Successful therapy of ocular rosacea with topical ivermectin

Approximately 75% of cutaneous rosacea patients also suffer from an ocular involvement with blepharitis and meibomian gland dysfunction often presented as chalazia. Clinical symptoms are foreign body sensation, light sensitivity, burning and tearing.

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Cost-effectiveness of CI in developing countries

Purpose of review Cost-effectiveness of cochlear implants is a major concern for expanding these services to low-income and middle-income developing countries. Recent findings Recent studies have applied appropriate methodology to make determination of cost-effectiveness for cochlear implants in developing countries. In addition, important parameters that effect cost-effectiveness have been reviewed in a systematic way. The combination of these new studies along with existing reports of cochlear implant programmes in developing countries allows for a discussion of cost and outcomes determinants that drive cost-effectiveness in these environments. Summary Cochlear implants are a very cost-effective treatment for profound hearing loss in all high-resource countries and in many low-income and middle-income developing countries. A number of cost considerations affect cost-effectiveness of cochlear implants in developing countries including device cost and device-related expenses such as power consumption and reliability, but also including rehabilitation and access-related expenses. Large-scale programmes confer an advantage for cost-effectiveness, primarily through device-related savings. Correspondence to James Saunders, MD, FACS, Division of Otolaryngology, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA. E-mail: james.e.saunders@hitchcock.org Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Cost-effectiveness of CI in developing countries

Purpose of review Cost-effectiveness of cochlear implants is a major concern for expanding these services to low-income and middle-income developing countries. Recent findings Recent studies have applied appropriate methodology to make determination of cost-effectiveness for cochlear implants in developing countries. In addition, important parameters that effect cost-effectiveness have been reviewed in a systematic way. The combination of these new studies along with existing reports of cochlear implant programmes in developing countries allows for a discussion of cost and outcomes determinants that drive cost-effectiveness in these environments. Summary Cochlear implants are a very cost-effective treatment for profound hearing loss in all high-resource countries and in many low-income and middle-income developing countries. A number of cost considerations affect cost-effectiveness of cochlear implants in developing countries including device cost and device-related expenses such as power consumption and reliability, but also including rehabilitation and access-related expenses. Large-scale programmes confer an advantage for cost-effectiveness, primarily through device-related savings. Correspondence to James Saunders, MD, FACS, Division of Otolaryngology, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA. E-mail: james.e.saunders@hitchcock.org Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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In case you missed it – basic science advances in Transplantation 2017

Developments in organ preservation techniques, novel immunosuppressants and improved diagnostics have made organ transplantation the success it is today. That does not mean that we are not still striving to perfect techniques, or that there are no more problems to solve. New strategies to address the donor organ shortage, prevent and manage antibody-mediated rejection, lower long-term allograft failure rates and reduce the toxicity of life-long immunosuppressive medication are urgently needed, and are being widely researched. Both fundamental research and preclinical studies aim to solve these problems and, ultimately, benefit organ transplant recipients. This article highlights the latest technical developments and trends in xenotransplantation, tissue injury and regeneration, immunosuppression, and transplantation immunology described in the most viewed and cited papers published in the Basic Sciences section of the Transplantation journal during the year 2017. Address for correspondence: Carla C. Baan, PhD, Erasmus MC-University Medical Centre, The Rotterdam Transplant Group, Department of Internal Medicine, P.O. Box 2040, Room Nc-508, 3000 CA Rotterdam, The Netherlands. Telephone: +31-10-7038293. T: @BaanCarla / @RotterdamTrans. Email: c.c.baan@erasmusmc.nl Authorship. C C Baan wrote the manuscript. Disclosures. None Funding. None Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Defining Outcomes for β-Cell Replacement Therapy in the Treatment of Diabetes: a Consensus Report on the Igls Criteria from the IPITA/EPITA Opinion Leaders Workshop

β-cell replacement therapy, available currently as pancreas or islet transplantation, has developed without a clear definition of graft functional and clinical outcomes. The International Pancreas & Islet Transplant Association (IPITA) and European Pancreas & Islet Transplantation Association (EPITA) held a workshop to develop consensus for an IPITA/EPITA Statement on the definition of function and failure of current and future forms of β-cell replacement therapy. There was consensus that β-cell replacement therapy could be considered as a treatment for β-cell failure, regardless of etiology and without requiring undetectable C-peptide, accompanied by glycemic instability with either problematic hypoglycemia or hyperglycemia. Glycemic control should be assessed at a minimum by glycated hemoglobin (HbA1c) and the occurrence of severe hypoglycemia. Optimal β-cell graft function is defined by near-normal glycemic control (HbA1c ≤6.5% [48 mmol/mol]) without severe hypoglycemia or requirement for insulin or other antihyperglycemic therapy, and with an increase over pretransplant measurement of C-peptide. Good β-cell graft function requires HbA1c 50%) reduction in insulin requirements and restoration of clinically significant C-peptide production. Marginal β-cell graft function is defined by failure to achieve HbA1c

