User login
Pregnancy boosts risk of ventral hernia recurrence
Pregnancy is associated with a significant increase in the risk of ventral hernia recurrence after repair, according to a population-based cohort study published online in the American Journal of Surgery.
Analysis of registry data from 3,578 Danish women of reproductive age who had previously undergone ventral hernia repair showed that subsequent pregnancy was associated with a 56% higher risk of recurrence (95% confidence interval, 1.09-2.25; P = .016), compared with women who did not get pregnant (Am J Surg. 2017 April 5. doi: 10.1016/j.amjsurg.2017.03.044).
They noted that few studies have directly reported on the rate of ventral hernia recurrence after pregnancy, and the results that do exist are conflicting.
The overall rate of ventral hernia recurrence in the cohort was 12.5%, 67.9% of whom subsequently underwent reoperation to repair. The median time from hernia repair to pregnancy was 1.1 years, and median follow-up was 3.1 years.
Umbilical and incisional hernia repair were independently associated with a higher risk of recurrence (hazard ratio, 1.55 and 3.30, respectively) than epigastric repair, while larger hernia defects also increased the risk of recurrence.
“According to Laplace’s law, both the abdominal wall stretch and the raised intra-abdominal pressure theoretically strain the repaired ventral hernia site and are likely involved in the associated increased risk of recurrence,” the authors wrote. “Furthermore, prolonged duration of the second stage of labor and the use of manual fundal pressure might increase the risk of ventral hernia recurrence.”
The authors pointed out that inadequate fixation and lateral detachment of the mesh material were the most commonly reported mechanisms involved in ventral hernia recurrence after mesh repair. The fact that most mesh materials are far less elastic than the abdominal wall could account for the association between pregnancy and recurrence.
Based on the findings, they suggested that elective surgery for incisional or umbilical hernia repair be postponed until after the last planned pregnancy and that female patients of reproductive age be counseled on the increased risk of recurrence with pregnancy should they choose to undergo ventral hernia repair. They also noted that the natural course of an untreated ventral hernia, how it responds to pregnancy, and the risk of emergency repair during pregnancy need further investigation.
The study was supported by grants from Edgar Schnohr, MD, Dr MSc & Wife Gilberte Schnohr’s Foundation, and Bispebjerg Hospital. No conflicts of interest were declared.
Pregnancy is associated with a significant increase in the risk of ventral hernia recurrence after repair, according to a population-based cohort study published online in the American Journal of Surgery.
Analysis of registry data from 3,578 Danish women of reproductive age who had previously undergone ventral hernia repair showed that subsequent pregnancy was associated with a 56% higher risk of recurrence (95% confidence interval, 1.09-2.25; P = .016), compared with women who did not get pregnant (Am J Surg. 2017 April 5. doi: 10.1016/j.amjsurg.2017.03.044).
They noted that few studies have directly reported on the rate of ventral hernia recurrence after pregnancy, and the results that do exist are conflicting.
The overall rate of ventral hernia recurrence in the cohort was 12.5%, 67.9% of whom subsequently underwent reoperation to repair. The median time from hernia repair to pregnancy was 1.1 years, and median follow-up was 3.1 years.
Umbilical and incisional hernia repair were independently associated with a higher risk of recurrence (hazard ratio, 1.55 and 3.30, respectively) than epigastric repair, while larger hernia defects also increased the risk of recurrence.
“According to Laplace’s law, both the abdominal wall stretch and the raised intra-abdominal pressure theoretically strain the repaired ventral hernia site and are likely involved in the associated increased risk of recurrence,” the authors wrote. “Furthermore, prolonged duration of the second stage of labor and the use of manual fundal pressure might increase the risk of ventral hernia recurrence.”
The authors pointed out that inadequate fixation and lateral detachment of the mesh material were the most commonly reported mechanisms involved in ventral hernia recurrence after mesh repair. The fact that most mesh materials are far less elastic than the abdominal wall could account for the association between pregnancy and recurrence.
Based on the findings, they suggested that elective surgery for incisional or umbilical hernia repair be postponed until after the last planned pregnancy and that female patients of reproductive age be counseled on the increased risk of recurrence with pregnancy should they choose to undergo ventral hernia repair. They also noted that the natural course of an untreated ventral hernia, how it responds to pregnancy, and the risk of emergency repair during pregnancy need further investigation.
The study was supported by grants from Edgar Schnohr, MD, Dr MSc & Wife Gilberte Schnohr’s Foundation, and Bispebjerg Hospital. No conflicts of interest were declared.
Pregnancy is associated with a significant increase in the risk of ventral hernia recurrence after repair, according to a population-based cohort study published online in the American Journal of Surgery.
Analysis of registry data from 3,578 Danish women of reproductive age who had previously undergone ventral hernia repair showed that subsequent pregnancy was associated with a 56% higher risk of recurrence (95% confidence interval, 1.09-2.25; P = .016), compared with women who did not get pregnant (Am J Surg. 2017 April 5. doi: 10.1016/j.amjsurg.2017.03.044).
They noted that few studies have directly reported on the rate of ventral hernia recurrence after pregnancy, and the results that do exist are conflicting.
The overall rate of ventral hernia recurrence in the cohort was 12.5%, 67.9% of whom subsequently underwent reoperation to repair. The median time from hernia repair to pregnancy was 1.1 years, and median follow-up was 3.1 years.
Umbilical and incisional hernia repair were independently associated with a higher risk of recurrence (hazard ratio, 1.55 and 3.30, respectively) than epigastric repair, while larger hernia defects also increased the risk of recurrence.
“According to Laplace’s law, both the abdominal wall stretch and the raised intra-abdominal pressure theoretically strain the repaired ventral hernia site and are likely involved in the associated increased risk of recurrence,” the authors wrote. “Furthermore, prolonged duration of the second stage of labor and the use of manual fundal pressure might increase the risk of ventral hernia recurrence.”
The authors pointed out that inadequate fixation and lateral detachment of the mesh material were the most commonly reported mechanisms involved in ventral hernia recurrence after mesh repair. The fact that most mesh materials are far less elastic than the abdominal wall could account for the association between pregnancy and recurrence.
Based on the findings, they suggested that elective surgery for incisional or umbilical hernia repair be postponed until after the last planned pregnancy and that female patients of reproductive age be counseled on the increased risk of recurrence with pregnancy should they choose to undergo ventral hernia repair. They also noted that the natural course of an untreated ventral hernia, how it responds to pregnancy, and the risk of emergency repair during pregnancy need further investigation.
The study was supported by grants from Edgar Schnohr, MD, Dr MSc & Wife Gilberte Schnohr’s Foundation, and Bispebjerg Hospital. No conflicts of interest were declared.
FROM THE AMERICAN JOURNAL OF SURGERY
Key clinical point: Pregnancy after ventral hernia repair can significantly increase the risk of recurrence.
Major finding: Pregnancy is associated with a 56% increase in the risk of recurrence of ventral hernia after repair.
Data source: A population-based cohort study of 3,578 women of reproductive age who underwent ventral hernia repair.
Disclosures: The study was supported by grants from Edgar Schnohr MD, Dr MSc & Wife Gilberte Schnohr’s Foundation, and Bispebjerg Hospital. No conflicts of interest were declared.
HCV seroconversion rate 0.1% after occupational exposure
An analysis of 13 years of accidental occupational exposures to hepatitis C virus–contaminated fluids or instruments has revealed a seroconversion rate of just 0.1%, significantly lower than that reported in the literature.
That’s according to an longitudinal analysis of data from a prospectively maintained database of 1,361 occupational injuries involving a hepatitis C virus–positive source that occurred between 2002 and 2015 conducted by Francesco M. Egro, MD, and his colleagues from the University of Pittsburgh Medical Center.
In the study, 65% of the exposures were caused by percutaneous injuries and 34% were caused by mucocutaneous injuries, and the remaining 1% were uncertain.
The hand was the most common site of injury (63%), followed by the face and neck (28%) and the arm, foot, leg, or trunk (4%). There was no record of the anatomical location of the injury in 5% of cases.
In nearly three-quarters of cases, blood was the source of exposure, while blood-containing saliva accounted for 3% of cases. The remaining 24% of cases were linked to other fluids such as peritoneal fluid, tracheal secretions, amniotic fluid, bloody irrigation fluid, and blood-containing feces.
“The risk of transmission after exposure to HCV-positive patients’ fluids or tissues other than blood is expected to be low, but has not been formally quantified,” the authors wrote. “Although there have been reports of HCV seroconversion after human bites and after punching a HCV-positive individual in the teeth, percutaneous exposures to the blood of a HCV-positive source remain the most common cause of occupational HCV transmission.”
While the rate of seroconversion was low, the authors encouraged prompt reporting, testing, and follow-up of exposed individuals.
No conflicts of interest were declared.
On Twitter @IDPractitioner
An analysis of 13 years of accidental occupational exposures to hepatitis C virus–contaminated fluids or instruments has revealed a seroconversion rate of just 0.1%, significantly lower than that reported in the literature.
That’s according to an longitudinal analysis of data from a prospectively maintained database of 1,361 occupational injuries involving a hepatitis C virus–positive source that occurred between 2002 and 2015 conducted by Francesco M. Egro, MD, and his colleagues from the University of Pittsburgh Medical Center.
In the study, 65% of the exposures were caused by percutaneous injuries and 34% were caused by mucocutaneous injuries, and the remaining 1% were uncertain.
