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1.
Artículo en Inglés | MEDLINE | ID: mdl-33808734

RESUMEN

(1) Background: Sleep apnea may be a risk factor for deep neck infection (DNI). The objective of this study was to investigate the effects of sleep apnea on DNI. (2) Methods: In this first nationwide retrospective cohort study on the sleep apnea-DNI correlation, we obtained data from the Longitudinal Health Insurance Database 2005, a subset of the Taiwan National Health Insurance Research Database. Patients who were newly diagnosed with sleep apnea between 1997 and 2012 were identified, and patients without sleep apnea were matched at a 1:4 ratio in age, sex, socioeconomic status, and urbanization level. The primary outcome of this study was DNI occurrence. The treatment modalities for sleep apnea and the comorbidities that occurred during the study period were also analyzed. (3) Results: Our sleep apnea and comparison (non-sleep apnea) cohorts comprised 6114 and 24,456 patients, respectively. We compared the cumulative incidence of DNI between these cohorts and found a greater incidence of DNI in the sleep apnea cohort (p < 0.001). A strong sleep apnea-DNI association was found following analysis via the adjusted Cox proportional-hazards model (full model hazard ratio, 1.71; 95% confidence interval, 1.28-2.28; p < 0.001). In the subgroup analysis, sleep apnea increased DNI risk in men, in those aged < 50 years, and in those without diabetes mellitus, end-stage renal disease, liver cirrhosis, autoimmune disease, obesity, tonsillectomy, or adenotonsillectomy. (4) Conclusions: Our results confirmed sleep apnea to be an independent risk factor for DNI. Physicians should be aware of the potential occurrence of DNI in patients with sleep apnea.


Asunto(s)
Infecciones , Síndromes de la Apnea del Sueño , Anciano , Estudios de Cohortes , Humanos , Incidencia , Masculino , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de Riesgo , Síndromes de la Apnea del Sueño/epidemiología , Taiwán/epidemiología
2.
Emerg Med Clin North Am ; 39(2): 379-394, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33863466

RESUMEN

Infections in elderly patients can prove diagnostically challenging. Age-related factors affecting the immune system in older individuals contribute to nonspecific presentations. Other age-related factors and chronic conditions have symptoms that may or may not point to an infectious diagnosis. Delay in administration of antimicrobials can lead to poor outcomes; however, unnecessary administration of antimicrobials can lead to increased morbidity and contribute to the emergence of multidrug-resistant organisms. Careful clinical assessment and consideration of patient history and risk factors is crucial. When necessary, antimicrobials should be chosen that are appropriate for the diagnosis and deescalated as soon as possible.


Asunto(s)
Infecciones/diagnóstico , Infecciones/tratamiento farmacológico , Anciano , Envejecimiento , Antiinfecciosos/uso terapéutico , Programas de Optimización del Uso de los Antimicrobianos , Humanos , Inmunosenescencia , Incidencia , Prevalencia , Factores de Riesgo
3.
An. Fac. Cienc. Méd. (Asunción) ; 54(1): 137-142, 20210000.
Artículo en Español | LILACS | ID: biblio-1178959

RESUMEN

El desbridamiento temprano seguido de cobertura con piel autóloga ha demostrado reducir la mortalidad en los pacientes quemados. En pacientes con quemaduras extensas, la carencia de zonas de piel donante es un factor limitante a la hora del tratamiento. El hecho de que no se pueda lograr un desbridamiento y cobertura completos en un primer tiempo favorece la infección de la quemadura y la septicemia, pudiendo tener consecuencias nefastas. Por tanto, es necesario disponer de otras opciones distintas a los injertos mallados de piel parcial, el tratamiento estándar hoy día. Presentamos el caso clínico de un niño con quemaduras severas y describimos los resultados obtenidos con el uso de la membrana amniótica como cobertura temporal y al injerto mallado tipo MEEK.


