.gov (United States)

    Orme, Michelle E; MacGilchrist, Katherine S; Mitchell, Stephen; Spurden, Dean; Bird, Alex

    2012-01-01

    Background Biologic disease-modifying antirheumatic drugs (bDMARDs) extend the treatment choices for rheumatoid arthritis patients with suboptimal response or intolerance to conventional DMARDs. The objective of this systematic review and meta-analysis was to compare the relative efficacy of EU-licensed bDMARD combination therapy or monotherapy for patients intolerant of or contraindicated to continued methotrexate. Methods Comprehensive, structured literature searches were conducted in Medline, Embase, and the Cochrane Library, as well as hand-searching of conference proceedings and reference lists. Phase II or III randomized controlled trials reporting American College of Rheumatology (ACR) criteria scores of 20, 50, and 70 between 12 and 30 weeks’ follow-up and enrolling adult patients meeting ACR classification criteria for rheumatoid arthritis previously treated with and with an inadequate response to conventional DMARDs were eligible. To estimate the relative efficacy of treatments whilst preserving the randomized comparisons within each trial, a Bayesian network meta-analysis was conducted in WinBUGS using fixed and random-effects, logit-link models fitted to the binomial ACR 20/50/70 trial data. Results The systematic review identified 10,625 citations, and after a review of 2450 full-text papers, there were 29 and 14 eligible studies for the combination and monotherapy meta-analyses, respectively. In the combination analysis, all licensed bDMARD combinations had significantly higher odds of ACR 20/50/70 compared to DMARDs alone, except for the rituximab comparison, which did not reach significance for the ACR 70 outcome (based on the 95% credible interval). The etanercept combination was significantly better than the tumor necrosis factor-α inhibitors adalimumab and infliximab in improving ACR 20/50/70 outcomes, with no significant differences between the etanercept combination and certolizumab pegol or tocilizumab. Licensed-dose etanercept, adalimumab

  13. Improved training of house officers in a rheumatology consult service.

    Science.gov (United States)

    Mazzuca, S A; Brandt, K D; Katz, B P

    1993-06-01

    This study examined whether the clinical environment could be used to increase internal medicine house officers' adoption of care recommendations taught in a didactic conference. Subjects were 11 internal medicine house officers who served 6-week rheumatology elective rotations. At the start of each of four rotation periods, house officers attended a 1-hour conference in which periarticular rheumatic disorders associated with knee pain (anserine bursitis, pseudothrombophlebitis) and shoulder pain (bicipital tendinitis) were discussed. All house officers also practiced physical examination techniques on anatomic models simulating the disorders. During alternate rotation periods, reminder sheets were appended to the records of arthritis patients with histories of chronic knee or shoulder pain. The frequency with which house officers followed conference recommendations was documented by direct observation (6 house officers in 17 encounters with reminders, 5 house officers in 30 encounters without reminders). Specific questioning about a recent history of knee or shoulder pain and the performance of four of five recommended physical examination maneuvers were increased significantly by reminder sheets in patients' charts (P < 0.05 for all). Although rheumatology faculty often have limited options available to increase the number of house officer trainees or to intensify clinical activity, qualitative improvements within existing logistic parameters are feasible by assuring that the clinical environment (e.g., patient records) contains salient cues that will prompt desired actions.

  14. Advanced practice physiotherapy-led triage in Irish orthopaedic and rheumatology services: national data audit.

    Science.gov (United States)

    Fennelly, Orna; Blake, Catherine; FitzGerald, Oliver; Breen, Roisin; Ashton, Jennifer; Brennan, Aisling; Caffrey, Aoife; Desmeules, François; Cunningham, Caitriona

    2018-06-01

    Many people with musculoskeletal (MSK) disorders wait several months or years for Consultant Doctor appointments, despite often not requiring medical or surgical interventions. To allow earlier patient access to orthopaedic and rheumatology services in Ireland, Advanced Practice Physiotherapists (APPs) were introduced at 16 major acute hospitals. This study performed the first national evaluation of APP triage services. Throughout 2014, APPs (n = 22) entered clinical data on a national database. Analysis of these data using descriptive statistics determined patient wait times, Consultant Doctor involvement in clinical decisions, and patient clinical outcomes. Chi square tests were used to compare patient clinical outcomes across orthopaedic and rheumatology clinics. A pilot study at one site identified re-referral rates to orthopaedic/rheumatology services of patients managed by the APPs. In one year, 13,981 new patients accessed specialist orthopaedic and rheumatology consultations via the APP. Median wait time for an appointment was 5.6 months. Patients most commonly presented with knee (23%), lower back (22%) and shoulder (15%) disorders. APPs made autonomous clinical decisions regarding patient management at 77% of appointments, and managed patient care pathways without onward referral to Consultant Doctors in more than 80% of cases. Other onward clinical pathways recommended by APPs were: physiotherapy referrals (42%); clinical investigations (29%); injections administered (4%); and surgical listing (2%). Of those managed by the APP, the pilot study identified that only 6.5% of patients were re-referred within one year. This national evaluation of APP services demonstrated that the majority of patients assessed by an APP did not require onward referral for a Consultant Doctor appointment. Therefore, patients gained earlier access to orthopaedic and rheumatology consultations in secondary care, with most patients conservatively managed.

  15. Consenso 2012 da Sociedade Brasileira de Reumatologia sobre vacinação em pacientes com artrite reumatoide 2012 Brazilian Society of Rheumatology Consensus on vaccination of patients with rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Claiton Viegas Brenol

    2013-02-01

    Full Text Available OBJETIVO: Elaborar recomendações para a vacinação em pacientes com artrite reumatoide (AR no Brasil. MÉTODO: Revisão da literatura e opinião de especialistas membros da Comissão de AR da Sociedade Brasileira de Reumatologia e um pediatra reumatologista. RESULTADOS E CONCLUSÕES: Foram estabelecidas 12 recomendações: 1 Antes de iniciar drogas modificadoras do curso de doença, deve-se revisar e atualizar o cartão vacinal; 2 As vacinas contra influenza sazonal e contra H1N1 estão indicadas anualmente para pacientes portadores de AR; 3 A vacina antipneumocócica deve ser indicada para todos os pacientes; 4 A vacina contra varicela deve ser indicada para pacientes com história negativa ou duvidosa de infecção prévia por varicela; 5 A vacina contra HPV deve ser considerada em adolescentes e mulheres jovens; 6 A vacina antimeningocócica é indicada para pacientes portadores de AR apenas em casos de asplenia ou deficiência de complemento; 7 Existe orientação de imunização contra o Haemophilus influenzae tipo B de pacientes adultos asplênicos; 8 Não há indicação de uma vacina adicional contra BCG em pacientes com AR; 9 A vacina contra hepatite B é indicada para pacientes com anticorpos contra HBsAg negativos; considerar a vacina contra hepatite A em combinação com a hepatite B; 10 Pacientes com grande risco de contrair tétano que receberam rituximabe nas últimas 24 semanas devem utilizar imunização passiva com imunoglobulina antitetânica; 11 A vacina contra febre amarela é contraindicada nos pacientes com AR em uso de imunossupressores; 12 As recomendações acima descritas devem ser revisadas ao longo da evolução da AR.OBJECTIVE: To elaborate recommendations to the vaccination of patients with rheumatoid arthritis (RA in Brazil. METHOD: Literature review and opinion of expert members of the Brazilian Society of Rheumatology Committee of Rheumatoid Arthritis and of an invited pediatric rheumatologist. RESULTS AND

  16. Max Hirsch (1875-1941): His forgotten fate and his contributions to the founding of modern rheumatology.

    Science.gov (United States)

    Keitel, Wolfgang; Olsson, Leif; Matteson, Eric L

    2016-09-01

    To elucidate the connections between balneology and rheumatology in the founding period of the discipline of rheumatology, and describe the contributions of Max Hirsch, MD in the formation of professional rheumatology societies. Historical documents from the medical history collection of Vogelsang-Gommern, Germany, and original personal documents of the Hirsch family and information from the medical and historical period literature were used in developing this report. The first efforts at organizing rheumatology as a recognized clinical and academic discipline took place in the 1920s. Many of the first proponents were balneologists who cared for patients with chronic arthritic conditions without the benefit of effective medications. Max Hirsch, MD was a major figure in the development of modern rheumatology as it emerged from the provenance of balneology and orthopedics as a recognized organized medical discipline, contributing to the founding of the German Society for Rheumatology and the International League Against Rheumatism. Max Hirsch made significant contributions to scientific and organized rheumatology in the early days of the discipline. His contributions to the field and his fate as a Jewish physician have only recently come to light.

  17. Joint hypermobility syndrome in rheumatology

    Directory of Open Access Journals (Sweden)

    A. M. Satybaldyev

    2017-01-01

    Full Text Available Joint hypermobility syndrome (JHS is a disease characterized by symptoms of locomotor system involvement in the absence of obvious systemic rheumatic diseases (RDs. JHS accompanied by the symptomatology of RDs should be distinguished from isolated joint hypermobility, in which there are no complaints even in cases of its generalized manifestations and the patients feel virtually healthy. The paper provides an overview of the literature on the JHS. It gives diagnostic criteria for JHS (the Brighton criteria encompasses the Beighton score and the clinical manifestation of damages to the locomotor apparatus, visceral organs, and skin in this syndrome. Autonomic nervous system dysfunction as a possible manifestation of JHS and its impact on the daily life of patients are discussed. Attention is paid to the prevention and treatment of JHS. 

  18. INTRAVENOUS IMMUNOGLOBULIN IN PEDIATRIC RHEUMATOLOGY PRACTICE

    Directory of Open Access Journals (Sweden)

    E. I. Alexeeva

    2015-01-01

    Full Text Available Modern successful treatment of rheumatic diseases is impossible without the use of intravenous immunoglobulin. The use of intravenous immunoglobulin is based on strict indications developed as a result of long-term multicenter controlled studies. The article highlights the issues of using immunoglobulin in pediatric rheumatology practice, and provides the review of literature with the results from the evaluation of the efficiency of intravenous immunoglobulin confirming the efficiency of the drug only for certain rheumatic diseases. 

  19. Pharmacology of biosimilar candidate drugs in rheumatology: a literature review.

    Science.gov (United States)

    Araújo, F; Cordeiro, I; Teixeira, F; Gonçalves, J; Fonseca, J E

    2014-01-01

    To review current evidence concerning pharmacology of biosimilar candidates to be used in rheumatology. A PubMed search up to August 2013 was performed using relevant search terms to include all studies assessing pharmacological properties of biosimilar candidates to be used in rheumatology. Data on study characteristics, type of intervention, pharmacokinetics (PK), pharmacodynamics (PD) and bioequivalence ratios was extracted. Of 280 articles screened, 5 fulfilled our inclusion criteria. Two trials, PLANETAS and PLANETRA, compared CT-P13 and infliximab in patients with active ankylosing spondylitis and rheumatoid arthritis, respectively. PK bioequivalence was demonstrated in the phase 1 PLANETAS trial by highly comparable area under the curve (AUC) and maximum drug concentrations (Cmax), whose geometric mean ratios fell between the accepted bioequivalence range of 80-125%. Equivalence in efficacy and safety was demonstrated in the phase 3 PLANETRA trial. Two phase 1 trials comparing etanercept biosimilar candidates TuNEX and HD203 in healthy volunteers showed a high degree of similarity in AUC and Cmax, with respective geometric mean ratios between PK bioequivalence range. The last included trial referred to GP2013, a rituximab biosimilar candidate, which demonstrated PK and PD bioequivalence to reference product in three different dosing regimens in cynomolgus monkeys. Infliximab, etanercept and rituximab biosimilar candidates have demonstrated PK bioequivalence in the trials included in this review. CT-P13 has recently been approved for use in the European market and the remaining biosimilar candidates are currently being tested in patients with rheumatoid arthritis.

  20. Rheumatologic services in Central Asian countries: current state of development of rheumatology in Central Asia.

    Science.gov (United States)

    Omurzakova, Nazgul A; Yamano, Yoshihisa; Saatova, Guli M; Shukurova, Surayo M; Mirzakhanova, Mavliuda I; Kydyralieva, Ryskul B; Jumagulova, Aynagul S; Mirrakhimov, Erkin M; Seisenbaev, Askar Sh; Nishioka, Kusuki; Nakajima, Toshihiro

    2009-12-01

    Rheumatologic and public health services of Central Asia's republics have suffered hugely as a result of social and economic declines following the dissolution of the Union of Soviet Socialist Republics (USSR) and transition of these republics to market economies. Between 1990 and 2000 there was a mass outflow of highly skilled rheumatologists and teachers and researchers in rheumatology to countries abroad, leading to significant deprivation of rheumatological service in Central Asian countries. During this time, there was continued growth of various rheumatic diseases (RDs) including rheumatic fever, and musculoskeletal and connective tissue disorders. The medical and social burden of RDs imposed on society was strongly underestimated until recent times. There is an urgent need to define the epidemiology of RDs and their impact on the quality of life of people afflicted by these conditions, and to improve the diagnostics and treatment of these conditions.

  1. [Nailfold capillaroscopy: relevance to the practice of rheumatology].

    Science.gov (United States)

    Souza, Eduardo José do Rosário E; Kayser, Cristiane

    2015-01-01

    Nailfold capillaroscopy is a simple, low-cost method, that is extremely important in the evaluation of patients with Raynaud's phenomenon and of patients with systemic sclerosis (SSc) spectrum diseases. Besides its importance for the early diagnosis of SSc, nailfold capillaroscopy is a useful tool to identify scleroderma patients with high risk for development of vascular and visceral complications and death. The inclusion of capillaroscopy in the new classification criteria for SSc of the American College of Rheumatology (ACR) and European League Against Rheumatism (Eular) gives a new impetus to the use and dissemination of the method. In this paper, we present a didactic, non-systematic review on the subject, with emphasis on advances recently described. Copyright © 2014 Elsevier Editora Ltda. All rights reserved.

  2. Leprae reaction resembling rheumatologic disease as presenting feature of leprosy.

    Science.gov (United States)

    Baharuddin, Hazlyna; Taib, Tarita; Zain, Mollyza Mohd; Ch'ng, Shereen

    2016-10-01

    Leprosy is a chronic granulomatous infection caused by Mycobacterium leprae with predominant involvement of skin and nerves. We present a 70-year-old man with leprosy whose initial presentation resembled rheumatologic disease, due to leprae reaction. He presented with an 8-week history of worsening neuropathic pain in the right forearm, associated with necrotic skin lesions on his fingers that had ulcerated. Physical examination revealed two tender necrotic ulcers at the tip of the right middle finger and the dorsal aspect of the left middle finger. The patient had right wrist tenosynovitis and right elbow bursitis. Apart from raised inflammatory markers, the investigations for infection, connective tissue disease, vasculitis, thromboembolic disease and malignancy were negative. During the fourth week of hospitalization, we noticed a 2-cm hypoesthetic indurated plaque on the right inner arm. Further examination revealed thickened bilateral ulnar, radial and popliteal nerves. A slit skin smear was negative. Two skin biopsies and a biopsy of the olecranon bursa revealed granulomatous inflammation. He was diagnosed with paucibacillary leprosy with neuritis. He responded well to multidrug therapy and prednisolone; his symptoms resolved over a few weeks. This case illustrates the challenges in diagnosing a case of leprosy with atypical presentation in a non-endemic country. © 2016 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.

  3. Transmission of Human Respiratory Syncytial Virus in the Immunocompromised Ferret Model

    Science.gov (United States)

    de Waal, Leon; Smits, Saskia L.; Veldhuis Kroeze, Edwin J. B.; van Amerongen, Geert; Pohl, Marie O.; Osterhaus, Albert D. M. E.; Stittelaar, Koert J.

    2018-01-01

    Human respiratory syncytial virus (HRSV) causes substantial morbidity and mortality in vulnerable patients, such as the very young, the elderly, and immunocompromised individuals of any age. Nosocomial transmission of HRSV remains a serious challenge in hospital settings, with intervention strategies largely limited to infection control measures, including isolation of cases, high standards of hand hygiene, cohort nursing, and use of personal protective equipment. No vaccines against HRSV are currently available, and treatment options are largely supportive care and expensive monoclonal antibody or antiviral therapy. The limitations of current animal models for HRSV infection impede the development of new preventive and therapeutic agents, and the assessment of their potential for limiting HRSV transmission, in particular in nosocomial settings. Here, we demonstrate the efficient transmission of HRSV from immunocompromised ferrets to both immunocompromised and immunocompetent contact ferrets, with pathological findings reproducing HRSV pathology in humans. The immunocompromised ferret-HRSV model represents a novel tool for the evaluation of intervention strategies against nosocomial transmission of HRSV. PMID:29301313

  4. Parasites may exit immunocompromised northern pig-tailed macaques (Macaca leonina) infected with SIVmac239.

    Science.gov (United States)

    Song, Tian-Zhang; Zhang, Ming-Xu; Xia, Yu-Jie; Xiao, Yu; Pang, Wei; Zheng, Yong-Tang

    2018-01-18

    Parasites can increase infection rates and pathogenicity in immunocompromised human immunodeficiency virus (HIV) patients. However, in vitro studies and epidemiological investigations also suggest that parasites might escape immunocompromised hosts during HIV infection. Due to the lack of direct evidence from animal experiments, the effects of parasitic infections on immunocompromised hosts remain unclear. Here, we detected 14 different parasites in six northern pig-tailed macaques (NPMs) before or at the 50th week of simian immunodeficiency virus (SIV) infection by ELISA. The NPMs all carried parasites before viral injection. At the 50th week after viral injection, the individuals with negative results in parasitic detection (i.e., 08247 and 08287) were characterized as the Parasites Exit (PE) group, with the other individuals (i.e., 09203, 09211, 10205, and 10225) characterized as the Parasites Remain (PR) group. Compared with the PR group, the NPMs in the PE group showed higher viral loads, lower CD4 + T cells counts, and lower CD4/CD8 rates. Additionally, the PE group had higher immune activation and immune exhaustion of both CD4 + and CD8 + T cells. Pathological observation showed greater injury to the liver, cecum, colon, spleen, and mesenteric lymph nodes in the PE group. This study showed more seriously compromised immunity in the PE group, strongly indicating that parasites might exit an immunocompromised host.

  5. Advanced practice physiotherapy-led triage in Irish orthopaedic and rheumatology services: national data audit.

    LENUS (Irish Health Repository)

    Fennelly, Orna

    2018-06-01

    Many people with musculoskeletal (MSK) disorders wait several months or years for Consultant Doctor appointments, despite often not requiring medical or surgical interventions. To allow earlier patient access to orthopaedic and rheumatology services in Ireland, Advanced Practice Physiotherapists (APPs) were introduced at 16 major acute hospitals. This study performed the first national evaluation of APP triage services.

  6. Necrotizing myofasciitis: an atypical cause of ''acute abdomen'' in an immunocompromised child

    International Nuclear Information System (INIS)

    Donnelly, L.F.; Frush, D.P.; O'Hara, S.M.; Bisset, G.S. III

    1998-01-01

    We report the case of an immunocompromised 15-year-old boy who presented with symptoms mimicking an ''acute abdomen'' related to necrotizing myofasciitis of the anterior abdominal wall. CT demonstrated the abdominal wall process as the cause of the patient's symptoms and sonographically guided aspiration confirmed the diagnosis. Despite prompt diagnosis and aggressive surgical debridement, the infection continued to progress and the patient died within 24 h of presentation. (orig.)

  7. Necrotizing Fasciitis Caused by Inconspicuous Infection of Aeromonas hydrophila in an Immunocompromised Host

    Directory of Open Access Journals (Sweden)

    Kuo-Chun Liao

    2010-09-01

    Full Text Available We present a case of serious necrotizing fasciitis due to Aeromonas hydrophila without a suggestive history of routes of pathogen invasion in a 60-year-old male. Despite prompt broad-spectrum antibiotic and extensive surgical therapies, the patient died within 72 hours following initial presentation. Our experience suggests clinicians be highly alert to the disease when an immunocompromised patient featured fulminant soft-tissue infection in the endemic area.

  8. Microbiological, physicochemical and sensory evaluation of cabbage and carrot minimally processed salad after radiation treatment intended to immunocompromised patients or with special diets; Avaliacao microbiologica, fisico-quimica e sensorial de salada de repolho com cenoura minimamente processada apos o tratamento por radiacao gama destinado a pacientes imunocomprometidos ou com dietas especiais

    Energy Technology Data Exchange (ETDEWEB)

    Nunes, Thaise Cristine Fernandes

    2015-09-01

    During and after the treatment of cancer, people with HIV or transplants, the food intake can offer a well-being to the patient, because the action of eating right helps people to feel strong. Healthy people have their immune system working properly and can tolerate small amounts of bacteria. However, immunocompromised persons may not be able to and however immunocompromised people cannot fight this small amount of microorganisms and require a diet with very low microbiological count to avoid contact with potentially harmful bacteria. This is called neutropenic diet. These patients are susceptible to food contamination, so that it's not advisable the ingestion of raw products. The vegetable irradiation with low doses has the purpose of reducing the microbial load. The aim of this study was to obtain data on microbiological, sensorial e physicochemical aspects in minimally processed 'Primavera' salad irradiated with different doses of gamma radiation designed to immunocompromised patients. It were used doses of 1.0kGy, 2.0kGy, 3.0kGy and 4.0kGy irradiated in the Multipurpose Irradiator {sup 60}Co located in Radiation Technology Center. Microbiological analyzes were performed (n=25) using Petrifilm, sensory analysis using the sensory acceptance test (n=30) and triangular (n=15) and texture analysis (n=90) in the Food Microbiology Laboratory located at the Radiation Technology Center. The texture analysis was performed with the aid of a texturometer equipped with 5 kg load cell using a triangular cutting Warner-Bratzler Knife blade probe with the descent speed of 2mm/sec. All results were expressed in Newtons (N). The results showed that for microbiological analyzes the standards were followed according to the RDC 12/01 ANVISA. For the sensory test of acceptation no difference was found among the samples, however in the triangular test could be found slight differences between samples irradiated with 4.0kGy and control and there was significant

  9. Sterile diets for the immuno-compromised: Is there a need?

    Science.gov (United States)

    Butterweck, Joseph S.

    1995-02-01

    There is a general misunderstanding in the radiation processing industry about the use of sterile diets in the medical profession. Sterile diets are used on a limited basis in hospitals that specialize in cancer treatment and organ transplants. These patients are severely immuno-compromised. There are many other patients that are immuno-compromised that do not require sterile diets. These patients may require a diet that is pathogen-free and are aslo "low-microbial diets". Nosocomial infections have become a major issue in US hospitals. The "infection control committee" is the focus group responsible to assure nosocomial infections incidence are below the hospital goals. Application of ionizing radiation to sterilize diets has not been chosen because the product is not available at a reasonable total cost. This paper will discuss the hospitals views.

  10. Rheumatology Research Foundation Clinician Scholar Educator Award: Fifteen Years Promoting Rheumatology Educators and Education.

    Science.gov (United States)

    Berman, Jessica R; O'Rourke, Kenneth S; Kolasinski, Sharon L; Aizer, Juliet; Wheatley, Mary J; Battistone, Michael J; Siaton, Bernadette C; Criscione-Schreiber, Lisa; Pillinger, Michael H; Lazaro, Deana M

    2016-11-01

    The Rheumatology Research Foundation's Clinician Scholar Educator (CSE) award is a 3-year career development award supporting medical education research while providing opportunities for mentorship and collaboration. Our objective was to document the individual and institutional impact of the award since its inception, as well as its promise to strengthen the subspecialty of rheumatology. All 60 CSE Award recipients were surveyed periodically. Fifty-six of those 60 awardees (90%) responded to requests for survey information that included post-award activities, promotions, and further funding. Data were also collected from yearly written progress reports for each grant. Of the total CSE recipients to date, 48 of 60 (80%) are adult rheumatologists, 11 of 60 (18%) are pediatric rheumatologists, and 1 is an adult and pediatric rheumatologist. Two-thirds of survey respondents spend up to 30% of their total time in educational activities, and one-third spend greater than 30%. Thirty-one of the 60 CSE recipients (52%) have published a total of 86 medical education papers. Twenty-six of 52 (50%) had received an academic promotion following the award. Eleven awardees earned advanced degrees. We describe the creation and evolution of a grant program from a medical subspecialty society foundation and the impact on producing education research, individual identity formation, and ongoing support for educators. This community of rheumatology scholar educators now serves as an important resource at the national level for the American College of Rheumatology and its membership. We believe that this grant may serve as a model for other medical societies that want to promote education scholarship and leadership within their specialties. © 2016, American College of Rheumatology.

  11. Incentives in Rheumatology: the Potential Contribution of Physician Responses to Financial Incentives, Public Reporting, and Treatment Guidelines to Health Care Sustainability.

    Science.gov (United States)

    Harrison, Mark; Milbers, Katherine; Mihic, Tamara; Anis, Aslam H

    2016-07-01

    Concerns about the sustainability of current health care expenditure are focusing attention on the cost, quality and value of health care provision. Financial incentives, for example pay-for-performance (P4P), seek to reward quality and value in health care provision. There has long been an expectation that P4P schemes are coming to rheumatology. We review the available evidence about the use of incentives in this setting and provide two emerging examples of P4P schemes which may shape the future of service provision in rheumatology. Currently, there is limited and equivocal evidence in rheumatology about the impact of incentive schemes. However, reporting variation in the quality and provision of rheumatology services has highlighted examples of inefficiencies in the delivery of care. If financial incentives can improve the delivery of timely and appropriate care for rheumatology patients, then they may have an important role to play in the sustainability of health care provision.

  12. Consenso 2012 da Sociedade Brasileira de Reumatologia sobre o manejo de comorbidades em pacientes com artrite reumatoide 2012 Brazilian Society of Rheumatology Consensus on the management of comorbidities in patients with rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Ivânio Alves Pereira

    2012-08-01

    Full Text Available OBJETIVO: Elaborar recomendações da Comissão de Artrite Reumatoide da Sociedade Brasileira de Reumatologia (SBR para o manuseio das comorbidades em artrite reumatoide (AR. MÉTODOS: Revisão da literatura e opinião de especialistas da Comissão de AR da SBR. RESULTADOS E CONCLUSÕES: Recomendações: 1 Diagnosticar e tratar precoce e adequadamente as comorbidades; 2 O tratamento específico da AR deve ser adaptado às comorbidades; 3 Inibidores da enzima conversora da angiotensina (IECA ou bloqueadores dos receptores de angiotensina II (BRA são preferidos no tratamento da hipertensão arterial sistêmica; 4 Em pacientes com AR e diabetes mellitus, deve-se evitar o uso contínuo de dose cumulativa alta de corticoides; 5 Sugere-se o uso de estatinas para manter níveis de LDL menor que 100 mg/dL e índice aterosclerótico menor que 3,5 em pacientes com AR e comorbidades; 6 A síndrome metabólica deve ser tratada; 7 Recomenda-se a realização de exames para a investigação de aterosclerose subclínica; 8 Maior vigilância para um diagnóstico precoce de neoplasia oculta; 9 Medidas de prevenção para trombose venosa são sugeridas; 10 Recomenda-se a realização de densitometria óssea em pacientes com AR acima de 50 anos, e naqueles com idade menor com corticoide maior que 7,5 mg por mais de três meses; 11 Pacientes com AR e osteoporose devem evitar quedas, e devem ser aconselhados a aumentarem a ingestão de cálcio, aumentarem a exposição solar e fazerem atividade física; 12 Suplementação de cálcio e vitamina D é sugerida.Autilização de bisfosfonatos é sugerida para pacientes com escore T menor que -2,5 na densidade mineral óssea; 13 Recomenda-se equipe multidisciplinar, com participação ativa do médico reumatologista no tratamento das comorbidades.OBJECTIVE: To elaborate recommendations of the Rheumatoid Arthritis Committee of the Brazilian Society of Rheumatology (SBR to manage comorbidities in rheumatoid arthritis (RA

  13. Rheumatoid cachexia and other nutritional alterations in rheumatologic diseases.

    Science.gov (United States)

    Hurtado-Torres, Gilberto Fabián; González-Baranda, Lourdes Larisa; Abud-Mendoza, Carlos

    2015-01-01

    The prevalence of nutritional alterations in rheumatologic diseases ranges from 4 to 95%, depending on the detection method used. Formerly described as the single term rheumatoid cachexia, nutritional alterations can currently be grouped and subdivided based on the physiopathological mechanisms involved: chronic disease-related inflammatory conditions (cachexia), malnutrition associated to acute malnutrition inflammatory conditions (protein-caloric malnutrition) and starvation-related malnutrition. Clinical manifestations of malnutrition associated to rheumatic diseases vary from the patient with low weight or overweight and obesity; with lean body mass depletion as well as functional repercussions, and impact of quality of life as a common denominator. Additionally, the associated increase in body fat mass increases the risk for cardiovascular morbidity. A multidisciplinary approach towards rheumatic diseases should include aspects oriented towards prevention, early identification, diagnosis and correction of nutritional alterations. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  14. The 2017 EULAR standardised procedures for ultrasound imaging in rheumatology

    DEFF Research Database (Denmark)

    Möller, Ingrid; Janta, Iustina; Backhaus, Marina

    2017-01-01

    of MSUS evaluable structures; (2) a Delphi survey among rheumatologist and radiologist experts in MSUS to select MS and non-MS anatomic structures evaluable by US that are relevant to rheumatology, to select abnormalities evaluable by US and to prioritise these pathologies for rheumatology and (3...

  15. Performance on the adult rheumatology in-training examination and relationship to outcomes on the rheumatology certification examination.

