Use Of Appropriate Therapy Research Articles

B Cell-Activating Factor (BAFF) and Ubiquitin Enzyme A20 as Functional Proteins in Targeted Therapy on Patients with Systemic Lupus Erythematosus

BACKGROUND: Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by inflammation. The pathogenesis of SLE involves key proteins, including B cell-activating factor (BAFF) and the ubiquitin enzyme A20, both serving as negative regulators of inflammation and contributing to B cell homeostasis. In this review, focused on interventions directed at BAFF and the A20 enzyme, utilizing monoclonal antibodies either independently or in conjunction with conventional therapy for SLE patients.METHODS: A literature search was conducted on the PubMed platform by combining various terms, including "B-cells activating factor", "TNFAIP3 protein (human)", "therapeutics" or "drug therapy", and "lupus erythematosus, systemic" (limited to the last 10 years). From total of 104 articles discovered in thr search, the total number of articles collected after being filtered was 27 articles.RESULTS: Clinical development and evaluation have been conducted regarding the use of appropriate therapy for SLE patients. Selective BAFF inhibitor has been tested in clinical trials as a blocking agent in BAFF receptor (BAFF-R) and signaling nuclear factor-kappaB (NF-κB) by A20 bindings to inhibit the activation of autoreactive B cells. Just like other antimonoclonal therapies, BAFF and the A20 enzyme can be used as therapeutic targets with a single use or combined with the standard therapy in patients with SLE. In addition, the use of BAFF and A20 also shown to have safe side effects in patients with SLE. CONCLUSION: BAFF protein and A20 enzyme present promising therapeutic targets for managing autoimmune diseases like SLE. Therapeutic interventions can be administered individually or in conjunction with standard treatments. KEYWORDS: systemic lupus erythematosus, therapeutic targets, BAFF, A20

Short-term predictors of stereotactic radiosurgery outcome for untreated single non-small cell lung cancer brain metastases: a restrospective cohort study.

Stereotactic radiosurgery (SRS) is an option for brain metastases (BM) not eligible for surgical resection, however, predictors of SRS outcomes are poorly known. The aim of this study is to investigate predictors of SRS outcome in patients with BM secondary to non-small cell lung cancer (NSCLC). The secondary objective is to analyze the value of volumetric criteria in identifying BM progression. This retrospective cohort study included patients >18 years of age with a single untreated BM secondary to NSCLC. Demographic, clinical, and radiological data were assessed. The primary outcome was treatment failure, defined as a BM volumetric increase 12 months after SRS. The unidimensional measurement of the BM at follow-up was also assessed. One hundred thirty-five patients were included, with a median BM volume at baseline of 1.1 cm3 (IQR 0.4-2.3). Fifty-two (38.5%) patients had SRS failure at follow-up. Only right BM laterality was associated with SRS failure (p=0.039). Using the volumetric definition of SRS failure, the unidimensional criteria demonstrated a sensibility of 60.78% (46.11%-74.16%), specificity of 89.02% (80.18%-94.86%), positive LR of 5.54 (2.88-10.66) and negative LR of 0.44 (0.31-0.63). SRS demonstrated a 61.5% local control rate 12 months after treatment. Among the potential predictors of treatment outcome analyzed, only the right BM laterality had a significant association with SRS failure. The volumetric criteria were able to identify more subtle signs of BM increase than the unidimensional criteria, which may allow earlier diagnosis of disease progression and use of appropriate therapies.

