ABSTRACT
The recovery of motor functions after stroke is fostered by the functional integration of large-scale brain networks, including the motor network (MN) and high-order cognitive controls networks, such as the default mode (DMN) and executive control (ECN) networks. In this paper, electroencephalography signals are used to investigate interactions among these three resting state networks (RSNs) in subacute stroke patients after motor rehabilitation. A novel metric, the O-information rate (OIR), is used to quantify the balance between redundancy and synergy in the complex high-order interactions among RSNs, as well as its causal decomposition to identify the direction of information flow. The paper also employs conditional spectral Granger causality to assess pairwise directed functional connectivity between RSNs. After rehabilitation, a synergy increase among these RSNs is found, especially driven by MN. From the pairwise description, a reduced directed functional connectivity towards MN is enhanced after treatment. Besides, inter-network connectivity changes are associated with motor recovery, for which the mediation role of ECN seems to play a relevant role, both from pairwise and high-order interactions perspective.
Subject(s)
Brain Mapping , Stroke , Humans , Magnetic Resonance Imaging , Brain , CausalityABSTRACT
BACKGROUND: In areas of low physician density, especially as regards dermatologists in France, there is an increasing interest in tele-expertise. This is particularly the case in the Sarthe department, where the number of physicians continues to decline and access to care was further limited by the COVID 19 epidemic. STUDY DESIGN: We retrospectively collected data from tele-expertise requests submitted to Le Mans General Hospital by general practitioners via a dedicated platform between May 6, 2019, and April 9, 2021. RESULTS: Six hundred and forty three requests relating to 90 different diagnoses were recorded during this period. One hundred and thirty four patients (20% of requests) were invited to attend a face-to-face consultation within an average of 29â¯days. DISCUSSION: Through the use of tele-expertise at Le Mans Genreal Hospital it was possible to introduce a means of tackling the problem of the lack of dermatologists in the Sarthe department. Rapid responses enabled the number of consultation requests to be reduced, leading to fewer population displacements in the context of the present pandemic. CONCLUSION: These initial results are encouraging and confirm that tele-expertise seems a satisfactory option to optimize access to care for populations in areas of low physician density.
Subject(s)
COVID-19 , Physicians , Telemedicine , Male , Humans , Retrospective Studies , Hospitals, General , COVID-19/epidemiology , FranceSubject(s)
Gadolinium , Sialadenitis , Humans , Gadolinium/adverse effects , Contrast Media/adverse effectsABSTRACT
BACKGROUND: There is limited information about active tuberculosis (TB) occurring in psoriasis patients treated with Tumor necrosis factor (TNF) antagonists. OBJECTIVE: To describe the clinical characteristics of TB in psoriasis patients treated with TNF antagonists. METHODS: Nationwide retrospective study of psoriasis patients having experienced TB. Cases of TB were collected via three methods: search in the national pharmacosurveillance database, questionnaire to members of the French psoriasis research group, the college of French dermatology professors. We collected demographic data, TNF antagonist used, screening for latent tuberculosis infection, median time between TNF antagonists introduction and first symptoms, tests used for diagnosing TB infection, clinical features of tuberculosis and outcome. RESULTS: Eight centres reported 12 cases of TB between 2006 and 2014. They were nine men and three women with mean age of 49 years. All patients had adequate screening for latent tuberculosis. Three patients had stayed in endemic areas, three reported contact with a patient with TB. Tuberculosis presentation was extrapulmonary in 10 patients. Seven patients were treated with infliximab, four with adalimumab and one with certolizumab. The median time between TNF antagonist introduction and first symptoms of tuberculosis was 23.4 weeks (2-176). Six of the 12 patients had a positive direct examination and/or positive culture for Mycobacterium tuberculosis. Histological samples of affected organs taken from seven patients showed granulomatous inflammation in six, with caseating necrosis in five. Two of the 12 patients died of disseminated TB. CONCLUSION: This study shows tuberculosis in patients treated with TNF antagonists still occurs despite adherence to tuberculosis prevention guidelines. Prophylactic measures do not fully prevent the occurrence of tuberculosis. Rapid initiation of effective anti-tuberculosis treatment is important even in patients with negative mycobacteriological examination presenting with suggestive symptoms and organ involvement.
