Significant Risk Factor For Relapse Research Articles

Long-term results of treatment of patients with newly detected pulmonary tuberculosis

Introduction. The article is devoted to the effectiveness of the treatment of pulmonary tuberculosis with multiple (MDR) and broad drug resistance (XDR) M. tuberculosis (MBT) in patients after the end of the main course of treatment (intensive and continuation phase), which were observed with clinical cure in 3rd dispensary registration group.Aim. To study the long-term results of treatment of newly diagnosed patients with pulmonary tuberculosis with MDR and XDR MBT with the determination of significant risk factors for relapse in a megalopolis.Materials and methods. The main course of treatment was completed by 119 newly diagnosed patients with pulmonary tuberculosis with MDR or XDR TB for the period from 2013 to 2019, who were treated in anti-tuberculosis hospitals in St. Petersburg and outpatient in St. Petersburg Interdistrict Petrograd-Primorsky TB Dispensary No. 3. The patients were divided into two groups: the main group (MG) consisted of 40 people who received treatment regimens that included drugs (thioureidoiminomethylpyridinium perchlorate (perchlosone, bedaquiline, linezolid ), the control group (CG) – 79 people who received who received standard therapy, without the above drugs. The groups are comparable in clinical, radiological and bacteriological characteristics. The course of treatment was found effective in 86 (72.3%): in MG – in 34 (85.0%) people, in CG – in 52 (65.8%) people, p < 0.01. These 86 patients were transferred to the 3rd group of dispensary registration with a diagnosis of “clinical cure”.Results. Adverse treatment outcomes were analyzed, including the causes of tuberculosis recurrence. The use of drugs (perchlosone, bedaquiline, linezolid) in the complex chemotherapy of tuberculosis with MDR and XDR MBT increases the effectiveness of treatment of patients and significantly less often they have a recurrence of pulmonary tuberculosis (12.5%), compared with the group without the use of these drugs (27.8%). The most significant risk factors for relapses of drug-resistant tuberculosis: the preservation of residual cavities in the absence of bacterial excretion at the end of the main c male gender, concomitant pathology (HIV infection), past incarceration, late detection of the disease and destructive forms of tuberculosis.Conclusions. The main course of therapy was found to be effective in 86 (72.3%) in patients with MG – in 34 (85.0%) people, in CG – in 52 (65.8%) people, p < 0.01. All the patients who completed the course of therapy were transferred to the 3rd group of dispensary registration with a diagnosis of “clinical cure”. Relapses of the disease occurred much less frequently in patients receiving perchlozon, bedaquiline, linezolid in complex therapy compared with the control group.

Magnetic Resonance Imaging Can Be Used to Assess Sarcopenia in Children with Newly Diagnosed Crohn's Disease.

This study aimed to determine the proportion of patients with sarcopenia diagnosed by MRI and compare these results to bioelectrical impedance analysis (BIA). Children with newly diagnosed Crohn's disease (CD) who had MRI enterography (MRE) and BIA and had at least 12 months of follow-up were included. Total psoas muscle area (TPMA) and total paravertebral muscle (TPVM) were measured and compared to subjects' lean mass and the lean mass body index (LMBI) was assessed by BIA. 30 newly diagnosed children with CD were included (mean age 14.2 years, 53% male). Sarcopenia was found in 13 (43%) children; mean TPMA was 15.2 (1.1 SD) cm2 and TPVM 30.95 (1.7 SD) cm2. A highly positive correlation was shown for lean mass assessed by BIA and TPMA (0.706, p < 0.001) and TPVM (0.75, p < 0.001). Sarcopenia was more prevalent in boys (77% vs. 24%, p = 0.004), patients with the perianal disease (69% vs. 29%, p = 0.03), and children with sarcopenia were likely to receive anti-TNF (77% vs. 41%, p = 0.05). During the follow-up period, 16 (53%) children experienced a relapse. TPMA (HR 0.99, p = 0.018) and TPVM (HR 0.99, p = 0.031) values were statistically significant risk factors for relapse. A high proportion of patients with CD have sarcopenia at the time of the diagnosis. There is a good correlation between muscle mass assessed by MRI and BIA. Because MRI is performed in a great proportion of newly diagnosed CD patients it can also be used to assess the presence of sarcopenia.