S842 Opioid Dependence and Over-Prescription of Opioids in Patients With Co-Existing IBD and IBS

Introduction: Opioids are commonly prescribed to control pain for patients with inflammatory bowel disease (IBD). However, the wide use of narcotics raised concerns for possible opioid dependence and related mortality. IBD patients with co-existing irritable bowel syndrome (IBS) are more likely to complain about abdominal pain. The goal of the study was to determine the prevalence of opioid prescription and opioid dependence in patients with coexisting IBD and IBS, and to compare with IBD patients without IBS. Methods: A retrospective cohort analysis was performed using IBM Explorys (1999-2022), which contained deidentified patient information from more than 300 hospitals in the US. We selected patients with a diagnosis with IBD and IBS (IBD+IBS). The control group consist of patients with IBD without IBS (IBD). We collected information regarding opioid prescriptions and diagnosis of opioid dependence. Categorical data was presented as number of patients and percentage. Odd ratios (OR) with 95% confidence interval were used to compare the cohorts. Results: We identified a total of 38,650 patients with co-existing IBD and IBS and 327,770 patients with IBD without IBS (Table). 83.2% of patients in the IBD+IBS group and 62.6% of patients in the control group have been prescribed opioids (OR [2.87-3.03], p< 0.0001). Opioids were more commonly prescribed in the IBD+IBS cohort including morphine (48.5 vs 29.1%), Hydromorphone (44.7 vs 24.8%), Oxycodone (46.0 vs 27.2%) and Hydrocodone (58.4 vs 35.7%). Opioid dependence was also more common in the IBD+IBS group (4.8% vs 1.6%, OR [2.99-3.33], p< 0.0001). Conclusion: Patients with overlapping IBD and IBS are prescribed opiates more often than patients with IBD alone, and the former are more likely to be diagnosed with opioid dependence. Appropriate use of therapies approved for IBS, in conjunction with treatment of IBD may help reduce opiate use in this population. Table 1. - Opioid prescription and opioid dependence in patients with IBD+IBS and IBD alone IBD+IBS (N=38650) % IBD alone (N=327770) % OR 95% CI P Opioid dependence 1840 4.8% 5110 1.6% 3.16 2.99-3.33 < 0.0001 Opiate 32140 83.2% 205290 62.6% 2.95 2.87-3.03 < 0.0001 Morphine 18760 48.5% 95410 29.1% 2.30 2.25-2.35 < 0.0001 Hydromorphone 17260 44.7% 81420 24.8% 2.44 2.39-2.49 < 0.0001 Oxycodone 17780 46.0% 89210 27.2% 2.28 2.23-2.33 < 0.0001 Hydrocodone 22590 58.4% 117110 35.7% 2.53 2.48-2.59 < 0.0001

COVID-19: therapeutic misinformation and intoxications

The new coronavirus pandemic alarmed the world. Misinformation regarding prevention and treatment for safeguarding against this pandemic seemed to be life-threatening along with the spreading pandemic. Public health authorities in the world tried to battle this virtual virus by offering true information and correcting misinformation. However, the public misinformation through social media caused toxicological consequences in some parts of the world which provoked awareness, response, and concern of the public health authorities including the Food and Drug Administration (FDA) and the toxicology community. This study analysed the published literature on therapeutic disinformation during the COVID-19 pandemic and its toxicological effects. The electronic databases searched were Scopus, MEDLINE, Scielo. The used keywords were: “COVID-19”, “misinformation”, “social media”, “public health”, “drug toxicity”, and “education”. Finding new strategies for the prevention and treatment of the coronavirus again stresses the role of public education about true drug information. Hundreds of chemicals were/are being tested to be prophylactic medications or healing drugs for the coronavirus. Therefore, spreading accurate information and editing misinformation can be crucial. In summary, this commentary is going to bring attention to misinformation regarding prevention and treatment for safeguarding against the COVID-19 pandemic and its toxicological consequences and the need for public education on the appropriate use of therapies.

Reconsidering the role of glycaemic control in cardiovascular disease risk in type 2 diabetes: A 21st century assessment.

