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Introduction Scalp dandruff is a common dermatological condition characterized by flaking and itching of the scalp, affecting a significant portion of the population. Effective assessment methods are crucial for evaluating treatment outcomes. This study aimed to establish the reliability and correlation of three assessment techniques: Adherent Scalp Flaking Score (ASFS), phototrichogram using CASLite Nova, and the 60-second hair combing test. Methods This open-label, single-arm, single-center, prospective clinical study enrolled 12 adult subjects with mild to moderate dandruff. Evaluations were conducted before and after a standardized hair-wash intervention using three methods: ASFS, phototrichogram using CASLite Nova, and the 60-second hair combing test. The primary objective was to establish correlations between these assessment techniques. Inter-evaluator and inter-operator reliability were assessed using Fleiss Multirater Kappa. Results Significant reductions in dandruff were observed across all methods post-hair wash. The ASFS decreased from 23.67±2.06 at baseline to 6.67±4.46, showing a mean reduction of 17.00±5.22 (71.40%, p<0.001). phototrichogram analysis revealed that 60.42% of the total (n=96) scalp zones assessed were in normal condition post-hair wash compared to none at baseline. The 60-second hair combing test showed a reduction in non-adherent flakes, with 58.33% of subjects displaying light flakes and 41.67% showing no flakes post-hair wash. The chi-squared test indicated a significant association (p<0.001) between ASFS and phototrichogram results. Inter-evaluator variability for ASFS and the hair combing test demonstrated substantial agreement (Kappa=0.692 and 0.637, respectively, p<0.0001). Inter-operator reliability for phototrichogram also showed substantial agreement (Kappa=0.746, p<0.0001). Conclusion The study confirms the reliability and consistency of ASFS, phototrichogram, and the 60-second hair combing test in assessing scalp dandruff. The significant correlations of ASFS and phototrichogram via CASLite Nova validate their use in clinical settings. Comprehensive training for evaluators and operators is essential to achieve reproducible and accurate results. These findings provide a robust framework for future studies and clinical assessments of scalp dandruff.
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BACKGROUND: Collagen, a key protein in the body maintains hair, skin and bone health and its production tends to decrease in synthesis as humans age. The demand for vegan collagen-builder has increased worldwide due to increased adaptability to vegan diet. OBJECTIVE: This clinical study was designed aim to evaluate the safety and efficacy of vegan collagen builder (VEGCOL™ï¸) at different dosages (2.5, 5, and 10 g) in adult participants. METHODS: Total 66 subjects (22 subjects/dose) aged 30 to 50 years were enrolled, and 63 subjects completed the study. Duration of study was 60 days. Evaluations included change in skin elasticity, hydration, crow's feet area wrinkles, fine lines, skin, Glogau skin age, change in pain scale score, muscle strength and subject perception assessment about test treatment use. RESULTS: After 60 days of treatment, there was significant improvement in hair growth rate by 45.01%, 38.54% and 50.37% with p < 0.01 for doses 2.5, 5, and 10 g respectively. Additionally, 19.64% (p < 0.0001) and 20.51% (p < 0.0001) increase in hair density and hair thickness respectively was observed with 10 g dose. 2.5 g dose resulted in 33.03% (p < 0.01) increase in skin smoothness and 49.94% (p < 0.0001) decrease in crow's feet area wrinkles, decreased retraction time by 21.71 milliseconds (p < 0.05). 52.54% reduction in pain score (p < 0.001). No any adverse events were reported. CONCLUSION: Vegan collagen-builder effectively improved multiple age-related concerns such as wrinkles, fine lines, joint pain, muscle strength and hair growth. All respondents perceived the product as beneficial in improving the aesthetics of the skin, hair, and nails. The findings support the use of vegan collagen-builder as safe and efficacious in promoting healthier skin, stronger muscles, and improved hair and nail conditions.