Management of the odontogenic keratocysts from diagnosis to treatment: an algorithm derived from the comparison of a single institution experience and literature review

BackgroundThe aim of this study is to define an algorithm for the management of odontogenic keratocysts (OKCs) in order to reduce the recurrence rate (RR), morbidity and to analyse relapse risk factors. Material and MethodsThis article is a 10-years retrospective study on 67 patients treated for odontogenic keratocysts with different surgical options established on clinical and radiological evaluations. Recurrence free survival (RFS) and relapse risk factors were analysed with Kaplan-Meier method and log-rank tests, with a confidence interval set at 95 %. A literature research was performed using PubMed to find the most relevant and recent papers about the argument. ResultsFifty-five subjects were included: 38 out of 55 patients presented the disease only once, while the others 17 patients presented at least one relapse. The total amount of histological examined lesions and relative surgical procedures was 75. More aggressive treatments showed lower recurrence rate but higher morbidity; more conservative ones had better functional and aesthetic outcomes but higher recurrence rate. Considering the literature, conservative treatments plus adjuvant procedures can reduce the RR. The recurrence rate was estimated to be 25.3 % with a median time to relapse of 24 months. Multilocularity resulted a negative prognostic factor significantly associated with recurrence free survival (p = 0.048). ConclusionAccording to our results and to the literature, we propose a management algorithm from diagnosis to treatment of the OKCs based on dimensions and internal arrangement of lesions, type (primary lesion or recurrence), presence of bony erosions, noble structure/teeth involvement. Multilocularity represented a statistically significant risk factor for relapse.

The Impact of Graft CD3+ T-Cell Dose on the Outcome of T-Cell Replete Human Leukocyte Antigen-Mismatched Allogeneic Hematopoietic Peripheral Blood Stem Cells Transplantation.

Data on whether the graft CD3-positive (CD3+) T-cell dose in T-cell-replete human leukocyte antigen (HLA)-mismatched allogeneic hematopoietic peripheral blood stem cells transplantation (PBSCT) influences post-transplant outcomes are controversial. Using King Hussein Cancer Center (KHCC) Blood and Marrow Transplantation (BMT) Registry database, 52 adult subjects, receiving the first T-cell-replete HLA-mismatched allogeneic hematopoietic PBSCT for acute leukemias or myelodysplastic syndrome, were identified, from January 2017 to December 2020. The cutoff value of graft CD3+ T-cell dose was identified using the receiver operating characteristic (ROC) formula and Youden's analysis. Subjects were divided into two cohorts: cohort 1 with low CD3+ T-cell dose (n = 34) and cohort 2 with high CD3+ T-cell dose (n = 18). Correlative analyses were performed between CD3+ T-cell dose and the risk of graft-versus-host disease (GvHD), relapse, relapse-free survival (RFS), and overall survival (OS). P-values were two-sided and considered significant when P < 0.05. Subject covariates were displayed. Subject's characteristics were comparable, except for higher nucleated cells and more female donors in the high CD3+ T-cell cohort. The 100-day cumulative incidence of acute GvHD (aGvHD) was 45±7% and 3-year cumulative incidence of chronic GvHD (cGvHD) was 28±6.7%. There was no statistically significant difference between the two cohorts in aGvHD (50% vs. 39%, P = 0.4) or cGvHD (29% vs. 22%, P = 0.7). The 2-year cumulative incidence of relapse (CIR) was 67.5±16.3% for low compared with 14.3±6.8% for high CD3+ T-cell cohort (P = 0.018). Fifteen subjects relapsed and 24 have died, 13 due to disease relapse. There was an improvement in 2-year RFS (94% vs. 83%; P = 0.0022) and 2-year OS (91% vs. 89%; P = 0.025) in low CD3+ T-cell cohort compared with high CD3+ T-cell cohort. Graft CD3+ T-cell dose is the only significant risk factor for relapse (P = 002), and OS (P = 0.030) in univariate analysis which was maintained in multivariate for relapse (P = 0.003), but not for OS (P = 0.050). Our data suggest that high graft CD3+ T-cell dose is associated with lower risk of relapse, and might improve long-term survival, but has no influence on the risk of developing aGvHD or cGvHD.

The risk assessment of relapse among newly enrolled participants in methadone maintenance treatment: A group-LASSO based Bayesian network study.