    Science.gov (United States)

    Lohr, Kristine M; Clauser, Amanda; Hess, Brian J; Gelber, Allan C; Valeriano-Marcet, Joanne; Lipner, Rebecca S; Haist, Steven A; Hawley, Janine L; Zirkle, Sarah; Bolster, Marcy B

    2015-11-01

    The American College of Rheumatology (ACR) Adult Rheumatology In-Training Examination (ITE) is a feedback tool designed to identify strengths and weaknesses in the content knowledge of individual fellows-in-training and the training program curricula. We determined whether scores on the ACR ITE, as well as scores on other major standardized medical examinations and competency-based ratings, could be used to predict performance on the American Board of Internal Medicine (ABIM) Rheumatology Certification Examination. Between 2008 and 2012, 629 second-year fellows took the ACR ITE. Bivariate correlation analyses of assessment scores and multiple linear regression analyses were used to determine whether ABIM Rheumatology Certification Examination scores could be predicted on the basis of ACR ITE scores, United States Medical Licensing Examination scores, ABIM Internal Medicine Certification Examination scores, fellowship directors' ratings of overall clinical competency, and demographic variables. Logistic regression was used to evaluate whether these assessments were predictive of a passing outcome on the Rheumatology Certification Examination. In the initial linear model, the strongest predictors of the Rheumatology Certification Examination score were the second-year fellows' ACR ITE scores (β = 0.438) and ABIM Internal Medicine Certification Examination scores (β = 0.273). Using a stepwise model, the strongest predictors of higher scores on the Rheumatology Certification Examination were second-year fellows' ACR ITE scores (β = 0.449) and ABIM Internal Medicine Certification Examination scores (β = 0.276). Based on the findings of logistic regression analysis, ACR ITE performance was predictive of a pass/fail outcome on the Rheumatology Certification Examination (odds ratio 1.016 [95% confidence interval 1.011-1.021]). The predictive value of the ACR ITE score with regard to predicting performance on the Rheumatology Certification Examination

  16. Approach to skin and soft tissue infections in non-HIV immunocompromised hosts.

    Science.gov (United States)

    Burke, Victoria E; Lopez, Fred A

    2017-08-01

    Skin and soft tissue infections are frequent contributors to morbidity and mortality in the immunocompromised host. This article reviews the changing epidemiology and clinical manifestations of the most common cutaneous pathogens in non-HIV immunocompromised hosts, including patients with solid organ transplants, stem cell transplants, solid tumors, hematologic malignancies, and receiving chronic immunosuppressive therapy for inflammatory disorders. Defects in the innate or adaptive immune response can predispose the immunocompromised host to certain cutaneous infections in a predictive fashion. Cutaneous lesions in patients with neutrophil defects are commonly due to bacteria, Candida, or invasive molds. Skin lesions in patients with cellular or humoral immunodeficiencies can be due to encapsulated bacteria, Nocardia, mycobacteria, endemic fungal infections, herpesviruses, or parasites. Skin lesions may reflect primary inoculation or, more commonly, disseminated infection. Tissue samples for microscopy, culture, and histopathology are critical to making an accurate diagnosis given the nonspecific and heterogeneous appearance of these skin lesions due to a blunted immune response. As the population of non-HIV immunosuppressed hosts expands with advances in medical therapies, the frequency and variety of cutaneous diseases in these hosts will increase.

  17. Fit for work? Evaluation of a workshop for rheumatology teams.

    Science.gov (United States)

    Cohen, D; Khan, S; Marfell, N

    2016-06-01

    People with rheumatoid arthritis (RA) may rapidly cease work prematurely due to ill-health. A recent survey noted that a quarter of respondents with RA experienced job loss within a year of diagnosis and 50% stopped work within 6 years. To develop and pilot workshops to increase the knowledge, skills and confidence of rheumatology team members to support work-related issues in outpatient clinics. A 3-h interactive workshop, informed by rheumatology experts and the Royal College of General Practitioners (RCGP) National Education Programme (NEP) about work and health, was developed to address both knowledge and skills in the management of health and work consultations in an outpatient setting. Questionnaires were developed for use pre- and immediately post-workshop, with questions that focused on the confidence of delegates in managing these discussions and the importance they placed upon them. Ninety-nine participants attended five workshops throughout the UK between 2013 and 2104. Seventy-three per cent (72) completed the post-workshop questionnaire. Eighty-nine per cent found the workshop useful or very useful, 88% found it relevant or very relevant and 79% responded that it had an impact or a considerable impact on their practice. Wilcoxon matched pairs signed rank tests were carried out that showed an overall increase in confidence after training. The results suggest that the workshop was both relevant and useful to participants and had an impact on their practice. This was true for all specialities. The workshops also highlighted participants' desire to understand how to use the 'fit note' to enhance their patient management. © The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  18. Travel advice for the immunocompromised traveler: prophylaxis, vaccination, and other preventive measures

    Directory of Open Access Journals (Sweden)

    Patel RR

    2015-02-01

    Full Text Available Rupa R Patel,1 Stephen Y Liang,1 Pooja Koolwal,2 Frederick Matthew Kuhlmann1 1Division of Infectious Diseases, 2Division of Medical Education, Washington University School of Medicine, St Louis, MO, USA Abstract: Immunocompromised patients are traveling at increasing rates. Physicians caring for these complex patients must be knowledgeable in pretravel consultation and recognize when referral to an infectious disease specialist is warranted. This article outlines disease prevention associated with international travel for adults with human immunodeficiency virus, asplenia, solid organ and hematopoietic transplantation, and other immunosuppressed states. While rates of infection may not differ significantly between healthy and immunocompromised travelers, the latter are at greater risk for severe disease. A thorough assessment of these risks can ensure safe and healthy travel. The travel practitioners’ goal should be to provide comprehensive risk information and recommend appropriate vaccinations or prevention measures tailored to each patient’s condition. In some instances, live vaccines and prophylactic medications may be contraindicated. Keywords: immunocompromised, vaccines, travel, malaria, diarrhea

  19. Management of gout by UK rheumatologists: a British Society for Rheumatology national audit.

    Science.gov (United States)

    Roddy, Edward; Packham, Jon; Obrenovic, Karen; Rivett, Ali; Ledingham, Joanna M

    2018-05-01

    To assess the concordance of gout management by UK rheumatologists with evidence-based best-practice recommendations. Data were collected on patients newly referred to UK rheumatology out-patient departments over an 8-week period. Baseline data included demographics, method of diagnosis, clinical features, comorbidities, urate-lowering therapy (ULT), prophylaxis and blood tests. Twelve months later, the most recent serum uric acid level was collected. Management was compared with audit standards derived from the 2006 EULAR recommendations, 2007 British Society for Rheumatology/British Health Professionals in Rheumatology guideline and the National Institute for Health and Care Excellence febuxostat technology appraisal. Data were collected for 434 patients from 91 rheumatology departments (mean age 59.8 years, 82% male). Diagnosis was crystal-proven in 13%. Of 106 taking a diuretic, this was reduced/stopped in 29%. ULT was continued/initiated in 76% of those with one or more indication for ULT. One hundred and fifty-eight patients started allopurinol: the starting dose was most commonly 100 mg daily (82%); in those with estimated glomerular filtration rate <60 ml/min the highest starting dose was 100 mg daily. Of 199 who started ULT, prophylaxis was co-prescribed for 94%. Fifty patients started a uricosuric or febuxostat: 84% had taken allopurinol previously. Of 44 commenced on febuxostat, 18% had a history of heart disease. By 12 months, serum uric acid levels ⩽360 and <300 μmol/l were achieved by 45 and 25%, respectively. Gout management by UK rheumatologists concords well with guidelines for most audit standards. However, fewer than half of patients achieved a target serum uric level over 12 months. Rheumatologists should help ensure that ULT is optimized to achieve target serum uric acid levels to benefit patients.

  20. Disseminated strongyloidiasis in an immunocompromised host: A case report

    Directory of Open Access Journals (Sweden)

    Nurul Suhaiza Hassanudin

    2017-06-01

    Full Text Available Infections caused by Strongyloides stercoralis (S. stercoralis in human are generally asymptomatic, however in immunocompromised individual, hyperinfection may develop with dissemination of larvae to extra-intestinal organs. The diagnosis could be easily missed due to asymptomatic presentation and insufficient exposure towards the infection itself, which may lead to low index of suspicion as a consequence. In this report, a case of a Malaysian male with underlying diabetes mellitus, hypertension, cerebrovascular accident, bullous pemphigus and syndrome of inappropriate antidiuretic hormone secretion who initially complained of generalized body weakness and poor appetite without any history suggestive of sepsis is presented. However, he developed septicemic shock later, and S. stercoralis larvae was incidentally found in the tracheal aspirate that was sent to look for acid fast bacilli. Regardless of aggressive resuscitation, the patient succumbed due to pulmonary hemorrhage and acute respiratory distress syndrome. It was revealed that the current case has alarmed us via incidental finding of S. stercoralis larvae in the tracheal aspirate, indicating that the importance of the disease should be emphasized in certain parts of the world and population respectively.

  1. Achieving serum urate targets in gout: an audit in a gout-oriented rheumatology practice.

    Science.gov (United States)

    Corbett, Elizabeth J M; Pentony, Peta; McGill, Neil W

    2017-07-01

    To assess the proportion of patients with gout who achieve target serum urate levels, the drug regime required and the reasons for failing to do so. We reviewed the files of all patients with gout who presented to a gout-oriented rheumatology practice between January 2010 and September 2014. Two hundred and thirty patients agreed to commence urate lowering therapy (ULT); 73% achieved their urate target, including 74% with non-tophaceous gout (target ≤ 0.36 mmol/L) and 71% with tophi (target ≤ 0.30 mmol/L). Of the 62 who failed to reach target, in 61 it was due to non-adherence and in one due to inefficacy. Adherence remains the major challenge to successful long-term gout management. © 2017 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.

  2. Integrating rheumatology care in the community: can shared care work?

    Directory of Open Access Journals (Sweden)

    Anita YN Lim

    2015-08-01

    Full Text Available Introduction: Singapore's rapidly ageing population and chronic disease burden at public hospital specialist clinics herald a silver tsunami. In Singapore, “right siting” aims to manage stable chronic disease in primary care at a lower cost. To improve the quality of rheumatology care, we created shared care between rheumatologist and family physician to reduce hospital visits. Methods: Clinical practice improvement methodology was used to structure shared care of stable patients between hospital rheumatologists and eleven community family physicians; one ran a hospital clinic. A case manager coordinated the workflow. Results: About 220 patients entered shared care over 29 months. Patients without hospital subsidies (private patients and private family physicians independently predicted successful shared care, defined as one cycle of alternating care. Discussion: Our shared care model incorporated a case manager, systematic workflows, patient selection criteria, willing family physician partners and rheumatologists in the absence of organizational integration. Health care affordability impacts successful shared care. Government subsidy hindered right siting to private primary care. Conclusions: Financing systems in Singapore, at health policy level, must allow transfer of hospital subsidies to primary care, both private and public, to make it more affordable than hospital care. Structural integration will create a seamless continuum between hospital and primary care.

  3. Integrating rheumatology care in the community: can shared care work?

    Directory of Open Access Journals (Sweden)

    Anita YN Lim

    2015-08-01

    Full Text Available Introduction: Singapore's rapidly ageing population and chronic disease burden at public hospital specialist clinics herald a silver tsunami. In Singapore, “right siting” aims to manage stable chronic disease in primary care at a lower cost. To improve the quality of rheumatology care, we created shared care between rheumatologist and family physician to reduce hospital visits.Methods: Clinical practice improvement methodology was used to structure shared care of stable patients between hospital rheumatologists and eleven community family physicians; one ran a hospital clinic. A case manager coordinated the workflow.Results: About 220 patients entered shared care over 29 months. Patients without hospital subsidies (private patients and private family physicians independently predicted successful shared care, defined as one cycle of alternating care.Discussion: Our shared care model incorporated a case manager, systematic workflows, patient selection criteria, willing family physician partners and rheumatologists in the absence of organizational integration. Health care affordability impacts successful shared care. Government subsidy hindered right siting to private primary care.Conclusions: Financing systems in Singapore, at health policy level, must allow transfer of hospital subsidies to primary care, both private and public, to make it more affordable than hospital care. Structural integration will create a seamless continuum between hospital and primary care.

  4. Integrating rheumatology care in the community: can shared care work?

    Science.gov (United States)

    Lim, Anita Yn; Tan, Chuen Seng; Low, Bernadette Pl; Lau, Tang Ching; Tan, Tze Lee; Goh, Lee Gan; Teng, Gim Gee

    2015-01-01

    Singapore's rapidly ageing population and chronic disease burden at public hospital specialist clinics herald a silver tsunami. In Singapore, "right siting" aims to manage stable chronic disease in primary care at a lower cost. To improve the quality of rheumatology care, we created shared care between rheumatologist and family physician to reduce hospital visits. Clinical practice improvement methodology was used to structure shared care of stable patients between hospital rheumatologists and eleven community family physicians; one ran a hospital clinic. A case manager coordinated the workflow. About 220 patients entered shared care over 29 months. Patients without hospital subsidies (private patients) and private family physicians independently predicted successful shared care, defined as one cycle of alternating care. Our shared care model incorporated a case manager, systematic workflows, patient selection criteria, willing family physician partners and rheumatologists in the absence of organizational integration. Health care affordability impacts successful shared care. Government subsidy hindered right siting to private primary care. Financing systems in Singapore, at health policy level, must allow transfer of hospital subsidies to primary care, both private and public, to make it more affordable than hospital care. Structural integration will create a seamless continuum between hospital and primary care.

  5. Assessment of email communication skills of rheumatology fellows: a pilot study

    Science.gov (United States)

    Dhuper, Sonal; Siva, Chokkalingam; Fresen, John L; Petruc, Marius; Velázquez, Celso R

    2010-01-01

    Physician–patient email communication is gaining popularity. However, a formal assessment of physicians' email communication skills has not been described. We hypothesized that the email communication skills of rheumatology fellows can be measured in an objective structured clinical examination (OSCE) setting using a novel email content analysis instrument which has 18 items. During an OSCE, we asked 50 rheumatology fellows to respond to a simulated patient email. The content of the responses was assessed using our instrument. The majority of rheumatology fellows wrote appropriate responses scoring a mean (±SD) of 10.6 (±2.6) points (maximum score 18), with high inter-rater reliability (0.86). Most fellows were concise (74%) and courteous (68%) but not formal (22%). Ninety-two percent of fellows acknowledged that the patient's condition required urgent medical attention, but only 30% took active measures to contact the patient. No one encrypted their messages. The objective assessment of email communication skills is possible using simulated emails in an OSCE setting. The variable email communication scores and incidental patient safety gaps identified, suggest a need for further training and defined proficiency standards for physicians' email communication skills. PMID:20962134

  6. Invasive trichosporonosis due to Trichosporon asahii in a non-immunocompromised host: A rare case report

    Directory of Open Access Journals (Sweden)

    Rastogi V

    2007-01-01

    Full Text Available A case of invasive Trichosporonosis due to Trichosporon asahii in an otherwise healthy young adult male presenting as meningoencephalitis and pneumonia is reported here. T. asahii was isolated from cerebrospinal fluid and sputum of the patient and morphologic forms of organism was also demonstrated on direct Gram stain of sputum. The isolate was identified as T. asahii. The patient partially responded to fluconazole therapy. Our case suggests that T. asahii can no longer be linked with Trichospronosis in immunocompromised patient alone and any case of meningitis needs thorough mycological workup for its correct etiological identification and appropriate management.

  7. Developing an OMERACT Core Outcome Set for Assessing Safety Components in Rheumatology Trials

    DEFF Research Database (Denmark)

    Klokker, Louise; Tugwell, Peter; Furst, Daniel E

    2016-01-01

    in such COS. The Outcome Measures in Rheumatology (OMERACT) Filter 2.0 emphasizes the importance of measuring harms. The Safety Working Group was reestablished at the OMERACT 2016 with the objective to develop a COS for assessing safety components in trials across rheumatologic conditions. METHODS: The safety......OBJECTIVE: Failure to report harmful outcomes in clinical research can introduce bias favoring a potentially harmful intervention. While core outcome sets (COS) are available for benefits in randomized controlled trials in many rheumatic conditions, less attention has been paid to safety...... that patients consider relevant so that they will be able to make informed decisions. CONCLUSION: The OMERACT Safety Working Group will advance the work previously done within OMERACT using a new patient-driven approach....

  8. Policy challenges for the pediatric rheumatology workforce: Part I. Education and economics

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    Henrickson Michael

    2011-08-01

    Full Text Available Abstract For children with rheumatic conditions, the available pediatric rheumatology workforce mitigates their access to care. While the subspecialty experiences steady growth, a critical workforce shortage constrains access. This three-part review proposes both national and international interim policy solutions for the multiple causes of the existing unacceptable shortfall. Part I explores the impact of current educational deficits and economic obstacles which constrain appropriate access to care. Proposed policy solutions follow each identified barrier. Challenges consequent to obsolete, limited or unavailable exposure to pediatric rheumatology include: absent or inadequate recognition or awareness of rheumatic disease; referral patterns that commonly foster delays in timely diagnosis; and primary care providers' inappropriate or outdated perception of outcomes. Varying models of pediatric rheumatology care delivery consequent to market competition, inadequate reimbursement and uneven institutional support serve as additional barriers to care. A large proportion of pediatrics residency programs offer pediatric rheumatology rotations. However, a minority of pediatrics residents participate. The current generalist pediatrician workforce has relatively poor musculoskeletal physical examination skills, lacking basic competency in musculoskeletal medicine. To compensate, many primary care providers rely on blood tests, generating referrals that divert scarce resources away from patients who merit accelerated access to care for rheumatic disease. Pediatric rheumatology exposure could be enhanced during residency by providing a mandatory musculoskeletal medicine rotation that includes related musculoskeletal subspecialties. An important step is the progressive improvement of many providers' fixed referral and laboratory testing patterns in lieu of sound physical examination skills. Changing demographics and persistent reimbursement disparities will

  9. Pain, depressive symptoms and medication in German patients with rheumatoid arthritis-results from the linking patient-reported outcomes with claims data for health services research in rheumatology (PROCLAIR) study.

    Science.gov (United States)

    Jobski, Kathrin; Luque Ramos, Andres; Albrecht, Katinka; Hoffmann, Falk

    2017-07-01

    Pain and depressive symptoms are common in patients with rheumatoid arthritis (RA). Information on the prevalence and treatment of both conditions in German RA patients is scarce. Using data from a nationwide statutory health insurance fund (BARMER GEK), 6193 RA patients aged 18 to 79 years were provided with a questionnaire covering a variety of items such as demographics, medical condition and quality of life in 2015. Pain caused by the joint disorder (11-point scale) was classified as none existent/mild, moderate or severe. Depressive symptoms were determined using the World Health Organization's five-item Well-being Index and categorized as none existent, mild or moderate/severe. Another item covered additional use of over-the-counter drugs. Data were linked to dispensation records. A total of 3140 RA patients were included. Median age was 66 years (79% female). About 70% of patients were classified as having moderate or severe pain. Depressive symptoms were found in 52% and were far more common among patients with higher pain levels. Analgesic treatment ranged from 45% to 76% (non-opioid analgesics) and from 6% to 33% (opioids) in patients with no/mild pain and those reporting severe pain, respectively. In patients reporting moderate or severe pain, substantially higher prevalences of opioid use were observed among those with depressive symptoms. Depending on depressive symptoms, antidepressant use ranged from 7% to 37%. Overall, over-the-counter drug use varied between 30% and 59%. Pain and depressive symptoms are highly prevalent in German RA patients, often present together and influence each other's treatment. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  10. Pediatric rheumatology: what does the future hold?

    Science.gov (United States)

    Emery, Helen

    2004-08-01

    Effectiveness of the traditional rehabilitation approaches used in pediatric rheumatology has been difficult to prove and, in times of cost containment, this lack of evidence may lead to undertreatment with physical and occupational therapies. Quantitative methods such as those described in this issue by Broström and colleagues can be used to validate those approaches and to reinforce the need for careful attention to the effects of even minor loss of range and strength in children with juvenile arthritis. Historically, up to half of the children affected by polyarticular juvenile arthritis became disabled. Some factors that have led to improved outcomes for childhood rheumatic diseases are discussed, including medications (use of weekly low-dose methotrexate, intra-articular steroid injections, new biologic agents that specifically block mediators of inflammation, for example, tumor necrosis factor and interleukin-1), surgery (joint replacements), and psychosocial interventions (with schools and families). The importance of maintaining range of movement, strength, weight bearing, and ambulation, in an effort to prevent sequelae such as osteoporosis and wheelchair dependence, is emphasized. Early identification of children with rheumatic diseases and aggressive intervention, with a combined medical, rehabilitation, psychosocial, and, rarely, surgical approach, should now allow most affected children to reach adulthood with little or no disability.

  11. Wars in the history of rheumatology

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    P. Marson

    2011-09-01

    Full Text Available Some important discoveries in the history of rheumatology happened during war periods. It is well known that arthritis associated with conjunctivitis and urethritis, following dysenteric episodes, has been described during the First World War from the German Hans Reiter and, nearly contemporarily, from the French Nöel Fiessinger and Edgar Leroy. Less known is instead the fact that the first cases of sympathetic algoneurodystrophy have been reported by the American Silas Weir Mitchell in soldiers wounded by fire-arms, during the Civil War of Secession. Other war episodes have been crucial for the development of some drugs now abundantly applied to the care of rheumatic diseases. The discovery of therapeutic effects of immunosuppressive agents, in fact, happened as an indirect consequence of the use of poison gas, already during the First World War (mustard gas, but above all after an episode in the port of Bari in 1943, where an American cargo boat was sunk. It had been loaded with a quantity of cylinders containing a nitrogenous mustard, whose diffusion in the environment provoked more than 80 deaths owing to bone marrow aplasia.Moreover, the history of the cortisone shows a strict link to the Second World War, when Germany imported large quantities of bovine adrenal glands from Argentina, with the purpose of producing some gland extracts for the Luftwasse aviators, in order to increase their performance ability.

  12. Rheumatology education for undergraduate nursing, physiotherapy and occupational therapy students in the UK: standards, challenges and solutions.

    Science.gov (United States)

    Hewlett, S; Clarke, B; O'Brien, A; Hammond, A; Ryan, S; Kay, L; Richards, P; Almeida, C

    2008-07-01

    Rheumatological conditions are common, thus nurses (Ns) occupational therapists (OTs) and physiotherapists (PTs) require at least basic rheumatology knowledge upon qualifying. The aim of this study was to develop a core set of teaching topics and potential ways of delivering them. A modified Delphi technique was used for clinicians to develop preliminary core sets of teaching topics for each profession. Telephone interviews with educationalists explored their views on these, and challenges and solutions for delivering them. Inter-professional workshops enabled clinicians and educationalists to finalize the core set together, and generate methods for delivery. Thirty-nine rheumatology clinicians (12N, 14OT, 13PT) completed the Delphi consensus, proposing three preliminary core sets (N71 items, OT29, PT26). Nineteen educationalists (6N, 7OT, 6PT) participated in telephone interviews, raising concerns about disease-specific vs generic teaching and proposing many methods for delivery. Three inter-professional workshops involved 34 participants (clinicians: N12, OT9, PT5; educationalists: N2, OT3, PT2; Patient 1) who reached consensus on a single core set comprising six teaching units: Anatomy and Physiology; Assessment; Management and Intervention; Psychosocial Issues; Patient Education; and the Multi-disciplinary Team, recommending some topics within the units receive greater depth for some professions. An innovative range of delivery options was generated plus two brief interventions: a Rheumatology Chat Show and a Rheumatology Road Show. Working together, clinicians and educationalists proposed a realistic core set of rheumatology topics for undergraduate health professionals. They proposed innovative delivery methods, with collaboration between educationalists, clinicians and patients strongly recommended. These potential interventions need testing.

  13. Something fishy: an unusual Erysipelothrix rhusiopathiae infection in an immunocompromised individual.

    Science.gov (United States)

    Sinclair, Marie; Hawkins, Angela; Testro, Adam

    2013-04-03

    A 39-year-old man with a history of Crohn's disease presented to the emergency department with a 12-h history of worsening febrile illness. He deteriorated rapidly with progression to sepsis and was admitted to the intensive care unit. Initial treatment comprised broad spectrum antibiotics and inotropic support resulting in rapid improvement. With the immunocompromised state of the patient, and multiple blood cultures revealing Erysipelothrix rhusiopathiae, a detailed history disclosed a recent injury sustained from a fishing wire as the probable source of an infection. Treatment was narrowed to target the identified pathogen, the patient made a full recovery, and was counselled to be more cautious in future fishing activities.

  14. The Videofluorographic Swallowing Study in Rheumatologic Diseases: A Comprehensive Review

    Science.gov (United States)

    Di Piazza, Ambra; Costanzo, Massimo; Scopelliti, Laura; Salvaggi, Francesco; Cupido, Francesco; Salerno, Sergio; Lo Casto, Antonio; Midiri, Massimo; Lo Re, Giuseppe; Lagalla, Roberto

    2017-01-01

    Autoimmune connective tissue diseases are a heterogeneous group of pathologies that affect about 10% of world population with chronic evolution in 20%–80%. Inflammation in autoimmune diseases may lead to serious damage to other organs including the gastrointestinal tract. Gastrointestinal tract involvement in these patients may also due to both a direct action of antibodies against organs and pharmacological therapies. Dysphagia is one of the most important symptom, and it is caused by failure of the swallowing function and may lead to aspiration pneumonia, malnutrition, dehydration, weight loss, and airway obstruction. The videofluorographic swallowing study is a key diagnostic tool in the detection of swallowing disorders, allowing to make an early diagnosis and to reduce the risk of gastrointestinal and pulmonary complications. This technique helps to identify both functional and structural anomalies of the anatomic chain involved in swallowing function. The aim of this review is to systematically analyze the basis of the pathological involvement of the swallowing function for each rheumatological disease and to show the main features of the videofluorographic study that may be encountered in these patients. PMID:28706536

  15. Biosimilars in rheumatology: recommendations for regulation and use in Middle Eastern countries.

    Science.gov (United States)

    El Zorkany, Bassel; Al Ani, Nizar; Al Emadi, Samar; Al Saleh, Jamal; Uthman, Imad; El Dershaby, Yasser; Mounir, Mohamed; Al Moallim, Hani

    2018-05-01

    The increasing availability of biosimilar medicines in Middle Eastern regions may provide an opportunity to increase the number of rheumatology patients who have access to traditionally more expensive biologic medicines. However, as well as a lack of real-world data on the use of biosimilar medicines in practice, the availability of intended copies in the region may undermine physician confidence in prescribing legitimate biosimilar medicines. There is a need for regional recommendations for healthcare professionals to ensure that biosimilar drugs can be used safely. Therefore, a literature search was performed with the aim of providing important recommendations for the regulation and use of biosimilar medicines in the Middle East from key opinion leaders in rheumatology from the region. These recommendations focus on improving the availability of relevant real-world data, ensuring that physicians are aware of the difference between intended copies and true biosimilars and ensuring that physicians are responsible for making any prescribing and switching decisions.

  16. Elizabethkingia meningoseptica bacteremia in immunocompromised hosts: The first case series from India

    Directory of Open Access Journals (Sweden)

    Abdul Ghafur

    2013-01-01

    Full Text Available Background: Although Elizabethkingia meningoseptica (Chryseobacterium meningosepticum infections in immunocompromised hosts have been recognised, clinical data detailing these infections remain limited, especially from India. Antimicrobial susceptibility data on E. meningoseptica remain very limited, with no established breakpoints by Clinical and Laboratory Standards Institute (CLSI. The organism is usually multidrug resistant to antibiotics usually prescribed for treating Gram-negative bacterial infections, a serious challenge to the patient and the treating clinicians. Materials and Methods: The analysis was done in a tertiary care oncology and stem cell transplant center. Susceptibility testing and identification of E. meningoseptica was done using Vitek auto analyzer. Records of immunocompromised patients with E. meningoseptica bacteremia were analysed from January 2009 to March 2012. Results: A total of 29 E. meningoseptica bacteremia cases were documented between 2009 and 2012. Eleven patients were immunocompromised. Three were post stem cell transplant and one was post cord blood transplant. The mean age of the patients was 48.4 years. Mean Charlson′s comorbidity index was 5.7. Four had solid organ malignancies, five had hematological malignancies, and two had lymphoreticular malignancy. Eight patients had received chemotherapy. Mean Apache II score was 18. Mean Pitts score for bacteremia was 4.7. Two were neutropenic (one post SCT, one MDS post chemo with a mean white blood cell (WBC count of 450/mm 3 . Ten had a line at the time of bacteremia. Mean duration of the line prior to bacteremia was 8 days. Eight had line-related bacteremia. Three had pneumonia with secondary bacteremia. All received combination therapy with two or more antibiotics which included cotrimoxazole, rifampicin, piperacillin-tazobactam, tigecycline, or cefepime-tazobactam. All the isolates showed in vitro resistance to ciprofloxacin. Five patients died, but a

  17. MEDI4893* Promotes Survival and Extends the Antibiotic Treatment Window in a Staphylococcus aureus Immunocompromised Pneumonia Model.

    Science.gov (United States)

    Hua, L; Cohen, T S; Shi, Y; Datta, V; Hilliard, J J; Tkaczyk, C; Suzich, J; Stover, C K; Sellman, B R

    2015-08-01

    Immunocompromised individuals are at increased risk of Staphylococcus aureus pneumonia. Neutralization of alpha-toxin (AT) with the monoclonal antibody (MAb) MEDI4893* protects normal mice from S. aureus pneumonia; however, the effects of the MAb in immunocompromised mice have not been reported. In this study, passive immunization with MEDI4893* increased survival rates and reduced bacterial numbers in the lungs in an immunocompromised murine S. aureus pneumonia model. Lungs from infected mice exhibited alveolar epithelial damage, protein leakage, and bacterial overgrowth, whereas lungs from mice passively immunized with MEDI4893* retained a healthy architecture, with an intact epithelial barrier. Adjunctive therapy or prophylaxis with a subtherapeutic MEDI4893* dose combined with subtherapeutic doses of vancomycin or linezolid improved survival rates, compared with the monotherapies. Furthermore, coadministration of MEDI4893* with vancomycin or linezolid extended the antibiotic treatment window. These data suggest that MAb-mediated neutralization of AT holds promise in strategies for prevention and adjunctive therapy among immunocompromised patients. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

  18. Italian Society of Rheumatology (SIR recommendations for performing arthrocentesis

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    A. Spadaro

    2011-09-01

    Full Text Available Joint fluid aspiration, or arthrocentesis, is one of the most useful and commonly performed procedures for the diagnosis and treatment of rheumatic diseases, but to date no definite guidelines have been published. For this reason, a group of experts of the Italian Society of Rheumatology (SIR produced evidence based recommendations for performing arthrocentesis. Among them, the most relevant are: a arthrocentesis is necessary when synovial effusion of unknown origin is present, especially if septic or crystal arthritis is suspected; b the patient should be clearly informed of the benefits and risks of the procedure in order to give an informed consent; c ultrasonography should be used to facilitate arthrocentesis in difficult joints; d fluid evacuation often has a therapeutic effect and facilitates the success of the following intraarticular injection; e careful skin disinfection and the use of sterile, disposable material is mandatory for avoiding septic complications. Disposable, non sterile gloves should always be used by the operator, mainly for his own protection; f contraindications are the presence of skin lesions or infections in the area of the puncture; g the patient’s anticoagulant treatment is not a contraindication, providing the therapeutic range is not exceeded; h joint rest after arthrocentesis is not indicated. Several of these recommendations were based on experts’ opinion rather than on published evidence which is scanty.