The hand was the most common site of injury (63%), followed by the face and neck (28%) and the arm, foot, leg, or trunk (4%). There was no record of the anatomical location of the injury in 5% of cases.
In nearly three-quarters of cases, blood was the source of exposure, while blood-containing saliva accounted for 3% of cases. The remaining 24% of cases were linked to other fluids such as peritoneal fluid, tracheal secretions, amniotic fluid, bloody irrigation fluid, and blood-containing feces.
“The risk of transmission after exposure to HCV-positive patients’ fluids or tissues other than blood is expected to be low, but has not been formally quantified,” the authors wrote. “Although there have been reports of HCV seroconversion after human bites and after punching a HCV-positive individual in the teeth, percutaneous exposures to the blood of a HCV-positive source remain the most common cause of occupational HCV transmission.”
While the rate of seroconversion was low, the authors encouraged prompt reporting, testing, and follow-up of exposed individuals.
No conflicts of interest were declared.
On Twitter @IDPractitioner
An analysis of 13 years of accidental occupational exposures to hepatitis C virus–contaminated fluids or instruments has revealed a seroconversion rate of just 0.1%, significantly lower than that reported in the literature.
That’s according to an longitudinal analysis of data from a prospectively maintained database of 1,361 occupational injuries involving a hepatitis C virus–positive source that occurred between 2002 and 2015 conducted by Francesco M. Egro, MD, and his colleagues from the University of Pittsburgh Medical Center.
In the study, 65% of the exposures were caused by percutaneous injuries and 34% were caused by mucocutaneous injuries, and the remaining 1% were uncertain.
The hand was the most common site of injury (63%), followed by the face and neck (28%) and the arm, foot, leg, or trunk (4%). There was no record of the anatomical location of the injury in 5% of cases.
In nearly three-quarters of cases, blood was the source of exposure, while blood-containing saliva accounted for 3% of cases. The remaining 24% of cases were linked to other fluids such as peritoneal fluid, tracheal secretions, amniotic fluid, bloody irrigation fluid, and blood-containing feces.
“The risk of transmission after exposure to HCV-positive patients’ fluids or tissues other than blood is expected to be low, but has not been formally quantified,” the authors wrote. “Although there have been reports of HCV seroconversion after human bites and after punching a HCV-positive individual in the teeth, percutaneous exposures to the blood of a HCV-positive source remain the most common cause of occupational HCV transmission.”
While the rate of seroconversion was low, the authors encouraged prompt reporting, testing, and follow-up of exposed individuals.
No conflicts of interest were declared.
On Twitter @IDPractitioner
FROM THE AMERICAN JOURNAL OF INFECTION CONTROL
Key clinical point: Researchers have observed a low seroconversion rate after accidental occupational exposure to a HCV-contaminated source.
Major finding: The rate of seroconversion after exposure to a HCV-infected source such as blood was just 0.1% and only occurred after percutaneous exposure to blood.
Data source: A single-center database of 1,361 occupational injuries involving an HCV-positive source.
Disclosures: No conflicts of interest were declared.
Intervention improves use of treat to target in RA
A learning collaborative approach can significantly improve adherence to a treat-to-target approach in patients with rheumatoid arthritis, new research suggests.
While numerous clinical trials have shown that a strategy of treating to target achieves better outcomes, compared with usual care, there is evidence that this approach is not always practiced, wrote Daniel H. Solomon, MD, of the division of rheumatology at Brigham and Women’s Hospital, Boston, and his coauthors.
The intervention first involved the faculty developing a set of principles and concepts to describe the goals for implementing treat to target. These were then disseminated to the sites through a single face-to-face learning session and a series of webinars, which were also recorded and made available online. The first session also worked on team building within sites and on cross-site collaborative relationships.
“In this study, we found large benefits, despite using a relatively low-intensity approach to the learning collaborative, with only one face-to-face meeting,” wrote the authors, who noted that altogether the program involved around 20 hours per provider over 9 months.
The investigators used a composite treat-to-target implementation score as the primary outcome, which was based on the presence or absence of four measures deemed central to the principles and concepts of a treat-to-target strategy. The measures were:
- Specifying a disease activity target.
- Recording RA disease activity, using one of four recommended measures (Disease Activity Score-28, Simplified Disease Activity Index, Clinical Disease Activity Index, or Routine Assessment of Patient Index Data 3), with results described numerically or by category (remission, low, moderate, or high).
- When a decision was being made (change in target or change in treatment), documenting shared decision making.
- Basing treatment decisions on target and disease activity measure or describing reasons why treat to target was not adhered to.
The intervention increased the treat-to-target implementation score by 46 percentage points, from 11% to 57%. In comparison, the control arm had an increase of 14 percentage points, from 11% to 25% (P = .004). It achieved a substantial and significant increase in the proportion of participants for whom a treatment target was documented, from 0.6% at baseline to 45.6% at the 9-month follow-up, compared with a 12.5-point increase in the control group. The recording of disease activity increased from 20% to 89.1% in the intervention arm, compared with an increase from 30.2% to 52.3% in the control arm. Similarly, shared decision making increased from 51.3% to 85.9% in the intervention group, compared with a rise from 24.5% to 43% in the control arm.
The study also examined a range of secondary outcomes representing the impact of the intervention on patients. They found that a positive change in treat-to-target adherence score was seen in 83.8% of patients in the intervention arm, compared with 36.8% of patients in the control arm (P = .0001), when almost no patient visits at baseline were adherent to all components of treat to target.
At the 9-month follow-up, 25.9% of visits in the intervention arm were adherent to all four components of the treat-to-target approach, compared with 5.6% in the control arm.
The authors suggested that their learning collaborative approach could be applied across a range of chronic diseases.
“In fact, our model is consistent with the goals and strategy of the Million Hearts campaign to reduce cardiovascular disease burden across the U.S. by targeting five areas of goal-based therapy.”
There were no significant differences between the intervention and control arms in the number of orders for drug-monitoring laboratory tests or radiology orders. However, patients in the intervention arm had fewer adverse events than did those in the control arm (0.26 vs. 0.43 per patient; P = .043).
The investigators noted that the study was relatively small – involving just 11 sites – and the primary outcome was a process measure that did not reflect clinical outcomes and has not been validated.
The study was supported by the National Institutes of Health. One author declared salary support through research grants to his hospital from pharmaceutical companies, while another declared research grants from AbbVie for treat-to-target research activities.
A learning collaborative approach can significantly improve adherence to a treat-to-target approach in patients with rheumatoid arthritis, new research suggests.
While numerous clinical trials have shown that a strategy of treating to target achieves better outcomes, compared with usual care, there is evidence that this approach is not always practiced, wrote Daniel H. Solomon, MD, of the division of rheumatology at Brigham and Women’s Hospital, Boston, and his coauthors.
The intervention first involved the faculty developing a set of principles and concepts to describe the goals for implementing treat to target. These were then disseminated to the sites through a single face-to-face learning session and a series of webinars, which were also recorded and made available online. The first session also worked on team building within sites and on cross-site collaborative relationships.
“In this study, we found large benefits, despite using a relatively low-intensity approach to the learning collaborative, with only one face-to-face meeting,” wrote the authors, who noted that altogether the program involved around 20 hours per provider over 9 months.
The investigators used a composite treat-to-target implementation score as the primary outcome, which was based on the presence or absence of four measures deemed central to the principles and concepts of a treat-to-target strategy. The measures were:
- Specifying a disease activity target.
- Recording RA disease activity, using one of four recommended measures (Disease Activity Score-28, Simplified Disease Activity Index, Clinical Disease Activity Index, or Routine Assessment of Patient Index Data 3), with results described numerically or by category (remission, low, moderate, or high).
- When a decision was being made (change in target or change in treatment), documenting shared decision making.
- Basing treatment decisions on target and disease activity measure or describing reasons why treat to target was not adhered to.
The intervention increased the treat-to-target implementation score by 46 percentage points, from 11% to 57%. In comparison, the control arm had an increase of 14 percentage points, from 11% to 25% (P = .004). It achieved a substantial and significant increase in the proportion of participants for whom a treatment target was documented, from 0.6% at baseline to 45.6% at the 9-month follow-up, compared with a 12.5-point increase in the control group. The recording of disease activity increased from 20% to 89.1% in the intervention arm, compared with an increase from 30.2% to 52.3% in the control arm. Similarly, shared decision making increased from 51.3% to 85.9% in the intervention group, compared with a rise from 24.5% to 43% in the control arm.
The study also examined a range of secondary outcomes representing the impact of the intervention on patients. They found that a positive change in treat-to-target adherence score was seen in 83.8% of patients in the intervention arm, compared with 36.8% of patients in the control arm (P = .0001), when almost no patient visits at baseline were adherent to all components of treat to target.
At the 9-month follow-up, 25.9% of visits in the intervention arm were adherent to all four components of the treat-to-target approach, compared with 5.6% in the control arm.
The authors suggested that their learning collaborative approach could be applied across a range of chronic diseases.
“In fact, our model is consistent with the goals and strategy of the Million Hearts campaign to reduce cardiovascular disease burden across the U.S. by targeting five areas of goal-based therapy.”
There were no significant differences between the intervention and control arms in the number of orders for drug-monitoring laboratory tests or radiology orders. However, patients in the intervention arm had fewer adverse events than did those in the control arm (0.26 vs. 0.43 per patient; P = .043).
