Sex matters: COVID-19 in kidney transplantation

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Understanding the disease burden and unmet needs among patients with cutaneous lupus erythematosus: A qualitative study

Background: Cutaneous lupus erythematosus (CLE) is a rare dermatologic autoimmune disease marked by photosensitive lesions that can vary in appearance depending on the subtype. The extent to which CLE affects a patient’s quality of life (QoL) has not been fully characterized. Focus groups were conducted to explore patients’ perspectives of how CLE has affected their lives and to understand the unmet needs in regards to CLE treatment and care. Methods: This qualitative study involved three focus groups with a total of 19 patients with CLE. A moderator guide containing open-ended questions was used to assess how CLE affects overall QoL. The focus groups were audio-recorded with notetaking. Data were content-analyzed to identify emergent themes. Results: Four themes emerged as important to patients with CLE: disease sequelae, social interactions, functioning, and unmet needs. Most patients reported decreased QoL due to signs and symptoms such as dyspigmentation and scarring. Having CLE negatively affected patients’ mental health and personal relationships and led to negative coping strategies, such as recreational drug use. Issues related to body image were also elicited by patients. Patients cited unmet needs including lack of treatments to improve chronic skin lesions of CLE and inadequate patient education on living with CLE. Conclusions: Providers can look for signs of QoL impairment in patients with CLE by asking questions related to body image, mental health, social isolation, and coping mechanisms. Future QoL measures can include the effect of CLE-specific attributes such as scarring and dyspigmentation to empower patients’ voices in determining therapeutic efficacy in future clinical trials. Findings from our study have added a new understanding of daily experiences that were elicited directly from patients with CLE. Keywords: cutaneous lupus erythematosus, outcomes, unmet needs, qualitative, focus group, burden, quality of lif

Avaliação dos fatores associados a infecções recorrentes e/ou graves em pacientes com síndrome de Down

OBJETIVOS: avaliar as características epidemiológicas, clínicas e laboratoriais de pacientes com síndrome de Down e infecções recorrentes e/ou graves, bem como avaliar a presença de imunodeficiência nesta população. MÉTODOS: foram avaliados, através de protocolo epidemiológico, clínico e laboratorial, incluindo aspectos imunológicos, pacientes com diagnóstico de síndrome de Down, através de estudo cromossômico, com queixa de infecções recorrentes e/ou graves, acompanhados no Ambulatório de Alergia e Imunologia do Departamento de Pediatria da FMUSP, no período de 1990 a 1999. RESULTADOS: a distribuição entre sexos foi 1,6M : 1F, com idade variando entre um ano e 12 anos e 10 meses (média de 2a7m). Do total de 45 casos avaliados, 40 referiam infecções recorrentes, e cinco, sepse. Dos pacientes com infecções recorrentes, 31 preenchiam os critérios adotados de infecção de repetição, sendo as pneumonias e as rinofaringites as infecções mais referidas. Cardiopatias foram encontradas em 62,2% dos casos, sendo mais prevalentes nas crianças com pneumonias de repetição. Quanto aos parâmetros imunológicos, encontrou-se dois casos com deficiência de IgG2, dois com baixo número de linfócitos CD4+, e outros dois com redução de resposta proliferativa a mitógenos. Cinco casos apresentaram redução da atividade de células NK. Soropositividade para citomegalovírus foi encontrada em 22 de 36 casos avaliados (61,1%). CONCLUSÃO: embora os dados aqui relatados sejam específicos para esta população, ressaltam a necessidade da pesquisa de imunodeficiência em pacientes com síndrome de Down que mantenham processos infecciosos após o adequado controle das patologias associadas

A possible role for CCL27/CTACK-CCR10 interaction in recruiting CD4+ T cells to skin in human graft-versus-host disease

Graft-versus-host disease (GvHD) is a serious complication of allogeneic stem cell transplantation (SCT) affecting the skin, gut and liver. The involvement of distinct organs suggests a role for tissue-specific chemokines and their receptors in directing activated donor T cells to these sites. In this study the potential involvement of the skin-specific CCL27/CTACK-CCR10 interaction was investigated in 15 paediatric SCT patients with skin GvHD. During the course of skin GvHD, peripheral blood T cells from these patients contained a high proportion of CD4+ CCR10+ T cells that disappeared after the GvHD was resolved. These cells were CD45RO+, expressed additional skin homing markers (cutaneous lymphocyte-associated antigen and CCR4), and produced the T-cell helper type 1-cytokines tumour necrosis factor-alpha and interleukin-2. The increase in CD4+ CCR10+ T cells was absent in SCT patients without GvHD. Immunohistochemical investigations showed CD4+ CCR10+ T cells in the GvHD skin biopsies of the same patients, but not in the gut biopsies of patients also suffering from gut GvHD. The infiltration of CD4+ CCR10+ T cells in the GvHD-affected skin correlated with an enhanced epidermal expression of CCL27/CTACK, the ligand for CCR10. These findings support the involvement of CCL27/CTACK-CCR10 interaction in recruiting CD4+ T cells to the skin, thus contributing to the pathogenesis of acute GvHD.Faaij, Claudia M. J. M. ; Lankester, Arjan C. ; Spierings, Eric ; Hoogeboom, Manja ; Bowman, Edward P. ; Bierings, Marc ; Révész, Tom ; Egeler, R. Maarten ; Van Tol, Maarten J. D. ; Annels, Nicola

Perinatal maternal depressive symptoms alter amygdala functional connectivity in girls

10.1002/hbm.23873Human Brain Mapping392680-690HBMAEGUSTO (Growing up towards Healthy Outcomes