  19. Analysis of information on rheumatology from a selected Internet forum in the context of the need for telemedicine solutions

    Directory of Open Access Journals (Sweden)

    Rafał Szpakowski

    2015-12-01

    Full Text Available Objectives: The aim of this study was to determine how often patients and undiagnosed people who complain of musculoskeletal system and rheumatic diseases look for knowledge contained on an Internet forum. Content analysis was used to identify the level of Internet users’ activity in the rheumatology section, compared to other areas of medicine. Material and methods : Material included information posted on the Internet forum established at http://medyczka.pl/. The method employed was a quantitative and qualitative analysis of the content. The method was based on qualitative assessment of the first post in each thread presented on the rheumatologic subforum, by assigning keywords, subjectively determined by the researcher, to such a post. For each keyword a specific definition was established, determining a situation in which a given keyword was used. Results: The quantitative analysis qualified rheumatology in the last place in terms of Internet users’ activity compared to other branches of medicine. The qualitative assessment of the rheumatologic forum indicated that the three most common keywords were joint pain (32, joints swelling (13, and schoolage (13. The three most common intentional keywords (arranged in order of their decreasing number were diagnosis based on symptoms (29, interpretation of the laboratory test results (9, and how to deal with symptoms (8. Conclusions : The analysis leads to the conclusion that the rheumatologic subforum, along with other subforums listed above, presents a critically low level of discussion. There is a large disproportion between the number of active and passive forum users, suggesting that numerous individuals search the forum for presented information. Based on the qualitative analysis of the information stocks of the rheumatologic subforum, it was established that most of the questions posted concerned young individuals, who complained of joint pain and swelling, and asked for a possible

  20. Analysis of information on rheumatology from a selected Internet forum in the context of the need for telemedicine solutions.

    Science.gov (United States)

    Szpakowski, Rafał; Maślińska, Maria; Dykowska, Grażyna; Zając, Patrycja

    2015-01-01

    The aim of this study was to determine how often patients and undiagnosed people who complain of musculoskeletal system and rheumatic diseases look for knowledge contained on an Internet forum. Content analysis was used to identify the level of Internet users' activity in the rheumatology section, compared to other areas of medicine. Material included information posted on the Internet forum established at http://medyczka.pl/. The method employed was a quantitative and qualitative analysis of the content. The method was based on qualitative assessment of the first post in each thread presented on the rheumatologic subforum, by assigning keywords, subjectively determined by the researcher, to such a post. For each keyword a specific definition was established, determining a situation in which a given keyword was used. The quantitative analysis qualified rheumatology in the last place in terms of Internet users' activity compared to other branches of medicine. The qualitative assessment of the rheumatologic forum indicated that the three most common keywords were joint pain (32), joints swelling (13), and schoolage (13). The three most common intentional keywords (arranged in order of their decreasing number) were diagnosis based on symptoms (29), interpretation of the laboratory test results (9), and how to deal with symptoms (8). The analysis leads to the conclusion that the rheumatologic subforum, along with other subforums listed above, presents a critically low level of discussion. There is a large disproportion between the number of active and passive forum users, suggesting that numerous individuals search the forum for presented information. Based on the qualitative analysis of the information stocks of the rheumatologic subforum, it was established that most of the questions posted concerned young individuals, who complained of joint pain and swelling, and asked for a possible diagnosis based on the presented symptomatology, interpretation of the laboratory

  1. Symptoms of Infectious Diseases in Immunocompromised Travelers: A Prospective Study With Matched Controls

    NARCIS (Netherlands)

    Baaten, Gijs G.; Geskus, Ronald B.; Kint, Joan A.; Roukens, Anna H. E.; Sonder, Gerard J.; van den Hoek, Anneke

    2011-01-01

    Background. Immunocompromised travelers to developing countries are thought to have symptomatic infectious diseases more often and longer than non-immunocompromised travelers. Evidence for this is lacking. This study evaluates whether immunocompromised short-term travelers are at increased risk of

  2. Paediatric rheumatology practice in the UK benchmarked against the British Society for Paediatric and Adolescent Rheumatology/Arthritis and Musculoskeletal Alliance Standards of Care for juvenile idiopathic arthritis.

    Science.gov (United States)

    Kavirayani, Akhila; Foster, Helen E

    2013-12-01

    To describe current clinical practice against the BSPAR/ARMA Standards of Care (SOCs) for children and young people (CYP) with incident JIA. Ten UK paediatric rheumatology centres (including all current centres nationally accredited for paediatric rheumatology higher specialist training) participated in a retrospective case notes review using a pretested pro forma based on the SOC. Data collected per centre included clinical service configuration and the initial clinical care for a minimum of 30 consecutive new patients seen within the previous 2 years and followed up for at least 6 months. A total of 428 CYP with JIA (median age 11 years, range 1-21 years) were included, with complete data available for 73% (311/428). Against the key SOCs, 41% (175/428) were assessed ≤10 weeks from symptom onset, 60% (186/311) ≤4 weeks from referral, 26% (81/311) had eye screening at ≤6 weeks, 83% (282/341) had joint injections at ≤6 weeks, 59% (184/311) were assessed by a nurse specialist at ≤4 weeks and 45% (141/311) were assessed by a physiotherapist at ≤8 weeks. A median of 6% of patients per centre participated in clinical trials. All centres had access to eye screening and prescribed biologic therapies. All had access to a nurse specialist and physiotherapist. Most had access to an occupational therapist (8/10), psychologist (8/10), joint injection lists (general anaesthesia/inhaled analgesia) (9/10) and designated transitional care clinics (7/10). This first description of UK clinical practice in paediatric rheumatology benchmarked against the BSPAR/ARMA SOCs demonstrates variable clinical service delivery. Considerable delay in access to specialist care is evident and this needs to be addressed in order to improve clinical outcomes.

  3. Position paper from the Spanish Society of Rheumatology on biosimilar drugs.

    Science.gov (United States)

    Abad Hernández, Miguel Ángel; Andreu, José Luis; Caracuel Ruiz, Miguel Ángel; Belmonte Serrano, Miguel Ángel; Díaz-González, Federico; Moreno Muelas, José Vicente

    2015-01-01

    A biosimilar (BS) is a biological drug that contains a version of the active substance of an already authorized original biological product. The BSs are marketed after patent period of the original drug has ended and once it has been demonstrated that the differences regarding the innovative medicine have no relevant effect on its safety or clinical efficacy. The Spanish Society of Rheumatology, in line with the European Medicines Agency, considers that because of its nature and complexity of production, a BS cannot be considered to be the same as a generic drug. The Spanish Society of Rheumatology expresses an unequivocal commitment to the sustainability of the health system in our country and our steadfast alignment with all measures designed to ensure continuity, without reducing the quality of care. Therefore, we believe that the advent of BSs will likely facilitate access of patients with rheumatic diseases to the biological drugs. This article reviews the European Medicines Agency requirements for authorization, the Spanish legal framework and controversies on BS and presents the position paper of the Spanish Society of Rheumatology on these drugs. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  4. Rheumatology telephone advice line - experience of a Portuguese department.

    Science.gov (United States)

    Ferreira, R; Marques, A; Mendes, A; da Silva, J A

    2015-01-01

    Telephone helplines for patients are tool for information and advice. They can contribute to patient's satisfaction with care and to the effectiveness and safety of treatments. In order to achieve this, they need to be adequately adapted to the target populations, as to incorporate their abilities and expectations. a) Evaluate the adherence of patients to a telephone helpline managed by nurses in a Portuguese Rheumatology Department, b) Analyse the profile of users and their major needs, c) Analyse the management of calls by the nurses. The target population of this phone service are the patients treated at Day Care Hospital and Early Arthritis Clinic of our department. Nurses answered phone calls immediately between 8am and 4pm of working days. In the remaining hours messages were recorded on voice mail and answered as soon as possible. Details of the calls were registered in a dedicated sheet and patients were requested permission to use data to improve the service, with respect for their rights of confidentiality, anonymity and freedom of decision. In 18 months 173 calls were made by 79 patients, with a mean age of 47.9 years (sd=9.13). Considering the proportions of men and women in the target population, it was found that men called more frequently (M= 32.7% vs F= 20.4%, p=.016). The reasons for these calls can be divided into three categories: instrumental help, such as the request for results of complementary tests or rescheduling appointments (43.9% of calls); counselling on side effects or worsening of the disease/pain (31.2 %); counselling on therapy management (24.9%). Neither sex nor patient age were significantly related to these reasons for calling. Nurses resolved autonomously half (50.3%) of the calls and in 79.8% of the cases there was no need for patient referral to other health services. About a quarter of patients adhered to the telephone helpline.. Patients called to obtain support in the management of disease and therapy or to report side

  5. Biochemical assessement of liver enzymes in immunocompromised ...

    African Journals Online (AJOL)

    Aim: This study aims at the estimation of serum alkaline phosphatase (ALP), alanine aminotransferase (ALT), Aspartate aminotransferase (AST), and glutmyltransferase GGT (Liver enzymes) in Human immunodeficiency virus(HIV) and/or Acquired immune deficiency syndrome(AIDS) patients in parts of Edo State, Nigeria.

  6. Comparison of Two Molecular Assays for Detection and Characterization of Aspergillus fumigatus Triazole Resistance and Cyp51A Mutations in Clinical Isolates and Primary Clinical Samples of Immunocompromised Patients

    OpenAIRE

    Patricia Postina; Julian Skladny; Tobias Boch; Oliver A. Cornely; Oliver A. Cornely; Axel Hamprecht; Peter-Michael Rath; Jörg Steinmann; Oliver Bader; Thomas Miethke; Anne Dietz; Natalia Merker; Wolf-Karsten Hofmann; Dieter Buchheidt; Birgit Spiess

    2018-01-01

    In hematological patients, the incidence of invasive aspergillosis (IA) caused by azole resistant Aspergillus fumigatus (ARAf) is rising. As the diagnosis of IA is rarely based on positive culture in this group of patients, molecular detection of resistance mutations directly from clinical samples is crucial. In addition to the in-house azole resistance ARAf polymerase chain reaction (PCR) assays detecting the frequent mutation combinations TR34/L98H, TR46/Y121F/T289A, and M220 in the Aspergi...

  7. Self-management model in the scheduling of successive appointments in rheumatology.

    Science.gov (United States)

    Castro Corredor, David; Cuadra Díaz, José Luis; Mateos Rodríguez, Javier José; Anino Fernández, Joaquín; Mínguez Sánchez, María Dolores; de Lara Simón, Isabel María; Tébar, María Ángeles; Añó, Encarnación; Sanz, María Dolores; Ballester, María Nieves

    2018-01-08

    The rheumatology service of Ciudad Real Hospital, located in an autonomous community of that same name that is nearly in the center of Spain, implemented a self-management model of successive appointments more than 10 years ago. Since then, the physicians of the department schedule follow-up visits for their patients depending on the disease, its course and ancillary tests. The purpose of this study is to evaluate and compare the self-management model for successive appointments in the rheumatology service of Ciudad Real Hospital versus the model of external appointment management implemented in 8 of the hospital's 15 medical services. A comparative and multivariate analysis was performed to identify variables with statistically significant differences, in terms of activity and/or performance indicators and quality perceived by users. The comparison involved the self-management model for successive appointments employed in the rheumatology service of Ciudad Real Hospital and the model for external appointment management used in 8 hospital medical services between January 1 and May 31, 2016. In a database with more than 100,000 records of appointments involving the set of services included in the study, the mean waiting time and the numbers of non-appearances and rescheduling of follow-up visits in the rheumatology department were significantly lower than in the other services. The number of individuals treated in outpatient rheumatology services was 7,768, and a total of 280 patients were surveyed (response rate 63.21%). They showed great overall satisfaction, and the incidence rate of claims was low. Our results show that the self-management model of scheduling appointments has better results in terms of activity indicators and in quality perceived by users, despite the intense activity. Thus, this study could be fundamental for decision making in the management of health care organizations. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de

  8. Efficacy of an Interinstitutional Mentoring Program Within Pediatric Rheumatology.

    Science.gov (United States)

    Moorthy, Lakshmi Nandini; Muscal, Eyal; Riebschleger, Meredith; Klein-Gitelman, Marisa; Nigrovic, Lise E; Horon, Jeffrey R; Rouster-Stevens, Kelly; Ferguson, Polly J; Eberhard, B Anne; Brunner, Hermine I; Prahalad, Sampath; Schneider, Rayfel; Nigrovic, Peter A

    2016-05-01

    The small size of many pediatric rheumatology programs translates into limited mentoring options for early career physicians. To address this problem, the American College of Rheumatology (ACR) and the Childhood Arthritis and Rheumatology Research Alliance (CARRA) developed a subspecialty-wide interinstitutional mentoring program, the ACR/CARRA Mentoring Interest Group (AMIGO). We sought to assess the impact of this program on mentoring within pediatric rheumatology. In a longitudinal 3-year study, participant ratings from the AMIGO pilot program were compared with those after the program was opened to general enrollment. Access to mentoring as a function of career stage was assessed by surveys of the US and Canadian pediatric rheumatologists in 2011 and 2014, before and after implementation of AMIGO. Participants in the pilot phase (19 dyads) and the general implementation phase (112 dyads) reported comparable success in establishing mentor contact, suitability of mentor-mentee pairing, and benefit with respect to career development, scholarship, and work-life balance. Community surveys showed that AMIGO participation as mentee was high among fellows (86%) and modest among junior faculty (31%). Implementation correlated with significant gains in breadth of mentorship and in overall satisfaction with mentoring for fellows but not junior faculty. AMIGO is a career mentoring program that serves most fellows and many junior faculty in pediatric rheumatology across the US and Canada. Program evaluation data confirm that a subspecialty-wide interinstitutional mentoring program is feasible and can translate into concrete improvement in mentoring, measurable at the level of the whole professional community. © 2016, American College of Rheumatology.

  9. [Hospital financing in 2016. Relevant changes for rheumatology].

    Science.gov (United States)

    Fiori, W; Bunzemeier, H; Lakomek, H-J; Buscham, K; Lehmann, H; Fuchs, A-K; Bessler, F; Roeder, N

    2016-03-01

    Hospital financing 2016 will be influenced by the prospects of the approaching considerable changes. It is assumed that the following years will lead to a considerable reallocation of financial resources between hospitals. While not directly targeted by new regulations, reallocations always also affect specialties like rheumatology. Compared to the alterations in the legislative framework the financial effects of the yearly adaptation of the German diagnosis-related groups system are subordinate. Only by comprehensive consideration of current and expected changes a forward-looking and sustainable strategy can be developed. The following article presents the relevant changes and discusses the consequences for hospitals specialized in rheumatology.

  10. Dose reduction in high-resolution MSCT. Examinations of the chest for early detection of pneumonia in immunocompromised patients; High-Resolution-MSCT-Thoraxuntersuchungen zur Infiltratsuche. Untersuchung einer Dosisreduktion bei immunsupprimierten Patienten

    Energy Technology Data Exchange (ETDEWEB)

    Yamamura, J.; Adam, G.; Wedegaertner, U. [Klinik und Poliklinik fuer Diagnostische und Interventionelle Radiologie, Universitaetsklinikum Hamburg-Eppendorf (Germany); Wildberger, J.E.; Dichtl, D. [Klinik fuer Radiologische Diagnostik, RWTH Aachen (Germany); Nagel, H.D. [Philips Medizin Systeme GmbH, Hamburg (Germany)

    2009-06-15

    Purpose: the purpose of this study was to optimize high-resolution MSCT chest protocols for the evaluation of symptomatic immunosuppressed patients with suspected pneumonia using a dose-simulating program. Materials and methods: using the MSCT (Siemens, Erlangen, Germany), 30 immunosuppressed patients with suspected pneumonia were examined with a low-dose HRCT of the chest (120 kV, 100 eff.mAs and collimation of 4 x 1 mm). A dose-simulating program was used to reconstruct the raw data at four different dose levels (70, 50, 35 und 25 mAs). For dose simulation for each mAs product, the correspondent noise level was added to the data. Images were generated with a slice thickness of 1 mm and 5 mm in the lung window. The images were then evaluated independently by two radiologists and graded on a scale of 1 to 3 points: 1 = no pneumonia, 2 = unclear, 3 = pneumonia. A receiver operating curve (ROC) analysis was performed to calculate the area under the curve (AUC). The actual dosage in mSv was calculated. The sensitivity and specificity were evaluated. Results: out of 30 patients, 7 had a normal chest finding and 23 had pneumonia. The area under the ROC curve (AUC) was 1.0 for every dosage and slice thickness. Infiltrates were detected correctly for all dosage levels. The sensitivity was 100% for all dose levels and slice thicknesses. There was one false positive finding at 35 mAs and 1 mm slice thickness. At this dose level the specificity was reduced to 93%. A reduction to 25 mAs had no influence on the detection of pneumonia. Thus, MSCT examinations of the chest can be performed with 25 mAs without missing the right diagnosis, resulting in an effective dose of 1.15 mSv (men), 1.5 mSv (women) and a CTDIvol of 2.5 mGy. (orig.)

  11. Spondylodiscitis of the lumbar spine in a non-immunocompromised host caused by Yersinia enterocolitica O:9.

    Science.gov (United States)

    Ellenrieder, Martin; Zautner, Andreas E; Podbielski, Andreas; Bader, Rainer; Mittelmeier, Wolfram

    2010-04-01

    Here presented is an extremely rare case of a spinal osteomyelitis (L5-S1) with epidural empyema in a non-immunocompromised 62-year-old man caused by Yersinia enterocolitica O:9. The infection occurred acutely and required immediate surgical treatment. Y. enterocolitica was cultured from the empyema fluid, wound swabs of the intervertebral disc L5-S1 and stool cultures. Following the surgical decompression and antibiotic treatment, the patient recovered completely, without neurological deficits. A review of the literature revealed only sparse cases of spondylodiscitis due to other Y. enterocolitica serogroups. To our knowledge, we report here the first case of a spondylodiscitis of the lumbar spine caused by Y. enterocolitica serovar O:9 in a non-immunocompromised patient.

  12. The United States rheumatology workforce: supply and demand, 2005-2025.

    Science.gov (United States)

    Deal, Chad L; Hooker, Roderick; Harrington, Timothy; Birnbaum, Neal; Hogan, Paul; Bouchery, Ellen; Klein-Gitelman, Marisa; Barr, Walter

    2007-03-01

    To develop and apply a model that allows prediction of current and future supply and demand for rheumatology services in the US. A supply model was developed using the age and sex distribution of current physicians, retirement and mortality rates, the number of fellowship slots and fill rates, and practice patterns of rheumatologists. A Markov projection model was used to project needs in 5-year increments from 2005 to 2025. The number of rheumatologists for adult patients in the US in 2005 is 4,946. Male and female rheumatologists are equally distributed up to age 44; above age 44, men predominate. The percent of women in adult rheumatology is projected to increase from 30.2% in 2005 to 43.6% in 2025. The mean number of visits per rheumatologist per year is 3,758 for male rheumatologists and 2,800 for female rheumatologists. Assuming rheumatology supply and demand are in equilibrium in 2005, the demand for rheumatologists in 2025 is projected to exceed supply by 2,576 adult and 33 pediatric rheumatologists. The primary factors in the excess demand are an aging population which will increase the number of people with rheumatic disorders, growth in the Gross Domestic Product, and flat rheumatology supply due to fixed numbers entering the workforce and to retirements. The productivity of younger rheumatologists and women, who will make up a greater percentage of the future workforce, may also have important effects on supply. Unknown effects that could influence these projections include technology advances, more efficient practice methods, changes in insurance reimbursements, and shifting lifestyles. Current data suggest that the pediatric rheumatology workforce is experiencing a substantial excess of demand versus supply. Based on assessment of supply and demand under current scenarios, the demand for rheumatologists is expected to exceed supply in the coming decades. Strategies for the profession to adapt to this changing health care landscape include increasing

  13. Proceedings from the 7th Annual International Society for Musculoskeletal Imaging in Rheumatology (ISEMIR) conference

    DEFF Research Database (Denmark)

    Troum, Orrin M; Pimienta, Olga L; Schmidt, Wolfgang A

    2015-01-01

    The International Society for Musculoskeletal Imaging in Rheumatology (ISEMIR) was founded in 2005 with the goal of discussing matters related to imaging in rheumatology, particularly, validation, education, and use in clinical practice and research. Because the field of musculoskeletal (MSK...

  14. Decision Making with Ultrasound in Rheumatology

    NARCIS (Netherlands)

    M. van der Ven (Myrthe)

    2018-01-01

    markdownabstractThe _first aim_ of this thesis was to evaluate the added value of ultrasound in clinical decision making in patients with arthralgia, patients with psoriasis and monitoring RA patients. Our _second aim_ was to increase sensitivity of power Doppler ultrasound for MCP joints.

  15. Pediatric rheumatology: An under-recognized subspecialty in India

    Directory of Open Access Journals (Sweden)

    Akhila Kavirayani

    2017-01-01

    Full Text Available Pediatrics in India at the levels of both undergraduate and postgraduate training is often viewed upon as an acute disease specialty with little emphasis on chronic medical musculoskeletal diseases. Pediatric rheumatology is an under-recognized subspecialty of pediatrics which deals specifically with childhood arthritis, noninflammatory joint pains, connective tissue diseases, autoimmune diseases, vasculitis, and other rare inflammatory disorders. This article aims to give a bird's eye view of the repertoire of commonly encountered problems seen by a pediatric rheumatologist, via a classical case vignette for each topic followed by discussion. There is also mention of some rare diseases managed within pediatric rheumatology to give a flavor of the spectrum of diseases encountered. This is to raise awareness of the importance of pediatric rheumatology as a subspecialty within India and to prompt readers to seek specialist advice when encountering challenging cases. Pediatric rheumatologists network and work collaboratively with many other specialties such as ophthalmology, dermatology, neurology, orthopedics, nephrology, infectious diseases, immunology, and gastroenterology for combined care of diverse conditions. There is an unmet need in India to develop a training program for pediatric rheumatology so that shared care pathways with sensitized pediatricians and other specialists can be developed nationwide, to serve these children better to achieve optimal outcomes.

  16. Globalization of rheumatology: activities of ILAR. Think global - act local

    NARCIS (Netherlands)

    Dequeker, Jan; Rasker, Johannes J.; El-Hadidi, Tahsin

    2001-01-01

    In 1997 a distinguished EULAR rheumatologist involved in the development of biologics asked somewhat ironically, “What is ILAR [International League of Associations for Rheumatology] doing?” Now, 3 years later, we are in a position to review ILAR’s activities in recent years and its plans for the

  17. Rheumatology training experience across Europe: analysis of core competences

    NARCIS (Netherlands)

    Sivera, Francisca; Ramiro, Sofia; Cikes, Nada; Cutolo, Maurizio; Dougados, Maxime; Gossec, Laure; Kvien, Tore K.; Lundberg, Ingrid E.; Mandl, Peter; Moorthy, Arumugam; Panchal, Sonia; Da Silva, José A. P.; Bijlsma, Johannes W.; Ҫollaku, Ledio; Aroyan, Armine; Radner, Helga; Tushina, Anastasyia; de Langhe, Ellen; Sokolovic, Sekib; Shumnalieva, Russka; Baresic, Marko; Senolt, Ladislav; Holland-Fischer, Mette; Kull, Mart; Puolitaival, Antti; Gobejishvili, Nino; Hueber, Axel; Fanouriakis, Antonis; MacMullan, Paul; Rimar, Doron; Bugatti, Serena; Zepa, Julija; Menassa, Jeanine; Karpec, Diana; Misevska-Percinkova, Snezana; Cassar, Karen; Deseatnicova, Elena; Tas, SanderW; Lie, Elisabeth; Sznajd, Jan; Berghea, Florian; Povzun, Anton; Jeremic, Ivica; Mlynarikova, Vanda; Frank-Bertoncelj, Mojca; Chatzidionysiou, Katerina; Dumusc, Alexandre; Hatemi, Gulen; Ozdemirel, Erhan; Biliavska, Iuliia

    2016-01-01

    Background: The aim of this project was to analyze and compare the educational experience in rheumatology specialty training programs across European countries, with a focus on self-reported ability. Method: An electronic survey was designed to assess the training experience in terms of

  18. Educational needs of health professionals working in rheumatology in Europe.

    Science.gov (United States)

    Vliet Vlieland, Theodora P M; van den Ende, Cornelia H M; Alliot-Launois, Francoise; Beauvais, Catherine; Gobbo, Milena; Iagnocco, Annamaria; Lundberg, Ingrid E; Munuera-Martínez, Pedro V; Opava, Christina H; Prior, Yeliz; Redmond, Anthony; Smucrova, Hana; Wiek, Dieter

    2016-01-01

    To explore the availability of postgraduate education for health professionals (HPs) working in rheumatology in Europe, and their perceived educational needs and barriers for participation in current educational offerings. Structured interviews were conducted with national representatives of rheumatology HPs' organisations and an online survey among individual HPs was disseminated through existing European League Against Rheumatism (EULAR) networks (10 languages including English). These comprised questions on: availability of postgraduate education, familiarity with EULAR and its educational offerings, unmet needs regarding the contents and mode of delivery and potential barriers to participate in education (0-10 scales). According to 17 national representatives, postgraduate rheumatology education was most common for nurses, physical and occupational therapists. There were 1041 individuals responding to the survey, of whom 48% completed all questions. More than half (56%) were familiar with EULAR as an organisation, whereas rheumatology education for HPs in most countries. There are opportunities to raise awareness regarding EULAR educational offerings and to develop courses provided in HPs' own country, tailored to national needs and barriers and taking language barriers into consideration.

  19. Research priorities in pediatric rheumatology: The Childhood Arthritis and Rheumatology Research Alliance (CARRA consensus

    Directory of Open Access Journals (Sweden)

    Mellins Elizabeth D

    2008-04-01

    Full Text Available Abstract Background North American pediatric rheumatologists have created an investigator-initiated research network (the Childhood Arthritis and Rheumatology Research Alliance – CARRA to facilitate multi-centre studies. One of the first projects undertaken by this network was to define, by consensus, research priorities for the group, and if possible a first group-sponsored clinical trial in which all members could participate. Methods We determined consensus using the Delphi approach. This approach has been used extensively in health research to reach consensus in large groups. It uses several successive iterations of surveys eliciting ideas and opinions from specialists in the field. Three surveys were designed based on this method and were distributed to members of CARRA to elicit and rank-order research priorities. Results A response rate of 87.6% was achieved in the final survey. The most highly ranked research suggestion was to study infliximab treatment of uveitis unresponsive to methotrexate. Other highly ranked suggestions were to study i the treatment of systemic arthritis with anakinra and ii the treatment of pediatric systemic lupus erythematosus with mycophenolate mofetil. Conclusion The Delphi approach was an effective and practical method to define research priorities in this group. Ongoing discussion and cooperation among pediatric rheumatologists in CARRA and others world-wide will help in developing further research priorities and to facilitate the execution of clinical trials in the future.

  20. Association between antinuclear antibody titers and connective tissue diseases in a Rheumatology Department.

    Science.gov (United States)

    Menor Almagro, Raúl; Rodríguez Gutiérrez, Juan Francisco; Martín-Martínez, María Auxiliadora; Rodríguez Valls, María José; Aranda Valera, Concepción; de la Iglesia Salgado, José Luís

    To determine the dilution titles at antinuclear antibodies (ANA) by indirect immunofluorescence observed in cell substrate HEp-2 and its association with the diagnosis of systemic connective tissue disease in ANA test requested by a Rheumatology Unit. Samples of patients attended for the first time in the rheumatology unit, without prior ANA test, between January 2010 and December 2012 were selected. The dilution titers, immunofluorescence patterns and antigen specificity were recorded. In January 2015 the diagnosis of the patients were evaluated and classified in systemic disease connective tissue (systemic lupus erythematosus, Sjögren's syndrome, systemic sclerosis, undifferentiated connective, antiphospholipid syndrome, mixed connective tissue and inflammatory myophaty) or not systemic disease connective tissue. A total of 1282 ANA tests requested by the Rheumatology Unit in subjects without previous study, 293 were positive, predominance of women (81.9%). Patients with systemic connective tissue disease were recorded 105, and 188 without systemic connective tissue disease. For 1/640 dilutions the positive predictive value in the connective was 73.3% compared to 26.6% of non-connective, and for values ≥1/1,280 85% versus 15% respectively. When performing the multivariate analysis we observed a positive association between 1/320 dilution OR 3.069 (95% CI: 1.237-7.614; P=.016), 1/640 OR 12.570 (95% CI: 3.659-43.187; P=.000) and ≥1/1,280 OR 42.136 (95% CI: 8.604-206.345; P=.000). These results show association titles dilution ≥1/320 in ANA's first test requested by a Rheumatology Unit with patients with systemic connective tissue disease. The VPP in these patients was higher than previous studies requested by other medical specialties. This may indicate the importance of application of the test in a targeted way. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  1. Incorporating motivational interviewing into rheumatology care.

    Science.gov (United States)

    Palmer, Deborah; Miedany, Yasser El

    2018-04-12

    Deborah Palmer, Advanced Nurse Practitioner, North Middlesex University Hospital, and Yasser El Miedany, Consultant Rheumatologist, discuss ways to close the gap between disease control and patient empowerment.

  2. Mycobacterium avium intracellulare complex causing olecranon bursitis and prosthetic joint infection in an immunocompromised host

    Directory of Open Access Journals (Sweden)

    Eugene M. Tan

    2016-01-01

    Full Text Available Case: A 73-year-old immunocompromised male presented with recurrent left elbow swelling due to Mycobacterium avium intracellulare complex (MAC olecranon bursitis. 3 years after completing MAC treatment, he underwent right total knee arthroplasty (TKA. 1 year later, he developed TKA pain and swelling and was diagnosed with MAC prosthetic joint infection (PJI. He underwent TKA resection, reimplantation, and 12 months of anti-MAC therapy. This patient is the seventh case report of MAC olecranon bursitis and the third case report of MAC PJI. He is the only report of both MAC olecranon bursitis and PJI occurring in the same patient. Informed consent: This patient was informed and agreed to the publication of this material.

  3. Is Photodynamic Therapy with Adjunctive Non-Surgical Periodontal Therapy Effective in the Treatment of Periodontal Disease under Immunocompromised Conditions

    International Nuclear Information System (INIS)

    Javed, F.; Hezaimi, K.A.; Qadri, T.; Ahmed, H.B.; Corbet, F.E.; Romanos, G.E.