It is well known that the multiple factors contributing to the pathogenesis of type 2 diabetes (T2D) confer an increased risk of developing cardiovascular disease (CVD). Although the relationship between hyperglycaemia and increased microvascular risk is well established, the relative contribution of hyperglycaemia to macrovascular events has been strongly debated, particularly owing to the failure of attempts to reduce CVD risk through normalizing glycaemia with traditional therapies in high-risk populations. The debate has been further fuelled by the relatively recent discovery of the cardioprotective properties of glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors. Further, as guidelines now recommend individualizing glycaemic targets, highlighting the importance of achieving glycated haemoglobin (HbA1c) goals safely, the previously observed negative influences of intensive therapy on CVD risk might not present if trials were repeated using current-day treatments and individualized HbA1c goals. Emerging longitudinal data illuminate the overall effect of excess glucose, the impacts of magnitude and duration of hyperglycaemia on disease progression and risk of CVD complications, and the importance of glycaemic control at or early after diagnosis of T2D for prevention of complications. Herein, we review the role of glucose as a modifiable cardiovascular (CV) risk factor, the role of microvascular disease in predicting macrovascular risk, and the deleterious impact of therapeutic inertia on CVD risk. We reconcile new and old data to offer a current perspective, highlighting the importance of effective, early treatment in reducing latent CV risk, and the timely use of appropriate therapy individualized to each patient's needs.

Sex, Allergic Diseases and Omalizumab.

Gender differences are increasingly emerging in every area of medicine including drug therapy; however, specific gender-targeted studies are infrequent. Sex is a fundamental variable, which cannot be neglected. When optimizing therapies, gender pharmacology must always be considered in order to improve the effectiveness and safety of the use of drugs. Knowledge of gender differences promotes appropriate use of therapies and greater health protection for both genders. Further development of gender research would make it possible to report on differences in the assimilation and response of the female organism as compared to the male, in order to identify potential risks and benefits that can be found between genders. Furthermore, a better understanding of sex/gender-related influences, with regard to pharmacological activity, would allow the development of personalized “tailor-made” medicines. Here, we summarize the state of knowledge on the role of sex in several allergic diseases and their treatment with omalizumab, the first biologic drug authorized for use in the field of allergology.

Morphometric and immunohistochemical features of TTF-1 positive lung tumors: improvement of approaches to the diagnosis of unknown primary sites metastases

Verification of lung tumors in the practical activity of a pathomorphologist reached a completely different level due to the use of additional highly sensitive diagnostic methods (immunohistochemical (IHC) and cytogenetic studies). Thyroid transcription factor 1 (TTF-1) plays a key role in lung morphogenesis and is expressed in about 90 % of pulmonary small cell carcinomas. The positivity of TTF-1 in pulmonary and extrapulmonary neuroendocrine tumors is actively debated in the literature, therefore, the results of IHС on TTF-1 in metastases from an unknown source should be interpreted carefully and constantly improve differential diagnostic algorithms, expanding IHC panels with organ-specific markers, and focus on additional morphometric indicators research of nuclei of tumor cells.The aim of the work is to investigate the complex of morphological, morphometric, and IHC characteristics of TTF-1 positive lung tumors to improve the diagnostic algorithms for metastases from an unknown primary source.Materials and methods. A retrospective analysis of histological, morphometric and IHC characteristics of the biopsy material TTF-1 of positive lung carcinomas from 36 patients (10 women and 26 men) aged 29 to 81 years (mean 58.03±10.83 years) for the period 2015–2018, taken from the archive of the morphological department of the medical-diagnostic center of LLC “Pharmacies of the Medical Academy” (Ukraine, Dnipro).Results. In the diagnosis of carcinomas of unknown primary localization with suspected lung origin, it is necessary to take into account morphological, morphometric and IHC features together, which is associated with the similarity of metastases of squamous cell carcinomas of the head and neck, mucinous adenocarcinomas of the gastrointestinal tract and neuroendocrine carcinomas from Merkel cells corresponding to the histological forms lung tumors, as well as insufficient sensitivity of the marker TTF-1.Conclusions. Use of the minimum primary (Cytokeratin, Pan AE1 / AE3 (+) / Vimentin (- / +) / CD45 (-) / S100 (- / +)) and secondary (Ck 7 +, Ck 20 -, TTF-1 + ) IHC panels will prove that the phenotype of carcinoma of unknown primary site corresponds to the form of disseminated lung carcinoma, and additional markers Сk HMW, p63, Chromogranin A, Synaptofisin and / or CD56 together with morphometric indices of the nuclei will determine the histological form of lung carcinoma with justification for the use of appropriate therapy

Sustained Intraocular Pressure Rise after the Treat and Extend Regimen at 3 Years: Aflibercept versus Ranibizumab.

