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JMIR Dermatology Mar 2022Delusional infestation, also known as Ekbom syndrome, is a rare delusional disorder characterized by the fixed belief that one is infested with parasites, worms,...
BACKGROUND
Delusional infestation, also known as Ekbom syndrome, is a rare delusional disorder characterized by the fixed belief that one is infested with parasites, worms, insects, or other organisms. Although delusional infestation is a psychiatric condition, patients often consult dermatologists with skin findings, and it is currently unclear what treatments are recommended for this disorder.
OBJECTIVE
We aimed to systematically review and describe the treatment and management of patients presenting with primary delusional infestation.
METHODS
A systematic search was conducted using Ovid on MEDLINE, Embase, PsycINFO, and the Cochrane Register of Clinical Trials. Relevant data, including treatment, dosage, response, adherence, and side effects, were extracted and analyzed.
RESULTS
A total of 15 case series were included, comprising 280 patients (mean age 53.3 years, 65.4% female) with delusional infestation. Overall, aripiprazole had the highest complete remission rate at 79% (11/14), although this was limited to 14 patients. Among drug classes, selective serotonin reuptake inhibitors were the most effective with a 79% (11/14) complete remission rate and 43% (9/21) partial remission rate in patients with comorbid depression, anxiety, or trichotillomania. First-generation antipsychotics and second-generation antipsychotics had similar complete remission rates (56/103, 54.4% vs 56/117, 47.9%, respectively) and partial remission rates (36/103, 35% vs 41/117, 35%, respectively).
CONCLUSIONS
Due to the rarity of delusional infestation, we only found 15 case series. However, we found that first-generation antipsychotics appear to be similar in effectiveness to second-generation antipsychotics for the treatment of primary delusional infestation. Larger studies and randomized controlled trials are needed to evaluate the efficacy of pharmacological therapy for delusional infestation.
TRIAL REGISTRATION
PROSPERO CRD42020198161; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=198161.
PubMed: 37632851
DOI: 10.2196/34323 -
World Journal of Virology Nov 2021I will have a couple of comments on the issues elaborated in the article titled as 'Impact of COVID-19 in patients with lymphoid malignancies'. First, the author did not...
I will have a couple of comments on the issues elaborated in the article titled as 'Impact of COVID-19 in patients with lymphoid malignancies'. First, the author did not emphasize and overlook the prolonged persistence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in coronavirus disease 2019 (COVID-19) patients with hematological malignancies. Second, the rise of a chronic lymphoid leukemia clone in COVID-19 was not mentioned by the authors. Third, achieving a complete remission in asymptomatic COVID-19 patients with follicular lymphoma in partial remission after bendamustine-based therapy is not specific to this lymphoma subtype. Fourth, follicular lymphoma does not always undergo complete remission with SARS-CoV-2 infection. Our aim is to help the authors to discuss and clarify these issues a little more in COVID-19 patients with hematological malignancies.
PubMed: 34909407
DOI: 10.5501/wjv.v10.i6.329 -
American Journal of Kidney Diseases :... Dec 2021B-cell depletion with rituximab has emerged as a first-line therapy for primary membranous nephropathy (MN). However, most patients do not achieve complete remission...
RATIONALE & OBJECTIVE
B-cell depletion with rituximab has emerged as a first-line therapy for primary membranous nephropathy (MN). However, most patients do not achieve complete remission with rituximab monotherapy. In this case series, we report longer-term remission and relapse rates, anti-phospholipase A receptor (PLAR) antibody levels, B-cell levels, and serious adverse events in patients with primary MN who received rituximab combined with an initial short course of low-dose oral cyclophosphamide and a course of rapidly tapered prednisone.
STUDY DESIGN
Single-center retrospective case series.
SETTING & PARTICIPANTS
60 consecutive patients with primary MN treated with the combination of rituximab, low-dose cyclophosphamide, and prednisone at the Vasculitis and Glomerulonephritis Center at the Massachusetts General Hospital.
