Showing papers by "Lluís Puig published in 2012"

The relationship between microbiology results in the second of a two-stage exchange procedure using cement spacers and the outcome after revision total joint replacement for infection: The use of sonication to aid bacteriological analysis

Abstract: Patients with infected arthroplasties are normally treated with a two-stage exchange procedure using polymethylmethacrylate bone cement spacers impregnated with antibiotics. However, spacers may act as a foreign body to which micro-organisms may adhere and grow. In this study it was hypothesised that subclinical infection may be diagnosed with sonication of the surface biofilm of the spacer. The aims were to assess the presence of subclinical infection through sonication of the spacer at the time of a second-stage procedure, and to determine the relationship between subclinical infection and the clinical outcome. Of 55 patients studied, 11 (20%) were diagnosed with subclinical infection. At a mean follow-up of 12 months (interquartile range 6 to 18), clinical failure was found in 18 (32.7%) patients. Of the patients previously diagnosed with subclinical infection, 63% (7 of 11) had failed compared with 25% (11 of 44) of those without subclinical infection (odds ratio 5.25, 95% confidence interval 1.29 to 21.4, p = 0.021). Sonication of the biofilm of the surface of the spacer is useful in order to exclude subclinical infection and therefore contributes to improving the outcome after two-stage procedures.

Risk variants for psoriasis vulgaris in a large case–control collection and association with clinical subphenotypes

Abstract: Recent genome-wide association studies (GWASs) have identified >20 new loci associated with the susceptibility to psoriasis vulgaris (PsV) risk. We investigated the association of PsV and its main clinical subphenotypes with 32 loci having previous genome-wide evidence of association with PsV (P < 5e-8) or strong GWAS evidence (P < 5e-5 in discovery and P < 0.05 in replication sample) in a large cohort of PsV patients (n = 2005) and controls (n = 1497). We provide the first independent replication for COG6 (P = 0.00079) and SERPINB8 (P = 0.048) loci with PsV. In those patients having developed psoriatic arthritis (n = 955), we found, for the first time, a strong association with IFIH1 (P = 0.013). Analyses of clinically relevant PsV subtypes yielded a significant association of severity of cutaneous disease with variation at LCE3D locus (P = 0.0005) in PsV and nail involvement with IL1RN in purely cutaneous psoriasis (PsC, P = 0.007). In an exploratory analysis of epistasis, we replicated the previously described HLA-C-ERAP1 interaction with PsC. Our findings show that common genetic variants associated with a complex phenotype like PsV influence different subphenotypes of high clinical relevance.

Ustekinumab treatment of TNF antagonist-induced paradoxical psoriasis flare in a patient with psoriatic arthritis: case report and review.

Abstract: Background: Therapy with tumour necrosis factor α (TNF) inhibitors can be associated with paradoxical reactions, namely the de novo development or flaring of cond

Ustekinumab in clinical practice: response depends on dose and previous treatment

Abstract: Objectives To evaluate the efficacy of ustekinumab in a series of patients with moderate to severe psoriasis treated according to the European Medicines Agency (EMA) label and to identify factors such as dose, baseline PASI or previous treatment potentially related to therapeutic outcome. Methods Retrospective review of the clinical records from 36 consecutive patients treated with ustekinumab during at least 36 weeks at a single referral center. Candidates for treatment had a PASI ≥ 10 or a BSA ≥ 10 and either failure to respond to, or a contraindication to, or intolerance to some systemic or another biologic treatment. The main outcome measures were PASI improvement with respect to baseline at weeks 12 and 24 (prior to the third injection of ustekinumab). Results Overall 75%, 69%, and 86% patients achieved PASI75 response rates at weeks 12, 24 and 36, respectively. Patients weighing ≤ 100 kg and treated with 45 mg doses had better PASI 50, PASI75 and PASI90 response rates than heavier patients (treated with 90 mg) at every point in time, and the differences were statistically significant at week 24. PASI75 response rates at week 24 were significantly better in patients with no prior exposure to TNFα blocking agents (85% vs. 50%, P = 0.0235). Conclusions In clinical practice, ustekinumab is effective both in biologic-nayve patients and as salvage therapy when other biological treatments have failed. The response rates prior to the third injection in our series were better in patients weighing ≤ 100 kg and in those without previous exposure to biologics.