Subject(s)
Psoriasis/complications , Tuberculosis/drug therapy , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Adult , Aged , Female , France , Humans , Male , Middle Aged , Retrospective Studies , Tuberculosis/complications , Young AdultABSTRACT
In this paper, chronic rejections after transplantation of the lungs, heart, liver, and kidney are described. Chronic allograft dysfunction (CAD) plays an important role in all of these transplantations and has a significant influence on patient survival. The pathophysiological reasons for CAD varies greatly in the various organs.Chronic lung allograft dysfunction (CLAD) is the most important determinant of survival and quality of life after lung transplantation. Diagnosis is based on lung function, especially forced expiratory flow in 1 s (FEV1) decline. Prevention, early detection, and rapid treatment are extremely important. Azithromycin and extracorporeal photopheresis are commonly used for treatment because they usually positively influence the progression of lung remodeling.The expression for chronic rejection of the heart is cardiac allograft vasculopathy (CAV). Immunological and nonimmunological factors are important for its development. Due to limited therapeutic options, prevention is of utmost importance (administration of mTOR inhibitors and minimizing cardiovascular risk factors).The mid- and long-term survival rates after liver transplantation have hardly changed in recent decades, which is an indication of the difficulty in diagnosing chronic graft dysfunction. Chronic ductopenic rejection accounts for a small proportion of late graft dysfunction. Idiopathic posttransplant hepatitis and de novo autoimmune hepatitis are important in addition to recurrence of the underlying disease that led to transplantation.Chronic allograft nephropathy is the result of severe rejection which cumulates in increasing fibrosis with remodeling. The earliest possible diagnosis and therapy is currently the only option. Diagnosis is based on evidence of donor-specific antibodies and histological findings.
Subject(s)
Graft Rejection/mortality , Heart Diseases/mortality , Kidney Diseases/mortality , Lung Diseases/mortality , Organ Transplantation/mortality , Postoperative Complications/mortality , Causality , Chronic Disease , Humans , Liver Diseases/mortality , Prevalence , Risk Factors , Survival RateABSTRACT
BACKGROUND: Mycosis fungoides (MF) and pseudo-MF (or MF simulant) can be associated with B-cell malignancies, but distinction between a true neoplasm and a reactive process may be difficult. OBJECTIVES: To report seven patients with B-cell malignancy and folliculotropic MF or pseudo-MF and emphasize on criteria allowing distinction between the two conditions. METHODS: We retrospectively and prospectively included seven patients with B-cell malignancy who presented skin lesions histologically consisting in a folliculotropic T-cell infiltrate and reviewed the literature on the topic. RESULTS: Four men and three women had a chronic lymphocytic leukaemia (n = 6) or a MALT-type lymphoma (n = 1). Five patients had localized papules, and two had patches and plaques. Histological examination showed in all cases a diffuse dermal T-cell infiltrate with folliculotropic involvement and follicular mucinosis associated with clusters of the B-cell lymphoma, without significant expression of follicular helper T-cell markers. T-cell rearrangement studies showed a polyclonal pattern in the patients with papules and a monoclonal pattern in the cases of patches and plaques. Papular lesions had an indolent evolution, whereas patches and plaques persisted or worsened into transformed MF. CONCLUSION: Folliculotropic T-cell infiltrates associated with B-cell malignancies can be either a true folliculotropic MF or a pseudo-MF. The distinction between both conditions cannot rely only on the histopathological aspect, but needs both a clinical pathological correlation and the search for a dominant T-cell clone. Whether the neoplastic T and B cells derive from a common ancestor or the T-cell proliferation is promoted by the underlying B-cell lymphoma remains unsolved, but interaction between B and T cell in the skin does not appear to be dependent on a TFH differentiation of the T-cell infiltrate.