The investigators noted that the study was relatively small – involving just 11 sites – and the primary outcome was a process measure that did not reflect clinical outcomes and has not been validated.
The study was supported by the National Institutes of Health. One author declared salary support through research grants to his hospital from pharmaceutical companies, while another declared research grants from AbbVie for treat-to-target research activities.
A learning collaborative approach can significantly improve adherence to a treat-to-target approach in patients with rheumatoid arthritis, new research suggests.
While numerous clinical trials have shown that a strategy of treating to target achieves better outcomes, compared with usual care, there is evidence that this approach is not always practiced, wrote Daniel H. Solomon, MD, of the division of rheumatology at Brigham and Women’s Hospital, Boston, and his coauthors.
The intervention first involved the faculty developing a set of principles and concepts to describe the goals for implementing treat to target. These were then disseminated to the sites through a single face-to-face learning session and a series of webinars, which were also recorded and made available online. The first session also worked on team building within sites and on cross-site collaborative relationships.
“In this study, we found large benefits, despite using a relatively low-intensity approach to the learning collaborative, with only one face-to-face meeting,” wrote the authors, who noted that altogether the program involved around 20 hours per provider over 9 months.
The investigators used a composite treat-to-target implementation score as the primary outcome, which was based on the presence or absence of four measures deemed central to the principles and concepts of a treat-to-target strategy. The measures were:
- Specifying a disease activity target.
- Recording RA disease activity, using one of four recommended measures (Disease Activity Score-28, Simplified Disease Activity Index, Clinical Disease Activity Index, or Routine Assessment of Patient Index Data 3), with results described numerically or by category (remission, low, moderate, or high).
- When a decision was being made (change in target or change in treatment), documenting shared decision making.
- Basing treatment decisions on target and disease activity measure or describing reasons why treat to target was not adhered to.
The intervention increased the treat-to-target implementation score by 46 percentage points, from 11% to 57%. In comparison, the control arm had an increase of 14 percentage points, from 11% to 25% (P = .004). It achieved a substantial and significant increase in the proportion of participants for whom a treatment target was documented, from 0.6% at baseline to 45.6% at the 9-month follow-up, compared with a 12.5-point increase in the control group. The recording of disease activity increased from 20% to 89.1% in the intervention arm, compared with an increase from 30.2% to 52.3% in the control arm. Similarly, shared decision making increased from 51.3% to 85.9% in the intervention group, compared with a rise from 24.5% to 43% in the control arm.
The study also examined a range of secondary outcomes representing the impact of the intervention on patients. They found that a positive change in treat-to-target adherence score was seen in 83.8% of patients in the intervention arm, compared with 36.8% of patients in the control arm (P = .0001), when almost no patient visits at baseline were adherent to all components of treat to target.
At the 9-month follow-up, 25.9% of visits in the intervention arm were adherent to all four components of the treat-to-target approach, compared with 5.6% in the control arm.
The authors suggested that their learning collaborative approach could be applied across a range of chronic diseases.
“In fact, our model is consistent with the goals and strategy of the Million Hearts campaign to reduce cardiovascular disease burden across the U.S. by targeting five areas of goal-based therapy.”
There were no significant differences between the intervention and control arms in the number of orders for drug-monitoring laboratory tests or radiology orders. However, patients in the intervention arm had fewer adverse events than did those in the control arm (0.26 vs. 0.43 per patient; P = .043).
The investigators noted that the study was relatively small – involving just 11 sites – and the primary outcome was a process measure that did not reflect clinical outcomes and has not been validated.
The study was supported by the National Institutes of Health. One author declared salary support through research grants to his hospital from pharmaceutical companies, while another declared research grants from AbbVie for treat-to-target research activities.
FROM ARTHRITIS & RHEUMATOLOGY
Key clinical point:
Major finding: A site-based intervention increased a treat-to-target implementation score by 46 percentage points – from 11% to 57% – compared with a 14–percentage point increase in the control arm.
Data source: The cluster-randomized, wait list–controlled, quality improvement TRACTION trial, involving 11 sites and 641 patients.
Disclosures: The study was supported by the National Institutes of Health. One author declared salary support through research grants to his hospital from pharmaceutical companies, while another declared research grants from AbbVie for treat-to-target research activities.
Topical tretinoin resolves inflammatory symptoms in rosacea, in small study
SYDNEY, AUSTRALIA – Treatment with topical tretinoin resulted in complete resolution of rosacea symptoms in a significant number of patients, in a small retrospective study presented at the annual meeting of the Australasian College of Dermatologists.
“As an intermediary step between topical antibiotics and oral isotretinoin, we propose that topical tretinoin may be effective in the management and reduction of rosacea symptoms,” Emily Forward, MD, of the University of Sydney, said at the meeting. There has been recent discussion regarding the use of low-dose isotretinoin in the treatment of rosacea, but safety with long-term use is an issue, she noted.
More than 80% of patients had complete or excellent resolution of papules and pustules, with only one patient showing no benefit. Of the patients with erythema as the primary feature of their rosacea, 42% achieved complete resolution, 33% achieved excellent resolution, 17% achieved a good response, and 8% showed no benefit, Dr. Forward reported.
Among patients with telangiectasia, 40% achieved complete resolution, while 37% of those with flushing achieved complete resolution.
Topical tretinoin should be considered among the treatment options for rosacea “as it is effective, well tolerated, and has synergistic benefits in the prevention of photoaging,” Dr. Forward said. The ideal patient candidate would be someone with inflammatory features such as papules, pustules, or erythema, she added.
No patients experienced worsening of their symptoms with treatment, although one patient stopped treatment because of adverse effects. Dr. Forward also stressed that tretinoin is a known teratogen, so it should not be used during pregnancy or breastfeeding, or in patients trying to conceive.
In an interview, Dr. Forward said that she and her associates were surprised at the degree of improvement with topical tretinoin, particularly for erythema symptoms. However, she said it was important to educate patients about how to use topical tretinoin. “You use a pea-sized amount, at night, and in the beginning we advise them to use it every second or third day, and if they tolerate it they can increase the amount,” she said.
No conflicts of interest were declared.
SYDNEY, AUSTRALIA – Treatment with topical tretinoin resulted in complete resolution of rosacea symptoms in a significant number of patients, in a small retrospective study presented at the annual meeting of the Australasian College of Dermatologists.
“As an intermediary step between topical antibiotics and oral isotretinoin, we propose that topical tretinoin may be effective in the management and reduction of rosacea symptoms,” Emily Forward, MD, of the University of Sydney, said at the meeting. There has been recent discussion regarding the use of low-dose isotretinoin in the treatment of rosacea, but safety with long-term use is an issue, she noted.
More than 80% of patients had complete or excellent resolution of papules and pustules, with only one patient showing no benefit. Of the patients with erythema as the primary feature of their rosacea, 42% achieved complete resolution, 33% achieved excellent resolution, 17% achieved a good response, and 8% showed no benefit, Dr. Forward reported.
Among patients with telangiectasia, 40% achieved complete resolution, while 37% of those with flushing achieved complete resolution.
Topical tretinoin should be considered among the treatment options for rosacea “as it is effective, well tolerated, and has synergistic benefits in the prevention of photoaging,” Dr. Forward said. The ideal patient candidate would be someone with inflammatory features such as papules, pustules, or erythema, she added.
No patients experienced worsening of their symptoms with treatment, although one patient stopped treatment because of adverse effects. Dr. Forward also stressed that tretinoin is a known teratogen, so it should not be used during pregnancy or breastfeeding, or in patients trying to conceive.
In an interview, Dr. Forward said that she and her associates were surprised at the degree of improvement with topical tretinoin, particularly for erythema symptoms. However, she said it was important to educate patients about how to use topical tretinoin. “You use a pea-sized amount, at night, and in the beginning we advise them to use it every second or third day, and if they tolerate it they can increase the amount,” she said.
No conflicts of interest were declared.
SYDNEY, AUSTRALIA – Treatment with topical tretinoin resulted in complete resolution of rosacea symptoms in a significant number of patients, in a small retrospective study presented at the annual meeting of the Australasian College of Dermatologists.
“As an intermediary step between topical antibiotics and oral isotretinoin, we propose that topical tretinoin may be effective in the management and reduction of rosacea symptoms,” Emily Forward, MD, of the University of Sydney, said at the meeting. There has been recent discussion regarding the use of low-dose isotretinoin in the treatment of rosacea, but safety with long-term use is an issue, she noted.
More than 80% of patients had complete or excellent resolution of papules and pustules, with only one patient showing no benefit. Of the patients with erythema as the primary feature of their rosacea, 42% achieved complete resolution, 33% achieved excellent resolution, 17% achieved a good response, and 8% showed no benefit, Dr. Forward reported.
Among patients with telangiectasia, 40% achieved complete resolution, while 37% of those with flushing achieved complete resolution.
Topical tretinoin should be considered among the treatment options for rosacea “as it is effective, well tolerated, and has synergistic benefits in the prevention of photoaging,” Dr. Forward said. The ideal patient candidate would be someone with inflammatory features such as papules, pustules, or erythema, she added.
No patients experienced worsening of their symptoms with treatment, although one patient stopped treatment because of adverse effects. Dr. Forward also stressed that tretinoin is a known teratogen, so it should not be used during pregnancy or breastfeeding, or in patients trying to conceive.