Relapse is a great barrier to improving the effectiveness of methadone maintenance treatment (MMT). Participants with different treatment durations could vary in their compliance with MMT, which may lead to different levels of relapse risk. This study aims to identify the risk factors for relapse and assess the relapse risk of MMT participants of different treatment durations. This retrospective study used data collected from seven MMT clinics in Guangdong Province, China, from January 2010 to April 2017. Newly enrolled participants who received 6 (n = 903) and 12 (n = 710) months of consecutive treatment with complete data were included. We selected significant risk factors for relapse through the group lasso regression and then incorporated them into Bayesian networks to reveal relationships between factors and predict the relapse risk. The results showed that participants who received 6-month treatment had a lower relapse rate (32.0%) than those of 12-month treatment (39.0%, P < 0.05). Factors including personal living status and daily methadone dose were only influential to those who received the 6-month treatment. However, age, age at the initial drug use, HIV infection status, sexual behaviors, and continuous treatment days were common factors of both durations. The highest relapse risk for those after the 6-month treatment was inferred as 66.7% while that of the 12-month treatment was 83.3%. Farmers and those who have high accessibility to MMT services may require additional attention. It is necessary to implement targeted interventions and education based on the treatment durations of participants to decrease the relapse rate. Meanwhile, those about HIV/sexually transmitted infection prevention and anti-narcotics should be held in the whole process.

Long-Term Real-World Effectiveness of Aripiprazole Once-Monthly. Treatment Persistence and Its Correlates in the Italian and Spanish Clinical Practice: A Pooled Analysis.

BackgroundOne of the most significant risk factors for relapse and hospitalization in schizophrenia is non-adherence to antipsychotic medications, very common in patients with schizophrenia. The aim of this analysis was to evaluate the treatment persistence to aripiprazole once-monthly (AOM) and the factors affecting it in the pooled population of two similar studies performed previously in two different European countries.MethodsPooled analysis of two non-interventional, retrospective, patient record-based studies: DOMINO and PROSIGO. Both analyzed treatment persistence after starting AOM treatment in the real-world setting. The primary variable was persistence with AOM treatment during the first 6 months after treatment initiation. A multivariate Cox regression model was used to evaluate the influence of several baseline characteristics on the persistence.ResultsThe study population comprised 352 patients included in the two studies, DOMINO (n = 261) and PROSIGO (n = 91). The overall persistence with AOM treatment at the end of the 6-month observation period was 82.4%. The multivariate analysis showed that patients with “secondary school” level of education present a 67.4% lower risk of discontinuation within 6 months after AOM initiation when compared with “no/compulsory education patients” (p = 0.024). In addition, patients with an occupation present a 62.7% lower risk of discontinuation when compared with unemployed patients (p = 0.023). Regarding clinical history, patients with a Clinical Global Impression—Severity scale (CGI-S) score ≤3 present a 78.1% lower risk of discontinuation when compared with patients with a CGI-S score ≥6 (p = 0.044), while patients with a time since schizophrenia diagnosis ≤8.4 years present a 52.9% lower risk of discontinuation when compared with the rest of patients (p = 0.039).ConclusionThe AOM persistence rate observed in this study was 82.4%, which was higher than that reported in clinical trials, aligned with other real-life studies and higher than reported for other long-acting injectable antipsychotics. The persistence rate was high in complex patients, although patients with higher level of education, active occupation, lower initial CGI-S score and shorter time since the diagnosis of schizophrenia appear to be more likely to remain persistent with AOM during the 6 months after initiation.

Le Fort I osteotomy with segmentation for the treatment of maxillary dentoalveolar protrusion: a single-centre, 10-year outcome study

A retrospective study was conducted to evaluate the stability and complications of Le Fort I osteotomy with segmentation for the treatment of bimaxillary dentoalveolar protrusion. A total of 120 consecutive patients who had undergone orthognathic surgery between 2008 and 2017 at a single centre were recruited. Lateral cephalometric radiographs were taken before surgery, within 6 weeks after surgery, and at 2 years after surgery. U1–SN and U1–PP underwent mean uprighting of 8.7° and 9.6°, respectively, and mean relapse of 2.1° and 2.6°, respectively (both P < 0.05). The only significant risk factor for relapse was the use of intermaxillary fixation (risk ratio (RR) 1.2, P = 0.01). The most common complication was wound dehiscence (41.7%), which was a significant risk factor for wound infection (RR 3.3, P < 0.01) and fixation hardware exposure (RR 3.7, P < 0.01). Other common complications were gingival recession (40.8%), periodontal bone loss (40%), and blood loss requiring transfusion (26.7%), the latter of which was associated with the preoperative diagnosis of vertical maxillary excess (RR 2.4, P = 0.01). Some degree of relapse occurred in more than 90% of the patients by 2 years after surgery. The procedure is not without risks and complications but may be useful in severe cases.