Subject(s)
Leukemia, Lymphocytic, Chronic, B-Cell/pathology , Lymphoma, B-Cell, Marginal Zone/pathology , Mycosis Fungoides/pathology , Pseudolymphoma/pathology , Skin Neoplasms/pathology , T-Lymphocytes , Aged , Diagnosis, Differential , Female , Hair Follicle , Humans , Leukemia, Lymphocytic, Chronic, B-Cell/complications , Leukemia, Lymphocytic, Chronic, B-Cell/immunology , Lymphoma, B-Cell, Marginal Zone/complications , Lymphoma, B-Cell, Marginal Zone/immunology , Male , Middle Aged , Mycosis Fungoides/complications , Prospective Studies , Pseudolymphoma/complications , Retrospective Studies , Skin Neoplasms/complicationsABSTRACT
Based on nationwide data from the French national cancer institute (INCa), we analyzed the evolution of cancer genetics consultations and testing over time, and the uptake of targeted tests in relatives of families with BRCA1/2 or MMR genes mutation. Genetic testing and consultations for familial high-risk individuals are exclusively funded and monitored by the INCa in France. All nationwide cancer genetics centers reported annually standardized parameters of activity from 2003 to 2011. The analysis included a total of 240,134 consultations and 134,652 genetic tests enabling to identify 32,494 mutation carriers. Referral for hereditary breast and ovarian cancer (HBOC) or colorectal cancer predisposition syndromes represented 59 % (141,639) and 23.2 % (55,698) consultations, respectively. From 2003 to 2011, we found a dramatic and steady increase of tests performed for BRCA1/2 (from 2,095 to 7,393 tests/year, P < 0.0001) but not for MMR genes (from 1,144 to 1,635/year, P = NS). The overall percentage of deleterious mutations identified in the probands tested was 13.8 and 20.9 % in HBOC and Lynch syndromes, respectively. Pooled analysis for BRCA1/2 and Lynch syndrome tests showed an inverse relationship between the percentage of mutation detected and the absolute number of tests performed over the time (overall Cochran-Armitage test for trend: P < 0.001). In families with BRCA1/2 or MMR identified mutations, there was an average number of 2.94 and 3.28 relatives performing targeted tests, respectively. This nationwide study shows a lack of referral and genetic testing in Lynch as compared to HBOC syndromes. Only a third of relatives of a proband with a predisposing mutation performed a targeted test. Enhanced information about benefit of genetic testing should be given to clinicians and patients for Lynch syndrome and relatives of a proband carrying an identified predisposing mutation.
Subject(s)
Adaptor Proteins, Signal Transducing/genetics , Breast Neoplasms/genetics , Colorectal Neoplasms, Hereditary Nonpolyposis/genetics , DNA-Binding Proteins/genetics , Genes, BRCA1 , Genes, BRCA2 , Genetic Counseling/statistics & numerical data , Genetic Testing/statistics & numerical data , MutS Homolog 2 Protein/genetics , Neoplastic Syndromes, Hereditary/genetics , Nuclear Proteins/genetics , Ovarian Neoplasms/genetics , Referral and Consultation/statistics & numerical data , Breast Neoplasms/prevention & control , Cancer Care Facilities/statistics & numerical data , Colorectal Neoplasms, Hereditary Nonpolyposis/prevention & control , DNA Mismatch Repair/genetics , DNA Mutational Analysis/statistics & numerical data , Family Health , Female , France , Genetic Carrier Screening , Genetic Counseling/trends , Genetic Testing/trends , Humans , Laboratories/statistics & numerical data , Male , MutL Protein Homolog 1 , Mutation , Neoplastic Syndromes, Hereditary/prevention & control , Ovarian Neoplasms/prevention & control , Referral and Consultation/trendsABSTRACT
BACKGROUND: The aim of this study was to demonstrate noninferiority of everolimus with reduced cyclosporine (CsA) vs mycophenolate mofetil (MMF) with reduced CsA in improving renal function. METHODS: In this 1-year randomized, open-label, noninferiority study in maintenance heart transplant recipients with impaired renal function 70 patients received everolimus (n = 36) or MMF (n = 34) in combination with reduced CsA. The planned sample size was not reached as the study was prematurely discontinued due to slow recruitment. RESULTS: Noninferiority of the everolimus regimen could not be shown: In the total population MMF seemed to be favorable on renal function assessed by serum creatinine and filtration rates, but not in the subset of patients who reached the intended reduced CsA level. Incidence rates of rejection episodes were significantly higher under MMF at month 6 (P = .0332). CONCLUSIONS: Overall, the results of this trial using reduced CsA in combination with either everolimus or MMF show that there is evidence to reduce the CsA level when everolimus is given concomitantly and that the benefit of MMF with reduced CsA levels is limited due to insufficient immunosuppression.