Early debridement followed by coverage with autologous skin has been shown to reduce mortality in burn patients. In patients with extensive burns, the lack of areas of donor skin is a limiting factor at the time of treatment. The fact that a complete debridement and coverage cannot be achieved in the first stage favors the infection of the burn and septicemia, which can have dire consequences. Therefore, it is necessary to have other options than partial skin mesh grafts, the standard treatment today. We present the clinical case of a child with severe burns and describe the results obtained with the use of the amniotic membrane as temporary covering and the MEEK-type mesh graft.


Asunto(s)
Quemaduras , Sepsis , Trasplantes , Amnios , Infecciones
4.
San Salvador; MINSAL; abr. 26, 2021. 11 p. ilus, graf, tab, mapas.
No convencional en Español | LILACS, BISSAL | ID: biblio-1179092

RESUMEN

Resumen de eventos de notificación hasta SE 15/2021. Alertas internacionales. Situación epidemiológica de dengue. Situación epidemiológica de zika y chikungunya. Infección respiratoria aguda. Neumonías. Situación mundial del 2019-nCov (OMS. Vigilancia centinela de influenza y otros virus respiratorios. Vigilancia centinela de rotavirus. Enfermedad diarreica aguda. Fiebre tifoidea


Summary of notification events up to SE 15/2021. International alerts. Epidemiological situation of dengue. Epidemiological situation of Zika and Chikungunya. Acute respiratory infection. Pneumonia Global situation 2019-nCov (WHO. Sentinel surveillance of influenza and other respiratory viruses. Sentinel surveillance for rotavirus. Acute diarrheal disease. Typhoid fever


Asunto(s)
Epidemiología , Notificación , Publicaciones Electrónicas , Infecciones
5.
San Salvador; MINSAL; abr. 20, 2021. 11 p. ilus, graf, tab, mapas.
No convencional en Español | LILACS, BISSAL | ID: biblio-1178325

RESUMEN

Resumen de eventos de notificación hasta SE 14/2021. Alertas internacionales. Situación epidemiológica de dengue. Situación epidemiológica de zika y chikungunya. Infección respiratoria aguda. Neumonías. Situación mundial del 2019-nCov (OMS. Vigilancia centinela de influenza y otros virus respiratorios. Vigilancia centinela de rotavirus. Enfermedad diarreica aguda. Fiebre tifoidea


Summary of notification events up to SE 14/2021. International alerts. Epidemiological situation of dengue. Epidemiological situation of Zika and Chikungunya. Acute respiratory infection. Pneumonia Global situation 2019-nCov (WHO. Sentinel surveillance of influenza and other respiratory viruses. Sentinel surveillance for rotavirus. Acute diarrheal disease. Typhoid fever


Asunto(s)
Epidemiología , Publicaciones Electrónicas , Vigilancia , Infecciones
6.
BMC Infect Dis ; 21(1): 395, 2021 Apr 29.
Artículo en Inglés | MEDLINE | ID: mdl-33926373

RESUMEN

BACKGROUND: We describe the spectrum of ICD-10 classified causes for hospitalisations occurring between 2011 and 2018 in a cohort of people living with HIV (PLHIV). METHODS: This sub-study includes 798 PLHIV participating in the Antiretroviral, Sexual Transmission Risk and Attitudes (ASTRA) questionnaire study who were recruited from a large London centre. A medical record review identified the occurrence and causes of hospitalisation from the date of questionnaire completion (February-December 2011) until 1 June 2018. Up to five causes were classified by an HIV clinician using the ICD-10 system. RESULTS: There were 274 hospitalisations in 153 people (rate = 5.8/100 person-years; 95% CI: 5.1, 6.5). Causes were wide-ranging; the most common were circulatory (16.8%), digestive (13.1%), respiratory (11.7%), infectious diseases (11.0%), injury/poisoning (10.6%), genitourinary diseases (9.9%) and neoplasms (9.1%). A tenth (27/274) of hospitalisations were related to at least one AIDS-defining illness. Median duration of hospitalisation was 5 days (IQR 2-9). At the time of hospitalisation, median CD4 count was high (510 cells/µl; IQR: 315-739), while median CD4 nadir was relatively low (113 cells/µl; IQR: 40-239). At admission, half of individuals (51%) had a previous AIDS-defining illness and 21% had viral load > 50 copies/ml. Individuals admitted for infectious diseases were particularly likely to have unfavourable HIV-related clinical characteristics (low CD4, viral non-suppression, not on antiretroviral therapy (ART), previous AIDS). CONCLUSIONS: In the modern combination antiretroviral therapy era, the spectrum of causes of hospitalisation in PLHIV in the UK is wide-ranging, highlighting the importance of holistic care for PLHIV, including prevention, early detection and treatment of comorbidities.


