Prolonged Treatment Duration Research Articles

Factors influencing fish oil-based lipid emulsion effects in cholestatic infants

BackgroundThe efficacy of fish oil-based lipid emulsion (FOLE) in treating intestinal failure-associated liver disease and other cholestasis in children has been established. However, it has been found to be ineffective in some patients. This study aimed to identify factors negatively influencing FOLE administration. MethodsThis study included 21 patients treated with FOLE, who were less than 100 days old, and had direct bilirubin (D. Bil) levels ≥1.0 mg/dL. Differences in patient backgrounds between patients who eventually had a reduction in jaundice and those who did not, as well as factors affecting treatment duration in the reduction group, were investigated. ResultsAll four patients of the non-reduction group died of cholestasis and severe comorbidities. The D. Bil level at treatment initiation was significantly higher in the no-reduction group than in the reduction group (p = 0.006). The duration of FOLE administration in the reduction group was negatively correlated with gestational age (ρ = −0.603, p = 0.01). In contrast, a positive correlation was observed between age (ρ = 0.708, p = 0.002) and the D. Bil level at treatment initiation (ρ = 0.490, p = 0.046). ConclusionsFOLE treatment may be ineffective in patients with severe comorbidities. Preterm birth, high D. Bil levels, and older age at treatment initiation may be factors that result in prolonged treatment duration. Level of evidenceIII

Telephone follow-up contributes to improving adherence and treatment duration in patients with hepatocellular carcinoma treated with lenvatinib.

This study aimed to investigate whether telephone follow-up by clinical pharmacists for unresectable hepatocellular carcinoma (HCC) patients treated with lenvatinib (LEN) contributes to improved adherence and treatment duration for LEN. This retrospective study enrolled 132 patients with HCC who were treated with LEN. The patients were classified into non-telephone follow-up (n=32) or telephone follow-up groups (n=100) [the latter group was further classified into family-pharmacist (FP) telephone follow-up (n=18), or hospital family-pharmacist (HFP) telephone follow-up (n=82) groups]. The progression-free survival (PFS) in the telephone follow-up group was significantly higher than that in the non-telephone follow-up group (PFS 6.1months vs 3.7months, P=0.001, respectively). Although treatment duration was significantly longer in the telephone follow-up group than in the non-telephone follow-up group [median treatment duration: 10.4months vs 4.1months, P=0.001, respectively.], no significant differences were noted between the HFP telephone follow-up group and FP telephone follow-up groups (10.3months vs 13.3months, P=0.543). Self-interruption and adverse-event discontinuation in the HFP-telephone follow-up group were significantly lower than those in the FP-telephone and non-telephone groups (0% vs 11.1% vs 18.8%; P<0.001, 25.6% vs 33.3% vs 53.1%; P=0.022, respectively). Telephone follow-up contributes to prolonged treatment duration for LEN in patients with HCC treated. Moreover, telephone follow-up with an HFP may further improve treatment adherence.

Impact of a Multifaceted Intervention on Antibiotic Prescribing for Cystitis and Asymptomatic Bacteriuria in 23 Community Hospital Emergency Departments.

Background: Urinary tract infections (UTIs) are over-diagnosed and over-treated in the emergency department (ED) leading to unnecessary antibiotic exposure and avoidable side effects. However, data describing effective large-scale antimicrobial stewardship program (ASP) interventions to improve UTI and asymptomatic bacteriuria (ASB) management in the ED are lacking. Methods: We implemented a multifaceted intervention across 23 community hospital EDs in Utah and Idaho consisting of in-person education for ED prescribers, updated electronic order sets, and implementation/dissemination of UTI guidelines for our healthcare system. We compared ED UTI antibiotic prescribing in 2021 (post-intervention) to baseline data from 2017 (pre-intervention). The primary outcomes were the percent of cystitis patients prescribed fluoroquinolones or prolonged antibiotic durations (>7 days). Secondary outcomes included the percent of patients treated for UTI who met ASB criteria, and 14-day UTI-related readmissions. Results: There was a significant decrease in prolonged treatment duration for cystitis (29% vs 12%, P < .01) and treatment of cystitis with a fluoroquinolone (32% vs 7%, P < .01). The percent of patients treated for UTI who met ASB criteria did not change following the intervention (28% pre-intervention versus 29% post-intervention, P = .97). A subgroup analysis indicated that ASB prescriptions were highly variable by facility (range 11%-53%) and provider (range 0%-71%) and were driven by a few high prescribers. Conclusions: The intervention was associated with improved antibiotic selection and duration for cystitis, but future interventions to improve urine testing and provide individualized prescriber feedback are likely needed to improve ASB prescribing practice.