Subject(s)
Cyclosporine/administration & dosage , Graft Rejection/prevention & control , Graft Survival/drug effects , Heart Transplantation , Immunosuppressive Agents/administration & dosage , Mycophenolic Acid/analogs & derivatives , Sirolimus/analogs & derivatives , Aged , Biomarkers/blood , Creatinine/blood , Cyclosporine/adverse effects , Drug Therapy, Combination , Early Termination of Clinical Trials , Everolimus , Female , Germany , Glomerular Filtration Rate/drug effects , Graft Rejection/epidemiology , Heart Transplantation/adverse effects , Humans , Immunosuppressive Agents/adverse effects , Incidence , Kidney/drug effects , Kidney/physiopathology , Male , Middle Aged , Mycophenolic Acid/administration & dosage , Mycophenolic Acid/adverse effects , Patient Selection , Prospective Studies , Sample Size , Sirolimus/administration & dosage , Sirolimus/adverse effects , Time Factors , Treatment OutcomeABSTRACT
We investigated two nonsynonymous variants (rs30187 and rs27044) of ERAP1 gene in HLA-B27 positive individuals (150 spondyloarthritis and 108 controls) and in general ankylosing spondylitis (AS) patients (n = 137) vs random controls (n = 139). Both single nucleotide polymorphisms (SNPs) were associated with the risk of spondyloarthritis [odds ratio (OR) 1.80, 95% confidence interval (CI) 1.24-2.62, P = 0.001 for rs30187, OR 1.58, 95% CI 1.07-2.34, P = 0.02 for rs27044]. The CC haplotype was a protective factor (P = 0.002), while the TG haplotype was a risk factor (P = 0.01) for spondyloarthritis. The SNP rs30187 was also associated with the risk of HLA-B27+ AS. For the general group of AS, the carriers of minor alleles showed an increased risk for the disease (OR 1.92, 95% CI 1.17-3.13 for rs30187, OR 1.74, 95% CI 1.08-2.80 for rs27044). This is the first study that shows the association of ERAP1 gene variants and haplotypes with HLA-B27 positive spondyloarthritis.