    2013-01-01

    The aim was to assess whether or not photodynamic therapy (PDT) with adjunctive scaling-and-root-planing (SRP) is effective in the treatment of periodontitis under immunocompromised conditions. PubMed/Medline and Google-Scholar databases were searched from 1967 to May 2013 using various key words. Six studies (five experimental and one clinical) were included. In the clinical study, SRP with PDT was reported to be ineffective in treating chronic periodontitis in T2DM patients. All experimental studies reported significantly less bone loss in periodontal defects treated with SRP+PDT than those treated with SRP alone. Efficacy of PDT+SRP in the treatment of periodontal disease under immunocompromised conditions remains unclear. (author)

  4. Is Photodynamic Therapy with Adjunctive Non-Surgical Periodontal Therapy Effective in the Treatment of Periodontal Disease under Immunocompromised Conditions

    Energy Technology Data Exchange (ETDEWEB)

    Javed, F.; Hezaimi, K. A. [King Saud Univ., Riyadh (Saudi Arabia). College of Applied Medical Sciences; Qadri, T. [Karolinska Inst., Huddinge (Sweden). Dept. of Dental Medicine; Ahmed, H. B. [Al-Farabi Dental College, Riyadh (Saudi Arabia). Dept. of Dentistry; Corbet, F. E. [University of Hong Kong, Hong Kong (Hong Kong). Dept. of Periodontology; Romanos, G. E. [Stony Brook University, New York (United States). School of Dental Medicine

    2013-10-15

    The aim was to assess whether or not photodynamic therapy (PDT) with adjunctive scaling-and-root-planing (SRP) is effective in the treatment of periodontitis under immunocompromised conditions. PubMed/Medline and Google-Scholar databases were searched from 1967 to May 2013 using various key words. Six studies (five experimental and one clinical) were included. In the clinical study, SRP with PDT was reported to be ineffective in treating chronic periodontitis in T2DM patients. All experimental studies reported significantly less bone loss in periodontal defects treated with SRP+PDT than those treated with SRP alone. Efficacy of PDT+SRP in the treatment of periodontal disease under immunocompromised conditions remains unclear. (author)

  5. Developing an OMERACT Core Outcome Set for Assessing Safety Components in Rheumatology Trials: The OMERACT Safety Working Group.

    Science.gov (United States)

    Klokker, Louise; Tugwell, Peter; Furst, Daniel E; Devoe, Dan; Williamson, Paula; Terwee, Caroline B; Suarez-Almazor, Maria E; Strand, Vibeke; Woodworth, Thasia; Leong, Amye L; Goel, Niti; Boers, Maarten; Brooks, Peter M; Simon, Lee S; Christensen, Robin

    2017-12-01

    Failure to report harmful outcomes in clinical research can introduce bias favoring a potentially harmful intervention. While core outcome sets (COS) are available for benefits in randomized controlled trials in many rheumatic conditions, less attention has been paid to safety in such COS. The Outcome Measures in Rheumatology (OMERACT) Filter 2.0 emphasizes the importance of measuring harms. The Safety Working Group was reestablished at the OMERACT 2016 with the objective to develop a COS for assessing safety components in trials across rheumatologic conditions. The safety issue has previously been discussed at OMERACT, but without a consistent approach to ensure harms were included in COS. Our methods include (1) identifying harmful outcomes in trials of interventions studied in patients with rheumatic diseases by a systematic literature review, (2) identifying components of safety that should be measured in such trials by use of a patient-driven approach including qualitative data collection and statistical organization of data, and (3) developing a COS through consensus processes including everyone involved. Members of OMERACT including patients, clinicians, researchers, methodologists, and industry representatives reached consensus on the need to continue the efforts on developing a COS for safety in rheumatology trials. There was a general agreement about the need to identify safety-related outcomes that are meaningful to patients, framed in terms that patients consider relevant so that they will be able to make informed decisions. The OMERACT Safety Working Group will advance the work previously done within OMERACT using a new patient-driven approach.

  6. [Structural quality of rheumatology clinics for children and adolescents. Paper by a task force of the "Society of Pediatric and Adolescent Rheumatology" and of the "Association of Rheumatology Clinics in Germany"].

    Science.gov (United States)

    Michels, H; Ganser, G; Dannecker, G; Forster, J; Häfner, R; Horneff, G; Küster, R M; Lakomek, H-J; Lehmann, H; Minden, K; Rogalski, B; Schöntube, M

    2006-07-01

    Rheumatic diseases in childhood and adolescence differ from those of adulthood according to type, manifestation, treatment and course. A specialized therapy, starting as early as possible, improves the prognosis, can prevent long-term damage and saves the costs of long-term care. Only a specialized pediatric care system can guarantee optimum quality of the processes involved and the results for rheumatology in childhood and adolescence within a global financial system. This requires adequate structural quality of the specialized clinics and departments for pediatric rheumatology. The management of rheumatic diseases in childhood and adolescence is comprehensive and requires a multidisciplinary, specialized and engaged team which can cover the whole spectrum of rheumatic diseases with their various age-dependent aspects. In order to guarantee an adequate, cost-efficient routine, a specialized center which concentrates on inpatient care should treat at least 300 patients with pediatric rheumatic diseases per year. The diagnoses should be divided among the various disease categories with at least 70% of them involving inflammatory rheumatic diseases. For the inpatient care of small children, an accompanying person (parent) is necessary, requiring adequate structures and services. Patient rooms as well as diagnostic (radiography, sonography, etc.) and therapeutic services (physiotherapy, occupational therapy, pool, etc.) must be adequate for small children and school children as well as adolescents. Suitable mother-child units must also be provided and a school for patients is required within the clinic. A pediatric rheumatologist must be available 24 h a day, and it must be possible to reach other specialists within a short time. For painful therapeutic procedures, age-appropriate pain management is obligatory. A continuous adjustment of these recommendations to changing conditions in health politics is intended.

  7. Increased occurrence of cardiovascular events and comorbidities in a general rheumatology cohort.

    LENUS (Irish Health Repository)

    Mohammad, A

    2012-02-01

    BACKGROUND: To identify cardiovascular and other comorbidities in a general rheumatology cohort. METHODS: Interviews\\/retrospective chart audits were conducted on 1,000 patients attending rheumatology outpatient clinics of a university teaching hospital. Comorbidities were classified using the Charlson comorbidity index (Ambrose et al. in Ir J Med Sci 178(1):53-55, 2009). RESULTS: Mean age 58 +\\/- 15.3 years, mean BMI 26. Of the patients, 400 (40%) were diagnosed with dyslipidemia and hypertension (p = 0.002), 160 (16%) with obesity and 80 (8%) with hypothyroidism. Overall 160 (16%) patients were diagnosed with coronary heart disease (CHD). Of these, 120 (75%) had RA (p = 0.001), 100 (63%) were male, mean age 60 +\\/- 15.8 years, 120 (75%) had dyslipidemia and BMI > 30 (p = 0.002), 112 (70%) were smokers (p = 0.002), 40 (25%) were diagnosed with diabetes mellitus and 20 (12%) with hypothyroidism. CONCLUSIONS: The increased prevalence of these comorbidities may serve as a reminder to the rheumatologists that many of their patients will have coexistent disease of which they need to be aware to properly plan their management.

  8. Infections in an inpatient rheumatology unit: how big is the problem?

    Directory of Open Access Journals (Sweden)

    Romana Vieira

    2016-10-01

    Full Text Available Patients with rheumatic diseases are at high risk of infections. As quantification and characterization of infections in daily practice is a crucial exercise to delineate strategies to overcome this problem, we aimed to describe the prevalence of infections in an inpatient rheumatology unit. A cross-sectional analysis of all patients admitted at the São João Hospital Centre Rheumatology Unit between January 1st 2012 and December 31st 2013 was performed. We found a 31.7% (n=79 period prevalence of infection and a total number of infections of 97 (1.23 infections per patient. They were the admission reason in 17.6% (n=44 and hospital acquired in 19.0% (n=15 of the cases. The urinary tract was the most commonly affected (32.0%; n=31 and Escherichia coli (17.5%; n=17 the most frequently identified infectious agent. Infection prolonged the hospital length of stay in 34.2% (n=27 of the cases but any death occurred as a direct consequence of it. Patients with infection were older, had longer rheumatic disease duration and longer hospital length of stay than those without infection. We conclude that the prevalence of infection in our inpatient population is high but most cases were non complicated, easily treated with common antibiotics and, importantly, not associated with higher lethality.

  9. Survey of herbal cannabis (marijuana) use in rheumatology clinic attenders with a rheumatologist confirmed diagnosis.

    Science.gov (United States)

    Ste-Marie, Peter A; Shir, Yoram; Rampakakis, Emmanouil; Sampalis, John S; Karellis, Angela; Cohen, Martin; Starr, Michael; Ware, Mark A; Fitzcharles, Mary-Ann

    2016-12-01

    Cannabinoids may hold potential for the management of rheumatic pain. Arthritis, often self-reported, is commonly cited as the reason for the use of medicinal herbal cannabis (marijuana). We have examined the prevalence of marijuana use among 1000 consecutive rheumatology patients with a rheumatologist-confirmed diagnosis and compared in an exploratory manner the clinical characteristics of medicinal users and nonusers. Current marijuana use, medicinal or recreational, was reported by 38 patients (3.8%; 95% CI: 2.8-5.2). Ever use of marijuana for medical purposes was reported by 4.3% (95% CI: 3.2-5.7), with 28 (2.8%; 95% CI: 1.9-4.0) reporting current medicinal use. Current medicinal users had a spectrum of rheumatic conditions, with over half diagnosed with osteoarthritis. Medicinal users were younger, more likely unemployed or disabled, and reported poorer global health. Pain report and opioid use was greater for users, but they had similar physician global assessment of disease status compared with nonusers. Medicinal users were more likely previous recreational users, with approximately 40% reporting concurrent recreational use. Therefore, less than 3% of rheumatology patients reported current use of medicinal marijuana. This low rate of use in patients with a rheumatologist-confirmed diagnosis is in stark contrast to the high rates of severe arthritis frequently reported by medicinal marijuana users, especially in Canada. Familiarity with marijuana as a recreational product may explain use for some as disease status was similar for both groups.

  10. Ferrets as a Novel Animal Model for Studying Human Respiratory Syncytial Virus Infections in Immunocompetent and Immunocompromised Hosts

    Science.gov (United States)

    Stittelaar, Koert J.; de Waal, Leon; van Amerongen, Geert; Veldhuis Kroeze, Edwin J.B.; Fraaij, Pieter L.A.; van Baalen, Carel A.; van Kampen, Jeroen J.A.; van der Vries, Erhard; Osterhaus, Albert D.M.E.; de Swart, Rik L.

    2016-01-01

    Human respiratory syncytial virus (HRSV) is an important cause of severe respiratory tract disease in immunocompromised patients. Animal models are indispensable for evaluating novel intervention strategies in this complex patient population. To complement existing models in rodents and non-human primates, we have evaluated the potential benefits of an HRSV infection model in ferrets (Mustela putorius furo). Nine- to 12-month-old HRSV-seronegative immunocompetent or immunocompromised ferrets were infected with a low-passage wild-type strain of HRSV subgroup A (105 TCID50) administered by intra-tracheal or intra-nasal inoculation. Immune suppression was achieved by bi-daily oral administration of tacrolimus, mycophenolate mofetil, and prednisolone. Throat and nose swabs were collected daily and animals were euthanized four, seven, or 21 days post-infection (DPI). Virus loads were determined by quantitative virus culture and qPCR. We observed efficient HRSV replication in both the upper and lower respiratory tract. In immunocompromised ferrets, virus loads reached higher levels and showed delayed clearance as compared to those in immunocompetent animals. Histopathological evaluation of animals euthanized 4 DPI demonstrated that the virus replicated in the respiratory epithelial cells of the trachea, bronchi, and bronchioles. These animal models can contribute to an assessment of the efficacy and safety of novel HRSV intervention strategies. PMID:27314379

  11. Ferrets as a Novel Animal Model for Studying Human Respiratory Syncytial Virus Infections in Immunocompetent and Immunocompromised Hosts

    Directory of Open Access Journals (Sweden)

    Koert J. Stittelaar

    2016-06-01

    Full Text Available Human respiratory syncytial virus (HRSV is an important cause of severe respiratory tract disease in immunocompromised patients. Animal models are indispensable for evaluating novel intervention strategies in this complex patient population. To complement existing models in rodents and non-human primates, we have evaluated the potential benefits of an HRSV infection model in ferrets (Mustela putorius furo. Nine- to 12-month-old HRSV-seronegative immunocompetent or immunocompromised ferrets were infected with a low-passage wild-type strain of HRSV subgroup A (105 TCID50 administered by intra-tracheal or intra-nasal inoculation. Immune suppression was achieved by bi-daily oral administration of tacrolimus, mycophenolate mofetil, and prednisolone. Throat and nose swabs were collected daily and animals were euthanized four, seven, or 21 days post-infection (DPI. Virus loads were determined by quantitative virus culture and qPCR. We observed efficient HRSV replication in both the upper and lower respiratory tract. In immunocompromised ferrets, virus loads reached higher levels and showed delayed clearance as compared to those in immunocompetent animals. Histopathological evaluation of animals euthanized 4 DPI demonstrated that the virus replicated in the respiratory epithelial cells of the trachea, bronchi, and bronchioles. These animal models can contribute to an assessment of the efficacy and safety of novel HRSV intervention strategies.

  12. A tailored-guided internet-based cognitive-behavioral intervention for patients with rheumatoid arthritis as an adjunct to standard rheumatological care : results of a randomized controlled trial

    NARCIS (Netherlands)

    Ferwerda, Maaike; van Beugen, Sylvia; van Middendorp, Henriët; Spillekom-van Koulil, Saskia; Donders, A. Rogier T.; Visser, Henk; Taal, Erik; Creemers, Marjonne C.W.; van Riel, Piet L.C.M.; Evers, Andrea W.M.

    2017-01-01

    For patients with chronic pain conditions such as rheumatoid arthritis (RA), who experience elevated levels of distress, tailored-guided internet-based cognitive-behavioral treatment may be effective in improving psychological and physical functioning, and reducing the impact of RA on daily life. A

  13. A tailored-guided internet-based cognitive-behavioral intervention for patients with rheumatoid arthritis as an adjunct to standard rheumatological care: results of a randomized controlled trial

    NARCIS (Netherlands)

    Ferwerda, M.; Beugen, S. van; Middendorp, H. van; Koulil, S. van; Donders, A.R.T.; Visser, H.; Taal, E.; Creemers, M.C.; Riel, P.L.C.M. van; Evers, A.W.M.

    2017-01-01

    For patients with chronic pain conditions such as rheumatoid arthritis (RA), who experience elevated levels of distress, tailored-guided internet-based cognitive-behavioral treatment may be effective in improving psychological and physical functioning, and reducing the impact of RA on daily life. A

  14. Study of vitamin D status of rheumatoid arthritis patients Rationale and design of a cross-sectional study by the osteoporosis and metabolic bone diseases study group of the Italian Society of Rheumatology (SIR

    Directory of Open Access Journals (Sweden)

    M. Antonelli

    2011-09-01

    Full Text Available The fundamental role of Vitamin D has been long known in regulating calcium homeostasis and bone metabolism. An increased contribution of Vitamin D was recently described in association with a lower incidence of Rheumatoid Arthritis (RA. This must not be surprising, as the immunomodulating effects of Vitamin D are clear, which have been attributed protective effects in autoimmune disorders such as some chronic inflammatory bowel diseases, multiple sclerosis and type I diabetes. An interaction was suggested between Vitamin D metabolism and inflammation indexes through mediation of TNF-a which is also especially involved in osteoclastic resorption and therefore in bone loss processes. Some preliminary data would indicate an association between seasonal changes of Vitamin D serum levels, latitude and disease activity (DAS28 in RA patients. Consequently, the Osteoporosis and Metabolic Bone Diseases Study Group of SIR believes that there are grounded reasons for assessing the Vitamin D status of RA patients in order to investigate whether this is to be related to physiopathological and clinical aspects of disease other than those of bone involvement. Primary end point of the study will be to assess the levels of 25 OH Vitamin D in RA patients. Secondary endpoints will include correlation with disease activity, densitometry values and bone turnover. The cross-sectional study will enrol patients of both sex genders, age ranging between 30 and 75 years according to the 1988 ACR criteria, onset of symptoms at least 2 years prior to study enrollment. Patients will be excluded suffering from osteometabolic diseases, liver and kidney insufficiency and those administered Vitamin D boli in the previous 12 months. Disease activity will be evaluated with the HAQ. Haematochemical tests and femoral and lumbar bone densitometry will be performed, unless recently undergone by patients. Blood levels of 25 OH C Vitamin D and PHT and of the two bone remodeling markers

  15. Demyelinizing neurological disease after treatment with tumor necrosis factor alpha-inhibiting agents in a rheumatological outpatient clinic

    DEFF Research Database (Denmark)

    Theibich, Ali; Dreyer, Lene; Magyari, Melinda

    2014-01-01

    Biological treatment with inhibitors of the pro-inflammatory cytokine TNF-alpha has dramatically improved the disease course of several chronic rheumatologic conditions. Adverse events (AEs) are primarily infections and hypersensitivity reactions. Demyelinizing neurological symptoms resembling...... multiple sclerosis (MS) have been described as a rare AE. During about 10-year use of anti TNF-alpha, the Danish Medicines Agency has recorded eight cases of MS like AEs. The objective of this study was to estimate the incidence of demyelinizing AEs both in the central and peripheral nervous system after...... treatment with anti TNF-alpha in a cohort of patients from a large rheumatologic outpatient clinic in Copenhagen. In a 4-year period from January 2008 to December 2011, approximately 550 patients annually were undergoing treatment with anti TNF-alpha inhibitors in our department. We collected data on all...

  16. RelA Mutant Enterococcus faecium with Multiantibiotic Tolerance Arising in an Immunocompromised Host.

    Science.gov (United States)

    Honsa, Erin S; Cooper, Vaughn S; Mhaissen, Mohammed N; Frank, Matthew; Shaker, Jessica; Iverson, Amy; Rubnitz, Jeffrey; Hayden, Randall T; Lee, Richard E; Rock, Charles O; Tuomanen, Elaine I; Wolf, Joshua; Rosch, Jason W

    2017-01-03

    Serious bacterial infections in immunocompromised patients require highly effective antibacterial therapy for cure, and thus, this setting may reveal novel mechanisms by which bacteria circumvent antibiotics in the absence of immune pressure. Here, an infant with leukemia developed vancomycin-resistant Enterococcus faecium (VRE) bacteremia that persisted for 26 days despite appropriate antibiotic therapy. Sequencing of 22 consecutive VRE isolates identified the emergence of a single missense mutation (L152F) in relA, which constitutively activated the stringent response, resulting in elevated baseline levels of the alarmone guanosine tetraphosphate (ppGpp). Although the mutant remained susceptible to both linezolid and daptomycin in clinical MIC testing and during planktonic growth, it demonstrated tolerance to high doses of both antibiotics when growing in a biofilm. This biofilm-specific gain in resistance was reflected in the broad shift in transcript levels caused by the mutation. Only an experimental biofilm-targeting ClpP-activating antibiotic was able to kill the mutant strain in an established biofilm. The relA mutation was associated with a fitness trade-off, forming smaller and less-well-populated biofilms on biological surfaces. We conclude that clinically relevant relA mutations can emerge during prolonged VRE infection, causing baseline activation of the stringent response, subsequent antibiotic tolerance, and delayed eradication in an immunocompromised state. The increasing prevalence of antibiotic-resistant bacterial pathogens is a major challenge currently facing the medical community. Such pathogens are of particular importance in immunocompromised patients as these individuals may favor emergence of novel resistance determinants due to lack of innate immune defenses and intensive antibiotic exposure. During the course of chemotherapy, a patient developed prolonged bacteremia with vancomycin-resistant Enterococcus faecium that failed to clear

  17. [Clinical guideline for the treatment of lupus nephritis and single-centre results of mycofenolate mofetil among patients with lupus nephritis in the National Institute of Rheumatology and Physiotherapy, Budapest].

    Science.gov (United States)

    Szabó, Melinda Zsuzsanna; Kiss, Emese

    2016-08-01

    The authors present the latest guideline for the treatment of lupus nephritis and their own single-centre results with mycofenolate mofetil treated lupus nephritis. Lupus nephritis and mainly its proliferative form is a frequent and potentially life-threatening manifestation of systemic lupus erythematosus that can lead to end-stage renal disease. The treatment of lupus nephritis greatly improved in the last decades; mycofenolate mofetil has become an alternative of cyclophosphamide both in remission induction and as a maintenance regimen as well in the treatment of Class III and IV glomerulonephritis. The authors ordered mycofenolate mofetil for 25 patients with lupus nephritis so far. Histologically most of them had Class III (A/C) or IV (A) glomerulonephritis (30-30%), and only 16% of the patients had renal impairment at that time. Mycofenolate mofetil given after glucocorticoid and cyclophosphamide induction therapy reduced the daily proteinuria from 3.18 grs to 1.06 grs. Complete remission could be achieved in 24% and partial remission in 48% of the patients. The authors conclude that mycofenolate mofetil is effective in the therapy of lupus nephritis. Orv. Hetil., 2016, 157(35), 1385-1393.

  18. Estudo comparativo das características clínicas e abordagem de pacientes com fibromialgia atendidos em serviço público de reumatologia e em consultório particular Comparative study of the clinical features and approach of the patients with fibromyalgia assisted at the rheumatology outpatient clinic and at physician private practice

    Directory of Open Access Journals (Sweden)

    José Eduardo Martinez

    2006-02-01

    correlação entre a intensidade dos sintomas e renda familiar ou escolaridade não se mostrou diferente do ponto de vista estatístico. CONCLUSÃO: não houve relação entre a apresentação clínica da FM e nível socioeconômico determinado pela renda familiar nem a escolaridade formal. Observou-se associação entre o acesso ao serviço assistencial privado e menor idade de instalação da doença. Isso pode ter ocorrido por facilidade de assistência médica mais precoce nesse grupo.INTRODUCTION: Fibromyalgia is a painful chronic syndrome associated to tender areas on digital palpation. Its origin is unknown and probably related to a dysfunction on pain processing pathways. The most frequent accompanying symptoms are: fatigue, sleeping disorders, chronic migraine, irritable bowels syndrome and others disorders. There is an important emotional influence related to stress response. Education, social and economical status could influence clinical presentation. The main purpose of the present study are to determine if there are differences in clinical presentation, symptoms intensity and type of treatment among patients treated in public or private health systems and establish if there is a correlation among main symptoms intensity, family income and formal education status. PATIENTS AND METHODS: Eighty patients that fulfilled the American College of Rheumatology (ACR Classification Criteria for Fibromyalgia had been studied. They were divided in two groups according to treatment location: 40 patients have been assisted at the Rheumatology Outpatient Clinic of Sorocaba Hospital Complex (SHC and 40 patients at one of the authors' private practice. Clinical variables (pain, fatigue, anxiety, depression and quality of life were measured through a numerical analogic scales (0 - 10. Family income was evaluated according to the number of minimum wages earned monthly and education according to complete years of formal education. Comparison among groups was analyzed using Chi

  19. [G-DRG system 2009: relevant changes for rheumatology].

    Science.gov (United States)

    Fiori, W; Liedtke-Dyong, A; Lakomek, H-J; Buscham, K; Lehmann, H; Liman, W; Fuchs, A-K; Bessler, F; Roeder, N

    2009-08-01

    The following article presents the main general and specific changes in the G-DRG (German diagnosis-related groups) system in terms of the classification systems for diagnoses and procedures as well as the billing process for 2009. Of fundamental relevance is the national weighting of the G-DRG I97Z (complex rheumatologic treatment), which up to now had to be negotiated individually by each hospital. Emphasis is also put on case auditing by the health insurers. Being primarily a tool for redistribution of resources, every hospital has to analyze the economic effects of the 2009 G-DRG system by applying the G-DRG transition grouper to its own cases. Depending on their clinical focus rheumatological departments may experience positive or negative consequences from the development. The strain imposed on hospitals by inadequate refunding of rising costs has to be assessed separately from the effects of redistribution by the G-DRG system.

  20. [The G-DRG system 2008. Relevant changes for rheumatology].

    Science.gov (United States)

    Fiori, W; Lakomek, H-J; Buscham, K; Lehmann, H; Liman, W; Fuchs, A-K; Hülsemann, J L; Roeder, N

    2008-05-01

    The G-DRG system 2008 once again brings many changes to rheumatological departments in Germany. The following article presents the main general and specific changes in the G-DRG system, as well as in the classification systems for diagnoses and procedures and in invoicing for 2008. Since the G-DRG system is only a tool for the redistribution of resources, every hospital needs to analyze the economic effects of the system by applying the G-DRG transition grouper to its own cases. Depending on their clinical focus, rheumatological departments may experience positive or negative effects from the system's application. The strain placed on hospitals by the inadequate funding of increased costs needs to be assessed separately from the effects of redistribution by the G-DRG system.

  1. [Max Hirsch founder of rheumatology in Germany: banished and murdered].

    Science.gov (United States)

    Keitel, W

    2014-08-01

    The Jewish physician and scientist Dr. Max Hirsch (1875-1941) made a substantial contribution to consolidation of the foundations of his professional discipline, balneology, and in particular developed the social aspects. He recognized the economic significance of diseases of the musculoskeletal system very early on and gathered important ideas from abroad. Together with the department head in the Prussian Ministry of Education and Cultural Affairs, the Privy Councillor Prof. Dr. Eduard Dietrich and later alone, he was editor of various balneological journals. He worked as general secretary of the Deutsche Gesellschaft für Rheumatologie (German Society of Rheumatology) from the beginning of its existence (1927) and created the publication series Veröffentlichungen der Deutschen Gesellschaft für Rheumabekämpfung (Publications of the German Society against Rheumatism) and Rheuma-Jahrbuch (Annual review of rheumatology) in 1929, 1930 and 1931 and organized seven rheumatology congresses up to 1933. After the accession to power of the National Socialists, Max Hirsch and Eduard Dietrich were deposed from office. Hirsch emigrated to Latvia via Switzerland and the Soviet Union with his wife and one son where they were murdered in the course of the Jewish pogrom. The second son escaped with his family to Sweden.

  2. How to prescribe physical exercise in rheumatology

    Directory of Open Access Journals (Sweden)

    S. Maddali Bongi

    2011-06-01

    Full Text Available Physical exercise, aiming to improve range of movement, muscle strength and physical well being, lately substituted the immobilization previously prescribed in rheumatic diseases. International guidelines, recommendations of Scientific Societies, and structured reviews regard physical exercise as of pivotal importance in treating rheumatoid arthritis, ankylosing spondylitis, osteoarthritis, fibromyalgia syndrome, osteoporosis, and to be considered in connective tissue diseases. Therapeutic exercise should: aim to improve firstly local symptoms and then general health; respect the pain threshold; be a part of a treatment including pharmacological therapies and other rehabilitation techniques, be administered by skilled physiotherapist under the guide of a rheumatologist, be different according to different diseases, disease phases and patient expectations.

  3. Aceclofenac in rheumatology: The golden mean

    Directory of Open Access Journals (Sweden)

    Andrei Evgenyevich Karateev

    2013-01-01

    Full Text Available Effective pain relief is an essential component of combination therapy for rheumatic diseases (RD. Amongst analgesics, there are nonsteroidal anti-inflammatory drugs (NSAIDs that hold a central position. Nineteen different representatives of this group are currently used in Russia, which allows the most appropriate medication to be chosen for each clinical situation and a specific patient. The primary difference between NSAIDs is their safety. There are two polar groups of NSAIDs: 1 nonselective COX-2 inhibitors (nNSAIDS that rather frequently cause complications in the gastrointestinal tract (GIT, but are safer for the cardiovascular system; and 2 highly selective COX-2 inhibitors (coxibs that are, on the contrary, characterized by a lower risk for GIT disease, but a higher risk for cardiovascular events. Aceclofenac, a drug that has moderate COX-2 selectivity, holds a good position between nNSAIDs and coxibs, which makes its use advisable for most patients with RD. Clinical trials and epidemiological studies show that both the GIT and cardiovascular system well tolerate the drug. This review gives the basic data pertaining to the evaluation of the safety of aceclofenac, including the results of the last (2012 meta-analysis of population-based studies of the risk of GIT bleeding due to the use of various NSAIDs and those of the AEROPLAN Russian study (of aceclofenac versus nimesulide.

  4. Uso da oxigenoterapia hiperbárica em pacientes de um serviço de reumatologia pediátrica Hyperbaric oxygen therapy in patients of a pediatric rheumatology service

    Directory of Open Access Journals (Sweden)

    Juliana Figueira M. R. Rossi

    2005-04-01

    Full Text Available A oxigenoterapia hiperbárica consiste na respiração de oxigênio puro sob pressão maior que uma atmosfera e vem sendo empregada no tratamento adjuvante de lesões ulceradas de várias etiologias. Foram analisados retrospectivamente os prontuários de seis pacientes atendidos no Ambulatório de Reumatologia Pediátrica do Instituto da Criança do Hospital das Clínicas da FMUSP entre 1996 e 2002, submetidos à oxigenoterapia hiperbárica. Esse procedimento foi indicado pela presença de osteomielite crônica e lesões ulceradas (por vasculite ou infecção que não responderam ao tratamento habitual. Dois pacientes apresentaram poliarterite nodosa cutânea, dois osteomielite crônica multifocal recorrente, um esclerodermia cutânea difusa e um pioderma gangrenoso. Cinco pacientes eram do sexo feminino (idade variou de 6 a 13,2 anos. As sessões de oxigenoterapia hiperbárica foram realizadas sob pressões que variaram de 2,4 a 2,8 atmosferas absolutas, com duração de duas horas. O número mínimo de sessões foi 18 e o máximo 80. Em cinco pacientes houve completa cicatrização das lesões. A paciente com esclerodermia cutânea abandonou o tratamento após a décima oitava sessão, pois retornou a sua cidade natal, com melhora parcial das lesões cutâneas. O principal evento adverso durante as sessões foi otalgia, após as primeiras sessões, que desapareceu com diminuição da pressão dentro da câmara e da duração da sessão. Não foram observados perfuração timpânica ou outros eventos adversos. A oxigenoterapia hiperbárica foi eficaz e bem tolerada nos pacientes com doenças reumatológicas e lesões vasculíticas ulceradas ou infectadas e osteomielite crônica.The hyperbaric oxygen therapy consists in the breathing of pure oxygen under pressures higher than one atmosphere and has been used in the treatment of ulcerated lesions of various etiologies. Six patients followed at the Rheumathology Unit, Instituto da Crian

  5. Magnetic resonance tomography and ultrasound in rheumatology

    International Nuclear Information System (INIS)

    Kainberger, F.; Czerny, C.; Trattnig, S.; Lack, W.; Machold, K.; Graninger, W.