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Agammaglobulinemia , Pénfigo , Enfermedades Cutáneas Infecciosas , Humanos , Rituximab/efectos adversos , Pénfigo/tratamiento farmacológico , Brote de los Síntomas , Agammaglobulinemia/inducido químicamente , Anticuerpos Monoclonales de Origen Murino , Celulitis (Flemón) , Factores Inmunológicos/efectos adversosRESUMEN
BACKGROUND: Hair serum is recommended therapy for the management of hair fall problems. People of all ages suffer from hair fall. AIM: To evaluate safety and efficacy of hair growth promoting product in healthy adult subjects with hair fall complaints (Alopecia). METHODS: In this safety and efficacy clinical study, 32 healthy individuals (aged 18-45 years) experiencing hair loss were enrolled. Participants applied 0.5 mL of the product to the affected scalp area daily for 60 days. The study evaluated various factors, including hair growth rate, thickness, density, scalp condition using CASLite-Nova, anagen-to-telogen ratio, hair fall reduction, overall hair and scalp appearance, hair strength, and participants' subjective perceptions of the product. RESULTS: Highly statistically significant improvement was observed in hair growth rate, thickness, and density at Day 30 and Day 60. Hair growth rate increased (p-value <0.01) by 10.52% in 30 days and 31.62% in 60 days after test product application. Average hair growth increased by 424.21 µm/day and 487.31 µm/day at Day 30 and 60 respectively. The hair growth improved by up to 1.5 times after 60 days of usage in healthy subjects with hair fall complaints. No adverse events or product-related adverse events were reported. CONCLUSION: Hair serum containing REGENDIL™ (Redensyl, AnaGain, Procapil, Capilia longa), and 5 kDa hyaluronic acid was efficacious and well tolerable in reducing hair fall (Alopecia). Hair serum significantly improved hair growth, hair density, hair thickness, and hair strength within 60 days of usage, thereby demonstrating it worth as a beneficial inclusion as a daily haircare product.
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Alopecia , Cabello , Adulto , Humanos , Alopecia/diagnóstico , Alopecia/tratamiento farmacológico , Sujetos de Investigación , Cuero Cabelludo , Voluntarios SanosRESUMEN
Hypereosinophilia can be primary, including idiopathic hypereosinophilic syndrome (HES) and chronic eosinophilic leukemia, or secondary/reactive to various infective and non-infective stimuli. Chronic oro-genital ulcerations can occur due to various dermatological and non-dermatological disorders, and many times it serves as a useful indicator of an underlying systemic disorder. Hence, a case presenting with chronic oro-genital ulcerations needs a thorough evaluation. We are reporting an interesting case of a middle-aged male who had chronic oro-genital ulcerations as a presenting feature of chronic eosinophilic leukemia with FIP1L1-PDGFRA fusion (FIP1-like 1/platelet-derived growth factor receptor alpha). The patient's oro-genital ulcerations responded excellently to imatinib.
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BACKGROUND: India is witnessing an epidemic of dermatophytosis. The role of host immune response against fungi in chronicity and dissemination is topic of ongoing research. We conducted cross-sectional comparative study to determine the difference in Th1 (IFN-γ) and Th2 (IL4) response in serum and tissue between acute and localised vs. chronic and disseminated cases. METHODS: Patients (18-60 years) were divided in two groups-group A (n = 114, BSA <5%, single anatomic site, duration <6 months, n = 118) and group B (n = 107 BSA >10%, > one anatomic site, duration >12 months, n = 118). Clinical parameters along with serum levels of IgE, IL-4 and IFN-γ and expression of IL4 and IFN-γ in dermal infiltrate were compared between group. RESULTS: Trichophyton mentagrophytes complex was commonest causative fungi. Serum levels of IgE were significantly higher (median A-539.2, B-2901.0, p < .001) whereas levels IL-4(median A-21.3, B-20.4, p < .001) and IFN-γ(median A-9.6, B-5.1, p < .001) were significantly lower in chronic cases. Expression of IL-4 was observed in most biopsy specimens in both groups without any difference in intensity of staining. Expression of IFN-γ was not detected in all but one specimen across both the groups. Severe itching (OR:0.050, CI:0.018, 0.139, p < .001), sign of topical steroid abuse (OR:0.203,CI:0.077, 0.537; p = .001), ↓IFN-γ (OR:4.683, CI:1.634, 13.418; p = .004) correlated significantly and independently with chronic dermatophytosis. CONCLUSION: Our study shows chronic and disseminated cases of dermatophytosis differ immunologically in terms of higher IgE, and lower IL4 and IFN-γ. Expression of IL4 is present in tissue of both acute, localised and chronic disseminated cases. Expression of IFN-γ cannot be established in our study.