Clinical significance of thyroglobulin antibodies and thyroid peroxidase antibodies in Graves' disease: a cross-sectional study.

The significance of thyroglobulin antibodies (TgAbs) and thyroid peroxidase antibodies (TPOAbs) in Graves' disease (GD) remains unclear. Therefore, this study aimed to clarify the clinical significance of TgAbs and TPOAbs in GD. A total of 442 patients with GD were recruited and divided into four groups based on TgAb and TPOAb positivity. Their clinical parameters and the characteristics of the groups were compared. Cox proportional hazard regression analysis was performed to assess risk factors for GD remission. The free triiodothyronine (FT3) level was significantly higher in groups positive for TgAbs and TPOAbs than in the other groups. The FT3 to free thyroxine (FT4) (FT3/FT4) ratio was significantly higher and thyrotropin-stimulating hormone (TSH) receptor antibodies (TRAbs) were significantly lower in the TgAb+/TPOAb- group. Time to FT4 recovery was significantly shorter for groups negative for TPOAbs, whereas time to TSH recovery was significantly longer for groups positive for TPOAbs. Cox proportional hazard regression analysis revealed that TgAb positivity, prolonged treatment duration with antithyroid drugs, and Graves' ophthalmopathy treated with methylprednisolone were significantly associated with GD remission and that a smoking history, elevated FT3/FT4 ratio, and treatment with propylthiouracil hindered GD remission. The contributions of TgAbs and TPOAbs to GD pathogenesis differ. Patients positive for TgAbs develop GD with lower TRAb titers and undergo earlier remission than those negative for TgAbs. Patients positive for TPOAbs develop GD with high TRAb titers and need a long time to achieve remission.

Mannan-conjugated birch pollen allergoids reduce the combined symptom and medication score in birch pollen allergic patients already in the first treatment year and further decreases with prolonged treatment duration

The success of allergen immunotherapy for the treatment of allergic rhinoconjunctivitis is most evident during the respective pollen season. Here, we evaluated the combined symptom and medication score (CSMS) from 3 studies in patients with allergic rhinoconjunctivitis treated with mannan-conjugated birch pollen allergoids (T502).

“I Need You!” Patients’ Care Dependency Patterns During Psychotherapy for Personality Disorders and Its Association with Symptom Reduction and Wish for Treatment Continuation

Different views exist regarding the nature of patients’ dependency in psychotherapy (trait versus contextual dependency), and its impact on treatment outcome and duration. Therefore we examined whether patients’ levels of care dependency changed over time during a 9-month treatment period, and whether care dependency was related to symptom reduction and patients’ wish for treatment continuation at the end of the treatment. Participants in this longitudinal study were 113 patients (Mage = 33.6, 78% female) with personality disorders receiving inpatient or daycare group psychotherapy. Both increases and decreases on different aspects of care dependency were found over the course of treatment. Decreases in dependency were related to larger symptom reduction, and higher levels of care dependency, especially patients’ lack of perceived alternative options for the current treatment, were related to patients’ stronger wish to continue their treatment. Changes in care dependency during treatment mainly supports the contextual view on patients’ care dependency, and decreasing levels of dependency may have beneficial treatment effects. However, dependency may also lead to prolonged treatment duration. Clinical implications for therapists are presented.