Asunto(s)
Infecciones por VIH/epidemiología , Infecciones por VIH/etiología , Hospitalización/estadística & datos numéricos , Adulto , Antirretrovirales/uso terapéutico , Recuento de Linfocito CD4 , Enfermedades Cardiovasculares/epidemiología , Estudios de Cohortes , Comorbilidad , Enfermedades del Sistema Digestivo/epidemiología , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Infecciones/epidemiología , Londres/epidemiología , Masculino , Persona de Mediana Edad , Neoplasias/epidemiología , Carga Viral
7.
BMC Infect Dis ; 21(1): 285, 2021 Mar 20.
Artículo en Inglés | MEDLINE | ID: mdl-33743592

RESUMEN

BACKGROUND: The systemic response to an infection might influence the pharmacokinetics of antibiotics. To evaluate the desired possibility of an earlier (< 24 h) IV-to-oral switch therapy in febrile non-ICU, hospitalized patients, a systematic review was performed to assess the effect of the initial phase of a systemic infection on the bioavailability of orally administered antibiotics in such patients. METHODS: An electronic search was conducted in MEDLINE and Embase up to July 2020. Studies were selected when outcome data were collected during the initial stage of a febrile disease. Outcome data were (maximum) serum concentrations, time of achieving maximum serum concentration, and the area-under-the-plasma-concentration-time curve or bioavailability of orally administered antibiotics. Risk of bias was assessed. RESULTS: We identified 9 studies on 6 antibiotics. Ciprofloxacin was the most frequently studied drug. Outcomes of the studies were heterogeneous and generally had a high risk of bias. Three small studies, two on ciprofloxacin and one on clarithromycin, compared the pharmacokinetics of febrile patients with those of clinically recovered patients and suggested that bioavailability was not altered in these patients. Other studies either compared the pharmacokinetics in febrile patients with reported pharmacokinetic values from earlier studies in healthy volunteers (n = 2), or provided no comparison at all and were non-conclusive (n = 4). CONCLUSION: There is a clear knowledge gap regarding the bioavailability of orally administered antibiotics in non-ICU patients during the initial phase of a systemic infection. Well-designed studies on this topic are necessary to elucidate whether patients can benefit from the advantages of an earlier IV-to-oral switch.


Asunto(s)
Antibacterianos/farmacocinética , Infecciones/tratamiento farmacológico , Administración Oral , Antibacterianos/uso terapéutico , Disponibilidad Biológica , Ciprofloxacino , Fiebre , Humanos
8.
Int J Mol Sci ; 22(5)2021 Feb 25.
Artículo en Inglés | MEDLINE | ID: mdl-33669068

RESUMEN

Tunneling nanotubes (TNTs) are recognized long membrane nanotubes connecting distance cells. In the last decade, growing evidence has shown that these subcellular structures mediate the specific transfer of cellular materials, pathogens, and electrical signals between cells. As intercellular bridges, they play a unique role in embryonic development, collective cell migration, injured cell recovery, cancer treatment resistance, and pathogen propagation. Although TNTs have been considered as potential drug targets for treatment, there is still a long way to go to translate the research findings into clinical practice. Herein, we emphasize the heterogeneous nature of TNTs by systemically summarizing the current knowledge on their morphology, structure, and biogenesis in different types of cells. Furthermore, we address the communication efficiency and biological outcomes of TNT-dependent transport related to diseases. Finally, we discuss the opportunities and challenges of TNTs as an exciting therapeutic approach by focusing on the development of efficient and safe drugs targeting TNTs.


