Επιδημιολογική καταγραφή και διαγνωστική μελέτη του κινδύνου καρδιαγγειακών συμβαμάτων στην ψωρίαση

Εισαγωγή: Η ψωρίαση είναι μια χρόνια, πολυπαραγοντική, φλεγμονώδης νόσος που συνεπάγεται υπερπολλαπλασιασμό των κερατονοκυττάρων στην επιδερμίδα. Μια σωρεία μελετών αποδεικνύει ένα σαφή συσχετισμό της νόσου με μια σειρά συστηματικών νοσημάτων όπως η ψωριασική αρθρίτιδα, τα φλεγμονώδη νοσήματα του εντέρου, η καρδιαγγειακή νόσος και η κατάθλιψη. Σκοπός: Στόχος αυτής της αναδρομικής μελέτης ήταν να συλλέξει δεδομένα που αφορούν τον επιπολασμό των καρδιαγγειακών συμβαμάτων σε ασθενείς με ψωρίαση οι οποίοι εμφάνιζαν ή όχι συννοσηρότητες σχετικές με την επίπτωση MACES. Μέθοδοι: Οι 76 ασθενείς (28 άνδρες και 28 γυναίκες), οι οποίοι παρακολουθούνταν στο ειδικό ιατρείο ψωρίασης της Β’ Πανεπιστημιακής Κλινικής Δερματικών και Αφροδίσιων Νόσων του Π.Γ.Ν. Αττικόν, και οι οποίοι είχαν υποβληθεί σε καρδιολογικό και αγγειολογικό έλεγχο από την Β’ Πανεπιστημιακή Καρδιολογική Κλινική του Π.Γ.Ν. Αττικόν, ερωτήθησαν και απάντησαν σε ερωτήματα σχετικά με τα δημογραφικά τους στοιχεία και το ιατρικό ιστορικό τους. Αποτελέσματα: Mείζων καρδιαγγειακό σύμβαμα εμφανίστηκε στο 21,3% των ασθενών, χωρίς σημαντική διαφορά μεταξύ ανδρών και γυναικών. Η ηλικία εμφάνισης MACES επηρεάζεται στατιστικώς σημαντικά από την ηλικία του ασθενούς με ψωρίαση (p= 0,001), ενώ από την ανάλυση της σχέσης φύλου και αριθμού MACES προέκυψε ότι οι άνδρες τείνουν να έμφανίζουν μεγαλύτερο αριθμό συμβαμάτων σε σχέση με τις γυναίκες (p=0,09). Από την πολυπαραγοντική ανάλυση της σχέσης ύπαρξης συννοσηροτήτων και εμφάνισης καρδιαγγειακών συμβαμάτων προέκυψε στατιστικώς σημαντικό αποτέλεσμα με τους περισσότερους ασθενείς να πάσχουν από συννοσηρότητες (p=0,04). Στην επιμέρους ανάλυση της καθεμίας από αυτές, προέκυψε στατιστικώς σημαντική συσχέτιση μεταξύ των ψωριασικών ασθενών πασχόντων από αρτηριακή υπέρταση (p=0,001), δυσλιπιδαιμία (p=0,001) και σακχαρώδη διαβήτη (p=0,007), και της εμφάνισης MACES. Συμπεράσματα: Ως συνολική εκτίμηση, ο αυξημένος κίνδυνος εμφάνισης καρδιαγγειακών συμβαμάτων στους ασθενείς με ψωρίαση είναι υπαρκτός και είναι σαφώς μεγαλύτερος με την συνύπαρξη προδιαθεσικών παραγόντων.Introduction: Psoriasis is a chronic, multifactorial, inflammatory disease that involves hyperproliferation of the keratinocytes in the epidermis. Evidence from numerous studies show a clear association of the disease with a variety of systemic disorders such as arthritis, inflammatory bowel disease, cardiovascular disease and depression. Objectives: Aim of this cross-sectional study was to collect data on the prevalence of major adverse cardiovascular events in patients with psoriasis and comorbidities related to cardiovascular diseases. Methods: 76 patients (28 males and 28 females) who are followed up at the Psoriasis Outpatient Clinic of the 2nd Department of Dermatology and Venereology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece, were examined for cardiovascular diseases from 2nd Cardiology Department of the same hospital and answered questions about demographic data and personal medical history. Results: Major adverse cardiovascular event was reported in 21,3% of patients, without significant difference between males and females. The age of appearance of MACES influenced statistically significantly by the age of patient with psoriasis (p=0,001), while analysis between gender and number of MACES exhibited that males appear greater number of events than females (p=0,09). Multivariable analysis of the relationship of comorbidities and cardiovascular events statistically significant effect exhibited with the majority of patients suffering from comorbidities (p=0,04). Analyzing each comorbidity, indicated statistically significant correlation between patients with psoriasis and hypertension (p=0,001), dyslipidemia (p=0,001) and diabetes mellitus (p=0,007), and experiencing MACES. Conclusion: As an overall estimate, the risk of cardiovascular events in patients of psoriasis is real and much stronger when comorbidities coexist

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Safety and Effectiveness of Mycophenolate Mofetil in Interstitial Lung Diseases: Insights from a Machine Learning Radiographic Model