Purpose To determine the risk factors associated with sustained intraocular pressure (IOP) rise in patients enrolled in the treat and extend (T&E) protocol receiving aflibercept/ranibizumab therapy for 3 years. Design Retrospective, observational chart review. Setting. Multicentric. Patients. 789 patients (1021 eyes; 602 males) enrolled in T&E using aflibercept/ranibizumab for diabetic macular edema (DME), wet age-related macular degeneration (AMD), or macular edema in retinal vein occlusion (RVO). Intervention. The history, examination (clinical and special investigations), and treatment records were thoroughly scrutinized. Sustained IOP rise was defined as a rise in IOP above baseline by ≥6 mmHg and/or >24 mmHg on 2 or more consecutive visits. The Wilk–Shapiro test was used for confirming normality of data. The Mantel–Haenszel test and generalized estimating equations were used to analyse multicentric data as well as to analyse data from both eyes of the same patients in the event that both eyes were under therapy. The relative risk, chi-square test (with and without Yates' correction), and univariate and multivariate analysis were used wherever appropriate. Statistical significance was set at P < 0.05. The primary outcome measure was the determination of risk factors for sustained IOP rise with ranibizumab/aflibercept therapy. Secondary outcome measures included determining the incidence of IOP rise (short term and sustained), visual field, and retinal nerve fibre layer (RNFL) changes. Results The mean follow-up was 42.4 months. Male gender, South Asian ethnicity, older age, presence of AMD and vein occlusion, use of ranibizumab, higher number of injections, narrow angles, switch to bevacizumab/ranibizumab, and preexisting glaucoma were associated with sustained IOP rise. No significant visual field and RNFL changes were seen. The overall incidence was 8.91%. No patient required filtering surgery. No patient with IOP rise returned to baseline. Conclusion IOP rise is an important consideration as the chronicity of the condition can eventually lead to glaucomatous changes in eyes with already compromised vision. Follow-ups and use of appropriate therapy can be determined correspondingly.

Phenotype, genotype and glycaemic variability in people with activating mutations in the ABCC8 gene: response to appropriate therapy.

To examine the phenotypic features of people identified with ABCC8-maturity-onset diabetes of the young (MODY) who were included in the adult 'Mater MODY' cohort and to establish their response to sulfonylurea therapy. Ten participants with activating ABCC8 mutations were phenotyped in detail. A 2-hour oral glucose tolerance test was performed to establish glycaemic tolerance, with glucose, insulin and C-peptide measurements taken at baseline and 30-min intervals. Insulin was discontinued and sulfonylurea therapy initiated after genetic diagnosis of ABCC8-MODY. A blinded continuous glucose monitoring sensor was used to establish glycaemic control on insulin vs a sulfonylurea. The mean age at diagnosis of diabetes was 33.8 ± 11.1 years, with fasting glucose of 18.9 ± 11.5 mmol/l and a mean (range) HbA1c of 86 (51,126) mmol/mol [10.0 (6.8,13.7)%]. Following a genetic diagnosis ofABCC8-MODY three out of four participants discontinued insulin (mean duration 10.6 ± 1.69 years) and started sulfonylurea treatment. The mean (range) HbA1c prior to genetic diagnosis was 52 (43,74) mmol/mol (6.9%) and the post-treatment change was 44 (30,57) mmol/mol (6.2%; P=0.16). Retinopathy was the most common microvascular complication in this cohort, occurring in five out of 10 participants. Low-dose sulfonylurea therapy resulted in stable glycaemic control and the elimination of hypoglycaemic episodes attributable to insulin therapy. The use of appropriate therapy at the early stages of diabetes may decrease the incidence of complications and reduce the risks of hypoglycaemia associated with insulin therapy.