Asunto(s)
Comunicación Celular/efectos de los fármacos , Desarrollo de Medicamentos/métodos , Uniones Intercelulares/metabolismo , Neoplasias/metabolismo , Animales , Transporte Biológico Activo/efectos de los fármacos , Transporte Biológico Activo/genética , Transporte Biológico Activo/fisiología , Comunicación Celular/genética , Humanos , Infecciones/tratamiento farmacológico , Infecciones/metabolismo , Uniones Intercelulares/efectos de los fármacos , Uniones Intercelulares/patología , Uniones Intercelulares/ultraestructura , Neoplasias/tratamiento farmacológico , Neoplasias/patología , Enfermedades Neurodegenerativas/tratamiento farmacológico , Enfermedades Neurodegenerativas/metabolismo
9.
Medicine (Baltimore) ; 100(11): e24762, 2021 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-33725942

RESUMEN

ABSTRACT: Chemokines are majorly involved in inflammatory and immune responses. The interferon-γ-inducible chemokines C-X-C motif chemokines 9 and 10 (CXCL9 and CXCL10) are considerably associated with Th1 cells and monocytes, and their expression levels rapidly increase during the early episodes of renal allograft rejection and various infectious diseases. CXCL13 is one of the most potent B-cell and T follicular helper-cell chemoattractants. The expression of CXCL13 in the presence of infection indicates an important chemotactic activity in multiple infectious diseases. C-C motif chemokine ligand 2 (CCL2) can attract monocytes and macrophages during inflammatory responses. However, there are no studies on the role of these chemokines in posttransplant infection in kidney transplant recipients.In this study, CXCL9, CXCL10, CXCL13, and CCL2 were analyzed using the Bio-Plex suspension array system before transplant and 30 days after transplant.The serum levels of CXCL9 and CXCL13 30 days after kidney transplant were associated with infection within 1 year after transplant (P = .021 and P = .002, respectively). The serum levels of CXCL9 and CXCL13 before surgery and those of CCL2 and CXCL10 before and after surgery were not associated with infection within 1 year after transplant (P > .05). The combination of postoperative day (POD) 30 CXCL9 and postoperative day 30 CXCL13 provided the best results with an area under the curve of 0.721 (95% confidence interval, 0.591-0.852), with a sensitivity of 71.4% and specificity of 68.5% at the optimal cutoff value of 52.72 pg/mL.As important chemokines, CXCL9 and CXCL13 could be used to predict the occurrence of infection after kidney transplant.


Asunto(s)
Quimiocina CXCL13/sangre , Quimiocina CXCL9/sangre , Infecciones/etiología , Enfermedades Renales/sangre , Trasplante de Riñón/efectos adversos , Complicaciones Posoperatorias/etiología , Adulto , Biomarcadores/sangre , Quimiocina CCL2/sangre , Quimiocina CXCL10/sangre , Femenino , Humanos , Enfermedades Renales/cirugía , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Valor Predictivo de las Pruebas , Periodo Preoperatorio , Estudios Retrospectivos
11.
Front Public Health ; 9: 638975, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33777887

RESUMEN

Objective: Understanding gender differences in responses of health-care workers (HCWs) to COVID-19 outbreak is an effective way to promote customized supports. Methods: During February 2020, 103 HCWs infected with COVID-19 (64 females and 39 males) and 535 uninfected HCWs (383 females and 152 males) were recruited in a cross-sectional study. Level of attention, six emotional status, and self-evaluation of eight protective measures were recorded. Multivariable Firth's logistic regressions were applied to explored independent effect of gender. Results: During early outbreak, female HCWs were more likely to give greater attention, adjusted OR:1.92 (95%CI 1.14-3.23) in total HCWs. Higher proportion of anxiety was observed in female HCWs, adjusted OR:3.14 (95%CI 1.98-4.99) for total HCWs, 4.32(95%CI 1.32-14.15) for infected HCWs and 2.97 (1.78, 4.95) for uninfected HCWs. Proportion of pessimism, fear, full of fighting spirit, and optimism were low, and no gender differences were observed. During a later outbreak, a majority of HCWs reported being very familiar with eight protective measures. After training, a proportion of high self-evaluation in hand hygiene, wearing gloves, and surgical masks increased independently in female HCWs, and adjusted ORs were 3.07 (95% CI 1.57-5.99), 2.37 (95% CI 1.26-4.49), and 1.92 (95% CI 1.02-3.62), respectively. Infection status amplified gender difference in anxiety, hand hygiene, and glove wearing. Conclusion: Female HCWs perceived the outbreak seriously, effective emotional and psychological well-ness should be targeted at female HCWs preferentially, and male HCWs should be encouraged to express their feelings and be further trained.