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Citocinas , Tiña , Estudios Transversales , Citocinas/metabolismo , Humanos , Inmunidad , Inmunoglobulina E , Interleucina-4 , Células TH1/metabolismo , Células Th2RESUMEN
Peripheral T-cell lymphoma (PTCL) comprises 5-20% of all non-Hodgkin lymphomas (NHL). These all have different morphological patterns, phenotypes, and clinical presentations making it a diverse group of lymphomas. PTCL, not otherwise specified (PTCL-NOS), is a subtype considered to have a poor prognosis and a low overall survival rate of only about 30-40%. We report a case of primary cutaneous PTCL-NOS presenting in a young pregnant female with multiple progressive, tender, and necrosed nodules all over her body for 3 months. Her skin biopsy findings led us to suspect malignancy, and via immunohistochemistry (IHC), her diagnosis was confirmed. Cutaneous lymphoma is a dangerous albeit rare entity and should be kept in mind when the commoner differentials have been ruled out.
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BACKGROUND: Acne vulgaris is a chronic, inflammatory skin condition of pilosebaceous units. The standard treatment involves topical and oral antibiotics, retinoids, benzoyl peroxide, and other synthetic compounds, mostly associated with adverse effects. Hence, herbal skincare products are considered nowadays. AIM: To evaluate the safety and efficacy of Purifying Neem Face Wash (PNFW), an herbal skincare product in the prevention and/or reduction of mild-to-moderate acne. METHODS: An open-label, single-center, single-arm, four-week clinical study was conducted with subjects having either mild-to-moderate acne or oily skin and non-existent acne. The performance of PNFW in the reduction and/or prevention of acne was detected by counting cutaneous inflammatory and non-inflammatory acne lesions in each of the four visits. Sebum level and skin hydration of both cheeks were measured via sebumeter and corneometer, respectively. Self-assessment questionnaires were used to assess the subjects' responses toward PNFW. RESULTS: Out of 120 study subjects, 79% and 72% showed either reduction or no new appearance of inflammatory and non-inflammatory acne lesions, respectively, from baseline to Visits 3 and 4. Skin sebum level and skin hydration showed a statistically significant decrease (p < 0.001) and increase (p < 0.001), respectively, in Visits 3 and 4. Self-assessment surveys showed the satisfaction of the subjects about the product in terms of condition improvement, ease in use, and fragrance. CONCLUSION: The present study indicated the beneficial effect of the herbal ingredients (neem and turmeric) of Himalaya's PNFW in the prevention and reduction of mild-to-moderate acne with no side effects.
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Acné Vulgar , Azadirachta , Acné Vulgar/complicaciones , Adulto , Antibacterianos/uso terapéutico , Peróxido de Benzoílo/efectos adversos , Humanos , Piel/patología , Resultado del TratamientoRESUMEN
We present a method to map fluorescence resonance energy transfer (FRET) parameters of a bifunctional photodynamic therapy agent, (2-[1-hexyloxyethyl]-2-devinyl pyropheophorbide-a)-cyanine dye (HPPH-CD) conjugate, which consists of a photosensitizer (HPPH) and a fluorescent agent CD. We utilized time-domain fluorescence diffuse optical tomography, the normalized Born ratio model in the Fourier-domain, and an iterative algorithm to map depth-resolved spatial heterogeneities of FRET parameters. Our results exhibited depth-resolved changes of fluorophore's lifetime and the distance maps due to FRET between HPPH and CD. Our model suggests a potential approach of using FRET parameters to monitor efficacies of multifunctional photodynamic therapy agents in deep tissue.