FINDINGS
After treatment initiation, median follow-up was 38 (interquartile range [IQR], 25-62) months; 100% of patients achieved partial remission, defined as a urinary protein-creatinine ratio (UPCR) < 3 g/g and a 50% reduction from baseline, at a median of 3.4 months. By 2 years after treatment initiation, 83% achieved complete remission, defined as a UPCR < 0.3 g/g. The median time to complete remission was 12.4 months. Immunologic remission (defined by an anti-PLAR titer < 14 RU/mL) was achieved by 86% and 100% of anti-PLAR seropositive patients (n = 29) at 3 and 6 months, respectively, after treatment initiation. After 1 year, the median UPCR fell from 8.4 (IQR, 5.0-10.7) to 0.3 (IQR, 0.2-0.8) g/g (P < 0.001). No patient relapsed throughout the duration of B-cell depletion. Relapse occurred in 10% of patients at 2 years after the onset of B-cell reconstitution following the last rituximab dose. Over a combined follow-up time of 228 patient-years, 18 serious adverse events occurred. One death occurred unrelated to treatment or primary MN, and 1 patient progressed to kidney failure requiring kidney replacement therapy.
LIMITATIONS
Absence of a comparison group.
CONCLUSIONS
All patients with primary MN treated with combination therapy achieved partial remission and most achieved a durable complete remission with an acceptable safety profile.
Topics: Cyclophosphamide; Follow-Up Studies; Glomerulonephritis, Membranous; Humans; Immunosuppressive Agents; Prednisone; Receptors, Phospholipase A2; Retrospective Studies; Rituximab; Treatment Outcome
PubMed: 34174365
DOI: 10.1053/j.ajkd.2021.04.014 -
Danish Medical Journal Jan 2021The prevalence of severe obesity is increasing and highly associated with co-morbidities such as Type 2 diabetes (T2D). Furthermore, quality of life (QoL) is negatively...
INTRODUCTION
The prevalence of severe obesity is increasing and highly associated with co-morbidities such as Type 2 diabetes (T2D). Furthermore, quality of life (QoL) is negatively affected among patients with severe obesity and T2D. Studies have found that gastric bypass surgery may lead to remission of T2D and improved QoL. The aim of this study was to investigate the association between partial remission of T2D and change in QoL from baseline to a one-year follow-up in severely obese patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB).
METHODS
This cohort study was based on data from patients with T2D undergoing LRYGB at a private hospital in Denmark and included 704 patients among whom 337 (48%) patients with T2D contributed with data in the analysis. Data were collected preoperatively and at a one-year follow-up. Preoperative T2D status was patient-reported and validated through the patient's medical record. At the one-year follow-up, partial remission was defined as an HbA1c concentration less than 7.3% with no use of antidiabetics. Continued T2D was defined as intake of diabetic medication or an HbA1c concentration > 7.3%. QoL was measured by the Moorehead-Ardelt QoL Questionnaire. Multiple linear regression was applied.
RESULTS
At the one-year follow-up, the prevalence of partial remission of T2D was 72.7%. No significant association was seen between partial remission of T2D after LRYGB and change in QoL one year later. Loss to follow-up was 35.8%.
CONCLUSIONS
The majority of patients with T2D experienced partial remission one year after undergoing LRYGB surgery. However, partial remission of T2D was not associated with an improved QoL.
FUNDING
none.
TRIAL REGISTRATION
not relevant.
Topics: Body Mass Index; Cohort Studies; Diabetes Mellitus, Type 2; Gastric Bypass; Humans; Laparoscopy; Obesity, Morbid; Quality of Life; Treatment Outcome; Weight Loss
PubMed: 33543699
DOI: No ID Found -
Journal of Crohn's & Colitis Mar 2024Although ulcerative proctitis [UP] can dramatically impair quality of life, treatment efficacy has been poorly investigated in UP as it was historically excluded from...
