ABSTRACT
BACKGROUND: Drug survival analysis of biologic agents in psoriasis is of extreme importance, as it allows not only the evaluation of objective clinical outcomes (such as effectiveness and safety) but also of factors that are associated with patients' adherence to treatment. The aim of this study was to evaluate and compare the drug survival of the most recent biologic agents approved for the treatment of moderate-to-severe psoriasis-ustekinumab, secukinumab, ixekizumab, brodalumab, guselkumab, and risankizumab-and to identify clinical predictors that can influence the drug survival of these drugs. METHODS: This retrospective multicentric cohort study from 16 dermatology centers in Portugal, Spain, Italy, Switzerland, Czech Republic, Canada, and the United States included patients that started IL-12/23, IL-17 (IL-17A and IL-17R) and IL-23 inhibitors for the treatment of psoriasis between January 1, 2012 and December 31, 2019. Survival analysis was performed using a Kaplan-Meier estimator, to obtain descriptive survival curves, and proportional hazard Cox regression models. RESULTS: A total of 3312 treatment courses (total patients: 3145) were included in the study; 1118 (33.8%) with an IL-12/23 inhibitor (ustekinumab), 1678 (50.7%) with an IL-17 inhibitor [911 (27.5%) on secukinumab, 651 (19.7%) on ixekizumab, 116 (3.5%) on brodalumab], and 516 (15.5%) with an IL-23 inhibitor [398 (12.0%) on guselkumab, 118 (3.5%) on risankizumab]. At 18 months, the cumulative probability of survival was 96.4% for risankizumab, 91.1% for guselkumab, 86.3% for brodalumab, 86.1% for ustekinumab, 82.0% for ixekizumab, and 79.9% for secukinumab. Using ustekinumab as reference, drug survival of guselkumab was higher (HR 0.609; 95% CI 0.418-0.887) and that of secukinumab was lower (HR 1.490; 95% CI 1.257-1.766). In the final multivariable model, secukinumab, female sex, higher BMI, and prior exposure to biologic agents significantly increased the risk of drug discontinuation, whereas risankizumab was protective. CONCLUSION: In this multinational cohort with 8439 patient-years of follow-up, the cumulative probability of drug survival for all drugs was >79% at 18 months. Prescribed biologic, female sex, higher BMI, and previous exposure to biologic agents were predictors of drug discontinuation. Drug survival of guselkumab and risankizumab was higher than that of ustekinumab, and secukinumab was lower.
Subject(s)
Biological Products/therapeutic use , Dermatologic Agents/therapeutic use , Psoriasis/drug therapy , Adult , Aged , Biological Products/pharmacology , Dermatologic Agents/pharmacology , Female , Follow-Up Studies , Humans , Interleukin-12/antagonists & inhibitors , Interleukin-12/immunology , Interleukin-17/antagonists & inhibitors , Interleukin-17/immunology , Interleukin-23/antagonists & inhibitors , Interleukin-23/immunology , Male , Middle Aged , Psoriasis/immunology , Remission Induction/methods , Retrospective Studies , Time Factors , Treatment OutcomeSubject(s)
Chlamydia Infections/epidemiology , Chlamydia trachomatis/isolation & purification , Gonorrhea/epidemiology , Mycoplasma Infections/epidemiology , Mycoplasma genitalium/isolation & purification , Neisseria gonorrhoeae/isolation & purification , Vagina/microbiology , Adolescent , Adult , Brazil/epidemiology , Chlamydia Infections/diagnosis , Cross-Sectional Studies , Female , Gonorrhea/diagnosis , Humans , Mass Screening , Middle Aged , Mycoplasma Infections/diagnosis , Prevalence , Prospective Studies , Risk Factors , Sexually Transmitted Diseases, Bacterial/epidemiology , Sexually Transmitted Diseases, Bacterial/microbiologyABSTRACT
Community Based Organizations (CBOs) are important health system stakeholders with the mission of addressing the social and economic needs of individuals and groups in a defined geographic area, usually no larger than a county. The access and success efforts of CBOs vary, depending on the integration between health care providers and CBOs but also in relation to the community participation level. To achieve widespread results, it is important to carefully design an efficient network which can serve as a bridge between the community and the health care system. This study addresses this challenge through a location-allocation model that deals with the hierarchical nature of the system explicitly. To reflect social welfare concerns of equity, local accessibility, and efficiency, we develop the model in a multi-objective framework, capturing the ambiguity in the decision makers' aspiration levels through a fuzzy goal programming approach. This study reports the findings for the real case of Shiraz city, Fars province, Iran, obtained by a thorough analysis of the results.
