Possibility Of Remission Research Articles

Electroconvulsive Therapy (ECT) in Major Depression: Oldies but Goodies.

Electroconvulsive therapy is one of the useful treatment methods for symptom improvement and remission in patients with treatment-resistant depression. Considering the various clinical characteristics of patients experiencing depression, key indicators are extracted from structural brain magnetic resonance imaging, functional brain magnetic resonance imaging, and electroencephalography (EEG) data taken before treatment, and applied as explanatory variables in machine learning and network analysis. Studies that attempt to make reliable predictions about the degree of response to electroconvulsive treatment and the possibility of remission in patients with treatment-resistant depression are continuously being published. In addition, studies are being conducted to identify the correlation with clinical improvement by taking structural-functional brain magnetic resonance imaging after electroconvulsive therapy in depressed patients. By reviewing and integrating the results of the latest studies on the above matters, we aim to present the usefulness of electroconvulsive therapy for improving the personalized prognosis of patients with treatment-resistant depression.

NEW TREATMENT METHODS OF SARCOIDOSIS: NARRATIVE REVIEW

Multiple organs are affected by the systemic, granulomatous disease known as sarcoidosis, which has an unpredictable clinical course and an unclear etiology. Systemic therapy is required for approximately 50% of patients with sarcoidosis to treat their illness. The usual first-line treatment for sarcoidosis is oral glucocorticoids. Long-term high-dose use may cause significant morbidity in patients over time. We searched the PubMed database for articles about randomized controlled trials involving novel treatments for sarcoidosis conducted over ten years between 2012 and 2021. We looked for information on novel treatments and strategies for treating pulmonary sarcoidosis. Out of the 26 entries, the search yielded, we chose 11 studies that we thought were pertinent and served as the foundation for this analysis. (("Sarcoidosis treatment"[Mesh]) AND "Pulmonary sarcoidosis"[Mesh]) were the search terms used. Diagnosing sarcoidosis, developing therapeutic behavior, overseeing long-term treatment, and ensuring patient compliance are all very challenging. Although it is difficult to predict how the disease will progress, more than half of the cases have the possibility of remission. Multidisciplinary studies are still required to test new drugs.

IDF21-0422 Two Anniversaries, Two Pandemics, Two Histories

Background: As we remember the therapeutic development of insulin one hundred years ago, in Tulsa, Oklahoma we remember a race massacre in the same year. Are these connected? How? Elbert Huang, University of Chicago’s Center for Chronic Disease Research and Policy, writes that diabetes has been called a “slow moving pandemic.” As U.S. outbreaks surge, a study finds 40% of people who have died with COVID-19 had diabetes (Terhune et al, 7/24/2020 Reuters). The Center for Disease Control (2020) shows the prevalence of diabetes is highest among American Indians/Alaska Natives (14.7%) Hispanics (12.5%), non-Hispanic Blacks (11.7%), and non-Hispanic whites (7.5%). American Indians, Latinos and Blacks are suffering from COVID-19 in the same disproportionate numbers. COVID-19 can grow vigorously in a high blood sugar environment and may cause new cases of diabetes. A woman with diabetes loses a longtime relationship when her friend refuses to wear a mask around her. There are complex interactions between previously adaptive survival mechanisms, pre-Columbian culture and diet. Conquest by Europeans resulted in genocide, great poverty and oppression of indigenous peoples across the Americas. It brought slavery to the Americas when large numbers were needed to grow tobacco and sugar cane from new demands. During high or chronic levels of stress, the adaptive mechanism known as fight or flight allows people to protect themselves in emergency conditions, becomes destructive when people are not allowed to fight or flee. Cortisol, produced during these times, becomes toxic to the body and the brain, impairs immune systems, increases heart and vascular diseases, and lowers resistance to diabetes. In the extreme situation of genocide and slavery, stress becomes chronic and the levels of cortisol remain elevated. In times of famine, the ability of the individual to “store” fat in the abdomen was critical. In times of feast, the survival mechanism is no longer adaptive and can result in obesity, diabetics and death. What then are the factors that make these populations vulnerable to obesity, diabetes and Covid? Violence, poverty and racism remain for peoples whose once adaptive survival responses now contribute to disease and death. Many in the Hispanic community have the same story of conquest. The majority are poor. To the extent that they are considered to be “undocumented aliens,” their lives are precarious. “Black Lives Matter” is the response not only to poverty and racism but violence, especially the killing of innocent blacks by law enforcement. The legitimate fear of driving while black and brown is part of daily life. Native Americans have the highest numbers of violence of any group. It is statistically Caucasian male against Native male and female. Present examples are the large numbers of trafficking and murder of Native American women. These concerns are important to understand in our Native American organization with minority clients. Their concerns are about obesity, genetics, intergenerational/ongoing trauma, medication side effects, racism, community mistrust, lack of education, blame, confusion about diets, surgical intervention, family/friend support, and possibility of remission.