BACKGROUND
Although ulcerative proctitis [UP] can dramatically impair quality of life, treatment efficacy has been poorly investigated in UP as it was historically excluded from phase 2/3 randomised controlled trials in ulcerative colitis. Our aim was to assess the effectiveness and safety of tofacitinib for the treatment of UP.
METHODS
We conducted a retrospective, multicentre study in 17 GETAID centres, including consecutive patients with UP treated with tofacitinib. The primary endpoint was steroid-free remission between Week 8 and Week 14, defined as a partial Mayo score of 2 [and no individual subscore above 1]. Secondary outcomes included clinical response and steroid-free remission after induction and at 1 year.
RESULTS
All the 35 enrolled patients previously received anti-tumour necrosis factor [TNF] therapy and 88.6% were exposed to at least two lines of biologics. At baseline, the median partial Mayo score was 7 (intequartile range [IQR] [5.5-7]). After induction [W8-W14], 42.9% and 60.0% of patients achieved steroid-free remission and clinical response, respectively. At 1 year, the steroid-free clinical remission and clinical response rates were 39.4% and 45.5%, respectively, and 51.2% [17/33] were still receiving tofacitinib treatment. Survival without tofacitinib withdrawal was estimated at 50.4% (95% confidence interval [CI] [35.5-71.6]) at 1 year. Only a lower partial Mayo at baseline was independently associated with remission at induction (0dds ratio [OR] = 0.56 for an increase of 1, (95% CI [0.33-0.95], p = 0.03). Five [14.3%] adverse events were reported, with one leading to treatment withdrawal [septic shock secondary to cholecystitis].
CONCLUSION
Tofacitinib may offer a therapeutic option for patients with refractory UP.
Topics: Humans; Tumor Necrosis Factor Inhibitors; Retrospective Studies; Quality of Life; Proctitis; Piperidines; Pyrimidines
PubMed: 37796025
DOI: 10.1093/ecco-jcc/jjad169 -
Alimentary Pharmacology & Therapeutics Jun 2024While filgotinib, an oral Janus kinase (JAK) 1 preferential inhibitor, is approved for moderately to severely active ulcerative colitis (UC), real-world studies...
BACKGROUND AND AIMS
While filgotinib, an oral Janus kinase (JAK) 1 preferential inhibitor, is approved for moderately to severely active ulcerative colitis (UC), real-world studies assessing its short- and long-term efficacy and safety are limited.
METHODS
This is a multicenter, retrospective study of UC patients who started filgotinib between March 2022 and September 2023. The primary outcome was clinical remission, defined as a partial Mayo score ≤1 with a rectal bleeding score of 0, or Simple Clinical Colitis Activity Index (SCCAI) ≤2 with a blood-in-stool score of 0. Secondary outcomes included clinical response, corticosteroid-free remission, and endoscopic improvement. Outcomes were assessed at 10, 26, and 58 weeks based on patients with available follow-up. Adverse events were evaluated.
RESULTS
We identified 238 UC patients and 54% had prior exposure to biologics/JAK inhibitors. The median baseline partial Mayo score and SCCAI were 5 (IQR 3-6) and 4 (IQR 2-7). Clinical remission rates based on per-protocol analysis at 10, 26, and 58 weeks were 47% (70/149), 55.8% (48/86), and 64.6% (31/48), respectively. At a median follow-up of 28 weeks (IQR 10-54) with a discontinuation rate of 39%, the rates of clinical remission, clinical response, corticosteroid-free remission, and endoscopic improvement were 39.9% (81/203), 54.7% (111/203), and 36.5% (74/203), and 43.5% (10/23), respectively. These rates were comparable between biologic/JAK inhibitor-naïve and -experienced patients. While three patients (1.3%) developed herpes zoster infection, no cases of thrombosis or death were reported.
CONCLUSIONS
Real-world data demonstrate favourable clinical and safety outcomes of filgotinib for UC.