Detection of Brucellosis in dairy cows at Goshta and Mohmand Dara Districts of Nangarhar Province, Afghanistan

Background: Brucellosis is an infectious zoonotic diseases caused by a gram-negative, facultative, intracellular bacterial organism of the genus Brucella that is harmful to many animal and human species. The purpose of this study was to assess the detection of Brucellosis as well as potential risk variables linked with districts, breeds (Local, HF, and Jersey) and age (2-4, 5-7, and more than 7 years). Materials and Methods: In the current investigation, 150 blood and milk samples were obtained from the districts of Goshta and Mohmand Dara and analyzed for Brucella antibodies using the Milk Ring Test (MRT), the Rose Bengal Plate Test (RBPT), and the Standard Tube Agglutination Test (STAT). Findings: A total of 150 samples were evaluated for this investigation, and 30 (20%) of them tested positive for brucellosis. Among these 30 positive cases, 19 (63.33%) were positive in Goshta district and 11 (15.7%) were positive in Mohmand Dara district. Out of 30 positive samples, 19 (63.33%) were positive in local dairy cows, 5 (16.66%) in HF, and 6 (20.00%) in Jersey breeds. According to results of present study, a significant association was documented between brucellosis and age of the dairy cows as higher prevalence was recorded for 5-7 years old (X2=10.500, P=0.005). In a comparison of serum and milk antibody detection assays, it was found that serum had a greater antibody detection rate than milk. Conclusion: This study uses MRT, RBPT, and STAT as screening tools to add some information about the frequency of brucellosis in dairy cows breeds that are available in the Mohmand Dara and Goshta areas. The prevalence of brucellosis was higher in local dairy cows compared to other dairy breeds. Brucellosis' significance to the dairy sector and its possible effects on people's health such as zoonotic effects, antibiotics resistance, relapse of the diseases, prolonged treatment duration, side effects of antibiotics and limited treatment options during pregnancy.

958. Is Dalbavancin a Reliable Treatment Option in Socially Challenged Populations?

Abstract Background Dalbavancin (DAL) is a lipoglycopeptide antibacterial that was granted full FDA approval for the treatment of acute bacterial skin and skin structure infections (ABSSSI) in 2014. Due to its long terminal half-life of 14.4 days, DAL has been used off-label to treat infections that require a prolonged duration of treatment, especially in patients with challenging social situations. We aimed to evaluate the differences in outcomes and clinical effectiveness of DAL, primarily in deep-seated infections in an academic health system. Methods We performed a retrospective review of all the adult patients ( &amp;gt;18 years old) with DAL orders within our health care system between January 1st, 2016, and July 16th, 2021. Baseline characteristics were collected, including age, gender, race, history of illicit drug use disorder (IDUD), diagnosis, and recommended DAL regimen. Follow-up data, including completion of treatment, outpatient visits to infectious diseases clinic, and recurrence of infection within six months, were also collected. Results A total of 50 patients were identified during the study time frame. The median age was 45.5 years, 62% were male, 82% were white, and 62% had a history of IDUD (Table 1). DAL was used predominantly to treat bone and joint infections (e.g., osteomyelitis, septic arthritis), followed by bacteremia, endocarditis, and ABSSSI (Table 1). The most common regimen used is 1500 mg weekly for two doses. Patients with a history of IDUD are less likely to complete the recommended treatment regimen (64.5% vs. 100%; p=0.003), and less likely to follow in the infectious disease clinic (16.1% vs. 52.6%, p=0.016) when compared to patients with no history of IDUD. Twelve patients had either objective evidence or clinical suspicion for recurrence within six months. Although there was a trend for higher recurrence among patients with IDUD (29% vs. 16%), there was no statistical difference with a p-value of 0.332 (Table 2). In addition, DAL was well-tolerated among most patients. Table 1.Baseline characteristics of the study population. Table 2. Outcomes of patients with dalbavancin orders. Conclusion Although DAL is a safe and convenient antimicrobial option, more efforts should be made to establish consistent treatment regimens for its off-label use. Those with social barriers such as IDUD might benefit from additional measures to ensure treatment completion and proper follow-up. Disclosures All Authors: No reported disclosures.

