Multidisciplinary approach to treatment with immune checkpoint inhibitors in patients with HIV, tuberculosis, or underlying autoimmune diseases

Autoimmune diseases; Checkpoint inhibition therapy; Human immunodeficiency virusEnfermedades autoinmunes; Terapia de inhibición de puntos de control; Virus de inmunodeficiencia humanaMalalties autoimmunes; Teràpia d'inhibició del punt de control; Virus de la immunodeficiència humanaWe reviewed the available information on the use of immune checkpoint inhibitors (ICIs) in populations with special conditions, namely, patients with HIV, tuberculosis, or underlying autoimmune disease. Available data show that treatment with ICIs is safe in patients with HIV; it is advisable, however, that these patients receive adequate antiretroviral therapy and have an undetectable viral load before ICIs are initiated. Tuberculosis reactivation has been reported with the use of ICIs, possibly due to immune dysregulation. Tuberculosis has also been associated with the use of immunosuppressors to treat immune-related adverse events (irAEs). Active tuberculosis must be ruled out in patients with symptoms or signs, and selected patients may benefit from screening for latent tuberculosis infection, although more data are required. Limited data exist regarding the safety of ICIs in patients with cancer and autoimmune disease. Data from observational studies suggest that up to 29% of patients with a preexisting autoimmune disease treated with an ICI present with an autoimmune disease flare, and 30% present with a de novo irAE of any type. The frequency of flares appears to differ according to the type of ICI received, with higher rates associated with PD-1/PD-L1 inhibitors. The most common autoimmune diseases for which patients reported flares with ICI therapy are rheumatoid arthritis, other inflammatory arthritis, and psoriasis. Most studies have reported flares or de novo irAEs associated with ICIs that were mild to moderate, with low rates of discontinuation and no deaths due to flares. Therefore, the use of ICIs in these patients is possible, but careful monitoring is required.ML-O's work is supported by the National Cancer Institute (#CA237619)

Cognitive Abilities: Intergenerational Transmission by Socioeconomic Levels

Resumen: Un modelo switching aplicado a información de la encuesta ENNViH 2002 evidencia diferencias significativas en la formación de habilidad cognitiva infantil através de los estratos sociales mexicanos. Un pequeño conjunto de variables de política pública y de características económicas de la localidad detecta un importante gradiente y variaciones en los determinantes familiares de la habilidad cognitiva infantil. Los niños de estratos sociales bajos adquieren una menor habilidad cognitiva, y dependen de la satisfacción de necesidades más básicas, que los de niveles mas altos. En los estratos bajos los coeficientes son consistentes con la existencia de restricciones de riqueza, que impiden una inversión óptima en el desarrollo infantil.Using the ENNViH 2002 survey, a switching model shows that significant diferences exist in the formation of infant cognitive ability across Mexican social strata. Public policy variables and local economic characteristics are suficient to detect an important gradient in cognitive abilities and their family determinants in children. Children from lower strata acquire lower cognitive abilities and depend on the satisfaction of more basic needs than children in higher strata. Coeficients for the lower strata are consistent with the existence of wealth restrictions that impede optimal investment in child development.habilidades cognitivas, desigualdad, intergeneracional, politica publica, cognitive ability, inequality, intergenerational, public policy, switching

Inpatient rehabilitation did not positively affect 6-month patient-reported outcomes after hip or knee arthroplasty

Background: The aim of this study was to compare patient-reported outcomes 6 months after hip or knee arthroplasty in subjects who were discharged to home compared to those who attended inpatient rehabilitation. Methods: Seven hundred and forty-eight consecutive total hip or knee replacement patients were identified from a prospective database. Preoperative and 6-month post-operative patient-reported outcome measures were recorded. Forty-four patients discharged directly to home were cohort matched by age, gender, procedure and surgeon to 44 patients from the cohort who received inpatient care. Patient outcomes were compared using SPSS version 24 software. Results: Both cohorts saw significant improvements from baseline at 6 months. Median length of rehabilitation for the inpatient group was 7 days (4 – 16 days). There was no significant difference between the groups based on patient-reported outcomes. There was a clinically significant difference (P = 0.047) in the body mass index of the Home Group (mean = 27) to Rehab Group (mean = 29). Conclusion: Our study has shown that inpatient rehabilitation after hip or knee arthroplasty did not positively affect 6-month patient-reported satisfaction, expectation, pain, quality of life, activities of daily living scores, when compared with subjects who were discharged direct to home. A significant average saving of $5600 per patient with the use of home dis- charge is a promising avenue for health cost reduction, and health resource distribution

Habilidades Cognitivas: Transmision Intergeneracional Por Niveles Socioeconomicos

Resumen: Un modelo switching aplicado a información de la encuesta ENNViH 2002 evidencia diferencias significativas en la formación de habilidad cognitiva infantil através de los estratos sociales mexicanos. Un pequeño conjunto de variables de política pública y de características económicas de la localidad detecta un importante gradiente y variaciones en los determinantes familiares de la habilidad cognitiva infantil. Los niños de estratos sociales bajos adquieren una menor habilidad cognitiva, y dependen de la satisfacción de necesidades más básicas, que los de niveles mas altos. En los estratos bajos los coeficientes son consistentes con la existencia de restricciones de riqueza, que impiden una inversión óptima en el desarrollo infantil. Abstract: Using the ENNViH 2002 survey, a switching model shows that significant diferences exist in the formation of infant cognitive ability across Mexican social strata. Public policy variables and local economic characteristics are suficient to detect an important gradient in cognitive abilities and their family determinants in children. Children from lower strata acquire lower cognitive abilities and depend on the satisfaction of more basic needs than children in higher strata. Coeficients for the lower strata are consistent with the existence of wealth restrictions that impede optimal investment in child development

