OBJECTIVE: The objective of this study was to assess inhaler therapy adherence and evaluate the impact of targeted interventions among children with bronchial asthma. METHODS: A prospective interventional study was conducted at a tertiary care center involving 114 asthmatic children aged 6–11 years. Adherence was assessed using the Adherence to Asthma Medication Questionnaire at baseline, 3 months, and 6 months. Intervention comprised caregiver counseling, educational pamphlets, technique demonstrations, and myth correction. Statistical analysis was performed using SPSS v29.0. RESULTS: The mean age of participants was 8.01 ± 1.84 years, with a male predominance (62.3%). Baseline mean adherence score was 26.88 ± 9.08, improving significantly to 54.35 ± 7.44 after intervention (P < 0.001). Adherence improved from 1.8% at 3 months to 82.5% at 6 months. Key barriers included improper technique, misconceptions, and forgetfulness. Socioeconomic status, parental education, and environmental exposures were significantly associated with asthma control (P < 0.001). CONCLUSIONS: Caregiver-targeted interventions significantly improved inhaler adherence and asthma control in children. Strategies including education, demonstration, and follow-up are crucial to optimize asthma outcomes.
Background: Previous studies demonstrated that the addition of anterior nares to axilla/groin skin testing substantially improved the detection of Candidozyma auris colonization (Proctor et al., Nature Medicine, 2021; Sansom et al., CID, 2024), but these observations were limited by small sample sizes and reflected mostly nursing home residents. We aimed to assess the benefit of adding nares testing to axilla/groin testing among hospitalized patients participating in C. auris point prevalence surveys (PPSs). Methods We conducted a prospective observational study at three long-term acute care hospitals (LTACHs) in the Chicago region, one of which also included distinct inpatient rehabilitation floors. Facilities participated in quarterly public health-led C. auris PPSs from May 2024 to October 2025. Patients underwent swab sampling at two sites: composite bilateral axillae/groin (swab 1) and bilateral anterior nares (swab 2). Samples were processed at a central laboratory for C. auris detection by PCR using a validated assay with enzymatic preprocessing and automated DNA extraction. Primary analyses were restricted to patients with results available from both sampling sites; a positive C. auris test from either body site was considered the reference standard. Analyses were performed using R v4.5.2 (www.r-project.org) and Stata/SE v18.0 (Stata Corp., College Station, TX). Results Across 18 PPSs, 769 of 867 (89%) eligible patients participated. The overall C. auris prevalence was 46% (317/685) among LTACH patients and 15% (13/84) among rehabilitation patients. Among all patients who tested positive for C. auris, 64% were in Contact Precautions for any reason at time of PPS and 34% were previously known to be C. auris colonized. After excluding 16 patients who were missing a body site specimen, 753 patients were eligible for analysis (670 LTACH, 83 rehabilitation). Among 320 patients with C. auris detected at any body site, 301 were detected by axilla/groin screening (94% sensitivity; 95% confidence interval 91% to 96%) and 234 (73%) tested positive at the anterior nares for C. auris. Inclusion of nares swabbing identified 19 additional patients who would have been missed by axilla/groin screening alone, corresponding to an incremental increase of 6%. Conclusion Among LTACH and rehabilitation patients, C. auris colonization was common and PPSs identified a substantial number of patients not previously known to be colonized. The incremental benefit of adding nares screening was modest compared to axilla/groin screening alone. Testing more body sites can identify more C. auris colonized patients, but facilities should balance benefit versus cost of expanded screening approaches.