411: CEFAZOLIN VERSUS NAFCILLIN IN THE TREATMENT OF MSSA ENDOCARDITIS

Introduction: Methicillin-sensitive Staphylococcus aureus (MSSA) is associated with considerable mortality, particularly in infections such as infective endocarditis (IE). Current guidelines endorse nafcillin (NAF) as first-line therapy for MSSA IE, while cefazolin (CFZ) is an alternative for patients with penicillin allergy. Reluctance in using CFZ stems from the inoculum effect, a phenomenon of reduced CFZ susceptibility in the presence of high organism burden. CFZ is more conveniently dosed with a favorable safety profile, positioning it as an appealing option for the prolonged treatment duration required for IE. New evidence suggests similar rates of clinical failure between CFZ and NAF in MSSA bacteremia, but data in IE, where organism inoculum is higher, is limited. This study compares the effectiveness and safety of CFZ and NAF in patients with MSSA IE. Methods: This multicenter retrospective cohort study included patients with definite or possible MSSA IE from 2015-2021. Subjects were treated with CFZ or NAF within 48 hours of MSSA identification. The primary outcome examined 30-day all-cause mortality, persistent bacteremia, and changes in agent due to treatment failure. Secondary outcomes are treatment failure, and adverse events. Results: Among 140 patients, 111 received CFZ and 29 were treated with NAF. While groups had comparable durations of antibiotic therapy, CFZ patients experienced significantly shorter hospital stays at a median of 15 days compared to 24 days in the NAF group. There was no significant difference between 90-day mortality, readmission, or reinfection between treatment groups, although NAF showed a significantly increased incidence of persistent bacteremia. Beyond this, treatment NAF led to more LFT elevations, acute kidney injury and a higher rate of antimicrobial switches. Conclusions: CFZ demonstrated comparable effectiveness to NAF in the treatment of MSSA IE. Significantly fewer patients in the CFZ group had persistent bacteremia, while patients receiving NAF required more changes in therapy. This may be reflective of the significantly higher rate of acute kidney injury and LFT abnormalities. These results emphasize that CFZ continues to be better tolerated by patients, while the prospect of treatment failure from the inoculum effect was not evident in this study.

Evaluation of Radiation Exposure Due to Dental Radiographs Taken during Endodontic Treatment Sessions in Young Permanent Teeth.

Background and Objectives: The aim of this study was to retrospectively analyze the duration of treatment and the number of dental radiographs taken during endodontic treatment (endo-t) of young permanent teeth (YPT). Materials and Methods: Age, gender, affected tooth number, apex status, duration of treatment and dental radiographs taken during this period were retrospectively evaluated in pediatric patients aged 6−15 years who presented to the pedodontic department for endo-t of anterior YPT. Data were analyzed with Kruskal Wallis H, Dunn and Pearson chi-square tests. p < 0.05 was accepted as statistically significant in all analyses. Results: Anterior endo-t was initiated in 471 of 9,200 pedodontic patients between the ages of 6 and 15 years who applied to our university. The reason for seeking treatment was caries (8.1%) and trauma (91.9%). It was observed that 59% of the teeth had an open apex and 45.7% had a closed apex. A total of 1893 periapical radiographs (Per-R) and 245 panoramic radiographs (Pan-R) were taken from 471 pediatric patients during the treatment period. Total number of dental radiographs was 2138 with 4.5 per patient. Number of Per-R was lower in patients whose treatment was completed in a single session (p < 0.001). There was no difference in the number of Pan-R with respect to duration of treatment (p = 0.560). Conclusions: In children, the number of Per-R significantly increased with prolonged duration of treatment encompassing multiple sessions for endo-t procedures of anterior YPT, decided based on the apex and lesion status of the affected tooth. Especially in long-term traditional apexification treatments, treatment should be carried out in children with the ALADAIP (As Low As Diagnostically Achievable being Indication-oriented and Patient-specific) principle in mind.

Risk of recurrent thromboembolic events according to treatment duration in patients with superficial vein thrombosis treated with intermediate dose of tinzaparin.

