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sbah.org.za

the steve biko academic hospital is a purely tertiary healthcare institution, rendering specialized and highly specialized services to medically referred patients.

nucleodoconhecimento.com.br

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hkmj.org

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rbcp.org.br

a revista brasileira de cirurgia plástica é o órgão oficial de divulgação da sociedade brasileira de cirurgia plástica (sbcp), tem como objetivo registrar a produção científica em cirurgia plástica, fomentar o estudo, aperfeiçoamento e atualização dos profissionais da especialidade.

sosyalarastirmalar.com

the journal of international social research

rmdopen.bmj.com

Objective Glucocorticoid (GC) tapering and withdrawal to reduce damage represents a key aspect of the European Alliance of Associations for Rheumatology (EULAR) SLE recommendations. However, optimal strategies for relapse-free GC cessation remain ill-defined. We characterised clinical predictors and their combined effect on flares in patients with SLE who discontinued GC.Methods Retrospective cohort of 324 patients with active SLE (PGA ≥1.5 and/or SLEDAI-2K ≥6) who received GC as part of treatment intensification (median follow-up 60 months). Survival and generalised linear models estimated SELENA-SLEDAI flare risks and their predictors.Results GCs were discontinued in 220 (67.9%) patients with 1-year risks for overall and severe flares of 50% and 25%, respectively (HR: 1.48; 95% CI: 1.12 to 1.96 for overall flares; HR: 1.52; 95% CI: 1.03 to 2.25 for severe flares, compared with non-withdrawers). Flare risk was lowered when GCs were ceased during remission (DORIS) or Lupus Low Disease Activity State (LLDAS; excluding remission) (HR for severe flares: 0.23; 0.12 to 0.43 and 0.30; 0.18 to 0.50, respectively), with each additional month in targets providing further protection. Hydroxychloroquine prevented total (HR: 0.37; 0.26 to 0.53) and severe flares (HR: 0.33; 0.21 to 0.52), while mycophenolate and azathioprine reduced overall flares. Prednisone tapering from 7.5 mg/day to 0 over >6 months improved severe flare-free outcome (HR: 0.57; 0.37 to 0.90). Random survival forests identified DORIS/LLDAS, hydroxychloroquine use and slow GC tapering as top predictors, whose coexistence reduced overall and severe flares by ~25 fold and ~50 fold, respectively. This combination reduced damage (IRR: 0.31; 0.08 to 0.84) without inducing flares (IRR: 0.52; 95% CI: 0.18 to 1.16) compared with GC non-withdrawers.Conclusion Low or absent disease activity, slow tapering and hydroxychloroquine use minimise the risk of flares, facilitating GC discontinuation—a major goal in SLE.

ww3.rics.org

An ambitious plan to decarbonise Sweden’s energy has led to a colossal tunnel excavation under its capital city, using a 240-metre-long boring machine

liuc.academia.edu

Università Carlo Cattaneo - LIUC on academia.edu

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