The Experts below are selected from a list of 327 Experts worldwide ranked by ideXlab platform
M Fregoso - One of the best experts on this subject based on the ideXlab platform.
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single center experience with use of letermovir for cmv Prophylaxis or treatment in thoracic organ transplant recipients
Transplant Infectious Disease, 2019Co-Authors: S. Aryal, A Cochrane, A W Brown, Oksana A Shlobin, L Marinak, J Chun, S D Nathan, Shalika B Katugaha, K Ahmad, M FregosoAbstract:Background Cytomegalovirus (CMV) infection is common in thoracic organ transplant recipients. Valganciclovir and ganciclovir are used for both Prophylaxis and treatment of this infection, but intolerance and treatment failure are common. Letermovir has been demonstrated to reduce the risk of CMV infection when used for Prophylaxis in allogeneic hematopoietic cell transplantation. However, there are no data on its efficacy in thoracic organ transplantation. Methods We examined the use of letermovir for either CMV Prophylaxis (primary and secondary) or treatment in heart and lung transplant recipients at our institution from February 1, 2018, through December 31, 2018. Results Nine total patients received letermovir at our institution (8 lung transplant, 1 heart transplant) during the study period. Letermovir was prescribed for CMV Prophylaxis in eight patients (primary Prophylaxis in two patients and secondary Prophylaxis in 6 patients), and for treatment of CMV DNAemia in two cases. One patient received letermovir for both secondary Prophylaxis and treatment on separate occasions. Three out of 8 (37.5%) patients receiving letermovir for Prophylaxis developed CMV DNAemia during Prophylaxis. One patient treated for CMV disease had clinical failure with a sharp rise in serum CMV DNA PCR. The other patient treated for low-grade CMV DNAemia initially had a slight rise in CMV DNA PCR, but has since had a sustained response. No major side effects were experienced, and 2 patients reported minor side effects. Conclusion Letermovir was well tolerated with only minor side effects reported; however, the rate of development of CMV DNAemia on Prophylaxis was considerable. Further study of the dosing and efficacy of letermovir for CMV Prophylaxis or treatment in thoracic organ transplant recipients is warranted.
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Single-center experience with use of letermovir for CMV Prophylaxis or treatment in thoracic organ transplant recipients.
Transplant Infectious Disease, 2019Co-Authors: S. Aryal, A Cochrane, A W Brown, Oksana A Shlobin, L Marinak, J Chun, S D Nathan, Shalika B Katugaha, K Ahmad, M FregosoAbstract:BACKGROUND: Cytomegalovirus (CMV) infection is common in thoracic organ transplant recipients. Valganciclovir and ganciclovir are used for both Prophylaxis and treatment of this infection, but intolerance and treatment failure are common. Letermovir has been demonstrated to reduce the risk of CMV infection when used for Prophylaxis in allogeneic hematopoietic cell transplantation. However, there are no data on its efficacy in thoracic organ transplantation. METHODS: We examined the use of letermovir for either CMV Prophylaxis (primary and secondary) or treatment in heart and lung transplant recipients at our institution from February 1, 2018, through December 31, 2018. RESULTS: Nine total patients received letermovir at our institution (8 lung transplant, 1 heart transplant) during the study period. Letermovir was prescribed for CMV Prophylaxis in eight patients (primary Prophylaxis in two patients and secondary Prophylaxis in 6 patients), and for treatment of CMV DNAemia in two cases. One patient received letermovir for both secondary Prophylaxis and treatment on separate occasions. Three out of 8 (37.5%) patients receiving letermovir for Prophylaxis developed CMV DNAemia during Prophylaxis. One patient treated for CMV disease had clinical failure with a sharp rise in serum CMV DNA PCR. The other patient treated for low-grade CMV DNAemia initially had a slight rise in CMV DNA PCR, but has since had a sustained response. No major side effects were experienced, and 2 patients reported minor side effects. CONCLUSION: Letermovir was well tolerated with only minor side effects reported; however, the rate of development of CMV DNAemia on Prophylaxis was considerable. Further study of the dosing and efficacy of letermovir for CMV Prophylaxis or treatment in thoracic organ transplant recipients is warranted.
F Maschio - One of the best experts on this subject based on the ideXlab platform.