Introduction: Treatment of interstitial lung diseases (ILDs) other than idiopathic pulmonary fibrosis (IPF) often includes systemic corticosteroids. Use of steroid-sparing agents is amenable to avoid potential side effects. Methods: Functional indices and high-resolution computed tomography (HRCT) patterns of patients with non-IPF ILDs receiving mycophenolate mofetil (MMF) with a minimum follow-up of 1 year were analyzed. Two independent radiologists and a machine learning software system (Imbio 1.4.2.) evaluated HRCT patterns. Results: Fifty-five (n = 55) patients were included in the analysis (male: 30 [55%], median age: 65.0 [95% CI: 59.7-70.0], mean forced vital capacity %predicted [FVC %pred.] +/- standard deviation [SD]: 69.4 +/- 18.3, mean diffusing capacity of lung for carbon monoxide %pred. +/- SD: 40.8 +/- 14.3, hypersensitivity pneumonitis: 26, connective tissue disease-ILDs [CTD-ILDs]: 22, other ILDs: 7). There was no significant difference in mean FVC %pred. post-6 months (1.59 +/- 2.04) and 1 year (-0.39 +/- 2.49) of treatment compared to baseline. Radiographic evaluation showed no significant difference between baseline and post-1 year %ground glass opacities (20.0 [95% CI: 14.4-30.0] vs. 20.0 [95% CI: 14.4-25.6]) and %reticulation (5.0 [95% CI: 2.0-15.6] vs. 7.5 [95% CI: 2.0-17.5]). A similar performance between expert radiologists and Imbio software analysis was observed in assessing ground glass opacities (intraclass correlation coefficient [ICC] = 0.73) and reticulation (ICC = 0.88). Fourteen patients (25.5%) reported at least one side effect and 8 patients (14.5%) switched to antifibrotics due to disease progression. Conclusion: Our data suggest that MMF is a safe and effective steroid-sparing agent leading to disease stabilization in a proportion of patients with non-IPF ILDs. Machine learning software systems may exhibit similar performance to specialist radiologists and represent fruitful diagnostic and prognostic tools

The efficacy and tolerability of tetracyclines and clindamycin plus rifampicin for the treatment of hidradenitis suppurativa; results of a prospective European cohort study.

Tetracyclines and clindamycin plus rifampicin combination therapy are both considered first-line therapy in current Hidradenitis Suppurativa (HS) guidelines. However, evidence for their efficacy is drawn from small studies, often without validated outcomes.info:eu-repo/semantics/publishe

The efficacy and tolerability of tetracyclines and clindamycin plus rifampicin for the treatment of hidradenitis suppurativa: Results of a prospective European cohort study

Background: Tetracyclines and clindamycin plus rifampicin combination therapy are both considered first-line therapy in current hidradenitis suppurativa guidelines. However, evidence for their efficacy is drawn from small studies, often without validated outcomes. Objective: To assess the 12-week efficacy of oral tetracyclines and a combination of clindamycin and rifampicin. Methods: A prospective, international cohort study performed between October 2018 and August 2019. Results: In total, 63.6% of the included 283 patients received oral tetracyclines, and 36.4% were treated with clindamycin and rifampicin. Both groups showed a significant decrease in International Hidradenitis Suppurativa Severity Score System from baseline (both P < .001). The Hidradenitis Suppurativa Clinical Response (HiSCR) was achieved in 40.1% and 48.2% of patients, respectively (P = .26). Patient characteristics or disease severity were not associated with the attainment of HiSCR or the minimal clinically important differences for the Dermatology Life Quality Index and pain. Limitations: Cohort study. Respectively, 23.9% and 19.4% of patients had to be excluded from the HiSCR analysis for the tetracycline and combination therapy group because of a low abscess and nodule count at baseline. Conclusion: This study shows significant efficacy of both tetracycline treatment and clindamycin and rifampicin combination therapy after 12 weeks in patients with hidradenitis suppurativa. No significant differences in efficacy were observed between the 2 treatments, regardless of disease severity

The efficacy and tolerability of tetracyclines and clindamycin plus rifampicin for the treatment of hidradenitis suppurativa : Results of a prospective European cohort study

Background: Tetracyclines and clindamycin plus rifampicin combination therapy are both considered first-line therapy in current hidradenitis suppurativa guidelines. However, evidence for their efficacy is drawn from small studies, often without validated outcomes. Objective: To assess the 12-week efficacy of oral tetracyclines and a combination of clindamycin and rifampicin. Methods: A prospective, international cohort study performed between October 2018 and August 2019. Results: In total, 63.6% of the included 283 patients received oral tetracyclines, and 36.4% were treated with clindamycin and rifampicin. Both groups showed a significant decrease in International Hidradenitis Suppurativa Severity Score System from baseline (both P <.001). The Hidradenitis Suppurativa Clinical Response (HiSCR) was achieved in 40.1% and 48.2% of patients, respectively (P =.26). Patient characteristics or disease severity were not associated with the attainment of HiSCR or the minimal clinically important differences for the Dermatology Life Quality Index and pain. Limitations: Cohort study. Respectively, 23.9% and 19.4% of patients had to be excluded from the HiSCR analysis for the tetracycline and combination therapy group because of a low abscess and nodule count at baseline. Conclusion: This study shows significant efficacy of both tetracycline treatment and clindamycin and rifampicin combination therapy after 12 weeks in patients with hidradenitis suppurativa. No significant differences in efficacy were observed between the 2 treatments, regardless of disease severity