In an interview, Dr. Forward said that she and her associates were surprised at the degree of improvement with topical tretinoin, particularly for erythema symptoms. However, she said it was important to educate patients about how to use topical tretinoin. “You use a pea-sized amount, at night, and in the beginning we advise them to use it every second or third day, and if they tolerate it they can increase the amount,” she said.
No conflicts of interest were declared.
AT ACDASM 2017
Key clinical point: Topical tretinoin may be useful in treating erythema and the inflammatory symptoms of rosacea.
Major finding: More than 80% of patients with rosacea had complete or excellent resolution of papules and pustules with topical tretinoin 0.05%.
Data source: A retrospective study of 25 patients with mild to severe rosacea.
Disclosures: No conflicts of interest were declared.
Survey: Botulinum toxin achieves durable improvements in hyperhidrosis
SYDNEY, AUSTRALIA – Botulinum toxin therapy achieved substantial and durable improvements in symptoms in the majority of patients with axillary hyperhidrosis, in a retrospective study presented at the annual meeting of the Australasian College of Dermatologists.
Sydney dermatologist Robert Rosen, MMed, and his associates analyzed survey data from 200 patients with primary axillary hyperhidrosis who had been treated with 100 units of botulinum toxin at a hyperhidrosis referral center between 2006 and 2016. Patients were aged 12 years or older, and had had axillary hyperhidrosis for 6 months or longer that had not responded to treatment with 20% topical aluminum chloride.
Of these patients, 96% reported at least moderate satisfaction with the results of their treatment with botulinum toxin, with a mean satisfaction rating of 3.41 on a four-point scale that ranged from 1 (slight improvement) to 4 (complete abolition of signs and symptoms).
Durability of effect increased with successive treatments, according to 42% of the patients. There was no change in durability among 44% of the survey respondents, and 14% reported a shortened durability with successive treatments.
More than 80% of patients reported life-changing or substantial improvements in their quality of life after treatment with botulinum toxin, 14% reported some improvement, and 3% reported no improvement.
Only 6.5% of patients reported compensatory sweating elsewhere on the body, a rate similar to that of 5% reported in other studies, Dr. Rosen pointed out. This was in contrast to the 85%-90% rate of compensatory hyperhidrosis after surgical sympathectomy reported in other studies.
“That’s a big procedure and if you have compensatory hyperhidrosis elsewhere, you wouldn’t be terribly satisfied,” he said.
Dr. Rosen and his associates also looked at prognostic factors that might predict response to botulinum toxin. “People who did better with durability were those people who had sweating elsewhere, so they had more than one site of primary hyperhidrosis,” or they had failed other treatments, he said at the meeting.
In an interview, Dr. Rosen said that any treatment with a success rate greater than 90% was extraordinary. “It’s something that we as dermatologists can do where we have a lot of patient gratitude and satisfaction,” he noted. “Before we had this therapy, our other therapies were not great and people were quite desperate and had surgery, and the problem with surgery … is that they got compensatory hyperhidrosis elsewhere.”
Dr. Rosen, of Southern Suburbs Dermatology in Sydney, disclosed serving as a consultant for Allergan and Galderma unrelated to this research. No other conflicts of interest were declared.
SYDNEY, AUSTRALIA – Botulinum toxin therapy achieved substantial and durable improvements in symptoms in the majority of patients with axillary hyperhidrosis, in a retrospective study presented at the annual meeting of the Australasian College of Dermatologists.
Sydney dermatologist Robert Rosen, MMed, and his associates analyzed survey data from 200 patients with primary axillary hyperhidrosis who had been treated with 100 units of botulinum toxin at a hyperhidrosis referral center between 2006 and 2016. Patients were aged 12 years or older, and had had axillary hyperhidrosis for 6 months or longer that had not responded to treatment with 20% topical aluminum chloride.
Of these patients, 96% reported at least moderate satisfaction with the results of their treatment with botulinum toxin, with a mean satisfaction rating of 3.41 on a four-point scale that ranged from 1 (slight improvement) to 4 (complete abolition of signs and symptoms).
Durability of effect increased with successive treatments, according to 42% of the patients. There was no change in durability among 44% of the survey respondents, and 14% reported a shortened durability with successive treatments.
More than 80% of patients reported life-changing or substantial improvements in their quality of life after treatment with botulinum toxin, 14% reported some improvement, and 3% reported no improvement.
Only 6.5% of patients reported compensatory sweating elsewhere on the body, a rate similar to that of 5% reported in other studies, Dr. Rosen pointed out. This was in contrast to the 85%-90% rate of compensatory hyperhidrosis after surgical sympathectomy reported in other studies.
“That’s a big procedure and if you have compensatory hyperhidrosis elsewhere, you wouldn’t be terribly satisfied,” he said.
Dr. Rosen and his associates also looked at prognostic factors that might predict response to botulinum toxin. “People who did better with durability were those people who had sweating elsewhere, so they had more than one site of primary hyperhidrosis,” or they had failed other treatments, he said at the meeting.
In an interview, Dr. Rosen said that any treatment with a success rate greater than 90% was extraordinary. “It’s something that we as dermatologists can do where we have a lot of patient gratitude and satisfaction,” he noted. “Before we had this therapy, our other therapies were not great and people were quite desperate and had surgery, and the problem with surgery … is that they got compensatory hyperhidrosis elsewhere.”
Dr. Rosen, of Southern Suburbs Dermatology in Sydney, disclosed serving as a consultant for Allergan and Galderma unrelated to this research. No other conflicts of interest were declared.
SYDNEY, AUSTRALIA – Botulinum toxin therapy achieved substantial and durable improvements in symptoms in the majority of patients with axillary hyperhidrosis, in a retrospective study presented at the annual meeting of the Australasian College of Dermatologists.
Sydney dermatologist Robert Rosen, MMed, and his associates analyzed survey data from 200 patients with primary axillary hyperhidrosis who had been treated with 100 units of botulinum toxin at a hyperhidrosis referral center between 2006 and 2016. Patients were aged 12 years or older, and had had axillary hyperhidrosis for 6 months or longer that had not responded to treatment with 20% topical aluminum chloride.
Of these patients, 96% reported at least moderate satisfaction with the results of their treatment with botulinum toxin, with a mean satisfaction rating of 3.41 on a four-point scale that ranged from 1 (slight improvement) to 4 (complete abolition of signs and symptoms).
Durability of effect increased with successive treatments, according to 42% of the patients. There was no change in durability among 44% of the survey respondents, and 14% reported a shortened durability with successive treatments.
More than 80% of patients reported life-changing or substantial improvements in their quality of life after treatment with botulinum toxin, 14% reported some improvement, and 3% reported no improvement.
Only 6.5% of patients reported compensatory sweating elsewhere on the body, a rate similar to that of 5% reported in other studies, Dr. Rosen pointed out. This was in contrast to the 85%-90% rate of compensatory hyperhidrosis after surgical sympathectomy reported in other studies.
“That’s a big procedure and if you have compensatory hyperhidrosis elsewhere, you wouldn’t be terribly satisfied,” he said.
Dr. Rosen and his associates also looked at prognostic factors that might predict response to botulinum toxin. “People who did better with durability were those people who had sweating elsewhere, so they had more than one site of primary hyperhidrosis,” or they had failed other treatments, he said at the meeting.
In an interview, Dr. Rosen said that any treatment with a success rate greater than 90% was extraordinary. “It’s something that we as dermatologists can do where we have a lot of patient gratitude and satisfaction,” he noted. “Before we had this therapy, our other therapies were not great and people were quite desperate and had surgery, and the problem with surgery … is that they got compensatory hyperhidrosis elsewhere.”
Dr. Rosen, of Southern Suburbs Dermatology in Sydney, disclosed serving as a consultant for Allergan and Galderma unrelated to this research. No other conflicts of interest were declared.
AT ACDASM 2017
Key clinical point: Botulinum toxin therapy achieves substantial and durable improvements in axillary hyperhidrosis symptoms in a majority of patients with hyperhidrosis.
Major finding: Almost all patients (96%) reported moderate improvement or better with botulinum toxin treatment of primary axillary hyperhidrosis.
Data source: A retrospective review of 200 patients with primary axillary hyperhidrosis, treated over a decade.
Disclosures: Dr. Rosen declared consultancies with Allergan and Galderma unrelated to this research. No other conflicts of interest were declared.
Muscle-related AEs reported in statin trial suggest ‘nocebo’ effect
Patients are more likely to report muscle-related adverse events (AEs) with statin therapy if a trial is unblinded, according to an analysis of a large clinical trial.
In the lipid-lowering arm of the Anglo-Scandinavian Cardiac Outcomes trial (ASCOT-LLA), 10,180 patients were randomized 1:1 to atorvastatin 10 mg daily or matching placebo for a median for 3.3 years. After the trial was terminated for efficacy, all patients were offered open-label atorvastatin, with 6,409 users and 3,490 nonusers then followed for a median of 2.3 years.
However, during the nonblinded, nonrandomized phase, the rate of muscle-related adverse events was 41% higher in individuals taking atorvastatin, compared with nonusers (1.26% vs. 1% per annum, P = .006). This was despite the fact that patients who reported muscle-related adverse events during the blinded phase were less likely to remain on a statin during the nonblinded phase, compared with those who had not reported this adverse event (Lancet. 2017 May 2. doi: 10.1016/S0140-6736[17]31075-9).
