g This open-label multicenter clinical trial conducted in Mexico assessed the immunogenicity and safety of a 13-valent pneumococcal conjugate vaccine (PCV13) in adults >50 years of age not previously vaccinated with the 23-valent pneumococcal polysaccharide vaccine (PPSV23). The PCV13 elicited a robust immune response in this study population, as reflected by the magnitude of fold rises in functional antibody levels measured by serotype-specific opsonophagocytic activity (OPA) assays before and 1 month after vaccination. Although the prevaccination OPA geometric mean titers (GMTs) for the majority of the serotypes were significantly lower in the 50-to 64-year age group than those in the >65-year age group, the postvaccination immune responses were generally similar. The overall immune responses were higher for the majority of the serotypes in the Mexican study population than those in similar adult study populations who received the PCV13 in Europe and the United States. PCV13 was well tolerated, and there were no vaccine-related serious adverse events. In conclusion, PCV13 is safe and immunogenic when administered to adults >50 years of age in Mexico and has the potential to protect against vaccine-type pneumococcal disease. (This study has been registered at ClinicalTrials.gov under registration no. NCT01432262.) D iseases caused by Streptococcus pneumoniae are a major worldwide public health problem affecting all age groups, with the highest mortality rates in adults Ͼ65 years of age and in individuals with underlying disease (1, 2). In adults Ն50 years of age in Latin American countries, including Mexico, communityacquired pneumonia (CAP) caused mainly by S. pneumoniae is associated with high rates of morbidity and mortality, with the incidence increasing substantially with age (3, 4). Worldwide, 20 serotypes account for Ͼ70% of invasive pneumococcal disease (IPD) in children Ͻ5 years of age, although the prevalence of each varies by region (5). In Latin American and Caribbean countries, the 21 most common serotypes causing IPD in young children, in order of decreasing frequency, are serotypes 14, 6B, 5, 1, 23F, 6A, 18C, 19F, 19A, 9V, 7F, 3, and 4, which are included in the 13-valent pneumococcal conjugate vaccine (PCV13), as well as nonvaccine serotypes 8, 15B, 12F, 2, 12A, 9A, 45, and 46 (5). Castañeda et al. (6) reported similar findings from the Sistema de Redes de Vigilancia de los Agentes Responsables de Neumonias y Meningitis Bacterianas (SIREVA) surveillance data from Latin America and the Caribbean from 2007 to 2009 in children Ͻ5 years of age; since the introduction of PCV7, serotype replacement with nonvaccine serotypes, especially 19A, has been observed. The Mexico-specific SIREVA II data from 2011 in children Ͻ6 years of age and adults Ն50 years of age reported that the PCV13 serotypes were the most frequently isolated, in particular, serotype 19A (7).Vaccination is considered an important preventive strategy for adults and children, in part because of the increased prevalence of S. pneumoniae ...

Cutaneous T-cell lymphomas are a heterogeneous group of T-cell lymphoproliferative diseases affecting the skin. Mycosis fungoides and Sezary syndrome are the most studied variants of them. The literature review includes the latest published data on the pathological processes development in mycosis fungoides and Sezary syndrome and the diagnosis of these diseases. The genomic instability features in cutaneous T-cell lymphomas are described, the existing hypotheses of the origin of these diseases are considered based on the results of T-cell receptor repertoire studying.