Background: We queried long term acute care hospitals (LTACHs) within the NALTH network regarding facility characteristics, C. auris prevention practices, and perceived barriers to C. auris prevention. Methods: Participating facilities completed a REDCap survey of multiple choice, free response, and ranked choice questions. Quantitative and descriptive analyses were performed for completed surveys. Perceived barriers and important tools for C. auris prevention were assessed with ranked choice questions and analyzed by non-weighted counts. Results: Among 33 responses from 56 eligible LTACHs (Figure 1, Table 1), 23 (70%) had ever identified at least one case of C. auris infection or colonization. Eighteen of 33 (54%) reported identifying cases of C. auris within the past 3 months (Figure 2) and 9 of 33 (27%) had experienced suspected within-facility transmission. All facilities employed multimodal approaches for C. auris infection prevention (Table 2). More than half of LTACHs reported routine C. auris screening programs (21, 64%), including in response to a known C. auris case (n=15) and/or screening for asymptomatic colonization at the time of LTACH admission (n=12). The most frequently reported barriers to effective C. auris infection prevention included lack of communication between healthcare facilities at the time of patient transfer (n=16), lack of training and education for frontline staff (n=15), and lack of compliance with personal protective equipment (n=12). The most impactful methods anticipated to support future C. auris prevention included improved communication between facilities at the time of patient transfer (n=15), standardized protocols for C. auris decolonization (n=15), and standardized protocols for C. auris screening and isolation (n=14). Conclusion: Most participating LTACHs within the NALTH network reported firsthand experience with C. auris. Universally, responding facilities employed multimodal evidence-based infection prevention and control methods targeted against C. auris. Future research should focus on improving inter-facility communication of C. auris colonization or infection status, development of novel decolonization strategies, and standardization of surveillance practices.
Background Resistance or intolerance to the available tyrosine kinase inhibitors (TKIs) remains a treatment challenge for patients with chronic myeloid leukaemia. We aimed to report the safety, antileukaemic activity, and pharmacokinetics of oral vodobatinib, a novel selective BCR::ABL1 TKI, in patients with Philadelphia chromosome- positive (Ph-positive) chronic myeloid leukaemia who previously received at least three TKIs, including ponatinib and asciminib. Methods This open-label, multicentre, phase 1/2 trial was conducted at 28 clinical sites across ten countries (Belgium, France, Hungary, India, Italy, Romania, South Korea, Spain, UK, and the USA). Patients aged 18 years or older with Ph-positive chronic myeloid leukaemia or acute lymphoblastic leukaemia (eligible only for the phase 1 study), and an Eastern Cooperative Oncology Group performance status of 2 or lower were eligible. Phase 1 included patients who previously received at least three TKIs or had no other available treatment options. Phase 2 required patients to have treatment resistance or intolerance (or both) with loss of response to at least three TKIs and previous ponatinib use. A key exclusion criterion for both phases was presence of the Thr315Ile mutation. Patients self-administered oral vodobatinib (12-240 mg) once per day for each 28-day treatment cycle and for up to 60 months (ie, 65 cycles) unless patient discontinuation due to adverse events, progressive disease, lost to follow-up, or death. The primary endpoints were to determine the maximum tolerated dose (based on dose-limiting toxicities in phase 1) and antileukaemic activity of vodobatinib (ie, major cytogenetic response for chronic-phase and major haematological response for accelerated-phase or blast-phase in phase 2). Assessment of vodobatinib safety, activity, and pharmacokinetics were determined based on the pooled analysis of data from the phase 1 and 2 studies. This trial is registered with ClinicalTrials.gov, NCT02629692 (active). At data cutoff (July 15, 2023), phase 2 enrolment was closed early on June 22, 2023, due to recruitment-related challenges. Findings 78 patients were enrolled and received at least one vodobatinib dose (safety and efficacy analysis set). Between April 6, 2017, and June 20, 2023, phase 1 enrolled 58 patients and phase 2 enrolled 20 patients between March 3, 2020, and March 29, 2023. We included 66 (85%) patients with chronic-phase, eight (10%) with accelerated-phase, and four (5%) with blast-phase chronic myeloid leukaemia. 