“This observation is consistent with a nocebo effect, whereby subjective AEs (e.g., symptoms reported by patients) can be more likely to be attributed to a treatment thought to cause some particular side effect,” wrote Ajay Gupta, MD, of the National Heart and Lung Institute at Imperial College London and his coauthors.
Musculoskeletal and connective tissue disorders and blood and lymphatic system disorders were also reported more commonly among those taking statins, compared with those not in the nonblinded phase. Apart from these, there were no other significant differences in the rate of other adverse events.
In the blinded phase, patients taking atorvastatin reported significantly lower rates of sleep disturbance, compared with those on placebo, but there was a significant 23% higher rate of renal and urinary adverse events in the atorvastatin arm, compared with the placebo arm. Researchers were not able to draw any conclusions about the incidence of cognitive impairment because there were too few cases.
“We hope that the demonstration in the ASCOT-LLA, of not only the absence of adverse effects of statin therapy on muscle-related and other AEs but also the effect of ascertainment bias in nonblinding studies (which have been the basis of many of the misleading claims), will help to counter the adverse effect on public health of exaggerated claims about statin side effects,” the authors wrote.
The study was funded by Pfizer, Servier Research Group, and Leo Laboratories. Four authors declared personal fees, funding, or speakers honoraria from pharmaceutical companies, including Pfizer. One author was also noted for having sought retraction of papers published about the side-effects of statin therapy. No other conflicts of interest were declared.
Patients are more likely to report muscle-related adverse events (AEs) with statin therapy if a trial is unblinded, according to an analysis of a large clinical trial.
In the lipid-lowering arm of the Anglo-Scandinavian Cardiac Outcomes trial (ASCOT-LLA), 10,180 patients were randomized 1:1 to atorvastatin 10 mg daily or matching placebo for a median for 3.3 years. After the trial was terminated for efficacy, all patients were offered open-label atorvastatin, with 6,409 users and 3,490 nonusers then followed for a median of 2.3 years.
However, during the nonblinded, nonrandomized phase, the rate of muscle-related adverse events was 41% higher in individuals taking atorvastatin, compared with nonusers (1.26% vs. 1% per annum, P = .006). This was despite the fact that patients who reported muscle-related adverse events during the blinded phase were less likely to remain on a statin during the nonblinded phase, compared with those who had not reported this adverse event (Lancet. 2017 May 2. doi: 10.1016/S0140-6736[17]31075-9).
“This observation is consistent with a nocebo effect, whereby subjective AEs (e.g., symptoms reported by patients) can be more likely to be attributed to a treatment thought to cause some particular side effect,” wrote Ajay Gupta, MD, of the National Heart and Lung Institute at Imperial College London and his coauthors.
Musculoskeletal and connective tissue disorders and blood and lymphatic system disorders were also reported more commonly among those taking statins, compared with those not in the nonblinded phase. Apart from these, there were no other significant differences in the rate of other adverse events.
In the blinded phase, patients taking atorvastatin reported significantly lower rates of sleep disturbance, compared with those on placebo, but there was a significant 23% higher rate of renal and urinary adverse events in the atorvastatin arm, compared with the placebo arm. Researchers were not able to draw any conclusions about the incidence of cognitive impairment because there were too few cases.
“We hope that the demonstration in the ASCOT-LLA, of not only the absence of adverse effects of statin therapy on muscle-related and other AEs but also the effect of ascertainment bias in nonblinding studies (which have been the basis of many of the misleading claims), will help to counter the adverse effect on public health of exaggerated claims about statin side effects,” the authors wrote.
The study was funded by Pfizer, Servier Research Group, and Leo Laboratories. Four authors declared personal fees, funding, or speakers honoraria from pharmaceutical companies, including Pfizer. One author was also noted for having sought retraction of papers published about the side-effects of statin therapy. No other conflicts of interest were declared.
Patients are more likely to report muscle-related adverse events (AEs) with statin therapy if a trial is unblinded, according to an analysis of a large clinical trial.
In the lipid-lowering arm of the Anglo-Scandinavian Cardiac Outcomes trial (ASCOT-LLA), 10,180 patients were randomized 1:1 to atorvastatin 10 mg daily or matching placebo for a median for 3.3 years. After the trial was terminated for efficacy, all patients were offered open-label atorvastatin, with 6,409 users and 3,490 nonusers then followed for a median of 2.3 years.
However, during the nonblinded, nonrandomized phase, the rate of muscle-related adverse events was 41% higher in individuals taking atorvastatin, compared with nonusers (1.26% vs. 1% per annum, P = .006). This was despite the fact that patients who reported muscle-related adverse events during the blinded phase were less likely to remain on a statin during the nonblinded phase, compared with those who had not reported this adverse event (Lancet. 2017 May 2. doi: 10.1016/S0140-6736[17]31075-9).
“This observation is consistent with a nocebo effect, whereby subjective AEs (e.g., symptoms reported by patients) can be more likely to be attributed to a treatment thought to cause some particular side effect,” wrote Ajay Gupta, MD, of the National Heart and Lung Institute at Imperial College London and his coauthors.
Musculoskeletal and connective tissue disorders and blood and lymphatic system disorders were also reported more commonly among those taking statins, compared with those not in the nonblinded phase. Apart from these, there were no other significant differences in the rate of other adverse events.
In the blinded phase, patients taking atorvastatin reported significantly lower rates of sleep disturbance, compared with those on placebo, but there was a significant 23% higher rate of renal and urinary adverse events in the atorvastatin arm, compared with the placebo arm. Researchers were not able to draw any conclusions about the incidence of cognitive impairment because there were too few cases.
“We hope that the demonstration in the ASCOT-LLA, of not only the absence of adverse effects of statin therapy on muscle-related and other AEs but also the effect of ascertainment bias in nonblinding studies (which have been the basis of many of the misleading claims), will help to counter the adverse effect on public health of exaggerated claims about statin side effects,” the authors wrote.
The study was funded by Pfizer, Servier Research Group, and Leo Laboratories. Four authors declared personal fees, funding, or speakers honoraria from pharmaceutical companies, including Pfizer. One author was also noted for having sought retraction of papers published about the side-effects of statin therapy. No other conflicts of interest were declared.
FROM THE LANCET
Key clinical point: Patient reports of muscle-related adverse events related to statin use increases significantly after unblinding.
Major finding: The rate of muscle-related adverse events was 41% higher in individuals taking atorvastatin than in nonusers in the nonblinded phase of a trial, compared with no significant difference between arms in the blinded phase.
Data source: The lipid-lowering arm of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT-LLA) involving 10,180 patients.
Disclosures: The study was funded by Pfizer, Servier Research Group, and Leo Laboratories. Four authors declared personal fees, funding, or speakers honoraria from pharmaceutical companies, including Pfizer. One author was also noted for having sought retraction of papers published about the side effects of statin therapy. No other conflicts of interest were declared.
Consider strongyloidiasis before giving oral steroids
SYDNEY – Think twice before prescribing oral steroids for patients who have urticarial dermatitis, diarrhea, and cough, especially if they have lived in or recently traveled to tropical areas, Ian McCrossin, MD, said at the annual meeting of the Australasian College of Dermatologists.
Strongyloides stercoralis, or threadworm, infection can flare dramatically when patients take oral steroids. “You get thousands of worms, and they punch their way through the bowel wall and take the bowel organisms with them; that’s when you get septicaemia,” Dr. McCrossin, a dermatologist from Liverpool Hospital, Sydney, said in an interview.
Dr. McCrossin cited an Australian study that found a strongyloides infection was present in 11.6% of 309 Vietnam veterans living in South Australia.
Risk factors for Strongyloides hyperinfection include compromised immunity, human T-cell lymphotropic virus type 1, alcohol use disorder, malnutrition, and oral steroid use. Mortality rates from the resulting sepsis are as high as 87%, Dr. McCrossin said.
IgG ELISA is a reliable test for established strongyloidiasis, but is less effective for recent infection, hyperinfection, and in patients who are immunosuppressed. Eosinophilia has a poor predictive value. Light microscopy of stool samples may require evaluation of multiple stool samples unless the patient had hyperinfection.
Treatment generally consists of ivermectin, 200 mcg/kg orally for 1-2 days. Follow-up stool exams should be performed 2-4 weeks after treatment to confirm clearance of infection. In those patients with hyperinfections, ivermectin 200 mcg/kg orally is given daily until stool and/or sputum exams are negative for 2 weeks.
Dr. McCrossin declared no conflicts of interest.
SYDNEY – Think twice before prescribing oral steroids for patients who have urticarial dermatitis, diarrhea, and cough, especially if they have lived in or recently traveled to tropical areas, Ian McCrossin, MD, said at the annual meeting of the Australasian College of Dermatologists.
Strongyloides stercoralis, or threadworm, infection can flare dramatically when patients take oral steroids. “You get thousands of worms, and they punch their way through the bowel wall and take the bowel organisms with them; that’s when you get septicaemia,” Dr. McCrossin, a dermatologist from Liverpool Hospital, Sydney, said in an interview.
Dr. McCrossin cited an Australian study that found a strongyloides infection was present in 11.6% of 309 Vietnam veterans living in South Australia.