Subject(s)
Community Health Services/organization & administration , Resource Allocation/methods , Algorithms , Health Planning , Health Policy , Humans , Iran , Models, Theoretical , Organizational Case StudiesABSTRACT
We investigate how braneworld gravity affects gravitational collapse and black hole formation by studying Oppenheimer-Snyder-like collapse on a Randall-Sundrum-type brane. Without making any assumptions about the bulk, we prove a no-go theorem: the exterior spacetime on the brane cannot be static, which is in stark contrast with general relativity. We also consider the role of Kaluza-Klein energy density in collapse, using a toy model.
ABSTRACT
Las reacciones reversales tardías son episodios agudos producidos por un incremento de la inmunidad celular, en pacientes de lepra que ya han concluído su períodod de tratamiento. En estas circunstancias, su diagnóstico diferencial con la recidiva de la enfermedad, es a menudo dificultoso, e implica una conducta terapéutica diferentre que llevará a la reanudación de la poliquimioterapia en el último caso. Si bien existen algunos criterios que orientan la diferenciación entre ambas, debido a la importancia del compromiso neuronal que generalmente acompaña a las reacciones reversales, se preconiza el tratamiento precoz con esteroides, no sólo como prueba terapéutica sino como un método para prevenir importantes secuelas discapacitantes
Subject(s)
Humans , Diagnosis, Differential , Leprosy , RecurrenceABSTRACT
Las reacciones reversales tardías son episodios agudos producidos por un incremento de la inmunidad celular, en pacientes de lepra que ya han concluído su períodod de tratamiento. En estas circunstancias, su diagnóstico diferencial con la recidiva de la enfermedad, es a menudo dificultoso, e implica una conducta terapéutica diferentre que llevará a la reanudación de la poliquimioterapia en el último caso. Si bien existen algunos criterios que orientan la diferenciación entre ambas, debido a la importancia del compromiso neuronal que generalmente acompaña a las reacciones reversales, se preconiza el tratamiento precoz con esteroides, no sólo como prueba terapéutica sino como un método para prevenir importantes secuelas discapacitantes(AU)
Subject(s)
Humans , Leprosy , Diagnosis, Differential , RecurrenceABSTRACT
OBJECTIVE: A novel system for nutrient analysis has been developed and tested over 5 years. Its key features are a nutrient database of 600 commonly eaten foods (95% of foods eaten in 7-day surveys); a booklet identifying each food with a bar code, bar codes for gram weight and for portion sizes (small, medium, large) and a bar-code reader with dietary analysis software for PCs. In the present study the bar-code system has been evaluated by comparison with a commonly used manual entry nutrient analysis software for dietitians' use. DESIGN: Cross-sectional. SETTING: Glasgow city district. SUBJECTS: One hundred and sixty adults aged 18-65 years old. RESULTS: Comparing mean intakes for macro- and micronutrients, using the Bland and Altman method, the bias between the two methods was small, ranging from 0.93 to 1.03. The bar-code system took significantly less professional time in data entry and nutrient analysis than the widely used manual system (29min per 7-day diary vs. 47 min per 7-day diary, P < 0.001). CONCLUSIONS: It is suggested that the bar-code system offers greater speed with a saving of professional time needed for nutrient analysis of dietary surveys. This system is commended for maintaining accuracy while promoting economy.
Subject(s)
Diet Surveys , Electronic Data Processing , Food/statistics & numerical data , Adolescent , Adult , Aged , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Scotland/epidemiologyABSTRACT
Asbestiform mineral particles can be detected and identified by means of a polarized light microscope, making use of the dispersion staining technique. In order to obtain dispersion staining (central stop), che rays which pass undeviated through liquid and specimen must be stopped. A microscope objective can be fitted with a device which can insert a central stop on the objective back focal plane to prevent undeviated rays from reaching the objective. Alternatively, the sample can be observed in a conventional dark field set-up, that is, it can be illuminated by a hollow cone of light of greater aperture than the microscope objective so that only rays which are strongly deviated can enter the objective. The first method, proposed by McCrone and widely used in the USA, allows very bright and defined colors to be obtained but at the same time entails low resolution. The second method, recommended by italian regulations as a method that can be used in asbestos characterization, produces less defined and fainter colors. By suitably modifying the angular aperture of the illuminating cone and regulating the distance between condenser and specimen, good results were achieved: on the one hand a good image resolution were retained, on the other, the colors observed were bright and well defined. The detection of these colors can represent a fundamental step in the characterization of the specimen under analysis.