On the remitting course of brain tumors

A number of authors (Belenkaya, Volkova-Pavlova, Garkavi, Pussep, Razdolsky, etc.) pointed out the possibility of remission in brain tumors. Arais and Blazhko point out that a remitting course is characteristic of vascular tumors such as angiomas and angioreticulomas. According to Khokhlova, the relapsing course of the disease is typical for cystic degenerated brain tumors in children. Fidelgolts also believes that remissions can be caused by the formation of cysts and changes in the blood filling of tumors. Ninidze and Lyubarskaya observed significant remissions in ventricular tumors.

Discontinuation of antiseizure medications in seizure-free patients with long-term follow-up: Patients’ profile, seizure recurrence, and risk factors

ObjectiveTo compare withdrawal of antiseizure medications (ASM) to continued treatment in newly diagnosed individuals achieving seizure freedom, and assess the risk of relapse and factors associated with relapse. MethodsThis is a multicenter retrospective cohort study with long-term follow-up. Patients with newly diagnosed epilepsy were identified from the medical records of 13 Italian epilepsy centers and followed up until the most recent visit or death. Seizure-free patients discontinuing treatment were compared to patients who maintained treatment for baseline characteristics. Treatment was stopped upon clinical judgment. The probability of relapse was calculated with the Kaplan–Meier method. Demographic, clinical, and instrumental variables associated with relapse were assessed with Cox proportional hazards models. ResultsOne thousand and six patients aged 1 month to 72 years at diagnosis were enrolled and followed up for 17,892 person-years (median follow-up, 9.9 years). Three hundred and twenty patients (31.8%) underwent one or more treatment discontinuations. Factors associated with ASM withdrawal were younger age at remission and normal psychiatric examination. The probability of relapse after the first withdrawal was 16% at six months, 24% at 12 months, and 36%, 45%, and 53% at three, five, and ten years, respectively. The probability of remission after the first relapse was 59% at one month, 67%, 72, and 76% at three, six, and 12 months, respectively. Variables associated with relapse were age 14+ years, structural etiology, abnormal neuroimaging, ASM initiation after a single seizure, and symptomatic/cryptogenic epilepsy. ConclusionsAbout one half of seizure-free patients stopping ASM relapse in 10 years. However, the possibility of remission after relapse is high, particularly in children and patients with idiopathic/cryptogenic epilepsy. Treatment deprescription might be encouraged at least in these patients.

EATING DISORDERS AND PREGNANCY: LITERATURE REVIEW

This review highlights the features that affect fertility and pregnancy in women with eating disorders, possible complications and clinical management of such patients by an obstetrician-gynecologist. Such obstetric and gynecological aspects associated with eating disorders as fertility disorders, unplanned pregnancy, intrauterine growth retardation, miscarriage and premature labor, deficit of lactation and others are considered. We also describe the influence of pregnancy on the course of eating disorders: the possibility of remission, followed by a high risk of relapse, postpartum depression and anxiety disorders. Moreover, we talk about the necessity of screening eating disorders among women of reproductive age and the importance of multidisciplinary management of pregnancy in such patients.

Prognostic value of phospholipase A2 receptor in primary membranous nephropathy: a systematic review and meta-analysis.

We aimed to evaluate the prognostic value of serum anti-PLA2R and glomerular PLA2R deposit (gPLA2R) in predicting remission of proteinuria in Primary Membranous Nephropathy (PMN) patients. PUBMED, EMBASE, WEB OF SCIENCE, COCHRANE LIBRARY and CNKI were searched from 2008 January to December 2018. Heterogeneity was assessed by Cochran Q test and I2. Source of heterogeneity was explored by subgroup analysis and sensitivity analysis. Totally 2345 patients from 29 cohort studies were eligible for inclusion. The results suggested that PMN patients with negative anti-PLA2R at the time of biopsy had a 1.31 times (95% CI 1.12-1.46, p < 0.05) higher possibility in achieving remission than those with positive anti-PLA2R. The clearance of anti-PLA2R at the end of immunosuppressive therapy showed an even greater chance of achieving remission (RR = 2.86, 95% CI 1.75-4.69, p < 0.05). The relative ratios for complete remission and spontaneous remission with negative anti-PLA2R were 1.65 (95% CI 1.46-1.87, p < 0.05) and 1.93, respectively (95% CI 1.53-2.45, p < 0.05), and heterogeneity percentages were I2 = 18% and 46%, respectively. The possibility for remission was significantly greater among PMN patients with negative gPLA2R (RR = 1.30, 95% CI 1.13-1.50, p < 0.05). Subgroup analyses revealed that retrospective design of study might be the potential source of heterogeneity. Negative anti-PLA2R or gPLA2R might predict higher possibility of remission, and the presence of anti-PLA2R or gPLA2R might serve as a useful biomarker for clinical outcome and predicting response to immunosuppressive therapy in PMN.

