Objectives: To investigate the changes in characteristics of patients with infective endocarditis in Iran and comparing the results with the changing profiles of Infection Endocarditis (IE) in other countries.
Methodology: We studied all patients with definite or possible IE seen at four referral teaching hospitals in Iran from Jan. 1995 to Dec. 2010. The data was analyzed both collectively and separately in two consecutive eight-year periods, i.e. 1995-2003 and 2004-2010.
Results: A total of 286 episodes of IE, 172 males and 114 females, were reviewed from which 162 ones were in the first eight-year time period and 124 episodes in the second one. Mean age of the patients was significantly increased in the second eight-year period (24.2±11 vs 39.4±15 years old, p value = 0.01). Increase in the episodes caused by Staphylococcus aureus was significant (40.7% vs 22.8%, p value = 0.01). The mean size of the vegetation was noticeably higher among IDUs than non-IDUs (1.53±0.1cm vs 0.76±0.2cm, p value < 0.001). As well as extra cardiac complications, mortality rate was noticeably higher among the patients with vegetation size ≥ 1cm (34.4% vs 16.3%, p value = 0.003). There was not a significant difference regarding the mortality rate between the conservatively and surgically treated patients (20.7% vs 22.9%, p value = 0.07).
Conclusion: The most important changing characteristic of IE which influences the outcome of the disease seems to be vegetation size which can account for as the outcome predictor.
Immune checkpoint inhibitors can cause immune side effects, with myasthenia gravis (MG) being relatively rare. With this review, we present 66-year-old man with melanoma treated with pembrolizumab who developed MG. With immuno-oncology (IO) single agent usage, 42 cases reported new-onset MG and 9 cases reported exacerbation of pre-existing MG. Among the patients who had new-onset MG after administration of programmed cell death protein 1 (PD-1) inhibitors, 14 patients (38.8%) developed severe respiratory failure and required intubation and 10 patients (27.02%) died. Among the patients with exacerbation of pre-existing MG after receiving PD-1 inhibitors, 1 patient (11.1%) required intubation, and no death was reported. Combination IO therapy-induced MG was reported in seven cases, with at least two cases complicated by respiratory failure and one death. Our observations suggest a possible difference in the severity of the disease and outcome among different IO therapy options.
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