    1996-01-01

    Technical innovations and software improvements in magnetic resonance imaging (MRI) and high-resolution sonography (US) have definitely influenced the diagnostic imaging of rheumatic diseases. For MRI, improvements in surface coils, dedicated low-field systems (0.2 T), and software improvements (shorter acquisition times and refinements of fat suppressing techniques) must be mentioned. For sonography, the main innovations concern the development of higher transducer frequencies (7-15 Mhz) and power Doppler imaging. Clinical evaluations have shown that MRI and US are most useful in cases of suspected rheumatic disease with negative plain film radiographs and for documenting the course of the disease, diagnosing of early rheumatoid arthritis, making a differential diagnosis in clinically unclear rheumatic diseases, investigating vascularization, and quantifying pannus formation. In order to improve diagnostic efficacy the role of MRI and US in the management of patients with rheumatic disease should be reconsidered. (orig.) [de

  6. The utility of bone scans in rheumatology

    International Nuclear Information System (INIS)

    Duncan, I.; Dorai-Raj, A.; Khoo, K.; Tymans, K.; Brook, A.

    1997-01-01

    Full text: Introduction: Bone scans are the commonest diagnostic imaging services requested by Australian rheumatologists. Medicare figures suggest that an average rheumatologist orders about $50 000 (AUS) of bone scans annually. Aims: To ascertain the reasons why rheumatologists request bone scans and how it affects their patient management. Methods: A two-part prospective survey was administered before and after every bone scan ordered by four rheumatologists over a six-month period in 1996. Results: A total of 136 bone scans were requested (66.2% whole body; 33.8% regional; 6% SPECT). The primary indications for scanning were (1) to confirm a clinical diagnosis (38%); (2) to exclude a diagnosis (34%); (3) to localize site of pain (17%); and (4) to assist in management (6%). The common diseases that rheumatologists were attempting to confirm/exclude with bone scanning were inflammatory arthritis, malignancy, and fracture. However, the commonest provisional and final diagnosis was soft tissue rheumatism (18%) followed by inflammatory arthritis (15%) and osteoarthritis (11%). In 24% of patients with a provisional diagnosis of soft tissue rheumatism the diagnosis was changed by the bone scan. The scan was successful in excluding a diagnosis in 88 per cent where this was the primary indication for the test. It was successful in confirming a diagnosis in 79 per cent where this was the primary indication. In 32 per cent the bone scan altered the clinical diagnosis and in 43 per cent it altered management. The bone scan result prevented further investigations in 60 per cent. Conclusions: The commonest pre-scan and post-scan diagnosis is soft tissue rheumatism. Rheumatologists predominantly request bone scanning to confirm or exclude their clinical suspicion of inflammatory arthritis, malignancy, and fracture. Bone scans were successful in achieving these objectives in at least 79 per cent of cases

  7. Sterilization of ready to eat meals destined to immunocompromised by irradiation

    International Nuclear Information System (INIS)

    Berhouma, Hiba

    2011-01-01

    Immunocompromised patients who have a dysfunction in one or more components of the immune system must follow a diet low in bacteria. Several methods are used to obtain this type of system such as pasteurization (65-10 degree), wet sterilization (120 degree - 140 degree UHT) or dry ( 180 degree), heating in the oven convection ((250 degree) and radappertization). In Tunisia, the CNGMO uses sterilization in a forced air oven 120 degree for 20 min. Of high radiation doses 5, 10 and 15 KGy were used in this study to achieve sterilization of Couscous. The dose of 5 KGy improves the bacteriological quality (reduce the microbial load of 2048 to 1 log CFU/g) of this dish while preserving the organoleptic qualities. The comparison sample irradiated 5 KGy and the heat-treated seems to be very close during the various tests. except that the heat-treated has a high oxidation state (TBARS value of 7900.90 mg / kg).

  8. Toward the Development of a Core Set of Outcome Domains to Assess Shared Decision-making Interventions in Rheumatology

    DEFF Research Database (Denmark)

    Toupin-April, Karine; Barton, Jennifer; Fraenkel, Liana

    2017-01-01

    OBJECTIVE: The aim of this Outcome Measures in Rheumatology (OMERACT) Working Group was to determine the core set of outcome domains and subdomains for measuring the effectiveness of shared decision-making (SDM) interventions in rheumatology clinical trials. METHODS: Following the OMERACT Filter 2.......0, and based on a previous literature review of SDM outcome domains and a nominal group process at OMERACT 2014, (1) an online Delphi survey was conducted to gather feedback on the draft core set and refine its domains and subdomains, and (2) a workshop was held at the OMERACT 2016 meeting to gain consensus...... ranged from 83% to 100% of respondents). At OMERACT 2016, only 8% of the 96 attendees were patients/caregivers. Despite initial votes of support in breakout groups, there was insufficient comfort about the conceptualization of these 7 domains and 17 subdomains for these to be endorsed at OMERACT 2016...

  9. [Tubulointerstitial nephritis with uveitis (TINU) syndrome. A relatively rare rheumatological differential diagnosis with unexplained uveitis].

    Science.gov (United States)

    Häusler, U; Guminski, B; Helmchen, U; Kisters, K; Heinz, C; Braun, J

    2013-05-01

    The tubulo-interstitial nephritis and uveitis (TINU) syndrome, first described in 1975, is a rare disease most probably of autoimmune origin that is characterized by unilateral or bilateral uveitis and tubulointerstitial nephritis. Most patients are adolescents and it is sometimes associated with other autoimmune diseases, such as spondyloarthritis, rheumatoid arthritis and hyperthyroidosis. This article reports the case of a 43-year-old female patient who presented with refractory recurrent bilateral uveitis despite therapy with high doses of corticosteroids in combination with cyclosporin. When the patient was referred to this hospital for rheumatological examination after almost 1 year of therapy, mild renal insufficiency and proteinuria were found. The kidney biopsy revealed interstitial nephritis, partly crescent-shaped and partly chronic. A diagnosis of TINU syndrome was made and treatment with adalimumab in combination with methotrexate was started. The favorable clinical outcome indicated that tumor necrosis factor (TNF) alpha may play an important role in the pathogenesis of TINU syndrome.

  10. A multi-centre study of interactional style in nurse specialist- and physician-led Rheumatology clinics in the UK.

    Science.gov (United States)

    Vinall-Collier, Karen; Madill, Anna; Firth, Jill

    2016-07-01

    Nurse-led care is well established in Rheumatology in the UK and provides follow-up care to people with inflammatory arthritis including treatment, monitoring, patient education and psychosocial support. The aim of this study is to compare and contrast interactional style with patients in physician-led and nurse-led Rheumatology clinics. A multi-centre mixed methods approach was adopted. Nine UK Rheumatology out-patient clinics were observed and audio-recorded May 2009-April 2010. Eighteen practitioners agreed to participate in clinic audio-recordings, researcher observations, and note-taking. Of 9 nurse specialists, 8 were female and 5 of 9 physicians were female. Eight practitioners in each group took part in audio-recorded post-clinic interviews. All patients on the clinic list for those practitioners were invited to participate and 107 were consented and observed. In the nurse specialist cohort 46% were female; 71% had a diagnosis of Rheumatoid Arthritis (RA). The physician cohort comprised 31% female; 40% with RA and 16% unconfirmed diagnosis. Nineteen (18%) of the patients observed were approached for an audio-recorded telephone interview and 15 participated (4 male, 11 female). Forty-four nurse specialist and 63 physician consultations with patients were recorded. Roter's Interactional Analysis System (RIAS) was used to code this data. Thirty-one semi-structured interviews were conducted (16 practitioner, 15 patients) within 24h of observed consultations and were analyzed using thematic analysis. RIAS results illuminated differences between practitioners that can be classified as 'socio-emotional' versus 'task-focussed'. Specifically, nurse specialists and their patients engaged significantly more in the socio-emotional activity of 'building a relationship'. Across practitioners, the greatest proportion of 'patient initiations' were in 'giving medical information' and reflected what patients wanted the practitioner to know rather than giving insight into

  11. Ureaplasma parvum causes hyperammonemia in a pharmacologically immunocompromised murine model.

    Science.gov (United States)

    Wang, X; Greenwood-Quaintance, K E; Karau, M J; Block, D R; Mandrekar, J N; Cunningham, S A; Mallea, J M; Patel, R

    2017-03-01

    A relationship between hyperammonemia and Ureaplasma infection has been shown in lung transplant recipients. We have demonstrated that Ureaplasma urealyticum causes hyperammonemia in a novel immunocompromised murine model. Herein, we determined whether Ureaplasma parvum can do the same. Male C3H mice were given mycophenolate mofetil, tacrolimus, and prednisone for 7 days, and then challenged with U. parvum intratracheally (IT) and/or intraperitoneally (IP), while continuing immunosuppression over 6 days. Plasma ammonia concentrations were determined and compared using Wilcoxon rank-sum tests. Plasma ammonia concentrations of immunosuppressed mice challenged IT/IP with spent broth (median, 188 μmol/L; range, 102-340 μmol/L) were similar to those of normal (median, 226 μmol/L; range, 154-284 μmol/L, p > 0.05), uninfected immunosuppressed (median, 231 μmol/L; range, 122-340 μmol/L, p > 0.05), and U. parvum IT/IP challenged immunocompetent (median, 226 μmol/L; range, 130-330 μmol/L, p > 0.05) mice. Immunosuppressed mice challenged with U. parvum IT/IP (median 343 μmol/L; range 136-1,000 μmol/L) or IP (median 307 μmol/L; range 132-692 μmol/L) had higher plasma ammonia concentrations than those challenged IT/IP with spent broth (p < 0.001). U. parvum can cause hyperammonemia in pharmacologically immunocompromised mice.

  12. Patient’s Knowledge and Perception Towards the use of Non-steroidal Anti-Inflammatory Drugs in Rheumatology Clinic Northern Malaysia

    Science.gov (United States)

    Sulaiman, Wahinuddin; Seung, Ong Ping; Ismail, Rosli

    2012-01-01

    Objective In Rheumatology, non-steroidal anti-inflammatory drugs (NSAIDs) has been widely prescribed and used. However, despite their clinical benefits in the management of inflammatory and degenerative joint disease, NSAIDs have considerable side effects, mostly affecting the upper gastrointestinal system, which therefore, limit their use. This study was conducted to determine the patients’ knowledge and perception regarding the used of NSAIDS. Methods A total of 120 patients who attended the rheumatology clinic Hospital, Raja Permaisuri Bainun, Malaysia, and received NSAIDs more than 3 months were interviewed irrespective of their rheumatological conditions. Patient’s knowledge and perception on the side effects of NSAIDs were recorded. Result Fifty-four percent of the patients obtained information regarding the side effect of NSAIDs either from the rheumatologist, rheumatology staff nurse or other medical staffs (75.4%). The remaining 45.8% were naive of such knowledge. Fifteen percent obtained the information by surfing the internet and 9.2% from printed media. Twenty-four (24.2%) patients, experienced indigestion and/or stomach discomfort attributed to NSAIDs used. Two patients (1.7%) had hematemesis and malena once. Conclusion This study shows that half of the patients who attended the rheumatology clinic were unaware of the side effect of NSAIDs. Available data showed that most of the knowledgeable patients are more conscience and self-educated. This study also reveals the important roles of clinicians, trained staff nurses as well as the pharmacist in providing the guidance and knowledge of any medication taken by patients. PMID:23226825

  13. Nefropatia por IgA em portadores de espondiloartrites acompanhados no Serviço de Reumatologia do Hospital das Clínicas da UFMG IgA nephropathy in patients with spondyloarthritis followed-up at the Rheumatology Service of Hospital das Clínicas/UFMG

    Directory of Open Access Journals (Sweden)

    Daniela Castelo Azevedo

    2011-10-01

    Full Text Available OBJETIVO: Determinar a frequência das glomerulonefrites nos pacientes espondiloartríticos acompanhados em Serviço de Reumatologia Brasileiro e avaliar variáveis clínicas correlacionadas. PACIENTES E MÉTODOS: Os pacientes foram avaliados quanto às características sociodemográfi cas, tipo de espondiloartrite, tempo e atividade da doença, uso de anti-infl amatórios não esteroides, presença do HLA-B27, níveis de creatinina e ureia séricas, presença de comorbidades e presença de hematúria e/ou proteinúria. Os pacientes com hematúria foram submetidos à pesquisa de dismorfi smo eritrocitário, e aqueles com proteinúria submeteram-se à quantifi cação da proteína na urina de 24 horas. Biópsia renal foi indicada para aqueles com hematúria de origem glomerular e/ou proteinúria maior que 3,5 g. RESULTADOS: Foram avaliados 76 pacientes. A alteração mais frequente no exame de urina de rotina foi a hematúria microscópica (44,7%, geralmente intermitente e em amostra isolada de urina durante o seguimento do paciente. Em oito (10,5% dos pacientes a hematúria sugeriu origem glomerular. A biópsia renal foi realizada em cinco deles, e mostrou nefropatia por IgA em quatro (5,3% e doença da membrana fi na em um paciente. CONCLUSÕES: Notou-se alta frequência de alterações no exame de urina desse subgrupo de pacientes, assim como alta prevalência de nefropatia por IgA. Apesar de mais estudos sobre o assunto serem necessários para melhor esclarecimento desses resultados, a realização periódica de exames de urina deveria ser recomendável.OBJECTIVE: To determine the frequency of glomerulonephritis in patients with spondyloarthritis followed-up at a Brazilian Rheumatology Service, and to evaluate the clinical variables associated. PATIENTS AND METHODS: Patients were assessed for sociodemographic characteristics, type of spondyloarthritis, time since diagnosis and disease activity, non-steroidal anti-infl ammatory drug use, HLA

  14. Avaliação dos óbitos e necropsias em pacientes internados em um serviço de reumatologia pediátrica por um período de dez anos Deaths and necropsies evaluation in hospitalized patients of a pediatric rheumatology unit for a period of ten years

    Directory of Open Access Journals (Sweden)

    Mércia Moreira Facó

    2005-04-01

    Full Text Available OBJETIVO: correlacionar os dados clínicos do óbito com achados de necropsia em pacientes internados em uma unidade de reumatologia pediátrica. MÉTODOS: o estudo é uma coorte histórica. Em dez anos, no período compreendido entre janeiro de 1994 e dezembro de 2003, ocorreram 57.159 internações com 1.907 (3% óbitos no Instituto da Criança. Destas internações, 548 (1% apresentaram doenças reumáticas ou pediátricas e foram acompanhadas pela Unidade de Reumatologia Pediátrica, incluindo 348 pacientes. Os óbitos e as necropsias foram analisados e a classificação de Goldman foi utilizada para detectar discordância entre o diagnóstico clínico do óbito e a necropsia. RESULTADOS: no período do estudo, 34 (10% pacientes evoluíram para óbito. As principais doenças associadas ao óbito foram: lúpus eritematoso sistêmico juvenil (LESJ em 18 pacientes (53% e artrite idiopática juvenil (AIJ em sete casos (21%. Necropsias foram realizadas em 21 pacientes (64% dos óbitos. Nos 18 casos de LESJ, a atividade da doença esteve presente em 16 casos, sendo associada à septicemia em 15 deles. Discordância entre o diagnóstico clínico e necropsia foi evidenciada em seis casos com LESJ: três com infecções fúngicas, um com tuberculose, um com nefrite proliferativa difusa e outro com aterosclerose. Sete pacientes com AIJ evoluíram para óbito: septicemia em quatro e síndrome de ativação macrofágica em três. Em um caso de AIJ foi diagnosticado, exclusivamente na necropsia: linfoma de Hodgkin, aterosclerose e infarto anterior do miocárdio. CONCLUSÕES: a freqüência de óbitos foi 10% e necropsia evidenciou doença infecciosa, aterosclerose ou neoplasia não diagnosticadas previamente. A necropsia é importante para determinar eventos não esclarecidos ou duvidosos no óbito e deve ser sempre solicitada.OBJECTIVE: to correlate the clinical data of necropsies in hospitalized patients of a Pediatric Rheumatology Unit. METHODS: this

  15. Leprosy Mimicking Common Rheumatologic Entities: A Trial for the Clinician in the Era of Biologics

    Directory of Open Access Journals (Sweden)

    Deepak Rath

    2014-01-01

    Full Text Available Rheumatoid arthritis and seronegative spondyloarthritis, which make up the lion’s share of cases attending a rheumatology clinic, are relatively easy to diagnose. However, when an entity of infective aetiology like leprosy known to be a great mimic of different autoimmune conditions presents with features similar to these, the possibility of it being diagnosed at the outset is very slim indeed. The ease with which the diagnosis of leprosy can be missed assumes sinister proportions as the use of disease modifying agents can have deleterious effects in these patients. In the era of increasing availability and use of biologic disease modifying agents, it is imperative not only to actively rule out the presence of leprosy but also to make it a part of the prebiologic screening of patients in whom biologics are being planned to be administered, especially in leprosy endemic areas.

  16. Recommendations of the Brazilian Society of Rheumatology for the induction therapy of ANCA-associated vasculitis

    Directory of Open Access Journals (Sweden)

    Alexandre Wagner Silva de Souza

    Full Text Available Abstract The purpose of these recommendations is to guide the appropriate induction treatment of antineutrophil cytoplasmic antibody-associated vasculitis (AAV patients with active disease. The recommendations proposed by the Vasculopathies Committee of the Brazilian Society Rheumatology for induction therapy of AAV, including granulomatosis with polyangiitis, microscopic polyangiitis and renal-limited vasculitis, were based on systematic literature review and expert opinion. Literature review was performed using Medline (PubMed, EMBASE and Cochrane database to retrieve articles until October 2016. PRISMA guidelines were used for the systematic review and articles were assessed according to the Oxford levels of evidence. Sixteen recommendations were made regarding different aspects of induction therapy for AAV. The purpose of these recommendations is to serve as a guide for therapeutic decisions by health care professionals in the management of AAV patients presenting active disease.

  17. [The G-DRG System 2009--relevant changes for rheumatology].

    Science.gov (United States)

    Fiori, W; Liedtke-Dyong, A; Lakomek, H-J; Buscham, K; Lehmann, H; Liman, W; Fuchs, A-K; Bessler, F; Roeder, N

    2010-05-01

    The following article presents the major general and specific changes in the G-DRG system, in the classification systems for diagnoses and procedures as well as for the billing process for 2010. Since the G-DRG system is primarily a tool for the redistribution of resources, every hospital needs to analyze the economic effects of the changes by applying the G-DRG transition-grouper to its own cases. Depending on their clinical focus, rheumatological departments may experience positive or negative consequences from the adjustments. In addition, relevant current case law is considered.

  18. Value of 3-dimensional (3D) imaging in rheumatology

    International Nuclear Information System (INIS)

    Fredy, D.

    1990-01-01

    The whole body scanner (Exel 2.400) of the Centre Hospitalier Sainte-Anne enables the three-dimensional reconstruction, with visualization, of the object in its real volume in less than 10 minutes after taking 20 to 40 radiological sections. The exploration can be complete at all levels. Bone lesions can be perfectly shown, the study of osteoarticular or intraspinal abnormalities is facilitated, all solution of continuity can be detected. A soft parts program as well as a colour program enable a clear and rapid visualization of organic lesions. Three-dimensional imaging can be of great value in rheumatology [fr

  19. Person-centred care in nurse-led outpatient rheumatology clinics: Conceptualization and initial development of a measurement instrument.

    Science.gov (United States)

    Bala, Sidona-Valentina; Forslind, Kristina; Fridlund, Bengt; Samuelson, Karin; Svensson, Björn; Hagell, Peter

    2018-06-01

    Person-centred care (PCC) is considered a key component of effective illness management and high-quality care. However, the PCC concept is underdeveloped in outpatient care. In rheumatology, PCC is considered an unmet need and its further development and evaluation is of high priority. The aim of the present study was to conceptualize and operationalize PCC, in order to develop an instrument for measuring patient-perceived PCC in nurse-led outpatient rheumatology clinics. A conceptual outpatient PCC framework was developed, based on the experiences of people with rheumatoid arthritis (RA), person-centredness principles and existing PCC frameworks. The resulting framework was operationalized into the PCC instrument for outpatient care in rheumatology (PCCoc/rheum), which was tested for acceptability and content validity among 50 individuals with RA attending a nurse-led outpatient clinic. The conceptual framework focuses on the meeting between the person with RA and the nurse, and comprises five interrelated domains: social environment, personalization, shared decision-making, empowerment and communication. Operationalization of the domains into a pool of items generated a preliminary PCCoc/rheum version, which was completed in a mean (standard deviation) of 5.3 (2.5) min. Respondents found items easy to understand (77%) and relevant (93%). The Content Validity Index of the PCCoc/rheum was 0.94 (item level range, 0.87-1.0). About 80% of respondents considered some items redundant. Based on these results, the PCCoc/rheum was revised into a 24-item questionnaire. A conceptual outpatient PCC framework and a 24-item questionnaire intended to measure PCC in nurse-led outpatient rheumatology clinics were developed. The extent to which the questionnaire represents a measurement instrument remains to be tested. Copyright © 2018 John Wiley & Sons, Ltd.

  20. Evaluation of a novel 7-joint ultrasound score in daily rheumatologic practice: a pilot project.

    Science.gov (United States)

    Backhaus, M; Ohrndorf, S; Kellner, H; Strunk, J; Backhaus, T M; Hartung, W; Sattler, H; Albrecht, K; Kaufmann, J; Becker, K; Sörensen, H; Meier, L; Burmester, G R; Schmidt, W A

    2009-09-15

    To introduce a new standardized ultrasound score based on 7 joints of the clinically dominant hand and foot (German US7 score) implemented in daily rheumatologic practice. The ultrasound score included the following joints of the clinically dominant hand and foot: wrist, second and third metacarpophalangeal and proximal interphalangeal, and second and fifth metatarsophalangeal joints. Synovitis and synovial/tenosynovial vascularity were scored semiquantitatively (grade 0-3) by gray-scale (GS) and power Doppler (PD) ultrasound. Tenosynovitis and erosions were scored for presence. The scoring range was 0-27 for GS synovitis, 0-39 for PD synovitis, 0-7 for GS tenosynovitis, 0-21 for PD tenosynovitis, and 0-14 for erosions. Patients with arthritis were examined at baseline and after the start or change of disease-modifying antirheumatic drug (DMARD) and/or tumor necrosis factor alpha (TNFalpha) inhibitor therapy 3 and 6 months later. C-reactive protein level, erythrocyte sedimentation rate, rheumatoid factor, anti-cyclic citrullinated peptide, Disease Activity Score in 28 joints (DAS28), and radiographs of the hands and feet were performed. One hundred twenty patients (76% women) with rheumatoid arthritis (91%) and psoriatic arthritis (9%) were enrolled. In 52 cases (43%), erosions were seen in radiography at baseline. Patients received DMARDs (41%), DMARDs plus TNFalpha inhibitors (41%), or TNFalpha inhibitor monotherapy (18%). At baseline, the mean DAS28 was 5.0 and the synovitis scores were 8.1 in GS ultrasound and 3.3 in PD ultrasound. After 6 months of therapy, the DAS28 significantly decreased to 3.6 (Delta = 1.4), and the GS and PD ultrasound scores significantly decreased to 5.5 (-32%) and 2.0 (-39%), respectively. The German US7 score is a viable tool for examining patients with arthritis in daily rheumatologic practice because it significantly reflects therapeutic response.

  1. Policy challenges for the pediatric rheumatology workforce: Part II. Health care system delivery and workforce supply.

    Science.gov (United States)

    Henrickson, Michael

    2011-01-01

    The United States pediatric population with chronic health conditions is expanding. Currently, this demographic comprises 12-18% of the American child and youth population. Affected children often receive fragmented, uncoordinated care. Overall, the American health care delivery system produces modest outcomes for this population. Poor, uninsured and minority children may be at increased risk for inferior coordination of services. Further, the United States health care delivery system is primarily organized for the diagnosis and treatment of acute conditions. For pediatric patients with chronic health conditions, the typical acute problem-oriented visit actually serves as a barrier to care. The biomedical model of patient education prevails, characterized by unilateral transfer of medical information. However, the evidence basis for improvement in disease outcomes supports the use of the chronic care model, initially proposed by Dr. Edward Wagner. Six inter-related elements distinguish the success of the chronic care model, which include self-management support and care coordination by a prepared, proactive team. United States health care lacks a coherent policy direction for the management of high cost chronic conditions, including rheumatic diseases. A fundamental restructure of United States health care delivery must urgently occur which places the patient at the center of care. For the pediatric rheumatology workforce, reimbursement policies and the actions of health plans and insurers are consistent barriers to chronic disease improvement. United States reimbursement policy and overall fragmentation of health care services pose specific challenges for widespread implementation of the chronic care model. Team-based multidisciplinary care, care coordination and self-management are integral to improve outcomes. Pediatric rheumatology demand in the United States far exceeds available workforce supply. This article reviews the career choice decision-making process

  2. Policy challenges for the pediatric rheumatology workforce: Part II. Health care system delivery and workforce supply

    Directory of Open Access Journals (Sweden)

    Henrickson Michael

    2011-08-01

    Full Text Available Abstract The United States pediatric population with chronic health conditions is expanding. Currently, this demographic comprises 12-18% of the American child and youth population. Affected children often receive fragmented, uncoordinated care. Overall, the American health care delivery system produces modest outcomes for this population. Poor, uninsured and minority children may be at increased risk for inferior coordination of services. Further, the United States health care delivery system is primarily organized for the diagnosis and treatment of acute conditions. For pediatric patients with chronic health conditions, the typical acute problem-oriented visit actually serves as a barrier to care. The biomedical model of patient education prevails, characterized by unilateral transfer of medical information. However, the evidence basis for improvement in disease outcomes supports the use of the chronic care model, initially proposed by Dr. Edward Wagner. Six inter-related elements distinguish the success of the chronic care model, which include self-management support and care coordination by a prepared, proactive team. United States health care lacks a coherent policy direction for the management of high cost chronic conditions, including rheumatic diseases. A fundamental restructure of United States health care delivery must urgently occur which places the patient at the center of care. For the pediatric rheumatology workforce, reimbursement policies and the actions of health plans and insurers are consistent barriers to chronic disease improvement. United States reimbursement policy and overall fragmentation of health care services pose specific challenges for widespread implementation of the chronic care model. Team-based multidisciplinary care, care coordination and self-management are integral to improve outcomes. Pediatric rheumatology demand in the United States far exceeds available workforce supply. This article reviews the career

  3. [Changes for rheumatology in the G-DRG system 2005].

    Science.gov (United States)

    Fiori, W; Roeder, N; Lakomek, H-J; Liman, W; Köneke, N; Hülsemann, J L; Lehmann, H; Wenke, A

    2005-02-01

    The German prospective payment system G-DRG has been recently adapted and recalculated. Apart from the adjustments of the G-DRG classification system itself changes in the legal framework like the extension of the "convergence period" or the limitation of budget loss due to DRG introduction have to be considered. Especially the introduction of new procedure codes (OPS) describing the specialized and complex rheumatologic treatment of inpatients might be of significant importance. Even though these procedures will not yet develop influence on the grouping process in 2005, it will enable a more accurate description of the efforts of acute-rheumatologic treatment which can be used for further adaptations of the DRG algorithm. Numerous newly introduced additive payment components (ZE) result in a more adequate description of the "DRG-products". Although not increasing the individual hospital budget, these additive payments contribute to more transparency of high cost services and can be addressed separately from the DRG-budget. Furthermore a lot of other relevant changes to the G-DRG catalogue, the classification systems ICD-10-GM and OPS-301 and the German Coding Standards (DKR) are presented.