Metastatic bone lesions of men in combination with an increase in serum PSA from the point of view of diagnosing carcinomas of unknown primary localization

In cases of “malignant neoplasm of unknown origin” of men with bone metastases, it is the serum PSA level that can be crucial for further treatment. The literature describes carcinomas with bone metastases and an increase in the prostate-specific antigen, which were twice refuted by a prostate biopsy but had a positive dynamic during anti-androgen therapy (bicalutamide) in combination with chemotherapy (zoledronic acid). The aim of the work is to improve diagnostic algorithms, to investigate a complex of morphological, morphometric and immunohistochemical characteristics of metastatic foci in the bones, which are represented by adenocarcinomas of unknown primary localization in men with increased serological marker PSA, compared with primary carcinomas of the prostate gland. Materials and methods. A retrospective analysis of clinical data, histological and immunohistochemical characteristics of 21 observations of biopsy material from patients with primary carcinoma of the prostate gland (group 1, men aged 56 to 82 years, average 66.00 ± 7.76; median 65) and 10 patients with bone carcinoma metastases without primary localization and increased serum marker PSA (group 2, men aged 43 to 57 years, mean 50.00 ± 9.89; median 46.5) on the basis of the morphological department of diagnostic center “Pharmacy of Medical Academy” for the period 2015–2017. Results. Morphological, morphometric and immunohistochemical changes of carcinomas of unknown primary site in men with metastatic bone lesions and increased serum marker PSA associated with the acquisition of more aggressive properties were identified in comparison with the primary carcinomas of the prostate gland, which tend to local distribution. There were prevalence of poorly differentiated histological forms of metastatic adenocarcinomas, an objective reduction in the area and perimeter of nuclei (P = 0.00002, P < 0.0001, respectively), possible loss of immunohistochemical markers AMACR (p504s) and AR (androgen receptors) specific for acinar prostate carcinomas (P = 0.008). Conclusion. The use of minimal primary immunohistochemical panel from cytokeratin, Pan AE1/AE3 (+) / Vimentin(-) / CD45(-) / S100(-) and secondary – cytokeratin 8(+) / PSA(+) / AMACR (p504s)(+) panels / AR(+/-) will allow to prove the conformity of the carcinoma phenotype with unknown primary site in men with metastatic bone lesions and an increase in the PSA serological marker to the form of disseminated prostate carcinoma with justification for the use of appropriate therapy in cases of non-informative prostate biopsy.

Use of Topical Steroids in Conjunctivitis: A Review of the Evidence.

Conjunctivitis, or inflammation of the conjunctiva, is a common condition that can be caused by infectious (eg, bacterial or viral infections) and noninfectious (eg, allergy) etiologies. Treatment involves diagnosis of the underlying cause and use of appropriate therapies. A broad-spectrum therapy that can address multiple etiologies, and also the accompanying inflammation, would be very useful. In this review, we discuss the usefulness of topical ophthalmic corticosteroids and ophthalmic formulations that combine corticosteroids with anti-infectives/antibiotics for treating acute infectious conjunctivitis. A review of the published literature and relevant treatment guidelines. Topical corticosteroids are useful in treating ocular inflammation, but most treatment guidelines recommend steroid use generally in severe cases of conjunctivitis. This is partly due to risks associated with steroid use. These risks include potential for prolonging adenoviral infections and potentiating/worsening herpes simplex virus infections, increased intraocular pressure, glaucoma, and cataracts. Most of these perceived risks are not, however, supported by high-quality clinical data. They are also associated with long-term steroid uses that are dissimilar to applications for infectious conjunctivitis. Clinical data show that ophthalmic formulations that combine corticosteroids with broad-spectrum anti-infectives could be effective and well tolerated when used for short-term treatment (≤2 weeks). Corticosteroids, in combination with anti-infectives, could be a promising treatment option for acute conjunctivitis subject to development of further evidence on their effectiveness and safety in conjunctivitis treatment.