Autologous Stem Cell Transplantation For Adult Burkitt Lymphoma In The Rituximab Era: A Retrospective Study Of The Lymphoma Working Party (LWP) Of The European Group For Blood and Marrow Transplantation (EBMT)

IntroductionThe role of autologous stem cell transplantation (ASCT) for Burkitt Lymphoma (BL) in adults in the era of modern intensive chemotherapeutic regimes remains to be defined. The addition of Rituximab has been shown to improve outcomes in patients with BL, but how this influences outcomes for patients receiving ASCT is not clear. Prior studies of ASCT in BL have often included large number of patients treated with outmoded CHOP-like regimes, have often included children, and have combined outcomes of BL and Burkitt-like lymphoma (BLL). MethodWe conducted a retrospective registry based analysis of adult patients who were reported to the EBMT as having a diagnosis of BL and who had received an ASCT in the period of 2000-2011. Treatment history and histology reports were collected as part of the study. ResultsData including histology reports were returned for 125 patients who received a first ASCT between 2000 and 2011. Median age was 38.5y (range 16-64); 89 patients (71%) were male. While the diagnosis by pathology report was considered to be classic BL in 97 (78%) cases, the diagnostic possibility of BLL or atypical BL was considered in 28 (22%) cases. Twenty-one patients (17%) had stage I/II and 99 (80.5%) had stage III/IV disease. Fifty-one patients (53.7%) received Rituximab as part of 1st line treatment. Of all patients, 90 (74%), and 31 (25%) patients received ASCT in CR1/ VGPR1/PR1, and >CR1/ advanced disease (AD), respectively.5 year estimates for overall survival (OS) for the CR1 and VGPR1/PR groups were 80% and 71% respectively (p=0.23). Factor that was significant for OS in multivariate analysis (MVA) by Cox modeling, for the CR1/VGPR1/PR1 group was age <39 vs >39 (HR = 6.21 ; 95%CI 2.03-19 ; p=0.0013); status at transplant, i.e., PR1/VGPR1 vs CR1 (HR = 2.25 ; 95%CI 0.90-5.61) approached significance (p=0.081). Age >39 was the only significant risk factor for disease fee survival (DFS) in this group (HR = 3.11 ; 95%CI 1.27-7.6 ;p=0.0131). CNS involvement was a significant risk factor for relapse (HR 3.58, 95%CI 1.27-11.62, p= 0.017). Of note, administration of Rituximab as part of 1stline therapy did not appear to impact on OS or DFS. For patients receiving ASCT in CR>1 and AD, the OS was 59% and 25% respectively (p=0.042). Achievement of a subsequent CR had a significant impact on OS (HR 2.84, 95%CI 1.03-7.79, p=0.042) and DFS (HR 2.64, 95%CI 0.97-7.17, p=0.056). There was a trend for improved DFS for the BL vs the BLL patients that approached statistical significance (p=0.059). ConclusionIn this analysis of 125 adult patients with BL and BLL who received an ASCT in the era of intensive chemoimmunotherapy, disease status at transplant was the main determinant of outcome; age influenced OS and DFS for patients autografted in CR1/PR1/VGPR1. Prior Rituximab therapy did not predict post ASCT outcomes. Patients in PR1/ VGPR1 at the time of ASCT had outcomes that were not significantly inferior to those transplanted in CR1, and the former group of patients represent a subset who are most likely to derive a benefit from proceeding to an upfront ASCT. For those patients who have a chemosensitive relapse, ASCT offers the probability of salvaging a significant proportion. Patients with AD and chemoresistant disease had poor outcomes, and in such patients modalities of treatment other than ASCT should be pursued. Disclosures:Sureda:Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees. Afanasyev:Alexion: Honoraria. Dreger:Riemser Pharma: Consultancy, Honoraria, Research Funding.