  4. Septic arthritis: a 12 years retrospective study in a rheumatological university clinic

    Directory of Open Access Journals (Sweden)

    L. Riato

    2011-09-01

    Full Text Available Background: Septic arthritis is a disabling and potentially life-threatening condition that requires prompt diagnosis and treatment. The most important risk factors are joint prosthesis, pre-existing joint disease and immunosuppressive drugs. The aim of our study therefore was to revaluate all septic arthritis cases discharged from our Rheumatologic Unit in the last 12 years, to assess the risk factors, the clinical and laboratory characteristics, the causative microorganisms and its possible increase in frequency. Methods: The medical records of 42 consecutive patients with septic arthritis discharged from our Rheumatology Unit between January 1995 and December 2006 were reviewed. The patients ranged in age from 23 to 90 and there isn’t gender predominance. Septic arthritis was diagnosed based on the finding of purulent material in the joint space and/or the isolation of a bacterial pathogen from joint fluid. Demographic data, risk factors, co-morbidity, clinical manifestations, time interval between symptoms onset and diagnosis, treatment and laboratory data including serum white blood cell count, erythrocyte sedimentation rate (ESR, C reactive protein (CRP, synovial white blood cells and culture results were analysed. We considered these parameters in the whole population and in two different age groups (≤60, >60 and tried to determine if there was a change of microorganisms involved in septic arthritis during the years. Results: Of 42 patients, 47% were aged 60 and younger. Only 10 patients were admitted to our unit before 2001. A predisposing factor was recorded in 90,5% of cases: 15 patients had rheumatoid arthritis, 8 were diabetic, 6 had seronegative arthritis, 4 had a connective tissue disease, 8 patients had a prosthetic infection and 3 were subjected recently to arthrocentesis. We found that patients aged 60 and younger were more frequently affected by joint disease and had a synovial white blood cell count lower than patients

  5. Prevalence of serological markers for celiac disease (IgA and IgG class antigliadin antibodies and IgA class antiendomysium antibodies in patients with autoimmune rheumatologic diseases in Belo Horizonte, MG, Brazil Pesquisa de anticorpos antigliadina (classes IgA e IgG e anticorpos antiendomísio classe IgA, em pacientes com doenças reumatológicas autoimunes em Belo Horizonte, Brasil

    Directory of Open Access Journals (Sweden)

    Victor de Barros Koehne

    2010-09-01

    Full Text Available CONTEXT: Patients with autoimmune rheumatologic conditions and celiac disease tend to have a variety of autoantibodies, many of which have no clear pathogenic role. The literature contains frequent reports of celiac disease being more prevalent in patients with rheumatologic diseases, although this remains controversial. OBJECTIVES: To investigate the prevalence of positive serum tests for celiac disease, particularly IgA and IgG antigliadin (AGA antibodies and IgA antiendomysium antibodies (EmA in patients with autoimmune rheumatologic diseases. A second aim was to correlate positive serum tests with prednisone and immunosuppressant medication. METHODS: A total of 190 adults and pediatric patients with a variety of autoimmune rheumatologic diseases (systemic lupus erythematosus, rheumatoid arthritis, juvenile rheumatoid arthritis and spondyloarthrophathies were evaluated and tested for IgA and IgG antigliadin-antibodies and IgA antiendomysium antibodies. Patients with positive serum tests underwent endoscopic duodenal biopsies for pathology studies. RESULTS: There were four positive sera (2.1% for AGA IgA, all of which tested negative for AGA IgG and EmA. Three sera (1.6% tested positive for AGA IgG; all were negative for AGA IgA and EmA. The EmA test at a 1:2.5 serum dilution tested positive in 94 patients (49.5%; at a 1:5 serum dilution it was positive in 41 patients (21.6%. Eleven subjects tested positive for EmA at 1:40 dilution; and all of these tested negative for IgA tissue antitransglutaminase (tTG antibodies. Nine of the 11 EmA-positive patients and all 7 patients with positive antigliadin antibodies tests underwent duodenal endoscopic biopsies, and no significant changes were demonstrated in their duodenal mucosa. A positive EmA was associated with elevated optical density AGA IgA readings; however, there was no relationship between positive EmA and AGA IgG optical density readings. Prednisone and immunosuppressant use were unrelated

  6. State of the art on nailfold capillaroscopy: a reliable diagnostic tool and putative biomarker in rheumatology?

    Science.gov (United States)

    Cutolo, Maurizio; Smith, Vanessa

    2013-11-01

    Capillaroscopy is a non-invasive and safe tool to morphologically study the microcirculation. In rheumatology it has a dual use. First, it has a role in differential diagnosis of patients with RP. Second, it may have a role in the prediction of clinical complications in CTDs. In SSc, pilot studies have shown predictive associations with peripheral vascular and lung involvement hinting at a role of capillaroscopy as putative biomarker. Also and logically, in SSc, microangiopathy, as assessed by capillaroscopy, has been associated with markers of the disease such as angiogenic/static factors and SSc-specific antibodies. Moreover, morphological assessments of the microcirculation (capillaroscopy) seem to correlate with functional assessments (such as laser Doppler). Because of its clinical and research role, eyes are geared in Europe to expand the knowledge of this tool. Both the European League Against Rheumatism (EULAR) and the ACR are stepping forward to this need.

  7. Current state of biosimilars in Mexico: The position of the Mexican College of Rheumatology, 2016.

    Science.gov (United States)

    Xibille, Daniel; Carrillo, Sandra; Huerta-Sil, Gabriela; Hernández, Ramiro; Limón, Leonardo; Olvera-Soto, Guadalupe; Jara-Quezada, Luis Javier; Esquivel, Abdieel; Pérez-Rodríguez, Marcela

    The present document is a position statement of the Mexican College of Rheumatology on the use of biosimilars in rheumatic diseases. This position considers that biosimilars should be considered as interchangeable, that automatic substitution without previous notice in stable patients during follow-up is not ethical, that the approval of a biosimilar should only be given after exhaustive review of preclinical and clinical data marked by Mexican regulations, that it should be clearly stated in the nomenclature of biologic drugs which is the innovator and which is the biosimilar, that it is not correct to choose a biosimilar as treatment based only on economic reasons or extrapolate indications based only on the approval of the innovator and in the absence of safety and efficacy data for the biosimilar. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  8. Rheumatoid arthritis disease activity measures: American College of Rheumatology recommendations for use in clinical practice.

    Science.gov (United States)

    Anderson, Jaclyn; Caplan, Liron; Yazdany, Jinoos; Robbins, Mark L; Neogi, Tuhina; Michaud, Kaleb; Saag, Kenneth G; O'Dell, James R; Kazi, Salahuddin

    2012-05-01

    Although the systematic measurement of disease activity facilitates clinical decision making in rheumatoid arthritis (RA), no recommendations currently exist on which measures should be applied in clinical practice in the US. The American College of Rheumatology (ACR) convened a Working Group (WG) to comprehensively evaluate the validity, feasibility, and acceptability of available RA disease activity measures and derive recommendations for their use in clinical practice. The Rheumatoid Arthritis Clinical Disease Activity Measures Working Group conducted a systematic review of the literature to identify RA disease activity measures. Using exclusion criteria, input from an Expert Advisory Panel (EAP), and psychometric analysis, a list of potential measures was created. A survey was administered to rheumatologists soliciting input. The WG used these survey results in conjunction with the psychometric analyses to derive final recommendations. Systematic review of the literature resulted in identification of 63 RA disease activity measures. Application of exclusion criteria and ratings by the EAP narrowed the list to 14 measures for further evaluation. Practicing rheumatologists rated 9 of these 14 measures as most useful and feasible. From these 9 measures, the WG selected 6 with the best psychometric properties for inclusion in the final set of ACR-recommended RA disease activity measures. We recommend the Clinical Disease Activity Index, Disease Activity Score with 28-joint counts (erythrocyte sedimentation rate or C-reactive protein), Patient Activity Scale (PAS), PAS-II, Routine Assessment of Patient Index Data with 3 measures, and Simplified Disease Activity Index because they are accurate reflections of disease activity; are sensitive to change; discriminate well between low, moderate, and high disease activity states; have remission criteria; and are feasible to perform in clinical settings. Copyright © 2012 by the American College of Rheumatology.

  9. Pre-travel care for immunocompromised and chronically ill travellers: A retrospective study

    NARCIS (Netherlands)

    van Aalst, Mariëlle; Verhoeven, Roos; Omar, Freshta; Stijnis, Cornelis; van Vugt, Michèle; de Bree, Godelieve J.; Goorhuis, Abraham; Grobusch, Martin P.

    2017-01-01

    Background: Immunocompromised and chronically ill travellers (ICCITs) are susceptible to travel related diseases. In ICCITs, pre-travel care regarding vaccinations and prophylactics is complex. We evaluated the protection level by preventive measures in ICCITs by analysing rates of vaccination

  10. Inherent Risk Factors for Nosocomial Infection in the Long Stay Critically Ill Child Without Known Baseline Immunocompromise: A Post Hoc Analysis of the CRISIS Trial.

    Science.gov (United States)

    Carcillo, Joseph A; Dean, J Michael; Holubkov, Richard; Berger, John; Meert, Kathleen L; Anand, Kanwaljeet J S; Zimmerman, Jerry; Newth, Christopher J; Harrison, Rick; Burr, Jeri; Willson, Douglas F; Nicholson, Carol; Bell, Michael J; Berg, Robert A; Shanley, Thomas P; Heidemann, Sabrina M; Dalton, Heidi; Jenkins, Tammara L; Doctor, Allan; Webster, Angie

    2016-11-01

    Nosocomial infection remains an important health problem in long stay (>3 days) pediatric intensive care unit (PICU) patients. Admission risk factors related to the development of nosocomial infection in long stay immune competent patients in particular are not known. Post-hoc analysis of the previously published Critical Illness Stress induced Immune Suppression (CRISIS) prevention trial database, to identify baseline risk factors for nosocomial infection. Because there was no difference between treatment arms of that study in nosocomial infection in the population without known baseline immunocompromise, both arms were combined and the cohort that developed nosocomial infection was compared with the cohort that did not. There were 254 long stay PICU patients without known baseline immunocompromise. Ninety (35%) developed nosocomial infection, and 164 (65%) did not. Admission characteristics associated with increased nosocomial infection risk were increased age, higher Pediatric Risk of Mortality version III score, the diagnoses of trauma or cardiac arrest and lymphopenia (P risk of developing nosocomial infection (P risk factors (P < 0.05); whereas trauma tended to be related to nosocomial infection development (P = 0.07). These data suggest that increasing age, cardiac arrest and lymphopenia predispose long stay PICU patients without known baseline immunocompromise to nosocomial infection. These findings may inform pre-hoc stratification randomization strategies for prospective studies designed to prevent nosocomial infection in this population.

  11. Enquiries to the United Kingdom National Travel Advice Line by healthcare professionals regarding immunocompromised travellers.

    Science.gov (United States)

    Allen, Joanna E; Patel, Dipti

    2016-03-01

    People who travel while immunocompromised are more at risk of serious travel-related infection. Their condition, medications or treatments can contraindicate, decrease the effectiveness of or increase the toxicity of vaccinations or malaria chemoprophylaxis. Therefore, immunocompromised travellers require careful assessment and specialized pre-travel advice. The aims of this study were to investigate enquiries by healthcare professionals (HCPs) to the UK National Travel Health Network and Centre (NaTHNaC) advice line regarding travellers with immunocompromise and to identify their most common concerns. Documentation for all calls taken by advisers at the London office during 2013 was reviewed. Of the 4910 enquiries to the London NaTHNaC advice line, 397 calls concerned immunocompromised travellers (8.1%). The majority of immunocompromised travellers were planning to visit Sub-Saharan Africa (53%) for the purpose of tourism (43%). Sixty-seven percent of enquiries concerned vaccine use, 11% were about malaria chemoprophylaxis, 20% were about both and 2% were for other reasons. Causes of immunocompromise included inflammatory or autoimmune conditions (43%), cancer (18%), splenic dysfunction (13%), immunosuppressive drugs (12%), human immunodeficiency virus (11%), primary immunodeficiency (1%), neutropenia (0.5%) and thymus abnormalities (0.5%). There were frequent enquires to the advice line by UK HCPs regarding immunocompromised travellers. The travellers in this study had a wide range of underlying medical conditions and varying levels of immunocompromise. These enquiries may reflect a lack of clarity in current national guidelines, difficulties in interpreting them or both. Establishing the reasons for these deficiencies as well as the reasons behind UK HCP concerns and lack of confidence requires further investigation. This research has highlighted potential knowledge gaps and will help inform future guidance and educational activities for UK HCPs advising

  12. Enhancing the reporting and transparency of rheumatology research

    DEFF Research Database (Denmark)

    Christensen, Robin; Bliddal, Henning; Henriksen, Marius

    2013-01-01

    Manuscripts and abstracts from biomedical journals frequently do not contain proper information for meeting required standards and serving the multiple needs of their end users. Reporting guidelines and checklists help researchers to meet those standards by providing rules or principles......, to present a structured overview of reporting guidelines that rheumatology journals could apply, and to encourage their use by journal authors, editors, and reviewers, including those of Arthritis Research & Therapy. Internationally recognized reporting guidelines exist for a diversity of research areas. We...... encourage colleagues to consult the 'Enhancing the QUAlity and Transparency Of health Research' (EQUATOR) network when writing scientific papers. EQUATOR is an international initiative that seeks to improve the reliability and value of biomedical research literature by promoting transparent and accurate...

  13. A Rare Cause of Massive Upper Gastrointestinal Hemorrhage in Immunocompromised Host.

    Science.gov (United States)

    Abdullah, Obai; Pele, Nicole A; Fu, Yumei; Ashraf, Imran; Arif, Murtaza; Bechtold, Matthew L; Grewal, Ajitinder; Hammad, Hazem T

    2012-02-01

    Mucormycosis is an invasive and aggressive opportunistic fungal infection that usually presents with rhinocerebral or pulmonary involvement and rarely involves the gastrointestinal tract. The disease is acute with mortality rate up to 100%. A 68-year-old male was undergoing treatment at a local hospital for COPD exacerbation with IV steroids and antibiotics. Two weeks into his treatment he suddenly developed massive upper GI bleeding and hemodynamic instability that necessitated transfer to our tertiary care hospital for further treatment and management. An urgent upper endoscopy revealed multiple large and deep gastric and duodenal bulb ulcers with stigmata of recent bleeding. The ulcers were treated endoscopically. Biopsies showed fibrinopurulent debris with fungal organisms. Stains highlighted slightly irregular hyphae with rare septa and yeast suspicious for Candida. The patient was subsequently placed on fluconazole. Unfortunately, the patient's general condition continued to worsen and he developed multiorgan failure and died. Autopsy revealed disseminated systemic mucormycosis. Most of the cases of gastrointestinal mucormycosis were reported from the tropics and few were reported in the United States. The disease occurs most frequently in immunocompromised individuals. The rare incidence of GI involvement, acute nature, severity and the problematic identification of the organisms on biopsies make antemortem diagnosis challenging. Treatment includes parenteral antifungals and debridement of the infected tissues. Gastroenterologists should be aware of this rare cause of gastrointestinal bleeding and understand the importance of communication with the reviewing pathologist so that appropriate, and often lifesaving, therapies can be administered in a timely manner.

  14. Patient’s Knowledge and Perception Towards the use of Non-steroidal Anti-Inflammatory Drugs in Rheumatology Clinic Northern Malaysia

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    Wahinuddin Sulaiman

    2012-11-01

    Full Text Available Objective: In Rheumatology, non-steroidal anti-inflammatory drugs (NSAIDs has been widely prescribed and used. However, despite their clinical benefits in the management of inflammatory and degenerative joint disease, NSAIDs have considerable side effects, mostly affecting the upper gastrointestinal system, which therefore, limit their use. This study was conducted to determine the patients’ knowledge and perception regarding the used of NSAIDS.Methods: A total of 120 patients who attended the rheumatology clinic Hospital, Raja Permaisuri Bainun, Malaysia, and received NSAIDs more than 3 months were interviewed irrespective of the irrheumatological conditions. Patient’s knowledge and perception on the side effects of NSAIDs were recorded.Result: Fifty-four percent of the patients obtained information regarding the side effect of NSAIDs either from the rheumatologist, rheumatology staff nurse or other medical staffs (75.4%. The remaining 45.8% were naive of such knowledge. Fifteen percent obtained the information by surfing the internet and 9.2% from printed media. Twenty-four (24.2% patients, experiencedin digestion and/or stomach discomfort attributed to NSAIDsused. Two patients (1.7% had hematemesis and malena once.Conclusion: This study shows that half of the patients who attended the rheumatology clinic were unaware of the side effect of NSAIDs. Available data showed that most of the knowledgeable patients are more conscience and self-educated. This study also reveals the important roles of clinicians, trained staff nurses as well as the pharmacist in providing the guidance and knowledge of any medication taken by patients.

  15. Symptoms of infectious diseases in immunocompromised travelers: a prospective study with matched controls.

    Science.gov (United States)

    Baaten, Gijs G; Geskus, Ronald B; Kint, Joan A; Roukens, Anna H E; Sonder, Gerard J; van den Hoek, Anneke

    2011-01-01

    Immunocompromised travelers to developing countries are thought to have symptomatic infectious diseases more often and longer than non-immunocompromised travelers. Evidence for this is lacking. This study evaluates whether immunocompromised short-term travelers are at increased risk of diseases. A prospective study was performed between October 2003 and May 2010 among adult travelers using immunosuppressive agents (ISA) and travelers with inflammatory bowel disease (IBD), with their non-immunocompromised travel companions serving as matched controls with comparable exposure to infection. Data on symptoms of infectious diseases were recorded by using a structured diary. Among 75 ISA, the incidence of travel-related diarrhea was 0.76 per person-month, and the number of symptomatic days 1.32 per month. For their 75 controls, figures were 0.66 and 1.50, respectively (p > 0.05). Among 71 IBD, the incidence was 1.19, and the number of symptomatic days was 2.48. For their 71 controls, figures were 0.73 and 1.31, respectively (p > 0.05). These differences also existed before travel. ISA had significantly more and longer travel-related signs of skin infection and IBD suffered more and longer from vomiting. As for other symptoms, no significant travel-related differences were found. Only 21% of immunocompromised travelers suffering from diarrhea used their stand-by antibiotics. ISA and IBD did not have symptomatic infectious diseases more often or longer than non-immunocompromised travelers, except for signs of travel-related skin infection among ISA. Routine prescription of stand-by antibiotics for these immunocompromised travelers to areas with good health facilities is probably not more useful than for healthy travelers. © 2011 International Society of Travel Medicine.

  16. Parasites may exit immunocompromised northern pig-tailed macaques (Macaca leonina infected with SIVmac239

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    Tian-Zhang Song

    2018-01-01

    Full Text Available Parasites can increase infection rates andpathogenicity in immunocompromised humanimmunodeficiency virus (HIV patients. However, invitro studies and epidemiological investigationsalso suggest that parasites might escapeimmunocompromised hosts during HIV infection.Due to the lack of direct evidence from animalexperiments, the effects of parasitic infections onimmunocompromised hosts remain unclear. Here,we detected 14 different parasites in six northernpig-tailed macaques (NPMs before or during the50th week of post-simian immunodeficiency virus(SIV infection by ELISA. The NPMs all carriedparasites before viral injection. At the 50th week afterviral injection, the individuals with negative resultsin parasitic detection (i.e., 08247 and 08287 werecharacterized as the Parasites Exit (PE group, withthe other individuals (i.e., 09203, 09211, 10205, and10225 characterized as the Parasites Remain (PRgroup. Compared with the PR group, the NPMs in thePE group showed higher viral loads, lower CD4+ Tcells counts, and lower CD4/CD8 rates. Additionally,the PE group had higher immune activation andimmune exhaustion of both CD4+ and CD8+ T cells.Pathological observation showed greater injury tothe liver, cecum, colon, spleen, and mesentericlymph nodes in the PE group. This study showedmore seriously compromised immunity in the PEgroup, strongly indicating that parasites might exit animmunocompromised host.

  17. Mass spectrometry imaging: a novel technology in rheumatology.

    Science.gov (United States)

    Rocha, Beatriz; Ruiz-Romero, Cristina; Blanco, Francisco J

    2017-01-01

    Mass spectrometry imaging (MSI) is used to determine the relative abundance and spatial distribution of biomolecules such as peptides, proteins, lipids and other organic compounds in tissue sections by their molecular masses. This technique provides a sensitive and label-free approach for high-resolution imaging, and is currently used in an increasing number of biomedical applications such as biomarker discovery, tissue classification and drug monitoring. Owing to technological advances in the past 5 years in diverse MSI strategies, this technology is expected to become a standard tool in clinical practice and provides information complementary to that obtained using existing methods. Given that MSI is able to extract mass-spectral signatures from pathological tissue samples, this technique provides a novel platform to study joint-related tissues affected by rheumatic diseases. In rheumatology, MSI has been performed on articular cartilage, synovium and bone to increase the understanding of articular destruction and to characterize diagnostic and prognostic biomarkers for osteoarthritis, rheumatoid arthritis and osteoporosis. In this Review, we provide an overview of MSI technology and of the studies in which joint tissues have been analysed by use of this methodology. This approach might increase knowledge of rheumatic pathologies and ultimately prompt the development of targeted strategies for their management.

  18. Art and rheumatology: the artist and the rheumatologist's perspective.

    Science.gov (United States)

    Hinojosa-Azaola, Andrea; Alcocer-Varela, Jorge

    2014-10-01

    The reflection of medicine in the universal arts has motivated several rheumatologists to discover features of rheumatic diseases depicted by the artist's eyes long before they were defined as specific pathologic entities. The result has been the identification of several pieces of art dating from the Middle Ages, the Renaissance, the Baroque and Post-Impressionist periods that depict clear features of several rheumatic diseases such as RA, OA, camptodactyly and temporal arteritis, among others. On the other hand, great artists such as Pierre-Auguste Renoir, Antoni Gaudí, Raoul Dufy, Paul Klee, Frida Kahlo and Niki de Saint Phalle are good examples of how rheumatic diseases such as RA, scleroderma and chronic pain can influence the artist's perspective, the technique used and the content of their work. Art can serve as a powerful resource to understand the natural course of diseases. By learning through the artist's eyes the way illnesses behave and evolve in time, rheumatologists can trace the history of several conditions. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  19. Flipped Learning: Can Rheumatology Lead the Shift in Medical Education?

    Science.gov (United States)

    El Miedany, Yasser; El Gaafary, Maha; El Aroussy, Nadia; Youssef, Sally

    2018-04-16

    To: 1. implement flipped classroom rheumatology teaching for undergraduate education. 2. Evaluate outcomes of teaching using OSCE assessment and student perceived effectiveness and satisfaction survey. The flipped classroom education was conducted in 3 phases. Phase 1: carried out in the students' own time. Web links were emailed to assist exposure of the instructional part of the lesson online. Phase 2: interactive in-class activity to share personal reflection and reinforce the key aspects. Phase 3: a simulated OSCE assessment. A cohort of 56-students, who were taught in the last educational year on the same topics according to standard teaching protocols, were included as control group. The clinical Outcomes were assessed using the scores of the OSCE examination model. Academic outcomes included the engagement measure as well as the students' answers to perceived effectiveness and satisfaction survey. There was no significant difference regarding demographics between the 2 students' groups. There was significant improvement (plearning, in contrast to the control group, in terms of clinical (OSCE score) as well as communication skills. Student perceived effectiveness and satisfaction was significantly higher among the flipped learning (plearning cohort showed a state of engagement significantly higher than the control group (plearning implementation musculoskeletal learning successfully demonstrated a promising platform for using technology to make better use of the students' time, and for increasing their satisfaction. Active learning increases student engagement and can lead to improved retention of knowledge. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  20. Immunology for rheumatology residents: working toward a Canadian national curriculum consensus.

    Science.gov (United States)

    Chow, Shirley L; Herman-Kideckel, Sari; Mahendira, Dharini; McDonald-Blumer, Heather

    2015-01-01

    Immunologic mechanisms play an integral role in understanding the pathogenesis and management of rheumatic conditions. Currently, there is limited access to formal instruction in immunology for rheumatology trainees across Canada. The aims of this study were (1) to describe current immunology curricula among adult rheumatology training programs across Canada and (2) to compare the perceived learning needs of rheumatology trainees from the perspective of program directors and trainees to help develop a focused nationwide immunology curriculum. Rheumatology trainees and program directors from adult rheumatology programs across Canada completed an online questionnaire and were asked to rank a comprehensive list of immunology topics. A modified Delphi approach was implemented to obtain consensus on immunology topics. Only 42% of program directors and 31% of trainees felt the current method of teaching immunology was effective. Results illustrate concordance between program directors and trainees for the highest-ranked immunology topics including innate immunity, adaptive immunity, and cells and tissues of the immune system. However, there was discordance among other topics, such as diagnostic laboratory immunology and therapeutics. There is a need to improve immunology teaching in rheumatology training programs. Results show high concordance between the basic immunology topics. This study provides the groundwork for development of future immunology curricula.

  1. Current educational status of paediatric rheumatology in Europe: the results of PReS survey.

    Science.gov (United States)

    Demirkaya, E; Ozen, S; Türker, T; Kuis, W; Saurenmann, R K

    2009-01-01

    To understand the status of education and problems in paediatric rheumatology practice in Europe, through a survey. A 26-item questionnaire was conducted during the 14th Congress of the Paediatric Rheumatology European Society in Istanbul, 2007. Physicians who were practicing or studying within the field of paediatric rheumatology for at least one year were included in the survey. One hundred and twenty eight physicians, 79 paediatric rheumatologists (including 5 paediatric immunologists and 10 paediatric nephrologists), 34 paediatric rheumatology fellows and 15 adult rheumatologists completed the survey. The physicians were from: Europe 95 (81.9%), South America 12 (10.4%), Middle East 5 (4.3%), Asia 2 (1.7%), Africa 2 (1.7%). The duration of training for paediatric rheumatology ranged between 1-5 years (mean: 3.12+/-1.11). Sixty physicians scored their education as unsatisfactory and among those, 48 physicians were from Europe. Physicians reported good skills in the following items; intraarticular injections (83.3%); soft tissue injections (47.6%); evaluation of radiographs (67.5%); whereas competence in the evaluation of computed tomography/magnetic resonance imaging (30.5%); and musculoskeletal sonography (16.7%) was much lower. A need for improved basic science and rotations among relevant fields were specifically expressed. Being a relatively new speciality in the realm of paediatrics, paediatric rheumatology education at the European level needs to be further discussed, revised and uniformed.

  2. Experience of Comamonas acidovorans keratitis with delayed onset and treatment response in immunocompromised cornea.

    Science.gov (United States)

    Lee, Sang Mok; Kim, Mee Kum; Lee, Jae Lim; Wee, Won Ryang; Lee, Jin Hak

    2008-03-01

    To report 2 cases of Comamonas acidovorans keratitis in immunocompromised cornea. A complete review of the medical records of the two cases of Comamonas acidovorans keratitis. We found some similarities in clinical courses of two cases. Both of them showed development of keratitis during the management with corticosteroids, delayed onset, slow response to antibiotics, and relatively less affected corneal epithelium. Comamonas acidovorans is known as a less virulent organism. However it can cause an indolent infection that responds slowly even to adequate antibiotics therapy in immunocompromised corneas.

  3. Antigenic and anticorpal diagnosis of invasive aspergillosis and candidosis in immunocompromised host

    Directory of Open Access Journals (Sweden)

    Marco Machetti

    2009-03-01

    Full Text Available Invasive aspergillosis (IA and candidemia are an increasing cause of morbidity and mortality in immunocompromised patients, but diagnostic procedures are often hampered by critical patients conditions. In recent years, non-culture methods have reached a standardization level suitable to be marketed and widely employed. A method for a panfungal antigenic diagnosis, is the detection in serum of (1→3-ß-D-Glucan (BDG, a polisaccaridic component of fungal cell wall. Best results can be obtained in Aspergillus, Candida and Fusarium infections, while the test performs poorly with Cryptococcus and in zygomycosis. The use of this method are limited by the high costs and by the need of disposable materials certified as glucan-free, in order to avoid false positive results. Galactomannan (GM antigen detection is a method for non-invasive diagnosis of IA. The assay, in latex agglutination (LA and enzymeimmunoassay (EIA format, detect GM in serum, whose presence correlates with IA. Sensitivity and specificity strongly fluctuate (50-100% and 81-98% respectively depending on the time of sampling, the positivity cut-off employed, the concomitant administration of antifungal drugs and of some antibiotics. Nevertheless the method is a very useful and widely employed tool for the diagnosis of IA. For the diagnosis of candidemia, two Candida antigens may be detected in serum: the 56°C heat-labile antigen in LA format, and the mannan antigen, in LA and EIA format. Both the methods perform quite well, but sensitivities and specificities are not so good to allow a routinely and useful use in clinical practice.

  4. Italian Society for Rheumatology recommendations for the management of hand osteoarthritis

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    M. Manara

    2013-10-01

    Full Text Available Hand osteoarthritis (OA is a common and potentially disabling disease, with different features from hip and knee OA so that a specific therapeutic approach is required. Evidence based recommendations for the management of hand OA were developed by the European League Against Rheumatism (EULAR in 2006. The Italian Society for Rheumatology (SIR aimed to update, adapt to national contest and disseminate the EULAR recommendations for the management of hand OA. The multidisciplinary group of experts included specialists involved in the management of patients with hand OA. In order to maintain consistency with EULAR recommendations, a similar methodology was utilized by the Italian group. The original propositions were reformulated in terms of a search query and for every recommendation a systematic search was conducted updating EULAR recommendations’ review. The propositions were translated in Italian and reformulated basing on collected evidences and expert opinion. The strength of recommendation was measured for each proposition with the EULAR ordinal and visual analogue scales. The original 11 propositions of EULAR recommendations were translated and adapted to Italian context. Further evidences were collected about non-pharmacological therapies, local treatments, intra-articular injection with SYSADOA and corticosteroids, and surgery. The SIR has developed updated recommendations for the management of hand OA adapted to the Italian healthcare system. Their implementation in clinical practice is expected to improve the management of patients with hand OA.

  5. [Vaccination against yellow fever among patients on immunosuppressors with diagnoses of rheumatic diseases].

    Science.gov (United States)

    Mota, Licia Maria Henrique da; Oliveira, Ana Cristina Vanderley; Lima, Rodrigo Aires Corrêa; Santos-Neto, Leopoldo Luiz dos; Tauil, Pedro Luiz

    2009-01-01

    Yellow fever is endemic in some countries. The anti-yellow fever vaccine is the only effective means of protection but is contraindicated for immunocompromised patients. The aim of this paper was to report on a case series of rheumatological patients who were using immunosuppressors and were vaccinated against this disease. This was a retrospective study by means of a questionnaire applied to these patients, who were vaccinated 60 days before the investigation. Seventy patients of mean age 46 years were evaluated. Most of them were female (90%). There were cases of rheumatoid arthritis (54), systemic lupus erythematosus (11), spondyloarthropathy (5) and systemic sclerosis (2). The therapeutic schemes included methotrexate (42), corticosteroids (22), sulfasalazine (26), leflunomide (18), cyclophosphamide (3) and immunobiological agents (9). Sixteen patients (22.5%) reported some minor adverse effect. Among the eight patients using immunobiological agents, only one presented a mild adverse effect. Among these patients using immunosuppressors, adverse reactions were no more frequent than among immunocompetent individuals. This is the first study on this topic.

  6. Teaching musculoskeletal examination skills to UK medical students: a comparative survey of Rheumatology and Orthopaedic education practice.

    Science.gov (United States)

    Blake, Tim

    2014-03-28

    Specialists in Rheumatology and Orthopaedics are frequently involved in undergraduate teaching of musculoskeletal (MSK) examination skills. Students often report that specialty-led teaching is inconsistent, confusing and bears little resemblance to the curricula. The Gait, Arms, Legs and Spine (GALS) is a MSK screening tool that provides a standardised approach to examination despite it being fraught with disapproval and low uptake. Recent studies would appear to support innovative instructional methods of engaging learners such as patient educators and interactive small group teaching. This comparative cross-sectional survey evaluates the current state of undergraduate teaching in Rheumatology and Orthopaedics, including preferred teaching methods, attitudes towards GALS, and barriers to effective teaching. An electronic questionnaire was sent to specialist trainees and Consultants in the East and West Midlands region, representing 5 UK medical schools. Descriptive statistical data analysis was performed. There were 76 respondents representing 5 medical schools. There was a request for newer teaching methodologies to be used: multi-media computer-assisted learning (35.5%), audio-visual aids (31.6%), role-playing (19.7%), and social media (3.9%). It is evident that GALS is under-utilised with 50% of clinicians not using GALS in their teaching. There is a genuine desire for clinical educators to improve their teaching ability, collaborate more with curriculum planners, and feel valued by institutions. There remains a call for implementing a standardised approach to MSK clinical teaching to supersede GALS.

  7. A concise evaluation and management curriculum for physicians in training improved billing at an outpatient academic rheumatology clinic.