Subject(s)
Aminopeptidases/genetics , Genetic Predisposition to Disease , HLA-B27 Antigen/genetics , Polymorphism, Single Nucleotide , Spondylitis, Ankylosing/genetics , Adult , Case-Control Studies , Female , Haplotypes , Humans , Male , Minor Histocompatibility Antigens , Risk FactorsSubject(s)
Dermatology/methods , Prisoners , Skin Diseases/therapy , Telemedicine , Dermatology/trends , France , Humans , Program Evaluation , Remote Consultation/organization & administration , Remote Consultation/statistics & numerical data , Skin Diseases/diagnosis , Telemedicine/organization & administration , Telemedicine/statistics & numerical data , Treatment Outcome , Videoconferencing/organization & administration , Videoconferencing/statistics & numerical dataABSTRACT
BACKGROUND: Cytomegalovirus (CMV) causes several complications following cardiac transplantation including cardiac allograft vasculopathy. Previous studies suggested that immunosuppressive treatment based on everolimus might reduce CMV infection. Aiming to better characterize the action of everolimus on CMV and its interplay with patient/recipient serology and anti-CMV prophylaxis, we analyzed data from 3 large randomized studies comparing various everolimus regimens with azathioprine (AZA)- and mycophenolate mofetil (MMF)-based regimens. METHODS: CMV data were analyzed from 1009 patients in 3 trials of de novo cardiac transplant recipients who were randomized to everolimus 1.5 mg/day, everolimus 3 mg/day, or AZA 1-3 mg/kg/day, plus standard-dose (SD) cyclosporine (CsA; study B253, n = 634); everolimus 1.5 mg/day plus SD- or reduced-dose (RD)-CsA (study A2403, n = 199); and everolimus 1.5 mg/day plus RD-CsA or MMF plus SD-CsA (study A2411, n = 176). RESULTS: In study B253, patients allocated to everolimus experienced almost a 70% reduction in odds of experiencing CMV infection compared with AZA (P < 0.001). In study A2403, CMV infection was low in both everolimus arms, irrespective of CsA dosing, and in study A2411, patients allocated to everolimus experienced an 80% reduction in odds of experiencing CMV infection, compared with MMF (P < 0.001). CMV syndrome/disease was rare and less frequent in everolimus-treated patients. Subgroup analyses showed that the benefit everolimus provides, in terms of CMV events, is retained in CMV-naïve recipients and is independent of anti-CMV prophylaxis or preemptive approaches. CONCLUSIONS: Everolimus is associated with a lower incidence of CMV infection compared with AZA and MMF, which combined with its immunosuppressive efficacy and antiproliferative effects may positively impact long-term outcomes.
Subject(s)
Cytomegalovirus Infections/prevention & control , Heart Transplantation , Immunosuppressive Agents/therapeutic use , Sirolimus/analogs & derivatives , Adolescent , Adult , Aged , Azathioprine/therapeutic use , Cyclosporine/therapeutic use , Cytomegalovirus/isolation & purification , Cytomegalovirus Infections/epidemiology , Drug Therapy, Combination , Everolimus , Female , Humans , Incidence , Male , Middle Aged , Postoperative Complications/prevention & control , Sirolimus/therapeutic use , Statistics as TopicABSTRACT
Chronic courses of hepatitis E virus (HEV) infections have been described in immunosuppressed patients. We aimed to study the role of HEV infections in heart transplant recipients (HTR). 274 HTR were prospectively screened for HEV infection using an anti-HEV-IgG ELISA and HEV-PCR. In addition, 137 patients undergoing cardiac surgery (non-HTR) and 537 healthy subjects were studied cross-sectionally. The anti-HEV-IgG seroprevalence was 11% in HTR, 7% in non-HTR and 2% in healthy controls (HTR vs. healthy controls p<0.0001; non-HTR vs. healthy controls p<0.01). Anti-HEV tested positive in 4.0% in control cohorts of other immunocompromised patients (n = 474). Four HTR (1.5%) were chronically infected with HEV as shown by HEV-PCR and all four patients had liver transaminases of >200 IU/L and histological or clinical evidence of advanced liver disease. In three patients ribavirin treatment was successful with a sustained biochemical and virological response while treatment failed in one cirrhotic patient after ribavirin dose reduction. Heart transplant recipients and patients undergoing cardiac surgery have an increased risk for HEV infections. Chronic hepatitis E may explain elevated liver enzymes in heart transplant recipients. Treatment of HEV infection with ribavirin is effective but the optimal dose and duration of ribavirin therapy remains to be determined.