Measurable residual disease affects allogeneic hematopoietic cell transplantation in Ph+ ALL during both CR1 and CR2

AbstractAlthough measurable residual disease (MRD) at the time of allogeneic hematopoietic cell transplantation (allo-HCT) has been reported to be an important prognostic factor for Philadelphia chromosome (Ph)–positive acute lymphoblastic leukemia (ALL) during first complete remission (CR1), the prognostic impact of MRD is unclear during second CR (CR2). To clarify the impact of MRD for both CR1 and CR2, we analyzed data from a registry database including 1625 adult patients with Ph+ ALL who underwent first allo-HCT during either CR1 or CR2 between 2002 and 2017. Adjusted overall and leukemia-free survival rates at 4 years were 71% and 64%, respectively, for patients undergoing allo-HCT during CR1 with MRD−, 55% and 43% during CR1 with MRD+, 51% and 49% during CR2 with MRD−, and 38% and 29% during CR2 with MRD+. Although survival rates were significantly better among patients with CR1 MRD− than among patients with CR2 MRD−, no significant difference was observed in survival rate between patients with CR1 MRD+ and CR2 MRD−. Relapse rates after 4 years were 16% in patients with CR1 MRD−, 29% in CR1 MRD+, 21% in patients with CR2 MRD−, and 46% in patients with CR2 MRD+. No significant difference was identified in relapse rate between patients with CR1 MRD− and CR2 MRD−. CR2 MRD− was not a significant risk factor for relapse in multivariate analysis (hazard ratio, 1.26; 95% confidence interval, 0.69-2.29; P = .45 vs CR1 MRD−). MRD at time of allo-HCT was an important risk factor in patients with Ph+ ALL during both CR1 and CR2.

Predictive ability of scoring systems towards casting in treatment of idiopathic clubfoot by the Ponseti method in infants.

A prospective study to find a correlation between the severity of clubfoot and the number of casts required for the correction was conducted. The relationship of early relapse with the severity of the deformity was also studied. A total of 42 infants (61 feet) with primary and idiopathic clubfeet were included in the study. Previously treated and clubfeet due to secondary causes were excluded. All clubfeet were treated by the Ponseti method, and the Pirani score, Dimeglio score and Foot Bimalleolar (FBM) angle were taken at presentation and before every casting and at 6 months of follow-up. The average age of the child at presentation was 24 days, the average initial Pirani score was 4.172, the average initial Dimeglio score was 14.36 and the average FBM angle was 63.87 degrees. The average number of corrective casts given was 5.08 (range 2-8). The regression analysis showed a low correlation between Pirani and Dimeglio scores with the number of casts. There was no correlation between FBM angle and casting. Eleven of the 61 feet had a relapse (18%). Ten of 11 relapsed feet had a midfoot Pirani score of equal to or more than 2. The regression analysis shows a low correlation between Pirani and Dimeglio scores with the number of casts. There was no correlation between FBM angle and casting. Midfoot score equal to or more than 2 is a significant risk factor for relapse.

Diagnosis and prognostic value of markers of oncogenesis in patients with hyperplastic endometrial processes with uterine fibroids

Introduction: The relevance of the study of the problem of endometrial hyperplastic processes (EHP) is due primarily to the high risk of malignancy of this pathology and its recurrent course. Despite numerous studies on EHP, some issues of pathogenesis, diagnosis and treatment of this pathology remain debatable.Objective: To evaluate the levels of APRIL, survinin and phosphoPTEN in serum of women with various forms of EHP in combination with uterine fibroids and their prognostic value for recurrence.Materials and Methods: 105 women with endometrial hyperplastic processes and endometrial adenocarcinoma were examined during the study. The first group consisted of 34 women with simple endometrial hyperplasia without atypia (SEHWA), the second group included 47 patients with complex endometrial hyperplasia without atypia (CEHWA). The groups were divided into subgroups with or without uterine fibroids. The third group consisted of 26 women with endometrial adenocarcinoma.Results: Level of APRIL was increased in the CEHWA group compared to the control group (p&lt;0,05) and the SEHWA (p&lt;0,05). Women with endometrial adenocarcinoma had significantly higher APRIL levels compared to controls and patients with both types of endometrial hyperplasia (p&lt;0,05). Women with SEHWA had significantly higher level of survinin compared to controls (p&lt;0,05). Patients with CEHWA and adenocarcinoma had serum levels of survinin higher than those in the control and SEHWA groups (p&lt;0,05).Conclusions: Adequate prognostic significance for the occurrence of relapses of EHP had the increasing of APRIL level greater than 43 pg/ml and survinin level greater than 70 pg/ml. In patients with EHP in combination with uterine fibroids a significant risk factor for relapse was an increasing of APRIL level greater than 43 pg/ml.