To evaluate the risk of symptomatic venous thromboembolism (VTE) recurrence at 3months in relation to treatment duration, according to baseline risk factor profiles, in patients with superficial vein thrombosis (SVT) treated with intermediate dose of tinzaparin. We performed a pooled analysis on individual data from two prospective studies designed to assess the efficacy and safety of tinzaparin in intermediate dose (131IU/kg) in patients with SVT. Treatment duration was at the treating physician's discretion. All patients were followed up for at least 3months. A total of 956 patients (65% female, mean age 58.7 ± 13.7years) were included. The median treatment duration was 30days (range, 3-200days). History of deep vein thrombosis (DVT), location of SVT above the knee, and palpable induration were the only independent factors associated with prolonged treatment duration. During follow-up, 95.9% of patients were event free. Outcomes-related adverse events occurred in 39 (4.1%) patients and their median duration of treatment was 33days (range, 7-200days). Recurrent VTE events occurred in 33 patients, including 22 cases of SVT recurrence, 8 cases of DVT, and 1 case of pulmonary embolism. The median time to the event was 29 (6-113) days. Recurrent thromboembolic events were not related to treatment duration as occurred in 17 patients (51.5%) treated up to 30days and in 16 patients (48.8%) received prolong treatment (p = .46). Length of thrombus at the index event was significantly associated with higher risk for VTE recurrence. Intermediate dose of tinzaparin for 30days is an effective and safe treatment for SVT. The risk of recurrent VTE events may be higher in patients with greater amount of thrombus at index event.

Treatment of Herpes Simplex Virus Type 2 Meningitis: A Survey Among Infectious Diseases Specialists in France, Sweden, Australia, and Denmark.

We aimed to describe attitudes toward treatment of herpes simplex virus type 2 (HSV-2) meningitis and prioritize future trials. This was a self-administered online survey of HSV-2 meningitis treatment among infectious diseases (ID) specialists in France, Sweden, Australia, and Denmark. A total of 223 ID specialists (45% female) from France (36%), Denmark (24%), Sweden (21%), and Australia (19%) participated in the survey, primarily from university hospitals (64%). The estimated overall response rate was 11% and ranged from 6% (Australia) to 64% (Denmark). Intravenous (IV) acyclovir followed by oral valacyclovir was the favored treatment in 110 of 179 (61%), whereas monotherapy with either IV acyclovir or oral valacyclovir was used by 35 of 179 (20%) and 34 of 179 (19%), respectively. The median total duration was reported to be 7 days (interquartile range, 7-10 days) regardless of antiviral regimen. Immunocompromise influenced decisions on antiviral treatment in 110 of 189 (58%) of respondents, mainly by prolonged total duration of treatment (36/110 [33%]), prolonged IV administration (31/110 [28%]), and mandatory antiviral treatment (25/110 [23%]). Treatment with acyclovir/valacyclovir versus placebo and comparison of acyclovir versus valacyclovir were assigned the highest prioritization scores for future randomized controlled trials on HSV-2 meningitis. Perceptions of indications for as well as type and duration of antiviral treatment varied substantially among ID specialists.

He–Ne Laser Priming Enhances Drought Tolerance in Wheat through Differential Modification of Photosynthetic Pigments and Antioxidative Enzymes

Water stress seriously impacts agro-systems worldwide, severely affecting plant growth and crop productivity. Radio-priming agents such as lasers can induce stress tolerance in plants due to their physiological roles in growth and development. The potential protective role of He–Ne laser pretreatment (i.e., one, two and five min at 630 nm) was evaluated in germination and growth of two wheat varieties, FSD-2008 and Anaj-2017, under water-stressed (50% field capacity) environments. Drought and laser priming significantly affected the growth (shoot and shoot fresh and dry weight and lengths), grain yield (number of total and fertile tillers and 100-grain weight), biochemical attributes (total soluble proteins and total free amino acids), and ionic concentration of both tested wheat varieties. In this study, the 2 min laser priming treatments were most effective for protecting wheat plants from drought stress. While the prolonged treatment duration significantly inhibited growth. We conclude that laser pretreatment assisted wheat plants in sustaining biomass assimilation, growth and yield formation by protecting their pigments and key metabolites from drought-induced oxidative injury. This study suggested that 2 min of laser priming had a much better result than other time duration, i.e., 1 and 5 min of laser priming.