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The effect of pregnancy on the long-term risk of graft loss, cardiovascular disease and death in kidney transplanted women in Norway: a retrospective cohort study

ABSTRACTBackgroundKidney transplant recipients have now conceived for almost 50 years. Nevertheless, few studies have evaluated long-term health outcomes for kidney transplanted women following pregnancies.MethodsWe conducted a retrospective cohort study of all Norwegian women receiving a kidney transplant before the age of 50 years between 1969 and 2013, with graft loss, cardiovascular disease and death as outcomes. Baseline characteristics for all women were ascertained at first transplantation, with information about exposure, outcomes and potential confounders collected from medical records. To account for changes in pregnancy status, data were analyzed using proportional hazard Cox regression with pregnancy status as a time-dependent covariate changing at the time of pregnancy.ResultsOf 650 women studied, 124 had a pregnancy following kidney transplantation. During the study period graft loss, cardiovascular disease and death occurred in 237, 73 and 274 women, respectively. Pregnancy was associated with 54% lower risk of graft loss (95% confidence interval [CI]: 25% to 71%) and 72% lower risk of death (95% CI: 53% to 84%). Adjusting for possible confounders had a minimal impact on estimated values. There were considerable uncertainties and no statistically significant results regarding the estimated risk of cardiovascular disease following pregnancy (univariate hazard ratio; 0.91, 95% CI: 0.43 to 1.92, multivariate hazard ratio; 0.71, 95% CI: 0.32 to 1.60).ConclusionsKidney transplanted women with pregnancies have a low risk of subsequent graft loss or death. These results are reassuring for the current clinical practice. Background Kidney transplant recipients have now conceived for almost 50 years. Nevertheless, few studies have evaluated long-term health outcomes for kidney transplanted women following pregnancies. Methods We conducted a retrospective cohort study of all Norwegian women receiving a kidney transplant before the age of 50 years between 1969 and 2013, with graft loss, cardiovascular disease and death as outcomes. Baseline characteristics for all women were ascertained at first transplantation, with information about exposure, outcomes and potential confounders collected from medical records. To account for changes in pregnancy status, data were analyzed using proportional hazard Cox regression with pregnancy status as a time-dependent covariate changing at the time of pregnancy. Results Of 650 women studied, 124 had a pregnancy following kidney transplantation. During the study period graft loss, cardiovascular disease and death occurred in 237, 73 and 274 women, respectively. Pregnancy was associated with 54% lower risk of graft loss (95% confidence interval [CI]: 25% to 71%) and 72% lower risk of death (95% CI: 53% to 84%). Adjusting for possible confounders had a minimal impact on estimated values. There were considerable uncertainties and no statistically significant results regarding the estimated risk of cardiovascular disease following pregnancy (univariate hazard ratio; 0.91, 95% CI: 0.43 to 1.92, multivariate hazard ratio; 0.71, 95% CI: 0.32 to 1.60). Conclusions Kidney transplanted women with pregnancies have a low risk of subsequent graft loss or death. These results are reassuring for the current clinical practice. Corresponding author: Dr Guri B. Majak, Women and Children´s Division, Oslo University Hospital Rikshospitalet, Postbox 4950 Nydalen, 0424 Oslo, Norway. Email: gurifb@hotmail.com Authorship Contribution GBM conceived and contributed to the design of the study, recruitment of patients, data collection, the analysis and interpretation of the data, and drafted the first version of the manuscript. AVR, HWF and TH made substantial contributions to the design of the study and the analysis and interpretation of the data, provided intellectual input and supervision throughout the study, and contributed substantially to drafting of the manuscript. TMM was the principal investigator. He made substantial contributions to the design of the study, contributed to the analysis and interpretation of the data, provided intellectual input and supervision throughout the study, and contributed substantially to drafting the manuscript. All of the authors revised the article, commented on draft versions, and provided final approval of the version to be published, and agreed to be accountable for all aspects of the work in terms of ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Disclosure The authors declare no conflicts of interest Funding This research was funded by grants from the South-Eastern Norway Regional Health Authority. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Coexistence of chronic myeloid leukemia and diffuse large B-cell lymphoma with antecedent chronic lymphocytic leukemia: a case report and review of the literature

Chronic lymphocytic leukemia and chronic myeloid leukemia are the most common types of adult leukemia. However, it is rare for the same patient to suffer from both. Richter's transformation to diffuse large B-...

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