Treatment and outcomes at Takiwasi Center, a Peruvian therapeutic community: identifying patient-related indicators

Purpose Substance abuse is a major public health concern, with over millions of people suffering from it worldwide. Although there is an abundance of treatment options, many of these rehabilitative trajectories are subject to “drop-out”. In addition, “drop-out” is a significant risk factor for relapse. There is an urgent demand for effective treatment, which would enable patients to reduce abuse and prevent relapse. Takiwasi is an addiction treatment centre that combines traditional Amazonian plant medicine with conventional western medicine and psychotherapy. The purpose of this paper is to explore whether socio-demographics factors, such as education level and occupation, psychiatric comorbidities and primary drug use, are associated with treatment non-completion of Ayahuasca (AYA)-assisted addiction therapy. Design/methodology/approach Data on the first treatment episode of 121 patients were collected from the patient database from the years 2012 to 2017. To determine whether there is an association between the variables of interest and treatment non-completion, a χ2 analysis and a logistic regression analysis were performed. Findings Of the 121 patients analysed, 48.2 per cent completed their treatment, whilst 51.8 per cent did not. Students compared to those who are employed showed significantly higher odds for treatment non-completion (p=0.006; OR=3.7; 95% CI=1.5–9.6). Other variables in the multivariable analysis showed no significant relationship with treatment non-completion. While several limitations restricted the study, the findings suggest that the AYA-assisted treatment in Takiwasi may benefit from additional support for patients who are students. Moreover, it is advised to conduct more long-term follow-up of patients in order to gain better insight into the outcome of treatment at an AYA-assisted treatment centre. Originality/value It appears that AYA-assisted therapy in a therapeutic community is a feasible type of treatment for addiction, for which further studies should elucidate the role of motivation in relation to socio-demographic factors and type of addiction in the risk of treatment non-completion.

Relapse patterns and predictors of IgG4-related diseases involved with autoimmune pancreatitis: A single-center retrospective study of 115 patients.

Autoimmune pancreatitis is an autoimmune disorder accompanied by clinicopathological manifestations that have been established as immunoglobulin (IgG)4-related diseases (IgG4-RD). Other IgG4-RD are often involved with autoimmune pancreatitis. They sometimes relapse despite a favorable response to steroid therapy. This study aimed to clarify the patterns and risk factors for extrapancreatic relapse. We reviewed the data of 115 patients diagnosed with definite autoimmune pancreatitis type 1 and followed up for > 1 year. We analyzed two items: the timing and pattern of extrapancreatic relapse, and risk factors for relapse with three common manifestations: IgG4-related sclerosing cholangitis (SC), IgG4-related dacryoadenitis and sialadenitis (DS), and IgG4-related retroperitoneal fibrosis (RF). Remission was achieved in all patients, except one. The extrapancreatic relapse rates were 11.0%, 19.7%, and 40% within 3, 5, and 10 years, respectively. Of 26 patients with extrapancreatic relapse, nine (34.6%) relapsed with a new IgG4-RD. Based on multivariate analysis, the interval between symptom onset and steroid initiation, and the presence of RF at onset were significant risk factors for relapse with SC and RF, respectively. Our results indicate that they may be various extrapancreatic relapse patterns especially in autoimmune pancreatitis with other organ involvement. Patients with a delayed initiation of steroids or RF at onset should be carefully followed up as high-risk groups for SC and RF relapse.

Risk factors for relapse in pediatric nephrotic syndrome

Background Nephrotic syndrome (NS) is the most common kidney disease in children and is characterized by edema, massive proteinuria, hypoalbuminemia, and hyperlipidemia. High relapse rate remains a major problem in the management of this syndrome.&#x0D; Objective To identify risk factors for relapse in pediatric nephrotic syndrome.&#x0D; Methods This study was carried out in the Wahidin Sudirohusodo Teaching Hospital in Makassar, South Sulawesi, Indonesia, from January to August 2017 using complete medical records of children diagnosed with NS. Subjects were divided into 2 groups: 1) relapsed NS or 2) non-relapsed NS. The following potential risk factors for relapse were analyzed using Chi-square test: age, sex, nutritional status, hypertension, serum creatinine level, and infection at the time of established diagnosis of NS.&#x0D; Results A total of 142 children with NS who fulfilled the inclusion criteria aged 1.4 to 17.5 years were included in the study. Subjects were mostly boys (66.2%), with a male: female ratio of 1.95:1. The relapsed NS group had 80 cases (56.3%) and the non-relapsed NS group had 62 cases (43.7%). Statistical analysis revealed that nutritional status was a significant risk factor for relapse in pediatric nephrotic syndrome (P&lt;0.05).&#x0D; Conclusion Nutritional status is an independent risk factor for relapse in pediatric nephrotic syndrome.