PCN50 CHEAPER BUT AT WHAT PRICE? EXAMPLE OF DECREMENTALLY COST-EFFECTIVENESS ANALYSIS COMPARING MULTI-GENE ASSAYS IN BREAST CANCER

Value-based models are intended to support appropriate use of one procedure/test over another. Cost-ineffective care may nevertheless occur, due to lack of information or to financial incentives. Guidelines state that the 21-gene assay (Oncotype DX®, Genomic Health, Inc.) is the preferred multi-gene assay (MGA) to predict chemotherapy benefit in early stage breast cancer (ESBC). We sought to compute the “decrementally cost-effective” savings (Nelson Ann Intern Med 2009) that might justify substituting another MGA, PAM50-ROR (Prosigna®, NanoString). We conducted a decision analysis using Markov Chain Monte Carlo simulation to estimate posterior distributions in 100,000 women with ESBC. Risk estimates of PAM50-ROR to predict above/below the 21-gene result threshold for chemotherapy benefit (RS=25; Sparano NEJM 2018) were extracted from three published discordance studies. Primary endpoints were: (1) number of women tested with PAM50-ROR recommended adjuvant chemotherapy discordant with 21-gene results (discordant-aCT) and (2) QALY loss from suboptimal therapy choice due to discordance. Incidence of adverse events with chemotherapy, risk of distant recurrence, quality of life effects, and time discounting were based on published estimates (Chandler JCO 2018). The number of women who were discordant-aCT was 23,853 (IQR 16,044 – 26,870) — almost 1 in 5 women tested. The total QALY loss associated with PAM50-ROR versus 21-gene was 24,593 years (IQR 12,265 – 27,161). To be decrementally cost-effective at the $100K threshold, PAM50-ROR would have to save at least $20,000 per patient. Use of appropriate therapy guided by the 21-gene assay reduces distant recurrence incidence and saves costs versus no MGA testing (Hochheiser JCER 2019). Discordant therapy choice resulting from PAM50-ROR use results in QALY losses. PAM50-ROR cannot be decrementally cost-effective, because the required savings is 4× higher than the 21-gene assay price. This case study illustrates that value-based payment models need safeguards to avoid potentially suboptimal substitution of preferred interventions.

Searching for Bacteria in Neural Tissue From Amyotrophic Lateral Sclerosis.

Despite great efforts in the investigation, the exact etiology of amyotrophic lateral sclerosis (ALS) is a matter of intensive research. We recently advanced the idea that ALS might be caused by fungal infection. Indeed, fungal yeast and hyphal structures can be directly visualized in neural tissue of ALS patients, and a number of fungal species have been identified in the central nervous system (CNS). In the present work, we tested the possibility that bacterial infections can accompany these mycoses. Our findings establish the presence of bacterial DNA in different regions of the CNS from all ALS patients examined. Specifically, we used PCR and next generation sequencing (NGS) to precisely determine the bacterial species present in ALS tissue. Consistent with these findings, immunohistochemistry analysis of CNS sections using specific anti-bacterial antibodies identified prokaryotic cells in neural tissue. Finally, we assayed for the repeat expansion of the hexanucleotide repeat GGGGCC in C9orf72, which is considered the most common genetic cause of ALS in patients, using DNA extracted from ALS CNS tissue. We failed to find this repeated sequence in any of the eleven patients analyzed. Our results indicate that bacterial DNA and prokaryotic cells are present in CNS tissue, leading to the concept that both fungal and bacterial infections coexist in patients with ALS. These observations lay the groundwork for the use of appropriate therapies to eradicate the polymicrobial infections in ALS.

Autoimmune connective tissue diseases and pregnancy.

Autoimmune connective tissue-diseases are more frequent in women and deserve a multidisciplinary approach in which the dermatologist play a major role together with other physicians. Pregnancy in these patients has to be considered a high-risk situation, because of possible worsening of the mother's disease and increased morbility and mortality for the fetus; also, therapies have to be chosen carefully because some drugs cannot be used during pregnancy. For all these reasons, the decision to become pregnant needs to consider the type of disease, stage of disease, age and clinical condition, and requires a multidisciplinary approach. A correct counselling, a close monitoring, a specific approach based on the risks involved and the use of appropriate therapies are the keys to obtain optimal pregnancy outcomes.