Habilidades Cognitivas: Transmision Intergeneracional Por Niveles Socioeconomicos

Resumen: Un modelo switching aplicado a información de la encuesta ENNViH 2002 evidencia diferencias significativas en la formación de habilidad cognitiva infantil através de los estratos sociales mexicanos. Un pequeño conjunto de variables de política pública y de características económicas de la localidad detecta un importante gradiente y variaciones en los determinantes familiares de la habilidad cognitiva infantil. Los niños de estratos sociales bajos adquieren una menor habilidad cognitiva, y dependen de la satisfacción de necesidades más básicas, que los de niveles mas altos. En los estratos bajos los coeficientes son consistentes con la existencia de restricciones de riqueza, que impiden una inversión óptima en el desarrollo infantil. Abstract: Using the ENNViH 2002 survey, a switching model shows that significant diferences exist in the formation of infant cognitive ability across Mexican social strata. Public policy variables and local economic characteristics are suficient to detect an important gradient in cognitive abilities and their family determinants in children. Children from lower strata acquire lower cognitive abilities and depend on the satisfaction of more basic needs than children in higher strata. Coeficients for the lower strata are consistent with the existence of wealth restrictions that impede optimal investment in child development

A Systematic Review of Clinical Practice Guidelines for Cancer Screening in Patients with Autoimmune Diseases

https://openworks.mdanderson.org/sumexp23/1110/thumbnail.jp

Plantar Fasciitis—A Comparison of Treatment with Intralesional Steroids versus Platelet-Rich Plasma

Background: Many treatment options for plantar fasciitis currently exist, some with great success in pain relief. The objective of our study was to compare the use of intralesional steroids with platelet-rich plasma (PRP), using pain scales and functional evaluation, in patients with plantar fasciitis who did not respond to conservative treatment. Methods: A controlled, randomized, blinded clinical assay was performed. Patients were assigned to one of the two groups by selecting a sealed envelope. The steroid treatment group received 8 mg of dexamethasone plus 2 mL of lidocaine as a local anesthetic. The PRP treatment group received 3 mL of PRP activated with 0.45 mL of 10% calcium gluconate. All of the patients were evaluated at the beginning of the study, and at 2, 4, 8, 12, and 16 weeks post-treatment with the Visual Analog Scale (VAS), Foot and Ankle Disability Index (FADI), and American Orthopedic Foot and Ankle Society (AOFAS) scale. Results: The right foot was the most frequently affected foot (63%). The average age of the patients was 44.8 years (range, 24–61 years). All scales used (VAS, FADI and AOFAS) showed that the difference was not statistically significant between the two groups. Conclusions: We can conclude that the use of PRP is an effective treatment method for patients with plantar fasciitis who do not respond to conservative treatment because PRP demonstrates an efficacy equal to that of steroids. However, the cost and the time for preparation the PRP are two of the disadvantages of this treatment. (J Am Podiatr Med Assoc 107(6): 490-496, 2017

Comparative evaluation of three semi-quantitative radiographic grading techniques for knee osteoarthritis in terms of validity and reproducibility in 1759 X-rays: report of the OARSI–OMERACT task force

OBJECTIVE: The objective of this work was to compare the measurement properties of three categorical X-ray scoring methods of knee osteoarthritis (OA), both on semiflexed and extended views. METHODS: In data obtained from trials and cohorts, X-rays were graded using Kellgren and Lawrence (KL), the OA Research Society International (OARSI) joint space narrowing score, and measurement of joint space width (JSW). JSW was analyzed as a categorical variable. Construct validity was assessed through logistic regression between X-ray stages and Western Ontario and McMaster Universities OA Index. Inter-observer reliability was assessed in 50 subjects for extended views by weighted kappa. Intra-observer reliability and sensitivity to change were assessed separately for extended and semiflexed views in 50 patients who had both views performed, over a 30-month interval, by weighted kappa and standardized response mean (SRM). RESULTS: Extended views were available from three trials and two cohorts (1759 X-rays), including one trial in which both extended and semiflexed views (antero-posterior) were obtained. Correlation with clinical parameters was low for the three scoring methods, except for the single community-based cohort. Inter-rater reliability was higher for categorical JSW in extended views (kappa, 0.86 vs 0.56 and 0.48 for KL and OARSI, respectively). Intra-rater reliability was higher for categorical JSW, both in extended views (0.83 vs 0.61 and 0.71) and in semiflexed views (0.89 vs 0.50 and 0.67). Sensitivity to change was also higher for categorical JSW, particularly in semiflexed views (SRM, 0.49 vs 0.22 and 0.34). CONCLUSION: These results indicate categorical JSW, in particular on semiflexed views, may be the preferred method to evaluate structural severity in knee OA clinical trials

Patient Decision Aids for Colorectal Cancer Screening

Decision aids (DAs) prepare patients to make decisions about healthcare options consistent with their preferences. Helping patients choose among available options for colorectal cancer (CRC) screening is important because rates are lower than screening for other cancers. This systematic review describes studies evaluating patient DAs for CRC screening in average-risk adults and their impact on knowledge, screening intentions, and uptake