Topics: Humans; Colitis, Ulcerative; Male; Retrospective Studies; Female; Adult; Middle Aged; Japan; Treatment Outcome; Triazoles; Pyridines; Remission Induction; Janus Kinase Inhibitors; Severity of Illness Index; Aged
PubMed: 38494867
DOI: 10.1111/apt.17961 -
Journal of Neurology Oct 2021Occipital lobe epilepsies (OLE) comprise 5-10% of focal epilepsies in surgical and paediatric series; with little data from adult medical cohorts. This longitudinal...
OBJECTIVE
Occipital lobe epilepsies (OLE) comprise 5-10% of focal epilepsies in surgical and paediatric series; with little data from adult medical cohorts. This longitudinal study examined OLE patients, to characterise prevalence, semiology, co-morbidity and prognosis in a neurology outpatient setting.
METHODS
24 adult OLE patients identified over 12 months from 1548 patients in a neurologist's service were followed over 12 years.
RESULTS
92% of these OLE patients had simple visual hallucinations, misdiagnosed in 40% of cases. 75% had co-morbid interictal migraine and 38% had visual field defects. Only 33% achieved long-term remission, and only 2 /10 (20%) of OLE patients with a structural aetiology were seizure-free. The two patients with migralepsy achieved remission.
CONCLUSION
Adult OLE accounted for 7.7% of focal epilepsies in this cohort, misdiagnosed or misclassified in 40%. Most patients had co-existing migraine. A minority had migralepsy characterised by a longer aura and good prognosis. Remission rates were lower than that of childhood OLE and general adult epilepsy populations, strengthening the argument for considering epilepsy surgery in drug-resistant OLE patients with a structural cause. Precision medicine will potentially refine diagnosis and management in those OLE patients without an identified cause but is predicated on accurate clinical phenotyping.
Topics: Adult; Child; Drug Resistant Epilepsy; Electroencephalography; Epilepsies, Partial; Epilepsy; Humans; Longitudinal Studies; Occipital Lobe
PubMed: 33900448
DOI: 10.1007/s00415-021-10557-y -
Trends in Endocrinology and Metabolism:... Feb 2024Shortly after diagnosis of type 1 diabetes mellitus (T1DM) and initiation of insulin therapy, many patients experience a transient partial remission (PR) phase, also... (Review)
Review
Shortly after diagnosis of type 1 diabetes mellitus (T1DM) and initiation of insulin therapy, many patients experience a transient partial remission (PR) phase, also known as the honeymoon phase. This phase presents a potential therapeutic opportunity due to its association with immunoregulatory and β cell-protective mechanisms. However, the lack of biomarkers makes its characterization difficult. In this review, we cover the current literature addressing the discovery of new predictive and monitoring biomarkers that contribute to the understanding of the metabolic, epigenetic, and immunological mechanisms underlying PR. We further discuss how these peripheral biomarkers reflect attempts to arrest β cell autoimmunity and how these can be applied in clinical practice.
Topics: Humans; Diabetes Mellitus, Type 1; Insulin; Biomarkers; Autoimmunity; Insulin-Secreting Cells
PubMed: 37949732
DOI: 10.1016/j.tem.2023.10.005 -
Frontiers in Pharmacology 2023The effectiveness and safety of vedolizumab (VDZ) against ulcerative colitis (UC) have been validated in several randomized controlled trials and real-world studies in...