Daylight-Mediated Photodynamic Therapy for Actinic Keratosis

ABSTRACT Actinic (solar) keratoses are premalignant lesions caused by prolonged exposure to ultraviolet radiation, with the potential to progress into squamous cell carcinoma. Hence, use of appropriate therapies is critical for effective treatment. Daylight-mediated photodynamic therapy with methyl aminolevulinate cream is a convenient new option for the safe and effective treatment of actinic (solar) keratosis lesions, offering similar efficacy to conventional photodynamic therapy, nearly painless treatment, and reduced in-clinic times. Use of appropriate therapies and optimization of clinical practice are critical for safe and effective treatment. Nurses play a key role in ensuring best clinical practice and effective treatment. This article explains the practicalities and principles of daylight-mediated photodynamic therapy to ensure best practice by treating nurses.

Gaps in Diagnosis and Treatment of Cardiovascular Risk Factors in Patients with Psoriatic Disease: An International Multicenter Study.

We aimed to estimate the proportion of underdiagnosis and undertreatment of cardiovascular risk factors (CVRF) in an international multicenter cohort of patients with psoriasis and psoriatic arthritis (PsA). A cross-sectional analysis was conducted of patients with psoriatic disease from the International Psoriasis and Arthritis Research Team cohort. The presence of modifiable CVRF [diabetes, hypertension (HTN), dyslipidemia, smoking, elevated body mass index, and central obesity] and the use of appropriate therapies for HTN and dyslipidemia were determined. The 10-year CV risk was calculated according to the Framingham Risk Score. Physician adherence with guidelines for the treatment of dyslipidemia and HTN was assessed. Regression analysis was used to assess predictors of undertreatment of HTN and dyslipidemia. A total of 2254 patients (58.9% PsA, 41.1% psoriasis) from 8 centers in Canada, the United States, and Israel were included. Their mean age was 52 ± 13.8 years and 53% were men. Of the patients, 87.6% had at least 1 modifiable CVRF, 45.1% had HTN, 49.4% dyslipidemia, 13.3% diabetes, 75.3% were overweight or obese, 54.3% central obesity, and 17.3% were current smokers. We found 59.2% of patients with HTN and 65.6% of patients with dyslipidemia were undertreated. Undertreatment was associated with younger age (≤ 50 yrs), having psoriasis, and male sex. In real-world settings, a large proportion of patients with psoriasis and PsA were underdiagnosed and undertreated for HTN and dyslipidemia. Strategies to improve the management of CVRF in psoriatic patients are warranted.

Daylight-Mediated Photodynamic Therapy for Actinic Keratosis

ABSTRACT Actinic (solar) keratoses are premalignant lesions caused by prolonged exposure to ultraviolet radiation, with the potential to progress into squamous cell carcinoma. Hence, use of appropriate therapies is critical for effective treatment. Daylight-mediated photodynamic therapy with methyl aminolevulinate cream is a convenient new option for the safe and effective treatment of actinic (solar) keratosis lesions, offering similar efficacy to conventional photodynamic therapy, nearly painless treatment, and reduced in-clinic times. Use of appropriate therapies and optimization of clinical practice are critical for safe and effective treatment. Nurses play a key role in ensuring best clinical practice and effective treatment. This article explains the practicalities and principles of daylight-mediated photodynamic therapy to ensure best practice by treating nurses.

CAUTIs and CLABSIs: Do Physicians REALLY Know What They Are?

