- The influence of mTOR inhibitors on the incidence of CMV infection in high-risk donor positive/recipient negative (D+/R-) kidney transplant recipients. [Journal Article]
- TITranspl Infect Dis 2018 Apr 21; :e12907
- Several studies and meta-analysis suggest the mTOR inhibitors are associated with reduced incidence of CMV infection after kidney transplantation, although their effects on the high-risk population h...
Several studies and meta-analysis suggest the mTOR inhibitors are associated with reduced incidence of CMV infection after kidney transplantation, although their effects on the high-risk population have not been investigated thoroughly. This retrospective cohort study investigates the association between immunosuppression and CMV infection in D+/R- kidney transplant recipients receiving preemptive therapy. All patients received rabbit anti-thymocyte globulin, tacrolimus, prednisone and azathioprine (AZA), mycophenolate (MPA) or everolimus (EVR). Among 89 D+R-, the overall incidence of CMV infection was 76%, with no difference among the groups AZA vs. MPA vs. EVR (73 vs. 83 vs. 74%, p=0.643). CMV infection occurred later (31 in AZA vs. 31 in MPA vs. 43 days in EVR group, p<0.001) and showed a lower trend of recurrences (57% in AZA vs. 79% in MPA vs. 48% in EVR group, p=0.058) in the everolimus group. There were no differences in the IgG seroconversion rate (82% in AZA vs. 76% in MPA vs. 72% in EVR group, p=0.983). There were no differences in the incidence of biopsy-proven acute rejection (10% in AZA vs. 8% in MPA vs. 6% in EVR group, p=0.811) and renal function at 12 months (53.6 in AZA vs. 60.3 in MPA vs. 55.4 ml/min/1.73 m2 in EVR group). In this cohort of high-risk CMV D+/R- kidney transplant recipients receiving rATG induction and tacrolimus, the use of mTOR inhibitors could only show a tendency towards but not a significant difference on the incidence of CMV events, when compared to antimetabolites. This article is protected by copyright. All rights reserved.
- Successful use of azathioprine in glucocorticoid refractory immune amegakaryocytic thrombocytopenia of lupus. [Letter]
- RCReumatol Clin 2018 Apr 17
- Natural history and outcome of inflammatory bowel diseases in children in Saudi Arabia: A single-center experience. [Journal Article]
- SJSaudi J Gastroenterol 2018 Apr 18
- CONCLUSIONS: Many issues in pediatric IBD can predict the natural history of the disease including growth failure, complications, need for more aggressive medical treatment, and/or surgery. More studies are needed from the region focusing on factors that may affect the natural history and disease progression.
- An atypical case of neurosarcoidosis presenting with neovascular glaucoma. [Review]
- JOJ Ophthalmic Inflamm Infect 2018 Apr 18; 8(1):7
- CONCLUSIONS: A patient with neurosarcoidosis presenting with compressive ischemic optic disc edema and neovascular glaucoma is described, increasing the diversity of clinical presentations and confirming the diagnostic challenge of neurosarcoidosis.
- Current diagnosis and treatment of polymyositis and dermatomyositis. [Journal Article]
- MRMod Rheumatol 2018 Apr 18; :1-24
- Idiopathic inflammatory myopathies (IIMs) are heterogeneous disorders that affect the skeletal muscles. Polymyositis, dermatomyositis, and inclusion body myositis are major IIM subsets. Immune-mediat...
Idiopathic inflammatory myopathies (IIMs) are heterogeneous disorders that affect the skeletal muscles. Polymyositis, dermatomyositis, and inclusion body myositis are major IIM subsets. Immune-mediated necrotizing myopathy became recognized as a potentially new IIM subset. Since the new classification criteria published by the International Myositis Classification Criteria Project have higher sensitivity and specificity for IIM classification and subclassification than the previous criteria, they should help precise diagnosis. It should be noted that several tests available in current clinical practice, such as electromyography, magnetic resonance imaging, and other myositis-specific autoantibodies than anti-Jo-1 antibodies, were not included in the new criteria. As for treatment, glucocorticoids are used empirically as the first-line treatment despite their various adverse effects. Concomitant treatment with steroid-sparing immunosuppressive agents, including methotrexate, azathioprine, calcineurin inhibitors, mycophenolate mofetil, and cyclophosphamide, reduces successfully initial glucocorticoid doses for the remission induction, the relapse risk during glucocorticoid tapering, and adverse effects of glucocorticoids. Treatment with biologics, including rituximab and abatacept, seems promising in some IIM patients. Multi-target treatment with glucocorticoids and several steroid-sparing immunosuppressive agents is effective in refractory IIM patients. Considering proven steroid-sparing efficacy and tolerability of multi-target treatment in patients with other autoimmune diseases, it should be a good therapeutic option for IIMs.