Asunto(s)
Adaptación Psicológica , Brotes de Enfermedades/estadística & datos numéricos , Personal de Salud/psicología , Conductas de Riesgo para la Salud , Infecciones/psicología , Estrés Psicológico , Adulto , China/epidemiología , Estudios Transversales , Femenino , Personal de Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Factores Sexuales , Encuestas y Cuestionarios
12.
Int. j. med. surg. sci. (Print) ; 8(1): 1-9, mar. 2021. ilus
Artículo en Español | LILACS | ID: biblio-1151628

RESUMEN

La terapia con fármacos antagonistas del factor de necrosis tumoral alfa ha sido beneficiosa en el tratamiento de varias enfermedades como las del tejido conectivo e inflamatorias del intestino, pero no está exenta de riesgos. Las principales complicaciones de estas drogas inmunosupresoras son las infecciones, y la tuberculosis pulmonar es una de las principales afecciones, que se pueden observar en los pacientes con este tipo de tratamiento.Se presentó una mujer de 31 años, atendida en el Hospital Clínico Quirúrgico Hermanos Ameijeiras, La Habana, Cuba, con antecedentes de colitis ulcerativa, que hace 3 meses recibe terapia con Infliximab. Acude al hospital por referir 4 días previos al ingreso, fiebre de 390 C dos veces al día, acompañándose de cefalea, pérdida del apetito y dolor en la región perineal. Se le realizó radiografía de tórax, donde se describe radiopacidad heterogénea que va desde el cuerno superior del hilio derecho hasta planos axilares, en la tomografía axial de tórax reportan consolidación en segmento anterior del lóbulo superior derecho con presencia de broncograma aéreo y en el lavado bronquial microbiológico para bacilos ácido-alcohol resistentes se informó codificación 8, positivo a Mycobacterium tuberculosis. El diagnóstico preciso de tuberculosis relacionada con el uso de fármacos antagonistas del factor de necrosis tumoral alfa requiere un alto índice de sospecha y una investigación detallada. Existe un alto grado de complejidad diagnóstica, por la existencia de un amplio espectro clínico y la necesidad de excluir otras enfermedades.


Tumor necrosis factor alpha antagonist drug therapy has been beneficial in the treatment of several diseases such as connective tissue and inflammatory bowel diseases, but it is not without risks. The main complications of these immunosuppressive drugs are infections, and pulmonary tuberculosis is one of the main conditions, which can be observed in patients with this type of treatment. A 31-year-old woman, treated at the Hermanos Ameijeiras Clinical Surgical Hospital, Havana, Cuba, with a history of ulcerative colitis, who has been receiving Infliximab therapy for 3 months, presented. He went to the hospital for referring 4 days prior to admission, a fever of 390 C twice a day, accompanied by headache, loss of appetite and pain in the perineal region. A chest X-ray was performed, which described heterogeneous radiopacity that goes from the upper horn of the right hilum to axillary planes, in the chest axial tomography they report consolidation in the anterior segment of the right upper lobe with the presence of air bronchogram and in the bronchial lavage microbiological for acid-fast bacilli coding 8, positive for mycobacterium tuberculosis was reported. Accurate diagnosis of tuberculosis related to the use of tumor necrosis factor alpha antagonist drugs requires a high index of suspicion and detailed investigation. There is a high degree of diagnostic complexity, due to the existence of a wide clinical spectrum and the need to exclude other diseases.