The incidences of hospital-acquired conditions, such as catheter-associated urinary tract infections (CAUTIs) and central line-associated blood stream infections (CLABSIs) are being used to compare quality at institutions and determine reimbursements. These data come from the University HealthSystem Consortium (UHC) administrative database that relies almost exclusively on physician documentation as opposed to objective U.S. Centers for Disease Control and Prevention (CDC) guidelines. We hypothesize that the UHC-identified rates of CAUTIs and CLABSIs are inaccurate compared with the CDC definitions for these infections. We performed a retrospective study from January 2012 through September 2013 comparing the incidences of CLABSIs and CAUTIs, as identified through our UHC database to those identified by the Department of Epidemiology using strict CDC guidelines. We performed subset analysis on those infections identified by UHC but not CDC to determine the causes for these discrepancies. There were a total of 221 CAUTIs and 238 CLABSIs identified during this time frame. Of these, 16 CAUTIs (7.2%) and 44 (18.5%) CLABSIs were detected by both UHC and CDC. 72.4% (42/58) of the CAUTIs and 52.7% (49/93) of the CLABSIs identified by UHC were not identified by CDC. 91% (163/179) of the CAUTIs and 77% (145/189) of the CLABSIs identified by CDC were not identified by UHC. The cause of these differences in identification included lack of culture data, lack of positive cultures, and catheters present on admission. There is a major disconnect between identification of infections depending on what process is used. This can lead to inappropriate treatment and inaccurate institutional comparisons that impact reimbursements. Because UHC identification of infections are primarily based on physician documentation, educating providers should result in more accurate recognition of infections thereby ensuring appropriate use of therapy.

Successful maintenance on sulphonylurea therapy and low diabetes complication rates in a HNF1A-MODY cohort.

HNF1A gene mutations are the most common cause of maturity-onset diabetes of the young (MODY) in the UK. Persons with HNF1A-MODY display sensitivity to sulphonylurea therapy; however, the long-term efficacy is not established. There is limited literature as to the prevalence of micro- and macrovascular complications in this unique cohort. The aim of this study was to determine the natural progression and clinical management of HNF1A-MODY diabetes in a dedicated MODY clinic. Sixty patients with HNF1A-MODY and a cohort of 60 BMI-, age-, ethnicity- and diabetes duration-matched patients with Type 1 diabetes mellitus participated in the study. All patients were phenotyped in detail. Clinical follow-up of the HNF1A-MODY cohort occurred on a bi-annual basis. Following a genetic diagnosis of MODY, the majority of the cohort treated with sulphonylurea therapy remained insulin independent at 84-month follow-up (80%). The HbA1c in the HNF1A-MODY group treated with sulphonylurea therapy alone improved significantly over the study period [from 49 (44-63) mmol/mol, 6.6 (6.2-7.9)% to 41 (31-50) mmol/mol, 5.9 (5-6.7)%; P = 0.003]. The rate of retinopathy was significantly lower than that noted in the Type 1 diabetes mellitus group (13.6 vs. 50%; P = 0.0001).There was also a lower rate of microalbuminuria and cardiovascular disease in the HNF1A-MODY group compared with the Type 1 diabetes mellitus group. This study demonstrates that the majority of patients with HNF1A-MODY can be maintained successfully on sulphonylurea therapy with good glycaemic control. We note a significantly lower rate of micro- and macrovascular complications than reported previously. The use of appropriate therapy at early stages of the disorder may decrease the incidence of complications.

The Evaluation and Treatment of Adult Nocturnal Enuresis

Nocturnal enuresis is less common in adults than in childhood and is a significant cause of social and psychological debility and distress to patients, who may delay seeking treatment for fear of stigma. There is often an absence of significant underlying anatomical or functional pathology in patients with isolated nocturnal enuresis. A careful clinical assessment including a frequency-volume urine chart, post-voiding residual, and video-urodynamic assessment will identify the most appropriate treatment pathway by casting light on underlying pathophysiological abnormality. This will help direct the appropriate use of therapy whether it is desmopressin to reduce dieresis or an anticholinergic directed at detrusor overactivity. There is currently debate over the benefit of behavioral modification therapy, alarm systems and recently the role of posterior tibial nerve stimulation therapy in adult patients suffering from nocturnal enuresis. Adult onset nocturnal enuresis can be a sign of chronic retention and warrants urgent urological assessment and treatment.