Pilot study on the probability of drug-drug interactions among direct oral anticoagulants (DOACs) and antiseizure medications (ASMs): a clinical perspective.

BACKGROUND: There is little and controversial information about changes in plasma concentrations (PCs) or clinical events during coadministration of antiseizure medications (ASMs) and direct oral anticoagulants (DOACs). We aimed to explore possible determinants of dosage class among DOACs trough PCs when ASMs are co-administered and the relative risks. We also provided some clinical examples of patients' management. METHODS: Data on adult patients concomitantly treated with ASMs (grouped in enzyme-inducing [I-ASMs], non-inducing [nI-ASMs], and levetiracetam [LEV]) and DOACs with at least one measurement of DOACs' PC were retrospectively collected. The role of DOAC-ASM combinations in predicting PC class (ranging from I at ischemic/thromboembolic risk to IV at increased bleeding risk) was investigated by an ordered logit model, and the marginal probabilities of belonging to the four dosage classes were calculated. RESULTS: We collected 46 DOACs' PCs out of 31 patients. There were 5 (10.9%) determinations in class I (4 out of 5 with concomitant I-ASMs) and 5 (10.9%) in class IV. The rivaroxaban/I-ASM combination was associated with lower DOAC dosages than rivaroxaban/LEV (OR: 0.00; 95% CI: 0.00-0.62). Furthermore, patient's probability of being in class I was approximately 50% with the rivaroxaban/I-ASM combination, while apixaban, dabigatran, and edoxaban had the highest cumulative probability of being in class II or III despite the ASM used. CONCLUSION: These preliminary results confirm the reduction of DOAC's PC by I-ASMs and suggest a better manageability of apixaban, dabigatran, and edoxaban independently from the concomitant ASM, whereas rivaroxaban seems the most liable to PC alterations with I-ASMs.

Cerebral Tumefactive Inflammatory Lesion Occurrence During Ixekizumab Treatment in a Patient With Active Psoriatic Arthritis.

INTRODUCTION: Ixekizumab is an anti-interleukin-17A (IL-17A) humanized monoclonal antibody approved for the treatment of moderate-to-severe plaque psoriasis, active psoriatic arthritis, and ankylosing spondylitis. Central nervous system inflammatory manifestations are atypical during therapy with IL-17A inhibitors, with only one case of myelitis described to date. CASE REPORT: A 72-year-old man with a medical history of active psoriatic arthritis was admitted to our department owing to the acute onset of left face numbness 1 month after the first ixekizumab administration. Magnetic resonance imaging of the brain displayed a large T2-hyperintense infratentorial lesion involving the root of the fifth and seventh left cranial nerves. A thorough laboratoristic and instrumental work-up did not show elements suggestive of extracerebral neoplasms or infections. Therefore, neuronavigation-assisted brain biopsy was performed, and histologic analysis of the lesion revealed the presence of wide aggregates of foamy histiocytes diffusely infiltrating the brain parenchyma, in the absence of malignant tissue or histologic elements suggestive of central nervous system infections or primary histiocytoses. Steroid treatment (dexamethasone 8 mg/daily) was then administered with subsequent clinical amelioration. One month after hospital discharge, a brain magnetic resonance imaging showed a nearly complete resolution of the lesion. CONCLUSION: This is the first case of a cerebral inflammatory lesion occurring during treatment with ixekizumab. Although very rare, neurological complications may occur during anti-IL-17A therapies, thus leading to the need for careful monitoring of patients exposed to these drugs.

Relationship between hair cortisol concentrations and cognitive functioning in adolescents with ADHD.

Background: Our study aimed to explore whether the hair cortisol concentration (HCC), a measure of long-term cortisol output, is associated with poorer cognitive functioning in adolescents with attention deficit and hyperactivity disorder (ADHD). We further aimed to test the potential moderating effects of sex and childhood maltreatment.Methods: In this cross-sectional study, fifty-three adolescents with ADHD were studied. The ADHD Rating Scale (ADHD-RS) and Childhood Trauma Questionnaire (CTQ) were administered. Seven cognitive tasks from the Cambridge Neuropsychological Test Automated Battery (CANTAB) were administered, and two cognitive factors (attention and memory and executive functioning) were identified by confirmatory factor analysis. A 3-cm hair sample from the posterior vertex region of the head was obtained. HCCs were determined by a high-sensitivity enzyme immunoassay kit. Multiple linear regression analyses were used to explore the association between HCCs and either cognitive performance or ADHD severity while adjusting for sex, childhood maltreatment and the ADHD-RS total score.Results: Sex moderated the relationship between HCCs and attention/memory confirmatory factor analysis (CFA) scores, with better performance in boys with higher HCCs. HCCs were not associated with executive functioning or ADHD symptoms. Childhood maltreatment was associated with inattention symptoms in adolescents with ADHD.Conclusions: Our study suggests that HCCs are positively associated with attention and memory performance in adolescents with ADHD, with a moderating effect of sex (the relationship is strongest in boys).