Analysis of associated risk factors among recurrent cutaneous leishmaniasis patients: A cross-sectional study in Khyber Pakhtunkhwa, Pakistan

BackgroundLeishmaniasis is the second and fourth highest cause of mortality and morbidity respectively among all tropical diseases. Recurrence in the onset of leishmaniasis is a major problem that needs to be addressed to reduce the case fatality rate and ensure timely clinical intervention. Here we are investigating the association of risk factors with recurrent cutaneous leishmaniasis to address this issue. Material and methodsPatients received by Nasser Ullah Khan Babar Hospital in Peshawar, Pakistan from March 2019 to July 2020 were enrolled in this study. Those patients who developed symptoms after completion of treatment were included in Group-A while those who had atypical scars like leishmaniasis but were negative for cutaneous leishmaniasis were included in the comparison group tagged as Group B. All those individuals who had completed six weeks of treatment for CL but had normal complete blood counts (CBC) were included to avoid other underlying immunological pathologies, while we excluded those participants who had co-morbidities like diabetes, liver disease, cardiac disease, and pregnant and lactating women through their history Association was tested between Group-A and Group-B with other explanatory variables through chi-square test. The regression model was proposed to determine the predictors. ResultA total of 48 participants of both sexes were included in the study with a mean age of 32.2 ± 15.10. The data suggest that females are overrepresented among the patients with recurrent leishmaniasis [21(53.8 %,); p = 0.07]. Compared to patients; healthy participants had a higher proportion of adults (19–59 years) versus adolescents (13–18 years) [26(66.7 %) vs 07(17.9), p = 0.004]. Multivariate logistic regression analysis shows that females are 2.1 times more prone to infections among cases as compared to healthy individuals [unadjusted OR 2.20, 95 % confidence interval (CI) 1.5–10.6, p = 0.02; adjusted OR 2.1, 95 % CI 1.50–10.69, p = 0.02]. We propose that patients receiving intradermal were less likely to be infected as compared to those receiving intralesional injections [unadjusted OR 0.07.0, 95 % confidence interval (CI) 1.18–3.37, p = 0.03; adjusted OR 0.06, 95 % CI 1.18–3.38, p = 0.03]. ConclusionOld age (adults) and sex (females) were the strongest predictors to be associated with recurrent leishmaniasis. Similarly, the choice of intradermal as compared to intralesional injection and the prolonged treatment duration were strongly associated with greater chances of recurrence.

Dynamic Compression Therapy for Pectus Carinatum in Children and Adolescents: Factors for Success

BackgroundPectus carinatum (PC) is a congenital chest wall deformity. In childhood, it is increasingly treated with dynamic compression therapy. Factors for success for dynamic brace therapy are relatively unknown. MethodsBetween 2013 and 2020, 740 patients treated with the Dynamic Compression System (DCS), were studied. This included the effect of age, gender, pectus height, symmetry and pectus rigidity on treatment time and symptoms with linear multiple regression analyses. ResultsCarinatum height and high pressure of initial correction at the start of treatment were associated with a prolonged duration of treatment. For each cm increase in carinatum height, the total treatment duration increased with 1.9 months (p-value= 0.002, 95% CI: 0.70–3.13). An initial correction pressure of ≥7.6 pounds per square inch (psi), increased the treatment duration with 3.5 months (p-value 0.006, 95% CI: 1.04–6.01) compared to an initial correction pressure of ≤5.0 psi. A high initial pressure of correction of ≥7.6 psi increased the odds of having somatic symptoms with 1.19 (p-value= 0.012, 95% CI: 1.04–1.45) and psychosocial symptoms with 1.13 (p-value= 0.04, 95% CI: 1.01–1.27) compared to a low initial pressure of correction of ≤5.0 psi. An initial pressure of correction of 5.1–7.5 psi increased the odds of having somatic symptoms with 1.14 (p-value 0.046, 95% CI: 1.00–1.29) compared to an initial pressure of correction of ≤5.0 psi. Patients with asymmetric chests were more likely to abandon therapy ConclusionsHigh carinatum height and high initial pressure of correction are associated with prolonged bracing treatment and a higher failure rate. Level of EvidenceIII

Efficacy of bismuth for antibiotic-resistant Helicobacter pylori strains eradication: A systematic review and meta-analysis.