Asunto(s)
Humanos , Femenino , Adulto , Tuberculosis Pulmonar/diagnóstico por imagen , Infliximab/efectos adversos , Inmunosupresores/efectos adversos , Tuberculosis Pulmonar/etiología , Tomografía Computarizada por Rayos X , Infecciones/etiología
15.
Evol Psychol ; 19(1): 14747049211000714, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33752457

RESUMEN

It is puzzling why countries do not all implement stringent behavioral control measures to prevent the spread of COVID-19 even though preventive behaviors have been proven to be the only effective means to stop the pandemic. We provide a novel evolutionary life history explanation whereby pathogenic and parasitic prevalence represents intrinsic rather than extrinsic mortality risk that drives slower life history strategies and the related disease control motivation in all animals but especially humans. Our theory was tested and supported based on publicly available data involving over 150 countries. Countries having a higher historical prevalence of infectious diseases are found to adopt slower life history strategies that are related to prompter COVID-19 containment actions by the government and greater compliance by the population. Findings could afford governments novel insight into the design of more effective COVID-19 strategies that are based on enhancing a sense of control, vigilance, and compliance in the general population.


Asunto(s)
Control de la Conducta , Control de Enfermedades Transmisibles , Infecciones , Rasgos de la Historia de Vida , Conducta de Reducción del Riesgo , Control de la Conducta/legislación & jurisprudencia , Control de la Conducta/métodos , Control de la Conducta/psicología , /prevención & control , Control de Enfermedades Transmisibles/métodos , Control de Enfermedades Transmisibles/tendencias , Conducta Cooperativa , Salud Global , Regulación Gubernamental , Humanos , Infecciones/epidemiología , Infecciones/psicología , Infecciones/transmisión , Prevalencia
16.
Medicine (Baltimore) ; 100(10): e24430, 2021 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-33725821

RESUMEN

OBJECTIVE: It remains unclear whether transfusion strategies during orthopedic surgery and infection are related. The purpose of this study is to evaluate whether liberal blood transfusion strategies contribute to infection risk in orthopedic patients by analyzing randomized controlled trials (RCTs). METHODS: RCTs with liberal versus restrictive red blood cell (RBC) transfusion strategies were identified by searching PubMed, Embase, the Cochrane Central Register of Controlled Trials from their inception to July 2019. Ten studies with infections as outcomes were included in the final analysis. According to the Jadad scale, all studies were considered to be of high quality. RESULTS: Ten trials involving 3938 participants were included in this study. The pooled risk ratio (RR) for the association between liberal transfusion strategy and infection was 1.34 (95% confidence intervals [CI], 0.94-1.90; P = .106). The sensitivity analysis indicated unstable results, and no significant publication bias was observed. CONCLUSION: This pooled analysis of RCTs demonstrates that liberal transfusion strategies in orthopedic patients result in a nonsignificant increase in infections compared with more restrictive strategies. The conclusions are mainly based on retrospective studies and should not be considered as recommendation before they are supported by larger scale and well-designed RCTs.


Asunto(s)
Transfusión Sanguínea/estadística & datos numéricos , Infecciones/epidemiología , Cuidados Intraoperatorios/efectos adversos , Procedimientos Ortopédicos/efectos adversos , Complicaciones Posoperatorias/epidemiología , Pérdida de Sangre Quirúrgica/prevención & control , Humanos , Infecciones/etiología , Cuidados Intraoperatorios/métodos , Cuidados Intraoperatorios/estadística & datos numéricos , Complicaciones Posoperatorias/etiología , Ensayos Clínicos Controlados Aleatorios como Asunto , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo
17.
Artículo en Inglés | MEDLINE | ID: mdl-33632463

RESUMEN

Drug transporters, classified in various ways like efflux transporters and influx transporters; secretory transporters and absorptive transporters; ATP-driven transporters and Solute Linked Carrier (SLC) transporters are of great importance while studying pharmacokinetics. They have impeccable roles in the drug discovery process of infectious diseases. Many of these find a pivotal role in synthetic antimicrobial peptides. The chapter briefly elucidates the varied types and their significance.