43 (55%) of 78 patients were male and 35 (45%) were female. The median age was 590 years (IQR 470-660). The median follow-up was 223 months (IQR 111-439). Two patients receiving vodobatinib 240 mg had dose-limiting toxicities (one had grade 3 dyspnoea and the other had grade 2 fluid overload), thus the 204 mg dose was considered to be the maximum tolerated dose. 73 (94%) patients had one or more treatment-emergent adverse events, with most events being haematological or gastrointestinal that were grade 2 or lower in severity. Grade 3 or higher treatment-emergent adverse events occurred in 47 (60%) patients and included thrombocytopenia (14 [18%]), neutropenia (10 [13%]), anaemia (nine [12%]), and increased lipase (eight [10%]). Seven (9%) patients died during the study; one death was considered related to treatment by the clinical investigator. At data cutoff, major cytogenetic response was observed in 44 (70%) of 63 patients with chronic-phase chronic myeloid leukaemia, of which 12 (75%) of 16 patients in the phase 2 study had major cytogenetic response. For patients with accelerated-phase chronic myeloid leukaemia, six (86%) of seven patients had a major haematological response (median duration 178 [IQR 102-243]) at data cutoff; major haematological response was observed in three (100%) evaluable patients in the phase 2 study. Major haematological response was reached by two (50%) of four patients with blast-phase chronic myeloid leukaemia and the median duration of response was 62 months (IQR 32-93); no blast-phase patients were enrolled in the phase 2 study. Interpretation Pooled analysis of the phase 1 and 2 studies showed clinically meaningful antileukaemic activity of vodobatinib and a tolerable safety profile in patients with advanced chronic myeloid leukaemia who previously received multiple TKIs, including ponatinib and asciminib, addressing an otherwise unmet clinical need. The phase 2 study was statistically underpowered and warrants further investigation in a phase 3, randomised controlled trial and in an earlier treatment setting of the disease. Copyright (c) 2025 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.
Alopecia areata is an inflammatory autoimmune disease that presents as non-scarring hair loss in adults and children and causes substantial psychological distress, economic burden, and reduced quality of life for those affected. Although steroids and immunosuppressants are common treatments for alopecia areata, results from studies of Janus kinase inhibitors in the systemic management of alopecia areata, including those from long-term efficacy and safety studies on the Janus kinase 1/2 inhibitor baricitinib, show promising results. Despite alopecia areata placing a burden on healthcare systems in the Middle East, published data on the overall prevalence, patient characteristics, and treatment landscape for alopecia areata across the region are sparse, and a lack of approved therapies and insufficient access to treatment are treatment obstacles. Herein, we describe the burden of alopecia areata on patients and healthcare systems, review publications from the United Arab Emirates (UAE) on alopecia areata, highlight gaps in the data, and review clinical trial publications on the management of alopecia areata with baricitinib, the first Janus kinase inhibitor approved for the treatment of alopecia areata in the UAE. A regional expert assessment of the burden of alopecia areata and unmet medical needs in the UAE is provided, along with an expert opinion on treating patients with severe alopecia areata. Alopecia areata is a disease in which the immune system attacks healthy hair follicles, leading to hair loss. It occurs in both adults and children and can have a negative effect on mental health, cause financial worries, and lead to a reduced quality of life. For Middle Eastern countries, including the United Arab Emirates, there is a lack of published data that specifically describe the number of people affected by alopecia areata in the region, their features and medical needs, and the treatment options available to them. Several medications are licensed for the treatment of alopecia areata, including steroids, creams, and a group of medications called Janus kinase inhibitors. Baricitinib is a Janus kinase inhibitor. Even though baricitinib is approved for severe alopecia areata and expert dermatologists use it to successfully treat alopecia areata, the costs of Janus kinase inhibitors cannot be reimbursed for many patients in need globally, including many countries in the Middle East. This is because alopecia areata is not recognised as a dermatological immunological disease. This article highlights the need for more data from the Middle East and United Arab Emirates to support patients with alopecia areata to access the treatment they need to manage their condition.