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Prophylaxis after first febrile urinary tract infection in children a multicenter randomized controlled noninferiority trial
Pediatrics, 2008Co-Authors: Giovanni Montini, Federica Fregonese, Daniela Gobber, Pietro Zucchetta, Luca Rigon, Pier Paolo Molinari, Antonella Toffolo, Luigi Pavanello, Diego Cecchin, F MaschioAbstract:OBJECTIVES. Febrile urinary tract infections are common in children and associated with the risk for renal scarring and long-term complications. Antimicrobial Prophylaxis has been used to reduce the risk for recurrence. We performed a study to determine whether no Prophylaxis is similar to antimicrobial Prophylaxis for 12 months in reducing the recurrence of febrile urinary tract infections in children after a first febrile urinary tract infection. METHODS. The study was a controlled, randomized, open-label, 2-armed, noninferiority trial comparing no Prophylaxis with Prophylaxis (co-trimoxazole 15 mg/kg per day or co-amoxiclav 15 mg/kg per day) for 12 months. A total of 338 children who were aged 2 months to RESULTS. Intention-to-treat analysis showed no significant differences in the primary outcome between no Prophylaxis and Prophylaxis: 12 (9.45%) of 127 vs 15 (7.11%) of 211. In the subgroup of children with reflux, the recurrence of febrile urinary tract infections was 9 (19.6%) of 46 on no Prophylaxis and 10 (12.1%) of 82 on Prophylaxis. No significant difference was found in the secondary outcome: 2 (1.9%) of 108 on no Prophylaxis versus 2 (1.1%) of 187 on Prophylaxis. Bivariate analysis and Cox proportional hazard model showed that grade III reflux was a risk factor for recurrent febrile urinary tract infections. Whereas increasing age was protective, use of no Prophylaxis was not a risk factor. CONCLUSIONS. For children with or without primary nonsevere reflux, Prophylaxis does not reduce the rate of recurrent febrile urinary tract infections after the first episode.
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Prophylaxis after first febrile urinary tract infection in children a multicenter randomized controlled noninferiority trial
Pediatrics, 2008Co-Authors: Giovanni Montini, Federica Fregonese, Daniela Gobber, Pietro Zucchetta, Luca Rigon, Pier Paolo Molinari, Antonella Toffolo, Luigi Pavanello, Diego Cecchin, F MaschioAbstract:OBJECTIVES. Febrile urinary tract infections are common in children and associated with the risk for renal scarring and long-term complications. Antimicrobial Prophylaxis has been used to reduce the risk for recurrence. We performed a study to determine whether no Prophylaxis is similar to antimicrobial Prophylaxis for 12 months in reducing the recurrence of febrile urinary tract infections in children after a first febrile urinary tract infection. METHODS. The study was a controlled, randomized, open-label, 2-armed, noninferiority trial comparing no Prophylaxis with Prophylaxis (co-trimoxazole 15 mg/kg per day or co-amoxiclav 15 mg/kg per day) for 12 months. A total of 338 children who were aged 2 months to <7 years and had a first episode of febrile urinary tract infection were enrolled: 309 with a confirmed pyelonephritis on a technetium 99m dimercaptosuccinic acid scan with or without reflux and 27 with a clinical pyelonephritis and reflux. The primary end point was recurrence rate of febrile urinary tract infections during 12 months. Secondary end point was the rate of renal scarring produced by recurrent urinary tract infections on technetium 99m dimercaptosuccinic acid scan after 12 months. RESULTS. Intention-to-treat analysis showed no significant differences in the primary outcome between no Prophylaxis and Prophylaxis: 12 (9.45%) of 127 vs 15 (7.11%) of 211. In the subgroup of children with reflux, the recurrence of febrile urinary tract infections was 9 (19.6%) of 46 on no Prophylaxis and 10 (12.1%) of 82 on Prophylaxis. No significant difference was found in the secondary outcome: 2 (1.9%) of 108 on no Prophylaxis versus 2 (1.1%) of 187 on Prophylaxis. Bivariate analysis and Cox proportional hazard model showed that grade III reflux was a risk factor for recurrent febrile urinary tract infections. Whereas increasing age was protective, use of no Prophylaxis was not a risk factor. CONCLUSIONS. For children with or without primary nonsevere reflux, Prophylaxis does not reduce the rate of recurrent febrile urinary tract infections after the first episode.
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Prophylaxis after first febrile urinary tract infection in children? A multicenter, randomized, controlled, noninferiority trial.