Risk factors for Strongyloides hyperinfection include compromised immunity, human T-cell lymphotropic virus type 1, alcohol use disorder, malnutrition, and oral steroid use. Mortality rates from the resulting sepsis are as high as 87%, Dr. McCrossin said.
IgG ELISA is a reliable test for established strongyloidiasis, but is less effective for recent infection, hyperinfection, and in patients who are immunosuppressed. Eosinophilia has a poor predictive value. Light microscopy of stool samples may require evaluation of multiple stool samples unless the patient had hyperinfection.
Treatment generally consists of ivermectin, 200 mcg/kg orally for 1-2 days. Follow-up stool exams should be performed 2-4 weeks after treatment to confirm clearance of infection. In those patients with hyperinfections, ivermectin 200 mcg/kg orally is given daily until stool and/or sputum exams are negative for 2 weeks.
Dr. McCrossin declared no conflicts of interest.
SYDNEY – Think twice before prescribing oral steroids for patients who have urticarial dermatitis, diarrhea, and cough, especially if they have lived in or recently traveled to tropical areas, Ian McCrossin, MD, said at the annual meeting of the Australasian College of Dermatologists.
Strongyloides stercoralis, or threadworm, infection can flare dramatically when patients take oral steroids. “You get thousands of worms, and they punch their way through the bowel wall and take the bowel organisms with them; that’s when you get septicaemia,” Dr. McCrossin, a dermatologist from Liverpool Hospital, Sydney, said in an interview.
Dr. McCrossin cited an Australian study that found a strongyloides infection was present in 11.6% of 309 Vietnam veterans living in South Australia.
Risk factors for Strongyloides hyperinfection include compromised immunity, human T-cell lymphotropic virus type 1, alcohol use disorder, malnutrition, and oral steroid use. Mortality rates from the resulting sepsis are as high as 87%, Dr. McCrossin said.
IgG ELISA is a reliable test for established strongyloidiasis, but is less effective for recent infection, hyperinfection, and in patients who are immunosuppressed. Eosinophilia has a poor predictive value. Light microscopy of stool samples may require evaluation of multiple stool samples unless the patient had hyperinfection.
Treatment generally consists of ivermectin, 200 mcg/kg orally for 1-2 days. Follow-up stool exams should be performed 2-4 weeks after treatment to confirm clearance of infection. In those patients with hyperinfections, ivermectin 200 mcg/kg orally is given daily until stool and/or sputum exams are negative for 2 weeks.
Dr. McCrossin declared no conflicts of interest.
EXPERT ANALYSIS AT ACDASM 2017
HCV incidence in young women doubled from 2006 to 2014
The incidence of hepatitis C virus infection in reproductive-age women has doubled between 2006 and 2014 while the number of acute cases increased more than threefold, according to data published in the Annals of Internal Medicine.
Researchers analyzed data from the National Notifiable Diseases Surveillance System (NNDSS) from 2006 to 2014 and the Quest Diagnostics Health Trends national database from 2011 to 2014, finding 425,322 women with confirmed HCV infection, 40.4% of whom were aged 15 to 44 years.
Around half of all acute infections were in non-Hispanic white women, and of the 2,069 women with available risk information, 63% acknowledged injection drug use (Ann Intern Med. 2017 May 8. doi:10.7326/M16-2350).
The analysis also found 1,859 cases of hepatitis C infection in children aged 2-13 years. According to the Quest data, the proportion of children with current hepatitis C infection was 3.2-fold higher in children aged 2-3 years than in those aged 12-13 years.
Commenting on this age difference, Kathleen N. Ly, MPH, from the Centers for Disease Control and Prevention, and her coauthors noted that it may have been the result of decreased testing over time in children already known to have chronic hepatitis C infection, or could be caused by spontaneous remission of infection, which is more common in infants and children than in adults.
The rate of infection among pregnant women tested for hepatitis C virus between 2011 and 2014 was 0.73%, which the authors calculated would mean that overall, 29,000 women with hepatitis C virus infection gave birth during that period across the United States. Based on data from a recent systematic review and meta-analysis, which found a likely mother-to-child transmission rate of 5.8/100 live births, they estimated that 1,700 infants were born with hepatitis C infection during that period.
“In contrast, only about 200 childhood cases per year are reported to the NNDSS, which may suggest a need for wider screening for HCV in pregnant women and their infants, as is recommended for HIV and hepatitis B virus,” the authors wrote. “However, recommendations for screening in pregnant women and clearer testing guidelines for infants born to HCV-infected mothers do not exist at this time.”
The study was supported by the CDC. One author was an employee of Quest Diagnostics, but no other conflicts of interest were declared.
Recognizing hepatitis C infection in pregnant women and neonates is possible, and clinical trials of antiviral therapy may show safety and efficacy in pregnant women and in children. Rather than silence, HCV infection calls out for public health action directed at all aspects of the epidemic, including consideration of screening pregnant women. At the very least, screening of pregnant women for HCV infection risk factors, as well as risk-based testing, requires more emphasis. Another issue in need of attention is the lack of authoritative, consensus-based recommendations for the identification, testing, and case management of newborns of infected mothers.
Much work lies ahead to eradicate HCV, starting with resources for public health surveillance to monitor incidence and prevalence and to fully characterize the infection in the population. Strategies to effectively prevent or cure infection in reproductive-aged women and their sexual and needle-sharing partners are critical.
Alfred DeMaria Jr., MD, is from the Massachusetts Department of Public Health. These comments are taken from an accompanying editorial (Ann Intern Med. 2017 May 8. doi:10.7326/M17-0927). No conflicts of interest were declared.
Recognizing hepatitis C infection in pregnant women and neonates is possible, and clinical trials of antiviral therapy may show safety and efficacy in pregnant women and in children. Rather than silence, HCV infection calls out for public health action directed at all aspects of the epidemic, including consideration of screening pregnant women. At the very least, screening of pregnant women for HCV infection risk factors, as well as risk-based testing, requires more emphasis. Another issue in need of attention is the lack of authoritative, consensus-based recommendations for the identification, testing, and case management of newborns of infected mothers.
Much work lies ahead to eradicate HCV, starting with resources for public health surveillance to monitor incidence and prevalence and to fully characterize the infection in the population. Strategies to effectively prevent or cure infection in reproductive-aged women and their sexual and needle-sharing partners are critical.
Alfred DeMaria Jr., MD, is from the Massachusetts Department of Public Health. These comments are taken from an accompanying editorial (Ann Intern Med. 2017 May 8. doi:10.7326/M17-0927). No conflicts of interest were declared.
Recognizing hepatitis C infection in pregnant women and neonates is possible, and clinical trials of antiviral therapy may show safety and efficacy in pregnant women and in children. Rather than silence, HCV infection calls out for public health action directed at all aspects of the epidemic, including consideration of screening pregnant women. At the very least, screening of pregnant women for HCV infection risk factors, as well as risk-based testing, requires more emphasis. Another issue in need of attention is the lack of authoritative, consensus-based recommendations for the identification, testing, and case management of newborns of infected mothers.
Much work lies ahead to eradicate HCV, starting with resources for public health surveillance to monitor incidence and prevalence and to fully characterize the infection in the population. Strategies to effectively prevent or cure infection in reproductive-aged women and their sexual and needle-sharing partners are critical.
Alfred DeMaria Jr., MD, is from the Massachusetts Department of Public Health. These comments are taken from an accompanying editorial (Ann Intern Med. 2017 May 8. doi:10.7326/M17-0927). No conflicts of interest were declared.
The incidence of hepatitis C virus infection in reproductive-age women has doubled between 2006 and 2014 while the number of acute cases increased more than threefold, according to data published in the Annals of Internal Medicine.
Researchers analyzed data from the National Notifiable Diseases Surveillance System (NNDSS) from 2006 to 2014 and the Quest Diagnostics Health Trends national database from 2011 to 2014, finding 425,322 women with confirmed HCV infection, 40.4% of whom were aged 15 to 44 years.
Around half of all acute infections were in non-Hispanic white women, and of the 2,069 women with available risk information, 63% acknowledged injection drug use (Ann Intern Med. 2017 May 8. doi:10.7326/M16-2350).
The analysis also found 1,859 cases of hepatitis C infection in children aged 2-13 years. According to the Quest data, the proportion of children with current hepatitis C infection was 3.2-fold higher in children aged 2-3 years than in those aged 12-13 years.
Commenting on this age difference, Kathleen N. Ly, MPH, from the Centers for Disease Control and Prevention, and her coauthors noted that it may have been the result of decreased testing over time in children already known to have chronic hepatitis C infection, or could be caused by spontaneous remission of infection, which is more common in infants and children than in adults.
The rate of infection among pregnant women tested for hepatitis C virus between 2011 and 2014 was 0.73%, which the authors calculated would mean that overall, 29,000 women with hepatitis C virus infection gave birth during that period across the United States. Based on data from a recent systematic review and meta-analysis, which found a likely mother-to-child transmission rate of 5.8/100 live births, they estimated that 1,700 infants were born with hepatitis C infection during that period.
“In contrast, only about 200 childhood cases per year are reported to the NNDSS, which may suggest a need for wider screening for HCV in pregnant women and their infants, as is recommended for HIV and hepatitis B virus,” the authors wrote. “However, recommendations for screening in pregnant women and clearer testing guidelines for infants born to HCV-infected mothers do not exist at this time.”
The study was supported by the CDC. One author was an employee of Quest Diagnostics, but no other conflicts of interest were declared.