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Fotoquimioterapia , Tomografía Óptica , Transferencia Resonante de Energía de Fluorescencia , Fármacos Fotosensibilizantes/farmacologíaRESUMEN
Hepatitis C virus (HCV), a global health concern, has been linked to various hepatic and extrahepatic deleterious manifestations. Several observational studies have either supported the increased likelihood of coronary and carotid atherosclerosis after infection with HCV or refuted it. To date, there has been no clear consensus to support either train of thought, as randomized, controlled clinical trials have not been completed. In this review, we first discuss articles that support the notion that HCV infection leads to increased plaque formation due to systemic inflammation and then focus on articles that refute this idea. From the literature, we do know that both inflammatory and lipid processes play a role in plaque formation, and thus both components are important in the successful treatment of atherosclerosis. Based on our review of the literature, we do believe that HCV-infected individuals are at an increased risk for more severe coronary artery disease than their healthy counterparts. Although there is no irrefutable evidence that links HCV infection with plaque formation and/or rupture, cardioprotective measures should be taken to reduce poor health outcomes, especially in those individuals who are already at risk of coronary disease.
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Enfermedades de las Arterias Carótidas , Enfermedad de la Arteria Coronaria , Hepatitis C , Enfermedades de las Arterias Carótidas/etiología , Enfermedad de la Arteria Coronaria/etiología , Hepacivirus , Hepatitis C Crónica/complicaciones , HumanosRESUMEN
Recent studies have demonstrated immunologic dysfunction in severely ill coronavirus disease 2019 (COVID-19) patients. We use single-cell RNA sequencing (scRNA-seq) to analyze the transcriptome of peripheral blood mononuclear cells (PBMCs) from healthy (n = 3) and COVID-19 patients with moderate disease (n = 5), acute respiratory distress syndrome (ARDS, n = 6), or recovering from ARDS (n = 6). Our data reveal transcriptomic profiles indicative of defective antigen presentation and interferon (IFN) responsiveness in monocytes from ARDS patients, which contrasts with higher responsiveness to IFN signaling in lymphocytes. Furthermore, genes involved in cytotoxic activity are suppressed in both natural killer (NK) and CD8 T lymphocytes, and B cell activation is deficient, which is consistent with delayed viral clearance in severely ill COVID-19 patients. Our study demonstrates that COVID-19 patients with ARDS have a state of immune imbalance in which dysregulation of both innate and adaptive immune responses may be contributing to a more severe disease course.
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COVID-19/inmunología , Subgrupos Linfocitarios/inmunología , Síndrome de Dificultad Respiratoria/inmunología , Transcriptoma , Adulto , Anciano , Anciano de 80 o más Años , Presentación de Antígeno , COVID-19/complicaciones , COVID-19/patología , Femenino , Humanos , Interferones/metabolismo , Activación de Linfocitos , Masculino , Persona de Mediana Edad , Monocitos/metabolismo , RNA-Seq , Síndrome de Dificultad Respiratoria/etiología , Síndrome de Dificultad Respiratoria/patologíaRESUMEN
OBJECTIVE: The aim of the study was to investigate the implementation and patient satisfaction of telemedicine visits in a physical medicine and rehabilitation spine practice during COVID-19. DESIGN: This is a prospective cohort study. RESULTS: Of 172 patients, 97.6% were very satisfied or satisfied (83.7% of the patients were very satisfied) with their telemedicine appointment. In 44.4% of the cases, the physical medicine and rehabilitation physician prescribed medication to the patient, and in 21.6% of the cases, either an injection or radiofrequency ablation was ordered. Most patients (87%) did not have any issues during their encounter. Lastly, 64.5% of the patients preferred telemedicine over in-person appointments, whereas 56.1% of the patients who are 60 yrs and older responded the same. A total of 67.4% of those who had a follow-up visit would choose telemedicine over in-person. CONCLUSIONS: The results of this study show that telemedicine can provide very effective and satisfactory care in a physical medicine and rehabilitation spine practice. This was especially notable with follow-up visits where imaging and treatment plan can easily be discussed over telemedicine. Stay-at-home orders and improved reimbursement during the COVID-19 pandemic have spurred adoption of telemedicine with high patient satisfaction. We hope that physical medicine and rehabilitation physicians will be able to continue expanding patient access in the postpandemic world.
