Publications by authors named "Lega J"
Objective: To evaluate the benefits of surgical repair acute type A aortic dissection (ATAAD) on survival of octogenarians.
Methods: Patients who underwent surgery for acute ATAAD from the multicenter European Registry of Type A Aortic Dissection (ERTAAD) were the subjects of the present analysis.
Results: 326 (8.
Background And Aims: Systemic sclerosis (SSc) is an autoimmune connective disease characterised by excessive extracellular matrix deposition and widespread skin and internal organ fibrosis including various cardiac manifestations. Heart involvement is one of the leading causes of death among patients with SSc. In this study, we aimed to assess the effect of various vasodilator treatments.
View Article and Find Full Text PDFBackground: The current study aims to report the presentation of the malperfusion syndrome in patients with acute type A aortic dissection admitted to surgery and its impact on mortality.
Methods: Data were retrieved from the multicenter European Registry of Type A Aortic Dissection. The Penn classification was used to categorize malperfusion syndromes.
Article Synopsis
- The purpose of this project was to update the 2016 recommendations regarding the management of immunosuppressants or biologics in patients with giant cell arteritis (GCA).
- A task force of 18 physicians developed 26 validated recommendations after thorough discussion and a >85% consensus process.
- Key recommendations include using subcutaneous tocilizumab (TCZ) as a first-line treatment when glucocorticoid-sparing is needed, initiating TCZ at diagnosis for patients with specific high-risk conditions, and considering TCZ or methotrexate if glucocorticoid discontinuation is not feasible after 12 months.
Background And Aims: Statin-associated muscle symptoms (SAMS) are a major cause of treatment discontinuation. Clinical Pharmacogenetics Implementation Consortium (CPIC) recommend dose adjustment for statin treatment according to known SLCO1B1 genotype to reduce SAMS. We hypothesized that the association between SLCO1B1 genotype and SAMS is misestimated because of publication bias.
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- Giant cell arteritis (GCA) primarily affects women over 50, causing symptoms like headaches and jaw pain, and can lead to severe complications like vision loss due to eye involvement.
- Diagnosis relies on advanced imaging techniques such as FDG-PET and CT scans, while the temporal artery biopsy is considered the gold standard.
- Urgent treatment with high doses of corticosteroids is critical to prevent vision loss, and long-term management is necessary to monitor for recurrence and potential cardiovascular issues.
In an open prospective, multicenter study enrolling 48 selected patients with chronic immune thrombocytopenia who achieved complete response for 1 year on thrombopoietin receptor agonists, half of the patients maintained a sustained response off treatment 4 years after treatment discontinuation.
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- The study investigates gender differences in outcomes after type A aortic dissection (TAAD) surgery, focusing on both short- and long-term results.
- Data was collected from a multicenter European registry including 3902 TAAD surgery patients from 2005-2021, with a gender breakdown of 30.4% females.
- Results showed no significant early postoperative differences between genders, although males had a slightly better ten-year relative survival rate compared to females, despite advancements in surgical techniques over time.
Article Synopsis
- Extended aortic repair is essential for maintaining long-term surgical success in young patients with DeBakey type 1 aortic dissection, as they face higher risks of aortic degeneration due to their longer life expectancy.
- A study analyzed 1,199 patients under 60 who had aortic repair surgeries across Europe from 2005 to 2021, comparing outcomes between ascending aortic repair and total aortic arch repair techniques.
- Results showed no significant difference in the need for additional surgeries after 5 years between the two techniques, but total aortic arch repair had higher rates of postoperative complications like stroke and dialysis, while overall mortality rates were similar.
Article Synopsis
- Surgery for type A aortic dissection (TAAD) often leads to neurological complications, which were analyzed in a study of 3,902 patients from the European Registry of Type A Aortic Dissection.
- Out of these patients, 18.5% experienced strokes or global brain ischemia during hospitalization, with significant increases in in-hospital mortality linked to these complications: 25.6% for ischemic stroke, 48.7% for hemorrhagic stroke, and 74.0% for global brain ischemia.
- Although neurologic complications sharply increased early and midterm mortality, this negative impact on survival tended to diminish about one year post-surgery.
Background: Surgery for Stanford type A aortic dissection (TAAD) is associated with an increased risk of late aortic reoperations due to degeneration of the dissected aorta.
Methods: The subjects of this analysis were 990 TAAD patients who survived surgery for acute TAAD and had complete data on the diameter and dissection status of all aortic segments.
Results: After a mean follow-up of 4.
Article Synopsis
- Surgery for type A aortic dissection (TAAD) has a high early mortality risk, with in-hospital mortality rates increasing based on the urgency of the procedure, ranging from 10% for urgent surgeries to over 57% for the most critical salvage procedures.
- A multicenter study using data from the European Registry of TAAD (ERTAAD) found that preoperative arterial lactate levels correlate with procedure urgency, indicating that more critical cases are associated with poorer outcomes.
- The urgency classification enhances the ability to predict patient risk, suggesting that despite high mortality in severe cases, salvage surgeries are often justified as many patients can still survive to discharge.
Article Synopsis
- A systematic review and meta-analysis was conducted to evaluate the efficacy and safety of daptomycin compared to standard glycopeptides for complicated Gram-positive infections, focusing on all-cause mortality and clinical outcomes.
- The analysis included eight randomized controlled trials with a total of 1,095 patients, mainly with complex skin infections, and found no difference in all-cause mortality or clinical cure rates between daptomycin and control groups.
