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1.
JPEN J Parenter Enteral Nutr ; 45(6): 1369-1375, 2021 08.
Article in English | MEDLINE | ID: mdl-33586170

ABSTRACT

BACKGROUND: The direct effect of the coronavirus disease 2019 (COVID-19) pandemic on patients with intestinal failure (IF) has not been described. METHODS: We conducted a nationwide study of UK IF centers to evaluate the infection rates, presentations, and outcomes in patients with types 2 and 3 IF. RESULTS: A total of 45 patients with IF contracted COVID-19 between March and August 2020; this included 26 of 2191 (1.2%) home parenteral nutrition (HPN)-dependent adults and 19 of 298 (6.4%) adults hospitalized with type 2 IF. The proportion of patients receiving nursing care for HPN administration was higher in those with community-acquired COVID-19 (66.7%) than the proportion in the entire HPN cohort (26.1%; P < .01). Two HPN-dependent and 1 hospitalized patient with type 2 IF died as a direct consequence of the virus (6.7% of 45 patients with types 2 or 3 infected). CONCLUSION: This is the first study to describe the outcomes of COVID-19 in a large cohort of patients requiring long-term PN. Methods to reduce hospital and community nosocomial spread would likely be beneficial.


Subject(s)
COVID-19 , Intestinal Diseases , Parenteral Nutrition, Home , Adult , Humans , Intestinal Diseases/complications , Intestinal Diseases/therapy , Parenteral Nutrition, Home/adverse effects , Retrospective Studies , SARS-CoV-2 , United Kingdom/epidemiology
2.
Transplant Proc ; 48(2): 492-6, 2016 Mar.
Article in English | MEDLINE | ID: mdl-27109985

ABSTRACT

BACKGROUND: Cytomegalovirus (CMV) disease is a common and clinically significant complication following intestinal or multivisceral transplantation. CMV disease is more common in cases of serologic mismatch between donor and recipient. Though in some cases it may be asymptomatic, in the immunosuppressed population it often manifests with evidence of systemic infection or end-organ disease. METHODS: We conducted a retrospective review of all patients undergoing intestinal or multivisceral transplantation over 8 years at our institution. RESULTS: Forty-eight transplantations were performed, with 40% of the patients (19/48) having ≥1 episode of CMV viremia, which rose to 90% in the "donor-positive, recipient-negative" (DPRN) serologic mismatch group. The median time to 1st episode following transplantation was 22.3 weeks (range, 1-78) and median duration of each episode was 4.9 weeks (range, 1.6-37.4). Six of the 19 viremic patients (31.6%) developed virologic resistance with 4 of these occurring in the DPRN group. Four of the 6 patients with drug-resistant CMV died with CMV viremia. All patients with drug resistance acquired ganciclovir resistance; these patients were more challenging to manage with second-line toxicity-limited treatments, including foscarnet, cidofovir, and leflunomide. CMV immunoglobulin has been used and we briefly discuss the use of CMV-specific adoptive T-lymphocyte transfer in the management of 1 case. CONCLUSIONS: Post-transplantation CMV disease continues to be challenging to manage, and there is little consensus on optimal management strategies in this patient group, with a significant requirement for novel therapies; these may be pharmacologic or cell based. Extensive multidisciplinary discussion is important for most cases, but particularly for those patients who acquire virologic resistance.


Subject(s)
Cytomegalovirus Infections/epidemiology , Drug Resistance, Viral , Intestines/transplantation , Viremia/epidemiology , Adult , Aged , Antiviral Agents/therapeutic use , Cytomegalovirus Infections/drug therapy , Female , Foscarnet/therapeutic use , Ganciclovir/therapeutic use , Humans , Immunoglobulins/therapeutic use , Immunoglobulins, Intravenous , Immunosuppressive Agents/therapeutic use , Isoxazoles/therapeutic use , Leflunomide , Male , Middle Aged , Retrospective Studies , Viremia/drug therapy
3.
Aliment Pharmacol Ther ; 30(6): 614-20, 2009 Sep 15.
Article in English | MEDLINE | ID: mdl-19552632

ABSTRACT

BACKGROUND: Despite the wide use of azathioprine/mercaptopurine (AZA/MP) therapy in the management of both Crohn's disease (CD) and ulcerative colitis (UC), approximately 20% of patients cannot tolerate the drugs and 30% do not respond. AIM: To examine the efficacy and safety profile of methotrexate (MTX) in patients with CD or UC who are either intolerant or non-responsive to AZA/MP. METHODS: A total of 131 patients with IBD treated with MTX were identified. Retrospective data were obtained by case note review. Clinical response (defined as steroid withdrawal, normalization of previously raised CRP or physician's clinical assessment of improvement) was assessed at 6 months. RESULTS: Clinical response in Crohn's disease occurred in 18 of 29 patients (62%) refractory to AZA/MP and 42 of 70 patients (60%) intolerant to AZA/MP, with no difference between the groups (P = 1.0). In UC, clinical response was seen in 7 of 9 (78%) patients refractory to AZA/MP and 15 of 23 (65%) intolerant to thiopurines. MTX was well tolerated in a majority of individuals. CONCLUSIONS: Methotrexate appears effective in both CD and UC patients who fail to respond to or are intolerant to AZA/MP therapy.


Subject(s)
Azathioprine/therapeutic use , Immunosuppressive Agents/therapeutic use , Inflammatory Bowel Diseases/drug therapy , Mercaptopurine/therapeutic use , Methotrexate/administration & dosage , Adolescent , Adult , Aged , Aged, 80 and over , Drug Hypersensitivity , Drug Resistance , Female , Humans , Male , Middle Aged , Treatment Outcome , Young Adult
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