Influence of psoriatic arthritis on the efficacy of adalimumab and on the treatment response of other markers of psoriasis burden: subanalysis of the BELIEVE study

Abstract: Background: Adalimumab is a fully human anti-TNF monoclonal antibody with demonstrated efficacy and safety in patients with moderate to severe psoriasis and psoriatic arthritis (PsA). Objective: This study examined the effect of PsA on adalimumab treatment response in patients from the Phase IIIb BELIEVE trial (NCT00574249, ClinicalTrials.gov registry), and response of other markers of disease burden to adalimumab treatment. Methods: In this post hoc analysis, patients with or without a history of PsA and with moderate to severe psoriasis were randomized to adalimumab plus adjunctive topical therapy (calcipotriol/betamethasone dipropionate) or monotherapy (adalimumab plus matching topical vehicle). Results: Regardless of baseline PsA, improvement at Week 16 was seen in PASI 75, pruritus, PSSI, and DLQI (all patients), and mean NAPSI scores. Patients with PsA had HAQ improvement at Week 16, and compared to patients without PsA, had higher VAS pain scores. This analysis represents the first publication of the influence of PsA and PsA plus body weight on patient response to adalimumab, and response of scalp psoriasis, nail psoriasis, and patient-reported outcomes to adalimumab. The incidence of AEs was similar among all patients (62%), those with PsA (65%) and without PsA (60%). The most common AEs were infections (27%); 4.2% of all patients reported serious AEs. Conclusion: Adalimumab treatment resulted in comprehensive, clinically relevant improvements from baseline PsA status, in skin, nails, quality of life, pain and pruritus. Despite having more severely affected disease and quality of life, patients with PsA did not respond to adalimumab significantly differently from patients without PsA.

Validation of a new tool to assess health-related quality of life in psoriasis: the PSO-LIFE questionnaire

Abstract: Several questionnaires have been used to measure health related quality of life (HRQoL) in patients with psoriasis, few have been adapted for use in Spain; none of them was developed specifically for the Spanish population. The purpose of the study was to validate and assess the sensitivity to change of a new questionnaire to measure HRQOL in patients with psoriasis (PSO-LIFE). Observational, prospective, multicenter study performed in centers around Spain. Patients with active or inactive psoriasis completed the PSO-LIFE together with other Dermatology Quality of Life Index (DLQI) and Psoriasis Disability Index (PDI). A control group of patients with urticaria or atopic dermatitis was also included. Internal consistency and test-retest reliability of the PSO-LIFE were assessed by calculating Cronbach’s alpha and Intraclass Correlation Coefficient (ICC). Validity was assessed by examining factorial structure, the capacity to discriminate between groups, and correlations with other measures. Sensitivity to change was measured using effect sizes. The final sample included for analysis consisted of 304 patients and 56 controls. Mean (SD) age of psoriasis patients was 45.3 (14.5) years compared to 38.8 (14) years for controls (p < 0.01). Cronbach’s alpha for the PSO-LIFE was 0.95 and test-retest reliability using the ICC was 0.98. Factor analysis showed the questionnaire to be unidimensional. Mean (SD) PSO-LIFE scores differed between patients with psoriasis and controls (64.9 [22.5] vs 69.4 [17.3]; p < 0.05), between those with active and inactive disease (57.4 [20.4] vs 76.4 [20.6]; p < 0.01), and between those with visible and non-visible lesions (63.0 [21.9] vs. 74.8 [23.9]; p < 0.01). The correlation between PSO-LIFE and PASI scores was moderate (r = −0.43) while correlations with DLQI and PDI dimensions ranged from moderate to high (between 0.4 and 0.8). Effect size on the PSO-LIFE in patients reporting ‘much improved’ health status at study completion was 1.01 (large effect size). The present results provide substantial support for the reliability, validity, and responsiveness of the PSO-LIFE questionnaire in the population for which it was designed.

Prophylactic platelet transfusions

Abstract: R. N. I. Pietersz, H. W. Reesink, S. Panzer, M. P. Gilbertson, M. E. Borosak, E. M. Wood, G. C. Leitner, W. Rabitsch, C. Ay, M. Lambermont, V. Deneys, D. Sondag, V. Compernolle, D. Legrand, A. François, R. Tardivel, F. Garban, R. B. Sawant, P. Rebulla, M. Handa, H. Ohto, J.-L. H. Kerkhoffs, A. Brand, E. Zhiburt, J. Cid, G. Escolar, M. Lozano, L. Puig, F. Knutson, H. Hallböök, N. Lubenow, L. Estcourt, S. Stanworth, M. F. Murphy, L. Williams, D.L. Mraz, R.L. Ross & E. Snyder

Efficacy and Safety of Clinical Use of Etanercept for the Treatment of Moderate-to-Severe Psoriasis in Spain: Results of a Multicentric Prospective Study at 12 Months Follow-Up

Abstract: Background: The efficacy of etanercept in the treatment of psoriasis has been demonstrated in several clinical trials, but information regarding results derived from prospective observational studies in clinical practice is scarce. Objectives: To evaluate the efficacy and safety of etanercept administration according to routine clinical use in moderate-to-severe plaque psoriasis. Materials and Methods: Postauthorization, prospective study, carried out at 59 dermatology units in Spain. Patients diagnosed with moderate-to-severe plaque psoriasis received etanercept during a 12-month period. Results: Altogether, 444 patients were enrolled. Overall, 325 patients (73.2%) initiated etanercept treatment at a dose of 50 mg twice weekly; 96 patients (21.6%) received etanercept as a continuous regimen for the entire study period, and 348 patients (79.4%) an intermittent regimen. Among these, 185 patients (41.6% overall) received one course of treatment, stopped at various study points and did not restart etanercept treatment, whereas the remaining 163 patients (36.7% overall) stopped etanercept treatment, lost response, relapsed and were retreated. Most patients who interrupted etanercept treatment did so at month 6. Altogether, 79.7% of patients completed the study period. Etanercept treatment resulted in significant improvement in disease activity. A Psoriasis Area and Severity Index (PASI) 75 response was achieved by 76.1% of patients at month 6. Out of 252 adverse events reported, 31 were considered severe. Three possibly treatment-related malignancies were detected during the study. No opportunistic infections, tuberculosis or demyelinating events were reported. Conclusion: The PASI 75 response rate at month 6 in this observational, naturalistic study is similar to those observed in recent published trials with etanercept, and within the range of those reported for other marketed biologicals.