    Science.gov (United States)

    Hirsh, Joel M; Collier, David H; Boyle, Dennis J; Gardner, Edward M

    2010-04-01

    To study whether providing house staff with a brief lecture and handout about proper documentation could improve billing at an academic rheumatology clinic. The authors created an educational sheet about documentation and billing after a review of the common documentation omissions responsible for down coding (Appendix, Supplemental Digital Content 1, available at: http://links.lww.com/RHU/A8). Beginning in November of 2006, the house staff were provided with this sheet and a brief lecture regarding how outpatient evaluation and management levels of service are coded. The results of clinic billing from January 1, 2006 to October 31, 2006 and November 1, 2006 to August 31, 2007 were obtained from the physician billing office. The authors compared the average level of service, by appointment type, in the prepost comparison periods using the student t test. There was a significant improvement in the level of service billed for new visits (P < 0.001), consults (P < 0.001), and return visits (P < 0.001) after November 1, 2006. The percentage of patients evaluated for the first time who were billed as consults improved from 15% to 78% (P < 0.001 by chi2). These changes resulted in $34,342 of additional billing during the postintervention period. A simple strategy for educating the house staff about proper documentation of the history, physical examination, and clinical decision making resulted in a significant improvement in an academic rheumatology division's outpatient billing.

  8. Group for Research and Assessment of Psoriasis and Psoriatic Arthritis/Outcome Measures in Rheumatology Consensus-Based Recommendations and Research Agenda for Use of Composite Measures and Treatment Targets in Psoriatic Arthritis

    DEFF Research Database (Denmark)

    Coates, Laura C; FitzGerald, Oliver; Merola, Joseph F

    2018-01-01

    OBJECTIVE: A meeting was convened by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) and Outcome Measures in Rheumatology (OMERACT) to further the development of consensus among physicians and patients regarding composite disease activity measures and targets i...

  9. A system of networks and continuing education for physical therapists in rheumatology: a feasibility study

    Directory of Open Access Journals (Sweden)

    J. Verhoef

    2004-07-01

    Full Text Available Purpose: To evaluate the feasibility of regional physical therapy networks including continuing education in rheumatology. The aim of these networks was to improve care provided by primary care physical therapists by improving specific knowledge, technical and communicative skills and the collaboration with rheumatologists. Methods: In two regions in The Netherlands continuing education (CE programmes, consisting of a 5-day postgraduate training course followed by bimonthly workshops and teaching practices, were organised simultaneously. Network activities included consultations, newsletters and the development of a communication guideline. Endpoint measures included the participation rate, compliance, quality of the CE programme, teaching practices, knowledge, network activities, communication, number of patients treated and patient satisfaction. Results: Sixty-three physical therapists out of 193 practices (33% participated in the project. They all completed the education programmes and were formally registered. All evaluations of the education programmes showed positive scores. Knowledge scores increased significantly directly after the training course and at 18 months. A draft guideline on communication between physical therapists and rheumatologists was developed, and 4 newsletters were distributed. A substantial proportion of physical therapists and rheumatologists reported improved communication at 18 months. The mean number of patients treated by physical therapists participating in the networks increased significantly. Patients' satisfaction scores within the networks were significantly higher than those from outside the networks at 18 months. Conclusions: Setting up a system of networks for continuing education for physical therapists regarding the treatment of patients with rheumatic diseases is feasible. Further research will focus on the effectiveness of the system and its implementation on a larger scale.

  10. Vesicular stomatitis virus-based ebola vaccine is well-tolerated and protects immunocompromised nonhuman primates.

    Directory of Open Access Journals (Sweden)

    Thomas W Geisbert

    2008-11-01

    Full Text Available Ebola virus (EBOV is a significant human pathogen that presents a public health concern as an emerging/re-emerging virus and as a potential biological weapon. Substantial progress has been made over the last decade in developing candidate preventive vaccines that can protect nonhuman primates against EBOV. Among these prospects, a vaccine based on recombinant vesicular stomatitis virus (VSV is particularly robust, as it can also confer protection when administered as a postexposure treatment. A concern that has been raised regarding the replication-competent VSV vectors that express EBOV glycoproteins is how these vectors would be tolerated by individuals with altered or compromised immune systems such as patients infected with HIV. This is especially important as all EBOV outbreaks to date have occurred in areas of Central and Western Africa with high HIV incidence rates in the population. In order to address this concern, we evaluated the safety of the recombinant VSV vector expressing the Zaire ebolavirus glycoprotein (VSVDeltaG/ZEBOVGP in six rhesus macaques infected with simian-human immunodeficiency virus (SHIV. All six animals showed no evidence of illness associated with the VSVDeltaG/ZEBOVGP vaccine, suggesting that this vaccine may be safe in immunocompromised populations. While one goal of the study was to evaluate the safety of the candidate vaccine platform, it was also of interest to determine if altered immune status would affect vaccine efficacy. The vaccine protected 4 of 6 SHIV-infected macaques from death following ZEBOV challenge. Evaluation of CD4+ T cells in all animals showed that the animals that succumbed to lethal ZEBOV challenge had the lowest CD4+ counts, suggesting that CD4+ T cells may play a role in mediating protection against ZEBOV.

  11. Fecal Microbiota Transplantation Inhibits Multidrug-Resistant Gut Pathogens: Preliminary Report Performed in an Immunocompromised Host.

    Science.gov (United States)

    Biliński, Jarosław; Grzesiowski, Paweł; Muszyński, Jacek; Wróblewska, Marta; Mądry, Krzysztof; Robak, Katarzyna; Dzieciątkowski, Tomasz; Wiktor-Jedrzejczak, Wiesław; Basak, Grzegorz W

    2016-06-01

    Colonization of the gastrointestinal tract with multidrug-resistant (MDR) bacteria is a consequence of gut dysbiosis. We describe the successful utilization of fecal microbiota transplantation to inhibit Klebsiella pneumoniae MBL(+) and Escherichia coli ESBL(+) gut colonization in the immunocompromised host as a novel tool in the battle against MDR microorganisms. ClinicalTrials.gov identifier NCT02461199.

  12. Cost of common low back pain and lumbar radiculopathy in rheumatologic consultation in Lomé.

    Science.gov (United States)

    Fianyo, Eyram; Oniankitan, Owonayo; Tagbor Komi, C; Kakpovi, Kodjo; Houzou, Prénam; Koffi-Tessio Viwalé, E S; Mijiyawa, Moustafa

    2017-03-01

    The cost of low back pain was the subject of few studies in black Africa. To assess the cost of common low back pain and lumbar radiculopathy in Lomé. A six months study was realised in the rheumatologic department of CHU Sylvanus Olympio. 103 consecutive patients suffering from a common low back pain or lumbar radiculopathy were included. To assess direct, indirect and non-financial costs they were questioned about their expense during the year. Financial cost of common low back pain and lumbar radiculopathy amounted to 107.2 $ US (extremes: 5.8 and 726.1 $ US). This amount, quadruple of guaranteed minimum wage, felled under two headings: direct cost (56.3 $ US; 53% of total sum), indirect cost (50.3 $ US; 47% of total sum). Non-financial cost were: disruption in daily activities (94%), impact in emotional and sexual life (59%), impact on the family's budget (69%), abandon of family's projects (58%) or of leisure (42%). In black Africa top priority is given to the fight against infectious diseases those cause an important mortality. But common low back pain and lumbar radiculopathy, those have social and economic impact, should be given more attention.

  13. FUNGAL INFECTIONS OF THE EAR IN IMMUNOCOMPROMISED HOST: A REVIEW

    Directory of Open Access Journals (Sweden)

    Borlingegowda Viswanatha

    2011-01-01

           Hematological investigations play a very important role in confirming the diagnosis and immunity status of the patients. In diabetic patients with otomycosis, along with antifungal therapy blood sugar levels should be controlled with medical therapy to prevent complications.

  14. [The National Database of the Regional Collaborative Rheumatic Centers as a tool for clinical epidemiology and quality assessment in rheumatology].

    Science.gov (United States)

    Zink, Angela; Huscher, Dörte; Listing, Joachim

    2003-01-01

    The national database of the German Collaborative Arthritis Centres is a well-established tool for the observation and assessment of health care delivery to patients with rheumatic diseases in Germany. The discussion of variations in treatment practices contributes to the internal quality assessment in the participating arthritis centres. This documentation has shown deficits in primary health care including late referral to a rheumatologist, undertreatment with disease-modifying drugs and complementary therapies. In rheumatology, there is a trend towards early, intensive medical treatment including combination therapy. The frequency and length of inpatient hospital and rehabilitation treatments is decreasing, while active physiotherapy in outpatient care has been increased. Specific deficits have been identified concerning the provision of occupational therapy services and patient education.

  15. Secukinumab for rheumatology: development and its potential place in therapy

    Directory of Open Access Journals (Sweden)

    Koenders MI

    2016-06-01

    Full Text Available Marije I Koenders, Wim B van den Berg Experimental Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands Abstract: Rheumatic disease is not a single disorder, but a group of more than 100 diseases that affect joints, connective tissues, and/or internal organs. Although rheumatic diseases like rheumatoid arthritis (RA, psoriatic arthritis, and ankylosing spondylitis (AS differ in their pathogenesis and clinical presentation, the treatment of these inflammatory disorders overlaps. Non-steroid anti-inflammatory drugs are used to reduce pain and inflammation. Additional disease-modifying anti-rheumatic drugs are prescribed to slowdown disease progression, and is in RA more frequently and effectively applied than in AS. Biologicals are a relatively new class of treatments that specifically target cytokines or cells of the immune system, like tumor necrosis factor alpha inhibitors or B-cell blockers. A new kid on the block is the interleukin-17 (IL-17 inhibitor secukinumab, which has been recently approved by the US Food and Drug Administration for moderate-to-severe plaque psoriasis, psoriatic arthritis, and AS. IL-17 is a proinflammatory cytokine that has an important role in host defense, but its proinflammatory and destructive effects have also been linked to pathogenic processes in autoimmune diseases like RA and psoriasis. Animal models have greatly contributed to further insights in the potential of IL-17 blockade in autoimmune and autoinflammatory diseases, and have resulted in the development of various potential drugs targeting the IL-17 pathway. Secukinumab (AIN457 is a fully human monoclonal antibody that selectively binds to IL-17A and recently entered the market under the brand name Cosentyx®. By binding to IL-17A, secukinumab prevents it from binding to its receptor and inhibits its ability to trigger inflammatory responses that play a role in the development of various autoimmune diseases. With secukinumab being

  16. 2012 Brazilian Society of Rheumatology Consensus for the treatment of rheumatoid arthritis.

    Science.gov (United States)

    da Mota, Licia Maria Henrique; Cruz, Boris Afonso; Brenol, Claiton Viegas; Pereira, Ivanio Alves; Rezende-Fronza, Lucila Stange; Bertolo, Manoel Barros; de Freitas, Max Victor Carioca; da Silva, Nilzio Antonio; Louzada-Júnior, Paulo; Giorgi, Rina Dalva Neubarth; Lima, Rodrigo Aires Corrêa; da Rocha Castelar Pinheiro, Geraldo

    2012-01-01

    To elaborate recommendations for the treatment of rheumatoid arthritis in Brazil. Literature review with articles' selection based on evidence and the expert opinion of the Rheumatoid Arthritis Committee of the Brazilian Society of Rheumatology. 1) The therapeutic decision should be shared with the patient; 2) immediately after the diagnosis, a disease-modifying antirheumatic drug (DMARD) should be prescribed, and the treatment adjusted to achieve remission; 3) treatment should be conducted by a rheumatologist; 4) the initial treatment includes synthetic DMARDs; 5) methotrexate is the drug of choice; 6) patients who fail to respond after two schedules of synthetic DMARDs should be assessed for the use of biologic DMARDs; 7) exceptionally, biologic DMARDs can be considered earlier; 8) anti-TNF agents are preferentially recommended as the initial biologic therapy; 9) after therapeutic failure of a first biologic DMARD, other biologics can be used; 10) cyclophosphamide and azathioprine can be used in severe extra-articular manifestations; 11) oral corticoid is recommended at low doses and for short periods of time; 12) non-steroidal anti-inflammatory drugs should always be prescribed in association with a DMARD; 13) clinical assessments should be performed on a monthly basis at the beginning of treatment; 14) physical therapy, rehabilitation, and occupational therapy are indicated; 15) surgical treatment is recommended to correct sequelae; 16) alternative therapy does not replace traditional therapy; 17) family planning is recommended; 18) the active search and management of comorbidities are recommended; 19) the patient's vaccination status should be recorded and updated; 20) endemic-epidemic transmissible diseases should be investigated and treated.

  17. Progressive outer retinal necrosis in immunocompromised kidney allograft recipient.

    Science.gov (United States)

    Turno-Kręcicka, A; Boratyńska, M; Tomczyk-Socha, M; Mazanowska, O

    2015-06-01

    Ocular complications in patients who underwent renal transplantation are attributed to side effects of the immunosuppressive regimen. Progressive outer retinal necrosis (PORN) syndrome is a clinical variant of necrotizing herpetic retinopathy and it occurs almost exclusively in patients with acquired immunodeficiency syndrome. We present a case of a human immunodeficiency virus-negative patient who underwent renal transplant and, after a few years, developed bilateral PORN associated with viral infections. Varicella zoster virus (VZV) and BK virus were identified by polymerase chain reaction from the vitreous fluid. It is unclear which of the viruses identified had the dominant role in the pathogenesis of PORN and other organ damage, or whether their actions were synergistic. Adequate antiviral immune surveillance, as well as pre-transplant vaccination against VZV, may reduce the incidence of VZV infection and its complications. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  18. Characterization of Human Cytomegalovirus Genome Diversity in Immunocompromised Hosts by Whole-Genome Sequencing Directly From Clinical Specimens.

    Science.gov (United States)

    Hage, Elias; Wilkie, Gavin S; Linnenweber-Held, Silvia; Dhingra, Akshay; Suárez, Nicolás M; Schmidt, Julius J; Kay-Fedorov, Penelope C; Mischak-Weissinger, Eva; Heim, Albert; Schwarz, Anke; Schulz, Thomas F; Davison, Andrew J; Ganzenmueller, Tina

    2017-06-01

    Advances in next-generation sequencing (NGS) technologies allow comprehensive studies of genetic diversity over the entire genome of human cytomegalovirus (HCMV), a significant pathogen for immunocompromised individuals. Next-generation sequencing was performed on target enriched sequence libraries prepared directly from a variety of clinical specimens (blood, urine, breast milk, respiratory samples, biopsies, and vitreous humor) obtained longitudinally or from different anatomical compartments from 20 HCMV-infected patients (renal transplant recipients, stem cell transplant recipients, and congenitally infected children). De novo-assembled HCMV genome sequences were obtained for 57 of 68 sequenced samples. Analysis of longitudinal or compartmental HCMV diversity revealed various patterns: no major differences were detected among longitudinal, intraindividual blood samples from 9 of 15 patients and in most of the patients with compartmental samples, whereas a switch of the major HCMV population was observed in 6 individuals with sequential blood samples and upon compartmental analysis of 1 patient with HCMV retinitis. Variant analysis revealed additional aspects of minor virus population dynamics and antiviral-resistance mutations. In immunosuppressed patients, HCMV can remain relatively stable or undergo drastic genomic changes that are suggestive of the emergence of minor resident strains or de novo infection. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  19. Uveitis Events During Adalimumab, Etanercept, and Methotrexate Therapy in Juvenile Idiopathic Arthritis: Data From the Biologics in Pediatric Rheumatology Registry.

    Science.gov (United States)

    Foeldvari, Ivan; Becker, Ingrid; Horneff, Gerd

    2015-11-01

    Uveitis is a major extraarticular quality of life-restricting manifestation of juvenile idiopathic arthritis (JIA). The aim of the study is to describe the occurrence of uveitis in JIA patients receiving tumor necrosis factor inhibitors or methotrexate (MTX). Patients' characteristics, treatment, and the reported first occurrence of uveitis as an adverse event were searched in the Biologics in Pediatric Rheumatology Registry. The rates per exposed patients, exposure time, and time until event were calculated. Uveitis was reported as an adverse event in 75 of 3,467 patients; 51 of 2,844 patients were receiving MTX, 37 of 1,700 patients were receiving etanercept, and 13 of 364 patients were receiving adalimumab. Patients with uveitis were younger (mean ± SD age 4.6 ± 4.2 versus 7.4 ± 4.5 years; P uveitis diagnosis before starting treatment more often had a uveitis event (n = 28, 8.4%; OR 8.5, P uveitis event occurred: 11 while taking MTX (3.2 per 1,000 patient-years), 2 while taking etanercept monotherapy (1.9 per 1,000 patient-years), and 3 while taking etanercept and MTX combination (0.9 per 1,000 patient-years). A new uveitis event occurred early in the disease course after a median disease duration of 1.5 years (interquartile range [IQR] 1.3-3.8) while taking etanercept and 1.8 years (IQR 1.8-2.1) for the MTX cohort. A recurrent uveitis event was reported after a disease duration of 7.6 years (IQR 4.3-10.0) in the etanercept cohort and 4.8 years (IQR 1.0-5.8) in the MTX cohort. Univariate analysis showed that MTX, but not etanercept or adalimumab, led to a lower rate of uveitis. Patients with a history of uveitis had higher risks for uveitis events while taking both etanercept and adalimumab. Methotrexate turned out to be protective. Few patients developed a first uveitis event while taking etanercept, while the rate is comparable to that with MTX. Uveitis may not be attributed to be an adverse drug reaction to etanercept. © 2015, American

  20. American College of Rheumatology provisional criteria for defining clinical inactive disease in select categories of juvenile idiopathic arthritis.

    Science.gov (United States)

    Wallace, Carol A; Giannini, Edward H; Huang, Bin; Itert, Lukasz; Ruperto, Nicolino

    2011-07-01

    To prospectively validate the preliminary criteria for clinical inactive disease (CID) in patients with select categories of juvenile idiopathic arthritis (JIA). We used the process for development of classification and response criteria recommended by the American College of Rheumatology Quality of Care Committee. Patient-visit profiles were extracted from the phase III randomized controlled trial of infliximab in polyarticular-course JIA (i.e., patients considered to resemble those with select categories of JIA) and sent to an international group of expert physician raters. Using the physician ratings as the gold standard, the sensitivity and specificity were calculated using the preliminary criteria. Modifications to the criteria were made, and these were sent to a larger group of pediatric rheumatologists to determine quantitative, face, and content validity. Variables weighted heaviest by physicians when making their judgment were the number of joints with active arthritis, erythrocyte sedimentation rate (ESR), physician's global assessment, and duration of morning stiffness. Three modifications were made: the definition of uveitis, the definition of abnormal ESR, and the addition of morning stiffness. These changes did not alter the accuracy of the preliminary set. The modified criteria, termed the "criteria for CID in select categories of JIA," have excellent feasibility and face, content, criterion, and discriminant validity to detect CID in select categories of JIA. The small changes made to the preliminary criteria set did not alter the area under the receiver operating characteristic curve (0.954) or accuracy (91%), but have increased face and content validity. Copyright © 2011 by the American College of Rheumatology.

  1. Impact of Antiinflammatory Treatment on the Onset of Uveitis in Juvenile Idiopathic Arthritis: Longitudinal Analysis From a Nationwide Pediatric Rheumatology Database.

    Science.gov (United States)

    Tappeiner, Christoph; Schenck, Sandra; Niewerth, Martina; Heiligenhaus, Arnd; Minden, Kirsten; Klotsche, Jens

    2016-01-01

    Based on a nationwide database, this study analyzed the influence of methotrexate (MTX), tumor necrosis factor (TNF) inhibitors, and a combination of the 2 medications on uveitis occurrence in juvenile idiopathic arthritis (JIA) patients. Data from the National Paediatric Rheumatological Database in Germany were used in this study. Between 2002 and 2013, data from JIA patients were annually documented at the participating pediatric rheumatologic sites. Patients with a JIA disease duration of treatment on the occurrence of uveitis was evaluated by discrete-time survival analysis. A total of 3,512 JIA patients (mean ± SD age 8.3 ± 4.8 years, 65.7% female, 53.2% antinuclear antibody positive, and mean ± SD age at arthritis onset 7.8 ± 4.8 years) fulfilled the inclusion criteria. Mean ± SD total followup time was 3.6 ± 2.4 years. Uveitis developed in a total of 180 patients (5.1%) within 1 year after arthritis onset. Uveitis onset after the first year was observed in another 251 patients (7.1%). Disease-modifying antirheumatic drug (DMARD) treatment in the year before uveitis onset significantly reduced the risk for uveitis as follows: MTX: hazard ratio (HR) 0.63, P = 0.022; TNF inhibitors: HR 0.56, P uveitis risk (HR 0.29, P uveitis onset. Early MTX use within the first year of disease and the combination of MTX with a TNF inhibitor had the highest protective effect. © 2016 The Authors. Arthritis Care & Research published by Wiley Periodicals, Inc. on behalf of the American College of Rheumatology.

  2. Why do we choose rheumatology? Implications for future recruitment--results of the 2006 UK Trainee Survey.

    Science.gov (United States)

    Dunkley, L; Filer, A; Speden, D; Bax, D; Crisp, A

    2008-06-01

    Against changes to junior doctor career structure under MMC (Modernizing Medical Careers), and uncertainty about the future place of rheumatology, we explored critical factors in choice of rheumatology as a speciality, and asked what factors might govern choices of prospective trainees. Using these data, we developed suggestions to enhance future recruitment. A postal survey was sent to rheumatology specialist registrars (SpRs) on the Joint Committee for Higher Medical Training (JCHMT) database between December 2005 and January 2006, and concurrently by e-mail to the Rheumatologists at Training e-mail list. Seventy-three percent (165/227) of trainees responded. Of them, 89.1% had previous senior house officer (SHO) experience in rheumatology and 81.8% made a career decision in favour of rheumatology during their SHO post. The top four ranked factors influencing choice of rheumatology were SHO experience, subject matter, inspirational consultants and lifestyle aspects; 89.1% would still choose rheumatology now. Factors felt to be negatively influencing future trainees came under three key themes: poor student or postgraduate exposure, employment and service delivery issues (including concern over the future place of rheumatology in primary vs secondary care), and perceived poor profile of rheumatology. Factors positively influencing future candidates were subject matter, work/life balance and prior exposure to the speciality. Early postgraduate experience is key to choice of speciality. An overwhelming majority of trainees decide speciality during SHO experience. With ongoing changes in career structure, it is critical that rheumatology is incorporated into foundation and speciality training programmes and essential that continued measures are taken to improve the image of rheumatology.

  3. One Health in Practice: A Pilot Project for Integrated Care of Zoonotic Infections in Immunocompromised Children and Their Pets in Chile.

    Science.gov (United States)

    Peña, A; Abarca, K; Weitzel, T; Gallegos, J; Cerda, J; García, P; López, J

    2016-08-01

    Although pets provide physiological and psychological benefits to their owners, they are a potential source of zoonotic infections, especially for vulnerable individuals such as immunocompromised patients. During 1 year, we therefore performed a pilot project, which included 32 immunocompromised Chilean children and their family pets (35 dogs and 9 cats) with the aim of detecting, treating and preventing zoonotic infections. Children were examined by Infectious Diseases paediatricians and demographical and clinical information related to zoonotic infections were recorded. Pets were examined and sampled by veterinarians, who also administered missing routine vaccines and anti-parasitics. During family visits, all members were informed and educated about zoonoses and a satisfaction survey was performed. Visits also included vector control and indoor residual spraying with pyrethroids. Children were re-examined and re-tested according to the findings of their pets, and all detected zoonotic infections were treated both in children and pets. Physical examination revealed abnormalities in 18 dogs (51.4%) and three cats (33.3%). Twenty-eight (63.6%) of the pets were diagnosed with a zoonotic pathogen, and seven (15.9%) with a facultative pathogen. Most zoonotic agents were isolated from the pet's external ear and intestine. Bacteria with the highest pathogenic potential were Campylobacter jejuni and Brucella canis. In two children and their respective pets, the same zoonotic diseases were diagnosed (toxocariasis and giardiasis). Arthropods serving as potential vectors of zoonotic infections were found in 49% of dogs and 44% of cats. The pilot project was positively evaluated by the participating families. Our pilot project confirmed that pets are reservoir for various zoonotic agents in Chile and that the implementation of an integrated multidisciplinary programme was a valuable tool to prevent, diagnose and treat such zoonotic infections in vulnerable patients such as

  4. Proceedings from The 8th Annual International Society for Musculoskeletal Imaging in Rheumatology (ISEMIR) Conference

    DEFF Research Database (Denmark)

    Troum, Orrin M; Pimienta, Olga L; Olech, Ewa

    2016-01-01

    The International Society for Musculoskeletal Imaging in Rheumatology (ISEMIR) was founded in 2005 with the goal of discussing matters related to imaging in rheumatology, particularly, validation, education, and use in both clinical practice and research. The field of musculoskeletal (MSK) imaging...... is continuously evolving; therefore, education for healthcare providers in this field is of paramount importance. ISEMIR's international faculty and world-renowned experts presented the newest information as it relates to the use of magnetic resonance imaging (MRI) and ultrasound (US) at the 8th annual ISEMIR...

  5. "Big Data" in Rheumatology: Intelligent Data Modeling Improves the Quality of Imaging Data.

    Science.gov (United States)

    Landewé, Robert B M; van der Heijde, Désirée

    2018-05-01

    Analysis of imaging data in rheumatology is a challenge. Reliability of scores is an issue for several reasons. Signal-to-noise ratio of most imaging techniques is rather unfavorable (too little signal in relation to too much noise). Optimal use of all available data may help to increase credibility of imaging data, but knowledge of complicated statistical methodology and the help of skilled statisticians are required. Clinicians should appreciate the merits of sophisticated data modeling and liaise with statisticians to increase the quality of imaging results, as proper imaging studies in rheumatology imply more than a supersensitive imaging technique alone. Copyright © 2018 Elsevier Inc. All rights reserved.

  6. Nursing, occupational therapy, and physical therapy preparation in rheumatology in the United States and Canada.

    Science.gov (United States)

    Jette, A M; Becker, M C

    1980-11-01

    Directors of undergraduate programs in nursing, physical therapy, and occupational therapy in the United States and Canada were surveyed to determine the amount and perceived adequacy of the current degree of classroom and clinical exposure to the rheumatic diseases. One hundred ninety-one (73%) of the 262 mailed questionnaires were returned. Results indicate that regardless of the actual degree of rheumatologic classroom exposure, directors in all three disciplines view current amounts as adequate. A larger proportion views levels of clinical exposure as inadequate. In general, the Canadian programs had a greater emphasis on rheumatology than their United States counterparts.

  7. The Paediatric Rheumatology International Trials Organisation provisional criteria for the evaluation of response to therapy in juvenile dermatomyositis.

    Science.gov (United States)

    Ruperto, Nicolino; Pistorio, Angela; Ravelli, Angelo; Rider, Lisa G; Pilkington, Clarissa; Oliveira, Sheila; Wulffraat, Nico; Espada, Graciela; Garay, Stella; Cuttica, Ruben; Hofer, Michael; Quartier, Pierre; Melo-Gomes, Jose; Reed, Ann M; Wierzbowska, Malgorzata; Feldman, Brian M; Harjacek, Miroslav; Huppertz, Hans-Iko; Nielsen, Susan; Flato, Berit; Lahdenne, Pekka; Michels, Harmut; Murray, Kevin J; Punaro, Lynn; Rennebohm, Robert; Russo, Ricardo; Balogh, Zsolt; Rooney, Madeleine; Pachman, Lauren M; Wallace, Carol; Hashkes, Philip; Lovell, Daniel J; Giannini, Edward H; Gare, Boel Andersson; Martini, Alberto

    2010-11-01

    To develop a provisional definition for the evaluation of response to therapy in juvenile dermatomyositis (DM) based on the Paediatric Rheumatology International Trials Organisation juvenile DM core set of variables. Thirty-seven experienced pediatric rheumatologists from 27 countries achieved consensus on 128 difficult patient profiles as clinically improved or not improved using a stepwise approach (patient's rating, statistical analysis, definition selection). Using the physicians' consensus ratings as the "gold standard measure," chi-square, sensitivity, specificity, false-positive and-negative rates, area under the receiver operating characteristic curve, and kappa agreement for candidate definitions of improvement were calculated. Definitions with kappa values >0.8 were multiplied by the face validity score to select the top definitions. The top definition of improvement was at least 20% improvement from baseline in 3 of 6 core set variables with no more than 1 of the remaining worsening by more than 30%, which cannot be muscle strength. The second-highest scoring definition was at least 20% improvement from baseline in 3 of 6 core set variables with no more than 2 of the remaining worsening by more than 25%, which cannot be muscle strength (definition P1 selected by the International Myositis Assessment and Clinical Studies group). The third is similar to the second with the maximum amount of worsening set to 30%. This indicates convergent validity of the process. We propose a provisional data-driven definition of improvement that reflects well the consensus rating of experienced clinicians, which incorporates clinically meaningful change in core set variables in a composite end point for the evaluation of global response to therapy in juvenile DM. Copyright © 2010 by the American College of Rheumatology.

  8. Mentoring of young professionals in the field of rheumatology in Europe: results from an EMerging EUlar NETwork (EMEUNET) survey

    NARCIS (Netherlands)

    Frank-Bertoncelj, Mojca; Hatemi, Gulen; Ospelt, Caroline; Ramiro, Sofia; Machado, Pedro; Mandl, Peter; Gossec, Laure; Buch, Maya H.

    2014-01-01

    To explore perceptions of, participation in and satisfaction with mentoring programmes among young clinicians and researchers in rheumatology in Europe. To identify mentoring needs and expectations focusing on gender-specific differences. A survey on mentoring in rheumatology was distributed to

  9. The Spanish version of the 2010 American College of Rheumatology Preliminary Diagnostic Criteria for fibromyalgia: reliability and validity assessment.