The incidence of hepatitis C virus infection in reproductive-age women has doubled between 2006 and 2014 while the number of acute cases increased more than threefold, according to data published in the Annals of Internal Medicine.
Researchers analyzed data from the National Notifiable Diseases Surveillance System (NNDSS) from 2006 to 2014 and the Quest Diagnostics Health Trends national database from 2011 to 2014, finding 425,322 women with confirmed HCV infection, 40.4% of whom were aged 15 to 44 years.
Around half of all acute infections were in non-Hispanic white women, and of the 2,069 women with available risk information, 63% acknowledged injection drug use (Ann Intern Med. 2017 May 8. doi:10.7326/M16-2350).
The analysis also found 1,859 cases of hepatitis C infection in children aged 2-13 years. According to the Quest data, the proportion of children with current hepatitis C infection was 3.2-fold higher in children aged 2-3 years than in those aged 12-13 years.
Commenting on this age difference, Kathleen N. Ly, MPH, from the Centers for Disease Control and Prevention, and her coauthors noted that it may have been the result of decreased testing over time in children already known to have chronic hepatitis C infection, or could be caused by spontaneous remission of infection, which is more common in infants and children than in adults.
The rate of infection among pregnant women tested for hepatitis C virus between 2011 and 2014 was 0.73%, which the authors calculated would mean that overall, 29,000 women with hepatitis C virus infection gave birth during that period across the United States. Based on data from a recent systematic review and meta-analysis, which found a likely mother-to-child transmission rate of 5.8/100 live births, they estimated that 1,700 infants were born with hepatitis C infection during that period.
“In contrast, only about 200 childhood cases per year are reported to the NNDSS, which may suggest a need for wider screening for HCV in pregnant women and their infants, as is recommended for HIV and hepatitis B virus,” the authors wrote. “However, recommendations for screening in pregnant women and clearer testing guidelines for infants born to HCV-infected mothers do not exist at this time.”
The study was supported by the CDC. One author was an employee of Quest Diagnostics, but no other conflicts of interest were declared.
FROM THE ANNALS OF INTERNAL MEDICINE
Key clinical point: The incidence of hepatitis C infection increased significantly in reproductive age women during 2006-2014.
Major finding: The incidence of hepatitis C infection in reproductive-age women doubled during 2006-2014 while the number of acute cases increased more than threefold.
Data source: Analysis of data from the National Notifiable Diseases Surveillance System from 2006 to 2014 and the Quest Diagnostics Health Trends national database from 2011 to 2014.
Disclosures: The study was supported by the Centers for Disease Control and Prevention. One author was an employee of Quest Diagnostics, but no other conflicts of interest were declared.
Low-histamine diet reduces disease activity in chronic urticaria
A low-histamine diet could decrease symptoms and improve the quality of life for people with chronic spontaneous urticaria (CsU), according to Nicola Wagner, MD, of the department of dermatology at the Clinical Center Darmstadt (Germany) GmbH, Darmstadt, and her coauthors.
In their prospective study of 56 patients with a 3-month history of CsU (average 25 months) who followed a low-histamine diet for 3 weeks, 42 (75%) showed improvements in the urticaria activity score (UAS), compared to baseline. In nine patients (16%), disease activity remained the same, and five patients (9%) experienced worsening symptoms.
The primary endpoint, which was at least a three-point improvement in urticaria activity score, was reached by 34 patients (61%). Among these 34 patients, the average reduction in the UAS score during the last 4 days of the diet compared with the 4 days before starting the diet was 8.59 points (P less than .001), and dropped from 9.05 to 4.23 (P = .004) across the entire group (J Eur Acad Dermatol Venereol. 2017 Apr;31[4]:650-5).
The low-histamine diet omitted food such as cheese, preserved meats, strawberries, raspberries, citrus fruit, bananas, kiwis, plums, papaya, and alcohol, and included foods such as dairy, vegetables, fresh meat, eggs, bread, pasta, rice, and certain varieties of fish. “Many patients with CsU complain of worsening of symptoms by consuming histamine-rich food, like red wine or matured cheese, but to the best of our knowledge, until now no studies were available supporting these observations,” the authors wrote.
The low-histamine diet was also associated with an average improvement in Dermatological Life Quality Instrument Questionnaire from baseline of 2.08 points across all participants, while Chronic Urticaria Quality of Life Questionnaire scores improved by an average of 5.46 score points in the 52 patients for whom these evaluations were available.
“Quality of life showed an improvement by a low-histamine diet, which was surprising, because dieting may decrease quality of life,” the authors noted.
There was also a reduction in antihistamine use among participants taking antihistamines at baseline, with 39% (22 of 56) reducing their intake and just over half of these patients (12 of the 22) stopping antihistamines altogether.
The study measured levels of diamine oxidase – the enzyme responsible for disintegrating histamine – both before and after, and saw no significant change across the patient group. However, patients with higher urticaria activity scores at baseline did show a decline in diamine oxidase activity with the diet.
Addressing concerns that these improvements could simply reflect spontaneous remission of the disease, the authors pointed out that a previous study had found a remission rate of just 3.4% over 6 months.
Based on the results, they concluded that a low-histamine diet “might be recommended for a period of 3-4 weeks in CsU patients in order to reduce symptoms and antihistamine intake as well as to improve quality of life.”
The authors had no funding source or conflicts of interest to declare.
A low-histamine diet could decrease symptoms and improve the quality of life for people with chronic spontaneous urticaria (CsU), according to Nicola Wagner, MD, of the department of dermatology at the Clinical Center Darmstadt (Germany) GmbH, Darmstadt, and her coauthors.
In their prospective study of 56 patients with a 3-month history of CsU (average 25 months) who followed a low-histamine diet for 3 weeks, 42 (75%) showed improvements in the urticaria activity score (UAS), compared to baseline. In nine patients (16%), disease activity remained the same, and five patients (9%) experienced worsening symptoms.
The primary endpoint, which was at least a three-point improvement in urticaria activity score, was reached by 34 patients (61%). Among these 34 patients, the average reduction in the UAS score during the last 4 days of the diet compared with the 4 days before starting the diet was 8.59 points (P less than .001), and dropped from 9.05 to 4.23 (P = .004) across the entire group (J Eur Acad Dermatol Venereol. 2017 Apr;31[4]:650-5).
The low-histamine diet omitted food such as cheese, preserved meats, strawberries, raspberries, citrus fruit, bananas, kiwis, plums, papaya, and alcohol, and included foods such as dairy, vegetables, fresh meat, eggs, bread, pasta, rice, and certain varieties of fish. “Many patients with CsU complain of worsening of symptoms by consuming histamine-rich food, like red wine or matured cheese, but to the best of our knowledge, until now no studies were available supporting these observations,” the authors wrote.
The low-histamine diet was also associated with an average improvement in Dermatological Life Quality Instrument Questionnaire from baseline of 2.08 points across all participants, while Chronic Urticaria Quality of Life Questionnaire scores improved by an average of 5.46 score points in the 52 patients for whom these evaluations were available.
“Quality of life showed an improvement by a low-histamine diet, which was surprising, because dieting may decrease quality of life,” the authors noted.
There was also a reduction in antihistamine use among participants taking antihistamines at baseline, with 39% (22 of 56) reducing their intake and just over half of these patients (12 of the 22) stopping antihistamines altogether.
The study measured levels of diamine oxidase – the enzyme responsible for disintegrating histamine – both before and after, and saw no significant change across the patient group. However, patients with higher urticaria activity scores at baseline did show a decline in diamine oxidase activity with the diet.
Addressing concerns that these improvements could simply reflect spontaneous remission of the disease, the authors pointed out that a previous study had found a remission rate of just 3.4% over 6 months.
Based on the results, they concluded that a low-histamine diet “might be recommended for a period of 3-4 weeks in CsU patients in order to reduce symptoms and antihistamine intake as well as to improve quality of life.”
The authors had no funding source or conflicts of interest to declare.
A low-histamine diet could decrease symptoms and improve the quality of life for people with chronic spontaneous urticaria (CsU), according to Nicola Wagner, MD, of the department of dermatology at the Clinical Center Darmstadt (Germany) GmbH, Darmstadt, and her coauthors.
In their prospective study of 56 patients with a 3-month history of CsU (average 25 months) who followed a low-histamine diet for 3 weeks, 42 (75%) showed improvements in the urticaria activity score (UAS), compared to baseline. In nine patients (16%), disease activity remained the same, and five patients (9%) experienced worsening symptoms.
The primary endpoint, which was at least a three-point improvement in urticaria activity score, was reached by 34 patients (61%). Among these 34 patients, the average reduction in the UAS score during the last 4 days of the diet compared with the 4 days before starting the diet was 8.59 points (P less than .001), and dropped from 9.05 to 4.23 (P = .004) across the entire group (J Eur Acad Dermatol Venereol. 2017 Apr;31[4]:650-5).
The low-histamine diet omitted food such as cheese, preserved meats, strawberries, raspberries, citrus fruit, bananas, kiwis, plums, papaya, and alcohol, and included foods such as dairy, vegetables, fresh meat, eggs, bread, pasta, rice, and certain varieties of fish. “Many patients with CsU complain of worsening of symptoms by consuming histamine-rich food, like red wine or matured cheese, but to the best of our knowledge, until now no studies were available supporting these observations,” the authors wrote.