Antibiotic resistance of Helicobacter pylori (H.pylori) is increasing worldwide, and bismuth quadruple therapy has been recommended as a first-line regimen in many areas. This study aimed to investigate whether bismuth would improve the eradication rate (ER) of clarithromycin-/metronidazole-/levofloxacin-resistant H.pylori strains and how much additional efficacy bismuth could achieve. PubMed, EMBASE, Web of Science, and Cochrane Central databases for randomized controlled trials were systematically searched by two independent reviewers until 15 January 2022. Pooled ERs of clarithromycin-/metronidazole-/levofloxacin-resistant H.pylori strains were compared between bismuth-containing and non-bismuth therapies. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Eight studies enrolling 340 individuals were included. The RRs of pooled ERs compared between bismuth-containing and non-bismuth therapies were 1.83 for clarithromycin-resistant strains (95% CI 1.16-2.89, pooled ER: 76.9% vs. 36.6%, p=.009, I2 =0%), 1.39 for metronidazole-resistant strains (95% CI 1.09-1.78, pooled ER: 86.8% vs. 60.9%, p=.008, I2 =37%), 2.75 for dual clarithromycin/metronidazole-resistant strains (95% CI 1.01-7.52, pooled ER: 76.9% vs. 18.2%, p=.05, I2 =0%), and 1.04 for levofloxacin-resistant strains (95% CI 0.56-1.93, pooled ER: 63.4% vs. 54.3%, p=.90; I2 =60%). Bismuth significantly increased the ERs of clarithromycin-, metronidazole-, and dual-resistant strains by 40%, 26%, and 59%, respectively. Subgroup analysis of treatment duration showed that the significantly higher eradication rate for antibiotic-resistant strains in bismuth-containing therapy than non-bismuth therapy was only observed in 14-day treatment regimens and not in 7-day regimens (p=.02 and .17, respectively). Bismuth was most effective in improving the ERs of dual-resistant H.pylori strains, followed by clarithromycin- and metronidazole-resistant strains. Prolonged treatment duration might effectively improve the efficacy of bismuth in overcoming antibiotic resistance.

Drug Survival of Oral Retinoids in Hidradenitis Suppurativa: A Real-Life Cohort Study.

IntroductionCohort studies on the use of retinoids for hidradenitis suppurativa (HS) have yielded contradicting results. As the clinical presentation of HS is heterogeneous, with different predilection sites and hallmark features, it can be hypothesized that HS phenotypes are associated with the effectiveness of specific retinoid treatments.ObjectivesThe aim of this study was to evaluate the drug survival of oral retinoids in the treatment of HS and to establish predictors for longer treatment duration.MethodsA retrospective, dual-center study was conducted in the Netherlands in adult HS patients treated with oral retinoids between 2011 and 2021. Drug survival analyses were performed through Kaplan-Meier survival curves. Additionally, Cox regression models were used to determine predictors for a longer drug survival.ResultsIn total, 102 patients were included. Overall drug survival of (low-dose) isotretinoin (n = 66) at 12 and 24 months was 44.2% and 15.5%, respectively. Termination of treatment was mostly due to ineffectiveness (26%). Presence of widespread comedones (p = 0.03) and the use of concomitant systemic medication (p = 0.04) were associated with a prolonged treatment duration. For acitretin (n = 36), the overall drug survival was 42.0% at 12 months and 37.4% at 24 months, and was also predominantly determined by ineffectiveness (28%). Interestingly, the scarring folliculitis phenotype (p < 0.05) was associated with prolonged drug survival time for acitretin treatment relative to the regular phenotype.ConclusionComparable drug survival rates at 12 months for isotretinoin and acitretin were found. HS patients with widespread comedones and the scarring folliculitis phenotype could benefit from treatment with isotretinoin or acitretin, respectively.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40257-022-00725-9.

Interleukin-1 Antagonists for the Treatment of Recurrent Pericarditis.