Physician decision making in selection of second-line treatments in immune thrombocytopenia in children.

Immune thrombocytopenia (ITP) is an acquired autoimmune bleeding disorder which presents with isolated thrombocytopenia and risk of hemorrhage. While most children with ITP promptly recover with or without drug therapy, ITP is persistent or chronic in others. When needed, how to select second-line therapies is not clear. ICON1, conducted within the Pediatric ITP Consortium of North America (ICON), is a prospective, observational, longitudinal cohort study of 120 children from 21 centers starting second-line treatments for ITP which examined treatment decisions. Treating physicians reported reasons for selecting therapies, ranking the top three. In a propensity weighted model, the most important factors were patient/parental preference (53%) and treatment-related factors: side effect profile (58%), long-term toxicity (54%), ease of administration (46%), possibility of remission (45%), and perceived efficacy (30%). Physician, health system, and clinical factors rarely influenced decision-making. Patient/parent preferences were selected as reasons more often in chronic ITP (85.7%) than in newly diagnosed (0%) or persistent ITP (14.3%, P = .003). Splenectomy and rituximab were chosen for the possibility of inducing long-term remission (P < .001). Oral agents, such as eltrombopag and immunosuppressants, were chosen for ease of administration and expected adherence (P < .001). Physicians chose rituximab in patients with lower expected adherence (P = .017). Treatment choice showed some physician and treatment center bias. This study illustrates the complexity and many factors involved in decision-making in selecting second-line ITP treatments, given the absence of comparative trials. It highlights shared decision-making and the need for well-conducted, comparative effectiveness studies to allow for informed discussion between patients and clinicians.

Alopecia areata.

Alopecia areata is an autoimmune disorder characterized by transient, non-scarring hair loss and preservation of the hair follicle. Hair loss can take many forms ranging from loss in well-defined patches to diffuse or total hair loss, which can affect all hair-bearing sites. Patchy alopecia areata affecting the scalp is the most common type. Alopecia areata affects nearly 2% of the general population at some point during their lifetime. Skin biopsies of affected skin show a lymphocytic infiltrate in and around the bulb or the lower part of the hair follicle in the anagen (hair growth) phase. A breakdown of immune privilege of the hair follicle is thought to be an important driver of alopecia areata. Genetic studies in patients and mouse models have shown that alopecia areata is a complex, polygenic disease. Several genetic susceptibility loci were identified to be associated with signalling pathways that are important to hair follicle cycling and development. Alopecia areata is usually diagnosed based on clinical manifestations, but dermoscopy and histopathology can be helpful. Alopecia areata is difficult to manage medically, but recent advances in understanding the molecular mechanisms have revealed new treatments and the possibility of remission in the near future.

Physician Factors Determining Treatment Decisions in Selecting Second Line Agents for Pediatric ITP