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Infecciones por Coronavirus/epidemiología , Satisfacción del Paciente , Medicina Física y Rehabilitación/tendencias , Neumonía Viral/epidemiología , Telemedicina , Anciano , Dolor de Espalda/rehabilitación , Betacoronavirus , COVID-19 , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Estudios Prospectivos , SARS-CoV-2 , Encuestas y CuestionariosRESUMEN
3-(1'-Hexyloxyethyl)-3-devinyl-pyropheophorbide-a (HPPH or Photochlor), a tumor-avid chlorophyll-a derivative currently undergoing human clinical trials, was conjugated at various peripheral positions (position-17 or 20) of HPPH with either Gd(III)-aminobenzyl-DTPA (Gd(III) DTPA) or Gd(III)-aminoethylamido-DOTA (Gd(III) DOTA). The corresponding conjugates were evaluated for inâ vitro PDT efficacy, T1 , T2 relaxivities, inâ vivo fluorescence, and MR imaging under similar treatment parameters. Among these analogs, the water-soluble Gd(III)-aminoethylamido-DOTA linked at position-17 of HPPH, i. e., HPPH-17-Gd(III) DOTA, demonstrated strong potential for tumor imaging by both MR and fluorescence, while maintaining the PDT efficacy in BALB/c mice bearing Colon-26 tumors (7/10 mice were tumor free on day 60). In contrast to Gd(III) DTPA (Magnevist) and Gd(III) DOTA (Dotarem), the HPPH-Gd(III) DOTA retains in the tumor for a long period of time (24 to 48â h) and provides an option of fluorescence-guided cancer therapy. Thus, a single agent can be used for cancer-imaging and therapy. However, further detailed pharmacokinetic, pharmacodynamic, and toxicological studies of the conjugate are required before initiating Phase I human clinical trials.
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Antineoplásicos/farmacología , Quelantes/farmacología , Clorofila/análogos & derivados , Neoplasias del Colon/tratamiento farmacológico , Gadolinio/farmacología , Fármacos Fotosensibilizantes/farmacología , Animales , Antineoplásicos/síntesis química , Antineoplásicos/química , Línea Celular Tumoral , Proliferación Celular/efectos de los fármacos , Supervivencia Celular/efectos de los fármacos , Quelantes/síntesis química , Quelantes/química , Clorofila/química , Clorofila/farmacología , Neoplasias del Colon/diagnóstico por imagen , Ensayos de Selección de Medicamentos Antitumorales , Gadolinio/química , Humanos , Imagen por Resonancia Magnética , Ratones , Ratones Endogámicos BALB C , Neoplasias Experimentales/diagnóstico por imagen , Neoplasias Experimentales/tratamiento farmacológico , Imagen Óptica , Fármacos Fotosensibilizantes/síntesis química , Fármacos Fotosensibilizantes/químicaRESUMEN
Coronavirus disease 2019 (COVID-19) has quickly become the most serious pandemic since the 1918 flu pandemic. In extreme situations, patients develop a dysregulated inflammatory lung injury called acute respiratory distress syndrome (ARDS) that causes progressive respiratory failure requiring mechanical ventilatory support. Recent studies have demonstrated immunologic dysfunction in severely ill COVID-19 patients. To further delineate the dysregulated immune response driving more severe clinical course from SARS-CoV-2 infection, we used single-cell RNA sequencing (scRNAseq) to analyze the transcriptome of peripheral blood mononuclear cells (PBMC) from hospitalized COVID-19 patients having mild disease (n = 5), developing ARDS (n = 6), and recovering from ARDS (n = 6). Our data demonstrated an overwhelming inflammatory response with select immunodeficiencies within various immune populations in ARDS patients. Specifically, their monocytes had defects in antigen presentation and deficiencies in interferon responsiveness that contrasted the higher interferon signals in lymphocytes. Furthermore, cytotoxic activity was suppressed in both NK and CD8 lymphocytes whereas B cell activation was deficient, which is consistent with the delayed viral clearance in severely ill COVID-19 patients. Finally, we identified altered signaling pathways in the severe group that suggests immunosenescence and immunometabolic changes could be contributing to the dysfunctional immune response. Our study demonstrates that COVID-19 patients with ARDS have an immunologically distinct response when compared to those with a more innocuous disease course and show a state of immune imbalance in which deficiencies in both the innate and adaptive immune response may be contributing to a more severe disease course in COVID-19.