Treatment of severe psoriasis

Abstract: Despite the great advances brought about by biologic therapies, treatment of moderate-to-severe psoriasis often represents a challenge. Associated comorbidities may hamper the use of ciclosporin or methotrexate at effective doses, and obesity or heavy weight reduce the therapeutic expectations of systemic treatments, especially with regard to optimal response, which should be the ultimate goal of therapy. Combination therapy has been recognized to be an effective way of improving therapeutic response, and methotrexate at low doses seems especially well suited for combination with biologics, by improving response rates and reducing drug clearance and development of anti-drug antibodies. Secondary lack of response to biologics does occur in a small percentage of patients, and accounts in part for reduced drug survival in dermatology patients. In some cases, especially when the presence of anti-drug antibodies can be demonstrated, switching to another biologic agent in the same class may be effective, but some patients appear to be prone to developing anti-drug antibodies against several agents. In some cases, switching to another class of biologics (e.g. anti-p40 antibodies) can prove to be a very effective alternative, with an excellent safety profile. The present case report illustrates the optimization of therapeutic response to biologics using combination therapy and achieving long-lasting clearance of psoriasis following switching to ustekinumab in a patient who had shown secondary loss of response to several biologics.

Hematogenous septic arthritis of the hip in adult patients.

Abstract: [1] van Lelyveld-Haas LE, van Zanten AR, Borm GF, Tjan DH. Clinical validation of the non-invasive cardiac output monitor USCOM-1A in critically ill patients. Eur J Anaesthesiol 2008;25: 917-24. [2] Arora D, Chand R, Mehta Y, Trehan N. Cardiac output estimation after off-pump coronary artery bypass: a comparison of two different techniques. Ann Card Anaesth 2007;10:132-6. [3] Wong LS, Yong BH, Young KK, Lau LS, Cheng KL, Man JS, et al. Comparison of the USCOM ultrasound cardiac output monitor with pulmonary artery catheter thermodilution in patients undergoing liver transplantation. Liver Transpl 2008;14:1038-43. [4] Corley A, Barnett AG, Mullany D, Fraser JF. Nurse-determined assessment of cardiac output. Comparing a non-invasive cardiac output device and pulmonary artery catheter: a prospective observational study. Int J Nurs Stud 2009;46:1291-7. [5] Cattermole GN, Leung PY, Mak PS, Chan SS, Graham CA, Rainer TH. The normal ranges of cardiovascular parameters in children measured using the Ultrasonic Cardiac Output Monitor. Crit Care Med 2010;38:1875-81. [6] Nguyen HB, Losey T, Rasmussen J, Oliver R, Guptill M, Wittlake WA, et al. Interrater reliability of cardiac output measurements by transcutaneous Doppler ultrasound: implications for noninvasive hemodynamic monitoring in the ED. Am J Emerg Med 2006;24: 828-35. [7] Stewart GM, Nguyen HB, Kim TY, Jauregui J, Hayes SR, Corbett S. Inter-rater reliability for noninvasive measurement of cardiac function in children. Pediatr Emerg Care 2008;24:433-7. [8] Duchateau FX, Gauss T, Burnod A, Ricard-Hibon A, Juvin P, Mantz J. Feasibility of cardiac output estimation by ultrasonic cardiac output monitoring in the prehospital setting. Eur J Emerg Med 2011;18: 357-9. [9] Sturgess DJ, Pascoe RL, Scalia G, Venkatesh B. A comparison of transcutaneous Doppler corrected flow time, b-type natriuretic peptide and central venous pressure as predictors of fluid responsiveness in Hematogenous septic arthritis of the hip in adult patients

Impact of physical self-perception in surgical result of patients with adolescent idiopathic scoliosis

Abstract: Materials and methods Prospective study 32 patients surgery AIS from 2003 to 2006. 3 males-29 females. Mean age 15.9 years. BMI and Cobb angle was measured before surgery. After we measure Cobb, the physical alteration of perception by BSQ14, the postoperative satisfaction with a questionnaire of 8 questions and the SRS-22 [2].Patients were grouped according to BMI, BMI 18 (group 2) and to BSQ-14 >40 (group 1a) and BSQ< 40 (group 2a).