Prevalence of positive serology for sexually transmitted infections among older adults / Prevalência de sorologia positiva para infecções sexualmente transmissíveis entre idosos

Objective: To determine the seroreactivity profile for sexually transmitted infections (STIs) in a sample of community-dwelling older adults. Methods: Epidemiological survey using serological screening tests for reactivity to Treponema pallidum, HIV 1/2, and hepatitis B and C viruses in 495 older individuals (59.9% women) investigated regardless of signs or symptoms of STIs. Results: Reactivity rates for the etiological agents of AIDS and viral hepatitis B and C were compatible with the usual prevalence of these STIs in the Brazilian population. However, there was a very high prevalence of reactivity to syphilis (symptomatic or asymptomatic) in the group, equivalent to approximately 1290 cases per 10 000 older population, which suggests a proportionally greater exposure of older adults to infection with T. pallidum and to the risk of morbidity and mortality associated with STIs. Conclusions: This scenario indicates that adjustments are needed in geriatric centers to consider screening for STIs as an integral part of the routine clinical care of older people. (AU)

Objetivo: Averiguar o perfil sorológico de reatividade para infecções sexualmente transmissíveis (ISTs) em amostra de idosos residentes em comunidade. Metodologia: Inquérito epidemiológico por exames sorológicos de rastreio para reatividade contra Treponema pallidum, HIV 1/2 e os vírus associados às hepatites B e C em 495 indivíduos idosos (59.9% do sexo feminino) investigados independentemente de sinais ou sintomas para ISTs. Resultados: Taxas de reatividade para os agentes etiológicos da AIDS e das hepatites virais B e C mostraram-se compatíveis com as prevalências usuais de acometimento por essas ISTs na população brasileira. Entretanto, foi observada prevalência muito elevada de reatividade para sífilis (sintomática ou assintomática) no grupamento, equivalente à cerca de 1.290 casos por 10 mil pessoas idosas, o que sugere exposição proporcionalmente maior de idosos ao contágio por Treponema pallidum e aos risco da morbimortalidade associada a ISTs. Conclusões: Esse cenário indica que são necessárias adequações nos serviços de geriatria a fim de que considerem o rastreio para infecções sexualmente transmissíveis como parte integrante da rotina clínica de assistência a pessoas idosas. (AU)

Elevated serum IL-6 levels predict treatment interruption in patients with moderate to severe psoriasis: a 6-year real-world cohort study

Abstract Background: Real-world, primary data on the treatment of psoriasis are scarce, especially concerning the role of soluble biomarkers as outcome predictors. Objective: The authors evaluated the utility of Th1/Th17 serum cytokines along with clinical characteristics as predictors of drug survival in the treatment of psoriasis. Methods: The authors consecutively included participants with moderate to severe psoriasis who were followed up for 6 years. Baseline interferon-α, tumor necrosis factor-α, and inter-leukin (IL)-2, IL-4, IL-6, IL-10, and IL-17A were measured using a cytometric bead array; clinical data were assessed. The authors calculated hazard ratios (HRs) for drug survival using a Cox proportional hazards model. Results: The authors included 262 patients, most of whom used systemic immunosuppressants or biologics. In the multivariate model, poor quality of life measured by the Dermatology Life Quality Index (HR = 1.04; 95% CI 1.01-1.07; p = 0.012) and elevated baseline IL-6 (HR = 1.99; 95% CI 1.29-3.08; p = 0.002) were associated with treatment interruption. Study limitations: The main limitation of any cohort study is the presence of confounders that could not be detected in clinical evaluation. Conclusions: Poor quality of life and elevated baseline serum IL-6 level predicted treatment interruption in patients with moderate to severe psoriasis. Although IL-6 is not the most important mediator of the inflammatory pathway in the skin environment, it is an interesting biomarker candidate for predicting psoriasis treatment response.

Elevated serum IL-6 levels predict treatment interruption in patients with moderate to severe psoriasis: a 6-year real-world cohort study.

BACKGROUND: Real-world, primary data on the treatment of psoriasis are scarce, especially concerning the role of soluble biomarkers as outcome predictors. OBJECTIVE: The authors evaluated the utility of Th1/Th17 serum cytokines along with clinical characteristics as predictors of drug survival in the treatment of psoriasis. METHODS: The authors consecutively included participants with moderate to severe psoriasis who were followed up for 6 years. Baseline interferon-α, tumor necrosis factor-α, and interleukin (IL)-2, IL-4, IL-6, IL-10, and IL-17A were measured using a cytometric bead array; clinical data were assessed. The authors calculated hazard ratios (HRs) for drug survival using a Cox proportional hazards model. RESULTS: The authors included 262 patients, most of whom used systemic immunosuppressants or biologics. In the multivariate model, poor quality of life measured by the Dermatology Life Quality Index (HR = 1.04; 95% CI 1.01‒1.07; p = 0.012) and elevated baseline IL-6 (HR = 1.99; 95% CI 1.29‒3.08; p = 0.002) were associated with treatment interruption. STUDY LIMITATIONS: The main limitation of any cohort study is the presence of confounders that could not be detected in clinical evaluation. CONCLUSIONS: Poor quality of life and elevated baseline serum IL-6 level predicted treatment interruption in patients with moderate to severe psoriasis. Although IL-6 is not the most important mediator of the inflammatory pathway in the skin environment, it is an interesting biomarker candidate for predicting psoriasis treatment response.