    Science.gov (United States)

    Casanueva, Benigno; García-Fructuoso, Ferrán; Belenguer, Rafael; Alegre, Cayetano; Moreno-Muelas, José V; Hernández, José L; Pina, Tinitario; González-Gay, Miguel Á

    2016-01-01

    To investigate the reliability and validity of the Spanish version of the 2010 American College of Rheumatology (ACR) Preliminary Diagnostic Criteria for Fibromyalgia (FM) in patients with chronic pain. The 2010 ACR Preliminary Diagnostic Criteria for FM were adapted to a Spanish version following the guidelines of the Rheumatology Spanish Society Study Group of FM. Based on the 1990 ACR classi cation criteria for FM, patients with chronic pain were initially divided into two groups: a FM group and another group of non-FM individuals. Patients from the FM group were evaluated by tender points (TP) examination, Fibromyalgia Impact Questionnaire (FIQ), Widespread Pain Index (WPI), and Symptom Severity Scale (SSS). The non-FM (control) group included patients with rheumatoid arthritis (RA) and osteoarthritis (OA). They were evaluated by WPI and SSS. We included 1,169 patients divided into two groups: FM group (n=803; 777 women and 26 men) and non-FM group (n= 366; 147 patients with RA, and 219 with OA). The median value of TP and FIQ in the FM group was 16 and 74 respectively. The preliminary 2010 ACR criteria were met by 665 (82.8%) FM patients and by 112 (30.6%) patients from the non-FM group (pFIQ (p<0.0001), WPI (p<0.0001) and SSS (p<0.0001) were observed when FM patients fulfilling the 2010 ACR criteria were compared with the remaining FM patients who did not fulfill these criteria. Sensitivity of the Spanish version of the 2010 ACR criteria was 85.6% (95%CI: 83.1-88.1), speci city 73.2% (95%CI: 68.4-78), positive predictive value 87.7% (95%CI: 85.3-90.1) and negative predictive value 69.4% (95%CI: 64.5-74.2). Our results indicate that the 2010 ACR Preliminary Diagnostic Criteria for FM may be useful to establish a diagnosis of FM in Spanish individuals with chronic pain.

  10. Telemedicine and other care models in pediatric rheumatology: an exploratory study of parents' perceptions of barriers to care and care preferences.

    Science.gov (United States)

    Bullock, Danielle R; Vehe, Richard K; Zhang, Lei; Correll, Colleen K

    2017-07-11

    The United States pediatric rheumatology workforce is committed to a mission of providing children access to pediatric rheumatology care. With a limited number and distribution of pediatric rheumatologists, telemedicine has been proposed as one way to meet this mission, yet the adoption of this modality has been slower than expected. The purpose of this study was to explore the parent perspective on barriers to accessing pediatric rheumatology care and to explore the acceptability of telemedicine and other alternative care models. Over a period of six weeks, all new and return English-speaking parents/guardians of patients visiting a single center were offered an opportunity to complete a survey which assessed barriers to care and interest in alternative models of care. Responses were analyzed using descriptive statistics. Survey response rate was 72% (159/221). Twenty-eight percent (45/159) traveled more than three hours to the pediatric rheumatology clinic, and 43% (65/152) reported travel as inconvenient. An overwhelming majority of respondents (95%, 144/152) reported a preference for in-person visits over the option of telemedicine. This preference was similar regardless of whether respondents reported travel to the clinic as inconvenient vs convenient (inconvenient 92%, 60/65; convenient 97%, 84/87; p = 0.2881) and despite those reporting travel as inconvenient also reporting greater difficulty with several barriers to care. Those familiar with telemedicine were more likely to report a preference for telemedicine over in-person visits (27%, 3/11 vs 3%, 4/140; p = 0.0087). The option of an outreach clinic was acceptable to a majority (63%, 97/154); however, adult rheumatology and shared-care options were less acceptable (22%, 35/156 and 34%, 53/156 respectively). Among survey respondents, in-person visits were preferred over the option of telemedicine, even when travel was noted to be inconvenient. Telemedicine familiarity increased its acceptability

  11. Experience of Comamonas Acidovorans Keratitis with Delayed Onset and Treatment Response in Immunocompromised Cornea

    OpenAIRE

    Lee, Sang Mok; Kim, Mee Kum; Lee, Jae Lim; Wee, Won Ryang; Lee, Jin Hak

    2008-01-01

    Purpose To report 2 cases of Comamonas Acidovorans keratitis in immunocompromised cornea. Methods A complete review of the medical records of the two cases of Comamonas acidovorans keratitis. Results We found some similarities in clinical courses of two cases. Both of them showed development of keratitis during the management with corticosteroids, delayed onset, slow response to antibiotics, and relatively less affected corneal epithelium. Conclusions Comamonas Acidovorans is known as a less ...

  12. Fungus infection in immunocompromised rabbits: correlation of thin-section CT findings and histopathology

    International Nuclear Information System (INIS)

    Xue Feng; Liu Shiyuan; Xie Lixuan; Liu Kai; Zhang Jian; Chen Yousan; Li Huimin; He Jin

    2009-01-01

    Objective: To compare the thin-section CT findings of pulmonary candidiasis, aspergillosis and cryptococcosis with histopathology in immunocompromised rabbits and improve the diagnostic accuracy of fungus infection. Methods: Healthy New Zealand white rabbits were used for immunocompromised animal models. Thin-section CT scan was performed before and 2, 4, 6, 8, 10, 12, 14 d after inoculation. The pattern and distribution of the pulmonary abnormalities were retrospectively assessed by two thoracic radiologists and compared with histopathology. The granulocyte count was compared before and after administration of immunosuppressive agents. The paired t test, chi square test and the Fisher's exact test were used for the statistics. Results: Fourteen rabbits had candidiasis, 16 rabbits had eryptococcosis, 15 rabbits had aspergillosis. The granulocyte counts before and after administration of immunosuppressive agents were (2.91±0.92) and (0.35±0.19) x 10 9 /L respectively in candidiasis group, there was a significant difference (t=12.484, P 9 /L in aspergillosis group, there was a significant difference (t=5.792, P 9 /L in cryptococcosis group, there was a significant difference (t=8.199, P 0.05). Ground glass opacity (GGO) and consolidation were the two most common findings in immunocompromised rabbits with three fungus infections, areas of GGO was correlated with the congestion, hemorrhage, inflammatory cell infiltration and interstitial hyperplasia in pathology. Consolidation was correlated with the severe congestion, hemorrhage, inflammatory cell infiltration, interstitial hyperplasia, necrosis and vascular embolism in pathology. Conclusion: GGO and consolidation are the two most common findings of fungus infections in immunocompromised animal models and thin-section CT findings can reflect the pathological changes. (authors)

  13. Policy challenges for the pediatric rheumatology workforce: Part III. the international situation

    Directory of Open Access Journals (Sweden)

    Henrickson Michael

    2011-09-01

    Full Text Available Abstract Survival dominates current pediatric global health priorities. Diseases of poverty largely contribute to overall mortality in children under 5 years of age. Infectious diseases and injuries account for 75% of cause-specific mortality among children ages 5-14 years. Twenty percent of the world's population lives in extreme poverty (income below US $1.25/day. Within this population, essential services and basic needs are not met, including clean water, sanitation, adequate nutrition, shelter, access to health care, medicines and education. In this context, musculoskeletal disease comprises 0.1% of all-cause mortality in children ages 5-14 years. Worldwide morbidity from musculoskeletal disease remains generally unknown in the pediatric age group. This epidemiologic data is not routinely surveyed by international agencies, including the World Health Organization. The prevalence of pediatric rheumatic diseases based on data from developed nations is in the range of 2,500 - 3,000 cases per million children. Developing countries' needs for musculoskeletal morbidity are undergoing an epidemiologic shift to chronic conditions, as leading causes of pediatric mortality are slowly quelled. A global crisis of health care providers and human resources stems from insufficient workforce production, inability to retain workers in areas of greatest need, distribution disparity and poor management of both health care systems and health workforce. Internationally, the pediatric rheumatology workforce will also be in very short supply for the foreseeable future relative to projected demand. Physician extenders are an essential resource to meet this demand in underserved regions. They can be trained in common aspects of musculoskeletal medicine and rheumatic conditions. Innovative strategies have been introduced in the United Kingdom to address musculoskeletal medicine educational deficiencies. Telemedicine offers an important capacity to improve access to

  14. 2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative

    Science.gov (United States)

    Neogi, Tuhina; Jansen, Tim L Th A; Dalbeth, Nicola; Fransen, Jaap; Schumacher, H Ralph; Berendsen, Dianne; Brown, Melanie; Choi, Hyon; Edwards, N Lawrence; Janssens, Hein J E M; Lioté, Frédéric; Naden, Raymond P; Nuki, George; Ogdie, Alexis; Perez-Ruiz, Fernando; Saag, Kenneth; Singh, Jasvinder A; Sundy, John S; Tausche, Anne-Kathrin; Vaquez-Mellado, Janitzia; Yarows, Steven A; Taylor, William J

    2015-01-01

    Objective Existing criteria for the classification of gout have suboptimal sensitivity and/or specificity, and were developed at a time when advanced imaging was not available. The current effort was undertaken to develop new classification criteria for gout. Methods An international group of investigators, supported by the American College of Rheumatology and the European League Against Rheumatism, conducted a systematic review of the literature on advanced imaging of gout, a diagnostic study in which the presence of monosodium urate monohydrate (MSU) crystals in synovial fluid or tophus was the gold standard, a ranking exercise of paper patient cases, and a multi-criterion decision analysis exercise. These data formed the basis for developing the classification criteria, which were tested in an independent data set. Results The entry criterion for the new classification criteria requires the occurrence of at least one episode of peripheral joint or bursal swelling, pain, or tenderness. The presence of MSU crystals in a symptomatic joint/bursa (ie, synovial fluid) or in a tophus is a sufficient criterion for classification of the subject as having gout, and does not require further scoring. The domains of the new classification criteria include clinical (pattern of joint/bursa involvement, characteristics and time course of symptomatic episodes), laboratory (serum urate, MSU-negative synovial fluid aspirate), and imaging (double-contour sign on ultrasound or urate on dual-energy CT, radiographic gout-related erosion). The sensitivity and specificity of the criteria are high (92% and 89%, respectively). Conclusions The new classification criteria, developed using a data-driven and decision-analytic approach, have excellent performance characteristics and incorporate current state-of-the-art evidence regarding gout. PMID:26359487

  15. Manifestaciones reumatológicas de la enfermedad inflamatoria intestinal Rheumatologic manifestations of inflammatory bowel disease

    Directory of Open Access Journals (Sweden)

    Octavio Germán Muñoz Maya

    2006-01-01

    Full Text Available La enfermedad inflamatoria intestinal (EII se caracteriza por la activación inapropiada del sistema inmune de la mucosa intestinal y sus dos formas de presentación son: la colitis ulcerativa y la enfermedad de Crohn. Las manifestaciones extraintestinales se presentan hasta en el 36% de los pacientes y pueden comprometer cualquier órgano o sistema. La disfunción inmune se caracteriza por el desequilibrio entre los mediadores proinflamatorios y los antinflamatorios y se expresa como una enfermedad sistémica. Las manifestaciones reumatológicas asociadas a la EII son de tres tipos: la artritis periférica, la espondiloartropatía y una tercera categoría que incluye lesiones dérmicas, oftálmicas y del metabolismo óseo, entre otras. El manejo de estas manifestaciones se basa en la terapia sistémica para el control de la actividad inflamatoria local utilizando esteroides, derivados de la 5-ASA, inmunomoduladores y, en los últimos años, terapia anti-TNF. The main feature of inflammatory bowel disease (IBD is the continuous activation of the mucosa-associated immune system; the disease has two major forms of presentation: ulcerative colitis and Crohn´s disease. The extraintestinal manifestations are present in 36% of patients, and any organ can be affected. There is an imbalance between proinflammatory and antinflammatory cytokines leading to a systemic disease. The rheumatologic manifestations of the IBD are: Peripheral arthritis, spondyloarthropathy and a third category that includes dermic and ocular lesions as well as metabolic bone disease. Control of the extraintestinal manifestations is based on systemic therapy with steroids, 5-ASA derivatives and biological anti-TNF therapy.

  16. Including health equity considerations in development of instruments for rheumatology research

    DEFF Research Database (Denmark)

    O'Neill, Jennifer; Rader, Tamara; Guillemin, Francis

    2014-01-01

    The Outcome Measures in Rheumatology (OMERACT) Equity Special Interest Group (SIG) was established in 2008 to create a preliminary core set of outcome measures for clinical trials that can assess equity gaps in healthcare and the effectiveness of interventions to close or narrow gaps between...

  17. Characterizing the concept of activity pacing as a non-pharmacological intervention in rheumatology care

    DEFF Research Database (Denmark)

    Cuperus, N; Vliet Vlieland, Tpm; Brodin, N

    2016-01-01

    OBJECTIVE: To develop a consensual list of the most important aspects of activity pacing (AP) as an intervention within the context of non-pharmacological rheumatology care. METHOD: An international, multidisciplinary expert panel comprising 60 clinicians and/or healthcare providers experienced i...

  18. The impact factor of rheumatology journals : an analysis of 2008 and the recent 10 years

    NARCIS (Netherlands)

    Chen, Min; Zhao, Ming-Hui; Kallenberg, Cees G. M.

    2011-01-01

    Despite various weaknesses, the impact factor (IF) is still used as an important indictor for scientific quality in specific subject categories. In the current study, the IFs of rheumatology journals over the past 10 years were serially analyzed and compared with that from other fields. For the past

  19. No Evidence of Presence of Parvovirus 4 in a Swedish Cohort of Severely Immunocompromised Children and Adults

    Science.gov (United States)

    Tolfvenstam, Thomas; Norbeck, Oscar; Öhrmalm, Lars

    2012-01-01

    The recently discovered human parvovirus 4 (PARV4) has been associated with seropositivity for human immunodeficiency virus, hepatitis B virus and hepatitis C virus. High prevalence is seen especially in intravenous drug users. The virus has been detected in blood products and persons who have been repeatedly transfused have shown to be a risk-group. Furthermore, reports from different parts of the world suggesting a prevalence ranging from zero to one third of the healthy population and the virus is thought to cause a latent or persistent infection. We investigated the presence of PARV4 DNA and parvovirus B19 (B19) DNA in serum from 231 severely immunocompromised cancer patients that have been exposed for blood products. Compared to B19, which was found in 3.9% of the patients, we found no evidence of PARV4. Our results may indicate a very low prevalence of the virus in Sweden, and it would be useful to measure the real PARV4 exposure of the healthy population as well as individuals with known risk factors by serology. PMID:23050026

  20. No evidence of presence of parvovirus 4 in a Swedish cohort of severely immunocompromised children and adults.

    Directory of Open Access Journals (Sweden)

    Thomas Tolfvenstam

    Full Text Available The recently discovered human parvovirus 4 (PARV4 has been associated with seropositivity for human immunodeficiency virus, hepatitis B virus and hepatitis C virus. High prevalence is seen especially in intravenous drug users. The virus has been detected in blood products and persons who have been repeatedly transfused have shown to be a risk-group. Furthermore, reports from different parts of the world suggesting a prevalence ranging from zero to one third of the healthy population and the virus is thought to cause a latent or persistent infection. We investigated the presence of PARV4 DNA and parvovirus B19 (B19 DNA in serum from 231 severely immunocompromised cancer patients that have been exposed for blood products. Compared to B19, which was found in 3.9% of the patients, we found no evidence of PARV4. Our results may indicate a very low prevalence of the virus in Sweden, and it would be useful to measure the real PARV4 exposure of the healthy population as well as individuals with known risk factors by serology.

  1. Systemic lupus erythematosus in Spanish males: a study of the Spanish Rheumatology Society Lupus Registry (RELESSER) cohort.

    Science.gov (United States)

    Riveros Frutos, A; Casas, I; Rúa-Figueroa, I; López-Longo, F J; Calvo-Alén, J; Galindo, M; Fernández-Nebro, A; Pego-Reigosa, J M; Olivé Marqués, A

    2017-06-01

    Objective The objective of this study was to describe the demographic, clinical, and immunological manifestations of systemic lupus erythematosus (SLE) in male patients. Methods A cross-sectional, multicenter study was carried out of 3651 patients (353 men, 9.7%, and 3298 women, 90.2%) diagnosed with SLE, included in the Spanish Rheumatology Society SLE Registry (RELESSER). Results Mean ages (18-92 years) of symptom onset were 37 (SD 17) years (men) and 32 (SD 14) years (women). Male/female ratio was 1/9. Age of onset of symptoms and age at diagnosis were higher in men than in women ( p lupus nephritis was more common in men, being present in 155 (44.8%) of males versus 933 (29%) of females ( p  50 years had a higher mortality (odds ratios 3.6 and 2.1, respectively). Furthermore, SLE patients who developed pulmonary hemorrhage, pulmonary hypertension, psychiatric involvement, complement deficiency, and hemophagocytic syndrome also had higher mortality, regardless of gender. Conclusion Patients with SLE over the age of 50 years have an increased risk of mortality. In Caucasians, age at diagnosis and symptom onset is higher in men than in women. The diagnostic delay is shorter in men. Male SLE patients present more cardiovascular comorbidities, and also more serositis, adenopathies, splenomegaly, renal involvement, convulsion, thrombosis, and lupus anticoagulant positivity than women.

  2. Clostridium subterminale septicemia in an immunocompetent patient

    OpenAIRE

    Daganou Maria; Kyriakoudi Ann; Moraitou Helen; Pontikis Konstantinos; Avgeropoulou Stavrina; Tripolitsioti Paraskevi; Koutsoukou Antonia

    2016-01-01

    Clostridium subterminale is a Clostridium species that has been rarely isolated in the blood of immunocompromised patients. We report a case of C. subterminale septicemia in an immunocompetent patient who presented with acute mediastinitis following spontaneous esophageal rupture.

  3. Clostridium subterminale septicemia in an immunocompetent patient.

    Science.gov (United States)

    Daganou, Maria; Kyriakoudi, Ann; Moraitou, Helen; Pontikis, Konstantinos; Avgeropoulou, Stavrina; Tripolitsioti, Paraskevi; Koutsoukou, Antonia

    2016-01-01

    Clostridium subterminale is a Clostridium species that has been rarely isolated in the blood of immunocompromised patients. We report a case of C. subterminale septicemia in an immunocompetent patient who presented with acute mediastinitis following spontaneous esophageal rupture.

  4. and rheumatologic manifestations of chronic hepatitis C viru

    African Journals Online (AJOL)

    Enas Abdallah El-attar

    2013-04-17

    Apr 17, 2013 ... Immunological profile rheumatoid factor RF, ANA, C3, C4. Cryoglobulins. ..... standing disease process as 32% of our studied patients had liver cirrhosis. ..... graphic synovitis and predict power Doppler persistence in early.

  5. Internet use in rheumatology outpatients in 2006: gender less important.

    Science.gov (United States)

    Richter, J G; Becker, A; Koch, T; Nixdorf, M; Schacher, B; Monser, R; Specker, C; Alten, R; Schneider, M

    2009-01-01

    Exploring patients' Internet use, their online needs and requirements, expectations and attitudes towards the Internet is mandatory to effectively provide interactive online applications and information. Within a prospective study, 153 consecutive outpatients with rheumatoid arthritis, systemic lupus erythematosus or spondyloarthritis answered a paper-based questionnaire investigating their Internet use, interests, pattern and degree of utilization. Sociodemographic and functional disability data were collected. The data were compared with our survey of 2001 and to the normal German population. Patients were predominantly female (69.3%; n.s.). Mean age was 45.7+/-14.4 years (n.s.). 68.6% (+18.6%, p=0.0027) reported regular Internet use for 5.0+/-2.6 yrs. Internet use in 2006 is still age- and education-dependent (pInternet use from 2.9 to 6.1 hours/week (p=0.001, p=0.0006). Searching for health-related information remained an important topic. Interest in e-communication and interactive applications strongly increased. Independently of gender and functional disability, patients' future online interests focussed on information on diseases, medications, health care providers and patient education. Confidence in the Internet and reliability of information were rated unchanged since 2001. Gender no longer has significant impact on Internet use. The great potentials of Internet services-well accepted by patients and contributing substantially to more effective and improved disease (self-) management strategies-should encourage rheumatologists to provide interactive applications and high-quality information on Internet platforms and in routine patient care. Continuous research to explore the effects of Internet-delivered information on patients' attitudes,expectations, behaviour and outcome is required.

  6. Skin therapies: dermatologic perspective on the rheumatology-dermatology interface.

    Science.gov (United States)

    Sasaki, Jodie L; Koo, John Y

    2015-01-01

    Psoriasis is a common, chronic, inflammatory skin condition in which up to 42% of patients may develop psoriatic arthritis. Consequently, dermatologists and rheumatologists frequently manage the same patient for psoriasis and psoriatic arthritis, respectively. Hence, it is important for the two specialties to understand one another and work together to optimise care of patients with psoriatic disease. This article discusses several areas of clinical concern in which coordination of care is especially critical. First, when selecting a therapeutic modality, it is best to use treatments that improve both the joints and the skin, and exercise caution while using options that can rarely worsen the skin, such as systemic steroids. Second, a close working relationship between the two specialties is critical in making prompt and early diagnosis of psoriatic arthritis. Dermatologists often are on the frontlines for detecting early signs of joint involvement, and the prevalence of undiagnosed PsA among patients with psoriasis is estimated to be 15.5%. Third, in the rare instance of anti-TNF induced paradoxical worsening of the skin disease, it is highly recommended that these patients be referred to dermatologists as soon as possible for optimal management of the skin manifestations. Lastly, dermatologists in the US have a long history of undertreating generalised psoriasis, especially with regards to the use of systemic agents. Therefore, the consideration of systemic agents by the rheumatologist may greatly benefit the patient by treating both the joint and skin manifestations. In summary, this article highlights the importance of interdisciplinary coordination between rheumatologists and dermatologists for which both specialties offer unique and complementary expertise to the care of patients with psoriatic disease.

  7. "Rheum to Improve": Quality Improvement in Outpatient Rheumatology.

    Science.gov (United States)

    Chow, Shirley L; Shojania, Kaveh G

    2017-09-01

    The commitment to improve care processes and patient outcomes is a professional mandate for clinicians and is also seen as an operational priority for institutions. Quality improvement now figures in the accreditation of training programs, specialty examinations, and hospital scorecards. Rheumatologists have traditionally focused primarily on quality problems such as guideline adherence; however, improvement goals should also include other aspects of care that are helpful to patients and are professionally rewarding for practitioners. This review makes use of improvement projects in outlining tangible tools rheumatologists can use to resolve quality concerns in their practices.

  8. American College of Rheumatology/European League against Rheumatism Preliminary Definition of Remission in Rheumatoid Arthritis for Clinical Trials

    Science.gov (United States)

    Felson, David T.; Smolen, Josef S.; Wells, George; Zhang, Bin; van Tuyl, Lilian H. D.; Funovits, Julia; Aletaha, Daniel; Allaart, Renée; Bathon, Joan; Bombardieri, Stefano; Brooks, Peter; Brown, Andrew; Matucci-Cerinic, Marco; Choi, Hyon; Combe, Bernard; de Wit, Maarten; Dougados, Maxime; Emery, Paul; Furst, Dan; Gomez-Reino, Juan; Hawker , Gillian; Keystone, Edward; Khanna, Dinesh; Kirwan, John; Kvien, Tore; Landewé, Robert; Listing, Joachim; Michaud, Kaleb; Mola, Emilio Martin; Montie, Pam; Pincus, Ted; Richards, Pam; Siegel, Jeff; Simon, Lee; Sokka, Tuulikki; Strand, Vibeke; Tugwell, Peter; Tyndall, Alan; van der Heijde, Desirée; Verstappen, Suzan; White, Barbara; Wolfe, Fred; Zink, Angela; Boers, Maarten

    2010-01-01

    Background With remission in rheumatoid arthritis (RA) an increasingly attainable goal, there is no widely used definition of remission that is stringent but achievable and could be applied uniformly as an outcome in clinical trials. Methods A committee consisting of members of the American College of Rheumatology, the European League Against Rheumatism and the Outcome Measures in Rheumatology Initiative (OMERACT) met to guide the process and review prespecified analyses from clinical trials of patients with RA. The committee requested a stringent definition (little, if any, active disease) and decided to use core set measures to define remission including at least joint counts and an acute phase reactant. Members were surveyed to select the level of each core set measure consistent with remission. Candidate definitions of remission were tested including those that constituted a number of individual measures in remission (Boolean approach) as well as definitions using disease activity indexes. To select a definition of remission, trial data were analyzed to examine the added contribution of patient reported outcomes and the ability of candidate measures to predict later good x-ray and functional outcomes. Results Survey results for the definition of remission pointed to indexes at published thresholds and to a count of core set measures with each measure scored as 1 or less (e.g. tender and swollen joint counts, CRP and global assessments on 0-10 scale). Analyses suggested the need to include a patient reported measure. Examination of 2 year follow-up data suggested that many candidate definitions performed comparably in terms of predicting later good x-ray and functional outcomes, although DAS28 based measures of remission did not predict good radiographic outcomes as well as did the other candidate definitions. Given these and other considerations, we propose that a patient be defined as in remission based on one of two definitions : 1: When their scores on the

  9. African Journal of Rheumatology - Vol 6, No 1 (2018)

    African Journals Online (AJOL)

    Prevalence and risk factors for hyperuricemia among patients with hypertension at Moi Teaching and Referral Hospital, Eldoret, Kenya · EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. C.B. Mibey Sylvia, F Some, S Kimaiyo, C.M. Kwobah, G.O. Oyoo, 3-9 ...

  10. African Journal of Rheumatology - Vol 1, No 2 (2013)

    African Journals Online (AJOL)

    Prevalence of HIV infection among the patients with an avascular necrosis of the femoral head in Ouagadougou, Burkina Faso · EMAIL FULL TEXT EMAIL FULL TEXT DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. DD Ouédraogo, T Ouédraogo, F Kaboré, H Kafando, A Zan, R Bognounou, YJ Drabo, 57-60 ...

  11. A report from the American college of rheumatology/association of rheumatology health professionals (ACR/ARHP) - 2012 annual meeting (November 9-14, 2012 - Washington, D.C., USA).

    Science.gov (United States)

    Croasdell, G

    2013-02-01

    The annual meeting of the American College of Rheumatology (ACR), jointly held with the Association of Rheumatology Health Professionals (ARHP), brought together attendees focused on all aspects of rheumatology, including researchers looking into treatment options and various services around the care of rheumatologic conditions. As well as networking opportunities at the meeting, there were a wide range of symposia and posters available covering various conditions and levels of research. There were also educational and meet-the-professor sessions. This report will cover a selection of interesting talks from poster and oral sessions on the latest preclinical and clinical research. Copyright 2013 Prous Science, S.A.U. or its licensors. All rights reserved.

  12. 2016 American College of Rheumatology/European League Against Rheumatism Criteria for Minimal, Moderate, and Major Clinical Response in Juvenile Dermatomyositis An International Myositis Assessment and Clinical Studies Group/Paediatric Rheumatology International Trials Organisation Collaborative Initiative

    NARCIS (Netherlands)

    Rider, Lisa G.; Aggarwal, Rohit; Pistorio, Angela; Bayat, Nastaran; Erman, Brian; Feldman, Brian M.; Huber, Adam M.; Cimaz, Rolando; Cuttica, Rubén J.; de Oliveira, Sheila Knupp; Lindsley, Carol B.; Pilkington, Clarissa A.; Punaro, Marilynn; Ravelli, Angelo; Reed, Ann M.; Rouster-Stevens, Kelly; van Royen-Kerkhof, Annet; Dressler, Frank; Magalhaes, Claudia Saad; Constantin, Tamás; Davidson, Joyce E.; Magnusson, Bo; Russo, Ricardo; Villa, Luca; Rinaldi, Mariangela; Rockette, Howard; Lachenbruch, Peter A.; Miller, Frederick W.; Vencovsky, Jiri; Ruperto, Nicolino; Hansen, Paul; Apaz, Maria; Bowyer, Suzanne; Curran, Megan; Davidson, Joyce; Griffin, Thomas; Huber, Adam H.; Jones, Olcay; Kim, Susan; Lang, Bianca; Lindsley, Carol; Lovell, Daniel; Saad Magalhaes, Claudia; Pachman, Lauren M.; Pilkington, Clarissa; Ponyi, Andrea; Quartier, Pierre; Ramanan, Athimalaipet V.; Reed, Ann; Rennebohm, Robert

    2017-01-01

    Objective. To develop response criteria for juvenile dermatomyositis (DM). Methods. We analyzed the performance of 312 definitions that used core set measures from either the International Myositis Assessment and Clinical Studies Group (IMACS) or the Paediatric Rheumatology International Trials

  13. 2016 American College of Rheumatology/European League Against Rheumatism Criteria for Minimal, Moderate, and Major Clinical Response in Juvenile Dermatomyositis : An International Myositis Assessment and Clinical Studies Group/Paediatric Rheumatology International Trials Organisation Collaborative Initiative

    NARCIS (Netherlands)

    Rider, Lisa G.; Aggarwal, Rohit; Pistorio, Angela; Bayat, Nastaran; Erman, Brian; Feldman, Brian M.; Huber, Adam M.; Cimaz, Rolando; Cuttica, Rubén J.; De Oliveira, Sheila Knupp; Lindsley, Carol B.; Pilkington, Clarissa A.; Punaro, Marilynn; Ravelli, Angelo; Reed, Ann M.; Rouster-Stevens, Kelly; van Royen-Kerkhof, Annet; Dressler, Frank; Magalhaes, Claudia Saad; Constantin, Tamás; Davidson, Joyce E.; Magnusson, Bo; Russo, Ricardo; Villa, Luca; Rinaldi, Mariangela; Rockette, Howard; Lachenbruch, Peter A.; Miller, Frederick W.; Vencovsky, Jiri; Ruperto, Nicolino; Rider, Lisa G.; Ruperto, Nicolino; Miller, Frederick W.; Aggarwal, Rohit; Erman, Brian; Bayat, Nastaran; Pistorio, Angela; Huber, Adam M.; Feldman, Brian M.; Hansen, Paul; Rockette, Howard; Lachenbruch, Peter A.; Ruperto, Nicolino; Rider, Lisa G.; Apaz, Maria T; Bowyer, Suzanne; Cimaz, Rolando; Constantin, Tamás; Curran, Megan; Davidson, Joyce E.; Feldman, Brian M.; Griffin, Thomas; Huber, Adam H.; Jones, Olcay; Kim, Susan; Lang, Bianca; Lindsley, Carol; Lovell, Daniel J.; Saad Magalhaes, Claudia; Pachman, Lauren M.; Pilkington, Clarissa; Ponyi, Andrea; Punaro, Marilynn; Quartier, Pierre; Ramanan, Athimalaipet V; Ravelli, Angelo; Reed, Ann M.; Rennebohm, Robert; Sherry, David D.; Silva, Clovis A.; Stringer, Elizabeth; van Royen-Kerkhof, Annet; Wallace, Carol; Miller, Frederick W.; Oddis, Chester V