Pediatrics, 2008Co-Authors: Giovanni Montini, Federica Fregonese, Daniela Gobber, Pietro Zucchetta, Luca Rigon, Pier Paolo Molinari, Antonella Toffolo, Luigi Pavanello, Diego Cecchin, F MaschioAbstract:OBJECTIVES. Febrile urinary tract infections are common in children and associated with the risk for renal scarring and long-term complications. Antimicrobial Prophylaxis has been used to reduce the risk for recurrence. We performed a study to determine whether no Prophylaxis is similar to antimicrobial Prophylaxis for 12 months in reducing the recurrence of febrile urinary tract infections in children after a first febrile urinary tract infection. METHODS. The study was a controlled, randomized, open-label, 2-armed, noninferiority trial comparing no Prophylaxis with Prophylaxis (co-trimoxazole 15 mg/kg per day or co-amoxiclav 15 mg/kg per day) for 12 months. A total of 338 children who were aged 2 months to
Frank W G Leebeek - One of the best experts on this subject based on the ideXlab platform.
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Prophylaxis in severe forms of von willebrand s disease results from the von willebrand disease Prophylaxis network vwd pn
Haemophilia, 2013Co-Authors: Thomas C Abshire, Manuel Carcao, Augusto B Federici, M T Alvarez, J Bowen, Cox J Gill, Peter A Kouides, Karin Kurnik, Alice Lail, Frank W G LeebeekAbstract:The bleeding patterns of severe von Willebrand's disease (VWD) adversely affect quality of life, and may be life threatening. There is a presumed role for Prophylaxis with VWF-containing concentrates, but data are scarce. The von Willebrand Disease Prophylaxis Network (VWD PN) was formed to investigate the role of Prophylaxis in clinically severe VWD that is not responsive to other treatment(s). Using a retrospective design, the effect of Prophylaxis was studied. Availability of records to document, or reliably assess, the type and frequency of bleeding episodes prior to, and after, the initiation of Prophylaxis was required. Annualized bleeding rates were calculated for the period prior to Prophylaxis, during Prophylaxis and by primary bleeding indication defined as the site accounting for more than half of all bleeding symptoms. The Wilcoxon signed-rank test of differences in the medians was used. Sixty-one subjects from 20 centres in 10 countries were enrolled. Data for 59 were used in the analysis. The median age at onset of Prophylaxis was 22.4 years. Type 3 VWD accounted for the largest number (N = 34, 57.6%). Differences in bleeding rates within individuals during compared with before Prophylaxis were significant for the total group (P = 18. One person developed an inhibitor during treatment. We conclude that prophylactic treatment of VWD is efficacious. (Less)
Adam M Deane - One of the best experts on this subject based on the ideXlab platform.
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trials on stress ulcer Prophylaxis finding the balance between benefit and harm response to krag et al
Intensive Care Medicine, 2015Co-Authors: Adam M Deane, Gordon H GuyattAbstract:Dear Editor, We thank Dr. Krag and colleagues [1] for their comments. The authors concur with us regarding the need for further evidence to establish or refute the desirability of stress ulcer Prophylaxis for critically ill patients. The logic underlying the choice of trial design depends on one’s belief regarding the trial evidence and current convictions about the usefulness of stress ulcer Prophylaxis. The authors believe that the evidence supporting the benefit of Prophylaxis in reducing bleeding warrants low confidence, but that the intervention may impact on mortality, and that a trial evaluating the superiority of placebo is warranted. Our assessment is that the evidence supporting a reduction in clinically important upper gastrointestinal bleeding with Prophylaxis warrants at least moderate confidence. Given the routine acid suppression in many ICUs [2, 3], and incorporation of this approach in practice guidelines [4], it appears that the critical care community shares our assessment of the existing evidence. We therefore suggest that the key issue is whether the magnitude of effect on clinically important upper gastrointestinal bleeding from stress ulcer Prophylaxis is sufficient that it warrants continued use, particularly given risks and costs [5]. If this is the question, a non-inferiority design is appropriate. Regarding the choice of outcome for a trial of stress ulcer Prophylaxis: if Prophylaxis does influence mortality, we anticipate that the difference is extremely small [6], such that the target sample size suggested by these authors for a trial addressing mortality represents an underestimate. Whether ascertaining the impact of Prophylaxis on upper gastrointestinal bleeding—the outcome that stress ulcer Prophylaxis is designed to prevent—is a worthwhile endeavour is a matter of judgment. Our conviction is that given the widespread current use of Prophylaxis, and the uncertainty associated with its impact, such a trial is warranted.