Subject(s)
Heart Transplantation/immunology , Hepatitis Antibodies/analysis , Hepatitis E virus/immunology , Hepatitis E/epidemiology , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Biopsy, Needle , Case-Control Studies , Chronic Disease , Enzyme-Linked Immunosorbent Assay , Female , Follow-Up Studies , Germany/epidemiology , Heart Transplantation/statistics & numerical data , Hepatitis E/immunology , Hepatitis E/pathology , Hepatitis E virus/isolation & purification , Humans , Immunocompromised Host/immunology , Immunohistochemistry , Male , Middle Aged , Polymerase Chain Reaction , Prevalence , Prospective Studies , RNA, Viral/analysis , Risk Assessment , Sex Distribution , Statistics, Nonparametric , Survival Rate , Young AdultABSTRACT
After transplantation of solid organs or hematopoietic stem cells, a significant acute decrease in renal function occurs in the majority of patients. Depending on the degree of kidney injury, a large number of patients develop chronic kidney disease (CKD) and some develop end-stage renal disease requiring renal replacement therapy. The incidence varies depending on the transplanted organ, but important risk factors for the development of CKD are preexisting renal disease, hepatitis C, diabetes, hypertension, age, sex, posttransplant acute kidney injury and thrombotic microangiopathy. This review article focuses on the risk factors of posttransplant chronic kidney disease after organ transplantation, considering the current literature and integrates the incidence and the associated mortality rates of acute and chronic kidney disease. Furthermore, we introduce the RECAST (REnal Comorbidity After Solid organ and hematopoietic stem cell Transplantation) registry.
Subject(s)
Hematopoietic Stem Cell Transplantation/adverse effects , Kidney Diseases/etiology , Organ Transplantation/adverse effects , HumansABSTRACT
BACKGROUND: Antiphospholipid syndrome (APS) is characterised by arterial or venous thrombosis combined with the presence of specific antibodies known as antiphospholipids. It is commonly associated with cutaneous signs. Herein we report a case of atypical cutaneous eruption occurring during the course of APS and we discuss the possible mechanism. PATIENTS AND METHODS: A 45-year-old woman consulted twice within six months for an erythematosus papular eruption around the neckline. She was being followed-up for antiphospholipid syndrome treated with fluindione (Préviscan®), and her International Normalized Ratio (INR) was consistent with the prescribed anticoagulation target. Blood tests confirmed the presence of anticardiolipin and antiphospholipid antibodies, but no laboratory evidence of lupus was seen. Histopathological examination of a skin biopsy demonstrated the presence within the vascular lumen of a weakly eosinophilic anhistic substance positive for PAS stain. The patient was given acetone salicylic acid (Kardégic®) combined with fluindione, and four years later, she had presented no relapses. DISCUSSION: Despite a clinically evocative appearance, the diagnosis of lupus tumidus was ruled out in our patient by histopathological features, and associated systemic lupus erythematosus was repeatedly refuted on the basis of clinical and laboratory data. We suggest that the specific histological images of intraluminal deposits within the dermal vessels seen in this patient, although not typical of thrombosis, are associated with APS. The clinical remission seen from the start of antiplatelet treatment could be due to the action of these drugs against the obstruction of small-calibre dermal vessels.
Subject(s)
Antiphospholipid Syndrome/complications , Skin Diseases, Papulosquamous/etiology , Antibodies, Anticardiolipin/blood , Antibodies, Antiphospholipid/blood , Anticoagulants/therapeutic use , Antiphospholipid Syndrome/diagnosis , Antiphospholipid Syndrome/drug therapy , Female , Humans , Keratolytic Agents/therapeutic use , Middle Aged , Phenindione/analogs & derivatives , Phenindione/therapeutic use , Salicylic Acid/therapeutic use , Skin Diseases, Papulosquamous/drug therapyABSTRACT
Interstitial granulomatous dermatitis belongs to the group of aseptic cutaneous granulomas. It is a histopathological entity encountered in various pathological situations, such as polyarthritis including rheumatoid arthritis, but also systemic lupus erythematosus. It may also occur after systemic administration of medication, thus representing a drug-induced, interstitial granulomatous outbreak. This has recently been described after anti-TNF therapy was taken. We are reporting the case of a patient treated using adalimumab for rheumatoid arthritis and having developed interstitial granulomatous dermatitis during treatment, which revealed lupus erythematosus attributable to the biotherapy. The clinical appearance of interstitial granulomatous dermatitis can vary, and the diagnosis is confirmed by anatomo-pathological examination. Drug-induced interstitial granulomatous outbreaks have specific histological criteria, and secondary cases involving anti-TNF medication have been described. Cases of lupus attributable to anti-TNF therapy have also been described, and they have specific biological characteristics. Like idiopathic lupus, they may be associated with interstitial granulomatous dermatitis, but the association of an anti-TNF-induced lupus and this type of granulomatous has not, to our knowledge, been described before. We are reporting one case, which emphasises the importance of carrying out a complete and systematic aetiological assessment for all cases of interstitial granulomatous dermatitis, including where there is systemic disease or following medical treatment, either of which may provide an evident cause for the granulomatosis. In particular, the outbreak of interstitial granulomatous dermatitis during anti-TNF treatment should lead to screening for a drug-induced lupus, which would require the patient to stop such treatment.