Subject(s)
Asbestos/analysis , Microscopy, Polarization/methods , Color , Staining and LabelingABSTRACT
Se efectúa una revisión de la clasificación de la forma indeterminada de la lepra, sus características clínico-histológicas y evolutivas. La misma es considerada como una forma incial de la enfermedad que frecuentemente cura en forma espontánea, sin tratamiento. Sin embargo, en algunos casos puede evolucionar hacia las otras formas clínicas discapacitantes de la enfermedad, siendo importante su diagnóstico y tratamiento precoz. Se describen los últimos estudios realizados para llegar a un diagnóstico de certeza de esta forma inicial (PCR, Inmunoperoxidasas), y los estudios predictivos de su evolución hacia otras formas clínicas (dosaje de AC séricos, reacción de la lepromina). El diagnóstico temprano de la lepra indeterminada, sin discapacidades, es uno de los objetivos de los Programas de Control, para la eliminación de la enfermedad
Subject(s)
Humans , Immunoenzyme Techniques , Leprosy, Borderline/blood , Leprosy, Borderline/classification , Leprosy, Borderline/diagnosis , Leprosy, Borderline/immunology , Polymerase Chain Reaction , Argentina , Diagnosis, DifferentialABSTRACT
Se efectúa una revisión de la clasificación de la forma indeterminada de la lepra, sus características clínico-histológicas y evolutivas. La misma es considerada como una forma incial de la enfermedad que frecuentemente cura en forma espontánea, sin tratamiento. Sin embargo, en algunos casos puede evolucionar hacia las otras formas clínicas discapacitantes de la enfermedad, siendo importante su diagnóstico y tratamiento precoz. Se describen los últimos estudios realizados para llegar a un diagnóstico de certeza de esta forma inicial (PCR, Inmunoperoxidasas), y los estudios predictivos de su evolución hacia otras formas clínicas (dosaje de AC séricos, reacción de la lepromina). El diagnóstico temprano de la lepra indeterminada, sin discapacidades, es uno de los objetivos de los Programas de Control, para la eliminación de la enfermedad (AU)
Subject(s)
Humans , Leprosy, Borderline/classification , Leprosy, Borderline/diagnosis , Leprosy, Borderline/immunology , Leprosy, Borderline/blood , Polymerase Chain Reaction , Immunoenzyme Techniques , Argentina , Diagnosis, DifferentialABSTRACT
Se presenta el caso de un paciente portador de enfermedad de Hansen LL inactivo con una PCM crónica unifocal, localizada en cavidad bucal. Se resumen los aspectos clínicos, histopatológicos y laboratoriales de dicha enfermedad, la coincidencia de su área endémica con la lepra y las dificultades para arribar al diagnóstico definitivo(AU)
Subject(s)
Humans , Male , Middle Aged , Paracoccidioidomycosis/diagnosis , Paracoccidioidomycosis/therapy , Adrenal Cortex Hormones/administration & dosage , Tongue Diseases , Itraconazole/therapeutic use , LeprosyABSTRACT
Se presenta el caso de un paciente portador de enfermedad de Hansen LL inactivo con una PCM crónica unifocal, localizada en cavidad bucal. Se resumen los aspectos clínicos, histopatológicos y laboratoriales de dicha enfermedad, la coincidencia de su área endémica con la lepra y las dificultades para arribar al diagnóstico definitivo
Subject(s)
Humans , Male , Middle Aged , Adrenal Cortex Hormones/administration & dosage , Itraconazole/therapeutic use , Paracoccidioidomycosis/diagnosis , Paracoccidioidomycosis/therapy , Tongue Diseases , LeprosyABSTRACT
While many works compare traits of homeless adults across levels of alcohol use, few specifically consider whether drinking status affects determinants of either homelessness or "vulnerability" to homelessness. This paper relies on a 1986 Chicago, Illinois sample (n = 535) to consider the potential contributions of resources, social network characteristics, disaffiliation, and mental health problems. Results suggest that resource problems may determine homelessness regardless of drinking status. But drinking-associated problems may raise the resource threshold for "vulnerability," reduce the protection afforded by social networks against both homelessness and "vulnerability," increase the deleterious impact of disaffiliation, and spur complicating mental health problems.
