152 research outputs found
Peripheral blood regulatory T cell measurements correlate with serum vitamin D level in patients with psoriasis
OBJECTIVE:Vitamin D is the precursor of a hormone (1,25-dihydroxyvitamin D3), which has many biological effects in the skin. The immune modulator properties of vitamin D are mediated in part through effects on regulatory T cells (T-reg). Currently, in psoriasis, the relationship between vitamin D and T-reg has not well elucidated. We assess whether vitamin D status is correlated with circulating T-reg in patients affected by psoriasis and if there is a correlation with the severity of the disease evaluated with Psoriasis Area Severity Index (PASI) score.
PATIENTS AND METHODS:For each patient we have analyzed, PASI-score, serum levels vitamin D and regulatory T cell percentages. Spearmen's coefficient was used between serum vitamin D levels and the predictors. Subsequently, the independent predictive factors were assessed by Multiple Regression.
RESULTS:A total of 26 patients were included in our analysis. Using no parametric Spearman's Coefficient test between serum levels of vitamin D and the single variables, we found an association with T-reg population (p < 0.001) and with PASI-score (p = 0.04).
CONCLUSIONS:While vitamin D treatment induces a cytokine profile known to favor the differentiation of T cells with suppressive activity, at the same time, several studies showed how vitamin D can prime for tolerogenic dendritic cells able to favor the differentiation of Treg from T naïve cells. Low levels of vitamin-D may decrease the number of circulatory T-reg, disrupting the immunological homeostasis in psoriatic patients and encouraging the inflammatory activity
Symptoms and medical conditions in 204 912 patients visiting primary health-care practitioners in India: a 1-day point prevalence study (the POSEIDON study)
Background India has one of the highest disease burdens in the world. A better understanding of what ails India will
help policy makers plan appropriate health-care services and infrastructure development, design medical education
curricula, and identify health research priorities that are relevant to the needs of the country. The POSEIDON study
aimed to record the prevalence of symptoms and medical conditions for which patients visit a primary health-care
practitioner in India.
Methods We randomly selected 12 000 general practitioners, general physicians, and paediatricians from 880 cities
and towns and invited them to record demographic details, symptoms, and medical conditions for every patient they
saw on Feb 1, 2011. A further 1225 practitioners volunteered to participate and their responses were included. We did
simple descriptive analyses of prevalence rates and used χ² tests to study comorbid associations. Through application
of systems biology methods, we visualised inter-relations between organ involvement of diseases and symptoms and
deciphered how these associations change with age and gender.
Findings We included responses from 7400 health-care practitioners, which represented data for 204 912 patients, who
presented with 554 146 reasons for visit. Fever (35·5%) was the most common presenting symptom. More than half of all
patients presented with respiratory symptoms across all age groups and regions of India. Other common presentations
were digestive system symptoms (25%), circulatory symptoms (12·5%), skin complaints (9%), and endocrine disorders
(6·6%). Hypertension (14·52%), obstructive airways diseases (14·51%), and upper respiratory tract infections (12·9%)
were the most common diagnoses reported. Of note was that 21·4% of all patients with hypertension reported by the
primary health-care practitioners were younger than 40 years. Anaemia was the fourth most common disease reported
by these health-care practitioners and was most common in women of menstrual age living outside metro cities.
Interpretation The POSEIDON study provides insight into the reasons that patients visit primary health-care
practitioners in India; our results highlight important social and medical challenges in the developing world
Nonpegylated liposomal doxorubicin combination regimen in patients with diffuse large B-cell lymphoma and cardiac comorbidity. Results of the HEART01 phase II trial conducted by the Fondazione Italiana Linfomi
The purpose of this phase 2, multicenter study was to determine the activity and safety of nonpegylated liposomal doxorubicin as part of "R-COMP" combination in patients with diffuse large B-cell lymphoma and coexisting cardiac disorders. The study was conducted using a Bayesian continuing assessment method using complete remission rate and rate of cardiac events as study endpoints. Between November 2009 and October 2011, 50 evaluable patients were enrolled (median age, 76\ua0years). Median baseline left ventricular ejection fraction (LVEF) was 60%. Ischemic cardiopathy was the most frequent preexisting cardiac disorder (35%), followed by atrial fibrillation (15%), left ventricular hypertrophy (13%), and baseline LVEF <50% (12%). Based on the intent to treat analysis, overall response rate was 72%, including 28 patients in complete remission (complete remission rate, 56%), and 8 in partial remission (16%). At the end of treatment, grades 3 to 4 cardiac events were observed in 6 patients. No significant modifications from baseline values of LVEF were observed during treatment and follow-up. Nonpegylated liposomal doxorubicin instead of doxorubicin in the R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) regimen is a feasible option for patients with diffuse large B-cell lymphoma presenting with concomitant cardiac disorders
Perceptions of Kenyan adults on access to medicines for non-communicable diseases: A qualitative study
In Kenya, noncommunicable diseases (NCDs) account for 27% of all deaths. Adult Kenyans
have an 18% chance of dying prematurely from cancers, diabetes, cardiovascular diseases
or chronic respiratory diseases. A Novartis Access Initiative is making medicines available
to treat cardiovascular diseases, diabetes, chronic respiratory diseases, and breast cancer
in 30 countries, including Kenya. Little is known about patients' perceptions of access to
medicines for NCDs in Kenya. The study objective was to understand patients' perceptions
of access to medicines; as well as barriers and facilitators at the household, community, and
healthcare system level. A baseline qualitative study was conducted in eight of 47 counties
as part of an evaluation of the Novartis Access Initiative in Kenya. The 84 patients interviewed
through a household survey had been diagnosed and treated for an NCD. Although