Background: Decision-making in selecting second-line therapies for pediatric patients with immune thrombocytopenia (ITP) has not been studied. Using data collected from physicians experienced in treating ITP, we developed a conceptual model of factors that informed treatment choice. This study was a component of ICON1, a prospective, observational, longitudinal cohort study of second line treatments for childhood ITP performed by the Pediatric ITP Consortium of North America (ICON).Methods: Physicians who enrolled patients in ICON1 were asked to rank the top three reasons they chose a specific treatment so as to weight each factor. Those choices that were ranked 1, 2, or 3 were weighted to develop a propensity scored decisional model. In other questions, physicians were asked about all factors that may have influenced decisions to begin a particular second line therapy and this data was then used to examine additional factors that influenced therapy choices and to compare between therapies.Results: ICON1 enrolled 118 patients; 101 had primary ITP and 53 were receiving their first second line therapy. The majority of physicians in the study saw eleven or more patients per year, and the time since completion of fellowship ranged from 1 to 44 years (mean 12.5 (SD 11)).The most important factors guiding treatment decisions in propensity weighted modeling were "patient preference factors": patient/parental preference (40%), and treatment-related factors: possibility of remission (38%), side effect profile (36%), efficacy (27%), long-term toxicity (33%), and ease of administration (30%). Physician factors, such as experience and adhering to published guidelines, rarely influenced decision-making with only 2% of physicians giving published guidelines as a reason for choice of therapy, and there being no difference in choice based on years since fellowship or experience in treating ITP patients. However, 28% of physicians stated their comfort level with a treatment strongly influenced their choice. Additionally, 38% of physicians did not endorse any patient clinical factors (e.g. frequency of bleeding, expected compliance, response to other therapies, age, comorbidities) as key in their decision-making. Health system factors, such as insurance approval or distance from the closest medical center, rarely influenced treatment choice.Treatments could be categorized into five groups: oral immunosuppressive agents, rituximab, romiplostim, eltrombopag or splenectomy. A significant determinant of choosing splenectomy or rituximab was the "possibility of long-term remission" (p<0.001). A high percentage of treatment factors impacted the decision to prescribe: for rituximab 92% of physicians endorsed at least one treatment factor; for oral immunosuppressants, and romiplostim and eltrombopag, 100% of physicians endorsed at least one treatment factor. Among the top 3 choices for each medication, treatment related factors were major determinants (Table). Oral agents, were significantly more likely to be chosen for ease of administration and expected adherence (p<0.001). When examining the reasons physicians chose particular therapies, physicians indicated "this agent is most efficacious" most frequently for romiplostim, but not for eltrombopag (p<0.001) and were more likely to choose rituximab in patients in whom there was lower expected compliance (p=0.017).Conclusions: This first analysis of physician decision making regarding second line therapies shows that patient preference and physician perception of treatment characteristics (efficacy, side effects, possibility of long term remission) are primary drivers of physician choice in contrast to guidelines, clinical characteristics and health system factors. Future comparative effectiveness studies are necessary to better inform patient and physician choice. [Display omitted] DisclosuresLambert:Novartis: Consultancy. Grace:Agios Pharmaceuticals: Other: Scientific Advisor, Research Funding. Bussel:Cangene: Research Funding; GSK: Consultancy, Honoraria, Membership on an entity’s Board of Directors or advisory committees, Research Funding; Ligand: Membership on an entity’s Board of Directors or advisory committees, Research Funding; Sysmex: Research Funding; Symphogen: Membership on an entity’s Board of Directors or advisory committees; BiologicTx: Research Funding; Shionogi: Membership on an entity’s Board of Directors or advisory committees; Physicians Education Resource: Speakers Bureau; Protalex: Membership on an entity’s Board of Directors or advisory committees, Research Funding; Immunomedics: Research Funding; Rigel Pharmaceuticals: Membership on an entity’s Board of Directors or advisory committees, Research Funding; Boehringer Ingelheim: Research Funding; Novartis: Consultancy, Honoraria, Membership on an entity’s Board of Directors or advisory committees, Research Funding; UpToDate: Patents & Royalties; Momenta Pharmaceuticals: Membership on an entity’s Board of Directors or advisory committees; Prophylix Pharma: Membership on an entity’s Board of Directors or advisory committees, Research Funding; Genzyme: Research Funding; Eisai: Membership on an entity’s Board of Directors or advisory committees, Research Funding; Amgen: Consultancy, Honoraria, Membership on an entity’s Board of Directors or advisory committees, Research Funding. Haley:Baxalta: Membership on an entity’s Board of Directors or advisory committees; CSL Behring: Honoraria. Neufeld:Novartis: Consultancy.

Treating rheumatoid arthritis to target: physician and patient adherence issues in contemporary rheumatoid arthritis therapy.

Development of the treat-to-target (T2T) strategy, the process whereby drug therapy is adjusted until the therapeutic goal is achieved, has revolutionized how rheumatoid arthritis (RA) patients are treated. With the advent of T2T, the management of RA is more effective than ever, with the possibility of remission and other favorable clinical and patient-reported outcomes. Effective implementation of a T2T strategy in routine clinical practice mainly depends on the long-term commitment of physician and patient to T2T treatment recommendations. However, as T2T is a complex process involving aggressive early management with several steps of therapy modifications requiring frequent close monitoring of disease activity and drug toxicities, it may be more liable to suboptimal adherence in real-life clinical practice. The aim of the review is to present key issues related to patient medication adherence and physician adherence to the current RA treatment recommendations and their importance in optimizing the outcome of treatment in RA treated according to T2T strategy.

Plasma exchange and chelator therapy rescues acute liver failure in Wilson disease without liver transplantation.