Subject(s)
Antibodies, Monoclonal, Humanized/adverse effects , Dermatitis/etiology , Granuloma/chemically induced , Lupus Erythematosus, Systemic/chemically induced , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Adalimumab , Antibodies, Monoclonal, Humanized/therapeutic use , Arthritis, Rheumatoid/drug therapy , Biopsy , Comorbidity , Dermatitis/diagnosis , Dermatitis/epidemiology , Female , Granuloma/diagnosis , Granuloma/epidemiology , Humans , Lupus Erythematosus, Systemic/diagnosis , Lupus Erythematosus, Systemic/epidemiology , Middle Aged , Skin/pathologyABSTRACT
BACKGROUND: Hyperhidrosis is a functional disorder characterized by increased sweating that can greatly impair quality of life due to psychosocial factors. It is most often localized (underarms, hands, feet) but can also be generalized. In this case, after eliminating an underlying cause, systemic treatment may be proposed. In this retrospective study, we report the benefits and adverse effects of the anticholinergic drug oxybutynin. PATIENTS AND METHODS: All patients treated with oxybutynin between February 2008 and October 2010 for troublesome generalized hyperhidrosis were recruited after ruling out underlying disease. Oxybutynin (Ditropan(®)) was started at a dose of 1.25mg then increased in increments of 1.25mg every 4 days up to the lowest effective dose, which did not exceed 2.5mg three times per day in order to avoid serious adverse effects. After 2 months of treatment, patients were asked to rate their satisfaction on a scale of 0 to 10, as well as degree of efficacy, time to efficacy, type of adverse effects and whether or not treatment was continued. RESULTS: Thirty patients were included in this study: 24 women and 6 men aged 19 to 64 years (mean=33 years). The treatment was rated by 24 patients (80%) as very effective and by three patients (10%) as moderately effective. Three patients (10%) stopped the treatment due to adverse effects such as faintness and ocular accommodation disorders, and for these patients, the degree of satisfaction ranged from 1 to 3/10. For the other 27 patients, satisfaction was 6 to 10 with a median of 8.5. The onset of action was between 10 and 21 days with an average of 15.4 days. Adverse effects were present in 10 of 27 patients (37%) comprising dry mouth, which was well tolerated (grade 1). Mean follow-up was 14.9 months (2 months to 32 months), with two patients being lost to follow-up. DISCUSSION: The treatment of primary extended or generalized hyperhidrosis is not currently codified. Our study shows the efficacy of oxybutynin in this indication at a moderate dose, with good safety. The satisfaction index was high, with 80% of patients considering the drug very effective and for 10% considering it moderately effective. To our knowledge, this is the first retrospective study in a large population. A placebo-controlled study could provide the grounds for a therapeutic consensus concerning a drug widely known for many years in the treatment of extensive hyperhidrosis.