An Elevated Platelet Count Increases the Risk of Relapse in Ulcerative Colitis Patients with Mucosal Healing.

Background/AimsAlthough mucosal healing (MH) has been considered a treatment goal for patients with ulcerative colitis (UC), the risk factors predictive of relapse in patients who achieve MH are unknown. Because the platelet count has been shown to be a marker of inflammation in inflammatory bowel diseases, this study aimed to assess whether the platelet count could predict relapse in UC patients with MH.MethodsA prospective observational study was performed. UC patients with MH were consecutively enrolled in the study and monitored for at least 2 years or until relapse. The correlation between the incidence of relapse and the platelet count at the time of study enrollment was examined.ResultsIn total, 43 patients were enrolled, and 14 patients (33%) relapsed. The median platelet count at the time of enrollment in the patients who relapsed significantly differed from that in the patients who did not relapse (27.2×104/μL vs 23.8×104/μL, respectively; p=0.016). A platelet count >25.0×104/μL was a significant risk factor for relapse based on a multivariate analysis (hazard ratio, 4.85; 95% confidence interval, 1.07 to 25.28), and according to the Kaplan-Meier analysis, this cutoff could identify patients susceptible to relapse (p=0.041, log-rank test).ConclusionsThe platelet count could be used as a predictor of relapse in UC patients with MH.

Deep NPM1 Sequencing Following Allogeneic Hematopoietic Cell Transplantation Improves Risk Assessment in Adults with NPM1-Mutated AML

Relapse is the major cause of death in patients with acute myeloid leukemia (AML) after allogeneic hematopoietic cell transplantation (HCT). Measurable residual disease (MRD) detected by multiparameter flow cytometry (MFC) before and after HCT is a strong, independent risk factor for relapse. As next-generation sequencing (NGS) is increasingly applied in AML MRD detection, it remains to be determined if NGS can improve prediction of post-HCT relapse. Herein, we investigated pre-HCT MRD detected by MFC and NGS in 59 adult patients with NPM1-mutated AML in morphologic remission; 45 of the 59 had post-HCT MRD determined by MFC and NGS around day 28. Before HCT, MRD detected by MFC was the most significant risk factor for relapse (hazard ratio [HR], 4.63; P < .001), whereas MRD detected only by NGS was not. After HCT, MRD detected by either MFC or NGS was significant risk factor for relapse (HR, 4.96, P = .004 and HR, 4.36, P = .002, respectively). Combining pre- and post-HCT MRD provided the best prediction for relapse (HR, 5.25; P < .001), with a sensitivity at 83%. We conclude that NGS testing of mutated NPM1 post-HCT improves the risk assessment for relapse, whereas pre-HCT MFC testing identifies a subset of high-risk patients in whom additional therapy should be tested.

Risk Factors for Relapse of Antineutrophil Cytoplasmic Antibody-associated Vasculitis in Japan: A Nationwide, Prospective Cohort Study.

The aim was to elucidate the prognosis and risk factors associated with relapse during longterm remission maintenance therapy for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Patients with newly diagnosed AAV (n = 156) were registered in the Remission Induction Therapy in Japanese patients with ANCA-associated Vasculitides (RemIT-JAV) study, and among them, 83 patients who achieved remission were enrolled and followed up for 24 additional months in our nationwide, prospective cohort study (Co-RemIT-JAV; registration number UMIN 000006373). Patterns of maintenance therapy, effectiveness, and safety were evaluated from months 25 to 48 after the RemIT-JAV. The primary outcome measure was the rate of relapse. Secondary outcome measures included overall and renal survival, risk factors associated with relapse, and incidence rates of serious infections. The patients comprised 35 men and 48 women aged 65.3 ± 12.6 years. Between months 25 and 48, the survival rate was 95% (79/83). Causes of death included 1 thyroid cancer, 1 infection, and 2 unknown reasons. Four patients had developed endstage renal disease (ESRD) by Month 24; 1 developed ESRD beyond Month 25. The relapse rate was 24% (20/83) from months 25 to 48. Multivariable analysis revealed that oral prednisolone ≤ 2.5 mg/day at Month 24 was a significant risk factor for relapse between months 25 and 48 (HR = 3.1, 95% CI 1.1-8.5). One-quarter of patients with AAV relapsed during maintenance therapy, and relapse was associated with the dose of oral prednisolone 24 months after the initiation of remission induction therapy in Japan.