Subject(s)
Alcoholism/psychology , Ill-Housed Persons/psychology , Urban Population , Adult , Alcoholism/epidemiology , Chicago/epidemiology , Comorbidity , Diagnosis, Dual (Psychiatry) , Female , Ill-Housed Persons/statistics & numerical data , Humans , Male , Mental Disorders/epidemiology , Mental Disorders/psychology , Middle Aged , Poverty/psychology , Poverty/statistics & numerical data , Public Assistance/statistics & numerical data , Risk Factors , Sampling Studies , Urban Population/statistics & numerical dataABSTRACT
Background: Few recent data exist on the impact of travel-related health problems. Methods: A cohort study was conducted with follow-up by questionnaire of 2567 persons who had consulted the Zurich University Travel Clinic for travel health advice prior to visiting a developing country or eastern Europe. Of those questioned, 2109 (82.2%) could be evaluated. Results: More than one-third (800; 37.9%) had a health impairment, mainly illness leading to medical consultations in 224 (10.6%) individuals. Incapacitation was reported by 303 (14.4%) travelers, accounting for 2% of the total time abroad. The most frequent reasons for incapacitation were diarrhea and the common cold, particularly when accompanied by fever. Some 57 (7.1%) travelers consulted a doctor while abroad, and more than twice as many did so after returning home. Conclusions: This survey illustrates that despite efforts of travel medicine, the attack rate of health impairments remains virtually unchanged compared to 20 years ago. It provides one of the first overviews of incapacitation in travelers. To reduce the duration of incapacitation, one may wish to consider a travel kit which allows the patient self therapy for frequent and uncomplicated ailments.
ABSTRACT
Identification of asbestos in many different kinds of bulk materials was performed by means of optical microscopy and the results are reported in the present paper. Some hundreds of various samples taken aboard ships were analysed: panels, laggings, spray insulations, etc. These analyses were required to be not only reliable but also rapid. The results demonstrated the high reliability as well as the rapidity of the technique. Using both the well-known dispersion staining technique (with central stop objectives or with dark field condensers) and phase-contrast analyses on the same polarizing microscope, we carried out numerous checks on the optical properties of the fibres. Not only were dispersion staining colours detected but also refractive index, elongation and extinction signs, in order to obtain an absolutely certain identification. The Italian laws which deal with the asbestos detection discourage the use of the optical microscope because of its presumed unreliability. This paper tends to demonstrate that Italian laws underestimate the potential of the optical microscope. Optical microscopy is probably the only technique that is reliable, inexpensive and rapid at the same time.
Subject(s)
Asbestos/analysis , Construction Materials/analysis , Microscopy, Phase-Contrast/methods , Microscopy, Polarization/methods , Ships , Asbestos/chemistry , Chemical Phenomena , Chemistry, Physical , Microscopy, Phase-Contrast/instrumentation , Microscopy, Polarization/instrumentation , Reproducibility of ResultsABSTRACT
A study for evaluating the use of the Cardionomic system was conducted in six Italian Centres for Diabetes. Cardionomic is a portable computerised system that is used for a guided step-by-step performance of several cardiovascular tests for autonomic neuropathy (heart rate and blood pressure). It has been compared to the traditional method using an electrocardiograph. In this study, which involved 74 diabetic patients, 392 cardiovascular tests were conducted with the electrocardiograph and 392 were done using the portable system. The results were compared to the results obtained with the ECG assuming the latter as the standard ones. All the indices of validity that were investigated (sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio) indicate that the proposed system is reliable. Because it saves a considerable amount of time and is also easy to use, it represents a valid alternative for the routine screening of autonomic neuropathy.
Subject(s)
Autonomic Nervous System Diseases/diagnosis , Cardiovascular System/innervation , Diabetic Neuropathies/diagnosis , Diagnosis, Computer-Assisted , Electrocardiography , Mass Screening/methods , Adult , Aged , Autonomic Nervous System Diseases/prevention & control , Data Interpretation, Statistical , Diabetic Neuropathies/prevention & control , Evaluation Studies as Topic , Humans , Likelihood Functions , Middle Aged , Predictive Value of Tests , Sensitivity and SpecificityABSTRACT
Se presenta el caso de una paciente con diagnóstico de lepra lepromatosa de larga data que sufre una recaída clínica e histológica compatible con la variedad de Wade. Se revisan las características básicas de esta entidad y se plantea la sospecha clínica de sulfonorresistencia, por lo que se realiza tratamiento con ofloxacina y clofazimina lográndose de esta forma la estabilización de los lesiones
Subject(s)
Humans , Male , Middle Aged , Leprosy, Lepromatous/pathology , Leprosy, Lepromatous/therapy , ArgentinaABSTRACT
Se presenta el caso de una paciente con diagnóstico de lepra lepromatosa de larga data que sufre una recaída clínica e histológica compatible con la variedad de Wade. Se revisan las características básicas de esta entidad y se plantea la sospecha clínica de sulfonorresistencia, por lo que se realiza tratamiento con ofloxacina y clofazimina lográndose de esta forma la estabilización de los lesiones (AU)