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BACKGROUND & AIMS: Direct-acting antivirals (DAAs) are effective against hepatitis C virus and sustained virologic response is associated with reduced incidence of hepatocellular carcinoma (HCC). However, there is controversy over the use of DAAs in patients with active or treated HCC and uncertainty about optimal management of these patients. We aimed to characterize attitudes and practice patterns of hepatology practitioners in the United States regarding the use of DAAs in patients with HCC. METHODS: We conducted a survey of hepatology providers at 47 tertiary care centers in 25 states. Surveys were sent to 476 providers and we received 279 responses (58.6%). RESULTS: Provider beliefs about risk of HCC recurrence after DAA therapy varied: 48% responded that DAAs reduce risk, 36% responded that DAAs do not change risk, and 16% responded that DAAs increase risk of HCC recurrence. However, most providers believed DAAs to be beneficial to and reduce mortality of patients with complete response to HCC treatment. Accordingly, nearly all providers (94.9%) reported recommending DAA therapy to patients with early-stage HCC who received curative treatment. However, fewer providers recommended DAA therapy for patients with intermediate (72.9%) or advanced (57.5%) HCC undergoing palliative therapies. Timing of DAA initiation varied among providers based on HCC treatment modality: 49.1% of providers reported they would initiate DAA therapy within 3 months of surgical resection whereas 45.9% and 5.0% would delay DAA initiation for 3-12 months and >1 year post-surgery, respectively. For patients undergoing transarterial chemoembolization (TACE), 42.0% of providers would provide DAAs within 3 months of the procedure, 46.7% would delay DAAs until 3-12 months afterward, and 11.3% would delay DAAs more than 1 year after TACE. CONCLUSIONS: Based on a survey sent to hepatology providers, there is variation in provider attitudes and practice patterns regarding use and timing of DAAs for patients with HCC. Further studies are needed to characterize the risks and benefits of DAA therapy in this patient population.
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Carcinoma Hepatocelular , Quimioembolización Terapéutica , Hepatitis C Crónica , Neoplasias Hepáticas , Antivirales/uso terapéutico , Actitud , Carcinoma Hepatocelular/terapia , Hepatitis C Crónica/tratamiento farmacológico , Humanos , Neoplasias Hepáticas/terapia , Recurrencia Local de NeoplasiaRESUMEN
It is estimated that 10% of patients with secondary syphilis have liver enzyme elevations, but clinical hepatitis is rare. However, in HIV-positive patients, syphilitic hepatitis may be much more common. We report a case of a 67-year-old male who developed progressively elevated liver enzymes, followed by development of neurological symptoms and then rash. Though the timeline of his symptom development was unusual, his constellation of symptoms prompted an RPR and FTA-ABS which returned reactive. He was additionally found to be HIV positive with a CD4 count of 946. He was treated with IV Penicillin, and his hepatitis improved thereafter.
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Herein we report the synthesis, photophysical properties, positron emission tomography (PET) imaging and photodynamic therapy (PDT) efficacy of methyl 3-(1'-m-iodobenzyloxy)ethyl-3-devinyl-verdin 4 (with or without the 124 I isotope). The PET imaging ability and exâ vivo biodistribution of [124 I]4 were compared with the well-studied methyl [3-(124 1'-m-iodobenzyloxy)ethyl]-3-devinyl-pyropheophorbide-a methyl ester (PET-ONCO or [124 I]2) and [18 F]fluorodeoxyglucose ([18 F]FDG) in BALB/c mice bearing colon-26 tumors. Whole-body PET images of [124 I]4 containing a fused methoxy cyclohexenone ring system showed excellent tumor contrast with time (72>48>24â h post-injection). Exâ vivo biodistribution results indicate that relative to the current clinical standard [18 F]FDG and [124 I]2 in 2 % ethanol formulation, [124 I]4, at the same radioactive dose (25â µCi per mouse), showed higher tumor uptake at 24â h post-injection and longer tumor retention. In biological environments, compound 4 showed lower fluorescence and lower singlet oxygen yield than 2, which is possibly due to higher aggregation caused by the presence of a fused cyclohexenone ring system, resulting in limited inâ vitro/inâ vivo PDT efficacy. Therefore, the chlorophyll-a analogue [124 I]4 provides easy access to a novel PET imaging agent (with no skin phototoxicity) to image cancer types-brain, renal carcinomas, pancreas-in which [18 F]FDG shows limitations.