Asunto(s)
Proteínas Portadoras , Infecciones/metabolismo , Transporte Biológico , Proteínas Portadoras/clasificación , Proteínas Portadoras/metabolismo , Humanos
18.
Diabet Med ; 38(5): e14547, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33615546

RESUMEN

The coronavirus disease 2019 (COVID-19) pandemic has posed enormous challenges to healthcare systems worldwide. The negative impact of COVID-19 is widespread and includes not only people who contracted the disease but also those with chronic morbidities such as diabetes whose care is compromised due to diversion of medical resources. People with diabetes are generally more susceptible to infection as a result of altered immunity. People with diabetes have a worse prognosis from COVID-19 and there is evidence to suggest that severe acute respiratory syndrome coronavirus 2 may directly affect pancreatic function precipitating hyperglycaemic crises. In the United Kingdom, one of the most heavily affected countries, guidelines are in place to unify the management of people with diabetes hospitalized for COVID-19. Diabetes services are re-organized to ensure that medical care of people with diabetes is maintained despite resource and other practical constraints. Public health measures including social distancing, hand hygiene and the use of face masks are crucial in containing community transmission of the virus. Hong Kong, one of the most densely populated city in the world, is particularly vulnerable and has in place a stringent containment policy and aggressive contact tracing to ensure public safety during this pandemic.


Asunto(s)
/epidemiología , Control de Enfermedades Transmisibles/métodos , Diabetes Mellitus/epidemiología , /inmunología , /terapia , Comorbilidad , Prestación de Atención de Salud/organización & administración , Diabetes Mellitus/inmunología , Diabetes Mellitus/metabolismo , Diabetes Mellitus/terapia , Higiene de las Manos , Hong Kong/epidemiología , Humanos , Huésped Inmunocomprometido/inmunología , Infecciones/epidemiología , Infecciones/inmunología , Gripe Humana/epidemiología , Gripe Humana/inmunología , Máscaras , Guías de Práctica Clínica como Asunto , Política Pública , Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Reino Unido/epidemiología
19.
Am J Hematol ; 96(4): 455-461, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33529419

RESUMEN

Chimeric antigen receptor T-cell therapy (CAR T) is a novel intervention for relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL) and other hematologic malignancies. However, it is associated with prolonged hematologic toxicity (PHT) that is unpredictable and can significantly impair patients' quality of life. Reported here is a single-center experience with PHT in adult patients with R/R DLBCL who received commercial CAR T-cell therapy between March 1, 2018 and May 30, 2020. Prolonged hematologic toxicity was defined as ≥ grade 3 neutropenia or thrombocytopenia at day +30 after CAR T-cell therapy. Of the 31 patients identified, 18 patients (58%) developed PHT. Patients with PHT had a shorter 1-year overall survival (OS) than patients without PHT (36% vs. 81%, P < .05). There were no differences in the median time to ANC recovery for those with PHT compared to patients without PHT (16 days vs. 15 days). Several risk factors were identified to be associated with PHT including CRS (P = .002), receipt of tocilizumab (P = .002) or steroids (P = .033), peak ferritin >5000 ng/ml (P = .048), peak C-reactive protein (CRP) > 100 mg/L (P = .007), and ferritin greater than the upper limit of normal at day +30. Seven patients with PHT underwent a bone marrow biopsy after CAR T-cell therapy; all showed complete aplasia or were hypocellular with cellularity ranging from <5% to 10%. These findings identify PHT as a significant toxicity associated with CAR T-cell therapy and highlight the critical need for further investigations to describe PHT in larger cohorts and identify standards for management of this condition.


Asunto(s)
Inmunoterapia Adoptiva/efectos adversos , Linfoma de Células B Grandes Difuso/terapia , Neutropenia/etiología , Trombocitopenia/etiología , Corticoesteroides/administración & dosificación , Adulto , Anciano , Anciano de 80 o más Años , Anticuerpos Monoclonales Humanizados/administración & dosificación , Médula Ósea/patología , Terapia Combinada , Ciclofosfamida/administración & dosificación , Femenino , Ferritinas/sangre , Humanos , Infecciones/etiología , Estimación de Kaplan-Meier , Linfoma de Células B Grandes Difuso/sangre , Linfoma de Células B Grandes Difuso/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Vidarabina/administración & dosificación , Vidarabina/análogos & derivados , Adulto Joven
20.
JAMA Netw Open ; 4(2): e2036321, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33533931