Comparison of two smoking cessation interventions for inpatients.

ABSTRACTObjective:This study aimed to compare the effectiveness of two cognitive behavioral therapy-based smoking cessation interventions initiated during hospitalization and to evaluate the factors related to relapse after discharge. Methods:This was a prospective randomized study involving 90 smokers hospitalized in a university hospital. We collected data related to sociodemographic characteristics, reasons for admission, smoking-related diseases, smoking history, the degree of nicotine dependence (ND), and the level of craving. Patients were divided into two treatment groups: brief intervention (BrInter, n = 45); and intensive intervention with presentation of an educational video (InInterV, n=45). To assess relapse, all patients were assessed by telephone interview in the first, third, and sixth months after discharge. Abstinence was confirmed by measurement of exhaled carbon monoxide (eCO). Results:Of the 90 patients evaluated, 55 (61.1%) were male. The mean age was 51.1 ± 12.2 years. The degree of ND was elevated in 39 (43.4%), and withdrawal symptoms were present in 53 (58.9%). The mean eCO at baseline was 4.8 ± 4.5 ppm. The eCO correlated positively with the degree of ND (r = 0.244; p = 0.02) and negatively with the number of smoke-free days (r = −0.284; p = 0.006). There were no differences between the groups in terms of the variables related to socioeconomic status, smoking history, or hospitalization. Of the 81 patients evaluated at 6 months, 33 (40.7%) remained abstinent (9 and 24 BrInter and InInterV group patients, respectively; p = 0.001), and 48 (59.3%) had relapsed (31 and 17 BrInter and InInterV group patients, respectively; p= 0.001). Moderate or intense craving was a significant independent risk factor for relapse, with a relative risk of 4.0 (95% CI: 1.5-10.7; p < 0.00001). Conclusions:The inclusion of an educational video proved effective in reducing relapse rates. Craving is a significant risk factor for relapse.

Methods of Detection of Measurable Residual Disease in AML.

The presence of measurable ("minimal") residual disease (MRD) after induction and/or consolidation chemotherapy is a significant risk factor for relapse in patients with acute myeloid leukemia (AML). In recognition of the clinical significance of AML MRD, the European LeukemiaNet (ELN) recently recommended the establishment of CR-MRDNegative as a separate category of treatment response. This recommendation represents a major milestone in the integration of AML MRD testing in standard clinical practice. This review article summarizes the methodologies employed in AML MRD detection and their application in clinical studies that provide evidence supporting the clinical utility of AML MRD testing. Future MRD evaluations in AML likely will require an integrated approach combining multi-parameter flow cytometry and high-sensitivity molecular techniques applied to time points during and after completion of therapy in order to provide the most accurate and comprehensive assessment of treatment response.

Depression as a Risk Factor for Relapse After Inpatient Opioid Detoxification: 1-Year Follow-Up Study

Background: Opioid dependence is a complicated disorder in which multiple factors interact to influence initiation of use, repeated use, addiction, and relapse. Negative emotional states, such as anger, anxiety, depression, frustration, and boredom are also associated with the highest rate of relapse Objectives:: The researchers of the current study propose that depression is a significant risk factor for relapse after inpatient detoxification, for which they conducted this 1-year follow up study to compare relapsed with non-relapsed patient group with respect to their depressive symptoms. Patients and Methods: A total of 581 patients were admitted to the tertiary care institute of the current study from 1st of January 2014 to 31st of December 2015, out of which 115 subjects met the defined exclusion criteria or did not meet the inclusion criteria. The remaining 466 patients were considered for the study. All the patients were followed up for relapse and interviewed with the 24-item Hamilton Depression Rating Scale (HAM-D) every 2 weeks for the next 1 year. Relapsed and non-relapsed groups were compared. Results: No significant difference was found between relapsed and non-relapsed patients regarding their socio-demographic profile. In a comparison between relapsed and non-relapsed group, though both groups showed high mean depression score throughout the 1-year follow up, the relapsed group had a much higher score, almost double that of the other group. Very severe depression was seen in more than 16% of relapsed patients, which was absent in non-relapsed patients. Conclusions: The current study found persistent high mean depression scores after inpatient detoxification in both groups. Regular screening for depression is needed during post-detoxification follow up period as timely intervention may prevent relapse.