The effectiveness and safety of vedolizumab (VDZ) against ulcerative colitis (UC) have been validated in several randomized controlled trials and real-world studies in Western countries. However, there are few studies on VDZ in Asia, and the follow-up period for these studies is generally short. Therefore, this study evaluates the long-term effectiveness and safety of VDZ in Chinese patients with UC. This retrospective study included patients with moderate to severe UC treated with VDZ between September 2019 and April 2022 at Sir Run Run Shaw Hospital, College of Medicine Zhejiang University. Clinical response and remission were assessed using the patient reported outcomes and the partial Mayo Score, and mucosal remission and healing were assessed using the Mayo Endoscopy Score. The primary endpoint was defined as clinical remission at week 14, and secondary endpoints included clinical response and steroid-free clinical remission at week 14, clinical response, clinical remission, and steroid-free clinical remission at week 52, and mucosal remission and healing at weeks 14 ± 8 and 52 ± 8. Overall, 64 patients with moderate to severe UC were enrolled. The clinical response, clinical remission, and steroid-free clinical remission rates at week 14 were 73.4% (47/64), 65.6% (42/64), and 54.7% (35/64), respectively. Mucosal remission and healing rates at week 14 ± 8 were 64.7% (22/34) and 38.2% (13/34), respectively. A total of 48 patients were treated with VDZ for 52 weeks. Based on intention-to-treat analysis, the clinical response, clinical remission, and steroid-free clinical remission rates at week 52 were 68.8% (44/64), 64.1% (41/64), and 64.1% (41/64), respectively. Mucosal remission and healing rates at week 52 ± 8 were 70.6% (12/17) and 35.3% (6/17), respectively. During the follow-up period, the most common adverse event was skin rash (6/64). No cases of acute infusion reactions, delayed allergic reactions, new hepatitis B infections, active tuberculosis, or malignant tumors were reported. In this single-center retrospective real-world study, the effectiveness of long-term use of VDZ for Chinese patients with UC was similar to the outcomes previously reported in other geographical regions and populations; no new safety signals were found compared with other registered studies.
PubMed: 37214457
DOI: 10.3389/fphar.2023.1188751 -
Frontiers in Endocrinology 2023This long-term study aimed to analyze the associations between BMI -score, HbA1c, and daily insulin requirement (DIR) and the prevalence and duration of partial... (Observational Study)
Observational Study
BACKGROUND/OBJECTIVE
This long-term study aimed to analyze the associations between BMI -score, HbA1c, and daily insulin requirement (DIR) and the prevalence and duration of partial remission (PR) in children and adolescents with type 1 diabetes (T1D).
METHODS
After retrieving retrospective data for 195 patients from their health records at 24, 48, and 72 months after T1D diagnosis, the study group was comprised of 119 (57 girls) children with a complete dataset for all 6 years. PR was defined according to the ISPAD guidelines. Analyses were carried out in the whole group and subgroups according to PR duration: no PR at all (NPR), PR lasting less than 2 years (PR < 2), and PR at least 2 years (PR ≥ 2).
RESULTS
PR was observed in 63% of the patients (78.9% of overweight and 100% of obese patients). NPR patients showed the lowest mean initial BMI -score [-0.65 ± 1.29 vs. 0.02 ± 1.42, (PR < 2), = 0.01 and vs. 0.64 ± 1.43 (PR ≥ 2), = 0.17]. The dissimilarity in BMI across patients declined over time. Within the NPR group, the initial mean BMI -score significantly increased within the first 2 years (unadjusted < 0.001) and remained constant afterward. In the PR <2 group, the highest increase in BMI -score occurred after 4 years ( < 0.001) and then decreased ( = 0.04). In the PR ≥2, the BMI -score slightly decreased within the first 2 years ( = 0.02), then increased ( = 0.03) and remained unchanged for the last 2 years. Six years after T1D started, the mean DIRs do not differ among the patient groups (ANOVA = 0.272).
CONCLUSION
During 6 years of follow-up, PR occurred in almost two-thirds of the studied children including almost all overweight and obese children. We observed a gradual normalization of the BMI -score at the end of the follow-up. BMI -score increased slightly in children with no remission initially but remained later constant until the end of observation. In both remitter groups, the increase in BMI -score appeared later when the protective honeymoon period ended. Regardless of BMI -score, the β-cell destruction process progresses, and after 6 years, the DIR is similar for all patients.
Topics: Adolescent; Female; Humans; Child; Body Mass Index; Diabetes Mellitus, Type 1; Overweight; Pediatric Obesity; Retrospective Studies; Insulin
PubMed: 37780631
DOI: 10.3389/fendo.2023.1257758