S. Aryal - One of the best experts on this subject based on the ideXlab platform.
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single center experience with use of letermovir for cmv Prophylaxis or treatment in thoracic organ transplant recipients
Transplant Infectious Disease, 2019Co-Authors: S. Aryal, A Cochrane, A W Brown, Oksana A Shlobin, L Marinak, J Chun, S D Nathan, Shalika B Katugaha, K Ahmad, M FregosoAbstract:Background Cytomegalovirus (CMV) infection is common in thoracic organ transplant recipients. Valganciclovir and ganciclovir are used for both Prophylaxis and treatment of this infection, but intolerance and treatment failure are common. Letermovir has been demonstrated to reduce the risk of CMV infection when used for Prophylaxis in allogeneic hematopoietic cell transplantation. However, there are no data on its efficacy in thoracic organ transplantation. Methods We examined the use of letermovir for either CMV Prophylaxis (primary and secondary) or treatment in heart and lung transplant recipients at our institution from February 1, 2018, through December 31, 2018. Results Nine total patients received letermovir at our institution (8 lung transplant, 1 heart transplant) during the study period. Letermovir was prescribed for CMV Prophylaxis in eight patients (primary Prophylaxis in two patients and secondary Prophylaxis in 6 patients), and for treatment of CMV DNAemia in two cases. One patient received letermovir for both secondary Prophylaxis and treatment on separate occasions. Three out of 8 (37.5%) patients receiving letermovir for Prophylaxis developed CMV DNAemia during Prophylaxis. One patient treated for CMV disease had clinical failure with a sharp rise in serum CMV DNA PCR. The other patient treated for low-grade CMV DNAemia initially had a slight rise in CMV DNA PCR, but has since had a sustained response. No major side effects were experienced, and 2 patients reported minor side effects. Conclusion Letermovir was well tolerated with only minor side effects reported; however, the rate of development of CMV DNAemia on Prophylaxis was considerable. Further study of the dosing and efficacy of letermovir for CMV Prophylaxis or treatment in thoracic organ transplant recipients is warranted.
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Single-center experience with use of letermovir for CMV Prophylaxis or treatment in thoracic organ transplant recipients.
Transplant Infectious Disease, 2019Co-Authors: S. Aryal, A Cochrane, A W Brown, Oksana A Shlobin, L Marinak, J Chun, S D Nathan, Shalika B Katugaha, K Ahmad, M FregosoAbstract:BACKGROUND: Cytomegalovirus (CMV) infection is common in thoracic organ transplant recipients. Valganciclovir and ganciclovir are used for both Prophylaxis and treatment of this infection, but intolerance and treatment failure are common. Letermovir has been demonstrated to reduce the risk of CMV infection when used for Prophylaxis in allogeneic hematopoietic cell transplantation. However, there are no data on its efficacy in thoracic organ transplantation. METHODS: We examined the use of letermovir for either CMV Prophylaxis (primary and secondary) or treatment in heart and lung transplant recipients at our institution from February 1, 2018, through December 31, 2018. RESULTS: Nine total patients received letermovir at our institution (8 lung transplant, 1 heart transplant) during the study period. Letermovir was prescribed for CMV Prophylaxis in eight patients (primary Prophylaxis in two patients and secondary Prophylaxis in 6 patients), and for treatment of CMV DNAemia in two cases. One patient received letermovir for both secondary Prophylaxis and treatment on separate occasions. Three out of 8 (37.5%) patients receiving letermovir for Prophylaxis developed CMV DNAemia during Prophylaxis. One patient treated for CMV disease had clinical failure with a sharp rise in serum CMV DNA PCR. The other patient treated for low-grade CMV DNAemia initially had a slight rise in CMV DNA PCR, but has since had a sustained response. No major side effects were experienced, and 2 patients reported minor side effects. CONCLUSION: Letermovir was well tolerated with only minor side effects reported; however, the rate of development of CMV DNAemia on Prophylaxis was considerable. Further study of the dosing and efficacy of letermovir for CMV Prophylaxis or treatment in thoracic organ transplant recipients is warranted.