- Bullous Henoch-Schönlein purpura. Case report. [Journal Article]
- RCRev Chil Pediatr 2018; 89(1):103-106
- CONCLUSIONS: Although bullous lesions in HSP does not add morbidity, it is often an alarming phenomenon with multiple differential diagnoses. The anti-inflamatory effect of corticoids is likely to be beneficial in the treatment of patients with severe cutaneous involvement through inhibition of proinflammatory transcription factors and decreasing the production of the metalloproteinases.
- Chronic Genotype 3 Hepatitis E in Pregnant Woman Receiving Infliximab and Azathioprine. [Journal Article]
- EIEmerg Infect Dis 2018; 24(5):941-943
- Acute hepatitis E virus infection during pregnancy has a high fatality rate in developing countries. Little data are available on chronic infection in pregnant women. We report a case of chronic hepa...
Acute hepatitis E virus infection during pregnancy has a high fatality rate in developing countries. Little data are available on chronic infection in pregnant women. We report a case of chronic hepatitis E during treatment with infliximab and azathioprine, without adverse event during pregnancy and with spontaneous resolution after delivery.
- Predictors and clinical outcomes of follow-up loss in patients with inflammatory bowel disease. [Journal Article]
- JGJ Gastroenterol Hepatol 2018 Apr 17
- CONCLUSIONS: Follow up loss rate for IBD patients in remission state was 14.7% and the predictors were far from hospital and low CRP levels. Because most of follow-up loss patients experienced flare-up, clinicians need to try to encourage patients to keep their adherence.
- Rituximab was effective for acute disseminated encephalomyelitis followed by recurrent optic neuritis with anti-myelin oligodendrocyte glycoprotein antibodies. [Journal Article]
- BDBrain Dev 2018 Apr 13
- CONCLUSIONS: It is conceivable that anti-MOG antibodies are involved in the pathology of "ADEM followed by recurrent ON," and that the early introduction of rituximab, which is involved in the suppression of antibody production and has effects on CD20 T lymphocytes, may be a feasible treatment for ON. Due to the small number of patients, additional reports on prospectively followed patients are needed.
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- [Genetic polymorphisms of thiopurine methyltransferase and incidence of adverse events in patients with medical indication of azathioprine]. [Journal Article]
- MMedicina (B Aires) 2018; 78(2):65-70
- Azathioprine is a thiopurine which has a narrow therapeutic index and marked hematological and hepatic toxicity. Thiopurine s-methyltransferase is an enzyme involved in the metabolism of thiopurines....
Azathioprine is a thiopurine which has a narrow therapeutic index and marked hematological and hepatic toxicity. Thiopurine s-methyltransferase is an enzyme involved in the metabolism of thiopurines. Mutations in the gene that encodes the enzyme may augment the risk of adverse events. For that reason, pharmacogenetic determinations prior to the initiation of therapy can provide useful information for the future therapeutic strategy. Nevertheless, its utility in the local environment is not completely established. Forty-five subjects (13 men) who had been prescribed azathioprine were included. The presence of *2, *3A, *3B and *3C mutations were determined by PCR-RFLP, and the relationship between genotype and incidence of adverse events related to the drug was analyzed. Nine carried at least one non-functional allele, one of them with *3A/*3A genotype. Among the eighteen patients who initiated treatment with azathioprine, toxicity was detected in 3 cases: 2 mild events were observed in patients with normal genotype, and the only serious event (bone marrow suppression) occurred in the individual with homozygous mutant genotype. The only homozygous mutant patient developed the most severe of the registered events, in spite of being under treatment with low doses of azathioprine. This is the reason why enzymatic determination could be of utility, even though it does not replace clinical and biochemical follow-up in patients under thiopurine treatment.