The low-histamine diet was also associated with an average improvement in Dermatological Life Quality Instrument Questionnaire from baseline of 2.08 points across all participants, while Chronic Urticaria Quality of Life Questionnaire scores improved by an average of 5.46 score points in the 52 patients for whom these evaluations were available.
“Quality of life showed an improvement by a low-histamine diet, which was surprising, because dieting may decrease quality of life,” the authors noted.
There was also a reduction in antihistamine use among participants taking antihistamines at baseline, with 39% (22 of 56) reducing their intake and just over half of these patients (12 of the 22) stopping antihistamines altogether.
The study measured levels of diamine oxidase – the enzyme responsible for disintegrating histamine – both before and after, and saw no significant change across the patient group. However, patients with higher urticaria activity scores at baseline did show a decline in diamine oxidase activity with the diet.
Addressing concerns that these improvements could simply reflect spontaneous remission of the disease, the authors pointed out that a previous study had found a remission rate of just 3.4% over 6 months.
Based on the results, they concluded that a low-histamine diet “might be recommended for a period of 3-4 weeks in CsU patients in order to reduce symptoms and antihistamine intake as well as to improve quality of life.”
The authors had no funding source or conflicts of interest to declare.
FROM THE JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY AND VENEREOLOGY
Key clinical point: A low-histamine diet for 3-4 weeks may be a simple therapeutic option for patients suffering with chronic spontaneous urticaria (CsU).
Major finding: Three-quarters of patients with CsU showed an improvement in disease activity score after 3 weeks on a low-histamine diet.
Data source: A prospective 3-week study evaluating the impact of a low-histamine diet on 56 patients with CsU.
Disclosures: No conflicts of interest or study funding source were declared.
Underweight and rapid weight loss linked to cause-specific RA mortality
Being underweight or experiencing rapid weight loss are both independently associated with an increased risk of cause-specific mortality in individuals with rheumatoid arthritis, according to new research.
In a cohort of 1,600 U.S. veterans with rheumatoid arthritis who were followed for a median of 3.2 years, researchers found that being overweight (BMI 25-30 kg/m2) was associated with a 41% lower risk of cardiovascular mortality. Cumulative weight loss of greater than 10% and weight loss greater than 3 kg/m2 per year were both significantly associated with a twofold higher risk of cardiovascular mortality.
Similarly, more rapid weight loss of more than 3 kg/m2 per year was also associated with a greater than twofold increase in the risk of cancer mortality, while less rapid weight loss did not show a significant impact (Arthritis Care Res. 2017 Apr 20. doi: 10.1002/acr.23258).
Individuals who were underweight (BMI less than 20 kg/m2) had nearly a threefold greater risk of respiratory mortality, compared with individuals with a normal BMI. Researchers saw a dose-dependent association between respiratory mortality and percent of weight loss: 5%-10% weight loss was associated with an 86% higher risk of respiratory mortality, and greater than 10% weight loss showed a more than twofold greater risk.
This appears to be the first study to examine the impact of both BMI and weight loss on cause-specific mortality in rheumatoid arthritis, according to Bryant R. England, MD, of the VA Nebraska-Western Iowa Healthcare System of Nebraska, Omaha, and his coauthors.
“In this study of cause-specific mortality, we again demonstrate that underweight BMI and weight loss both drive mortality risk, but, importantly, this risk may differ across causes,” they wrote. “In cardiovascular and cancer mortality, we identified rapid and cumulative weight loss as the weight parameters most predictive of death, while in respiratory mortality underweight BMI was the weight parameter most predictive.”
Weight loss most likely reflects a systematic process, such as inflammation, that is a well-known risk factor for cardiovascular disease and mortality in people with rheumatoid arthritis, the authors suggested. Weight loss may also reflect comorbidities, chronic illness, disease phenotype, aging, smoking, and other factors, they said.
“Overall, these data illustrate the importance of considering the dynamic nature of body composition when assessing mortality risk in RA,” they said.
The authors noted that, while the study population was predominantly composed of older men, their findings were largely in agreement with those from studies with a higher proportion of women.
The researchers received grant support from the Department of Veterans’ Affairs and the National Institutes of Health. They reported having no conflicts of interest.
Being underweight or experiencing rapid weight loss are both independently associated with an increased risk of cause-specific mortality in individuals with rheumatoid arthritis, according to new research.
In a cohort of 1,600 U.S. veterans with rheumatoid arthritis who were followed for a median of 3.2 years, researchers found that being overweight (BMI 25-30 kg/m2) was associated with a 41% lower risk of cardiovascular mortality. Cumulative weight loss of greater than 10% and weight loss greater than 3 kg/m2 per year were both significantly associated with a twofold higher risk of cardiovascular mortality.
Similarly, more rapid weight loss of more than 3 kg/m2 per year was also associated with a greater than twofold increase in the risk of cancer mortality, while less rapid weight loss did not show a significant impact (Arthritis Care Res. 2017 Apr 20. doi: 10.1002/acr.23258).
Individuals who were underweight (BMI less than 20 kg/m2) had nearly a threefold greater risk of respiratory mortality, compared with individuals with a normal BMI. Researchers saw a dose-dependent association between respiratory mortality and percent of weight loss: 5%-10% weight loss was associated with an 86% higher risk of respiratory mortality, and greater than 10% weight loss showed a more than twofold greater risk.
This appears to be the first study to examine the impact of both BMI and weight loss on cause-specific mortality in rheumatoid arthritis, according to Bryant R. England, MD, of the VA Nebraska-Western Iowa Healthcare System of Nebraska, Omaha, and his coauthors.
“In this study of cause-specific mortality, we again demonstrate that underweight BMI and weight loss both drive mortality risk, but, importantly, this risk may differ across causes,” they wrote. “In cardiovascular and cancer mortality, we identified rapid and cumulative weight loss as the weight parameters most predictive of death, while in respiratory mortality underweight BMI was the weight parameter most predictive.”
Weight loss most likely reflects a systematic process, such as inflammation, that is a well-known risk factor for cardiovascular disease and mortality in people with rheumatoid arthritis, the authors suggested. Weight loss may also reflect comorbidities, chronic illness, disease phenotype, aging, smoking, and other factors, they said.
“Overall, these data illustrate the importance of considering the dynamic nature of body composition when assessing mortality risk in RA,” they said.
The authors noted that, while the study population was predominantly composed of older men, their findings were largely in agreement with those from studies with a higher proportion of women.
The researchers received grant support from the Department of Veterans’ Affairs and the National Institutes of Health. They reported having no conflicts of interest.
Being underweight or experiencing rapid weight loss are both independently associated with an increased risk of cause-specific mortality in individuals with rheumatoid arthritis, according to new research.
In a cohort of 1,600 U.S. veterans with rheumatoid arthritis who were followed for a median of 3.2 years, researchers found that being overweight (BMI 25-30 kg/m2) was associated with a 41% lower risk of cardiovascular mortality. Cumulative weight loss of greater than 10% and weight loss greater than 3 kg/m2 per year were both significantly associated with a twofold higher risk of cardiovascular mortality.
Similarly, more rapid weight loss of more than 3 kg/m2 per year was also associated with a greater than twofold increase in the risk of cancer mortality, while less rapid weight loss did not show a significant impact (Arthritis Care Res. 2017 Apr 20. doi: 10.1002/acr.23258).
Individuals who were underweight (BMI less than 20 kg/m2) had nearly a threefold greater risk of respiratory mortality, compared with individuals with a normal BMI. Researchers saw a dose-dependent association between respiratory mortality and percent of weight loss: 5%-10% weight loss was associated with an 86% higher risk of respiratory mortality, and greater than 10% weight loss showed a more than twofold greater risk.
This appears to be the first study to examine the impact of both BMI and weight loss on cause-specific mortality in rheumatoid arthritis, according to Bryant R. England, MD, of the VA Nebraska-Western Iowa Healthcare System of Nebraska, Omaha, and his coauthors.
“In this study of cause-specific mortality, we again demonstrate that underweight BMI and weight loss both drive mortality risk, but, importantly, this risk may differ across causes,” they wrote. “In cardiovascular and cancer mortality, we identified rapid and cumulative weight loss as the weight parameters most predictive of death, while in respiratory mortality underweight BMI was the weight parameter most predictive.”
Weight loss most likely reflects a systematic process, such as inflammation, that is a well-known risk factor for cardiovascular disease and mortality in people with rheumatoid arthritis, the authors suggested. Weight loss may also reflect comorbidities, chronic illness, disease phenotype, aging, smoking, and other factors, they said.
“Overall, these data illustrate the importance of considering the dynamic nature of body composition when assessing mortality risk in RA,” they said.
The authors noted that, while the study population was predominantly composed of older men, their findings were largely in agreement with those from studies with a higher proportion of women.
The researchers received grant support from the Department of Veterans’ Affairs and the National Institutes of Health. They reported having no conflicts of interest.
Key clinical point:
Major finding: Weight loss of greater than 10% is associated with a twofold increase in cardiovascular mortality, while weight loss of more than 3 kg/m2 per year was associated with a greater than twofold increase in the risk of cancer mortality.
Data source: A longitudinal cohort study of 1,600 U.S. veterans with rheumatoid arthritis.
Disclosures: The researchers received grant support from the Department of Veterans’ Affairs and the National Institutes of Health. They reported having no conflicts of interest.