Although most patients with acute pericarditis will recover, a minority will have recurrent, debilitating episodes. In these patients, refractory symptoms result in high morbidity, and typically require a prolonged duration of anti-inflammatory treatment. Initially, the efficacy of colchicine in both recurrent pericarditis and periodic fever syndromes suggested the central role of the inflammasome in pericarditis. Subsequently, the success of interleukin-1 antagonists in autoinflammatory diseases prompted further investigation in recurrent pericarditis. In current clinical practice, interleukin-1 antagonists include canakinumab, anakinra, and rilonacept. Both anakinra and rilonacept have demonstrated efficacy in randomized trials of patients with recurrent pericarditis. The aim of the current review is to explain the biological rationale for interleukin-1 antagonists in recurrent pericarditis, highlight supporting clinical evidence, and emphasizing future areas of investigation.

In vitro study of the antibacterial effect of plasma surface treatment using Argon gas on orthodontic stainless steel brackets against Streptococcus mutans and Lactobacillus acidophilus

Orthodontic treatment improves dental aesthetics. However, the prolonged duration of treatment and patient's oral hygiene results in more significant biofilm buildup and boosting concentrations of acidogenic bacteria, resulting in enamel demineralization. Plasma treatment technology has developed an interest in enhancing appliances' surface properties. The present study aimed to investigate cytotoxicity and antibacterial activity represented by anti-adhesion and anti-biofilm formation of Argon plasma treatment on orthodontic brackets against Streptococcus mutans and Lactobacillus acidophilus and evaluation the effect of change in plasma exposure duration on these properties in vitro. The study included three groups, group 1: untreated stainless steel brackets, group 2: brackets treated for 15 min, and group 3: brackets treated for 30 min. S.mutans and L.acidophilus were isolated from patients undergoing fixed orthodontic treatment. Microbiological tests included adhesion assay using plate counting method and biofilm formation assay using ELISA plate reader. S. mutans&amp; L. acidophilus were cultivated in three groups, and their adherence and biofilm formation were measured and compared. The biocompatibility of treated stainless steel brackets was evaluated by MTT assay. Results showed that groups 2 &amp; 3 had better anti-adhesion and anti-biofilm activity when compared with group 1, with a significant difference between group 1 &amp;group 3, in which group 3 recorded the lowest biofilm formation and the highest anti- anti-A adhesion activity. MTT showed that groups 2 and 3 exhibited more than 80% cell viability after 24, 48, and 72 hours. Plasma surface treatment of metal brackets possesses antibacterial activity against S.mutans and L.acidophilus; alteration exposure time impacts the development of these properties. Keywords. Plasma treatment, Argon gas, orthodontic brackets, biofilm, antimicrobial.

Characterising the chronicity of dupilumab-associated ocular surface disease: an analysis of a retrospective case series.

Background/aimsTo describe the clinical presentation and treatment response of dupilumab-associated ocular surface disease (DAOSD).MethodsThis is a retrospective case series of atopic dermatitis patients with DAOSD treated with dupilumab. All consecutive patients with atopic dermatitis referred by dermatologists for suspicion of DAOSD between May 2018 and June 2020 were systemically assessed by a single ophthalmologist. Presenting signs of DAOSD, duration of treatment and associated response are described.ResultsTwenty-eight patients had DAOSD during the study period. Average age was 45.6±14.8 years and 13 (46%) were female. Average follow-up was 15±10 months. Most presentations consisted in diffuse, inflammatory conjunctivitis (n=19, 68%). Other signs included peripheral corneal infiltrates (n=7, 25%), limbal nodules (n=7, 25%) and dry eye syndrome (n=6, 21%). To control ocular symptoms, tapering of corticosteroid eyedrops was slow: taper duration of strong and mild corticosteroid eyedrops averaged 10±8 weeks and 49±34 weeks, respectively. Four patients (14%) required an increase of corticosteroid eyedrops during taper due to clinical deterioration. Corticosteroid eyedrops were still required at final follow-up among 10 patients (36%). Dupilumab was temporarily stopped in 3 patients (11%), one of which did not wish to resume dupilumab for unrelated reasons. Symptomatic improvement and/or complete resolution was achieved in 25/26 patients at follow-up (96%) with empirical treatment.ConclusionsDAOSD may follow the course of a chronic illness. Long-term corticosteroid eyedrops were required in many patients and when taper was possible, this was done after a prolonged treatment duration. Most patients’ ocular symptoms could be controlled, allowing dupilumab continuation.