We studied the relationship between cortisol and cognition in adolescents with ADHD.Hair cortisol concentrations (HCCs) were determined.We explored the moderating effects of sex and childhood trauma.Sex moderated the relationship between HCCs and attention and memory.Childhood trauma did not moderate the relationship between HCCs and cognition.

Neurological complications in adult allogeneic hematopoietic stem cell transplant patients: Incidence, characteristics and long-term follow-up in a multicenter series.

Neurological complications (NCs) represent a diagnostic and clinical challenge in allogeneic hematopoietic stem cell transplant (alloHSCT) patients. We retrospectively analyzed NC incidence, etiology, timing, characteristics, outcome, and long-term effects in 2384 adult patients transplanted in seven Italian institutions between January 2007 and December 2019. Ninety-three (3.9%) patients were affected by 96 NCs that were infectious (29.2%), immune/inflammatory (26%), drug-related (12.5%), cerebrovascular (5.2%), metabolic (3.1%), related to central nervous system disease relapse (11.5%) and malignancy (3.1%), or undefined (9.4%). Six patients (6.4%) had neurological manifestations of chronic graft-versus-host disease (GVHD). NCs occurred on average at day +128 (from -5 to +4063). Early (< day +120) and late NCs had similar frequencies (46.9% vs 53.1%, p = 0.39). Thirty-one patients (33.3%) were affected by acute or chronic GVHD at the NC onset. With a median follow-up of 25.4 (0.4-163) months, the overall mortality due to NCs was 22.6%. The median time between NC onset and death was 36 (1-269) days. Infectious NCs were the main cause (61.9%) of NC-related mortality. A persistent neurological impairment occurred in 20.4% patients, 57.9% of whom being affected by immune/inflammatory NCs. This study highlights the rare, yet severe impact of alloHSCT-associated NCs on patient survival and long-term functional ability.

Cuidadores familiares de niños con cáncer y su funcionalidad / Caretakers families of children with cancer and you functionality

Objetivo: Describir las características de los cuidadores familiares principales y nivel de funcionalidad de niños con cáncer que asisten a instituciones de salud en Cartagena. Metodología: Estudio exploratorio realizado a 90 cuidadores y sus niños con cáncer que asisten a instituciones de salud de Cartagena. Se utilizaron dos cuestionarios: Caracterización de los cuidadores familiares con enfermedad crónica y funcionalidad de los niños a través del PULSES. La información se recolectó de junio a octubre de 2009; se utilizó estadística descriptiva para el manejo de los datos. La participación fue voluntaria y el manejo de la información confidencial. Resultados: Los padres cuidan a los niños en un 90 %; el 88 % son mujeres, en edades entre 18 a 59 años. El 51.1 % se encarga del cuidado del niño solo. Sabe leer y escribir el 95.6 % y el 59,9 % cursó bachillerato incompleto. El 81.1 % realiza labores del hogar y el 95,4 % pertenece a los estratos 1 y 2. El 100 % de los cuidadores cuidan al niño desde su diagnóstico; el 84,4 % lleva más de seis meses como cuidador; de ellos, el 68.9 % dedica las 24 horas del día al cuidado. Por inestabilidad de su patología, el 27,8 % de los niños es dependiente (PULSES 3 y 4) y el 20 % totalmente dependiente (PULSES 4). Conclusiones: Por ser niños, los padres son sus cuidadores, representados principalmente en la madre. Un número apreciable de niños es totalmente dependiente de su cuidador, lo cual, unido a la baja escolaridad del cuidador, representa una gran carga para este, porque su condición disminuye las posibilidades de comprender en su total dimensión la situación de su hijo y las orientaciones que el personal de salud le proporciona para su cuidado.

Objective: To describe the characteristics of the main family caregivers and the functional level of children with cancer who attend health facilities, Cartagena. Methodology: An exploratory study to 90 caregivers and children with cancer who attended a health institution in Cartagena. Two questionnaires were used to characterize the Caregivers, and children functionality was determined by using the PULSES profile. The dates were collected from June to October 2009 and descriptive statistics were used to manage the data. The participation was voluntary and the information was managed confidentially. Results: Parents caring for children by 90 %, 88 % of women, aged between 18 and 59. 51.1 % are alone to care for the child. Can read and write 95.6 %, 59.9 % had incomplete secondary school. The 81.1 % do housework and 95.4 % belong to strata 1 and 2. Caring for the child since their diagnosis, 84.4% have been caregiving for more than six months, 68.9 % of them spend 24 hours a day to care. Due to the instability of their condition, 27.8 % of children were dependent and 20 % were totally dependent. Conclusions: Children see parents as caregivers, in the figure of the woman. Their care-givers are at a disadvantage to understand the situation of their son because of a low level of schooling and not having a stable income prevents them from providing adequate care, making it essential that the State takes responsibility for chronic disease patients and it establishes mechanisms clearly defined, which supports for caregivers of this population group.