RESUMEN

Importance: Rituximab is among the most frequently used immunotherapies in pediatrics. Few studies have reported long-term adverse events associated with its use for children. Objective: To describe the use of rituximab and to assess whether its use is associated with short- or long-term adverse events, infections, or time to immune reconstitution in a diverse group of young people. Design, Setting, and Participants: This retrospective cohort study included 468 patients aged younger than 21 years who received rituximab for diverse indications between October 1, 2010, and December 31, 2017, at Texas Children's Hospital, a large pediatric referral hospital. Patterns of adverse events, infections, and immune recovery are described. Data analyses were conducted from December 2019 to June 2020. Exposure: One or more doses of rituximab. Main Outcomes and Measures: Adverse drug events (eg, anaphylaxis), incidence of mild and severe infections, and time to recovery of B lymphocyte subset counts and immunoglobulin levels. Survival models and logistic regression analyses and were used to identify associated risk factors of infectious and noninfectious adverse drug events. Results: We identified 468 patients receiving at least 1 dose of rituximab. The total follow-up time was 11 713 person-months. Of the 468 patients, 293 (62.6%) were female, the median (interquartile range) age at receipt of dose was 14.3 (9.9-16.8) years, and 209 (44.7%) were self-reported White Hispanic. Adverse events associated with rituximab infusion occurred in 72 patients (15.4%), and anaphylaxis occurred in 17 patients (3.6%). Long-term adverse events, such as prolonged neutropenia and leukoencephalopathy, were absent. Infections occurred in 224 patients (47.9%); 84 patients (17.9%) had severe infections, and 3 patients (0.6%) had lethal infections. Concurrent use of intravenous chemotherapy, treatment of systemic lupus erythematosus, neutropenia, and use of intravenous immunoglobulin were associated with increased risk of infection. Among 135 patients (28.8%) followed up to B cell count recovery, CD19+ or CD20+ cell numbers normalized in a median of 9.0 months (interquartile range, 5.9-14.4 months) following rituximab use; 48 of 95 patients (51%) evaluated beyond a year had low-for-age B cell counts. Recovery of CD27+ memory B cell number occurred in a median of 15.7 months (interquartile range, 6.0-22.7 months). Among patients with normal baseline values, low immunoglobulin G (IgG) levels developed in 67 of 289 patients (23.2%) and low IgM levels in 118 of 255 patients (40.8%); of these patients evaluated beyond 12 months from rituximab, 16 of 117 (13.7%) had persistently low IgG and 37 (33.9%) of 109 had persistently low IgM. Conclusions and Relevance: Rituximab is well tolerated among young people and is associated with few serious adverse events, but infections are common, corresponding to a prolonged period of B cell count recovery often lasting for longer than a year. Further examination of strategies to prevent infections following rituximab should be pursued.


Asunto(s)
Anafilaxia/epidemiología , Factores Inmunológicos/efectos adversos , Infecciones/epidemiología , Reacción en el Punto de Inyección/epidemiología , Neutropenia/epidemiología , Rituximab/efectos adversos , Adolescente , Agammaglobulinemia/inducido químicamente , Agammaglobulinemia/epidemiología , Anafilaxia/inducido químicamente , Enfermedades Autoinmunes del Sistema Nervioso/tratamiento farmacológico , Linfocitos B , Niño , Preescolar , Estudios de Cohortes , Encefalitis/tratamiento farmacológico , Femenino , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Lactante , Infecciones/inducido químicamente , Leucoencefalopatía Multifocal Progresiva/epidemiología , Efectos Adversos a Largo Plazo/inducido químicamente , Efectos Adversos a Largo Plazo/epidemiología , Lupus Eritematoso Sistémico/tratamiento farmacológico , Recuento de Linfocitos , Linfoma/tratamiento farmacológico , Masculino , Esclerosis Múltiple/tratamiento farmacológico , Síndrome Nefrótico/tratamiento farmacológico , Neutropenia/inducido químicamente , Oportunidad Relativa , Modelos de Riesgos Proporcionales , Púrpura Trombocitopénica Idiopática/tratamiento farmacológico , Índice de Severidad de la Enfermedad , Factores de Tiempo , Adulto Joven
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