Wilson disease (WD) in patients with a New Wilson Index (NWI) score ≥ 11 is fatal, and these patients are good candidates for liver transplantation (LT). However, plasma exchange and chelator therapy are indispensable and effective even for WD with a score ≥ 11. Moreover, continuous hemodiafiltration (CHDF) with these treatments is essential for acute liver failure (ALF) in WD with hepatic encephalopathy because CHDF can exclude toxic metabolites that may cause damage to the brain. Here, we describe four rescued patients presenting with ALF in WD and discuss the available treatment options. We have experienced 11 male and 8 female patients presenting with WD at the Department of Pediatrics, Kumamoto University Hospital between 1999 and 2014. A male and 4 female patients were diagnosed as WD with ALF using a combination of clinical findings and biochemical tests. The NWI score was ≥ 11 in cases 1 to 3. Cases 1 and 2 with hepatic encephalopathy received plasma exchange, CHDF, coagulation factor replacement treatment (CFRT) and LT. Cases 3 and 4 without encephalopathy obtained stable status without LT by plasma exchange, blood infusion, and CFRT. It is better to undergo LT for WD patients with a NWI score ≥ 11, however, there is a possibility of remission by plasma exchange and medical therapy even without LT. WD patients with a NWI score ≥ 11can be rescued by conservative therapy when the ALF of WD does not present with ALF and hepatic encephalopathy. Therefore, ALF with hepatic encephalopathy itself is an indication for LT in WD.

Restoration of β-cell function: New hope in the treatment of type 2 diabetes mellitus

Type 2 diabetes mellitus is a chronic progressing disease.In some recent studies,hyper glycemic patients get fine control of blood glucose without any hypoglycemic agents after a period of treatment.These results suggest the possibility of remission of islet β-cell function,at least in some diabetic patients.Restoration of β-cell function brings a new hope in the treatment for type 2 diabetes mellitus. Key words: Diabetes mellitus, type 2 ; Treatment ; Islet β-cell function

Pityriasis rubra pilaris type 1 spontaneously resolving after 20 years

Pityriasis rubra pilaris (PRP) is an uncommon, idiopathic, papulosquamous eruption. We report a longitudinal study of a patient with PRP type 1 who was treated with retinoid therapy for 9 years and whose symptoms resolved spontaneously after 20 years. There are no data in the literature on the disease course of PRP type 1 persisting beyond the usual 3 years. This case highlights both the extreme chronicity of PRP and the possibility of remission after many years of active disease.

Induction of long-term normoglycemia without medication in Korean type 2 diabetes patients after continuous subcutaneous insulin infusion therapy.

Our previous studies showed that some Korean type 2 diabetic patients could maintain long-term normal blood glucose control without any medication, referred to as remission after a certain period of normalization of blood glucose level by continuous subcutaneous insulin infusion (CSII) treatment. In this study we determined the clinical characteristics that influenced the induction of remission. Ninety-one type 2 diabetes mellitus (DM) patients were treated with CSII therapy. Follow-up examinations took place monthly, for sixteen months, at an outpatient clinic where blood glucose levels and insulin dosage were monitored. Overall, in 34.4% of all subjects, remission was induced after 53.6 +/- 38.9 days of CSII therapy and lasted for an average of 13.6 +/- 8.9 months during the study period. The total daily insulin dosage given to normalize blood glucose levels reached a maximum dosage at 7.3 +/- 1.2 days and gradually decreased in all subjects. It did not significantly decrease beyond 14.4 +/- 2.7 days of therapy in patients who did not experience remission, but did continuously decrease and reached zero in patients with remission. Remission rates were higher when patients started CSII therapy with a shorter history of diabetes, lower postprandial blood glucose levels, higher body mass index (BMI), and fewer chronic diabetic complications. These findings suggest that CSII therapy can induce remission in a significant proportion of Korean type 2 DM patients. The possibility of remission is higher if the severity of glucose toxicity is lower at the initiation stage of the therapy. It is suggested that CSII therapy might be considered as an early treatment for type 2 diabetic patients.

Drug treatment of acute leukaemia. Current status.

The drug treatment of acute leukaemia has changed considerably over the past years, offering the possibility of remission and, in some cases, cure. The broad outline of treatment schedules, the drugs in current use and newer approaches to therapy are discussed. Bone marrow transplantation is described in brief, as well as the role of support therapy.

The remission period in juvenile diabetes mellitus.

The fall in exogenous insulin requirements occurring after onset of juvenile diabetes mellitus is known as the phase of remission. In a retrospective study the incidence of remission period, its length and factors influencing it were determined. Remission occurred in 20% of those children who received conventional preparations. There was no sex differece in incidence of remission. A shorter duration of ketonuria after onset of treatment increased the chance of remission. Remission did not occur in those children aged less than 5 years. The results suggest that current initial management using mono-component insulin increases the possibility of remission.