BackgroundAccording to recent national and EULAR recommendation cardiovascular risk (CVR) in pts with RA should be evaluated using modified SCORE system. But a lot of investigations and real clinical data demonstrate that this system commonly down-estimates CVR in RA pts.ObjectivesAim of our study was to compare standard CVR assessment and additional CVR evaluation on the basis of specific disease-associated risk factors (RF) and CV system investigations in long standing RA.Methods118 pts (96 female, 22 male) aged from 34 to 74 years old (mean age 55.91±5.21) with long standing RA (duration >5 years) were observed. In all pts CVR was stratified according to modified SCORE. We have analysed pts medical cards and standard examination data to determine clinical features of RA and associated conditions to verify severity of CVR. In term to reveal asymptomatic CV disease pts had undergone additional investigations (echocardiography, Dopplerography of carotid arteries, ECG-monitoring).ResultsConventional CVRF were registered in 110 (93.22%) pts. Age>45 (male),>50 (female) was in 85 (72.03%) pts, BMI>25 kg/m2; in 10.17%, elevated cholesterol level and/or dyslipidemia in 41.52%, AH with target organ damage was detected in 45.76%, T2DM in 11.8%, CKD 3 stage in 10.17%, history of MI was in 2 (1.69%) pts. According to modified SCORE for RA very high, high, moderate and low CVR was detected in 17.80%, 47.46%, 18.64%, 16.10% cases respectively. High activity of RA was diagnosed in 61.02%, and erosive arthritis in 84.75% pts. Inadequate disease-modifying treatment was qualified in15.26% cases. Majority of pts (59.32%) received systemic glucocorticoids (GC) in daily doses from 2 to 12 mg of methylprednizolon, among these pts 14 (11.86%) have been taken GC in moderate and high dose for a long period. On the basis of instrumental data asymptomatic atherosclerosis of aorta and/or aortic valve and/or carotid arteries was detected in 44 pts (37.29%). Silent ischemia was revealed in 3 pts (2.54%). High disease activity and long term systemic GC treatment were associated with significantly high CV events in observed pts (p<0.05). Using obtained results we reassessed CVR in studied cohort. Revised data of CVR stratification suggest that 49 (41.53%) pts were in VH-CVR, 41 (34.75%) – in H-CVR, 16 (13.56%) in M-CVR and only 12 (10.17%) in L-CVR. The difference in pt ratio for CVR stratification was significant in accordance with χ2; criterion.ConclusionsObtained data suggest that modified SCORE is not absolutely reliable tool for precise CVR stratification in long standing RA. Additional investigations to define asymptomatic atherosclerosis and coronary artery disease are required in term to prevent CV complications especially in pts with high active erosive RA treated with systemic GC.Disclosure of InterestNone declared

Background:Patients with rheumatoid arthritis (RA) are in increased risk of developing comorbid conditions. Recent data suggest the relationship between severity of RA and concomitant diseases [1, 2]. Drug therapy is considered as impotent risk factor for numerous comorbidities. On the other hand comorbidity can impact negatively on the RA course and on the pts management [3].Objectives:The aim of our study was to evaluate the prevalence of concomitant conditions in RA pts, to compare the RA activity and management in relation with comorbidities.Methods:168 pts with established and longstanding RA were observed at in-patient clinic for RA clinical assessment and revealing concomitant diseases (cardiovascular, gastrointestinal, liver, pulmonary, endocrine, blood). The activity of disease according to DAS28-ESR index in RA subgroups with different comorbidities was compared. The spectrum and used doses of anti-rheumatic medications (DMARD, biologics, GC) in these subgroups was analyzed in term to assess the RA rational treatment.Results:The majority (88.1%) of observed RA pts had concomitant condition. The most frequent associated diseases were: cardiovascular (AH, IHD, HF, AF) in 86.9% and gastrointestinal (gastritis, duodenitis, gastroduodenal ulcer, colitis) in 64.3% less common comorbidities were anemia (30.9%), liver and kidney abnormalities (hepatomegaly, steatohepatitis, CKD, pyelonephritis) in 25% and 12.5% respectively, endocrine (type 2 diabetes mellitus, thyroid disorders) in 16.7%. Multimorbidity determined as combination of different system disorders in the setting of RA was detected in 54.8% of RA pts. We found out significant difference in RA activity on the basis of DAS28 between RA subgroup without concomitant conditions (the 1st) on the one hand and RA subgroups with comorbidities (the 2nd) (t1=2.76, p<0.01) or multimorbidities (t2=3.73, p<0.01) on the other hand (tab.1).IndexRA without comorbidities (1stgroup)RA with comorbidities(2nd group)RA with multimorbidities(3d group)DAS 284.20 ±0.315.09±0.095.44±0.12In RA with comorbidities/multimorbidities the mean doses of MTX and SSZ were lower than in RA without comorbidities, while the dose of GC and frequency of GC use was significantly higher in the 2nd and 3d groups (χ=4.25, 4.41 respectively). 55% of pts from the 1st group and only 19.6% of total amount of pts from the 2nd and 3d groups were treated with biologics (χ=5.67).Conclusion:Obtained data suggest that comorbidities have a negative impact on the severity of RA and can interfere in the implementation of T2T strategy in daily clinical practice.References:[1] Dougados M, Soubrier M, Antunez A, Balint P, Balsa A, Buch MH, et al. Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring: results of an international, cross-sectional study (COMORA). Ann Rheum Dis (2014) 73(1):62–8. doi:10.1136/annrheumdis-2013-204223[2] Radner H. Multimorbidity in rheumatic conditions. Wien Klin Wochenschr (2016) 128(21–22):786–90. doi:10.1007/s00508-016-1090-x[3] Radner H, Yoshida K,...