medicines at government facilities were free or cheaper than those sold in private pharmacies,
the availability of medicines presented a constant challenge. Patients often resorted to
private pharmacies, where NCD medicines cost more than at public facilities. Participants
with an NCD took their health seriously and strove to get the medicines, even under difficult
circumstances. Buying NCD medicines put a strain on the household budget, especially for
the lower-income participants. Some actions to overcome affordability barriers included:
borrowing money, selling assets, seeking help from relatives, taking on extra work, buying
partial dosages, leaving without the medicines, or resorting to non-medical alternatives. In
conclusion, access to NCD medicines is a major challenge for most adults in Kenya. As a
result, they engage in complex interactions between public, private facilities and pharmacies
to overcome the barriers. The government should ensure well-stocked public sector pharmacies
and subsidize prices of medicines for lower-income patients. Integration of industryled
access to medicine programs may help governments to obtain low cost supplies
Microenvironmental regulation of the IL-23R/IL-23 axis overrides chronic lymphocytic leukemia indolence
Although the progression of chronic lymphocytic leukemia (CLL) requires the cooperation of the microenvironment, the exact cellular and molecular mechanisms involved are still unclear. We investigated the interleukin (IL)-23 receptor (IL-23R)/IL-23 axis and found that circulating cells from early-stage CLL patients with shorter time-to-treatment, but not of those with a more benign course, expressed a defective form of the IL-23R complex lacking the IL-12R beta 1 chain. However, cells from both patient groups expressed the complete IL-23R complex in tissue infiltrates and could be induced to express the IL-12R. 1 chain when cocultured with activated T cells or CD40L(+) cells. CLL cells activated in vitro in this context produced IL-23, a finding that, together with the presence of IL-23 in CLL lymphoid tissues, suggests the existence of an autocrine/paracrine loop inducing CLL cell proliferation. Interference with the IL-23R/IL-23 axis using an anti-IL-23p19 antibody proved effective in controlling disease onset and expansion in xenografted mice, suggesting potential therapeutic strategies
COPD uncovered: an international survey on the impact of chronic obstructive pulmonary disease [COPD] on a working age population
Background: Approximately 210 million people are estimated to have chronic obstructive pulmonary disease [COPD] worldwide. The burden of disease is known to be high, though less is known about those of a younger age. The aim of this study was to investigate the wider personal, economic and societal burden of COPD on a cross country working-age cohort. Methods: A cross-country [Brazil, China, Germany, Turkey, US, UK] cross-sectional survey methodology was utilised to answer the research questions. 2426 participants aged 45-67 recruited via a number of recruitment methods specific to each country completed the full survey. Inclusion criteria were a recalled physician diagnosis of COPD, a smoking history of > 10 pack years and the use of COPD medications in the previous 3 months prior to questioning. The survey included items from the validated Work Productivity and Activity Impairment [WPAI] scale and the EuroQoL 5 Dimension [EQ-5D] scale. Disease severity was measured using the 5-point MRC [Medical Research Council] dyspnoea scale as a surrogate measure. Results: 64% had either moderate [n = 1012] or severe [n = 521] COPD, although this varied by country. 75% of the cohort reported at least one comorbid condition. Quality of life declined with severity of illness [mild, mean EQ-5D score = 0.84; moderate 0.58; severe 0.41]. The annual cost of healthcare utilisation [excluding treatment costs and diagnostic tests] per individual was estimated to be 880 [556] pound per annum and lifetime losses of 596,000 [377,000] pound for the cohort. 447 [similar to 40%] of the working population had retired prematurely because of COPD incurring individual estimated lifetime income losses of 141 m [89.6 pound m]. As the mean age of retirees was 58.3 and average time since retirement was 4 years, this suggests the average age of retirement is around 54. This would mean a high societal and economic impact in all study countries, particularly where typical state retirement ages are higher, for example in Brazil, Germany and the UK [65] and the US [65,66,67], compared to Turkey [58 for women, 60 for men] and China [60]. Conclusions: Although generalisation across a broader COPD population is limited due to the varied participant recruitment methods, these data nevertheless suggest that COPD has significant personal, economic and societal burden on working age people. Further efforts to improve COPD diagnosis and management are required
Withdrawal of mechanical ventilation in amyotrophic lateral sclerosis patients: a multicenter Italian survey
Background: Law 219/2017 was approved in Italy in December 2017, after a years-long debate on the autonomy of healthcare choices. This Law, for the first time in Italian legislation, guarantees the patient's right to request for withdrawal of life-sustaining treatments, including mechanical ventilation (MV). Objective: To investigate the current status of MV withdrawal in amyotrophic lateral sclerosis (ALS) patients in Italy and to assess the impact of Law 219/2017 on this practice. Methods: We conducted a Web-based survey, addressed to Italian neurologists with expertise in ALS care, and members of the Motor Neuron Disease Study Group of the Italian Society of Neurology. Results: Out of 40 ALS Italian centers, 34 (85.0%) responded to the survey. Law 219/2017 was followed by an increasing trend in MV withdrawals, and a significant increase of neurologists involved in this procedure (p 0.004). However, variations across Italian ALS centers were observed, regarding the inconsistent involvement of community health services and palliative care (PC) services, and the intervention and composition of the multidisciplinary team. Conclusions: Law 219/2017 has had a positive impact on the practice of MV withdrawal in ALS patients in Italy. The recent growing public attention on end-of-life care choices, along with the cultural and social changes in Italy, requires further regulatory frameworks that strengthen tools for self-determination, increased investment of resources in community and PC health services, and practical recommendations and guidelines for health workers involved
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