Subject(s)
Hyperhidrosis/drug therapy , Mandelic Acids/therapeutic use , Parasympatholytics/therapeutic use , Adult , Drug Evaluation , Female , Follow-Up Studies , Humans , Male , Mandelic Acids/administration & dosage , Mandelic Acids/adverse effects , Middle Aged , Parasympatholytics/administration & dosage , Parasympatholytics/adverse effects , Patient Satisfaction , Retrospective Studies , Treatment Outcome , Xerostomia/chemically induced , Young AdultABSTRACT
BACKGROUND: The risk factors for moderate or severe chronic renal dysfunction (MSCRD) among heart transplant recipients may be distinct from those previously recognized owing to recently improved clinical care. METHODS: We examined the clinical records of 88 adult patients who underwent first heart transplantations from 2000 to 2005 and survived 2 years. MSCRD was defined as a glomerular filtration rate (GFR) <60 mL/min/1.73 m(2) at 2 years after transplantation. Fifty patients were included in the MSCRD group and 38 in the non-MSCRD group. RESULTS: Loss of renal function was observed largely during the first 9 months after transplantation in the MSCRD group. The pretransplantation GFR was lower in the MSCRD group. Besides older age in the MSCRD group, there were no differences in baseline characteristics, immunosuppressive regimens, incidences of acute rejection episodes, cardiac allograft vasculopathy, or severe infections. The MSCRD group showed permanent lower posttransplantation hemoglobin levels. In multivariate logistic regression analysis, recipient age, pretransplantation GFR, postoperative intensive care unit stay and hemoglobin level at 9 month were unfavorable factors for posttransplantation MSCRD. CONCLUSIONS: In addition to recipient age and pretransplantation GFR as well established risk factors, our results suggest a prognostic value of a low early hemoglobin level for the development of chronic renal dysfunction after heart transplantation.
Subject(s)
Heart Transplantation , Hemoglobins/analysis , Kidney Failure, Chronic/physiopathology , Adult , Aged , Female , Glomerular Filtration Rate , Humans , Kidney Function Tests , Male , Middle Aged , Postoperative PeriodABSTRACT
Although malignancy is a major threat to long-term survival of heart transplant (HT) recipients, clear strategies to manage immunosuppression in these patients are lacking. Several lines of evidences support the hypothesis of an anticancer effect of proliferation signal inhibitors (PSIs: mammalian target of rapamycin [mTOR] inhibitors) in HT recipients. This property may arise from PSI's ability to replace immunosuppressive therapies that promote cancer progression, such as calcineurin inhibitors or azathioprine, and/or through their direct biological actions in preventing tumor development and progression. Given the lack of randomized studies specifically exploring these issues in the transplant setting, a collaborative group reviewed current literature and personal clinical experience to reach a consensus aimed to provide practical guidance for the clinical conduct in HT recipients with malignancy, or at high risk of malignancy, with a special focus on advice relevant to potential role of PSIs.
Subject(s)
Cell Proliferation/drug effects , Heart Diseases/complications , Heart Transplantation/adverse effects , Immunosuppressive Agents/therapeutic use , Neoplasms/drug therapy , Neoplasms/etiology , Postoperative Complications , Heart Diseases/surgery , HumansABSTRACT
We determined the distribution of human leukocyte antigen-C (HLA-C) allelic groups in a cohort of psoriatic arthritis (PsA) patients and a control population of Romanian ethnicity. A nominal association of HLA-C*06 with susceptibility to PsA was observed [P = 0.014, p(corr) > 0.05, odds ratio (OR) 2.1, 95% confidence interval (CI) 1.08-4.46]. When subanalyzing data according to PsA clinical phenotypes, association was noticed between HLA-C*06 and PsA with psoriasis onset before 40 years (p(corr) = 0.013, OR 3.7, 95% CI 1.58-9). This first report from Romania confirmed the association of HLA-C*06 with type I psoriasis in PsA patients. Other study findings, such as the relationship between HLA-C*06 and spondylitis or the protective effect of HLA-C*07 for the polyarthritis clinical phenotype of PsA, are of preliminary character and require verification.