- Daptomycin showed a higher microbiological cure rate and a significantly lower risk of severe adverse events compared to glycopeptides, although more high-quality trials are needed to confirm these findings, particularly for conditions like bacteraemia and endocarditis.
Background: Surgery for type A aortic dissection (TAAD) is associated with high risk of mortality. Current risk scoring methods have a limited predictive accuracy.
Methods: Subjects were patients who underwent surgery for acute TAAD at 18 European centers of cardiac surgery from the European Registry of Type A Aortic Dissection (ERTAAD).
The aim of this study was to assess the prevalence and the burden of difficult-to-treat primary ITP (pITP), defined by the need for another ITP treatment after romiplostim and eltrombopag. Adult patients were selected in the prospective, real-world CARMEN-France registry up to December 2021. Out of 821 adult patients with pITP, 29 had difficult-to-treat ITP (3.
View Article and Find Full Text PDFBackground: During the first wave of COVID-19, hydroxychloroquine (HCQ) was used off-label despite the absence of evidence documenting its clinical benefits. Since then, a meta-analysis of randomised trials showed that HCQ use was associated with an 11% increase in the mortality rate. We aimed to estimate the number of HCQ-related deaths worldwide.
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- The study aims to assess the risk of global infections in patients with psoriatic arthritis (PsA) and axial spondyloarthritis who are treated with targeted therapies.
- They systematically reviewed data from 60 randomized controlled trials with over 20,000 patients to analyze the rates of infections linked to various treatments.
- Findings revealed a moderate increase in overall infection risk, particularly in patients with axial spondyloarthritis, mainly driven by the use of TNF and IL-17 inhibitors, but there was no notable increase in serious infections.
Article Synopsis
- - Immune checkpoint inhibitors (ICIs) have significantly improved the treatment of metastatic melanoma, but they can cause immune-related adverse events (irAEs), which are still under debate regarding their impact on patient prognosis.
- - This study analyzed data from 14 randomized controlled trials, involving 7646 melanoma patients, to explore the relationship between irAEs and overall survival (OS) but found no significant correlation.
- - The results indicate that while irAEs are common, especially with combination therapies, they do not appear to indicate better survival outcomes for melanoma patients, suggesting no link between irAE occurrence and prognosis.
Heart and systemic sclerosis-findings from a national cohort study.
Rheumatology (Oxford)
November 2023
Objectives: Heart involvement is one of the leading causes of death in systemic sclerosis (SSc). The prevalence of SSc-related cardiac involvement is poorly known. Our objective was to investigate the prevalence and prognosis burden of different heart diseases in a nationwide cohort of patients with SSc.
View Article and Find Full Text PDFBackground: Acute type A aortic dissection (TAAD) is associated with significant mortality and morbidity. In this study we evaluated the prognostic significance of preoperative arterial lactate concentration on the outcome after surgery for TAAD.
Methods: The ERTAAD registry included consecutive patients who underwent surgery for acute type A aortic dissection (TAAD) at 18 European centers of cardiac surgery.
Objective: To estimate the incidence of infections among patients with psoriatic arthritis (PsA) or axial spondyloarthritis (axSpA), two distinct phenotypes included in the large group of spondyloarthritis (SpA), treated with tumour necrosis-factor-inhibitors, interleukin-17-inhibitors, Janus kinase-inhibitors, IL-23 or IL-12/23-inhibitors (IL-12/23i), phosphodiesterase 4-inhibitors or cytotoxic T-lymphocyte associated protein 4-Ig.
Methods: A meta-analysis of randomised controlled trials (RCTs), open-label extension and observational studies was conducted. Serious infections were defined as infections that were life-threatening, required intravenous antibiotics and/or hospitalisation.
Diagnostic value of elevated serum angiotensin-converting enzyme and lymphopenia in patients with granulomatous hepatitis.
Sarcoidosis Vasc Diffuse Lung Dis
September 2023
Article Synopsis
- - Granulomatous hepatitis (GH) can result from various causes, with sarcoidosis being a key granulomatous disease affecting the liver.
- - This study examined the potential of serum angiotensin converting enzyme (sACE) levels and lymphopenia as diagnostic markers for sarcoidosis in patients with GH by analyzing records from a French hospital.
- - Findings showed that lymphopenia had a high specificity for sarcoidosis diagnosis, especially when paired with elevated sACE levels, and this specificity was particularly high (100%) in patients under 50 years old.
Article Synopsis
- Treatment strategies for autoimmune acquired pure red cell aplasia (aPRCA) are tough due to a lack of controlled trials, and guidelines are based mainly on expert opinions.
- A systematic review and meta-analysis of 24 observational studies with 753 patients showed varying effectiveness among treatments, with corticosteroids yielding a 47% overall response rate (ORR) and cyclosporine A leading to a higher ORR of 74%.
- Cyclophosphamide showed a 49% ORR, and sirolimus, typically used after other treatments fail, exhibited an impressive ORR of 87%, highlighting that more research is needed to determine the best approaches for aPRCA management.
Bacterial infections are the most frequent precipitating event in patients with acute decompensation of cirrhosis (AD) and are associated with high mortality. Early diagnosis is challenging due to cirrhosis-related systemic inflammation. Here we investigated the potential of circulating microRNAs to diagnose bacterial infections and predict survival in cirrhotic patients with AD.
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