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Neoplasias del Colon/diagnóstico por imagen , Neoplasias del Colon/tratamiento farmacológico , Medios de Contraste/farmacología , Ciclohexanonas/farmacología , Fármacos Fotosensibilizantes/farmacología , Porfirinas/farmacología , Animales , Medios de Contraste/síntesis química , Medios de Contraste/farmacocinética , Medios de Contraste/efectos de la radiación , Ciclohexanonas/síntesis química , Ciclohexanonas/farmacocinética , Ciclohexanonas/efectos de la radiación , Femenino , Luz , Ratones Endogámicos BALB C , Fotoquimioterapia , Fármacos Fotosensibilizantes/síntesis química , Fármacos Fotosensibilizantes/farmacocinética , Fármacos Fotosensibilizantes/efectos de la radiación , Porfirinas/síntesis química , Porfirinas/farmacocinética , Porfirinas/efectos de la radiaciónRESUMEN
Background: Clinical and endoscopic recurrence are common after surgery in Crohn's disease (CD). Vedolizumab has been increasingly used to treat CD, however, its effectiveness in preventing postoperative recurrence remains unknown. We aimed to investigate the use of vedolizumab in the postoperative setting and compare the risk of recurrence between patients receiving vedolizumab and anti-tumor necrosis factor (TNF)-α agents. Methods: Medical records of CD patients who underwent surgery between April 2014 and June 2016 were reviewed. We first analyzed how frequently vedolizumab is used to prevent postoperative recurrence and compared the patient characteristics with those being treated with other therapies. Furthermore, the rates of endoscopic remission, defined as a simple endoscopic score for CD of 0, at 6-12 months after surgery were compared between patients receiving vedolizumab and anti-TNF-α agents. Clinical, biological, and histologic outcomes such as Harvey-Bradshaw index, C-reactive protein, and histologic inflammation also were compared between the 2 groups. Risks of recurrence were assessed by univariate, multivariate, and propensity score-matched analyses. Results: Among 203 patients that underwent a CD related surgery, 22 patients received vedolizumab as postoperative treatment. There were 58, 38, and 16 patients who received anti-TNF-α agents, immunomodulators, and metronidazole, respectively, whereas 69 patients were monitored without any medication. Patients receiving vedolizumab were young and frequently had perianal disease. Patients postoperatively treated with vedolizumab or anti-TNF-α agents were mostly treated with the same agent pre- and postoperatively. Rate of endoscopic remission at 6-12 months in the vedolizumab group was 25%, which was significantly lower as compared to anti-TNF-α agent group (66%, P = 0.01). Vedolizumab use was the only factor that was associated with an increased risk of endoscopic recurrence on both univariate (odds ratio (OR) 5.58, 95% confidence interval (CI) 1.51-24.3, P = 0.005) and multivariate analysis (OR 5.77, 95%CI 1.71-19.4, P = 0.005). The results were supported by a propensity score-matched analysis demonstrating lower rates of endoscopic remission (25 vs 69%, P = 0.03) in patients treated with vedolizumab as compared to anti-TNF-α agents. Conclusion: In the present retrospective cohort study of real-world experience, vedolizumab was shown to be commonly used as postoperative treatment for CD especially in high risk patients. Multivariate and propensity score-matched analyses showed that postoperative endoscopic recurrence in CD was higher with vedolizumab than with anti-TNF-α agents, but further investigation including controlled trials is required before determining the utility of vedolizumab in preventing postoperative recurrence of CD.